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Yr 5 - Neuro > Corrections > Flashcards

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1
Q

Mechanism of neostigmine?

A

Cholinesterase inhibitor (stops breakdown of ACh)

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2
Q

1st line mx of myasthenia gravis?

A

Pyridostigmine (cholinesterase inhibitor)

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3
Q

What is the most sensitive test for MG?

A

Single-fibre electromyography (SFEMG)

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4
Q

What imaging should be performed in MG? Why

A

CT or MRI - look for thymoma or thymic hyperplasia

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5
Q

Mx of a myasthenic crisis?

A

IV immunoglobulins & plasmapheresis

Patients may require non-invasive ventilation or mechanical ventilation.

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6
Q

What movements are typically spared in MND?

A

Eye movements

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7
Q

Describe swallowing in the early stages of bulbar-onset amyotrophic lateral sclerosis (ALS)

A

Patients often have more difficulty swallowing liquids than solids in the early stages.

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8
Q

Next step in any patient that is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA?

A

Immediate referral for imaging to exclude haemorrhage

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9
Q

Mx of a post-LP headache?

A

Caffeine & fluids

This is a low pressure headache

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10
Q

How can axillary freckles determine between NF1 and NF2?

A

Axillary freckles = NF1

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11
Q

What test in myasthenia gravis is most specific (and used for diagnosis)?

A

Antibody test for AChR antibodies

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12
Q

What does pabrinex contain?

A

B vitamins & vitamin C

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13
Q

How can multiple system atrophy be differentiated from Parkinson’s disease?

A

In multiple system atrophy, there is more severe & earlier onset of autonomic dysfunction (postural hypotension/erectile dysfunction).

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14
Q

What class of medication is ropinirole?

A

Dopamine agonist

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15
Q

What lobe does HSV-encephalitis typically affect?

A

Temporal lobes

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16
Q

What condition can increase risk of encephalitis?

A

HIV

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17
Q

What are the 2 most common triggers of autonomic dysreflexia?

A

1) urinary retention
2) faecal impaction

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18
Q

Migraine triggers?

Mneumonic: CHOCOLATE

A

Chocolate
Hangovers
Orgasms
Cheese
Caffeine
Oral contraceptive pill
Lie-ins
Alcohol
Travel
Exercise

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19
Q

Give 4 different types of aphasia

A

1) Wernicke’s (repetitive) aphasia

2) Broca’s (expressive) aphasia

3) Conduction aphasia

4) Global aphasia

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20
Q

Wernicke’s (receptive) aphasia is due to a lesion of what?

A

The superior temporal gyrus

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21
Q

What is the superior temporal gyrus typically supplied by?

A

Inferior division of the left MCA

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22
Q

What is the purpose of Wernicke’s area?

A

‘Forms’ the speech before ‘sending’ it to Broca’s area

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23
Q

Result of lesions Wernicke’s aphasia?

A

Sentences that make no sense, word substitution and neologisms but speech remains fluent - ‘word salad’

Comprehension is impaired

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24
Q

Broca’s (expressive) aphasia is due to a lesion of what?

A

Inferior frontal gyrus

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25
What is the inferior frontal gyrus supplied by?
Superior divisoin of the left MCA
25
Features of Broca's (expressive) aphasia?
Speech is non-fluent, laboured, and halting. Repetition is impaired Comprehension is NORMAL
26
What is conduction aphasia?
Due to lesion in connection between Wernicke's and Broca's area
27
Features of conduction aphasia?
Speech is fluent but repetition is poor. Aware of the errors they are making Comprehension is NORMAL
28
What is Guillain-Barre syndrome?
Immune mediated demyelination of the peripheral nervous system.
29
Does Guillain-Barre affect PNS or CNS?
PNS
30
What is Guillain-Barre often triggered by?
Infection (classically Campylobacter jejuni)
31
How can hyperventilation be used in patients with ICP?
1) Hyperventilation reduces blood carbon dioxide 2) This causes cerebral vasoconstriction 3) This reduces ICP
32
What is the key diagnostic test in suspected Guillain-Barre syndrome?
Lumbar puncture
33
Classic initial symptoms seen in Guillain-Barre?
around 65% of patients experience back/leg pain in the initial stages of the illness
34
What are the characteristic features of Guillain-Barre?
Progressive, SYMMETRICAL weakness of ALL the limbs: - the weakness is classically ascending i.e. the legs are affected first - reflexes are reduced or absent - sensory symptoms tend to be mild (e.g. distal paraesthesia) with very few sensory signs
35
What is there classically a history of in Guillain-Barre?
Gastroenteritis
36
LP results in Guillain Barre?
rise in protein with a WBC count (albuminocytologic dissociation) - found in 66%
37
What can nerve conduction studies show in Guillain-Barre?
decreased motor nerve conduction velocity (due to demyelination)
38
Features of Guillain Barre?
- limb weakness - respiratory muscle weakness - cranial nerve involvement e.g. diplopia - autonomic involvement e.g. urinary retention
39
What nerve roots does the biceps reflex test?
C5-C6
40
What is the Cushing's reflex?
Physiological nervous system response to increased ICP that results in hypertension and bradycardia.
41
What is Cushing's triad?
1) widening pulse pressure 2) bradycardia 3) irregular breathing
42
What medication can increase the risk of idiopathic intracranial hypertension?
Tetracyclines
43
In what condition is an 'empty delta sign' seen on venography?
Sagittal sinus thrombosis
44
What medication can be used in idiopathic intracranial HTN?
Acetazolamide
45
What class of medication is acetazolamide?
Carbonic anhydrase inhibitor
46
When assessing the GCS, should you take the best or worse response from both sides?
BEST
47
What is cataplexy?
A sudden and transient episode of muscle weakness, typically triggered by strong emotions such as laughter, anger or surprise
48
Mx of ALL patients with Bell's palsy within 72 hours of onset?
Oral pred & eye care e.g. artificial tears
49
Mid-shaft humeral fractures are associated with what nerve injury?
Radial nerve --> test wrist extension
50
Can drugs for neuropathic pain be used together?
Typically used as monotherapy i.e. if not working then drugs should be switched, not added
51
What is a very common early symptom of multiple sclerosis?
Lethargy
52
What CNs are affected in vestibular schwannomas?
V, VII and VIII
53
1st line prophylaxis of migraines in those with asthma?
Topiramate
54
In those with myasthenia gravis, which commonly used anaesthetic agent are they most likely be resistant to?
Suxamethonium
55
What are some medications that can exacerbate myasthenia gravis?
- penicillamine - quinidine, procainamide - beta-blockers - lithium - phenytoin - antibiotics: gentamicin, macrolides, quinolones, tetracyclines
56
What is springomyelia?
A collection of CSF in the spinal cord.
57
What is there a strong assosciation with in springomyelia?
A Chiari malformation
58
Mx of autonomic dysreflexia?
Removal/control of the stimulus (e.g. removal of faeces/urine) and treatment of any life-threatening hypertension and/or bradycardia
59
What 2 things must be ruled out in status epilepticus before thinking of other causes?
1) hypoxia 2) hypoglycaemia
60
To be counted as localising to pain in GCS, what must happen?
To be counted as localising, the arm must be brought above the clavicle, else it should be scored as 'flexing'
61
What is the commonest neurological manifestation of sarcoid?
Facial nerve palsy
62
What muscles are typically spared in MND?
Ocular muscles
63
Describe loss of taste in Bell's palsy?
Loss of taste of anterior 2/3 of tongue (on the same side as the facial weakness)
64
What is the ONLY cervical nerve root that comes out BELOW the vertebra?
C8
65
Features of CN III palsy?
- eye is deviated 'down and out' - ptosis - pupil may be dilated ('surgical' third nerve palsy)
66
Lesion to which CN would cause issues with the ability to look downward, causing vertical diplopia?
CN IV (trochlear)
67
What is a wide-based gait with loss of heel to toe walking called?
Ataxic gait
68
What class of abx can increase the risk of idiopathic intracranial HTN?
Tetracyclines e.g. doxycycline
69
Mx of Steven Johnson Syndrome?
1) cease the culprit drug 2) hospital admission is required, ideally to an intensive care unit or burns unit 3) fluid replacement via IV, as there is significant fluid loss from the blisters and red, oozing dermis. 4) nasogastric access is required
70
What CN is responsible for the corneal reflex?
CN V (1)
71
Which nerve roots does the triceps reflex test?
C7-C8
72
What can nitrous oxide abuse cause?
A functional B12 deficiency (the B12 levels will be normal) and can give rise to subacute combined degeneration of the spinal cord like in true B12 deficiency.
73
What 3 types of seizures are seen in JME?
1) absence 2) myoclonic 3) tonic clonic
74
What type of infarct can locked in syndrome occur in?
Basilar artery infarct
75
What % ICA stenosis is carotid endarterectomy indicated in?
>50% Most beneficial in >70%
76
Neuroimaging findings in normal pressure hydrocephalus?
Ventriculomegaly in the absence of, or out of proportion to, sulcal enlargement
77
What 2 features are seen in Weber's syndrome?
Midbrain stroke: 1) contralateral hemiparesis 2) ipsilateral CN III palsy
78
Minimum time you cannot drive post-stroke?
1 month Need to be assessed by doctor before can drive again
79
What infection is Guillain-Barre syndrome classically triggered by?
Campylobacter jejuni
80
What is intranuclear ophthalmoplegia?
A cause of horizontal disconjugate eye movement. Due to a lesion in the medial longitudinal fasciculus (MLF).
81
What is there a lesion in in internuclear ophthalmoplegia?
medial longitudinal fasciculus
82
Role of the medial longitudinal fasciculus?
controls horizontal eye movements by interconnecting the IIIrd, IVth and VIth cranial nuclei
83
Features of internuclear ophthalmoplegia?
1) impaired adduction of the eye on the same side as the lesion 2) horizontal nystagmus of the abducting eye on the contralateral side
84
Give 2 causes of internuclear ophthalmoplegia
1) MS 2) vascular disease
85
What is a Colle's fracture?
A fracture of the distal radius that sometimes involves the ulna.
86
Mx of a patient with a neuropathic bladder due to multiple sclerosis?
Intermittent self catheterisation
87
What is an isolated result of high protein in the CSF indicative of?
Guillain Barre syndrome
88
What should be given next in status epilepticus if 2x doses of IV lorazepam haven't worked?
IV levetiracetam, phenytoin or sodium valproate
89
Features of a CN III palsy?
- ptosis - down and out eye - dilated, fixed pupil
90
In regard to homonymous quadrantopias, what mneumonic can be used to remember location?
PITS Parietal-inferior, temporal-superior I.e. a left temporal lobe infact would cause a right superior quadrantopia a right parietal lobe infarct would cause a left inferior quadrantopia
91
Location of a lesion causing a bitemporal hemianopia?
Lesion of optic chiasm
92
Cause of a bitemporal hemianopia if upper quadrant defect > lower quadrant defect?
Inferior chiasmal compression, commonly a pituitary tumour
93
Cause of a bitemporal hemianopia if lower quadrant defect > upper quadrant defect?
Superior chiasmal compression, commonly a craniopharyngioma
94
What is the key diagnostic test in suspected Guillain Barre syndrome?
LP --> increased protein levels with normal WCC
95
How can giving dextrose/glucose before pabrinex affect Wernicke's encephalopathy?
Giving dextrose/glucose before pabrinex can precipitate/worsen wernicke's encephalopathy.
96

Yr 5 - Neuro (15 decks)

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