Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Yr 4 - ACC > Corrections - Neuro > Flashcards

Corrections - Neuro Flashcards

1
Q

In what scenarios is dexamethasone contraindicated in the management of meningitis?

A
  • septic shock
  • meningococcal septicaemia
  • immunocompromised
  • meningitis following surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the normal range of CSF protein?

A

0.15-0.40 g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the normal value of CSF glucose?

A

CSF glucose is normally >70% of the plasma glucose levels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which vaccines are offered for meningitis?

When are they offered?

A

Meningitis B vaccine –> all babies at 8 and 16 weeks, with a booster after their 1st birthday.

Hib/Meningitis C vaccine –> all babies around 12/13 months.

Meningitis ACWY vaccine at age 13-18 - especially for new university students.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which vaccine is recommended for ‘fresher’ university students?

A

Meningitis ACWY vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

A 69-year-old woman presents with a 3 week history of a headache which is worse on the right side. She is generally unwell and feels ‘weak’, noting particular difficulty in getting up from a chair.

What is condition?

A

Temporal arteritis.

The weakness is due to the presence of polymyalgia rheumatica, a condition which is on the same spectrum as temporal artertitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the features of Cushing’s reflex?

A

Bradycardia, hypotension (widened pulse pressure), & irregular respirations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Contraindications of lumbar puncture?

A

1) raised ICP (this may be demonstrated by the Cushing’s reflex)

2) meningococcal sepsis

3) severe respiratory/cardiac compromise

4) significant bleeding risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is alternative way to confirm diagnosis of meningitis in cases of raised ICP?

A

Whole blood PCR and blood cultures (if LP is contraindicated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What Abx is given as prophylaxis for meningitis?

A

Ciprofloxacin (or rifampicin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is venous sinus thrombosis?

A

A thrombotic obstruction of the cerebral veins and/or dural sinuses. The thrombus will reduce the venous drainage, increasing the intracranial pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What imaging is used to diagnose venous sinus thrombosis?

A

MR venogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Presentation of venous sinus thrombosis?

A

Raised ICP e.g. headache, N&V, reduced consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What vaccines should not be given in immunocompromised patients?

A

Live attenuated vaccines:

  • yellow fever
  • varicella zoster
  • MMR
  • TB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

With a medication overuse headache, can triptans be stopped suddenly or should they be gradually decreased?

A

Can be stopped abruptly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Features of encephalitis?

A
  • fever, headache, psychiatric symptoms, seizures, vomiting
  • focal features e.g. aphasia
  • peripheral lesions (e.g. cold sores) have no relation to the presence of HSV encephalitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is responsible for 95% of cases of encephalitis in adults?

A

HSV-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What brain lobes does encephalitis typically affect?

A

Temporal and inferior frontal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Management of all cases of suspected encephalitis?

A

IV aciclovir

Note - HSV meningitis can progress to encephalitis. In this case, add IV aciclovir to treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What medication is used for long-term prophylaxis of cluster headaches?

A

Verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What medication is used in acute management of cluster headaches?

A

1) Sumatriptan
2) 100% O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is Abx management for bacterial meningitis in patients:

1) 3 months - 50 years
2) >50 years

A

1) cefotaxime or ceftriaxone

2) cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is Herpes zoster ophthalmicus (HZO)?

A

Describes the reactivation of the VZV in the area supplied by the ophthalmic division of the trigeminal nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Features of herpes zoster ophthalmicus (HZO)?

A

1) vesicular rash around the eye, which may or may not involve the actual eye itself

2) Hutchinson’s sign: rash on the tip or side of the nose –> indicates nasociliary involvement and is a strong risk factor for ocular involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the most common causes of viral meningitis in adults?

A

Enteroviruses e.g. coxsackievirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the 3 most common organisms causing bacterial meningitis in neonates-3months old?

A

1) GBS
2) E. coli
3) Listeria monocytogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

To detect a SAH, when should the LP be done?

A

at least 12 hours after the start of the headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

1st line management of brain abscess?

A

IV 3rd generation cephalosporin (e.g. ceftriaxone) + metronidazole

Can add dex if oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Meningiomas are extra-axial lesions, what does this mean?

A

They do not arise from the brain parenchyma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the features of focal seizures with impaired awareness?

A
  • emotional disturbance e.g. patient may be become tearful
  • automatism (the performance of actions without conscious thought or intention)
  • post-ictal state in which patient may become very tired
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the 1st line for myoclonic seizures in males?

A

Sodium valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the 1st line for absence seizures?

A

Ethosuximide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Causes of serotonin syndrome?

A

Excess serotonin caused by:

1) SSRIs
2) SNRIs
3) Recreational drugs e.g. MDMA

34
Q

Symptoms of serotonin syndrome?

A
  • tremor
  • confusion
  • muscle rigidity
  • agitation
  • muscle twitching
  • hyperreflexia
  • autonomic hyperactivity e.g. tachycardia and hypertension
35
Q

What is the most common feature of carbon monoxide poisoning?

A

Headache (often described as dull, throbbing and frontal).

36
Q

Cause of headache in carbon monoxide poisoning?

A

Due to the formation of carboxyhaemoglobin in the blood which reduces oxygen delivery to the brain.

37
Q

What cerebral vessel is likely to be affected in patients presenting with contralateral homonymous hemianopia with macular sparing and visual agnosia?

A

Possterior cerebral artery (PCA)

38
Q

What are some factors that favour a pseudoseizure?

A
  • pelvic thrusting
  • family member with epilepsy
  • much more common in females
  • crying after seizure
  • don’t occur when alone
  • gradual onset
39
Q

How is serum prolactin affected in a true seizure?

A

Raised

40
Q

What is lateral medullary syndrome?

What vessel is affected?

What are the features?

A

What –> A neurological disorder causing a range of symptoms due to ischemia in the lateral part of the medulla oblongata in the brainstem

Vessel –> Posterior inferior cerebellar artery

Features;
- ataxia, nystagmus
- ipsilateral: facial pain and temperature loss
- contralateral: limb/torso pain and temperature loss

41
Q

How does lateral medullary syndrome cause ipsilateral facial pain and temperature loss?

A

Due to damage to the trigeminal nucleus, and the fact that the fibres of the trigeminal nerve do not decussate

42
Q

How does lateral medullary syndrome cause contralateral limb/torso pain and temperature loss?

A

due to damage to the lateral spinothalamic tract

43
Q

How does lateral medullary syndrome cause ataxia?

A

due to damage to the inferior cerebellar peduncle

44
Q

How does lateral medullary syndrome cause nystagmus?

A

due to damage to the vestibular nucleus

45
Q

What electrolyte abnormalities are caused by refeeding syndrome?

A

Hypokalaemia, hypomagnesaemia, hypophosphataemia

46
Q

What is the hallmark feature of refeeding syndrome?

A

Hypophosphataemia –> may result in significant muscle weakness, including myocardial muscle (→ cardiac failure) and the diaphragm (→ respiratory failure).

47
Q

Associated affects of a stroke affecting the anterior cerebral artery vs middle cerebral artery?

A

ACA:
- Contralateral hemiparesis and sensory loss
- Lower extremity > upper

MCA:
- Contralateral hemiparesis and sensory loss
- Upper extremity > lower
- Contralateral homonymous hemianopia
- Aphasia

48
Q

is contralateral homonymous hemianopia seen in a stroke affecting the ACA or MCA?

A

MCA

49
Q

How does the optic disc appear in temporal arteritis?

A

The optic disc appears pale and oedematous due to anterior ischaemic optic neuropathy secondary to inflammation of the posterior ciliary arteries.

50
Q

How does optic neuritis affect the eyes?

A
  • pain on movement
  • reduced visual acuity
  • relative afferent pupillary defect due to reduced response to light of the afferent pathway in the affected eye

-poor discrimination of colours, ‘red desaturation’

  • central scotoma
51
Q

What investigation is diagnostic in optic neuritis?

A

MRI of the brain and orbits with gadolinium contrast

52
Q

Management of TIA?

A

300mg aspirin and refer for assesment.

53
Q

Is a CT needed prior to aspirin 300mg in a TIA?

A

If patient not on anticoagulants –> not needed as haemorrhage rarely causes TIA

If patient is on anticoagulants/has coagulopathy –> immediate CT head would be indicated

54
Q

When is assessment needed following TIA?

A

24 hours –> if they present within 7 days of suspected TIA

7 days –> if they present after 7 days

55
Q

What investigation is required for all patients with intracranial bleesd who become unresponsive?

A

Urgent CT head –> to check for hydrocephalus.

56
Q

What does Horner’s syndrome classically present with?

A

Ipsilateral ptosis, miosis and anhydrosis

57
Q

What helps determine the site of the lesion in regard to Horner’s syndrome?

A

Anhydrosis.

If anhydrosis affects:

1) head, arm, trunk –> central lesions e.g. stroke, springomyelia

2) just face –> pre-ganglionic lesion e.g. Pancoast’s, cervical rib

3) absent –> post-ganglionic lesion e.g. carotid artery dissection

58
Q

What is the most characteristic feature of a common peroneal nerve lesion?

A

Foot drop

59
Q

Features of common peroneal nerve lesion?

A
  • foot drop (weakness of foot dorsiflexion)
  • weakness of foot eversion
  • weakness of extensor hallucis longus
  • sensory loss over the dorsum of the foot and the lower lateral part of the leg
  • wasting of the anterior tibial and peroneal muscles
60
Q

Management of acute relapse of MS?

A

High dose steroids (IV or oral).

61
Q

What is Uhthoff’s phenomenon?

A

A transient worsening of neurological function lasting <24 hours that can occur in MS due to increases in core body temperature e.g. hot weather, exercise, hot bath, fever.

62
Q

1st line management of focal seizures?

A

lamotrigine or levetiracetam

63
Q

1st line management of tonic clonic seizures?

A

Males –> sodium valproate

Females –> lamotrigine or levetiracetam

64
Q

1st steps in epilepsy management following a FIRST seizure?

A

Refer to epilepsy clinic before starting medications.

65
Q

Following a first seizure, anti-epileptic drug treatment should only be started before specialist review in exceptional circumstances.

What are these circumstances?

A

1) Seizure activity observed on EEG

2) Presence of a neurological deficit

3) Presence of a structural brain abnormality

4) Patient, parent or carer considers the risk of a further seizure to be unacceptable

66
Q

When is a carotid endarterectomy considered in patients?

A

Considered in a patient who has had a TIA with carotid artery stenosis exceeding 70% on the side contralateral to the symptoms

67
Q

How is carotid stenosis diagnosed (and degree of stenosis assessed)?

A

Duplex US

68
Q

Management of intracerebral haemorrhage following thrombolysis?

A

Stop aspirin 300mg and control BP (target for 140mmHg)

69
Q

What investigation should all TIA patients have?

A

Urgent carotid doppler (unless they are not a candidate for carotid endarterectomy)

70
Q

What is Ramsay Hunt syndrome?

A

Caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.

71
Q

features of Ramsay Hunt?

A
  • auricular pain is often the first feature
  • facial nerve palsy
  • vesicular rash around the ear
  • other features include vertigo and tinnitus
72
Q

Management of Ramsay Hunt?

A

Oral aciclovir & corticosteroids

73
Q

What is progressive supranuclear palsy?

A

A ‘Parkinson Plus’ syndrome.

Features:

  • postural instability and falls
  • stiff, broad-based gait
  • impairment of vertical gaze (down gaze worse than up gaze - patients may complain of difficultly reading or descending stairs)
  • parkinsonism: bradykinesia is prominent
  • cognitive impairment: primarily frontal lobe dysfunction
74
Q

What are the 1st line medications for management of spasticity in MS?

A

1) Baclofen (GABA agonist)

2) Gabapentin

75
Q

Following a head injury, NICE has guidance regarding whether a head CT is indicated immediately (i.e. within 1 hour) or within 8 hours.

What are the criteria for a CT head within 1 hour?

A
  • GCS < 13 on initial assessment
  • GCS < 15 at 2 hours post-injury
  • suspected open or depressed skull fracture
  • any sign of basal skull fracture
  • post-traumatic seizure
  • focal neurological deficit
  • more than 1 episode of vomiting
76
Q

What are the criteria for a CT head within 8 hours following a head injury?

A
  • age ≥65
  • any history of bleeding or clotting disorders including anticogulants
  • dangerous mechanism of injury e.g. fall from a height of greater than 1 metre or 5 stairs
  • more than 30 minutes’ retrograde amnesia of events immediately before the head injury
77
Q

If a patient is on warfarin who have sustained a head injury with no other indications for a CT head scan, when should a CT head scan be performed?

A

Within 8 hours of injury

78
Q

Which cranial nerve is susceptible to damage early in the course of raised ICP?

A

Abducens CN VI (due to its long intacranial course)

79
Q

Palsy of which cranial nerve results in defective abduction and therefore horizontal diplopia?

A

VI (Abducens)

80
Q

Which cranial nerve is affected in a relative afferent pupillary defect (RAPD)?

A

Optic nerve

81
Q
A

Yr 4 - ACC (73 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions