DPD Amir Sam 4 Flashcards
Neuro
What are the associated symptoms you should ask for in a neuro history?
Top to toe: Headache Visual changes Hearing changes Swallowing changes Neck stiffness Limb weakness/paraesthesia Bowels and bladder
What are the two things you should think about when taking a neuro history?
Anatomy and pathology
What are the different anatomical areas in which a lesion may occur?
Brain Spinal cord Nerve root Peripheral nerve Neuromuscular junction
How may a brain lesion present as a sensory defect?
Hemiparesis
How may a spinal cord lesion present as a sensory defect?
Paraparesis
How may a nerve root lesion present as a sensory defect?
Dermatomal paraesthesia
How may a peripheral nerve lesion present as a sensory defect?
Specific area/s (mono/polyneuropathy)
How may a NMJ lesion present as a sensory defect?
Generalised, systematic
What are the different pathologies that help differentiate a presentation?
Vascular Infection Inflammation/autoimmune Toxic/metabolic Tumour/metastases
What are the signs in the limbs of an upper motor lesion?
Spastic tone
Decreased power
Brisk reflexes
Upgoing plantars
What are the signs in the limbs of a lower motor lesion?
Flaccid tone
Decreased power
Decreased reflexes
What are the signs of cerebellar dysfunction?
DANISH Dysdiodochokinesia Ataxia Nystagmus Intention tremor Staccato speech Hypotonia/Heel-shin test positive
What type of lesion does a glove and stocking distribution imply?
Polyneuropathy
What is the management for diabetic neuropathy?
Duloxetine
What are the causes of peripheral neuropathy?
V DUA LIPA
Vit B12 deficiency Diabetes Uraemia Alcohol Low T4 (hypothyroidism) Iatrogenic- drugs Paraneoplasm Amyloidosis (Hx of myeloma/chronif infx/inflammation)
What is the likely cause of a sudden loss of vision?
A. Amaurosis fugax B. Anterior uveitis C. Papilloedema D. Papillitis E. Vitreous haemorrhage
E. Vitreous haemorrhage
What is the likely diagnosis in a female with blurred vision who had limb paraesthesia 2 weeks ago?
A. Amaurosis fugax B. Anterior uveitis C. Papilloedema D. Papillitis E. Vitreous haemorrhage
D. Papillitis
This Pt has MS, which commonly presents with optic neuritis aka papillitis
What is the likely cause of a gradual loss of vision, like curtains are closing across the eyes?
A. Amaurosis fugax B. Anterior uveitis C. Papilloedema D. Papillitis E. Vitreous haemorrhage
A. Amaurosis fugax
What is the likely cause of a Pt’s blurred vision who has had 2 months of a gradually increasing headache?
A. Amaurosis fugax B. Anterior uveitis C. Papilloedema D. Papillitis E. Vitreous haemorrhage
C. Papilloedema
What is the likely cause of a Pt with a red itchy eye?
A. Amaurosis fugax B. Anterior uveitis C. Papilloedema D. Papillitis E. Vitreous haemorrhage
B. Anterior uveitis
What are the causes of spastic paraparesis?
V- (can't think of one) I- HIV I- transverse myelitis, MS T- B12 deficiency T- paraneoplasm
What is meralgia paraesthetica?
Compression of the lateral femoral cutaneous nerve
What is the management for meralgia paraesthetica?
Assure the Pt
Advise weight loss
Give carbemazepine/gabapentin if persistent
What are the signs of a median nerve lesion?
Weak abductor pollicis brevis
Weak opposition
Paraesthesia in the palmar lateral 3 1/2 fingers
What are the signs of a radial nerve lesion?
Wrist drop
Paraesthesia in the dorsal medial half
What are the signs of a ulnar nerve lesion?
Paraesthesia in the dorsal lateral half + medial 1 1/2 fingers
What are some causes of sciatica?
Disc herniation
Spinal cord stenosis
Malignancy- eg. prostatic met compression
What condition causes Parkinsonism with an upgaze abnormality?
Progressive supranuclear palsy
What condition causes Parkinsonism, Alzheimer’s, and hallucinations?
Lewy body dementia
55 M confusion and chest pain No headache/neck stiffness Recently moved house with malfunctioning heating system Temp 37C, HR 110, BP 120/60 Normal examinations ECG- sinus tachy, widespread ST depression Urinalysis- NAD Blood glucose- 7.0mmol/L WCC- 7 CRP- <5 CT Head- NAD
What is the most likely cause (from VIITT)?
V- no mention of acute presentation I- WCC and temperature is normal I- CRP is normal T- potentially a toxic/metabolic cause T- CT head is clear
What may a post-ictal state imply?
Hx of seizures
Which area presents with expressive dysphagia when a lesion is present?
Broca’s area
Which area presents with receptive dysphagia when a lesion is present?
Wernicke’s area
What are the causes of confusion?
Hypoglycaemia
Vascular- bleed (headache, collapse), subdural haematoma
Infection
Inflammation
Toxic/metabolic- Drugs, vitamin deficiencies, endocrinopathies
Tumour/malignancy
What are the steps of the AMTS exam?
DOB Age Location Time of day Year Address (7 West St) Current monarch WWII end date Recognise 2 faces Count from 20 to 1
What are the features of meningitis?
Fever Neck stiffness Kernig's sign Bruzdinski's sign Non-blanching rash Photophobia
What are the features of SAH?
Sudden onset
Get a CT+LP for xanthochromia
What are the features of GCA?
>50 Raised ESR PMR Temporal tenderness Jaw claudication
What are the features of migraine?
Throbbing Vomiting Photophobia With/without aura FHx
What is the management for a stroke presenting <4.5hrs?
CT head
Thrombolysis
What is the management for a stroke presenting >4.5hrs?
CT head
Aspirin 300mg
SALT assessment
Supportive care
What is the management for a TIA?
Aspirin 300mg Dont treat BP unless >220/120 or other indications ECG/echo (AF) Carotid Doppler (carotid stenosis) Modify risk factors
40M Backache + LMN weakness Admitted to HDU Regular FVC On cardiac monitor and IVIG
What is the most likely cause?
A. Guillain-Barre syndrome B. Stroke C. Cord compression D. Cauda equina syndrome E. Myaesthenia gravis
A. Guillain-Barre syndrome
What are the causes of proximal myopathy?
Inflammation- myositis
Metabolic- COT (Cushing’s, osteomalacia, thyrotoxicosis)
