DPD Deck - NEURO Flashcards
1
Q
What two questions should you ask yourself about neurological conditions?
A
- Where is the lesion
2. What kind of pathology is this
2
Q
Where are some of the areas where lesions can occur?
A
The Brain The Spinal Cord The Nerve Roots The Peripheral Nerves The Neuromuscular Junction
3
Q
What are the kinds of pathologies that can occur?
A
Vascular - Like a stroke Infection Inflammation/Autoimmune Tumor/Malignancy - Like melanoma Toxic/Metabolic Hereditary/Congenital Degenerative
4
Q
What are some of the indications that a neurological pathology may be due to an infection?
A
Patient has... History of HIV Fevers Malaise Sub-acute onset Like to be an abscess or opportunistic infection
5
Q
A lesion at the level of the brain could present as?
A
Hemiparesis
A weakness of one side of the body
6
Q
A lesion at the level of the spinal cord could present as.?
A
Paraparesis
7
Q
Nerve Root compression could present as?
A
Abnormalities at a particular dermatome
8
Q
A lesion of the peripheral nerves could present as?
A
Weakness and sensory abnormality at the level of the sensory nerve
9
Q
A lesion at the level of the NMJ could present as?
A
Myasthenia Gravis
10
Q
List the differences between UPPER MOTOR NEURON diseases and LOWER MOTOR NEURON diseases
A
Upper motor neuron:
INCREASED tone
DECREASED power
INCREASED reflexes
Lower motor neuron:
DECREASED tone
DECREASED power
DECREASED reflexes
11
Q
What are the 5 cerebellar signs you should test for?
A
Ataxia Nystagmus Dysdiadochokinesia Intention tremor Speech change
12
Q
What are the speech changes you would see in someone with cerebellar defects?
A
Scanning speech
Slurred speech
13
Q
How would damage to the cerebral cortex affect sensation in the body?
A
It would result in a hemisensory loss
14
Q
How would damage to the spinal cord affect sensation in the body?
A
It would result in a ‘LEVEL’ loss, that is reduced sensation all the way up to a certain point
15
Q
How would damage to the nerve roots affect sensation in the body?
A
It would result in a DERMATOMAL LOSS
16
Q
What is damage to the nerve roots called?
A
Radiculopathy
17
Q
How would damage to a single nerve (mononeuropathy) affect sensation?
A
Loss of sensation in a particular area
18
Q
How would damange to multiple nerves affect sensation?
A
Gloves and Stocking distribution
19
Q
List the autoimmune conditions which can lead to neurological conditions
A
Rheumatoid
SLE
Sjorgens
Sarcoid
20
Q
List the metabloic conditions which can lead to neurological conditions
A
Diabetes
B12 deficiency
Amyloid
Alcohol
21
Q
What are the toxic/metabolic causes of peripheral neuropathy?
A
DRUGS - Metronidazole, phenytoin ALCOHOL B12 deficiency Diabetes Hypothyroidism Uraemia Amyloidosis
22
Q
What are some clues that a patient abused alcohol?
A
History
Raised Gamma GT
Raised MCV
23
Q
What are some clues that have B12 deficiency?
A
Anemia
Raised MCV
24
Q
What are some clues that a patient has diabetes?
A
History
Glucose/HbA1c
25
What are some clues that a patient has hypothyroidism?
Thyroid function tests
26
What are some ways to check if a patient has uremia?
Check their U and Es
27
What are some clues that a patient has amyloidosis?
History of myeloma
| History of chronic infection/inflammation
28
List the other causes of Peripheral neuropathy besides toxic/metabolic
1. Infection: HIV
2. Inflammation/autoimmune: Vasculitis, CTD, inflammatory demyelinating neuropathy
3. Tumor/malignancy: Paraneoplastic, Paraproteinaemia
4. Hereditary sensory motor neuropathy
29
What is Amaurosis fugax?
Painless temporary loss of vision in one or both eyes
30
What is Anterior uveitis?
Anterior uveitis is an inflammation of the middle layer of the eye. This layer includes the iris (colored part of the eye) and the adjacent tissue,
31
What is Papilledema?
Swelling of the optic disc due to increased intracranial pressure (No pain on eye movement)
Usually, the presentation is bilateral
Causes: brain tumor, respiratory failure, hypotonia, Isotretinoin
32
What is Papillitis?
Inflammation of the optic nerve head
Blurred optic disc margins
Blurred vision
Pain on eye movement
Reduced optic acuity
33
What is Vitreous Haemorrhage?
Leakage of blood into the vitreous humor of the eye
34
What is the other name for Papillitis?
Inflammatory optic neuritis
35
What are the features of Papillitis or Inflammatory optic neuritis?
Blurred optic disc margins
Blurred vision
Pain on eye movements
36
List the features of MS
Chronic, autoimmune, T-cell mediate, inflammation of CNS
Multiple plaques of demyelination are found in brain and spinal cord over years
F:M ratio is 2:1
Age of presentation: 20-40
HLA-DRB1*1501, DQA1*102 and BQB1*0602 increase susceptibility
EBV and HHV6 may trigger relapse/onset of MS
37
What are the 3 common presentations of MS?
Optic neuritis (papillits)
Brainstem demyelination - diplopia, vertigo+nystagmus
Spinal cord lesions - Paraparesis over days/weeks
38
List some symptoms of MS
```
VISUAL CHANGES
SENSORY SYMPTOMS - water down the back
Clumsy limb, loss of propioception
Unsteady/ataxia
Urinary urgency and frequency
FATIGUE
SPASTICITY
```
39
How is MS diagnosed?
A diagnosis of MS requires 2 or more attacks AFFECTING DIFFERENT PARTS OF THE CNS
I.e lesions seperated in time AND space
40
What are some signs to look out for in MS
EXAM:
SPASTICITY
UNSTEADY/ATAXIA
VISUAL CHANGES
HISTORY:
Ask about PREVIOUS EPISODES of vertigo or loss of vision in one eye
41
Describe Meralgia Paraesthetica
Numbness, burning increased sensation to light touch
Due to compression of Lateral Femoral cutaneous nerve
Tx: Reassure, avoid tight garments, LOSE WEIGHT
Persistent: Carbamazepine, Gabapentin
42
Describe the physical manifestations of:
1. Radial nerve palsy
2. Ulnar nerve palsy
3. Median nerve palsy
1. Wrist drop
2. Ulnar claw
3. Inability to aBduct or oppose the thumb
43
A disease of the nerve roots refers to?
A Radiculopathy
| example: Sciatica - pain in the buttock which radiates down the leg below the knee
44
How do radiculopathies occur?
Caused by compression
| due to Disc herniation or Spinal canal stenosis
45
List the features of Parkinson's
Tremor
Rigidity
Bradykinesia
46
List the features of Progressive supranuclear palsy
Parkinsonian features
| Upgaze abnormality
47
List the features of Lewy Body dementia
Hallucinations - animals, humans, a presence
Alzheimer's symptoms
Parkinsonism
48
List 4 DDx for confusion in patients
1. Post-ictal
2. Dysphasia (receptive or expressive) as a result of stroke or TIA
3. Dementia
4. Depression
49
What would suggest a patient is post-ictal?
A history of seizures
50
What would suggest a patient has dysphasia?
A history of stroke or TIA
51
What types of dementia would lead to confusion?
Vascular --> History of IHD/PVD
Alcoholic --> Signs of alcohol consumption
Alzheimer's dementia
Inherited e.g. Huntington's disease --> Other signs of Huntington's
52
What are some signs a patient is depressed?
Elderly
Withdrawn
Poor eye contact
Precipitating factor in the history
53
List more DDx of confusion (think surgical sieve)
Hypoglycaemia
Vascular
(Possible bleed: Headache, collapse OR Subarachnoid haemorrhage: Fall, fluctuating consciousness, sub-acute)
Infection - intracranial or extracranial (chest inf or UTI)
Inflammation
Tumor
Toxic/Metabolic
(Think about U&Es, LFTs, Drugs, Vitamin deficiences, endocrinopathies)
54
List the components of the Glasgow coma scale
Eyes (4)
Verbal (5)
Motor (6)
55
How do you score eye part of the GCS?
4 - Eye open spontaneously
3 - Eyes open to voice
2 - Eyes open to pain
1 - No eye opening
56
How do you score the verbal part of the GCS?
```
5 - Orientated
4 - Confused but still speaking properly
3 - Words
2- Sounds
1 - No sounds
```
57
How do you score the motor part of the GCS?
```
6 - Obeys command
5 - Localise pain
4 - Withdraws from pain
3 - Abnormal flexion
2 - Extension from pain
1 - No movement
```
58
List the questions asked in a AMTS
```
What is your DOB?
How OLD are you?
What is the TIME?
What YEAR is it?
WHERE are we right now?
Remember this address: West Register Street (ASK TO REPEAT AT THE END)
Ask them to IDENTIFY two people (what are their jobs/roles)
WHO is the CURRENT PM
WHEN was WW2
COUNT backwards from 20 down to 1
```
John I told you an address earlier can you remember what that address was?
59
What are the 4 presentations of HEADACHE you are likely to see in the emergency department?
1. Meningitis - Fever, neck stiffness, Kernig's sign
2. Subarachnoid haemorrhage - Sudden onset, CT, LP-xanthachromia
3. Migraine - Throbbing, vomiting, photo/phonophobia, FHx, Aura
4. Giant cell arteritis
60
Describe Giant Cell Arteritis
Seen in >50 years
Polymyalgia rheumatica - Shoulder girdle pain, constitutional upset, stiffness
ESR, Steroids, Try to prevent blindness
61
List the signs of Meningitis
Fever
Neck stiffness
Photophobia
Purpuric rash (in meningococcal meningitis)
KERNIG'S SIGN - An inability to straighten the leg when the hip is flexed 90 degrees
62
What are the signs of SAH
Sudden-onset headache sometimes described as thunder-clap
Vomitting
Headache and/or neck stiffness has very quick onset about 3 minutes
Coma
Positive Kernig's sign
63
List 2 differentials for SAH
Meningitis
| Call-Fleming syndrome
64
Describe the features of Giant Cell Arteritis
Inflammatory granulomatous arteritis of large cerebral arteries
Occurs in association with Polymyalgia rheumatica
The patient is usually > 50 years old
65
List the presenting symptoms of Giant Cell Arteritis
Severe headaches
Tender scalp or temple
Claudication of the jaw when eating
Tenderness and swelling of temporal or occipital arteries
Sudden, painless, temporary/permanent loss of vision in one eye
Also systematic manifestations: severe malaise, tiredness, and fever
66
What factor determines how you manage stroke?
Timing - is it <4.5 hours or >4.5 hours?
67
How do you manage a recent stroke?
Here we will take a recent stroke to mean <4.5 hours.
FIRST: Perform a CT head to check if there is a hemorrhage
If there is NO haemorrhage then begin THROMBOLYSIS
68
How do you manage a later stroke or one you are not sure when it occurred?
Here we will take a later stroke to mean >4.5 hours
FIRST: Perform a CT head to check for hemorrhage
SECOND: Give patient ASPIRIN (300 mg)
THIRD: Assess swallowing
FOURTH: Maintain hydration, oxygenation and monitor glc
69
How would manage someone with a TIA?
FIRST: Aspirin
SECOND: ECG/ECHO - To check for AF
THIRD: Carotid Doppler - To check for carotid artery stenosis
FOURTH: Risk factor modification like lose weight or give up smoking
NOTE: Do not treat BP unless it is >220/120 or if indicated
70
Describe the features of Guillan-Barre syndrome
Acute inflammatory demyelinating polyradiculoneuropathy
Onset occurs after an infection that may not even be identified
The weakness of distal limb muscles
Distal limb numbness
Low back pain
Weakness and sensory loss progresses proximally over 6 weeks
Confirm diagnosis via nerve conduction studies
Ventilatory support
Forced Vital Capacity must be monitored to recognize emerging respiratory muscle weakness
LWMH and compression stockings to reduce risk of thrombosis
Immunoglobulins given IV
