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Rahul's Basics > DPD Deck - NEURO > Flashcards

DPD Deck - NEURO Flashcards

1
Q

What two questions should you ask yourself about neurological conditions?

A
  1. Where is the lesion

2. What kind of pathology is this

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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
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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
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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
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5
Q

A lesion at the level of the brain could present as?

A

Hemiparesis

A weakness of one side of the body

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6
Q

A lesion at the level of the spinal cord could present as.?

A

Paraparesis

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7
Q

Nerve Root compression could present as?

A

Abnormalities at a particular dermatome

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8
Q

A lesion of the peripheral nerves could present as?

A

Weakness and sensory abnormality at the level of the sensory nerve

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9
Q

A lesion at the level of the NMJ could present as?

A

Myasthenia Gravis

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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

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11
Q

What are the 5 cerebellar signs you should test for?

A 
Ataxia
Nystagmus
Dysdiadochokinesia
Intention tremor
Speech change
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12
Q

What are the speech changes you would see in someone with cerebellar defects?

A

Scanning speech

Slurred speech

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13
Q

How would damage to the cerebral cortex affect sensation in the body?

A

It would result in a hemisensory loss

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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

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15
Q

How would damage to the nerve roots affect sensation in the body?

A

It would result in a DERMATOMAL LOSS

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16
Q

What is damage to the nerve roots called?

A

Radiculopathy

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17
Q

How would damage to a single nerve (mononeuropathy) affect sensation?

A

Loss of sensation in a particular area

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18
Q

How would damange to multiple nerves affect sensation?

A

Gloves and Stocking distribution

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19
Q

List the autoimmune conditions which can lead to neurological conditions

A

Rheumatoid
SLE
Sjorgens
Sarcoid

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20
Q

List the metabloic conditions which can lead to neurological conditions

A

Diabetes
B12 deficiency
Amyloid
Alcohol

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21
Q

What are the toxic/metabolic causes of peripheral neuropathy?

A 
DRUGS - Metronidazole, phenytoin 
ALCOHOL 
B12 deficiency 
Diabetes
Hypothyroidism
Uraemia
Amyloidosis
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22
Q

What are some clues that a patient abused alcohol?

A

History
Raised Gamma GT
Raised MCV

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23
Q

What are some clues that have B12 deficiency?

A

Anemia

Raised MCV

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24
Q

What are some clues that a patient has diabetes?

A

History

Glucose/HbA1c

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25
Q

What are some clues that a patient has hypothyroidism?

A

Thyroid function tests

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26
Q

What are some ways to check if a patient has uremia?

A

Check their U and Es

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27
Q

What are some clues that a patient has amyloidosis?

A

History of myeloma

History of chronic infection/inflammation

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28
Q

List the other causes of Peripheral neuropathy besides toxic/metabolic

A
  1. Infection: HIV
  2. Inflammation/autoimmune: Vasculitis, CTD, inflammatory demyelinating neuropathy
  3. Tumor/malignancy: Paraneoplastic, Paraproteinaemia
  4. Hereditary sensory motor neuropathy
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29
Q

What is Amaurosis fugax?

A

Painless temporary loss of vision in one or both eyes

30
Q

What is Anterior uveitis?

A

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
Q

What is Papilledema?

A

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
Q

What is Papillitis?

A

Inflammation of the optic nerve head

Blurred optic disc margins
Blurred vision
Pain on eye movement
Reduced optic acuity

33
Q

What is Vitreous Haemorrhage?

A

Leakage of blood into the vitreous humor of the eye

34
Q

What is the other name for Papillitis?

A

Inflammatory optic neuritis

35
Q

What are the features of Papillitis or Inflammatory optic neuritis?

A

Blurred optic disc margins
Blurred vision
Pain on eye movements

36
Q

List the features of MS

A

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-DRB11501, DQA1102 and BQB1*0602 increase susceptibility
EBV and HHV6 may trigger relapse/onset of MS

37
Q

What are the 3 common presentations of MS?

A

Optic neuritis (papillits)
Brainstem demyelination - diplopia, vertigo+nystagmus
Spinal cord lesions - Paraparesis over days/weeks

38
Q

List some symptoms of MS

A 
VISUAL CHANGES
SENSORY SYMPTOMS - water down the back
Clumsy limb, loss of propioception
Unsteady/ataxia
Urinary urgency and frequency 
FATIGUE
SPASTICITY
39
Q

How is MS diagnosed?

A

A diagnosis of MS requires 2 or more attacks AFFECTING DIFFERENT PARTS OF THE CNS
I.e lesions seperated in time AND space

40
Q

What are some signs to look out for in MS

A

EXAM:
SPASTICITY
UNSTEADY/ATAXIA
VISUAL CHANGES

HISTORY:
Ask about PREVIOUS EPISODES of vertigo or loss of vision in one eye

41
Q

Describe Meralgia Paraesthetica

A

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
Q

Describe the physical manifestations of:

  1. Radial nerve palsy
  2. Ulnar nerve palsy
  3. Median nerve palsy
A
  1. Wrist drop
  2. Ulnar claw
  3. Inability to aBduct or oppose the thumb
43
Q

A disease of the nerve roots refers to?

A

A Radiculopathy

example: Sciatica - pain in the buttock which radiates down the leg below the knee

44
Q

How do radiculopathies occur?

A

Caused by compression

due to Disc herniation or Spinal canal stenosis

45
Q

List the features of Parkinson’s

A

Tremor
Rigidity
Bradykinesia

46
Q

List the features of Progressive supranuclear palsy

A

Parkinsonian features

Upgaze abnormality

47
Q

List the features of Lewy Body dementia

A

Hallucinations - animals, humans, a presence
Alzheimer’s symptoms
Parkinsonism

48
Q

List 4 DDx for confusion in patients

A
  1. Post-ictal
  2. Dysphasia (receptive or expressive) as a result of stroke or TIA
  3. Dementia
  4. Depression
49
Q

What would suggest a patient is post-ictal?

A

A history of seizures

50
Q

What would suggest a patient has dysphasia?

A

A history of stroke or TIA

51
Q

What types of dementia would lead to confusion?

A

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
Q

What are some signs a patient is depressed?

A

Elderly
Withdrawn
Poor eye contact
Precipitating factor in the history

53
Q

List more DDx of confusion (think surgical sieve)

A

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
Q

List the components of the Glasgow coma scale

A

Eyes (4)
Verbal (5)
Motor (6)

55
Q

How do you score eye part of the GCS?

A

4 - Eye open spontaneously
3 - Eyes open to voice
2 - Eyes open to pain
1 - No eye opening

56
Q

How do you score the verbal part of the GCS?

A 
5 - Orientated
4 - Confused but still speaking properly
3 - Words
2- Sounds
1 - No sounds
57
Q

How do you score the motor part of the GCS?

A 
6 - Obeys command 
5 - Localise pain 
4 - Withdraws from pain 
3  - Abnormal flexion
2 - Extension from pain 
1 - No movement
58
Q

List the questions asked in a AMTS

A 
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
Q

What are the 4 presentations of HEADACHE you are likely to see in the emergency department?

A
  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
Q

Describe Giant Cell Arteritis

A

Seen in >50 years
Polymyalgia rheumatica - Shoulder girdle pain, constitutional upset, stiffness

ESR, Steroids, Try to prevent blindness

61
Q

List the signs of Meningitis

A

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
Q

What are the signs of SAH

A

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
Q

List 2 differentials for SAH

A

Meningitis

Call-Fleming syndrome

64
Q

Describe the features of Giant Cell Arteritis

A

Inflammatory granulomatous arteritis of large cerebral arteries
Occurs in association with Polymyalgia rheumatica
The patient is usually > 50 years old

65
Q

List the presenting symptoms of Giant Cell Arteritis

A

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
Q

What factor determines how you manage stroke?

A

Timing - is it <4.5 hours or >4.5 hours?

67
Q

How do you manage a recent stroke?

A

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
Q

How do you manage a later stroke or one you are not sure when it occurred?

A

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
Q

How would manage someone with a TIA?

A

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
Q

Describe the features of Guillan-Barre syndrome

A

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

Rahul's Basics (11 decks)

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