Formative Flashcards
How would the patient present with an expanding tumour around the spinal cord in T5-T7 region?
Would expand to affect where STT neurones are decussating across the anterior white commissure, but not affect ascending/descending neurones = bilateral loss of pain and temp sensation in T5-T7 segments only
When is Thiamine given?
Alcohol dependence (usually Thiamine, B1 deficient)
How would the pupils change with a lesion in the midbrain, pons or medulla?
Pons and medulla lesions would affect sympathetic outflow = pin point pupils
Midbrain lesion affects EWN = dilated pupils
What’s the hierarchy of evidence ?
Systematic reviews RCTs Cohort Case Cross sectional studies
Which area of basal ganglia generates tremors?
Globus pallidus
Which area of the ganglia is associated with hemiballismus?
Subthalamic nucleus
What type of movements does damage to the striatum cause (HD)?
Chorea and athetosis
What are signs of cerebellar damage?
DANISH Dysdiadochokinesia Dysmetria (pass pointing) Dystonia (hypotonia) Dysarthria (difficulty articulating speech) Dysphagia (problems with swallowing)
What’s the role of the suprachiasmatic nucleus?
Diurnal rhythm
What’s the role of the supraoptic nucleus?
Osmoregulation
What’s the role of the paraventricular nucleus?
ANS - stress, appetite
In a CSF sample when would lymphocytes or neutrophils be raised?
Lymphocytes - viral or TB
Neutrophils - bacterial
What’s the key sign of meningococcal disease?
Non-blanching (purpuric) rash
What types of dementia present cortically? What are their features?
Frontotemporal dementia
AD
CJD
Higher cortical abnormalities, dysphasia, agnosia, apraxia
What are types of subcortical dementia and how do they present?
PD, HD, normal pressure hydrocephalus
Apathetic
Forgetful and slow
Depression
Impaired visuospatial
Which types of dementia present cortically and sub-cortically?
DLB
Multi infarct
What parts of the brain does Korsakoff’s predominantly damage?
Mamillary bodies of hypothalamus
Anterior thalamic nucleus
= anterograde amnesia and confabulations
Where would the damage be for unilateral or bilateral hearing loss?
Unilateral: cochlear nerve of cochlear nuclei
Bilateral: primary auditory cortex
What’s the relationship between the 4th ventricle and CN VI and VII?
4th ventricle tumour/swelling can result in papilloedema, visual disturbance (unable to abduct), weakness of facial muscles
Which sinus runs close to the internal occipital protuberance?
Superior sagittal sinus drains posteriorly, where it splits into the transverse sinuses
Which cranial nerve nuclei are tested by the gag reflex?
Nucleus ambiguus and spinal trigeminal sensory nucleus
What’s the efferent limb of the corneal reflex?
Facial nerve to orbicularis oculi
can be damaged in forceps delivery by damaging stylomastoid foramen
What are the 3 features of DLB?
Parkinsonism, Dementia, Hallucinations
How does AD and DLB differ on imaging?
Rapid atrophy of hippocampus in AD
What class of drugs is used to slow progression of dementia?
Anticholinesterases
Despite the hallucinations, why are antipsychotics contraindicated in patients with DLB?
Will exacerbate the parkinsonism symptoms (D2 antagonism)
What are lay health beliefs? What are 4 sources of them?
Ordinary people (non medical professionals) knowledge of health and illness that are generally rooted in their own experience
Society, culture, personal experience, social identity
What’s the difference between moderate sedation and general anaesthesia?
In moderate sedation, patients are conscious but relaxed and able to maintain verbal communication
In GA there is loss of consciousness - the patient is without awareness and sensation
What scale is used to assess sedation and what’s the ideal score?
Ramsay scale 2 = calm
Richmond/Riker agitation scales too
What type of bleeds are lentiform or crescent shaped?
Lentiform = extradural (arterial) Crescent = subdural (venous)
What are the 2 legal principles under which someone who lacks capacity to consent can be treated?
Doctrine of necessity
Best interests
Which 2 people can make decisions on behalf of those without capacity?
Court appointed deputy
Lasting power of attorney
What are some visuospatial tests (of hemispatial neglect)?
Ask patient to draw a clock face
Draw a flower
What’s the visual deficit called when the lesion is in Meyer’s loop?
Upper quadrantopia
lower quadrantopia when superior aspect of optic radiation damaged
What’s inability to track movements/objects called? Damage where results in it?
Akinetopia
Dorsal pathway of vision runs through the parietal lobes to the frontal lobes
