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DPD Stuff > Gen Med 4 Neuro > Flashcards

Gen Med 4 Neuro Flashcards

1
Q

What is the gross anatomy of the nervous system?

A
  • Brain
  • Spinal cord
  • Nerve roots
  • Peripheral nerve(s)
  • Neuromuscular junction
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2
Q

What are the 12 cranial nerves and what do they control?

A
  • I: sense of smell
  • II: VA, VF, pupils, fundoscopy
  • III, IV, VI: diplopia
  • V: sensation, corneal reflex
  • VII: facial palsy
  • VIII: hearing
  • IX, X: Speech, swallowing
  • XI: Sternocleidomastoid, trapezius
  • XII: tongue movements
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3
Q

What do you test when examining limbs?

A
  • Inspection
  • Tone
  • Power
  • Reflexes
  • Coordination
  • Sensation
  • Gait
  • Back
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4
Q

How do upper and lower motor neurone disease signs differ?

A

Upper: Brisk reflexes (Upward plantar response), increased tone, decreased power

Lower: Hyporeflexia, hypotonia, low power

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5
Q

What are cerebellar signs?

A
  • Ataxia
  • Nystagmus
  • Dysdiadochokinesia (test rapidly alternating movements)
  • Intention tremor (finger‐nose‐finger test)
  • Speech: slurred, scanning
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6
Q

What are the distributions neuropathy can take?

A
  • Hemisensory loss (cerebral cortex)
  • Level (e.g. umbilicus) (Spinal cord)
  • Dermatome(s) (nerve root)
  • Specific area (Mononeuropathy)
  • Glove & stockings (polyneuropathy)
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7
Q 
• 55 yr old man
• Numbness & tingling in hands 
& feet
• PMH: type 1 DM
• On basal/bolus insulin
• HbA1C: 50 mmol/mol
• B12: 500 pg/ml (200 – 900) 
• eGFR: 90
• Reduced Sensation to PP (glove & 
stocking distribution)

What would you prescribe?

A

Duloxetine

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8
Q

What are the toxic/ metabolic causes of peripheral neuropathy?

A
  • Drugs
  • Alcohol
  • B12 deficiency
  • Diabetes
  • Hypothyroidism
  • Uraemia
  • Amyloidosis
[ Clues
• Hx
• Hx, 
increased GGT & MCV
• Anaemia, 
Increased MCV
• History, glucose/HbA1C
• TFTs
• U&Es
• History of myeloma or chronic 
infection/inflammation]
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9
Q

Other than diabetes, what are other causes of peripheral neuropathy?

A

• Infection– HIV
• Inflammation/Autoimmune– Vasculitis, CTD, inflammatory demyelinating neuropathy
• Tumour/Malignancy
– Paraneoplastic
– Paraproteinaemia
• Hereditary – Hereditary sensory motor neuropathy

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10
Q

How does optic neuritis present?

A

– Blurred optic disc margins
– Blurred vision
– Pain on eye movement

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11
Q

What can spastic paraparesis be caused by?

A 
– Vascular
– Infection
– Inflammation (demyelination)
• Transverse myelitis
– Toxic/Metabolic
– Tumour/Malignancy
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12
Q

How do you diagnose MS?

A
  • Two lesions

* Separated in time/space

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13
Q 
• 60 year old man
• Pain & paraesthesia on 
anteriolateral thigh
• PMH: Type 2 Diabetes
• Metformin
• HbA1C: 60 mmol/mol
• BMI: 30 kg/m2
• reduced PP sensation 
anterolateral thigh

What is the next step in management?

A

Lose weight

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14
Q

What is meralgia parasthetica and how do you treat it?

A 
• Compression of lateral 
femoral cutaneous nerve
• Reassure
• Avoid tight garments
• Lose weight
• If persistent:
– Carbamazepine
– Gabapentin
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15
Q

What is the sensation of the hand?

A

Ulnar- Medial 2 1/2 fingers
Median- Lateral 3 1/2 fingers and tips anteriorly
Radial- On back, lower half of thumb, index and middle and thenar area

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16
Q

What is radiculopathy?

A 
• Disease of the nerve roots
• Example: Lumosacral
• Pain in the buttock, 
radiating down the leg 
below the knee (‘sciatica’)
• Compression by
– Disc herniation
– Spinal canal stenosis
17
Q
  • 60 year old man
  • Recurrent falls
  • Tremor at rest
  • Rigidity
  • More forgetful
  • Dysphagia
  • Micrographia
  • Limited upgaze

Diagnosis?

A

Progressive supranuclear palsy

18
Q

What are the types of parkinsonian symptoms?

A 
Parkinson’s disease
– Dopaminergic neurons
– Substantia nigra
• Tremor, rigidity, 
bradykinesia

• PSP (Steele‐Richardson
syndrome)
• Parkinsonian features,
upgaze abnormality

• Lew body dementia
• Features of Alzheimer’s
disease, Parkinson’s &
hallucinations

19
Q

What are some causes of apparent confusion?

A
  • Post ictal (Hx of seizures)
  • Dysphasia (Hx stroke)
  • Dementia (IHD, alcohol, FHx, huntingtons)
  • Depressive pseudodementia (Elderly, withdrawn, poor eye contact)
20
Q

Why might someone present with acute confusion and reduced consciousness?

A

• Hypoglycaemia
• Vascular
– Bleed: Headache, collapse
– Subdural haematoma (Fall, fluctuating consciousness)
• Infection
– ? Temp, ? Intracranial, ? Extra‐cranial
• Inflammation
• Malignancy
• Metabolic/Toxic
– Drugs, U&Es, LFTs, Vitamin deficiencies, Endocrnipathies

21
Q

What are the questions in AMTSS?

A
  1. DOB
  2. Age
  3. Time
  4. Year
  5. Place
  6. Recall (West Register Street)
  7. Recognize doctor/nurse
  8. Prime Minister
  9. Second WW
  10. Count backwards from 20 to 1
22
Q

What are the parts of the GCS?

A 
Eye opening
4 = Spontaneous 
3 = Opens in response to voice
2 = Opens in response to painful stimuli
1 = Does not open 
5 = Oriented
4 = Confused
3 = Words
2 = Sounds
1 = No sounds
6 = Obeys commands
5 = Localizes pain
4 = Withdraws to painful stimuli
3 = Abnormal flexion
2 = Extension
1 = No movements
23
Q

What are the parts of the GCS?

A 
Eye opening
4 = Spontaneous 
3 = Opens in response to voice
2 = Opens in response to painful stimuli
1 = Does not open 
Verbal
5 = Oriented
4 = Confused
3 = Words
2 = Sounds
1 = No sounds
Motor
6 = Obeys commands
5 = Localizes pain
4 = Withdraws to painful stimuli
3 = Abnormal flexion
2 = Extension
1 = No movements
24
Q

If someone has a headache in the ED what might it be suggestive of other than stroke?

A

• Meningitis
• Fever, neck stiffness,
Kernig’s sign

  • Subarachnoid haemorrhage
  • Sudden onset
  • CT, LP (xanthochromia)
• Giant cell arteritis
– Polymyalgia rheumatica
– (Shoulder girdle pain, stiffness, constitutional upset)
• > 50 years
• ESR, steroids, Bx

• Migraine
• Throbbing, vomiting,
photo/phonophobia, FHx,
Aura

25
Q

How do you manage stroke?

A

• < 4.5 hours
– CT: no haemorrhage
– Thrombolysis (if no
contraindications)

• > 4.5 hours
– CT head (exclude 
haemorrhage)
– Aspirin (300mg), Swallow 
assessment
– Maintain hydration, 
oxygenations, monitor glc
26
Q

How do you manage a TIA?

A 
• Aspirin
• Don’t treat BP acutely
– unless > 220/120 or 
– other indication
• ECG, Echocardiogram
• Carotid Doppler
• Risk factor modification
27
Q
  • 40 year old
  • Backache
  • LMN weakness
  • Admitted to HDU
  • Regular FVC
  • Cardiac monitor
  • IVIG

Most likely diagnosis?

A

egwhret

28
Q

What are the simple causes of collapse?

A 
• Low glucose
• Heart
– Vasovagal
– Arrhythmia
– Outflow obstruction
– Postural hypotension
• Brain
– Seizure
29
Q

What are the complex causes of collapse?

A
  • Vasovagal
  • Atrial fibrillation
  • Ischaemic heart disease
  • Thyrotoxicosis
  • Sick sinus syndrome
  • Hypertensive heart disease
  • Cardiomyopathy
  • Rheumatic heart disease
  • SVT
  • Ventricular tachycardia
  • Brugada syndrome
  • Long QT syndrome
  • Complete heart block
  • Myocardial infarction
  • Electrolyte abnormalities
  • Aortic stenosis
  • HOCM
  • Peripheral neuropathy
  • Anti‐hypertensives
  • Pulmonary embolism
  • Hypoglycaemia
  • TIA
  • Seizures
  • Trauma
  • Meningitis/encephalitis
  • Brain tumour

DPD Stuff (23 decks)

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