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NMF: Neurology > GENERAL > Flashcards

GENERAL Flashcards

1
Q

What is the difference between the autonomic and somatic peripheral nervous system?

A

autonomic = involuntary so does not require dendrites to give that information so it is a unipolar neurone.

somatic = voluntary so requires afferent (sensory) and efferent (motor) neurones

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2
Q

Which neurotransmitters are used in the

a) parasympathetic
b) sympathetic

arms of the autonomic nervous system?

A

a) ACH

b) preganglionic = ACH
postganglionic = noradrenaline (because this will target the fight/flight response on to the organ)

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3
Q

Where are cell bodies found in the autonomic NS?

A

Pre-ganglionic = grey matter of CNS
- usually parasympathetic in the brain, sympathetic in
the spinal cord

Post-ganglionic = autonomic ganglia in the PNS

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4
Q

What is a glial cell?

A

A glial cell is a non-neuronal cell found in CNS and PNS. They help to maintain homeostasis by supporting neurones

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5
Q

Name some glial cells found in the CNS

A
  • astrocytes (blood brain barrier)
  • oligodendrocytes (produce myelin)
  • microglia (immune monitoring)
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6
Q

Name some glial cells found in the PNS

A
  • Schwann cells (produce myelin)

- satellite cells (Regulate external chemical environment same as astrocytes do in CNS)

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7
Q

What is found in the white matter of the brain?

A

axons

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8
Q

What is found in the grey matter of the brain?

A

neuronal cell bodies

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9
Q

What does dorsal mean?

A

posterior ( like the back of your hand)

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10
Q

What does ventral mean?

A

anterior

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11
Q

Which rami is sensory and which is motor?

A

dorsal = sensory

ventral = motor

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12
Q

What is the pyramidal system?

A

system of voluntary movement

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13
Q

Give some pyramidal signs

A

spasticity
hyperactive reflexes
loss of fine hand movements
extensor plantar response (Babinski sign)

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14
Q

What are the important tracts of the pyramidal system?

A

lateral and anterior corticospinal

corticobulbar

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15
Q

Where are the majority of UMN contained?

A

lateral corticospinal tract

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16
Q

When does
a) lateral
b) anterior
corticospinal tract cross?

A

a) at the medulla

b) at the spinal level it synapses at

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17
Q

Cerebellar signs

A 
DANISH
dysdiadochokinesia
ataxia
nystagmus
intention tremor 
scanning dysarthria
hyporeflexia
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18
Q

What is stereognosis?

A

the ability to recognise an object by touch

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19
Q

What is myoclonus?

A

sudden, involuntary focal/general muscle jerks

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20
Q

What is clonus?

A

a series of involuntary, rhythmic, muscular contractions and relaxations

–> sign of UMN lesion

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21
Q

prophylactic treatment for cluster headaches

A

verapamil

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22
Q

At what spinal levels can spinal cord injury cause autonomic dysreflexia?

A

above T6

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23
Q

Treatment of trigeminal neuralgia

A

carbamazepine

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24
Q

syringomyelia causes sensory dysfunction in which distribution

A

cape-like loss of pain and temperature due to involvement with spinothalamic tract

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25
Q

acute treatment of cluster headache

A

o2 + triptan

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26
Q

Is GABA or glutamate inhibitory?

A

GABA

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27
Q

How do you manage myasthenia gravis?

A

pyridostigmine (anticholinesterase inhibitor) + prednisolone

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28
Q

treat drug-induced parkinsonism

A

antimuscarinics eg procyclidine

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29
Q

What nerve can be injured by fracture to surgical neck of humerus?

A

axillary nerve

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30
Q

What nerve can be injured by fracture to humeral shaft?

A

radial nerve

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31
Q

treat delirium in parkinsons

A

lorazepam

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32
Q

Cause of

a) unilateral high-stepping gait
b) bilateral high-stepping gait

A

cause = foot drop

a) common peroneal nerve lesion
b) peripheral neuropathy

l4/5 disc herniation compressing l5

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33
Q

treat nausea in parkinson’s

A

domperidone

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34
Q

When shingles affects facial nerve

A

Ramsay Hunt syndrome

- vesicular rash around ear

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35
Q

Features of CRPS

A
  • disproportiante symptoms
  • allodynia
  • temperature and skin colur changes
  • oedema and swelling
  • motor dysfunction
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36
Q

How does
a) Klumpe’s palsy
b) Erb’s palsy
present?

A

a) weak intrinsic hand muscles

b) waiter’s tip: elbow flexion and forearm supination lost

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37
Q

What nerve roots does
a) Klumpe’s palsy
b) Erb’s palsy
affect?

A

a) C8-T1

b) C5-6

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38
Q

In which type of meningitis are steroids used? Why?

A

bacterial to reduce inflammation which is a major cause of morbidity

39
Q

True or false

“There is no effective vaccine against some of the common strains of meningococcal infection seen in the UK”

A

false

40
Q

Which of the following statements is TRUE?

A. Aciclovir is useful for treating most causes of viral meningitis
B. Listeria is a small Gram negative bacillus
C. Gentamicin has good penetration into CSF and is useful for treating
some types of meningitis
D. Listeria infection is associated with the consumption of soft cheese
E. Listeria meningitis is commonest in older children and young adults

A

D

41
Q

Why is ceftriaxone chosen for empirical treatment for
suspected bacterial meningitis instead of penicillin?

A. Ceftriaxone has a longer half-life than penicillin
B. Ceftriaxone penetrates better than penicillin into CSF
C. Most bacteria that cause meningitis are now penicillin resistant.
D. Resistance is less likely to emerge during therapy if ceftriaxone if
used
E. Ceftriaxone also has activity against Listeria infection

A

A: more effective to give a less amount of times

42
Q

Which area of the brain is responsible for nominal aphasia?

A

suggests an inferior parietal lesion, and area known as the angular gyrus.

43
Q

What is the mode of inheritance in

a) Wilson’s disease?
b) Becker’s muscular dystrophy?
c) Myoclonic epilepsy with ragged red fibers?

A

a) autosomal recessive
b) x-linked recessive
c) mitochondrial

44
Q

When do you see xanthochromic CSF?

A

sub-arachnoid haemorrhage

45
Q

What does CSF look like in

a) viral meningitis?
b) bacterial meningitis?

A

a) clear

b) cloudy

46
Q

When is protein most raised in CSF?

A

viral meningitis

47
Q

In which case would CSF have low glucose and increased neutrophils?

A

bacterial meningitis

48
Q

What is the first area of the brain affected by Alzheimer’s?

A

The nucleus basalis of Meynert (main source of cholinergic projections)

49
Q

MOA of lamotrigine

A

Lamotrigine antagonises voltage sensitive sodium channels and this reduces the release of glutamate, the main excitatory neurotransmitter.

50
Q

First-line management of Alzheimers

A

acetylcholinesterase inhibitor

eg. rivastigmine, donezapil and galantamine

51
Q

When can memantine be used?

A

add-on therapy in moderate alzheimer’s

monotherapy in severe

52
Q

What is memantine?

A

NMDA receptor blocker

53
Q

Weber test in

a) sensorineural hearing loss
b) conductive

A

a) localises to contralateral side

b) localises to same side

54
Q

Is bell’s palsy an UMN or LMN lesion ?

A

LMN so forehead not involved

55
Q

In which type of meningitis do you see a rash?

A

meningococcal (bacteria)

56
Q

What is the empirical treatment for bacterial meningitis?

A

IV ceftriaxone and dexamethasone

57
Q

Features of Bell’s palsy

A

paralysis of facial muscles
loss of lacrimation
hyperacusis

58
Q

Is sensation affected in Bell’s palsy?

A

no

sensory fibres carried by trigeminal nerve

59
Q

Which nerve is injured in wrist drop?

A

radial

60
Q

numb superior upper arm and weak shoulder abduction

A

axillary nerve

61
Q

first 15 degrees of shoulder abduction is done by which muscle?

A

supraspinatous

62
Q

Which cranial nerve supplies laryngeal muscles eg cricothyroid?

A

vagus

63
Q

acute, ascending paralysis with glove and stocking weakness

A

guillain-barre

64
Q

Lesion in a spinal tract would cause an UMN or LMN sign?

A

UMN

65
Q

Which blood test is raised in temporal arteritis?

A

ESR

66
Q

Signs of spinal injury

A

mixed UMN and LMN signs above the lesion

UMN signs below the lesion

67
Q

Psychiatric disorder + cerebellar dysfunction + parkinsonism

A

Wilson’s disease

68
Q

Which organism is Guillain-Barre particularly associated with?

A

Campylobacter jejuni

69
Q

Alcoholic encephalopathy is caused by deficiency of what?

A

vitamin B1 (thiamine)

70
Q

bilateral leg weakness, pes cavus + high-stepping gait

A

Charcot-Marie-Tooth

71
Q

A 60yr old woman has difficulty with speech. Her sentences are fluid but don’t make sense and she is unaware of this. She can follow simple commands.

A

Receptive aphasia –> Wernicke’s area (Superior temporal gyrus)

72
Q

A 70yr old man with slow speech and frequent pauses while he tries to remember words. He often resorts to saying “ the thing”

A

Expressive aphasia –> Broca’s area (Inferior frontal gyrus)

73
Q

Which medications cause impulsiveness in Parkinson’s treatment?

A

dopamine agonists eg ropinorole

74
Q

Stroke in which territory of the brain would cause weakness and sensory deficit for

a) lower limbs?
b) upper limbs?
c) both?

A

a) medial frontal and parietal lobes - forebrain - anterior cerebral artery
b) lateral frontal, parietal and temporal lobes - middle cerebral artery
c) occipital lobe - posterior cerebral artery

75
Q

Which cranial nerve is carried through the cavernous venous sinus?

A

ophthalmic division of trigeminal (V1)

76
Q

causes of Bell’s palsy

A 
idiopathic
mononeuritis multiplex
parotid inflammation
herpes zoster
pontine tumour or stroke
77
Q

What is Creutzfeldt-Jakob disease?

A

a fatal, degenerative brain disease where prion proteins (misfolded) cause degeneration and death of brain tissue resulting in a spongiform brain

78
Q

How is Creutzfeldt-Jakob disease transmitted?

A

exposure to infected brain tissue eg. cannibalism

rarely Autosomal dominant inheritance

79
Q

How does Creutzfeldt-Jacob disease present?

A

rapid onset dementia
myoclonus
personality changes
hallucinations

80
Q

What is mononeuritis multiplex?

A

a peripheral nerve disorder that affects 2+ random nerves

81
Q

How does mononeuritis multiplex present?

A

painful, asymmetrical sensory and motor features

82
Q

What causes mononeuritis multiplex?

A

axons are damaged by a systemic process eg. diabetes mellitus, rheumatoid arthritis, vasculitis

83
Q

Diagnose delirium

A

acute onset
inattention with fluctuating course
plus one of: disorganised thinking or altered level of consciousness

84
Q

Which type of chorea is caused by GBS infection in children?

A

synderham’s

85
Q

Which drug can slow progression of MND?

mechanism?

A

riluzole

anti-glutamate

86
Q

How does wilsons disease present in

a) children?
b) young adults?

A

a) liver problems

b) CNS problems eg. ataxia, tremor, slow movement, inc tone

87
Q

Differentiate multi system atrophy from other causes of Parkinsonism

A

early autonomic disturbance

eg. bladder/bowel problems, postural hypotension, erectile dysfunction

88
Q

Which cause of Parkinsonism presents with eye problems?

A

progressive supranuclear palsy

89
Q

treat SAH

A

nimodipine and surgical clipping

90
Q

what causes holmes tremor?

A

demyelination in the mid-brain

91
Q

What organism causes meningitis in neonates?

A

Group B strep

92
Q

What organism causes meningitis in children over 3 months + adults?

A

neisseria meningitidis

93
Q

What organism causes meningitis in >60?

A

listeria meningitis

94
Q

Which lobe is responsible for short term memory?

A

temporal

NMF: Neurology (9 decks)

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