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PRIYA NEURO > kumar and clark > Flashcards

kumar and clark Flashcards

1
Q

describe the MRC muscle power scale

A

5 - normal power
4 - active movement against gravity and resistance
3 - active movement against gravity only
2 - active movement with gravity eliminated
1 - flicker of contraction
0 - no contraction

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2
Q

list some excitatory neurotransmitters

A

acetylcholice, noradrenaline adreanline, 5HT, dopamine, glutamate, aspartate

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3
Q

list some inhibitory neurotransmitters

A

GABA, histamine, glycine

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4
Q

what is aphasia and damage to which lobe causes this symptom?

A

impairment of language

parietal lobe

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5
Q

what is hemiparesis and damage to which are of the brain causes this symptom?

A

weakness of one entire part of the body

internal capsule

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6
Q

damage to which nerve causes Bell’s Palsy?

A

CN VII - facial

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7
Q

where is broca’s area located?

A

left frontal lobe

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8
Q

where is Wernicke’s area located?

A

left temporo-parietal lobe

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9
Q

lesions posterior to the optic chaism cause what kind of visual field defects?

A

honoymous (ie involvement of the same part of the visual field in both eyes)

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10
Q

what does a complete CN V lesion cause?

A

unilateral sensory loss on the face, scalp anterior to the vertex, and the anteiror 2/3rds of the tongue and buccal mucosa
the jaw deviates to that side as the mouth opens

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11
Q

CN VII UMN lesions cause what?

A

weakness of the lower part of the face on the opposite side

frontalis is spared

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12
Q

CN VII LMN lesions cause what?

A

a complete unilateral LMN lesion causes weakness (ipsilateral) of all facial expression muscles
the angle of the mouth falls (unilateral dribbling)

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13
Q

what is meant by UMN lesions?

A

lesions in the pyramidal system

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14
Q

what are some features of UMN/ pyramidal system lesions?

A 
drift of upper limb
flaccid-spastic
exaggerated tendon reflex
loss of skilled finger/toe movement
no muscle wasting
no abdominal reflexes
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15
Q

what does hemiparesis mean?

A

weakness of limbs on one side

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16
Q

what does paraparesis mean?

A

weakness of both lower limbs

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17
Q

what does tetraparesis mean?

A

weakness of all 4 limbs

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18
Q

what are the 2 features of an extrapyramidal lesion?

A
  • reduction in speed of movements

- involuntary hyperkinetic movements

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19
Q

what is an example of an extrapyramidal condition?

A

parkinson’s disease

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20
Q

a lesion in one cerebellar lobe eg tumour / infarct causes disruption where?

A

on the same side

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21
Q

what is an intention tremor?

A
  • tremor exacerbated by action
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22
Q

which type of tremor is seen in parkinsons?

A

resting tremor

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23
Q

what are some features of LMN lesions?

A

weakness, wasting, hypotonia, reflex loss, fasiculations (muscle twitch), muscle contractions, trophic changes in skin and nails

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24
Q

what is the spinal reflex arc?

A

eg knee jerk

  • tap
  • stretch receptors in quadriceps tell LMNs (L3 + L4) to contract quadriceps muscle
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25
Q

what are the symptoms of spinal cord lesions?

A

tingling, electric-shock sensation, clumsiness, nukbness, tight-band like sensation

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26
Q

what is seen in a spinothalamic tract lesion?

A

contralateral loss of pain and temperature sensation with a clear level below the lesion

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27
Q

1st line immediate investigation for subarachnoid haemorrhgae?

A

CT

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28
Q

treatment for SAH?

A

nimodipide

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29
Q

most common cause of SAH?

A

berry aneurysm (develops within the circle of willis)

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30
Q

definition of subdural haematoma?

A

accumulation of blood in the subdural space following rupture of a vein

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31
Q

investigations for subdural haematoma and extradural haemorrhage ?

A

T1 weighted MRI

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32
Q

symptoms of extradural haemorrhage?

A

head injury > unconscious > good again > stupose

- ipsilateral dilated pupil + contralateral hemiparesis

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33
Q

who gets cluster headaches?

A

males 20-40 at nighttime

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34
Q

how to treat cluster headaches?

A

SC sumatriptan and high flow O2

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35
Q

how to treat trigeminal neuralgia?

A

carbamazepine 600-1200mg

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36
Q

what is hippocampal sclerosis?

A

major cause of epilepsy, main pathological substate causing temporal lobe epilepsy
visible on MRI

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37
Q

how to treat epilepsy >5 mins?

A

rectal diazepam, IV lorazepam or bucal midazolam

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38
Q

how to treat status epilepticus < 30 mins and >30 mins?

A

<30 mins IV lorazepam

>30 mins phenytoin

39
Q

what is narcolepsy and what are the 4 symptoms?

A

falling asleep during the day

  • excessive daytime sleepiness
  • cataplexy (loss of muscle tone, can be triggered by an emotional response eg laughing)
  • hallucinations
  • sleep paralysis
40
Q

what is the cause of narcolepsy?

A

abnormality in the brain neurotransmitter hypocretin (regulator of sleep)

41
Q

what does a petechial rash suggest?

A

meningiococcal infection

42
Q

what is a petechial rash?

A

round, red, small spots

43
Q

what are the clinical clues to a pneumococcal infection?

A

skull fracture, ear disease, congenital CNS lesion

44
Q

what are the clinical clues to a diagnosis of entervirus?

A

rash / pleuritic pain

45
Q

what are the symptoms of acute bacterial meningitis?

A

sudden, rigors, fever

46
Q

how long does viral meningitis last? is it severe?

A

4-10 days

no, self-limiting

47
Q

how to treat meningiococcal menigitis?

A

IV ABs

48
Q

how to investigate normal meningitis?

A

LP

49
Q

how to treat unknown menigiits?

A

cefotaxime

50
Q

how to treat meningitis in >50 or immunocompromised?

A

cefotaxime and ampicillin

51
Q

how to treat mengiococcal meningitis?

A

cefotaxime then change to benzylpenicillin

52
Q

how to treat TB menigitis

A

rifampicin, isoniazid but not ethambutol

53
Q

what are the symptoms of encephalitis?

A

personality changes, seizures, speech disturbance

54
Q

what is the main cause of viral encephalitis?

A

HSV

55
Q

what can be seen on MRI in viral encaphalitis?

A

swelling of temporal lobe

56
Q

how to treat viral encephalitis?

A

aciclovir

57
Q

what are the symptoms of whipple’s disease?

A

myoclonus, dementia + supranuclear opthalmoplegia

58
Q

what are the symptoms of a brain abscess?

A

headache, focal signs, epielsy, fever, leucocytosis, increased ESR

59
Q

first line investigation for brain abscess?

A

MRI

60
Q

most common causitive agent of spinal epidural abscess?

A

staph aureus

61
Q

what condition are gliomas associated with?

A

NF

62
Q

what are astrocytomas?

A
  • gliomas which arise from astrocytes

- classified I to IV

63
Q

what are oligodendrogliomas?

A
  • arise from oligodendrocytes
  • grow slowly over several decades
  • calcification is normal
64
Q

where do meningiomas arise from?

A

arachnoid

65
Q

are meningiomas benign or dangerous?

A

benign

66
Q

where do meningiomas normally occur?

A

along the intracranial venous sinuses

67
Q

where are neurofibromas bilateral?

A

in NF2

68
Q

which cells do neurofibromas arise from?

A

schwann cells

69
Q

where are neurofibromas found?

A

at the cerebellopontine angle

70
Q

what symptoms would be seen with a left frontal meningioma?

A
  • disturbance of personality
  • apathy (LO interest / enthusiasm)
  • impaired intellect
  • expressive apasia
  • right hemiparesis (as corticospinal tracts become invovled)
71
Q

what symptoms woudl be seen in a right parietal lobe glioma?

A
  • left homonymous field defect (optic radiations)
  • cortical sensory loss in left limb + hemiparesis
  • partial seizures
72
Q

what symptoms would be seen in a left VIII nerve sheath neurofibroma (acoustic neuroma)?

A
  • cerebellopontin angle
  • progressive deafness (VIII)
  • left facial numbness (V)
  • weakness (VII) followed by cerebellar ataxia on the same side
73
Q

what is arnold chiari and what is it a cause of?

A

cerebral tonsils descend into the cervical canal

infantile hydrocephalus

74
Q

what does the artery of adamkiewicz supply?

A

network of the spinal cord

75
Q

first line investigation in acute spinal cord compression?

A

MRI

76
Q

what is synringomyelia associated with ?

A

arnold-chiari

77
Q

what is synringobulbia?

A

cavity in the brainstem

78
Q

what is the definition of dementia?

A

an acquired loss of higher mental function, affecting 2 or more cognitive domains eg

  • episodic memory
  • language, frontal executive function, visuospatial, apraxia
79
Q

what are the symptoms of alzheimer’s disease?

A

memory impairment, language, apraxia, agnosia, personality

80
Q

what is the first line investigation of alzheimer’s disease and wha is seen on it?

A

MRI - atrophy of mesial temporal lobe structures

81
Q

what are the genetics associated with alzeimers?

A

APP (depoistion of B-amyloid in the cortex to form amyloid plaques)
presnillin 1 + 2

82
Q

what is frontotemporal dementia characterised by?

A

asymmetric frontal lobe + temporal lobe atrophy on MRI

83
Q

what are the symptoms of frontotemporal dementia?

A

impairment of language function
personality changes
apathy
disinhibiton

84
Q

what age is the normal onset for frontotemporal demnetia?

A

<65

85
Q

what are the symtpoms of vascular dementia?

A

apraxic gait, pyramidal signs, urinary incontinence

86
Q

what are the 4 types of motor neurone disease?

A

ALS
progressive muscular atrophy
progressive bulbar and pseudobulbar palsy
primary lateral sclerosis

87
Q

what is ALS and what are the symptoms?

A

upper and lower motor neurones

one limb and spread to others

88
Q

what would you find on examination of a patient with ALS?

A

UMN signs - brisk reflexes, extensor plantar responses and spasticity

89
Q

what is progressive muscular atrophy?

A

pure LMN presentation with weakness, muscle wasting and fasciculations

90
Q

what is progressive bulbar and psuedobulbar palsy?

A

lower CN nuclei adn their supranuclear connections are involved

91
Q

what are the symptoms of progressive bulbar and psuedobulbar palsy?

A

dysarthria, dysphagia, nasal regurgitation of fluids and chocking

92
Q

what is primary lateral sclerosis?

A

confined to UMNs, causing a slowly progressive tetraparesis and pseudobulbar palsy

93
Q

what are the symptoms of Guillian Barre?

A

paralysis 1-3 weeks after an infection

PRIYA NEURO (13 decks)

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