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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
what are the symptoms of spinal cord lesions?
tingling, electric-shock sensation, clumsiness, nukbness, tight-band like sensation
26
what is seen in a spinothalamic tract lesion?
contralateral loss of pain and temperature sensation with a clear level below the lesion
27
1st line immediate investigation for subarachnoid haemorrhgae?
CT
28
treatment for SAH?
nimodipide
29
most common cause of SAH?
berry aneurysm (develops within the circle of willis)
30
definition of subdural haematoma?
accumulation of blood in the subdural space following rupture of a vein
31
investigations for subdural haematoma and extradural haemorrhage ?
T1 weighted MRI
32
symptoms of extradural haemorrhage?
head injury > unconscious > good again > stupose | - ipsilateral dilated pupil + contralateral hemiparesis
33
who gets cluster headaches?
males 20-40 at nighttime
34
how to treat cluster headaches?
SC sumatriptan and high flow O2
35
how to treat trigeminal neuralgia?
carbamazepine 600-1200mg
36
what is hippocampal sclerosis?
major cause of epilepsy, main pathological substate causing temporal lobe epilepsy visible on MRI
37
how to treat epilepsy >5 mins?
rectal diazepam, IV lorazepam or bucal midazolam
38
how to treat status epilepticus < 30 mins and >30 mins?
<30 mins IV lorazepam | >30 mins phenytoin
39
what is narcolepsy and what are the 4 symptoms?
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
what is the cause of narcolepsy?
abnormality in the brain neurotransmitter hypocretin (regulator of sleep)
41
what does a petechial rash suggest?
meningiococcal infection
42
what is a petechial rash?
round, red, small spots
43
what are the clinical clues to a pneumococcal infection?
skull fracture, ear disease, congenital CNS lesion
44
what are the clinical clues to a diagnosis of entervirus?
rash / pleuritic pain
45
what are the symptoms of acute bacterial meningitis?
sudden, rigors, fever
46
how long does viral meningitis last? is it severe?
4-10 days | no, self-limiting
47
how to treat meningiococcal menigitis?
IV ABs
48
how to investigate normal meningitis?
LP
49
how to treat unknown menigiits?
cefotaxime
50
how to treat meningitis in >50 or immunocompromised?
cefotaxime and ampicillin
51
how to treat mengiococcal meningitis?
cefotaxime then change to benzylpenicillin
52
how to treat TB menigitis
rifampicin, isoniazid but not ethambutol
53
what are the symptoms of encephalitis?
personality changes, seizures, speech disturbance
54
what is the main cause of viral encephalitis?
HSV
55
what can be seen on MRI in viral encaphalitis?
swelling of temporal lobe
56
how to treat viral encephalitis?
aciclovir
57
what are the symptoms of whipple's disease?
myoclonus, dementia + supranuclear opthalmoplegia
58
what are the symptoms of a brain abscess?
headache, focal signs, epielsy, fever, leucocytosis, increased ESR
59
first line investigation for brain abscess?
MRI
60
most common causitive agent of spinal epidural abscess?
staph aureus
61
what condition are gliomas associated with?
NF
62
what are astrocytomas?
- gliomas which arise from astrocytes | - classified I to IV
63
what are oligodendrogliomas?
- arise from oligodendrocytes - grow slowly over several decades - calcification is normal
64
where do meningiomas arise from?
arachnoid
65
are meningiomas benign or dangerous?
benign
66
where do meningiomas normally occur?
along the intracranial venous sinuses
67
where are neurofibromas bilateral?
in NF2
68
which cells do neurofibromas arise from?
schwann cells
69
where are neurofibromas found?
at the cerebellopontine angle
70
what symptoms would be seen with a left frontal meningioma?
- disturbance of personality - apathy (LO interest / enthusiasm) - impaired intellect - expressive apasia - right hemiparesis (as corticospinal tracts become invovled)
71
what symptoms woudl be seen in a right parietal lobe glioma?
- left homonymous field defect (optic radiations) - cortical sensory loss in left limb + hemiparesis - partial seizures
72
what symptoms would be seen in a left VIII nerve sheath neurofibroma (acoustic neuroma)?
- cerebellopontin angle - progressive deafness (VIII) - left facial numbness (V) - weakness (VII) followed by cerebellar ataxia on the same side
73
what is arnold chiari and what is it a cause of?
cerebral tonsils descend into the cervical canal | infantile hydrocephalus
74
what does the artery of adamkiewicz supply?
network of the spinal cord
75
first line investigation in acute spinal cord compression?
MRI
76
what is synringomyelia associated with ?
arnold-chiari
77
what is synringobulbia?
cavity in the brainstem
78
what is the definition of dementia?
an acquired loss of higher mental function, affecting 2 or more cognitive domains eg - episodic memory - language, frontal executive function, visuospatial, apraxia
79
what are the symptoms of alzheimer's disease?
memory impairment, language, apraxia, agnosia, personality
80
what is the first line investigation of alzheimer's disease and wha is seen on it?
MRI - atrophy of mesial temporal lobe structures
81
what are the genetics associated with alzeimers?
APP (depoistion of B-amyloid in the cortex to form amyloid plaques) presnillin 1 + 2
82
what is frontotemporal dementia characterised by?
asymmetric frontal lobe + temporal lobe atrophy on MRI
83
what are the symptoms of frontotemporal dementia?
impairment of language function personality changes apathy disinhibiton
84
what age is the normal onset for frontotemporal demnetia?
<65
85
what are the symtpoms of vascular dementia?
apraxic gait, pyramidal signs, urinary incontinence
86
what are the 4 types of motor neurone disease?
ALS progressive muscular atrophy progressive bulbar and pseudobulbar palsy primary lateral sclerosis
87
what is ALS and what are the symptoms?
upper and lower motor neurones | one limb and spread to others
88
what would you find on examination of a patient with ALS?
UMN signs - brisk reflexes, extensor plantar responses and spasticity
89
what is progressive muscular atrophy?
pure LMN presentation with weakness, muscle wasting and fasciculations
90
what is progressive bulbar and psuedobulbar palsy?
lower CN nuclei adn their supranuclear connections are involved
91
what are the symptoms of progressive bulbar and psuedobulbar palsy?
dysarthria, dysphagia, nasal regurgitation of fluids and chocking
92
what is primary lateral sclerosis?
confined to UMNs, causing a slowly progressive tetraparesis and pseudobulbar palsy
93
what are the symptoms of Guillian Barre?
paralysis 1-3 weeks after an infection

PRIYA NEURO (13 decks)

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