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YEAR 6: PACES > Medicine 9 > Flashcards

Medicine 9 Flashcards

1
Q

Outline the investigations that may be used in patients with suspected Charcot-Marie-Tooth disease.

A 
Nerve conduction studies (demyelination will cause reduced velocity, axonal degeneration will cause reduced amplitude) 
Genetic testing (PMP22 gene)
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2
Q

Outline the management options for patients with Charcot-Marie-Tooth disease.

A

MDT: GP, neurologist, specialist nurses, physiotherapist, OT, orthotics
Foot care and careful shoe choice
Orthotics

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3
Q

Describe the pathway of the direct and consensual light reflex.

A

Retina –> Optic Nerve –> Pre-Tectal Nucleus –> Edinger-Westphal Nucleus (both) –> Oculomotor Nerve –> Ciliary Ganglion –> Pupillary Sphincter

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4
Q

Lesions in which parts of the nervous system could cause symmetrical weakness?

A

Cord lesions
Neuromuscular junction pathology (MG, LEMS)
Muscle pathology (e.g. myositis)

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5
Q

What are the different patterns of sensory loss and which lesions are they typically associated with?

A

Distal sensory loss - peripheral neuropathy (e.g. DM, B12, alcohol)
Sensory level - cord lesion (e.g. cord compression)
Dissociated sensory loss (e.g. loss of pain/temp with conservation of light touch) - cervical cord lesions (e.g. syringomyelia

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6
Q

Describe the main features of an anterior cerebral artery stroke.

A

Contralateral motor/sensory loss in LEGS > arms

Face is spared

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7
Q

Describe the main features of a middle cerebral artery stroke.

A

Contralateral motor/sensory loss in FACE/ARMS > legs
Contralateral homonymous hemianopia
Cognitive changes (dominant = aphasia; non-dominant = neglect/apraxia)

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8
Q

Describe the main features of a posterior cerebral artery stroke.

A

Contralateral homonymous hemianopia with macula sparing

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9
Q

What are the different anatomical levels at which pathology can cause muscle weakness?

A

Cerebrum/Brainstem - stroke, SOL, MS
Cord - MS, injury
Anterior Horn - MND, Polio
Nerve Roots/Plexus - cauda equina, cord compression
Motor Nerve - compression, mononeuritis multiplex, CMT
NMJ - Myasthenia, LEMS
Muscle - myositis, muscular dystrophy

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10
Q

List some causes of bilateral foot drop.

A

Charcot-Marie-Tooth disease
Guillain Barre syndrome
Cauda equina

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11
Q

List some causes of unilateral lower limb spasticity.

A

Stroke
MS
SOL

NOTE: it will cause a circumducting gait

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12
Q

List some causes of bilateral lower limb spasticity.

A 
Spinal Cord (compression, trauma, transverse myelitis) 
Cerebral palsy (bihemispheric)
MS (bihemispheric)
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13
Q

List some causes of mixed UMN and LMN symptoms.

A

Motor neurone disease
Friedreich ataxia
SACD
Taboparesis (syphylis)

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14
Q

List some causes of sensory ataxia.

A

Vestibular - Meniere’s disease, viral labyrinthitis

Proprioceptive Loss - B12 deficiency, DM, alcohol

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15
Q

List some causes of a postural tremor.

A 
Benign essential tremor 
Endocrine (thyrotoxicosis, hypoglycaemia)
Alcohol withdrawal
Beta-agonists 
Anxiety (physiological)
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16
Q

What is idiopathic focal dystonia?

A

Most common form of dystonia
Confined to one body part
E.g. spasmodic torticollis, blepharospasm, Writer’s cramp

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17
Q

List some causes of chorea.

A

Huntington’s chorea
Sydenham’s chorea (rheumatic fever)
Wilson’s disease
L-DOPA

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18
Q

Define dementia.

A

Chronically impaired cognition that affects multiple domains (memory, attention, language) without impairment of consciousness

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19
Q

List some causes of delirium.

A

Infection (UTI, sepsis)
Dehydration
Constipation
Drugs (e.g. opioids)
Metabolic (e.g. hyponatraemia, hypoglycaemia)
Intracranial pathology (e.g. subdural haemorrhage)

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20
Q

List some complications of subarachnoid haemorrhage.

A

Rebleeding
Cerebral ischaemia (vasospasm)
Hydrocephalus
Hyponatraemia

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21
Q

Which members of the MDT would be involved in the management of patients who have had a stroke?

A 
Neurologist 
Physiotherapist 
SALT 
Dietician 
OT 
Specialist nurse
22
Q

Which investigations should be done to find a potential source of an embolus in a patient with a TIA?

A

ECG
Echocardiogram
Carotid artery doppler

Check Risk Factors: FBC, U&E, ESR, glucose, lipids

23
Q

Which scoring system is used to assess the risk of future stroke in a patient who has had a TIA?

A

ABCD2
4 or more = TIA clinic within 24 hours
< 4 = TIA clinic within 1 week

24
Q

What are the typical features of cerebral venous sinus thrombosis?

A 
Headache 
Vomiting 
Seizures 
Reduced visual acuity 
Papilloedema 
Proptosis (cavernous sinus thrombosis)

NOTE: DDx - SAH, meningitis, managed with LMWH/warfarin, fibrinolytics

25
Q

List some risk factors for cerebral venous sinus thrombosis.

A 
Pregnancy 
OCP 
Head injury 
Dehydration 
Malignancy 
Thrombophilia
26
Q

List some contraindications for lumbar puncture.

A

Raised ICP
Thrombocytopaenia
Coagulopathy
Infection at LP site

27
Q

List some causes of provoked seizures.

A

Withdrawal (alcohol, opiates)
Metabolic (hypoglycaemia, hypocalcaemia)
Raised ICP (trauma, haemorrhage, SOL)
Infection (encephalitis)

28
Q

Which investigations should be requested in a patient who has had a seizure?

A 
FBC, U&E, Glucose 
AED levels 
Urine toxicology 
ECG 
EEG 
MRI (if adult and risk of SOL)
29
Q

What are the types of cerebral oedema?

A

Vasogenic (increased capillary permeability) - trauma, tumour, ischaemia, infection
Cytotoxic - e.g. hypoxia
Interstitial - e.g. obstructive hydrocephalus, hyponatraemia

30
Q

Which sensory and motor signs might you see in a patient with multiple sclerosis?

A

MOTOR: spastic weakness, transverse myelitis (weakness + numbness)
SENSORY: paraesthesia, reduced vibration sense

NOTE: patients may also have cerebellar signs (e.g. ataxia, dysarthria)

31
Q

What are some differentials for multiple sclerosis?

A

CNS sarcoidosis

SLE

32
Q

Which signs might you see in a patient with spinal cord compression?

A

Back pain
Progressive UMN weakness and sensory loss below the lesion (e.g. bilateral spasticity in lower limbs)
Radicular pain in dermatomal distribution

NOTE: tone and reflexes are initially REDUCED in acute cord compression

33
Q

Describe the clinical features of conus medullaris lesions.

A

Early constipation/retention
Mixed UMN/LMN weakness
Back pain
Sacral sensory disturbance

34
Q 
Which muscles are weak in the following nerve lesions?
C5fac
C6
C7
C8
A

C5 - deltoid, supraspinatus
C6 - biceps, brachioradialis (reduced biceps jerk)
C7 - triceps, finger extension (reduced triceps jerk)
C8 - finger flexors, intrinsic hand muscles

35
Q

How does L5 radiculopathy manifest?

A

Weak hallux extension
Foot drop
Reduced sensation on inner dorsum of foot

NOTE: MRI lumbar spine would be useful to check for compression

36
Q

How does S1 radiculopathy manifest?

A

Weak plantarflexion and eversion
Loss of ankle jerk
Reduced sensation over sole of foot and back of calf

NOTE: MRI lumbar spine would be useful to check for compression

37
Q

What are some complications of Bell’s palsy?

A 
Synkinesis (e.g. blinking causes upturning of mouth)
Crocodile tears (eating stimulates unilateral lacrimation)
38
Q

What are the features of radial nerve palsy?

A 
Finger drop (low)
Wrist drop (high) 
Triceps paralysis (very high) 
Loss of sensation of first dorsal web space
39
Q

What are the features of sciatic nerve palsy?

A

Weakness of knee flexion
Weakness of all muscles below the knee
Loss of sensation below knee laterally and foot

40
Q

What are the features of common peroneal nerve palsy?

A

Foot drop
Week dorsiflexion and eversion
Loss of sensation below knee laterally

41
Q

What are the features of tibial nerve injury?

A

Weak plantarflexion (can’t stand on toes)
Weak toe flexion
Loss of sensation to sole of foot

42
Q

List some causes of peripheral motor neuropathy.

A

Guillain Barre syndrome
Botulism
Charcot-Marie-Tooth
Lead poisoning

43
Q

List some causes of autonomic neuropathy.

A

Diabetes mellitus
HIV
SLE
Guillain-barre syndrome

44
Q

Outline the management of motor neurone disease.

A

MDT: neurologist, physio, OT, dietician, specialist nurse, GP
Medical: riluzole (antiglutamatergic)
Symptomatic: NG/PEG feeding, NIV for respiratory failure, analgesia, baclofen for spasticity

NOTE: most die of respiratory failure or infection

45
Q

List some causes of bulbar and pseudobulbar palsy.

A

Bulbar: MND, GBS, myasthenia, central pontine myelinolysis
Pseudobulbar: MS, stroke, MND

46
Q

Describe the typical clinical features of polio.

A

Asymmetrical LMN paralysis

No sensory involvement

47
Q

What are the clinical features of fascioscapulohumeral muscular dystrophy?

A

Weakness of face, shoulders and upper arms (often asymmetrical)
Winging of the scapula
Foot drop

48
Q

List some causes of cafe au lait spots.

A

NF1
McCune Albright syndrome
Noonan syndrome

49
Q

Outline the management of NF1.

A

MDT approach
Epilepsy management
Excise some neurofibromas (cosmetic/sarcomatous)
Genetic counselling

NOTE: it is autosomal dominant

50
Q

Outline the management of benign essential tremor.

A 
Avoidance of exacerbating factors (coffee, stress)
Beta-blockers (e.g. propanolol)
Anti-epileptics (e.g. topiramate) 
Benzodiazepines (e.g. clonazepam) 
Botulinum injections 
MRI-guided high intensity ultrasound

YEAR 6: PACES (22 decks)

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