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CP3 > Medicine/Neuro > Flashcards

Medicine/Neuro Flashcards

1
Q

Cerebellar signs

A
  1. (Truncal ataxia)
  2. Broad based ataxic gait
  3. Rhomberg positive
  4. Nystagmus
  5. (Saccades)
  6. Past pointing
  7. Dysphonia/Sticato (british constitution)
  8. Dysdiadochokinesia
  9. Rebound phenonemon
  10. (Pronator drift)
  11. Hyperreflexia
  12. Hypotonia
  13. Heel to shin coordination impairement
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2
Q

Brief causes of cerebellar disease

A
  • MS
  • Alcohol
  • Vascular
  • Inherited
  • Space occupying lesion

(MAVIS)

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3
Q

Summary of TACI, PACI, Lacunar, POCI (Full NCs under Medicine/Stroke)

A
  • TACI
  1. Hemiplegia
  2. Homonymous hemianopia
  3. Higher corticol dysfunction
  • PACI
    • 2 of 3
  • Lacunar
  1. Hemi-motor or hemi-sensory deficit only
    * POCI
  2. Visual fields affected
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4
Q

Define: hemiparesthesia, Hemiparesis and hemiplegia

A

Hemiparesthesia - altered sensation on one half of the body

Hemiparesis - weakness on one half of the body

Hemiplegia - paralysis of one half of the body

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5
Q

Explaining MS to a patient

A
  • Multiple sclerosis (MS) is a condition that can affect the brain and/or spinal cord, causing a wide range of potential symptoms, including problems with vision, arm or leg movement, sensation or balance.
  • Autoimmune condition where the body attacks the coating of nerves
  • It’s a lifelong condition that can sometimes cause serious disability, although it can occasionally be mild.
  • In many cases, it’s possible to treat symptoms. Average life expectancy is slightly reduced for people with MS.
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6
Q

Risk factors for MS

A
  • 20-30 years old
  • Female
  • FHx
  • Infections such as EBV
  • Caucasian
  • Autoimmune PMHx e.g. hypothyroid, DM I etc.
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7
Q

Common presentations of MS

A
  • double or blurred vision
  • numbness, weakness in one or two extremities
  • instability in walking
  • tremor
  • problems with bladder control
  • heat intolerance
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8
Q

Types and brief definition

A
  • Relapsing remitting
    • 80% of cases
    • Episodes/attacks of MS lasting days or weeks that may fully recover or leave patient with permanent problems
    • May turn into 2ary progressive
  • Primary progressive
    • 10% of cases
    • Slow progression of sx without remission, though may have ‘stable’ phases
  • 2ary progressive
    • Half of people with relapsing and remiting will develop this
    • Starts as relapsing and remiting then turns into a progressive picture
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9
Q

Investigations of suspected MS

A
  • Refer to neuro
  • 2 attacks - soft
  • Full neuro exam
  • MRI
  • Evoked potential test (EEG with eye test)
  • Lumber puncture looking for auto-immune antibodies
  • Bloods - to rule out other things
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10
Q

Differentials of MS

A
  • Stroke
  • Toxins
  • B-12 deficiency
  • Space occuping lesion
  • Other inflammatory disorders like lupus
  • HIV
  • Vasculitis
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11
Q

Treatment of MS

A
  • LEMONS (lifestyle, education, monitor for complications, nutrition)
  • Treat relapses
    • Steriods (pred) reduce length
    • Baclofen for mm spasms
  • Prevent relapses
    • Disease modifying drugs e.g. interferon beta, alemtuzumab
  • Treat symptoms
    • MDT
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12
Q

Circle of willis

A
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13
Q

Bells palsy features, causes, treatment

A

Bell’s Palsy (LMN) - temporary palsy of facial nn

Features - same side as lesion

  • Unilateral facial weakness incl forehead
  • Bell’s sign (eye rolls upward when trying to close eyelids)

Causes

  • Herpes (Ramsay-hunt syndrome vesicles in ear)
  • HIV
  • Sarciod
  • EBV
  • Lymes disease

Treatment

  • Eye protection - drops, patch
  • Prednisone
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14
Q

Other LMN CN7 palsy causes and associated features

A

Acoustic neuroma - CN5,6+8 involvement

Parotid tumour/ectomy - parotid lump/scar

Cholesteatoma - CN8 involvement

All features will be same side as lesion

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15
Q

UMN CN7 palsy features, causes and associated sx

A

Features

  • Forhead sparing
  • Opposite side to lesion

Causes

  • Stroke - hemianopia, hemiparasis/stesia, high cortical dysfunction
  • MS - multiple neuro foci e.g. vision problems, sensory and motor issues, bladder problems
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16
Q

Horners syndrome causes, sx, investigation

A

Horners syndrome - Damage to sympathetic chain that supplies face

Causes

  • Tumours (thyroid, brain, pancoast)
  • MS
  • Trauma e.g. thyriodectomy
  • Cervical rib
  • Migraine
  • Carotid aneursym/dissection
  • Otitis media

Features - all on same side as lesion

  • Ptosis
  • Anhydrosis (no sweating)
  • Miosis (contracted pupil)

Diagnosis

  • No reaction to cocaine eye drops, normally dilates

Investigation

  • Identify cause
    • MRI - Ca
    • Carotid USS - carotid pathology
    • CXR - pancoast
17
Q

Motor neurone disease: presenting sx/ RF

A

MN disease - degeneration of motor neurones

Presenting sx

  • Limb weakness
  • Slurred speech
  • Weak grip
  • MM cramps and fasiculations
  • Wgt loss
  • Laughing and crying at inappropriate times
  • FHx
  • Age <70
18
Q

Parkinsons: Triad

A

Parkinsons - Death of dopinergic nerves in basal ganglia

Triad (assymetrical)

  • Bradykinesia
  • Resting tremor
  • Cog wheel rigidity
19
Q

PD B symptoms

A

ASSYMETRICAL

  • Shuffling gait, limited arm swing, hesitation when starting and turning
  • Expressionless face
  • Slurred/slow/monotonous speech
  • Positive glabellar tap
  • Anosmia
  • Balance problems
  • Urinary/sexual dysfunction
  • Visual problems
  • Swallowing issues
  • Insomnia
  • Micrographia
20
Q

PD investigations and treatment

A

Investigations

  • Full neuro exam
  • Refer to specialist

Treatment

  • MDT
  • LEMON
  • L-Dopa
21
Q

PD plus syndromes and associated features

A
  • Multi-system-atrophy - Low BP/postural hypotension
  • Progressive supranuclear palsy (PSP) - Palsy of eye movement
  • Corticobasal degeneration - apraxia, acalculia, myoclonus
  • Lewy body dementia - dementia
22
Q

Peripheral neuropathy definition and examples

A

Peripheral neuropathy - damage to nns of peripheral nervous system

Examples

  • Foot drop - common peroneal nn
  • Diabetic - polyneuropathy
  • Carpal tunnel syndrome - median nn
  • Bell’s palsy - CN7
23
Q

Myopathy definition and examples

A

Myopathy - disease in which mm fibres don’t work properly

Examples

  • dermatomyositis - autoimmune condition that attacks skin and mm
  • polymyositis - inflammation of mm
  • myositis ossificans - mm turns into bone when injured
24
Q

Spinal cord stenosis: signs and sx, investigation, causes, treatment

A

Spinal cord stenosis - narrowing of spinal canal leading to pressure on spinal cord and nn roots. Can lead to cauda equina

Symptoms

  • Posterior back and leg (both) pain can also be: numbess, weakness, stiffness or parasthesia (pins and needles)
  • Variable exercise tolerance day to day
  • Sx relieved by bending forward or sitting down (shopping trolley)

Signs

  • Men
  • Lumbar
  • Variable hyporeflexia
  • Normal strength and sensation

Investigation

  • CT

Causes

  • OA
  • Disc degeneration
  • Pagets disease
  • Thick spinal ligaments
  • Previous spinal trauma

Treatment

  • Physio - exercise bike
  • Surgery if bad - laminectomy
  • Analgesia
25
Q

Cauda equina: signs and symptoms, causes, investigation, treatment

A

Cauda equina - compression of cauda equina L2 down

Signs

  • Leg weakness
  • Reduced anal tone and sensation
  • Urine retention check with catheter

Symptoms

  • Saddly anaesthesia
  • Severe lower back pain
  • Urinary and bowel problems - retention/incontinence of either
  • Leg pain/weakness/parasthesia bilateral

Causes

  • Central disc herniation
  • Spondylosis
  • Spinal stenosis
  • Tumour
  • Trauma
  • Infection

Investigation

  • Emergency MRI of lumbar spine

Treatment

  • Admit
  • Decompress - surgery
  • Analgesia
26
Q

Disc herniation - signs and symptoms, causes, investigation, treatment

A

Disc herniation - interverterbral disc prolapse leading to pressure on nerve roots

Signs

  • Decreased power, sensation, reflexes

Symptoms

  • Lumbar
  • Severe back pain, made worse by moving, bending forward, coughing, sitting, lateral flexion
  • Radiculopathy
  • Parastesia
  • Weakness
  • Leg pain
  • Back mm spasm

Causes

  • Age/degeneration
  • Lifting excess wgt
  • Excessive excerise
  • Obesity

Investigation

  • Spurlings, femoral nn stretch, straight leg raise
  • PNS

Treatment

  • Analgesia
  • Mm relaxants
  • TCA
  • Gabapentin
  • Rest
27
Q

Cervical myelopathy: signs, symptoms, causes, investigation, treatment

A

Cervical myelopathy - compression of cervical spinal cord

Signs

  • Weakness and wasting of hand mm
  • Hypereflexia
  • Clonus/Hofmans/Babinskis
  • Normal sensation

Symptoms

  • Progressive
  • Weakness
  • Arm, neck and leg pain
  • Problems with fine motor

Causes

  • Cord compression (tumour, disc herniation etc.)
  • Ischaemia from vascular compression
  • Osteophytes

Investigation

  • C-spine x-ray - osteophytes
  • MRI - canal stenosis, cord anomalies

Treatment

  • Depends on cause
  • Conservative: physio
  • Surgery for pain and progressive sx
28
Q

Radiculopathy: signs, symptoms, causes, investigations, treatment

A

Sciatica

Signs

  • Leg pain
  • Radiates below ankle
  • Positive SLR

Symptoms

  • sharp + shooting (worse w/ cough/sneeze)
  • altered sensation
  • reduced power corresponding myotone
  • absent/reduced reflexes
  • later muscle wasting/fasiculations

Causes

  • Prolapsed Intervertebral disc
  • Spinal stenosis
  • Cauda equina syndrome
  • Facet arthrosis

Investigations

  • Differentiate referred pain from nerve root pain
    • Referred pain
      • Dull Poorly localised
      • may affect both legs
    • nerve root pain
      • sharp well localised
      • closely follows dermatone
      • paraesthesia may be present
      • positive SLR

Treatments

  • Physiotherapy and education
  • Nerve root block
  • Epidural steroid injection
  • Foraminal steroid injection
  • Surgical decompression
29
Q

What is the difference between myelopathy and radiculopathy

A

Myelopathy - compression of spinal cord

Radiculopathy - compression of nerve root

30
Q

Define: Osteophytes, spondylosis, spondylolysis and spondylolisthesis

A

osteophytes - bony projection associated with the degeneration of cartilage at joints

spondylosis - umbrella term for spine degeneration

spondylolysis - stress fracture in pars interarticularis (pointy bit of vertebrae)

spondylolisthesis - Slippage of vertebrae from stress facture above

31
Q

what is the difference between bulbar and pseudobulbar palsy

A

bulbar palsy is a lower motor neuron lesion of cranial nerves 9, 10 and 12. Apseudobulbar palsy is an upper motor neuron lesion of cranial nerves 9, 10 and 12

32
Q
A

CP3 (11 decks)

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