Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ISCE > Neuro > Flashcards

Neuro Flashcards

1
Q

describe clasp knife rigidity

A

assoc with UMN sx increased tone that is velocity dependent ie the faster you move the pts mulsce the greater the resistence until it finally gives way

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what will an anterior cerebral artery occlusion result in?

A

weak, numb contralateral leg +/- similar milder arm sx

face is spared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what will a MCA occlusion result in

A

lateral part of each hemisphere - contralateral hemiparesis, hemisensory loss, contralateral homonymous hemianopia - dysphagia if dominant side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PCA - occlusion will result in?

A

supplies occipital lobe = contralateral homonymous hemianopia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

when would you suspect subclavian steal syndrome?

A

brainstem ischaemia can occur typically after use of the arm - suspect if BP differs by >20 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the most common headache

A

tension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what should you remember to ask in headache hx

A 
analgesia, sex , food 
photophobia 
rash 
weakness 
focal signs
vomiting 
worse on waking, lying down, coughing or bending forward 
any head trauma 
travelled anywhere 
pregnant 
change in pattern of usual headaches
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

investigation and management of trigeminal neuralgia

A

must do MRI to rule out other cuases
tx with carbemazepine
lamotrigine or gaba
surgery may be necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are possible migraine triggers

A 
chocolate 
hangovers 
orgasms 
cheese/caffeine 
oral contraceptive
lie-ins 
alcohol 
travel 
exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

wht is the management of migraine

A

propanolol and topiramate for prophylaxis
attack tx - oral triptan combined with NSAID or paracetamol + anti-emetic
Non-pharm - warm or cold packs on the head, acupuncture NICE recommends or transcutaneous nerve stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the causes of blackouts

A 
vasovagal (may have limb jerking)
situation syncope 
carotid sinus syncope 
epilepsy 
stokes-adam attacks - transient arrhythmias 
hypoglycaemia 
orthostatic hypotension 
dissociative seizures 
non-epileptic attack disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the cuases of conductive hearing loss

A

wax, otosclerosis, ottitis media, glue ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the cuases of sensioneural hearing loss

A

Presbyacusis, acoustic neuroma, toxin, MS, stroke, vasculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how would you describe a spastic gait

A

stiff, circumduction of legs +/- scuffing of toe of shoes = UMN lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what non-neuro considerations must you take into account in paralysed pts

A

avoid pressure sores - appropriate pressure relief mattresses
prevent thrombosis in paralysed limbs by freqent movement + pressure stockings + LMWH
bladder care
bowel evacuation
exercise to avoid inappropriate loss of function in partially paralysed limbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the acute management of a stroke?

A

protect the airway
maintain - consider endotracheal tube homeostasis - blood glucose, BP
screen swallow
supportive O2
CT/MRI within 1 hour
Thrombolysis - after ensuring no CI repeat CT 24 hr after lysis to exclude bleed
thrombectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the contraindications to thrombolysis

A 
major haemorrhage 
recent surgery or trauma
previous CNS bleed 
AVM 
severe liver disease
seizures at presentation 
blood glucose 
known clotting disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what investigations should you do following a stroke

A 
BP 
24 hr ECG to look for AF /CXR
doppler+/- CT angiography 
check glucose lipids
vasculitis? ANCA 
Young stroke screen - prothrombotic states, hyperviscosity, thrombocytopena, genetic tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Re-enablement post stroke

A 
MDT 
Barthels score - assess functioning 
rehab early to prevent complications 
swallow screen - salt input 
avoid further injury - OT social worker 
bladder and bowel care 
positioning 
monitor progress
monitor mood 
physio 
involve family/carer
advance directives
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the management of meningitis

A

Urgent admission to hospital

U/E FBC, LFT, glucose , coag, consider throat swabs - 1 for bacteria, 1 for viral, CXR, consider HIV, TB test
Blood cultures
serum pneumococcal and meningococcal PCR
LP within 1 hour if no signs of riased ICP

A-E approach
rule out sepsis - sepsis 6
IV dexamethasone if features of meningism
antibiotics - based on trust local guidelines - usually ceftrixone or discuss with microbiology
Low threshold for ICU
Isolate pt for 24 hours

If meningococcal infection - prophylaxis needed for close contacts = ciprofloxacin
if pneumococcal no prophylaxis required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what investigations should be performed in suspected encephalitis?

A

blood cultures, serum for viral PCR, toxoplasma IgM titre, malaria film
Contrast enhanced CT
LP
EEG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

hat is the tx of viral encephalitis

A

start aciclovir within 30 mns of pt arriving IV for 14 days for HSV
Supportive therapy in high dependency unit or ITU
Sx tx e.g. for seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the initial management of a head injury

A

A-E
O2 if sats <92% or hypoxic on ABG
Intubate and hyperventilate if needed
immobilise neck until C-spine injury excluded

Stp blood loss and support circulation
treat for shock if required

treat seizures

access GCS if less than 8 involve anaesthetics
assess for anterograde and retrograde amnesia

rapid examination survery
Ix - U/E glcuose, FBC, Blood alcohol, toxicology scree, ABGs and clotting

Neuro exam +hx 
evaluate wounds
check for CSF leak 
Palpate for any neck tenderness 
Radiology
24
Q

what is cushings response

A

BRADYCARDIA
Hypertension
Cheyne-Stokes respiration

25
Q

what investigations should you perform in signs of raised ICP

A 
U/E, FBC, LFT, glucose, serum osmolality, clotting, blood culture
consider toxicology screen 
CXR - source of infection e.g. abscess
CT head 
THen consider if LP is safe
26
Q

what is the emergency management of raised ICP

A 
involve senior 
A-E 
Correct hypotension, maintain Mean arterial pressure >90 mmHg and treat seizures 
Brief exam and hx - any clues e.g. rash 
elevate bed 30-40 degrees

If intubated hyperventilate the pt to reduce CO2 - this causes cerebral vasoconstriction and reduces ICP

Osmotic agents e.g. mannitol may be useful
If cerebral oedema ?dexameth

restrict fluid 
monitor pt closely 
aim to make a diagnosis 
treat cuase or exacerbting features 
- hyperglycaemia and hyponatraemia

definitive tx

27
Q

what is the management of SAH?

A 
Refer to neurosurgery immediately 
Resusitate this patient in an A-E approach 
Stop any anticoagulant e.g the DOAC
Analgesic 
Stool softener and anti-emetic

Investigations +
Digital subtraction angiogram - DSA
CT angiogram

Maintain cerebral perfusion but aim for BP to be less than 160
Prescribe Nimodipine
Consetn pt for surgery if applicable

Surgery – endovascular coiling is method of choice or surgical clipping.

Ongoing

  • Manage complications e.g. Hydrocephalus, rebleeding, cerebral ischaemia
  • Manage cerebral salt wasting syndrome – fluids +/- Na+
  • Rehab
  • MDT approach
28
Q

where is the most common dural venous sinus thrombosis?

A

sagittal sinus

29
Q

what are common cuases of intracranial venous thrombosis

A

pregnancy, COCP, head injury, dehydration, tumours and extracranial malignancy, recent LP
Infection, drugs, vasculitis

30
Q

how will a intracranial venous thrombosis appear on ct head

A

delta sign after 1 week

31
Q

management of intracranial venous thrombosis

A

senior help
anticoagulate
endovascular thrombolysis of anticoag doesnt work
monitor for signs of rasied ICP

32
Q

what is the management of an extradural haematoma

A

stabilise and transfer urgentyl to a neurosurgical unit or clot exacuation +/- ligaton of the bleeding
care of the airway and measures to decrease ICP

33
Q

what is the management of a subdural haematoma

A

reverse clottign abnormalities urgently. Surgical management depends on the size of clot its chronicity and the clinical picture if large they may require vacuation via craniotomy or burr hole washout
address cause of the truama - e.g. falls and abuse

34
Q

what are the 2 types of delirium

A

hypoactive - in whihc pt = slow and withdrawn

hyperactive restlessness, mood liability agitation and aggression

35
Q

what are the causes of delirium

A

Pain, Infection, Nutrition, Constipation, Hydration, Medication, Environment (PINCH ME)

36
Q

what is the management of delirium

A

Identify and tx the underlying cuase

  • reorientate the patient - explain where they are and who you are, hunt down hearing aids and glassess, visible clocks and calenders
  • encourage family and friends to visit
  • monitor fluid balance and encourage oral intake, think of constipation
  • mobilise
  • practise sleep hygiene
  • avoid or remove catheters, IV cannulae, monitoring leads and other devices
  • watch out for infection and physical discomfort
  • review medication
  • provide support
37
Q

how is dementia diagnosed

A 
hx + collateral 
cognitive testing - AMTS or similar 
MSE - depression hallucinations 
examination - parkinsons 
medication review - drug induced cognitive impairment
38
Q

what investigations should you perform in dementia

A

look for reversible causes - TSH, B12, folate, thiamine, calcium
MSU, FBC, ESR, LFT,UE
?MRI to rule out other pathologies normal-pressure hydrocepahlus
consider EEG if delirum or frontotempora dementia

39
Q

how do you manage dementia

A

integrated memory services for further assessment and management
medications - avoid drugs that hinder cognition
Cholinesterase inhibitor therapy with rivastigmine, donepezil, or galantamin
depression
capacity - advanced care directive, lasting power of attourney

40
Q

how do you investigate Causda equina?

A

ASIA chart
Urgent MRI spine
FBC, UE, LFT, Ca CRP

41
Q

what is the management of cauda equina

A

Analgesia, VTE prophlaxis
neurosurgery for decompression and discectomy

VTE prophlaxis
counselling and advice + physiological support regarding sexual dysfunction

MDT planning

Spinal injury rehab with a pt centred appraoch involving lots of therapists and staff

Important to think about bladder, bowel, skin, PT/OT - alterations to house and long term follow up planning

Bladder management as UTIs are major cuase of morbidity
with aim to presever renal function and contiencne
- pt may get urinary retention and overflow incontinence so risk of autonomic dysreflexia
teach self-catheterisation or indwelling catheter

importnatn to have a bowel regimen - use of laxatives, stook, softeners, digital stimulation and suppositiories

othosis to improve foot drop

42
Q

how do you investigate Causda equina?

A

ASIA chart
Urgent MRI spine
FBC, UE, LFT, Ca CRP

43
Q

what is the management of cauda equina

A

Analgesia, VTE prophlaxis
neurosurgery for decompression and discectomy

VTE prophlaxis
counselling and advice + physiological support regarding sexual dysfunction

MDT planning

Spinal injury rehab with a pt centred appraoch involving lots of therapists and staff

Important to think about bladder, bowel, skin, PT/OT - alterations to house and long term follow up planning

Bladder management as UTIs are major cuase of morbidity
with aim to presever renal function and contiencne
- pt may get urinary retention and overflow incontinence so risk of autonomic dysreflexia
teach self-catheterisation or indwelling catheter

importnatn to have a bowel regimen - use of laxatives, stook, softeners, digital stimulation and suppositiories

othosis to improve foot drop

44
Q

describe MSA

A

may have predom parkinsoniasm or cerebellar features
autonomic dysfucntion - orthostatic hypotension
symmetrical sx, rapid progresson

45
Q

describe progressive supranuvela palsy

A

vertical gaze palsy - esp downward
postural instability
fronal lobe abnormaities

46
Q

describe corticobasal degeneration

A

asymmetric motor anormlaities usually affects one limb plus cognitive impairment

47
Q

dx of parkinsons disease

A

made clinically - dopaminergic trail, could cnsider MRI, serum caeruloplasmin, genetic testing, and dopamine transporter imaging

48
Q

what ist the mx of parkinsons

A

physical and occupational therapy, including gait and balance training, stretching and strength exercises and speech therapy
MDT approach - physical and non-pharmacological therapies, progressive resistance exercises, gait training, music and dance therapy
pt education
DVLA advice
manage comorbidities
screening for non motor sx - depression, anxiety and fatigue, cognitive impairment, autonomic dysfunction, and sleep disturbances, cognitive training and vitamin and dietary supplements

medical - dopaminergic medication
1st llne for young or mild pts = MOA-B inhibitor , dopamine agonists and monitor for adverse features, carbidopa/levodopa - explain the up and down sx
+ COMT inhibitors - entracapone may increase the amount of levodopa for therapeutic benefit
DBS for refractory
apomorphine injections as sx worsen

49
Q

how is multiple sclerosis diagnosed

A

McDonald criteria, MRI brain/cord, FBC, metabolic panel, TSH, Vit B12, anti-NMO, CSF and evoked potentials

50
Q

mx of ALS

A

Currently no cure but aim is to provide symptomatic management and palliative intervention
refer to neuro MDT approach

Riluzole is yhr only drug that modifies disease course
start at time of diagnosis - monitor LFTs and FBCs
MDT clinics - resp therapists, physios and OTs, dietician , SALT conultant and a social worker

immunisations - pneumococcal and influenza and covid
informing pts, cunselling, end of life care, advance directives

manage the ses
excessive saliva - postiiton, oral care and glycopyrranium bromide
dysphagia - blednd tube, percutaneous endoscopic gastrostomy,
mucolytic - carbocysteine
spasticity - exercise and baclofen
consider opoids and NIV in end of care
screen for sx of depression in every clinic

51
Q

how do you diagnose ALS

A

El Escoral diagnostic, brain/cord MRI may rule out structural causes, LP to exclude inflam + neurophysiology, EMG

52
Q

what are the 3 main differentials of a sudden onset headache

A

brain haemmorhages
meningitis
GCA

53
Q

what ix do you do in myasthenia gravis

A

neurophysiology
spirometry
CT thorax
Serum ACh receptor

54
Q

what is the management of Myasthenia gravis

A

ach inhibitor - pyridostigmine
physio and OT
psychological support

corticosteroids can cause initial worsening, start at low dose with gradual increase
immunosuppressant and thymectomy

55
Q

how do you diagnose epilepsy

A

EEG

MRI

56
Q

how do you dx GBS?

A 
nerve conduction studies 
LP 
LFTs
Spirometry 
Antiganglioside antibody - antiGQ1b antibodies
potential stook culture for cause
57
Q

how do you manage GBS

A

Plasma exchange - IVIG
serial peak flow
pulse and BP monitored until thye are off venilaor support
DVT prophylaxis
intubation and ventilation esp if bulbar dysfunction
manage the pain - gabapentin or carbamazepine
rehab - - strengthening exercises
hypotension managaed with a fluid bolus

ISCE (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions