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Finals > Neuro > Flashcards

Neuro Flashcards

1
Q

Causes of vertigo

A

Benign paroxysmal positional vertigo (BPPV)
Vestibular neuronitis
Labyrinthitis
Meniere disease

Central causes:
TIA/brainstem infarct
Tumour
MS
Chiari formation
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2
Q

Conductive hearing loss causes

A

Otitis media (with effusion)
wax
perforated eardrum
cholesteaoma

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3
Q

Sensioneural hearing loss causes

A

Presbycusis - old age degeneration (noise trauma)
Menieres disease
infection (meningitis, labyrinthitis)
acoustic neuroma (neoplasm)

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4
Q

Rinnes test interpretation

A 
NORMAL = Air conduction better than bone
Conductive = bone conduction better than air
Sensioneural = Air better than bone
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5
Q

Webers test interpretation

A 
NORMAL = heard in midline
Conductive = heard in bad ear
Sensioneural = heard in good ear
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6
Q

What is BPPV

A

vertigo provoked by certain changes in head position.

movements = turning in bed, bending over, looking upward

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7
Q

Causes of BPPV

A

Idiopathic
head trauma
mastoid surgery

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8
Q

Symptoms of BPPV

A

vertigo on positional changes

DOES NOT cause hearing loss, fainting or any other neurological signs

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9
Q

BPPV pathophysiology

A

Utricle contains otoconia (calcium carbonate crystals), these become dislodged and migrate into the semicircular canals.
[Fluid in semicircular canals should not move but the crystals activate nerve endings as if the fluid is moving.

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10
Q

Diagnostic/treatment for BPPV

A

Epley manoeuvre

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11
Q

What is vestibular neuronitis

A

Inflammation of vestibular nerve commonly associated with acute illness

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12
Q

Causes of vestibular neuronitis

A

Sinusitis, URTI, vascular disease in the elderly

Commonly affects younger adults

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13
Q

What is labyrinthitis

A

infection of the inner ear, usually a viral cause and associated with vestibular neuritis.

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14
Q

Distinction between labyrinths and vestibular neuronitis

A

labyrinthitis results in hearing changes in addition to vertigo. May produce tinnitus

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15
Q

What is Menieres disease

A

chronic, incurable inner ear disorder as a result of large collections of fluid (endolymph) in the inner ear.
Unknown cause.
Develops in 40s-60s

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16
Q

Symptoms of Menieres disease

A

Fluctuating hearing loss and vertigo, tinnitus.

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17
Q

What are the two subtypes of haemorrhage stroke

A

intracerebral haemorrhage

subarachnoid haemorrhage

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18
Q

Where can an intracerebral haemorrhage occur

A

Intraparenchymal (within brain tissue)

Intraventricular (within the ventricles)

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19
Q

Classification system for ischaemic stroke

A

Bamford classification (based on clinical findings)

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20
Q

Signs of a total anterior circulation stroke TCAS

A

Need all three:
Unilateral weakness of face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia)

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21
Q

Signs of a partial anterior circulation stroke PCAS

A

Two of the following:
Unilateral weakness of face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia)

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22
Q

Signs of posterior circulation syndrome PCOS

A

One of the following:
Cranial nerve palsy and a contralateral motor/sensory deficit
Bilateral motor/sensory deficit
Conjugate eye movements (horizontal gaze palsy)
Cerebellar dysfunction (vertigo, nystagmus, gaze palsy)
Isolated homonymous hemianopia.

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23
Q

Lacunar stroke signs

A 
No loss of higher cerebral functions (dysphasia)
ONE of the following for diagnosis:
pure sensory stroke
pure motor strike
ataxic hemiparesis
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24
Q

Where do lacunar infarcts occur

A

cerebral white matter, basal ganglia, pons

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25
Q

Lesion of CN IV will cause what eye symptoms

A

Downward gaze and vertical diplopia

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26
Q

What eye muscles is CN III (oculomotor) responsible for

A

Medial rectus
Inferior oblique
Superior rectus
Inferior rectus

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27
Q

What functions does CN III have

A

Eye movement
pupil constriction
accommodation
eyelid opening

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28
Q

What would a palsy of CN III cause

A

ptosis
down and out eye
dilated fixed pupil

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29
Q

Which eye muscles is CN IV (trochlear) responsible for

A

Superior oblique

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30
Q

What would a palsy of CN IV cause

A

downward gaze

vertical diplopia

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31
Q

What are the functions of the trigeminal nerve CN V

A

Facial sensation

Mastication

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32
Q

What would a lesion of the trigeminal nerve cause

A 
Trigeminal neuralgia
loss of corneal reflex
loss of facial sensation
paralysis of mastication muscles
deviation of jaw to weak side
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33
Q

what are the branches of the trigeminal nerve

A

opthalmic - sensory
mandibular - mixed
maxillary - sensory

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34
Q

Where do the branches of the trigeminal exit the skulls

A

v1 - superior orbital fissue
v2 - foramen rotundum
v3 - foramen ovale

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35
Q

what eye muscles does the abducens nerve control

A

Lateral rectus

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36
Q

What would palsy of the abducens nerve cause

A

inability to abduct the eye - horizontal diplopia

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37
Q

where does the abducens nerve exit skull

A

superior orbital fissue

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38
Q

what does the facial nerve do

A

facial movement
taste anterior 2/3 of tongue
lacrimation
salivation

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39
Q

what would lesion of the facial nerve cause

A

paralysis of upper AND lower face
loss of corneal reflex
loss of taste
hyperacusis (louder sounds)

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40
Q

where does the facial nerve arise

A

internal auditory meatus

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41
Q

functions of VIII vestibulocochlear

A

hearing

balance

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42
Q

what does lesion of VIII cause

A

hearing loss
vertigo
nystagmus
acoustic neuroma (Schwann cell tumour of the cochlear nerve)

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43
Q

Where does CN VIII arise

A

internal auditory meatus

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44
Q

functions of IX glossopharyngeal

A

taste (posterior 1/3 of tongue)
salivation
swallowing

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45
Q

lesions of IX

A

hypersensitive carotid sinus reflex

loss of gag reflex

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46
Q

where does IX arise

A

jugular foramen

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47
Q

Functions of vagus X nerve

A

phonation
swallowing
innervation of viscera

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48
Q

lesions of vagus nerve

A

uvula deviation away from lesion

loss of gag reflex

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49
Q

where does the vagus nerve arise

A

jugular foramen

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50
Q

functions of XI accessory

A

head and shoulder movement

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51
Q

lesion of accessory nerve

A

weakness turning head to contralateral side

weakness of should adduction

52
Q

hypoglossal nerve fucntion

A

tongue movement

53
Q

lesion of hypoglossal

A

tongue deviate toward side of lesion

54
Q

where does the accessory nerve arise

A

jugular foramen

55
Q

where does hypoglossal nerve arise

A

hypoglossal canal

56
Q

where does olfactory nerve arise

A

cribriform plate

57
Q

where does optic nerve arise

A

optic canal

58
Q

where does trochlear nerve arise

A

superior orbital fissue

59
Q

where does oculomotor nerve arise

A

superior orbital fissure

60
Q

what is the number one cause of viral encephalitis

A

HSV

61
Q

Does HSV encephalitis occur in primary or secondary infection

A

BOTH!

62
Q

What happens after primary infection with HSV

A

migrates to sensory ganglion where it stay until a secondary infection occurs

63
Q

What happens when HSV reaches the brain

A

causes encephalitis

or meningoencephalitis

64
Q

presentation of HSV encephalitis

A

fever
headache
focal neuro signs

65
Q

Differentiation of HSV encephalitis from other causes

A

uncommon
SEVERE - 70% die without treatment
Early treatment important

66
Q

treatment for HSV encephalitis

A

IV acyclovir

67
Q

Where does HSV encephalitis target

A

temporal lobe

68
Q

neurological effects of HSV encephalitis

A

aphasia

seizures

69
Q

CSF changes HSV encephalitis

A

lymphocytosis
elevated protein
RBCs

70
Q

Class of drugs used for migraine prophylaxis/treatment

A

prophylaxis - 5-HT receptor Antagonists

treatment - 5-HT receptor agonists

71
Q

What is firstling treatment for migraine prophylaxis

A

propranolol

or topiramate

72
Q

When should topiramate be avoided

A

women of child bearing age
teratogenic
reduces effectiveness of contraceptives

73
Q

First line drug treatment of migraine

A

oral triptan + paracetamol/NSAID

74
Q

Second line treatment of migraine

A

metoclopramide (can cause acute dystonia in young)

prochlorperazine

75
Q

complimentary therapy for migraine

A

riboflavin supplements

acupuncture

76
Q

What is the first-line treatment drug of generalised seizures

A

sodium valproate (UNLESS WOMEN OF CHILDBEARING AGE)

77
Q

second line treatment for generalised seizures

A

lamotrigine
carbamazepine

[first-line for women of childbearing age]

78
Q

treatment of absence seizures

A

sodium valproate or ethosuximide

79
Q

first-line treatment of myoclonic seizures

A

sodium valproate

80
Q

second-line treatment of myoclonic siezures

A

clonazepam

lamotrigine

81
Q

Which seizures can carbamazepine exacerbate

A

absence or myoclonic

82
Q

Bamford classification criteria to be assessed

A

Unilateral hemiparesis and/or hemisensory loss of the face, arm and leg
homonymous hemianopia
higher cognitive dysfunction e.g. dysphasia

83
Q

Involvement of TACI

A

middle and anterior cerebral arteries

all 3 of Bamford criteria

84
Q

PACI involvement

A

smaller arteries of anterior circulation e.g. upper and lower division of middle cerebral artery
two of the Bamford criteria present

85
Q

Lacunar infarct involvement

A

Perforating arteries around the internal capsule, thalamus and basal ganglia

  1. unilateral weakness
  2. pure sensory stroke
  3. ataxic hemiparesis
86
Q

involvement of posterior circulation infarcts

A 
vertrebrobasilar arteries
one of the following:
1. cerebellar of brainstem syndromes
2. LOC
3. isolated homonymous hemianopia
87
Q

Management of TIA

A

ABCDE2 score
immediate 300mg aspirin (unless on anticoagulant or bleeding disorder)
Refer urgently to TIA assessment

88
Q

Management of haemorrhagic stroke

A

Stop anticoagulation
consider referral for neurosurgery
blood pressure management

89
Q

typical anterior cerebral stroke presentation

A

contralateral hemiparesis and sensory loss with weaker lower extremity (see cortical homunculus)

90
Q

MCA stroke presentation

A

contralateral hemiparesis and sensory loss with more upper extremity involvement
+hemianopia
+aphasia

91
Q

PCA stroke presenation

A 
Contralateral homonymous hemianopia with macular sparing
visual agnosia (can't visually understand objects i.e. recognise people)
92
Q

Weber’s syndrome (branches of the PCA that supply midbrain) presentation

A

Ipsilateral CN III palsy

contralateral weakness of upper and lower extremity

93
Q

posterior inferior cerebellar artery lateral medullary syndrome, Wallenberg syndrome presentation

A

Ipsilateral: face pain and temp loss
Contralateral: limb/torso pain and temp loss
Ataxia, nystagmus

94
Q

Anterior inferior cerebellar artery (lateral pontine syndrome) presentation

A

Wallenbergs + facial paralysis and deafness

95
Q

Retinal/opthalmic artery occlusion presentation

A

amaurosis fugax

96
Q

Basilar artery stroke

A

‘Locked-in’ syndrome (complete paralysis apart from eye movements)

97
Q

What do lacunar strokes have a high association with

A

hypertension

98
Q

Where is Wernicke’s area

A

temporal lobe

99
Q

where is Broca’s area

A

frontal lobe

100
Q

Signs of parietal lobe lesions

A

sensory inattention
praxis
tactile agnosia
inferior homonymous quadrantanopia (lesion of superior optic radiation on contralateral side)

101
Q

Signs of occipital lobe lesion

A 
Homonymous hemianopia (with macular sparing)
Cortical blindess (loss of vision)
visual agnosia
102
Q

Signs of temporal lobe lesion

A

Wernicke’s aphasia (word substitution)
superior homonymous quadrantanopia (pie in the sky, inferior optic radiation lesion)
auditory agnosia (impairment in sound perception)
prosopagnosia (difficulty recognising faces)

103
Q

Signs of frontal lobe lesions

A 
Broca's aphasia
disinhibition
perseveration (stuck on topic)
anosmia
inability to generate a list
104
Q

Signs of cerebellar midline lesions

A

gait and truncal ataxia

105
Q

signs of cerebellar hemisphere lesions

A

IPSILATERAL:

intention tremor, past pointing, dysdiadokinesis, nystagmus

106
Q

Features of MND

A 
UPPER AND LOWER MN SIGNS
fasciculations
vague sensory symptoms e.g. pain
wasting of small hand muscles
DOES NOT AFFECT OCCULAR MUSCLES
107
Q

UMN signs

A 
Spastic paralysis (twitch or spasm muscles)
hyperreflexia
hypertonia (rigid)
No fasciculations
positive Babinski sign
108
Q

LMN signs

A 
Flaccid paralysis (no movement)
hyporeflexia
hypotonia
fasciculations
negative Babinski sign
109
Q

Types of MND

A

amyotrophic lateral sclerosis
progressive muscular strophy
bulbar palsy

110
Q

Features of MS

A 
optic neuritis
Uhthoff's phenomenon (worsening of vision from heat)
paraesthesia
numbness
trigeminal neuralgia
spastic weakness
ataxia
tremor
111
Q

Which tracts does Brown-Sequard syndrome (spinal cord hemisection) affect

A

lateral corticospinal tract
dorsal columns
lateral spinothalamic tract

112
Q

Symptoms of Brown-Sequard syndrome

A

Ipsilateral spastic paresis below lesion
Ipsilateral loss of proprioception and vibration
Contralateral loss of pan and temperature

113
Q

What causes subacute combined degeneration of the cord

A

vitamin B12 and E deficiency

114
Q

Which tracts are affected by subacute degeneration of the cord

A

Lateral corticospinal tract
Dorsal column
Spinocerebellar tract

115
Q

Symptoms of subacute degeneration of the cord

A

bilateral spastic paresis
bilateral loss of proprioception and vibration sensation
bilateral limb ataxia

116
Q

Dermatome of thumb and index finger

A

C6

117
Q

Dermatome of middle finger and palm

A

C7

118
Q

Dermatome of ring and little finger

A

C

119
Q

Dermatome of nipples

A

T4

120
Q

Umbilicus dermatome

A

T10

121
Q

Knee caps dermatome

A

L4

122
Q

Big toe dermatome

A

L5

123
Q

Lateral foot, small toe dermatome

A

S1

124
Q

What visual defect is a pituitary tumour likely to cause

A

Bitemporal hemianopia (lesion of optic chiasm)

125
Q

Cause of superior homonymous quadrantanopia

A

lesion of inferior optic radiation (Meyer’s loop) - temporal lobe

126
Q

Cause of inferior homonymous quadrantanopia

A

Lesion of superior optic radiation (Baum’s loop) - parietal lobe

127
Q

Mnemonic for inferior/superior quadrantanopia

A

PITS
Pariteal = Inferior
Temporal = Superior

Finals (15 decks)

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