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Year 3 CCC - Amir Sam > Neuro > Flashcards

Neuro Flashcards

1
Q

DKA diagnosis

A

raised blood glucose(>11.1 mmol/L), or known diabetes
ketonuria ++ or more
serum bicarbonate <15 mmol/L
pH<7.3 (if measured)

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2
Q

management of DKA

1st step

A

1- fluid resus
dehydration and intravascular volume depletion is paramount and it is important to use the largest bore cannula possible (e.g. 14G) in at least two sites
1 litre of 0.9% sodium chloride as a bolus, followed by 1 litre over 1 hour, 1 litre over the next 2 to 4 hours, then 1 litre over 4 to 6 hours thereafter

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3
Q

2nd line management of DKA

A

watch out for plasma sodium / potassium irregularity
give 0.95 soidum w 40 mmol of potassium

once glucose down think of 10% dextrose

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4
Q

what should you be worried about in a DKA once treatment has been started?

A

hypikalaemia due to insulin therapy

= arrythmias

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5
Q

myeloma investigations

A 
blood films 
bone marrow apirate
mri whole spine
serum proetien lectrophoresis and free lgith chains
skeletal survey
thoracic and lumbar spine radiograph
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6
Q

management of hypercalcaemia in myeloma?

A

stop thiazide diuretics
start loop diuretics

hydration
haemodialysis
bisphonates

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7
Q

where is the lesion?

what are the possibilites

A

brain/ brainstem

spinal cord
nerve roots

peripheral nerves
neuromuscular junctions

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8
Q

pathology how can you categorise?

A

infection
inflammation
malignancy

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9
Q

UMN lesion sign?
tone?
power?
reflexes?

A

increased Spasticity
reduced power
hyperreflexia / brisk
plantar upgoing

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10
Q

LMN signs
tone
power
reflex

A

tone reduced / flaccid
power reduced
reflex diminished

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11
Q

what lesion gives you cranial nerve palsy?

A

brainstem lesion

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12
Q

if there is widespread neuro signs where can the lesion be?

if symmetrical limbs weakness / cranial nerves

A

must be a lesion in the neuromuscular junction

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13
Q

if pt presents with widespread cranial/ limb weakness [motor]
where would lesion be ?

what would be your top ddx?

what if this was also associated with pus filled abscesses on the skin?

A

neuromuscular junction problem

myasthenia gravis

must be an infectious cause
like botulism toxin

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14
Q

what toxin causes a lesion at neuromuscular junction

what neurotransmitter does it affect?

how does it work

A

ACTH

neuromuscular junction to cause muscle paralysis by inhibiting the release of acetylcholine from presynaptic motor neurons.

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15
Q

cerebeller signs

A 
ataxia
nystagmus
dysdiadochokinesia 
intention tremor 
speech
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16
Q

clinical features of cerebeller disease can be remmebered by the mneumonic DANISH

A 
Dysdiodochokinesia
Ataxia
Nystagmus
Intention tremor
slurred speech - dysarthria 
Hypotonia
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17
Q

what does a hemisensory loss indicate as to where a lesion may be?

A

lesion at cortex

i.e stroke

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18
Q

if sensory loss is bilateral to a point where would that inidcate the lesion is?

A

spinal cord as problems are at a sensory level

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19
Q

if dermal areas affected?
where is the lesion
what is this called?

A

nerve root

which would indicate a radiculopathy

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20
Q

what is a normal HBA1c mmol/mol?

A

4 – 5.6% (20 – 38 mmol/mol)

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21
Q

prediabetes HBA1c

A

5.7% and 6.4% (39 – 46 mmol/mol)

22
Q

HBA1c diabetes mmol/mol

A

6.5% (47 mmol/mol)

23
Q

normal eGFR
stage 2 eGFR
mL/min

A

above 90

60-89

24
Q

first-line peripheral neuropathy drug?

what other antidepressanrt is commonly prescribed for neuropathy

A

dulexetine - SNRI

amitriptyline - TCA

25
Q

what is the difference between neuropathy and radiculopathy?
firstly anatomically how do they differ?
give an example of neuropathy and radiculopathy

A

radiculopathy deals with damage to nerves associated with the spine
pinched nerves in the spine
Sciatica / lumbar radiculopathy L4/ L5 L5/S1

neuropathy is is damage to secondary nerves located at the peripheral of the body
damage to peripheral nerves [ outside the spine cord / brain ]
carpal tunnel syndrome

26
Q

peripheral neuropathy toxic/metabolic causes?

what two common conditions?

A

drugs / alcohol
b12 deficiency

diabetes / hypothyroidism

uraemia

27
Q

how would you find out if vit b12 deficiency was causing peripheral neuropathy?

A

anaemai and an increased MCV

28
Q

why is a hx of myeloma / chronic infection / inflammation imp when investigating neuropathy?

A

checking for amyloidosis
build up of amyloid protein
this is often secondary to infection, inflammation, malignancy

29
Q

infection
inflammation
malignancy

causes of peripheral neuropathy?

A

infection : HIV

inflammation: connective tissue disease like rheumatoid arthritis
malignancy: paraproteinaemia in myeloma

30
Q

what is a good sign of hereditary neuropathies on an xray of the foot?

what is one condition that causes this?

A

pes Cavus
high arch

charcot marie tooth

31
Q

parkinsons is defined by?

A

loss of dopamingeric neurons in the substantia nigra

tremor
rigidity
bradykinesia

32
Q

Parkinsonian features, upgaze abnormality

what condition presents with this?

A

progressive supra-nuclear palsy

33
Q

Features of Alzheimer’s disease, Parkinson’s & hallucinations
what condition?

A

lewy body

34
Q

GCS

eyes :
verbal response
motor respnse

A

4
5
6

35
Q

motor response
GCS
1-6

A 
6 = Obeys commands
5 = Localizes pain
4 = Withdraws to painful stimuli
3 = Abnormal flexion
2 = Extension
1 = No movements
36
Q

verbal response in GCS

A 
5 = Oriented
4 = Confused
3 = Words
2 = Sounds
1 = No sounds
37
Q

eyes

GCS

A 
4 = Spontaneous 
3 = Opens in response to voice
2 = Opens in response to painful stimuli
1 = Does not open
38
Q

TIA

therapy/ management

A

aspirin
carotid doppler
risk factor modify

39
Q

management for parkinsons

1st line

A

For first-line treatment:
if the motor symptoms are affecting the patient’s quality of life: levodopa
if the motor symptoms are not affecting the patient’s quality of life: dopamine agonist (non-ergot derived),
Pramipexole
Ropinirole

levodopa or monoamine oxidase B (MAO‑B) inhibitor

selegiline hydrochloride

40
Q

bilateral hypertonia
hyper reflexia
ankle clonus and upgoing plantar

UMN signs
eye blurred vision
on fundoscopy - optic neuritis

what can this be ?

A

suggest inflammation of spinal cord

spastic paraperesis - MS

vascular - stroke
infection 
inflammation - MS
toxic/metabolic
tumour -
41
Q

if a lesion is bilateral where is the lesion?

A

spinal cord not brainstem or cortical

42
Q

compression of nerve pattern?

A

sensory loss over a dermatome pattern

nerve affected

43
Q

median nerve distribution?

A

anterior aspect of hand and thumb, first 2 fingers

44
Q

ulnar nerve distribution?

A

pinky posteriorly

45
Q

radial nerve

A

thumb and first finger base - posteriorly

46
Q

what nerve supplies palmar part of hand?

A

median and ulnar

47
Q

what nerve supplies back of hand?

A

radial and ulnar- ulnar is pinky and ring

radial is thub base

48
Q

radiculopathy sensory loss

distribution?

A

dermatomes affected

49
Q

limited upgaze abnormality and parkinsonian features

A

progressive supranuclear palsy

50
Q

kernigs sign

A

extension of knee

then there is paiin§

Year 3 CCC - Amir Sam (4 decks)

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