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FINALS > Neuro > Flashcards

Neuro Flashcards

1
Q

Anterior cerebral artery stroke sx

A

Contralateral hemiparesis and sensory loss
Lower >upper

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2
Q

Middle cerebral artery stroke

A
  • Contralateral hemiparesis and sensory loss
  • Upper > lower
  • Contralateral homonymous hemianopia
  • Aphasia
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3
Q

Posterior cerebral artery

A
  • Contralateral homonymous hemianopia with macular sparing
  • Visual agnosia
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4
Q

Weber’s syndrome

A
  • Ipsilaterall CN 3 palsy
  • Contralateral wekaness of upper and lower extremity
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5
Q

PICA

A
  • Lateral medullary syndrome, wallenberg
  • Ipsilateral facial pain and temp loss
  • Contralateral limb/torso pain and temp loss
  • Ataxia
  • Nystagmus
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6
Q

Anterior inferior cerebellar artery stroke

A
  • simmilar to wallenbergs but ipsilateral facial paralysis and deafness
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7
Q

retinal/opthalmic artery stroke

A
  • amaurosis fugax
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8
Q

Basilar artery stroke

A

locked in

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9
Q

definition epilepsy

A
  • 2 unprovoked seizures >24hrs apart
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10
Q

partial/focal seizure

A
  • focal onset that can be referrable to single lobe
  • simple = no affect on consciousness or memory
  • complex = memory affected, post ictal confusion
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11
Q

primary generalised seiuzure

A
  • tonic
  • clonic
  • tonic clonic
  • myoclonic
  • atonic
  • absence
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12
Q

temporal lobe seizure

A
  • aura
  • anxiety
  • automatisms = lip smacking
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13
Q

frontal lobe seizure

A
  • motor features
  • jacksonian march
  • post ictal todds palsy
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14
Q

focal seizure mx

A
  • lamotrigine
  • levi
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15
Q

generalised tonic clonic mx

A
  • SV
  • lamotrigine or levetiracetam if childbearing
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16
Q

myoclonic mx

A
  • sv
  • levet
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17
Q

tonic and atonic mx

A
  • SV
  • lamot
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18
Q

DVLA criteria in eoilepsy?

A
  • remove licence until specific criteria met
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19
Q

benzo options for status

A
  • buccal midazolam 10mg
  • rectal diazepam 10mg
  • IV lorazepam 4mg
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20
Q

S+S ischaemic stroke

A
  • FAST
  • limb weakness opposite side infarct
  • contralateral hemiplegia/hemiparesis
  • vision loss/deficit
  • hh
  • aphasia
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21
Q

Ix ischaemic stroke

A
  • NCCT
  • MRI
  • Brachial BP
  • Bloods, XR, ECG
  • If CT shows hyper density = haemorrhagic
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22
Q

ischaemic stroke acute mx

A
  • thrombolysis within 4.5 hours onset with IV alteplase
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23
Q

ischaemic stroke long term mx

A
  • antihtn
  • antiplatelet = aspirin, clopi 75mg OD
  • aspirin = 300mg for 2w then reduced
  • Statin 20-80mg
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24
Q

thrombolysis CI

A
  • recent surgery 3m
  • recent arterial puncture
  • hx active malignancy
  • brain aneurysm
  • anticoagulation
  • liver disease or pancreatitis
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25
Q

haemorrhagic stroke mx

A
  • stop anticoagulant immediately
  • IV mannitol
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26
Q

carotid TIA S+S

A
  • amourosis fugax
  • aphasia
  • hemiparesis
  • hemisensory loss
  • HH
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27
Q

vertebrobasilar TIA S+S

A
  • diplopia, vertigo, vomiting
  • choking
  • ataxia
  • hemisensory loss
  • HH
  • tetraparesis
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28
Q

TIA Ix

A
  • diffusion weighted MRI
  • carrotid doppler +/- angiography
  • CT or DWMRI
  • bloods
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29
Q

Mx TIA

A
  • aspirin 300mg then 75 after 2w
  • statin
  • AF = anticoagulate
  • carotic endarterectomy if >70% stenosis
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30
Q

S+S SAH

A
  • thunderclap headache
  • neck stiffness
  • photophobia
  • vomiting
  • neurological sx
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31
Q

Ix SAH

A
  • CT head = hyper-attenuation in subarachnoid space
  • LP if CT normal = raised red cells and xanthochromia
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32
Q

Mx SAH

A
  • surgery = endovascular coiling, clipping
  • nimodipine
  • cerebral perfusion
  • dex
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33
Q

SAH aetiology

A
  • berry aneurysms
  • pckd
  • injury
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34
Q

extradural haemorrhage characteristic

A
  • head injury followed by brief unconsciousnes then fine
  • young males
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35
Q

extradural patho

A
  • fractured temporal or parietal bone = laceration MMA
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36
Q

S+S extradural

A
  • deteriorating consciousness after head injury
  • increasingly severe ehadache, vomiting, fits
  • ipsilateral pupil dilates, bilateral limb weak
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37
Q

Ix and Mx extradural

A
  • CT = lemon
  • blot evacuatio nad ligation
  • anticoag/platelet cessation
  • iv mannitol
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38
Q

subdural haemorrhage rf

A
  • elderly = falls, atrophy
  • shaking baby
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39
Q

S+S extradural

A
  • fluctuating cosnciousness
  • headache
  • confusion
  • unsteady
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40
Q

subdural ix

A
  • ct = banana
  • mri
  • clot +/- midline shift
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41
Q

mx subdural

A
  • burr twist
  • ac/ap cessation
  • iv mannitol
  • iv prothrombin and vit k
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42
Q

most common presentations of MS

A
  • optic neuritis
  • transverse myelitis
  • cerebellar related symptoms
  • brainstem syndromes
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43
Q

ms definition

A
  • chronic progressive autoimmune condition involving demyelination of CNS
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44
Q

feautres optic neuritis

A
  • central scotoma
  • pain on movmenet
  • impaired colour vision
  • RAPD = affected eye constricts more when shining light in contralateral eye
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45
Q

lhermitte’s sign

A
  • electric shock sensation down spin when flexing neck
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46
Q

ms ix

A
  • mri = brain and spine with contrast
  • lp = oligoclonal bands igG
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47
Q

MS Mx

A
  • RR mild = dimethyl fumarate
  • RR = monoclonal abs = alemtuzumab
  • methylpred for acute
  • baclofen and gabapentin for spasticity
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48
Q

ms relapse tx

A
  • 500mg oral steroids 5 days
  • 1g IV daily for 3-5 days
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49
Q

signs of lowe motor neuron disease

A
  • muscle wasting
  • reduced tone
  • fasciculations
  • reduced reflexes
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50
Q

signs of upper motor neuron disease

A
  • increased tone or spasticity
  • brisk reflexes
  • upgoing plantar reflex
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51
Q

what drug can slow als progression

A

riluzole

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52
Q

ALS S+S

A
  • UMN signs and LMN wasting
  • asymmetric
  • bab +ve
  • progressive focal muscle weakness and wasting
  • fasciculations
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53
Q

PBL S+S

A
  • lower cn nuclei
  • elderly women
  • dysarthria, dysphagia, nasal reurg
  • fasiculations
  • emotional incontinence
  • 1st affected = talking, chewing, swallowing
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54
Q

are PD symptoms symmetric or asymmetric

A
  • typically asymmetrical
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55
Q

parkinsons triad

A
  • resting tremor = pill rolling, better on movement
  • rigidity = cogwheel
  • bradykinesia = buttons, shuffle walk, blank face
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56
Q

PD patho

A
  • reduction of dopamine in basal ganglia
  • mitochondrial dysfunction and oxidative stress on SN
  • degeneration of dopaminergic neurones of SN
  • decreased DA synthesis = decreased thalamus activity = decreased movement
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57
Q

PD Ix

A
  • DaTSCAN
  • MRI
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58
Q

PD Mx

A
  1. levodopa with peripheral decarboxylase inhibitor = carbidopa
  2. COMT inhibitors = slows breakdown of levodopa in brain
  3. dopamine agonists
  4. MAOB inhibitors = increase circulating dopamine
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59
Q

main se levodopa

A

dyskinesia

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60
Q

parkinsons plus syndromes

A
  • multiple system atrophy = autonomic and cerebellar dysfunction
  • lewy body dementia
  • progressive supranuclear palsy
  • corticobasal degeneration
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61
Q

essential tremor features

A
  • fine tremor
  • symmetrical
  • worse on movement
  • worse when tired
  • improve by alcohol
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62
Q

mx essential tremor

A
  • propranolol
  • primidone
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63
Q

5 branches of facial nerve

A
  • temporal
  • zygomatic
  • buccal
  • marginal mandibular
  • cervical
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64
Q

forehead in UMN lesion?

A

spared

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65
Q

LMN facial nerve palsy

A
  • forehead affected
  • drooping eyelid
  • loss of nasolabial fold
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66
Q

Bells palsy S+S

A
  • unilateral LMN facial nerve palsy
  • reduction in movement on affected side
  • ear pain on affected side
  • dry mouth
  • incomplete eye closure
  • can get loss of taste on anterior 2/3
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67
Q

Mx bells

A
  • within 72 hours 50mg pred 10 days of 60mg 5 days and reduce regime
  • eye drops
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68
Q

ramsay hunt

A
  • caused by vzv
  • unilateral LMN palsy with painful vesicular rash in ear canal
  • tx = aciclovir and prednisolone
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69
Q

concerning features suggesting intracranial HTN

A
  • constant headache
  • nocturnal
  • worse on waking, coughing, straining
  • vomiting
  • papilloedema
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70
Q

cancers that most often spread to the brain

A
  • lung
  • breast
  • RCC
  • Melanoma
71
Q

what is acoustic neuroma

A
  • benign tumour of schwann cells that surround auditory nerve
  • occur at cerebellopontine angle
72
Q

AN - unilateral or bilateral

A
  • unilateral
  • associated with neurofibromatosis 2
73
Q

S+S AN

A
  • unilateral sensorineural hearing loss
  • unilateral tinnitus
  • dizzy
  • full ear
  • facial nerve palsy
74
Q

AN Mx

A
  • conservative
  • surgery
  • radiotherapy
75
Q

genetics of huntingtons

A
  • autosomal dominant
  • trinucelotide repeat disorder = CAG
  • Anticipation = successive generations have more repeats
76
Q

S+S HD

A
  • chorea
  • dystonia
  • rigidity
  • eye movement disorders
  • cognitive, psychiatric or mood problems
77
Q

antibodies found in MG

A
  • acetylcholine receptor antibodies
  • bind to postsynaptic acetylcholine receptors = failure to trigger muscle action potential
78
Q

S+S MG

A
  • proximal muscles of limbs = top down
  • har to climb stairs
  • diplopia
  • ptosis
  • swallowing
  • fatigue chewing
  • snarl
79
Q

Ix MG

A
  • AChR antibodies
  • CR or MRI thymus to look for thymoma
  • edrophonium test
80
Q

myasthenic crisis

A
  • resp muscle weakness
  • monitor FVC
  • plasmanephrines or IVIG
81
Q

MG Mx

A
  • pyridostigmine = cholinesterase inhib
  • immunosuppression
  • thymectomy
  • rituximab
82
Q

drugs that exacerbate MG

A
  • ciprofloxacin
  • azithromycin
  • propranolol
  • atenolol
  • verapimil
  • lithium
  • statin
83
Q

where is CSF contained

A
  • subarachnoid space = within the meninges
84
Q

msot common cause meningitis

A
  • neisseria meningitidis
85
Q

kernigs test

A
  • flex gip and knee to 90
  • straighten knee keeping hip flexed
  • pain = meningitis
86
Q

brudzinski test

A
  • flex chin to chest
  • positive = patient flexes hip and knees
87
Q

bacterial LP results

A
  • cloudy
  • high protein
  • low glucose
  • high neutrophils
  • bacterial culture
88
Q

viral LP results

A
  • clear
  • mildly raised protein
  • normal glucose
  • high lymphocytes
  • negative culture
89
Q

ix meningitis

A
  • lp
  • cultures
  • meningococcal pcr
90
Q

mx bacterial meningitis

A
  • benzylpeniccilin if before hospital
  • cefotaxime or ceftriaxone
  • dexamethasone
  • 60+ = cefotaxime and amoxicillin
91
Q

meningitis post exposure prohpylaxis?

A
  • ciprofloxacin if contact within 7 days
92
Q

4 first line treatments for neuropathic pain

A
  • amitriptyline
  • duloxetine
  • gabapentin
  • pregabalin
93
Q

presenting features of lambert eaton

A
  • proximal muscle weakness
  • autonomic dysfunction
  • reduced/absent tendon reflexes
94
Q

mx lambert eaton

A
  • amifampridine
95
Q

features charcot marie tooth

A
  • high foot arches
  • champagne bottle legs = distal uscle wasting
  • lower leg weakness = foot drop
  • reduced tendon reflexes and tone
  • peripheral neuropathy
96
Q

inhertance of charcot

A

autosomal dominant

97
Q

infections related to GBS

A
  • campylobacter
  • CMV
  • EBV
98
Q

S+S GBS

A
  • feet up
  • symetrical ascending weakness
  • reduced reflexes
99
Q

Ix GBS

A
  • nerve conduction = reduced signal
  • LP = raised protein, normal wcc and gluc
100
Q

mx gbs

A
  • IvIg
101
Q

neurofibromatosis type 1 gene

A
  • csome 17
  • cafe au lait
  • bony dysplasoa
  • yellow spots on iris
  • neurofibromas
102
Q

NF type 2 gene

A
  • csome 22
  • associated with acoustic neuromas
103
Q

3 branches of facial nerve

A
  • opthalmic V1
  • maxillary V2
  • mandibular V3
104
Q

S+S and Mx trigeminal neuralgoa

A
  • sudden pain
  • shooting, burning pain
  • triggered by touch, eating, cold
  • carbamezapine
105
Q

mx migraine

A
  • nsaids
  • triptans
  • antiemetic
106
Q

contraindications for triptans

A
  • HTN
  • Coronary artery disease-
  • previous stroke, TIA or MI
107
Q

migraine prophylaxis

A
  • propranolol
  • amitryptiline
  • topiramate
108
Q

mx cluster headaches

A
  • triptans
  • high flow 100% oxygen
  • prophylaxis = verapamil
109
Q

encephalitis S+S

A
  • fever, headache, N+V
  • seizures
  • altered mental state
  • rash
110
Q

encephalitis ix

A
  • bloods
  • csf
  • ct/mri
  • cultures
111
Q

mx enceph

A
  • aciclovir
  • benzylpen
112
Q

S+S carpal tunnel

A

Aching in hand and arm esp. night
Paraesthesia in thumb, index and middle finger
Relived by dangling
Sensory loss and weakness abductor pollis brevis

113
Q

mx carpal tunnel

A
  • splint
  • steroid injections
  • decompression
114
Q

drugs that exacerbate MG

A
  • ciprofloxacin
  • azithromycin
  • propranolol
  • atenolol
  • verapimil
115
Q

cauda equina S+S

A
  • saddle parasthesia
  • sudden onset
  • motor problems
  • lower back pain
  • bilateral LMN reflexes
  • absent ankle reflex
  • decreased sphincter tone
  • perianal sensory disturbance
  • incintinence
  • sexual dysfunction
116
Q

CE Ix

A
  • spine MRI
117
Q

femoral stretch tests

A

L4

118
Q

knee flexion tests

A

L5/S1

119
Q

straight leg tests

A

L5 S1

120
Q

plantar flexion tests

A

S1/2

121
Q

CE mx

A
  • epidural steroid
  • surgical decompression
122
Q

HZV

A
  • shingles
  • reactivation of chicken pox = infects dermatomes
123
Q

rash in shingles

A

localised ermatome erythematous maculopapular rash –> clear vesicles –> crust

124
Q

when to treat shingles

A

give aciclovir if within 72hrs of rash onset

125
Q

alzheimers pathology

A
  • atrophy of cerebral cortex
  • amyloid plaques and neurofibrillary tangles
  • accumulation of B amaloid peptide
126
Q

S+S alzheimers

A
  • loss recent memory
    Difficulty word finding
    Aphasia, apraxia, agnosia
    Frontal executive function
    Anosognosia = lack insight, stubbornness, denial
127
Q

mx alzheimers

A
  • acetylcholinesterase inhibitors = donepezil, rivastigmine
  • memantine in later stage
128
Q

vascular dementia

A

Multi infarct dementia
Reduced blood supply to brain
Onset can be within 3 months CVA
Stepwise progression

129
Q

vascular S+S

A

Stepwise in severity of symptoms
Gaint and attention problems
Incontinence
Personality change
Focal neuro signs
MRI = widespread small vessel disease

130
Q

lewy body dementia

A

LBD = when cognitive predate motor sx by >1 year

131
Q

LBD S+S

A

Stepwise in severity of symptoms
Gaint and attention problems
Incontinence
Personality change
Focal neuro signs
MRI = widespread small vessel disease

132
Q

front temporal dementia

A

Common in younger
Progressive degeneration
Personality change and behaviour disturbance
Progressive impairment of language

133
Q

vascular mx

A

AChE inhibitors
memantine

134
Q

parkinsons plus sx

A

Progressive supranuclear palsy = PD and vertical gaze
Multiple system atrophy = PD and PHypo, incontinence and impotence
Cortico basal degeneration = PD and spontaneous activity limb
LBD

135
Q

brown sequard findings

A

Ipsilateral hemiplegia
Ipsilateral loss of vibration and proprioception
Contralateral loss of pain and temperature

136
Q

wernickes aphasia

A

superior temporal gyrus = temporal lobe lesion
Speech fluent but word salad, neologisms, no sense
Impaired comprehension

137
Q

broca aphasia

A

Expressive
Inferior frontal gyrus = frontal lobe lesion
no fluent speech, laboured and halting but comprehension in tact and content words may be preserved

138
Q

GCS motor

A

6 = obey commands
5 = localises to pain
4 = withdraws
3 = flex to pain
2 = extends to pain
1 = none
Count best action

139
Q

GCS verbal

A

5 = orientated time place person
4 = confused
3 = innapropriate words
2 = sounds
1 = none

140
Q

GCS eye

A

4 = eye open spont
3 = open to speech
2 = open to pain
1 = none

141
Q

common peroneal nerve palsy

A

The sciatic nerve divides into the tibial and common peroneal nerves. Injury often occurs at the neck of the fibula
Common = foot drop.

142
Q

subacute combined degeneration of the cord

A

due to vitamin B12 deficiency
dorsal columns + lateral corticospinal tracts are affected
joint position and vibration sense lost first then distal paraesthesia
upper motor neuron signs typically develop in the legs, classically extensor plantars, brisk knee reflexes, absent ankle jerks
if untreated stiffness and weakness persist

143
Q

red flag TGN

A

<40
Sensory changes
Deafness or ear problems
Skin or oral lesions
Pain in Opthalmic division
Optic neuritis
FHx MS

144
Q

cushings triad in ICP

A
  • bradycardia
  • wide pulse pressure
  • irregular breathing
145
Q

ICP on eyes

A

down and out = 3rd nerve palsy

146
Q

4th CN palsy

A

vertical diplopia = defective downward gaze
Eye turns upwards when facing medially

147
Q

5th CN palsy

A
  • TGN
  • loss corneal reflex
  • loss face sensation
  • deviation of jaw to weak side
148
Q

6th CN palsy

A

horizontal diplopia
cant abduct eye

149
Q

9th nerve palsy

A

glossopharyngeal = loss gag reflex

150
Q

10th nerve palsy

A
  • uvula away from site
  • loss gag
    vagus
151
Q

12th nerve palsy

A
  • tongue to side of lesion
    hypoglossal
152
Q

S+S menieres

A
  • inner ear disorder
  • vertigo
  • fluctuating hearing loss
  • tinnitus
  • full ear
    unilateral
153
Q

how to diagnose menieres

A
  • 2 or more spont episodes of vertigo = 20m - 12h
  • low to medium sensorineural hearing loss in 1 ear
154
Q

menieres prophylaxis

A

betahistine

155
Q

menieres management

A
  • prochlorperazine
  • antihistamines
156
Q

triad in horners

A
  • ptosis
  • miosis
  • anhidrosis
157
Q

S+S GCA

A
  • headache
  • temporal artery tenderness
  • jaw claudication
  • vision loss
  • scalp tenerness
    mx = steroid
158
Q

3rd nerve palsy and pain?

A

posterior communicating artery aneurysm

159
Q

lacunar strokes

A
  • either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
  • associated with HTN
160
Q

stroke secondary prevention

A
  • clopidogrel and aspirin
  • dipyridamole with aspirin if clopi CI
161
Q

field defect if lesion on optic nerve

A
  • ipsilateral monocular blindness
162
Q

field defect if central optic chiasm lesion

A
  • bitemporal hemianopia
163
Q

field defect if lesion optic tract

A

contralateral HH

164
Q

progressive supranuclear palsy

A

parkinsonism and vertical gaze palsy

165
Q

cortico basal degeneration

A

parkinsonism and spontaneous activity of an affected limb

166
Q

Foot drop caused by…

A
  • Common peroneal nerve trauma
  • L5 root lesion = radiculopathy
167
Q

frontal lobe

A
  • problem solving and judgement
  • inhibition
  • personality and emotional traits
  • language production
168
Q

temporal lobe

A
  • understanding language
  • information retrieval
  • memory, hearing, learning
169
Q

parietal lobe

A
  • sense of touch, taste, smell
  • visual perception
  • reading, writing, maths
170
Q

what are the 2 ascending tracts

A
  • dorsal columns
  • spinalthalamic tracts
  • carry info to the brain
171
Q

what are the descending tracts

A
  • corticospinal = motor function from frontal lobe to muscles
    = carry info away from brain
172
Q

dorsal columns = sensations and deccusate

A
  • fine touch, proprioception, vibration
  • decussate medulla
  • posterior and ipsi
173
Q

spinothalamic tracts sensation and dec

A
  • pain and temperature
  • dec as soon as enter spinal tract
174
Q

brown sequard

A
  • ipsilateral spastic paralysis and loss of vibration and proprioception
  • contralateral loss pain and temp

FINALS (31 decks)

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