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Phase 2a > neuro > Flashcards

neuro Flashcards

1
Q

contents in subarachnoid space?

A

CSF

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2
Q

subdural space contents?

A

bridging veins

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3
Q

extradural space contents?

A

very narrow - potential space with meningeal vessels

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4
Q

bleeding of cerebral vessels what space they bleed into?

A

subarachnoid

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5
Q

ct scan of extra dural bleed?

A

lemon shape !!
white buldge and bleeds moves inward and compresses the brain - midline shift
skull fracture

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6
Q

ct scan of sub- dural bleed/ haemorrage?

A

dark grey area in shape of banana
seeping of blood is not limited
midlife shift - falx cerebri is moved

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7
Q

cp of subarachnoid haemorrage?

A

hit on back of head pain - sudden
may be concious - > unconscious
can be fatal

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8
Q

ct scan of Sub arachnoid HEAMORRAGE

A

fresh white in fissures and cisterns - into nooks and crannies

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9
Q

blood supply to lateral cerebral hemisphere?

A

middle cerebral artery

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10
Q

anterior cerebral hemisphere blood suple?

A

anterior cerebral artery

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11
Q

medial cerebral hemisphere blood supply?

A

anterior and posterior cerebral artery

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12
Q

where is primary visual cotex?

A

medial surface of occipital lobe

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13
Q

CONTENTS of spinal nerves?

A

motor fibres for skeletal muscles and sensory fibre
sympathetic fibres - smooth muscle and sweat glands

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14
Q

location of motor neurons in spinal cord?

A

ventral grey horn

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15
Q

location of sympathetic neurons?

A

T1 - L2

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16
Q

WHERE is location of parasymoathetic nuerons ?

A

brainstem and sacral

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17
Q

lateral cortical spinal tract?

A

travel from primary motor cortex to medulla and decussate and lower motor neuron in ventral grey horn - contralateral to where it orginated

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18
Q

injury to the corticospinal tract ?

A

origin is contralateral but if injury in chord there will be weakness on same side

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19
Q

ascending sensory pathways ?

A

DCML and Spinthalamic

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20
Q

lesions to DCML?

A

ipsilateral loss of fine touch and propioception becuase decussates in medulla in brainstem

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21
Q

lesion in spinothlamic tract ?

A

contralateral loss of impaired pain and temp sensation

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22
Q

cranial nerves may contain which fibre types ?

A
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23
Q

how to test trochlear?

A

movement of sup oblique
look medially and down

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24
Q

how to test abducens?

A

abduct eye
lateral recturs movement

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25
Q

facial nerve?

A

anterior 2/3 taste tongue
muscle facial expression - facial weakness

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26
Q

upper face innervation?

A

from contralateral and ipsilateral - both side of cortex -facial nerve

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27
Q

lower facial innervation?

A

from contralateral - opposite side of cortex - facial nerve

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28
Q

viral causes of meningitis?

A

Enteroviruses (including Echo virus, Coxsackie virus)
Herpes simplex virus
Mumps virus
Lymphocytic chorio meningitis virus
And historically, Poliovirus (also an enterovirus)

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29
Q

ix for encaphalitis?

A

CSF - glucose, proteins,
PCR for Enteroviruses, HSV and VZV and S. pneumoniae and N. meningitidis.
Blood – blood cultures and PCR for S. pneumoniae and N. meningitidis.

Nose and throat swabs – are plated out onto blood and chocolate agar and PCR for Enterovirus

Stool – stool PCR for Enterovirus.

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30
Q

CSF results consistant with bacterial encephalitis

A

The CSF is consistent with an inflammatory response to a bacterial infection.

A neutrophil prediminant leucocyotosis,
a raised protein and
a reduced CSF glucose to serum glucose ratio.
Neutrophils are professional phagocytes that respond to bacteria.

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31
Q

dominant hemisphere stroke symptoms?

A

left
expresive dysphasia
receptive dysphasia
dyslexia
dysgraphia

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32
Q

non dominant stroke symptoms?

A

usually right handed
anosognosia
denial of weakness/ neglect of paralysed limb

dressing apraxia
geographical agnosia

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33
Q

differential from strokes?

A

eplileptic seizure
TODS paraesis - tingling down one leg
space occupying lesion
- brain tumour
infection
metabolic - hypo/hyperglyceamia
MS
FND - previoous trauma (PTSD)
MIGRAINE
subdural haematoma

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34
Q

ix for stroke?
GS ?
1ST line?

A

FBC - to cancel other ddx
1st line = NCCT SCAN head -RULE out bleeding
GS = MRI diffusion weighted
blood test - glucose, FBC (polyctheamia), esr (vasculitis), U+E, INR (warfarin)
ANGIOGRAPHY
ECG - MI + AF

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35
Q

tx for ischeamic stroke?

A

thrombolysis - IV Alteplase within 4.5 hours

aspirin 300 mg for 2 weeks
clopidogrel switch to 75mg
asrovastatin

thrombectomy within 6 hours of symptoms

SALT support long term

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36
Q

classification scheme for ischeamic stroke?
most common cause of ischaemic stroke?

A

TOAST
1) large-artery atherosclerosis,
2) cardioembolism,
3) small-vessel occlusion
, 4) stroke of other determined etiology
hyperviscosity syndrome - polycynthaemia vera (+++RBC)
HYPOPERFUSION
vasculitis
5) stroke of undetermined etiology.

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37
Q

causes of small vessle ischeamic strokedisease? signs on scan?

A

htn
diabetes
smoking
aging
lacunes on brain

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38
Q

causes of cardioembolism?

A

mural thombus
atrial fib
endocarditis
atrial septal defect

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39
Q

classification of primary brain tumours?

A

not TNM!!!
WHO classification
histology
grade 1 - most begnign
grade 4 - most malignant

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40
Q

most common glioma (astrocytoma) ?

A

Glioblastoma multiforme
most aggressive grade 4

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41
Q

why do brain tumours not metasize ?

A

no lymphatic drainage

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42
Q

origins of secondary brain tumours?

A

-most common:
Lung
● Breast
● Colorectal

● Testicular
● Renal cell
● Malignant melanoma

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43
Q

clinical presentation of brain tumours?

A

high grade - 4-6 weeks = symptoms of raised intercranial pressure = cushings triad
- bradycardia, irregular respirations, widened pulse pressure.

headache
nausea
focal deficits
seizures

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44
Q

focal deficits in brain tumour ?

A

Frontal
- behavioral and emotional changes; impaired judgment, motivation or inhibition; impaired sense of smell or vision loss; paralysis on one side of the body; reduced mental abilities and memory loss.
Parietal
- mpaired speech; problems writing, drawing or naming; lack of recognition; spatial disorders and eye-hand coordination.
Occipital
- : vision loss in one or both eyes, visual field cuts; blurred vision, illusions, hallucinations
temporal
- difficulty speaking and understanding language; short-term and long-term memory problems; increased aggressive behavior

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45
Q

red flags for brain cancer?

A

headaches at night
unilateral
seziures
papilloedema
7th nerve palsy - bells palsy

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46
Q

focal seizure symptoms in parietal lobe?

A

Sensory disturbance – spreading tingling

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47
Q

focal seizure occipital lobe?

A

Positive visual disturbance - coloured balls

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48
Q

temporal lobe focal seizure?

A

Déjà vu
Jamais vu
Memories
Feeling of dread
Rising feelings
strange smells
Loss of awareness of surroundings
Staring
Lip smacking

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49
Q

frontal lobe focal seizure?

A

Limb jerking, head or eye deviation

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50
Q

ix for brain tumours?
what would they find ?

A

CT contrast enhancing
MRI
Brain biopsy/surgery
Histology, molecular markers and genetics:
MGMT methylation
IDH-1 mutation
Chromosome 1p19q loss (in oligodendroglial tumours)

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51
Q

tx for brain tumour ?

A

chemo (Temozolamide, PCV) and surgery to removal
steroids - dexamethasone
pallitive care and social care

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52
Q

tx for tension headaches

A

too much analgasia (opiods) can make it worse
- stress management + amitriptyline

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53
Q

cp for cluster headaches?

A

periodic sever pain
same hour for weeks at a time
unilateral + crescendo (rising in pain) and brief 30-90 min
agitated during the phase

ptosis - droopy eyelid
lacrimtion
nasal congestion
dilated unilateral pupil

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54
Q

epidemology for cluster headaches?

A

men, smoking, 30yrs

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55
Q

tx for acute cluster headaches vs prevention?

A

acute - SC sumatriptin or 100 % o2
prevention - short oral corticosteroids or verapamil (CCB)

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56
Q

side effcts of triptan?

A

asthenia - weakness / lack of energy
dizziness
dysponea -breathlessness
flushing

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57
Q

role of triptan?

A

migraine tx and cluster headaches
seratonin agonists

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58
Q

triggers of migraines?

A

stress -friday at end of work week
lack of sleep
fluctuation of estrogen
chocolate
cheese
red wine

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59
Q

example of anti emetic?

A

metoclopramide

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60
Q

why caution using ergots?

A

tx for migraines but can lead to dependance

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61
Q

dx of trigeminal nueralgia?

A

3 or more epsiodes with symptoms

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62
Q

tx for trigeminal nueralgia?

A

carbamazepine -decreases excitabilty by inhibiting Na+ channels
decompression of vascular loop near trigeminal nerve

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63
Q

3 types of stroke?

A

intrecerebral haemorrage
ischaemic
subarachnoid heamorrage

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64
Q

non modifable risk factors for stroke?

A

race afrocarribean > asian > caucasion
gender male > female
age older
previous vascular event

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65
Q

modifable rf for stroke?

A

DM
hyperlipideamia
smoking
stress - htn
contraceptive pill
polycytheamia

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66
Q

conciousness in stroke vs stroke mimics?

A

stroke - uncommon to have loss of conciousness
stroke mimics - common to loose conciousness

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67
Q

causes of subarachnoid haemmorage?

A

berry aneurysm (ACA or ant communicating) burst or trauma

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68
Q

cp of subarachnoid haemorrhage?

A

thunderclap headache - hit to head
raised bp
vomiting
physcial exertion = worse
loss of conciousness
distressed irritable
photophobia

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69
Q

subarachnoid haemmorhage ix?

A

CSF lumbar
ct scan
angiography ct

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70
Q

csf in viral vs bacterial meningitis?
color?
glucose?
protein?

A

bacterial; cloudy, polymorphs, glucose decreased, protein increased
viral: clear, high lymphocytes, glucose normal, protein increased

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71
Q

what is coning in RIP?

A

downward movement of cerebellar tonsil through foramen magnum - brainstem haemorrhage / obstruction of CSF pathways

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72
Q

ddx of subarachnoid haemorrhage?

A

meningitis
migraine

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73
Q

causes of subdural haemorrhage?

A

trauma - ruptures of bridging veins due to shearing - motoercycles accidenst and child abuse

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74
Q

cp of subdural haemorrhage?

A

slow progression
signs of RIP = cushing triad (bradycardia, wide pulse pressure, rapid breathing)
papillaroedema
cn3 palsy - down n out

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75
Q

tx for subdural haemorrhage?

A

ABCDE, start oxygen, BP normal
burr hole + craniotomy
iv mannitol to reduce ICP pressure

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76
Q

causes of epidural haemorrhage?

A

trauma rupture to middle meningeal artery

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77
Q

cp of extra dural haemorrhage?

A

lucid phase - feel fine
RIP = rapid drop in GCS (cushings triad)
cerebral tonsil coning = resp failure

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78
Q

tonic vs clonic epilepsy?

A

tonic- rigidity and small movement
clonic - jerking larger movements more space in between

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79
Q

ddx of epilepsy?

A
  • reflex syncope -sitting to upright
    duration 5-30 sec
    jerking
  • functional dissociative seizures
    mental prosesses triggered
    1- 20 minutes
    bilateral - tremour
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80
Q

phases of epilepsy?

A

prodrome
aura
ictal event
post ictal event

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81
Q

tx for generalised genetic epilepsy?

A

prevent triggers (predictable circumstances)
sodium valoproate –AED
women 15 - 45 yrs - lamotrigine

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82
Q

complications form tonic clonic seizures?

A

sudden death

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83
Q

tx for focal epilepsy ?

A

lamotrigine
carbamazepine

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84
Q

How does infectious meningitis enter ?

A

nasopharynx
previous surgery
brainstream

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85
Q

causes of meningitis?

A

bacterial
viral
parasitic
fungal

paraneoplastic
drug side effects

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86
Q

triad for meningitis?

A

fever,
headache
rash
neck stiffness

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87
Q

first line for suspected meningitits? 18 years old no PMH ?

A

IM BENZYLPENICILLIN

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88
Q

section of glasgow coma scale

A

best eye response
best verbal response
best motor response

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89
Q

contraindication for LP?

A

CLOTTING derangement
petechial rash
raised intercranial pressure - coning

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90
Q

causes of chronic meningitis?

A

tb and syphilis bacterial
fugal: cryptococcal

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91
Q

sx encephalitis vs meningitis?

A

encephalitis -confused, seizures, no rash

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92
Q

causes of encephalitis?

A

leisterria
herpes
VZV
malaria
Schistosomiasis

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93
Q

meningitis is inflammation of what?

A

pia and arachnoid layer

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94
Q

meningitis in old people?

A

s. pneumoniae
n. meningitidis
l monocytogenes

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95
Q

bacterial causes of meningitis ?

A

neisseria meningitidis (- diplococci)
strep pneumoniae (+ diplococci)
listeria spp (+ rods)
grou b strep (+ cocci)
H influenzae B (- rods)
E coli (- rods)

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96
Q

gram positive bacilli and growth on BA with narrow haemolytic zone?
ABX?

A

listeria monocytogenes
Amoxicillin!

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97
Q

listeria causes meningitis in what cohort of people?

A

immune comprimised!
pregnant
neonates
DM

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98
Q

thiazide vs loop diuretics ?

A

thiazides - increase ca+ reabsorptiom decrease excretion
loop diuretics - increase ca2+ excretion

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99
Q

CP of hypocalcaemia vs hypercalcaemia?

A

Hypo: SPASMODIC
spasm
periorbital numbness
anxious
seizures
muscle tone
orientation impaired
dermatitis
Chvosteks sign
Hyper: Bones, moan, groan, stones

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100
Q

Amaurosis fugax symptoms? what is it? causes

A

curtain descending on vision
painless short-lived monocular blindness

temporary obstruction
Occurs due to the temporary reduction in the retinal, ophthalmic or ciliary blood flow leading to temporary retinal hypoxia.

The principle cause of amaurosis fugax is transient obstruction e.g. due to emboli (atherosclerotic, sclerosis) , of the ophthalmic artery, which is a branch of the internal carotid artery.

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101
Q

common feature of late progression of alzheimers?

A

seizures and myoclonus

102
Q

ix for alzeihmers?

A

dx - pathological findings (history of epidosic memeory loss and negative routine test)
ct scan shows cerebral atrophy in temporal lobes
MRI - cerebral atrophy
CSF - beta amyloids or tau proteins

103
Q

pathophysiology of alzheimers?

A

over expression of APP so amyloid plaques + neurofibrillary tangles develop in the cerebral cortex

104
Q

risk factors for Alzheimer’s ?

A

downs syndrome
apolipoprotein E4 genotype = familial alzeihmers

105
Q

screening tools for dementia?

A

MMSE < 17
look at cognitive, behavioural and psychological symptoms, and the impact symptoms have on their daily life

106
Q

ddx for dementia?

A

delirium
depression

107
Q

cp for lewy body dementia?

A

visual hallucinations
memory disturbance
fluctations
parkinsonianism - no resting tremor

108
Q

pathophysiology of lewy body dementia?

A

lewy bodies alpha synuclein and ubiquitin proteins build up in substantia nigra and cerebral cortex

109
Q

tx for LBD?

A

ACETYLcholinsterase inhibitors - donepezil, galantamine
LEVODOPA - dopamine agonists

110
Q

most common cause of dementia?

A
  1. alzheimers
    2 .vascular dementia
  2. lewy body dementia
  3. frontotemporal lobe dementia - younger onset
111
Q

deteroiation of vascular vs alzheimers dementia?

A

vascular - step wise deteroriation
alzheimers - gradual decline

112
Q

causes of vascular dementia?

A

large vessel atheroma
small vessel vasculitis
lacunes
micro infarcts
all leading to ISCHAEMIA!

113
Q

CP OF vascular dementia?

A

ATTEntional impairment
behavioural change
cognitive slowing

114
Q

tx for vascular dementia?

A

prevent stroke !
ramipril
control of htn , hyperlipideamia
antiplatelets - aspirin or clopidogrel
NOT Acetylcholinesterase inhibitor - donezepil

115
Q

Causes of frontotemporal lobe dementia

A

autosomal dom
Pick bodies - stain silver proteins
with protein tau
chromosome 17

116
Q

CP of frontotemporal lobe dementia ?

A

Frontal atrophy - thinking and memory affected
temporal atrophy - speeech and language

117
Q

ubiquitin positive FTD?

A

FTD with MND
weakness and waisting and/ or limb muscles

118
Q

causes of friederics ataxia?

A

It is an autosomal recessive trinucleotide repeat disorder resulting in reduced level or function of the frataxin protein.

119
Q

history for ataxia?

A

age of onset
rapid or progressive
additional symptoms - urinary problems
family history
alcohol history
patterns of ataxia

120
Q

symptoms for ataxia?

A

dizziness- clumpsy/ wobbly not room spinning
slurred speech
tremor
fine motor skills

121
Q

cigns for ataxia

A

optic atrophy
nystagmus
dysarthria
tremor
dysmetria
wide based gate
tone - normal/ hypo or hyper

122
Q

ix for ataxia

A

FBC
U+E
LFT
HbA1c, b12
esr/ crp
gluten related serology -TGT
HLA - DQ2/ DQ8

MRI - atrophy

123
Q

life expectancy of MND?
RF?.

A

2-4 years less than 10% over 10 years
increased in males
increase with age

124
Q

motor nuerons in primary lateral sclerosis?

A

primary umn

125
Q

MN in primary muscular atrophy?

A

LMN

126
Q

mn in amytotrophic lateral sclerosis

A

both!

127
Q

fasciculations?

A

muscle with no nerves to control them
so neighbouring motor units increase in size
blockier movement - flickers of muscles contracting under skin

128
Q

overlap conditions with MND?

A

frontotemporal dementia
cognitive problems
parkinsonism

129
Q

MN that are unaffected by MND?

A

oculomotor
onuf nucleus -sphinctor functions!
abdominal reflexes are spared

130
Q

ddx with MND

A

spinomuscular atrophy
polio (post polio syndrome)

neuropathies - localised

myasthenia gravis

Parkinsons

131
Q

geentic factors for MND?

A

SOD 1 mutation

132
Q

DX FOR mnd?

A

CLINICAL DIAGNOSIS
Electromyography: in MND there will be evidence of fibrillation potentials
Nerve conduction studies: may show modest reductions in amplitude
MRI spine: imaging can help exclude spinal pathology which may mimic MND, such as cervical cord compression and myelopathy
Lumbar puncture: to exclude inflammatory causes
Pulmonary function tests: patients with MND are at risk of respiratory failure

133
Q

spinal vs bulbar ALS?

A

Spinal ALS (the classic MND syndrome)

Bulbar ALS (with early tongue and bulbar involvement)

134
Q

rf for MS?

A

northern european
female
family history
EBV exposure

135
Q

pathophyiosology of MS?

A

t4 hypersensity reaction against myelin - oligodendrocyte antigens
demyelination of CNS
gliosis follows and grey scar is formed

136
Q

progression of MS? TYPES?

A

relpasing - remitting -> secondary progressive (80%)
primary progressive (10-20%)

137
Q

signs of MS?

A

optic nueritis - cant see red
internuclear opthalmoplegia - inability to adduct and nystagmus of the abducting eye
UMN signs - not LMN
sensory signs = Numbness.
Pins and needles.
Tingling.
Crawling.
charcot neurological triad
electric shock when neck is flexed

138
Q

charcot neurological triad ?

A

nystagmus, - involuntary movement of eyes
intention tremor
scanning or staccato speech.

139
Q

lhermittes syndrome?

A

electric shock when flexing neck

140
Q

symptoms of MS?

A

uthoffs syndrome - sx worse after increased in temp!
blurred vision
parathesia -pins and needles
6th cranial nerve paly - abbducens
fatigue
difficulties swallowing

141
Q

ix for MS?

A

MRI
LUMBNAR PUNCTURE - IgG in CSF
Visual evoked potentials: responses recorded to visual stimulus using electrodes; delayed velocity but a normal amplitude

142
Q

diagnostic criteria for MS?

A

The McDonald criteria is used to diagnose MS.
at least 2 attacks at different times in different spaces (location on the CNS)

143
Q

TX FOR acute MS? relapsing?

A

high dose steroid - IV methylpredisolone
beta interferons - natalizumab
physiotherapy
baclofen for spascticity

144
Q

semantic dementia?

A

loss of knowledge of what objects are

145
Q

2nd line tx for alzheimers?

A

memantine
glutamate receptor antagonist

146
Q

depression vs dementia ?

A

depression - onset after traumatic incident
difficulty sleeping + awarness of memeory loss

147
Q

contraindications of sodium valporate?

A

not appropiate for women of child bearing age, as is tetrogenic

148
Q

side effects of levodopa?

A

hypotension

Restlessness

Gastrointestinal upset

In rare cases, dopamine excess can result in psychiatric reactions including acute psychosis.

149
Q

resp features in systemic sclerosis ?

A

Pulmonary fibrosis.
Pulmonary hypertension. This causes a picture of right heart failure, with exertional dyspnoea and fatigue or weakness with signs of right heart failure (eg. raised venous pressure, peripheral oedema, cardiac heave).
It can be asymptomatic for a long time before becoming rapidly apparent and so should be monitored for regularly with echocardiogram or diffusing capacity (DLco).

150
Q

enal features in systemic sclerosis ?

A

Scleroderma renal crisis. This causes a rapidly progressive renal failure, usually with hypertension which can cause headaches and seizures. Unlike renal disease in systemic lupus erythematosus and rheumatoid arthritis, scleroderma renal crisis is not due to glomerulonephritis, and so nephritic or nephrotic syndromes do not usually occur.

Blood pressure and renal function should be frequently monitored.

151
Q

visual field defect most common in optic neuritis?

A

central scotoma - black blur/ cot in middle of vision

152
Q

nitrates and viagra?

A

major contraindications since viagra causes vasodilation by enchancing NO effect

153
Q

where do vertebrl arteries arise from?

A

right vertebral from right subclavian from brachiocephalic
left vertebral from left subclavian straight from aorta

154
Q

right vs left common carotid ?

A

right from brachiocephalic
left from aorta

155
Q

function of calcium channel blocker in SAH?

A

VASOSPAMS to optimise cerebral perfusion
IV NIMODIPINE

156
Q

tx for major bleed on warfarin?

A

stop warfarin
vit K iv
prothrombin complex conc

157
Q

surgical tx for subarachnoid haem?

A

surgical clippin
endovascular coiling

158
Q

complications from MS?

A

spasiticy
immobilty
depression
fatigue
inconctinence
sexual dysfunction
cognitive impairement
tremor
ataxia

159
Q

essential tremor vs parkinson tremor?

A

essential - intention tremor = worsens with movement
parkinsons - resting tremor
pill rolling tremor

160
Q

medical tx for parkinson?

A

levodopa - as dose wears off, dyskinesia
MOA B inhibitors - selelgiline
dopamine agonists - ropinirole - sleepiness/ hallocunaitions

161
Q

dx for parkinsonism?

A

bradykinesia plus one - tremor, rigidity, postural insitibilty

162
Q

tx for migraines?

A

ibuprofen
spirin
triptans
antiemetics

163
Q

prophylactic for migraines?

A

PROPANOLOl
TOPIRAMATE - epilepsy
amitriptyline

164
Q

HYPONATREAMIa on braine?

A

cerebral oedma
movement from fluid into brain

165
Q

cure to increased intracranial pressure?

A

manitol
- hypertonic fluid
causes fluid out of brain

166
Q

medications with chlordiazepoxide?

A

thiamine
tx for chronic alchoholism
alcoholism causes thiamine deficency

167
Q

wernickes vs korsakoffs syndorme

A

wernickes - confusion, the inability to coordinate voluntary movement (ataxia) and eye (ocular) abnormalities
progresses to irreversible WKS (CAUSED BY ALCOHOL)

168
Q

ix for TIA?

A

history
ct head

169
Q

example of inherited anticipation?

A

Huntingtons
onset at younger ages with each generation due to progressive expansion of the CAG repeat

170
Q

dx of huntingtons?

A

genetic testing
clinical diagnosis

171
Q

tx of huntingtons?

A

chorea - jerking movements
neuroleptics - risperidone
tetrabenazine

172
Q

carbamazine and contraceptive pill and women of child bearing age ?
pregnancy what to do ?

A

The efficacy of the combined oral contraceptive pill is markedly reduced by interaction with drugs that induce hepatic enzyme activity such as Carbamazepine. There is therefore an increased risk of pregnancy due to decreased efficacy, and also increased risk of teratogenicity due to the anti-convulsant medication.

take folic acid!

173
Q

side effects of carbamize ?

A

leucopenia, thombocytopenia, hyponatraemia and hepatic dysfunction.

174
Q

pathologies affecting motor neurons?

A

MND, spinal atrophy, polio infection

175
Q

causes of spinal muscular atrophy ?

A

mutation of SMN1 gets deleted

176
Q

symtoms of peripheral nerve problems?

A

burning, tingling, freezing pain, numbness
weakness and muscle wasting
muscle coordination
foot drop
wrist drop

177
Q

presentation of mononeuropathy mulitple?

A

mutliple single nerves affect- asymmetrical numbeness
peripheral

178
Q

signs of CMT?

A

high arch feet
waiting of lower ankle and calfes
mes lines on nails
toes curled up
foot drop

179
Q

dx for CMt?

A

NCS
nerve biopsy
genetic testing

180
Q

causes of CMT?

A

pns polyneuropathy
auto dom on chromosome 17

181
Q

tx for guillain barre syndrome?

A

IViG and plasma exchange

182
Q

signs of mysthania gravis?

A

bulbar problem
fatigue ability quickly
swallowing difficulty
mysthenic snarl - face stuck
ptosis
starts head and neck
diplopia

183
Q

ages of mystheania gravis

A

young women and older men

184
Q

ddx for mysthaenia gravis?

A

miller fisher, graves disease
botulism
mitochondrial CPEO

185
Q

ix for mystheania gravis?

A

antibodies
EMG - muscle stimulation
SFEMG - senstive
nerve conduction studies
thoracic ct to exclude thymoma

186
Q

tx for mysthaenia gravis?

A

ACUTE: iv Ig - for acute !
- plasma exchange

1st line for long term - ACHesterase inhibitors - pyridostigmine
thymectomy
long term- corticosteroids

187
Q

causes of TIA?

A

atherothomboembloism mostly from the heart

188
Q

symptoms of TIA in carotid region?

A

aaures fugax
aphasia
hemipareisis
hemisensroy loss
hemianopic visual loss

189
Q

Ix of TIA

A

ct
doppler
angiography
FBS, inr, u+e
ECG

190
Q

tia tx?

A

300 mg aspirin
refer to specialist
antiplaetelet
75 mg aspirin daily with clopidogrel

191
Q

classification of stroke?

A

bramford stroke classification
TACS
PACS
LACS
POCS

192
Q

TACS symptoms?

A

ACA + MCA affected
ACA
leg weakness
gait apraxia
incontinence
drowsiness - frontal lobe

MCA
contralateral
weakness of face, arm + leg
homonymous hemianopia
higher cerebral dysfunction - dysphasia, aphasia

193
Q

PACS

A

partial anterior circulatory stroke
2 of the following
limb weakness
homonomous hemianopia
higher cerebral dsfunction - dysphagia

194
Q

LACS

A

lucenar stroke subcortical stroke secondary to small vessel disease

ataxic hemipareisis
pure sensory stroke
pure motor stroke

195
Q

POCS

A

posterior circulation syndrome
cranial nerve palsy
motor deficit
vertigo
nystagmus

196
Q

brainstem infarct CP?

A

quadrplegia
dysarthria + speech impairement
vertigo, n+v
loc/ DROWSINESS
locked in syndrome!

197
Q

tx for haemorragic stroke/

A

stop anticoagulants
reverse coagulation
lower BP - to below <140mmhg
IV manitol - hypertonic - fluid out of brain
decompression/ shunting

198
Q

rf for berry aneurysms

A
  • mostly anterior communicating + posterior
    PKD
    coarctation of aorta
    connective tissue disorder - marfans
199
Q

meningism during SAH? CP?

A

BLOOD causesing CSF blockage
hydrocephalus

Kernigs
Brudzinkis

200
Q

ix for SAH?

A

STARSHAPED ON ct
lumbar puncture - yellow with blood in csf (not if RIP)
MRI
CT angiography

201
Q

px for subdura;?

A

bleeding into bridging of subdural veins

202
Q

extradural haemmorage tx?

A

abcde assesment
iv mannitol
clot evacuation, ligation of middle meningeal artery

203
Q

fungal causes of menigintis?

A

cryptococcus neoformans

204
Q

csf in acute baterial vs chronic meningitis?

A

chronic - greeny
acute - cloudy pus

205
Q

rask in menigitis?

A

meningococcal septicaemia

206
Q

complications from meningits?

A

hearing loss
epilepsy
impairement

207
Q

prodrome:?

A

symptoms precede an epileptic attack

208
Q

status epilepticus?

A

seizure longer than 5 min

209
Q

tx for status epilepticus

A

iv benzodiapines - lorazepam
rectally if no IV

210
Q

myastheania crisis vs cholingeric?

A

cholgineric - OD of anticholinesterase drugs
muscle fasiculation
paralysis
pallor
sweating
small pupils

myasthenia
sever weakness
resp wekaness - shortness of breath

211
Q

drugs to avoid with mysaethnia gravis?

A

bb
gentamycin
ciprofloxacin
azithromycin
lithium

212
Q

pathophys of LEMS?

A

ANTIBODIES in presynaptic neuron block voltage gated calcium channels so no ACh released

213
Q

signs of LEMS?

A

DRY MOUTH
muscle weakness
cardinal sign: absence of tendon reflexes which return after contraction of relevant muscle

214
Q

dx of LEMS?

A

Electromyography: measures the electrical activity of muscles, lowered amplitude (similar to myasthenia gravis) but amplitude increases post exercise
antibodies

215
Q

LEMS associated with?

A

malignancy

216
Q

ix for epilepsy ?

A

EEG
CT
FBC
GLUCOSE
blood cultues
csf

217
Q

ecg of duchenne muscular dystrophy?

A

deep q waves
inverted t waves
tall r waves

218
Q

cause of parapelegia?

A

paralysis of BOTH LEGS ALWAYS caused by spinal cord lesion

219
Q

spinal cord compression symtpoms?

A

UMN symtpoms

220
Q

causes of spinal cord compression?

A

Osteophytes, Disc prolapse (slower onset), Tumour (slow onset)

221
Q

ix and tx of spinal cord compression?

A

Ix; MRI urgent
Tx: surgical decompression and dexamethasone

222
Q

cauda equina syndrome causes and sx?

A

Causes: Tumours, disc herniation, trauma can cause the compression
Sx: Lumbosacral pain (early), Saddle anesthesia (Do PR), areflexia, fasciculations, Loss of bowel / bladder control, urinary retention (late)

223
Q

cauda equina syndrome ix and tx?

A

MRI Spine
Do PR
Tx: Surgical decompression, high dose dexamethasone

224
Q

red flags for cauda equina syndrome?

A

Bilateral sciatica
Bilateral flaccid leg weakness
Saddle anesthesia
Bladder and bowel dysfunction
Erectile dysfunction
Areflexia

225
Q

damage to left meyers loop?

A

temporal damage right after visual cortex and before optic radiation
causes homonymous upper quadrantinopia

left upper nasal vision and right upper temporal vision

226
Q

damage to left baums loop?

A

baums loop is parietal right after visual cortex ]

homonymous lower quadrantinopia

left eye lower nasal and right lower temporal

227
Q

tx for carpel tunnel syndrome?

A

conservative - pain relief/ splint at night
hydrocortisone injection
surgery decompression

228
Q

cp of carpel tunnel syndrome?

A

Pain and paresthesia in hand (wake and shake-worse at night)
Loss of sensation Median nerve distribution (palm radial 3)
Wasting of abductor pollicis brevis – wasting of thenar eminence

229
Q

cancer associated with lambert eaton syndrome?

A

small cell ca lung!

230
Q

ide effects of mannitol?

A

pulmonary oedma

231
Q

tx for status epilepticus ?

A

1st - IV benzodiazapine lorazepam
2nd - phenobarbital
3rd- phenytoin

232
Q

tx for partial seizures?

A

carbazapine or lamotrigine

233
Q

signs positive for meningococcal septiceamia?

A

kernigs and brudzinksi test
kernigs - Knee extension is painful ! lie at 90 degress
brudzinksi - Neck flexion leads to kNee flexion

234
Q

peroneal nerve palsy CP vs L5 root lesion?

A

PNP - no enkle eversion and dorsiflexion
l5 root lesions - no ankle eversion, inversion and dorsiflexion

235
Q

tx for status epilepticus?

A

iv lorazapam

236
Q

Role of TLR 1 + 2
TLR 2+ 6?

A

BACTERIA
FUNGI
Lipoproteins
peptido glycans

237
Q

rOLE of TLR 4?

A

LIPOPOLYSACCHARIDES
gram negative

238
Q

role of TLR 5 ?

A

detects flagella

239
Q

which tlr are found within the endosome? intracellular?

A

TLR 3 - dna
TLR 7 + 8 - single stranded rna
tlr 9 - dna of bacteria and fungi

240
Q

role of dobutamine

A

increase force and rate of contraction of heart
agonist of b1 receptors - 1 heart
small input of alpa 1 receptors - arteries - vasoconstriction increases bp
small input of b2 receptors - 2 lungs

241
Q

tx for pneumocystits pneumonia

A

co tramoxazole

242
Q

anticholinesterase inhibitors?
side effects?
use?

A

donepezil + pyridostigmine
- alzheimers, MG, LE syndrome
fatigue, vomiting, diarrhoea, aggitiation

243
Q

horner syndrome caused by? features?

A

PAM
whore
HORNER

Ptosis
Anhidrosis - no sweating
Miosis

lesions the sympathetic trunk + pancoasts tumour

244
Q

guillain barre damage to what cells?

A

schwann cells

245
Q

when to do lumbar puncture in subdural haemorrage ?

A

12 hours so blood (bilirubin) is present in CSF

246
Q

pathophysiology of parkinsons ?

A

Substantia Nigra PARS COMPACTA (1) which results in an impaired NIGROSTRIATAL PATHWAY (1) and therefore results in PROBLEMS INITAIATING MOVEMENT

247
Q

test for ankylosing spondylosis?

A

schobers test
locate L5 and measure 10 cm above and 5 cm below adn then ask to bend as far as they can and if its less 20 cm thats a positive schober sign

248
Q

mech of action of paracetemol?

A

inhibit cox in CNS
inhibiting prostaglandin synthesis

249
Q

secondary causes of UTI?

A

INFLAMMATION OF BLADDER - CYSTITIS

250
Q

bleeding where in extradural haemorage?

A

middle meningeal artery

251
Q

OPIOD ANATGOINST FOR OPIOD OVERDOSE?

A

naloxone

Phase 2a (9 decks)

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