neuro Flashcards
1
Q
contents in subarachnoid space?
A
CSF
2
Q
subdural space contents?
A
bridging veins
3
Q
extradural space contents?
A
very narrow - potential space with meningeal vessels
4
Q
bleeding of cerebral vessels what space they bleed into?
A
subarachnoid
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
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
7
Q
cp of subarachnoid haemorrage?
A
hit on back of head pain - sudden
may be concious - > unconscious
can be fatal
8
Q
ct scan of Sub arachnoid HEAMORRAGE
A
fresh white in fissures and cisterns - into nooks and crannies
9
Q
blood supply to lateral cerebral hemisphere?
A
middle cerebral artery
10
Q
anterior cerebral hemisphere blood suple?
A
anterior cerebral artery
11
Q
medial cerebral hemisphere blood supply?
A
anterior and posterior cerebral artery
12
Q
where is primary visual cotex?
A
medial surface of occipital lobe
13
Q
CONTENTS of spinal nerves?
A
motor fibres for skeletal muscles and sensory fibre
sympathetic fibres - smooth muscle and sweat glands
14
Q
location of motor neurons in spinal cord?
A
ventral grey horn
15
Q
location of sympathetic neurons?
A
T1 - L2
16
Q
WHERE is location of parasymoathetic nuerons ?
A
brainstem and sacral
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
18
Q
injury to the corticospinal tract ?
A
origin is contralateral but if injury in chord there will be weakness on same side
19
Q
ascending sensory pathways ?
A
DCML and Spinthalamic
20
Q
lesions to DCML?
A
ipsilateral loss of fine touch and propioception becuase decussates in medulla in brainstem
21
Q
lesion in spinothlamic tract ?
A
contralateral loss of impaired pain and temp sensation
22
Q
cranial nerves may contain which fibre types ?
A
23
Q
how to test trochlear?
A
movement of sup oblique
look medially and down
24
Q
how to test abducens?
A
abduct eye
lateral recturs movement
25
facial nerve?
anterior 2/3 taste tongue
muscle facial expression - facial weakness
26
upper face innervation?
from contralateral and ipsilateral - both side of cortex -facial nerve
27
lower facial innervation?
from contralateral - opposite side of cortex - facial nerve
28
viral causes of meningitis?
Enteroviruses (including Echo virus, Coxsackie virus)
Herpes simplex virus
Mumps virus
Lymphocytic chorio meningitis virus
And historically, Poliovirus (also an enterovirus)
29
ix for encaphalitis?
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.
30
CSF results consistant with bacterial encephalitis
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.
31
dominant hemisphere stroke symptoms?
left
expresive dysphasia
receptive dysphasia
dyslexia
dysgraphia
32
non dominant stroke symptoms?
usually right handed
anosognosia
denial of weakness/ neglect of paralysed limb
dressing apraxia
geographical agnosia
33
differential from strokes?
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
34
ix for stroke?
GS ?
1ST line?
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
35
tx for ischeamic stroke?
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
36
classification scheme for ischeamic stroke?
most common cause of ischaemic stroke?
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.
37
causes of small vessle ischeamic strokedisease? signs on scan?
htn
diabetes
smoking
aging
lacunes on brain
38
causes of cardioembolism?
mural thombus
atrial fib
endocarditis
atrial septal defect
39
classification of primary brain tumours?
not TNM!!!
WHO classification
histology
grade 1 - most begnign
grade 4 - most malignant
40
most common glioma (astrocytoma) ?
Glioblastoma multiforme
most aggressive grade 4
41
why do brain tumours not metasize ?
no lymphatic drainage
42
origins of secondary brain tumours?
-most common:
Lung
● Breast
● Colorectal
● Testicular
● Renal cell
● Malignant melanoma
43
clinical presentation of brain tumours?
high grade - 4-6 weeks = symptoms of raised intercranial pressure = cushings triad
- bradycardia, irregular respirations, widened pulse pressure.
headache
nausea
focal deficits
seizures
44
focal deficits in brain tumour ?
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
45
red flags for brain cancer?
headaches at night
unilateral
seziures
papilloedema
7th nerve palsy - bells palsy
46
focal seizure symptoms in parietal lobe?
Sensory disturbance – spreading tingling
47
focal seizure occipital lobe?
Positive visual disturbance - coloured balls
48
temporal lobe focal seizure?
Déjà vu
Jamais vu
Memories
Feeling of dread
Rising feelings
strange smells
Loss of awareness of surroundings
Staring
Lip smacking
49
frontal lobe focal seizure?
Limb jerking, head or eye deviation
50
ix for brain tumours?
what would they find ?
CT contrast enhancing
MRI
Brain biopsy/surgery
Histology, molecular markers and genetics:
MGMT methylation
IDH-1 mutation
Chromosome 1p19q loss (in oligodendroglial tumours)
51
tx for brain tumour ?
chemo (Temozolamide, PCV) and surgery to removal
steroids - dexamethasone
pallitive care and social care
52
tx for tension headaches
too much analgasia (opiods) can make it worse
- stress management + amitriptyline
53
cp for cluster headaches?
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
54
epidemology for cluster headaches?
men, smoking, 30yrs
55
tx for acute cluster headaches vs prevention?
acute - SC sumatriptin or 100 % o2
prevention - short oral corticosteroids or verapamil (CCB)
56
side effcts of triptan?
asthenia - weakness / lack of energy
dizziness
dysponea -breathlessness
flushing
57
role of triptan?
migraine tx and cluster headaches
seratonin agonists
58
triggers of migraines?
stress -friday at end of work week
lack of sleep
fluctuation of estrogen
chocolate
cheese
red wine
59
example of anti emetic?
metoclopramide
60
why caution using ergots?
tx for migraines but can lead to dependance
61
dx of trigeminal nueralgia?
3 or more epsiodes with symptoms
62
tx for trigeminal nueralgia?
carbamazepine -decreases excitabilty by inhibiting Na+ channels
decompression of vascular loop near trigeminal nerve
63
3 types of stroke?
intrecerebral haemorrage
ischaemic
subarachnoid heamorrage
64
non modifable risk factors for stroke?
race afrocarribean > asian > caucasion
gender male > female
age older
previous vascular event
65
modifable rf for stroke?
DM
hyperlipideamia
smoking
stress - htn
contraceptive pill
polycytheamia
66
conciousness in stroke vs stroke mimics?
stroke - uncommon to have loss of conciousness
stroke mimics - common to loose conciousness
67
causes of subarachnoid haemmorage?
berry aneurysm (ACA or ant communicating) burst or trauma
68
cp of subarachnoid haemorrhage?
thunderclap headache - hit to head
raised bp
vomiting
physcial exertion = worse
loss of conciousness
distressed irritable
photophobia
69
subarachnoid haemmorhage ix?
CSF lumbar
ct scan
angiography ct
70
csf in viral vs bacterial meningitis?
color?
glucose?
protein?
bacterial; cloudy, polymorphs, glucose decreased, protein increased
viral: clear, high lymphocytes, glucose normal, protein increased
71
what is coning in RIP?
downward movement of cerebellar tonsil through foramen magnum - brainstem haemorrhage / obstruction of CSF pathways
72
ddx of subarachnoid haemorrhage?
meningitis
migraine
73
causes of subdural haemorrhage?
trauma - ruptures of bridging veins due to shearing - motoercycles accidenst and child abuse
74
cp of subdural haemorrhage?
slow progression
signs of RIP = cushing triad (bradycardia, wide pulse pressure, rapid breathing)
papillaroedema
cn3 palsy - down n out
75
tx for subdural haemorrhage?
ABCDE, start oxygen, BP normal
burr hole + craniotomy
iv mannitol to reduce ICP pressure
76
causes of epidural haemorrhage?
trauma rupture to middle meningeal artery
77
cp of extra dural haemorrhage?
lucid phase - feel fine
RIP = rapid drop in GCS (cushings triad)
cerebral tonsil coning = resp failure
78
tonic vs clonic epilepsy?
tonic- rigidity and small movement
clonic - jerking larger movements more space in between
79
ddx of epilepsy?
- reflex syncope -sitting to upright
duration 5-30 sec
jerking
- functional dissociative seizures
mental prosesses triggered
1- 20 minutes
bilateral - tremour
80
phases of epilepsy?
prodrome
aura
ictal event
post ictal event
81
tx for generalised genetic epilepsy?
prevent triggers (predictable circumstances)
sodium valoproate --AED
women 15 - 45 yrs - lamotrigine
82
complications form tonic clonic seizures?
sudden death
83
tx for focal epilepsy ?
lamotrigine
carbamazepine
84
How does infectious meningitis enter ?
nasopharynx
previous surgery
brainstream
85
causes of meningitis?
bacterial
viral
parasitic
fungal
paraneoplastic
drug side effects
86
triad for meningitis?
fever,
headache
rash
neck stiffness
87
first line for suspected meningitits? 18 years old no PMH ?
IM BENZYLPENICILLIN
88
section of glasgow coma scale
best eye response
best verbal response
best motor response
89
contraindication for LP?
CLOTTING derangement
petechial rash
raised intercranial pressure - coning
90
causes of chronic meningitis?
tb and syphilis bacterial
fugal: cryptococcal
91
sx encephalitis vs meningitis?
encephalitis -confused, seizures, no rash
92
causes of encephalitis?
leisterria
herpes
VZV
malaria
Schistosomiasis
93
meningitis is inflammation of what?
pia and arachnoid layer
94
meningitis in old people?
s. pneumoniae
n. meningitidis
l monocytogenes
95
bacterial causes of meningitis ?
neisseria meningitidis (- diplococci)
strep pneumoniae (+ diplococci)
listeria spp (+ rods)
grou b strep (+ cocci)
H influenzae B (- rods)
E coli (- rods)
96
gram positive bacilli and growth on BA with narrow haemolytic zone?
ABX?
listeria monocytogenes
Amoxicillin!
97
listeria causes meningitis in what cohort of people?
immune comprimised!
pregnant
neonates
DM
98
thiazide vs loop diuretics ?
thiazides - increase ca+ reabsorptiom decrease excretion
loop diuretics - increase ca2+ excretion
99
CP of hypocalcaemia vs hypercalcaemia?
Hypo: SPASMODIC
spasm
periorbital numbness
anxious
seizures
muscle tone
orientation impaired
dermatitis
Chvosteks sign
Hyper: Bones, moan, groan, stones
100
Amaurosis fugax symptoms? what is it? causes
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.
101
common feature of late progression of alzheimers?
seizures and myoclonus
102
ix for alzeihmers?
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
pathophysiology of alzheimers?
over expression of APP so amyloid plaques + neurofibrillary tangles develop in the cerebral cortex
104
risk factors for Alzheimer's ?
downs syndrome
apolipoprotein E4 genotype = familial alzeihmers
105
screening tools for dementia?
MMSE < 17
look at cognitive, behavioural and psychological symptoms, and the impact symptoms have on their daily life
106
ddx for dementia?
delirium
depression
107
cp for lewy body dementia?
visual hallucinations
memory disturbance
fluctations
parkinsonianism - no resting tremor
108
pathophysiology of lewy body dementia?
lewy bodies alpha synuclein and ubiquitin proteins build up in substantia nigra and cerebral cortex
109
tx for LBD?
ACETYLcholinsterase inhibitors - donepezil, galantamine
LEVODOPA - dopamine agonists
110
most common cause of dementia?
1. alzheimers
2 .vascular dementia
3. lewy body dementia
4. frontotemporal lobe dementia - younger onset
111
deteroiation of vascular vs alzheimers dementia?
vascular - step wise deteroriation
alzheimers - gradual decline
112
causes of vascular dementia?
large vessel atheroma
small vessel vasculitis
lacunes
micro infarcts
all leading to ISCHAEMIA!
113
CP OF vascular dementia?
ATTEntional impairment
behavioural change
cognitive slowing
114
tx for vascular dementia?
prevent stroke !
ramipril
control of htn , hyperlipideamia
antiplatelets - aspirin or clopidogrel
NOT Acetylcholinesterase inhibitor - donezepil
115
Causes of frontotemporal lobe dementia
autosomal dom
Pick bodies - stain silver proteins
with protein tau
chromosome 17
116
CP of frontotemporal lobe dementia ?
Frontal atrophy - thinking and memory affected
temporal atrophy - speeech and language
117
ubiquitin positive FTD?
FTD with MND
weakness and waisting and/ or limb muscles
118
causes of friederics ataxia?
It is an autosomal recessive trinucleotide repeat disorder resulting in reduced level or function of the frataxin protein.
119
history for ataxia?
age of onset
rapid or progressive
additional symptoms - urinary problems
family history
alcohol history
patterns of ataxia
120
symptoms for ataxia?
dizziness- clumpsy/ wobbly not room spinning
slurred speech
tremor
fine motor skills
121
cigns for ataxia
optic atrophy
nystagmus
dysarthria
tremor
dysmetria
wide based gate
tone - normal/ hypo or hyper
122
ix for ataxia
FBC
U+E
LFT
HbA1c, b12
esr/ crp
gluten related serology -TGT
HLA - DQ2/ DQ8
MRI - atrophy
123
life expectancy of MND?
RF?.
2-4 years less than 10% over 10 years
increased in males
increase with age
124
motor nuerons in primary lateral sclerosis?
primary umn
125
MN in primary muscular atrophy?
LMN
126
mn in amytotrophic lateral sclerosis
both!
127
fasciculations?
muscle with no nerves to control them
so neighbouring motor units increase in size
blockier movement - flickers of muscles contracting under skin
128
overlap conditions with MND?
frontotemporal dementia
cognitive problems
parkinsonism
129
MN that are unaffected by MND?
oculomotor
onuf nucleus -sphinctor functions!
abdominal reflexes are spared
130
ddx with MND
spinomuscular atrophy
polio (post polio syndrome)
neuropathies - localised
myasthenia gravis
Parkinsons
131
geentic factors for MND?
SOD 1 mutation
132
DX FOR mnd?
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
spinal vs bulbar ALS?
Spinal ALS (the classic MND syndrome)
Bulbar ALS (with early tongue and bulbar involvement)
134
rf for MS?
northern european
female
family history
EBV exposure
135
pathophyiosology of MS?
t4 hypersensity reaction against myelin - oligodendrocyte antigens
demyelination of CNS
gliosis follows and grey scar is formed
136
progression of MS? TYPES?
relpasing - remitting -> secondary progressive (80%)
primary progressive (10-20%)
137
signs of MS?
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
charcot neurological triad ?
nystagmus, - involuntary movement of eyes
intention tremor
scanning or staccato speech.
139
lhermittes syndrome?
electric shock when flexing neck
140
symptoms of MS?
uthoffs syndrome - sx worse after increased in temp!
blurred vision
parathesia -pins and needles
6th cranial nerve paly - abbducens
fatigue
difficulties swallowing
141
ix for MS?
MRI
LUMBNAR PUNCTURE - IgG in CSF
Visual evoked potentials: responses recorded to visual stimulus using electrodes; delayed velocity but a normal amplitude
142
diagnostic criteria for MS?
The McDonald criteria is used to diagnose MS.
at least 2 attacks at different times in different spaces (location on the CNS)
143
TX FOR acute MS? relapsing?
high dose steroid - IV methylpredisolone
beta interferons - natalizumab
physiotherapy
baclofen for spascticity
144
semantic dementia?
loss of knowledge of what objects are
145
2nd line tx for alzheimers?
memantine
glutamate receptor antagonist
146
depression vs dementia ?
depression - onset after traumatic incident
difficulty sleeping + awarness of memeory loss
147
contraindications of sodium valporate?
not appropiate for women of child bearing age, as is tetrogenic
148
side effects of levodopa?
hypotension
Restlessness
Gastrointestinal upset
In rare cases, dopamine excess can result in psychiatric reactions including acute psychosis.
149
resp features in systemic sclerosis ?
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
enal features in systemic sclerosis ?
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
visual field defect most common in optic neuritis?
central scotoma - black blur/ cot in middle of vision
152
nitrates and viagra?
major contraindications since viagra causes vasodilation by enchancing NO effect
153
where do vertebrl arteries arise from?
right vertebral from right subclavian from brachiocephalic
left vertebral from left subclavian straight from aorta
154
right vs left common carotid ?
right from brachiocephalic
left from aorta
155
function of calcium channel blocker in SAH?
VASOSPAMS to optimise cerebral perfusion
IV NIMODIPINE
156
tx for major bleed on warfarin?
stop warfarin
vit K iv
prothrombin complex conc
157
surgical tx for subarachnoid haem?
surgical clippin
endovascular coiling
158
complications from MS?
spasiticy
immobilty
depression
fatigue
inconctinence
sexual dysfunction
cognitive impairement
tremor
ataxia
159
essential tremor vs parkinson tremor?
essential - intention tremor = worsens with movement
parkinsons - resting tremor
pill rolling tremor
160
medical tx for parkinson?
levodopa - as dose wears off, dyskinesia
MOA B inhibitors - selelgiline
dopamine agonists - ropinirole - sleepiness/ hallocunaitions
161
dx for parkinsonism?
bradykinesia plus one - tremor, rigidity, postural insitibilty
162
tx for migraines?
ibuprofen
spirin
triptans
antiemetics
163
prophylactic for migraines?
PROPANOLOl
TOPIRAMATE - epilepsy
amitriptyline
164
HYPONATREAMIa on braine?
cerebral oedma
movement from fluid into brain
165
cure to increased intracranial pressure?
manitol
- hypertonic fluid
causes fluid out of brain
166
medications with chlordiazepoxide?
thiamine
tx for chronic alchoholism
alcoholism causes thiamine deficency
167
wernickes vs korsakoffs syndorme
wernickes - confusion, the inability to coordinate voluntary movement (ataxia) and eye (ocular) abnormalities
progresses to irreversible WKS (CAUSED BY ALCOHOL)
168
ix for TIA?
history
ct head
169
example of inherited anticipation?
Huntingtons
onset at younger ages with each generation due to progressive expansion of the CAG repeat
170
dx of huntingtons?
genetic testing
clinical diagnosis
171
tx of huntingtons?
chorea - jerking movements
neuroleptics - risperidone
tetrabenazine
172
carbamazine and contraceptive pill and women of child bearing age ?
pregnancy what to do ?
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
side effects of carbamize ?
leucopenia, thombocytopenia, hyponatraemia and hepatic dysfunction.
174
pathologies affecting motor neurons?
MND, spinal atrophy, polio infection
175
causes of spinal muscular atrophy ?
mutation of SMN1 gets deleted
176
symtoms of peripheral nerve problems?
burning, tingling, freezing pain, numbness
weakness and muscle wasting
muscle coordination
foot drop
wrist drop
177
presentation of mononeuropathy mulitple?
mutliple single nerves affect- asymmetrical numbeness
peripheral
178
signs of CMT?
high arch feet
waiting of lower ankle and calfes
mes lines on nails
toes curled up
foot drop
179
dx for CMt?
NCS
nerve biopsy
genetic testing
180
causes of CMT?
pns polyneuropathy
auto dom on chromosome 17
181
tx for guillain barre syndrome?
IViG and plasma exchange
182
signs of mysthania gravis?
bulbar problem
fatigue ability quickly
swallowing difficulty
mysthenic snarl - face stuck
ptosis
starts head and neck
diplopia
183
ages of mystheania gravis
young women and older men
184
ddx for mysthaenia gravis?
miller fisher, graves disease
botulism
mitochondrial CPEO
185
ix for mystheania gravis?
antibodies
EMG - muscle stimulation
SFEMG - senstive
nerve conduction studies
thoracic ct to exclude thymoma
186
tx for mysthaenia gravis?
ACUTE: iv Ig - for acute !
- plasma exchange
1st line for long term - ACHesterase inhibitors - pyridostigmine
thymectomy
long term- corticosteroids
187
causes of TIA?
atherothomboembloism mostly from the heart
188
symptoms of TIA in carotid region?
aaures fugax
aphasia
hemipareisis
hemisensroy loss
hemianopic visual loss
189
Ix of TIA
ct
doppler
angiography
FBS, inr, u+e
ECG
190
tia tx?
300 mg aspirin
refer to specialist
antiplaetelet
75 mg aspirin daily with clopidogrel
191
classification of stroke?
bramford stroke classification
TACS
PACS
LACS
POCS
192
TACS symptoms?
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
PACS
partial anterior circulatory stroke
2 of the following
limb weakness
homonomous hemianopia
higher cerebral dsfunction - dysphagia
194
LACS
lucenar stroke subcortical stroke secondary to small vessel disease
ataxic hemipareisis
pure sensory stroke
pure motor stroke
195
POCS
posterior circulation syndrome
cranial nerve palsy
motor deficit
vertigo
nystagmus
196
brainstem infarct CP?
quadrplegia
dysarthria + speech impairement
vertigo, n+v
loc/ DROWSINESS
locked in syndrome!
197
tx for haemorragic stroke/
stop anticoagulants
reverse coagulation
lower BP - to below <140mmhg
IV manitol - hypertonic - fluid out of brain
decompression/ shunting
198
rf for berry aneurysms
- mostly anterior communicating + posterior
PKD
coarctation of aorta
connective tissue disorder - marfans
199
meningism during SAH? CP?
BLOOD causesing CSF blockage
hydrocephalus
Kernigs
Brudzinkis
200
ix for SAH?
STARSHAPED ON ct
lumbar puncture - yellow with blood in csf (not if RIP)
MRI
CT angiography
201
px for subdura;?
bleeding into bridging of subdural veins
202
extradural haemmorage tx?
abcde assesment
iv mannitol
clot evacuation, ligation of middle meningeal artery
203
fungal causes of menigintis?
cryptococcus neoformans
204
csf in acute baterial vs chronic meningitis?
chronic - greeny
acute - cloudy pus
205
rask in menigitis?
meningococcal septicaemia
206
complications from meningits?
hearing loss
epilepsy
impairement
207
prodrome:?
symptoms precede an epileptic attack
208
status epilepticus?
seizure longer than 5 min
209
tx for status epilepticus
iv benzodiapines - lorazepam
rectally if no IV
210
myastheania crisis vs cholingeric?
cholgineric - OD of anticholinesterase drugs
muscle fasiculation
paralysis
pallor
sweating
small pupils
myasthenia
sever weakness
resp wekaness - shortness of breath
211
drugs to avoid with mysaethnia gravis?
bb
gentamycin
ciprofloxacin
azithromycin
lithium
212
pathophys of LEMS?
ANTIBODIES in presynaptic neuron block voltage gated calcium channels so no ACh released
213
signs of LEMS?
DRY MOUTH
muscle weakness
cardinal sign: absence of tendon reflexes which return after contraction of relevant muscle
214
dx of LEMS?
Electromyography: measures the electrical activity of muscles, lowered amplitude (similar to myasthenia gravis) but amplitude increases post exercise
antibodies
215
LEMS associated with?
malignancy
216
ix for epilepsy ?
EEG
CT
FBC
GLUCOSE
blood cultues
csf
217
ecg of duchenne muscular dystrophy?
deep q waves
inverted t waves
tall r waves
218
cause of parapelegia?
paralysis of BOTH LEGS ALWAYS caused by spinal cord lesion
219
spinal cord compression symtpoms?
UMN symtpoms
220
causes of spinal cord compression?
Osteophytes, Disc prolapse (slower onset), Tumour (slow onset)
221
ix and tx of spinal cord compression?
Ix; MRI urgent
Tx: surgical decompression and dexamethasone
222
cauda equina syndrome causes and sx?
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
cauda equina syndrome ix and tx?
MRI Spine
Do PR
Tx: Surgical decompression, high dose dexamethasone
224
red flags for cauda equina syndrome?
Bilateral sciatica
Bilateral flaccid leg weakness
Saddle anesthesia
Bladder and bowel dysfunction
Erectile dysfunction
Areflexia
225
damage to left meyers loop?
temporal damage right after visual cortex and before optic radiation
causes homonymous upper quadrantinopia
left upper nasal vision and right upper temporal vision
226
damage to left baums loop?
baums loop is parietal right after visual cortex ]
homonymous lower quadrantinopia
left eye lower nasal and right lower temporal
227
tx for carpel tunnel syndrome?
conservative - pain relief/ splint at night
hydrocortisone injection
surgery decompression
228
cp of carpel tunnel syndrome?
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
cancer associated with lambert eaton syndrome?
small cell ca lung!
230
ide effects of mannitol?
pulmonary oedma
231
tx for status epilepticus ?
1st - IV benzodiazapine lorazepam
2nd - phenobarbital
3rd- phenytoin
232
tx for partial seizures?
carbazapine or lamotrigine
233
signs positive for meningococcal septiceamia?
kernigs and brudzinksi test
kernigs - Knee extension is painful ! lie at 90 degress
brudzinksi - Neck flexion leads to kNee flexion
234
peroneal nerve palsy CP vs L5 root lesion?
PNP - no enkle eversion and dorsiflexion
l5 root lesions - no ankle eversion, inversion and dorsiflexion
235
tx for status epilepticus?
iv lorazapam
236
Role of TLR 1 + 2
TLR 2+ 6?
BACTERIA
FUNGI
Lipoproteins
peptido glycans
237
rOLE of TLR 4?
LIPOPOLYSACCHARIDES
gram negative
238
role of TLR 5 ?
detects flagella
239
which tlr are found within the endosome? intracellular?
TLR 3 - dna
TLR 7 + 8 - single stranded rna
tlr 9 - dna of bacteria and fungi
240
role of dobutamine
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
tx for pneumocystits pneumonia
co tramoxazole
242
anticholinesterase inhibitors?
side effects?
use?
donepezil + pyridostigmine
- alzheimers, MG, LE syndrome
fatigue, vomiting, diarrhoea, aggitiation
243
horner syndrome caused by? features?
PAM
whore
HORNER
Ptosis
Anhidrosis - no sweating
Miosis
lesions the sympathetic trunk + pancoasts tumour
244
guillain barre damage to what cells?
schwann cells
245
when to do lumbar puncture in subdural haemorrage ?
12 hours so blood (bilirubin) is present in CSF
246
pathophysiology of parkinsons ?
Substantia Nigra PARS COMPACTA (1) which results in an impaired NIGROSTRIATAL PATHWAY (1) and therefore results in PROBLEMS INITAIATING MOVEMENT
247
test for ankylosing spondylosis?
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
mech of action of paracetemol?
inhibit cox in CNS
inhibiting prostaglandin synthesis
249
secondary causes of UTI?
INFLAMMATION OF BLADDER - CYSTITIS
250
bleeding where in extradural haemorage?
middle meningeal artery
251
OPIOD ANATGOINST FOR OPIOD OVERDOSE?
naloxone
