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Neurology > Neuro > Flashcards

Neuro Flashcards

1
Q

how does lamotrigine work?

A

decreases sodium currents and glutamate transmission

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2
Q

how does carbamazepine work?

A

prevents repeated firing through sodium channels

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3
Q

how does sodium valproate work?

A

potentiates GABA activity

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4
Q

what is hypomimia?

A

lack of facial expression

sign of parkinsons

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5
Q

what can be given to help tremour? what is a side effect?

A

anticholinergic eg procyclidine

anti cholinergic burden = confusion

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6
Q

how to distinguish parkinsons from pressure hydrocephalus? (produces a magnetic gait)

A

parkinsons doesnt have incontinence

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7
Q

how to determine parkinsonian tremour from essential tremour?

A 
PD = pill rolling 
essential = worse on intention, better with alcohol and more family history
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8
Q

what is the Cushing reflex?

A

in ischaemic stroke
increasing BP, decreasing heart rate, erratic breathing
BP increases in response to hypoperfusion in brain
carotid sinus baroreceptors detect increased BP – slow heart rate
irregular breathing because brainstem is compressed by raised ICP

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9
Q

what does agonal breathing suggest?

A

herniation of the brainstem

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10
Q

what medications cause medication over use headache?

A

10 days/month: ergotamine
triptans
opioids

15 days/month: nsaid
paracetamol
aspirin

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11
Q

what virus causes chickenpox/shingles?

A

varicella zoster – chickenpox
lies dormant –
reactivates – shingles – now called herpes zoster

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12
Q

what can happen if you develop chickenpox for the first time in adulthood?

A

pneumonitis (can be fatal)

foetal varicella syndrome, if you catch it in pregnancy – causes maldevelopment of foetus

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13
Q

what is a chickenpox rash classically like?

A

macule-papule-vesicle-pustule-crust

centrifugal distribution

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14
Q

where does the chickenpox virus usually lay dormant?

A

dorsal route ganglion
trigeminal nerve
olfactory nerve

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15
Q

presentation of shingles?

A 
macular -- vesicular rash in dermatomal distribution, one side of midline, thoracic 
pain/itching/tingling/neuropathy 
malaise, myalgia
headache
fever
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16
Q

investigations for shingles?

& a specific stain?

A

serology
viral PCR
tzank - confirms presence of herpesvirus but doesnt differentiate which

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17
Q

management of shingles?

A

aciclovir or valaciclovir

iv immunoglobulin

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18
Q

what is ramsey-hunt syndrome?

A 
complication of shingles
paralysis of facial nerve
rash on ear/mouth
tinitus 
hearing loss
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19
Q

are brain tumours generally malignant or benign?

A

55% are malignant

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20
Q

are brain tumours usually primary or secondary?

A

secondary / metastatic more common

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21
Q

what grading system do brain tumours follow, how does it work?

A

WHO classicification

1 - slow growing benign
2 - cytological atypia eg large hyperchromic nuclei
3 - anaplasia, mitotic
4 - microvascular proliferation or necrosis

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22
Q

what is the most common type of brain tumour?

A

glioma

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23
Q

what is an empendymoma?

A

from lining of ventricle/central canal

a glioma

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24
Q

what is oligodendroglioma? how can it be identified? what does it cause?

A 
40s and 50s 
frontal cortex = behavioural changes 
grade 2 or 3 
calcification 
deletion of 1p1qq
glioma
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25
Q

what is glioblastoma mutliformae?

A

glioma
from astrocytes
very malignant, grade 4
de novo or develop from grade 2 astrocytoma

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26
Q

what is a diffuse astrocytoma?

A

grade 2
type of glioma
can develop into glioblastoma multiformae which is much more malignant

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27
Q

what is an anaplastic astrocytoma?

A 
grade 3 (anaplastic)
type of glioma
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28
Q

what is a pilocytic tumour?

A

glioma
grade 1
in children
good prognosis

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29
Q

what is mengingioma?

A

generally benign

cause symptoms because take up space = nerve lesions & raised ICP

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30
Q

what is a hemangioblastoma?

A

brain tumour from blood vessels
develops in cerebellum in middle age
usually low grade

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31
Q

what is acoustic neuroma?

A

aka schwanoma - cn 8

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32
Q

what is medulloblastoma?

A

brain cancer
small blue cell
cerebellum in children
grade 4

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33
Q

focal neurological manifestation of a frontal cortex problem?

A

hemiparesis

personality change

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34
Q

focal neurological manifestation of a temporal lobe problem?

A

dysphasia

amnesia

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35
Q

focal neurological manifestation of a occipital lobe problem?

A

contralateral visual defect

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36
Q

focal neurological manifestation of a parietal lobe problem?

A

hemisensory loss

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37
Q

in brain tumour what is the headache like?

A

worse on coughing/bending/lying/in morning
constant
disturbs sleep

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38
Q

some symptoms of raised ICP?

A 
headache
vomitting
seizures 
papilloedema 
3rd and 6th CN palsies 
visual field defects
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39
Q

investigations for ?brain tumour?

A

MRI (then maybe fMRI)
CT contrast
stereotactic biopsy for histology
– MGMT methylation predicts response to treatment
–IDH-1 mutation indicates glioma replication

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40
Q

what chemotherapy is commonly used for brain tumour?

A

PCV - procarbazine, lomustine, vincristine

temozolamide

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41
Q

what is usually 1st line for glioma?

A

radiotherapy

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42
Q

which tumours are most likely to metastasise to the brain?

A 
lung
breast
prostate
colorectal
renal
malignant melanoma
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43
Q

in lateral tentorial herniation what is compressed?

A

posterior cerebral and superior cerebellar arteries
cerebellum and midbrain
CN 3

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44
Q

how is peripheral neuropathy defined?

A

axonal or demyelinating damage to several nerves

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45
Q

5 aetiology of peripheral neuropathy?

A 
Diabetes 
Alcohol
Vit b12 deficiency
Infective eg guillian barre, lyme 
Drugs - isoniazid, amiodarone

gluten sensitivity
CKD
amyloid, sarcoid
paraneoplastic

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46
Q

schwann cells vs oligodendrocytes?

A

both produce myelin
schwann - peripheral
oligodendrocytes - cns

47
Q

5 mechanisms of damage in peripheral neuropathy?

A

demyelination / schwann cell damage
axonal degradation - eg charcot marie tooth
compression
wallerian - trauma - axon separated from cell body
infarction - eg diabetes, arteritis
infiltration - leprosy, cancer

48
Q

what are the 4 types of sensory fibre?

A

A alpha
A beta
A delta
C

49
Q

what are A alpha fibres?

A 
sensory neurones
large 
myelinated
proprioception
if there is damage to them you fall over when you close your eyes
50
Q

what are A beta fibres?

A

large, myelinated

fine touch, vibration

51
Q

what are A delta fibres?

A

small
myelinated
pain & cold
damage = loss of sensation or severe neuropathic pain

52
Q

what are C fibres?

A 
sensory
unmyelinated
slow pain
very small so vulnerable to damage
damage = loss of pain or neuropathic pain
53
Q

what motor neurones are affected in peripheral neuropathy, & when?
what symptoms?

A

lower motor neurones, motor neurone involvement is a late sign
muscle cramp
weakness
atrophy - distal muscles - foot arches, pes cavus
fasciculations

54
Q

what pattern of neurones are affected in symmetrical sensorimotor neuropathy?

A

longest first - so starts in toes and ascends
sensory then motor
sensory - pain, tingling, numbness

55
Q

what pattern of neurones are involved in asymetrical sensory peripheral neuropathy?
what causes this?

A

patchy
dorsal route ganglion

paraneoplastic
sjorens
gluten

56
Q

what is mononeuritis multiplex?

A

peripheral neuropathy aka asymmetrical sensorimotor

loss of motor & sensory in two separate areas

57
Q

what is assymetrical sensorimotor peripheral neuropathy most associated with?

A

systemic vasculitis

58
Q

what will you see on clinical examination of someone with peripheral neuropathy?

A

decreased reflexes
sensory deficits
weakness
wasting

59
Q

investigation of peripheral neuropathy?

A

nerve conduction studies

    • if demyelination, conduction will be slow
    • if the axon is damaged, impulse will be smaller
60
Q

treatment for cramps in neuropathy?

A

quinine

61
Q

treatment for pain in peripheral neuropathy?

A

amitryptiline

gabapentin

62
Q

how is Huntingtons inherited?

A

autosomal dominant

anticipation so if parents are borderline but dont have symptoms, their child could still have it

63
Q

what kind of mutation is seen in Huntingtons?

A 
trinucleotide repeat (CAG)
on chr 4, huntingtin / HTT gene
64
Q

what does the mutation in Huntingtons code for & what is the effect of the mutation?

A

CAG codes for glutamine
too many CAG repeats = build up of glutamine
= misfolding/aggregation
= loss of GABA producing cells, loss of inhibitionn

65
Q

how is movement affected in Huntingtons?

A

it can be initiated but then is hard to stop or change

66
Q

clinical presentation of Huntingtons?

A 
cognitive / mood changes 
chorea - involuntary abnormal movements 
eye movement disorders
dysarthria
dysphagia
dementia
infections
67
Q

management of Huntingtons disease?

A

antipsychotic eg olanzapine
tetrabenazine - DA depleting
benzodiazepine

68
Q

3 places that can be stenosed in spinal cord stenosis & the names for them?

A

central spinal canal = central stenosis
nerve root canals = lateral stenosis
intervertebral foramina = foramina stenosis

69
Q

3 causes of spinal stenosis?

A 
congenital
age related degeneration
herniated disk
thickening of ligaments eg ligamentum flavum 
fractures
tumour
spondylolisthesis (slipped disk)
70
Q

presentation of spinal cord stenosis?

A 
gradual
intermittent neurogenic claudication
leg weakness worse when standing 
saddle anaesthesia
lower back/buttock/leg pain
71
Q

investigations for spinal stenosis?

A

MRI

CT angiogram and ABPI to exclude peripheral artery disease

72
Q

how does B12 deficiency affect the spinal cord and what is the effect of this lesion?

A

B12 deficiency = posterior spinal cord syndrome

affects dorsal columns = bilateral loss of proprioception and fine touch

73
Q

what does syringomyelia cause?

A

syringomyelia = development of fluid filled cyst in spinal cord
cape like distriibution - loss of sensation over arms

74
Q

what is an afferent fibre?

A

afferent = sensory

annie is sensitive

75
Q

what is an efferent fibre?

A

efferent = motor

has an effect on the muscle

76
Q

what is in a cognitive impairment screen?

A 
orientation
attention
language 
visuospatial
motor
77
Q

what are red flags for spinal cord compression? - 3

A

loss of bowel/bladder function
UMN in lower limbs
LMN in upper limbs

78
Q

what is brown sequard syndrome?

A

hemisection of the spinal cord

in exams is typically A&E knife injury + loss of sensation

79
Q

presentation of brown sequard syndrome?

A

ipsilateral hemiplegia (loss of proprioception, vibration sensation and potentially spastic pareparesis)
contralateral pain and temperature loss below lesion
complete loss of sensation at site of penetration

80
Q

first line investigation for brown-sequard (or any penetrating trauma?)

A

plain radiograph

can do MRI/neuro exam later

81
Q

treatment for brown sequard?

A

spine immobilisation
steroids
physio

82
Q

what is charcot marie tooth?

A

inherited peripheral neuropathy

83
Q

the 4 types of charcot marie tooth syndrome?

A

1 - unstable myelin - children, weakness and loss of sensation starting from feet and going up
2 - axonal - like type 1 but later onset
3 - marked segmental demyelination - floppy baby
4 - demyelination - males more common

84
Q

how is duchenne muscular dystrophy inherited?

A

x linked - males

85
Q

what is the problem in duchenne muscular dystrophy?

A

lack of dystrophin (which should strengthen muscle)

86
Q

presentation of duchenne muscular dystrophy?

A 
cannot run, hop or jump 
fatigue
recurrent falls 
under 3 
milestones delayed 
speech is slurred
87
Q

investigation for duchenne muscular dystrophy?

A

raised serum creatinine kinase

muscle biopsy

88
Q

complications of duchenne muscular dystrophy?

A 
learning difficulties 
resp failure
cardiomyopathy 
osteoporosis 
infections
89
Q

what is clozepine?

A

an antipsychotic, dopamine antagonist

important because can cause Parkinsonism

90
Q

where is the clot if there is hemianopia?

A

posterior circulation

91
Q

risk factors for intracerebral haemorrhage?

A

hypertension
age / smoking // alcohol / diabetes
anticoagulation/ thrombolysis
microanneurysms

92
Q

what is hydrocephalus caused by?

A

CSF obstruction

raised ICP

93
Q

when can you test CSF for xanthrochromia?

A

after 12hrs

only if ICP is fine

94
Q

what is wernickes encephalopathy?

A

ataxia
opthalmoplegia
confusion

vitamin B1 deficiency - thiamine
chronic alcoholics
flapping tremour
management - B vitamin infusion

95
Q

most common origin of secondary brain tumour?

A

non small cell lung cancer

96
Q

what is korsakoffs?

A

ecephalopathy can develop from wernickes

97
Q

what kind of acteylcholine receptors are affected in myasthenia gravis?

A

nicotinic

98
Q

if there is automatisms where is the seizure?

A

temporal lobe

99
Q

if there is motor features eg jacksonian march where is the seizure?

A

frontal lobe

100
Q

locked in syndrome is caused by damage to which vessels?

A

pontine

101
Q

signs of raised ICP?

A 
papilloedema 
vomitting
seizures 
extensor posturing 
pupil dilation (cn3 palsy)
cn6 palsy 
headache 
decreased consciousness
102
Q

what is delirium tremens?

A

alcohol withdrawal

103
Q

what is Romberg’s test?

A

for peripheral neuropathy
ask patient to close their eyes
and stand on one leg
if either proprioception or vestibular function is compromised they will fall over –> pos rhombergs test
pos rhombergs indicates peripheral neuropathy eg vit b12 deficiency, ehlers danlos, or vestibular dysfunction

if they sway but dont fall over this indicates cerebellar pathology

104
Q

progressive weakness that gets better with exertion is

A

lambert eaton myasthenic syndrome

related to small cell lung cancer

105
Q

apart from the neuropathy, how does vit B12 deficiency present?

A 
anaemia
yellow tinge 
angular cheilitis 
depression etc 
fatigue 
glossitis
106
Q

what kind of motor neurones are found in the anterior horn cells?

A

lower

107
Q

what is gowers sign?

A

in duchenne muscular dystrophy

use arms to get up from sitting

108
Q

gambling is linked with what parkinsons drugs?

A

dopamine agonists eg ropinarole

109
Q

what cranial nerves are involved in the reflex that makes you blink when something touches the cornea?

A

sensing - trigeminal nerve. if this is damaged the opposite eye wont blink either

motor - facial nerve. if this is damaged one eye will not blink, when you touch it or the other one. but the other eye will respond in both situations

110
Q

nystagmus is a problem with which cranial nerve?

A

vestibulocochlear

111
Q

of the 6 eye movement muscles, which 2 are not innervated by CN3?

A

LR6 SO4 (lardy arse sofa)

lateral rectus - 6 (abducens)
superior oblique - 4

112
Q

who gets Felty’s syndrome?

A

50-70s white with long standing rheumatoid arthritis

113
Q

what are the 3 components of charcots neurological triad and who does it affect?

A

MS
dysarthria (scanning/stuccato speech)
intention tremour
nystagmus

Neurology (20 decks)

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