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PACES week > Neuro > Flashcards

Neuro Flashcards

1
Q

Fx of charcot marie tooth disease

A

Bilateral foot drop
High stepping gait
Champagne bottle legs
Bilateral pes cavus

Weakness and mild sensory loss

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2
Q

What is miller-fischer syndrome

A

Proximal variant of GBS causing ataxia, opthalmoplegia, areflexia (anti-GQ1b antibodies)

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3
Q

GBS Mx

A

IVIG
Methylprednisolone

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4
Q

Cerebellar signs

A

Dysdiadochokinesia.
Ataxia (wide-based gait and posture)
Nystagmus.
Intention tremor.
Slurred, staccato speech.
Hypotonia/heel-shin test

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5
Q

Differential diagnoses if it is MND

A

Cervical myeloradiculopathy (would have sensory disturbance)

Multifocal motor neuropathy

Syringomyelia (but would have sensory disturbance)

Friedreich’s ataxia (but would have cerebellar signs and dorsal column sensory loss)

Subacute combined degeneration of the cord (but would have dorsal column sensory loss)

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6
Q

Types of MND (4)

A

Amyotrophic lateral sclerosis: Mixed upper and lower motor neurone signs
Primary lateral sclerosis: Upper motor neurone signs only
Progressive muscular atrophy: Lower motor neurone signs only
Progressive bulbar/pseudobulbar palsy

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7
Q

Mx of MND

A

Physio, SALT, specialist nurse

Anticholinergics, baclofen, Riluzole

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8
Q

Fx of Klinefleters
Tx?

A

Subfertility
Gynaecomastia
Tall
Small testes
Sparse facial & body hair

Testosterone injections
Referal to fertility clinic (intracytoplasmic sperm injection)

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9
Q

Mx of TIA

A

ABCD2 score - admit for urgent assessment if score 4 or more/crescendo TIAs/AF/taking anticoagulant therapy (need to exclude a bleed)

Aspirin 300mg daily, then clopidogrel 75mg OD after 2 weeks

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10
Q

Ix of myasthenia gravis

A

AChR antibodies
Tensilon test (give IV anticholinesterase injection and look for improvement in ptosis)

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11
Q

Most common adult muscular dystrophy

A

Myotonic dystrophy

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12
Q

Pakrinson’s Ix

A

CT/MRI to rule out vascular cause

Ioflupane I123 injection
- Binds to dopaminergic neurones and allows visualisation of substantial nigra

Caeruloplasmin (low in Wilson’s)

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13
Q

Parkinson’s Mx

A

MDT approach: neurologist, physio

L-DOPA + Carbidopa or benserazide
Da agonists: ropinerole
MAO-B inhibitors: rasagline

Citalopram if depressed

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14
Q

L-Dopa side effects

A

Dyskinesia
Mouth dryness
Insomnia
N/V

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15
Q

Differentials for tremor

A

Parkinson’s
Intention tremor - cerebellar
Benign essential tremor

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16
Q

Cerebellar syndrome Mx

A

MDT approach, reduce alcohol

Specific causes:
MS: methylprednisolone
EtOH: Pabrinex, tapering course of chlordiazepoxide
Infarct: consider thrombolysis
Schwannoma: gamma-knife, surgery
Wilson’s: penicillamine

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17
Q

Fx of Friedrich’s ataxia?

A

Pes cavus
Bilateral cerebellar ataxia
Leg wasting + areflexia but extensor plantars
Loss of vibration and proprioception

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18
Q

UMN signs (4)

A

↑ tone

Pyramidal distribution of weakness
Leg: extensors stronger than flexors
Arm: flexors stronger than extensors

Hyper-reflexion

Extensor plantars

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19
Q

Likely cause of UMN signs bilaterally in lower limb

A

MS
Cord Compression
Cerebral palsy
Cord Trauma

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20
Q

Likely cause of UMN signs unilaterally in lower limb

A

Stroke
MS
SOL
Cord Compression
Cerebral Palsy

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21
Q

What is Beck’s syndrome?

A

Infarction of spinal cord in distribution of anterior spinal artery: ventral 2/3 of cord

Quadriparesis
Impaired pain and temperature sensation
Preserved touch and proprioception

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22
Q

Fx of Syringomelia

A

Cape distribution of loss of pain and temperature sensation

Wasting/weakness of hands ± Claw hand
Loss of reflexes in upper limb
Charcot joints: shoulder and elbow

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23
Q

dDx for stroke

A

Head injury
↑ or ↓ glucose
SOL
Infection
Drugs: e.g. opiate OD

24
Q

Acute stroke MX

A

Consider thrombolysis if 18-80yrs and <4.5hrs since onset of symptoms
Alteplase (rh-tPA)
→ ↓ death and dependency (OR 0.64)
CT 24h post-thrombolysis to look for haemorrhage

Aspirin 300mg PO/PR once haemorrhagic stroke excluded ± PPI
Clopidogrel if aspirin sensitive

25
Q

MS ix

A

MRI
LP

26
Q

Prevent a relapse of MS

A

Natalizumab
IFN - B

27
Q

MS Tx

(FDPSUET)

A

Fatigue: modafinil

Depression: SSRI (citalopram)

Pain: amitryptylline, gabapentin

Spasticity: physio, baclofen,

Urgency / frequency: oxybutynin

ED: sildenafil

Tremor: clonazepam

28
Q

Poor prognosis in MS

A

Older female
Motor signs @ onset
Many relapses early on
Many MRI lesions

29
Q

dDx for MND

A

Cervical cord compression
Brainstem lesion
Polio

30
Q

dDx for mixed UMN and LMN signs

A

MND
Friedrich’s ataxia
SCDC - Subacute combined degeneration of the spinal cord

31
Q

MND Ix

A

Brain/spine MRI
LP to exclude inflammatory cause

32
Q

MND Mx

A

MDT approach
Riluozle
Supportive Mx (e.g. NIV for resp failure, amitriptyline for drooling)

33
Q

Types of MND

A

Amyotrophic Lateral Sclerosis (50%)

Primary lateral sclerosis (30%) (mainly UMN)

Progressive bulbar palsy (only affects CN 9-12)

Progressive Muscular Atrophy (LMN only)

34
Q

LMN signs

A

Wasting
Fasciculation
Hypotonia
Hyporeflexia

35
Q

Fx of peripheral polyneuropathy?

A

Bilateral, symmetrical, glove and stocking distribution of sensory loss

LMN signs, weakness

36
Q

Mx of peripheral polyneuropathy

A

MDT approach

Foot care
Optimise glycaemic control
Avoid alcohol

Neuropathic pain: amitriptyline, gabapentin

37
Q

dDx for peripheral polyneuropathy?

A

DM
Alcohol
B12 deficiency
Drug induced (isoniazid, vincristine)

38
Q

Sx of Charcot-Marie Tooth syndrome

A

Pes Cavus
Champagne bottle legs
High-stepping gait: foot drop
Weak foot and toe dorsiflexion
Absent ankle jerks
Variable loss of sensation

39
Q

Charcot Marie Tooth Mx

A

MDT approach

Foot care
Ankle brace

40
Q

Myasthenia Gravis Mx

A

Pyridostigmine
Immunosuppresants: steroids and azathioprine

Acute: Plasmapharesis or IvIg

41
Q

dDx for bilateral ptosis

A

MG
Myotonic dystrophy
Congenital
Senile

42
Q

GBS Ix

A

Evidence of infection: e.g. stool MC+S
Anti-ganglioside Abs
LP: ↑↑ CSF protein
Nerve conduction studies: demyelination

43
Q

Facial nerve palsy Ix

A

Glucose
Serology: VZV, Lyme disease
MRI

44
Q

Palsy caused by a posterior communicating artery aneurysm

A

Occulomotor

45
Q

Holmes-aide pupil

A

Dilated pupil that has no response to light and sluggish response to accommodation

46
Q

Argyll Robertson Pupil?

A

Small, irregular pupils
Accommodate but doesn’t react to light

47
Q

Most common causes of RAPD

A

MS
Glaucoma

48
Q

Causes of bitemporal hemianopia

A

Lesion at optic chiasm

Pituitary tumour
Craniopharyngioma

49
Q

Fx of CN4 palsy

A

Slight head tilt: ocular torticollis

Appear normal in rest position

Failure to depress eye in adduction

Diplopia maximal down and in

May have trouble walking down stairs

50
Q

What is an Internuclear Ophthalmoplegia

A

Failure of ipsilateral adduction
Nystagmus in the contralateral abducting eye

51
Q

Where does sound lateralise to in Weber’s test

A

Conductive: lateralises to abnormal ear

SNHL: lateralises to normal ear

52
Q

What is meant by:
dysphonia
dysarthria
dysphasia

A

Dysphonia: impaired production of voice sounds

Dysarthria: impaired articulation of sound → words

Dysphasia: impairment of language

53
Q

Where is Wernicke’s and Brocas. What do they affect

A

Broca’s area: frontal lobe
Non-fluent speech
Comprehension intact

Wernicke’s Area: temporal lobe
Fluent but meaningless speech
Comprehension impaired

54
Q

What causes claw hand (4th and 5th finger)

A

Ulnar nerve palsy

55
Q

What causes weakness of wrist extension?

A

Radial Palsy

56
Q

What is myotonic dystrophy

A

Trinucleotide repeat

Presents in early adulthood, progressive muscle wasting

Myopathic facies, frontal balding, cataracts, decreased power in face and bulbar muscles

Wasting of face, neck and distal arms

Absent reflexes
Weakness

57
Q

What can cause: Asymmetric LMN paralysis
No sensory involvement

A

Polio

PACES week (8 decks)

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