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neuro Flashcards

1
Q

types if brain herniation

A

uncal (transtentorial)
subfalcine
tonsillar
central

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2
Q

what typ eof brain herniation causes a blown pupil

A

uncal - presses on CN III

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3
Q

what type of brain herniation causes contralateral leg weakness and how

A

subfalcine herniation
catches the anterior cerebral arteries

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4
Q

if someone has extreme HTN and bradycardia whta type of brain herniation is suspected

A

tonsillar

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5
Q

what is done in a cerebellar examination

A

D- dysdiadokinesia
A- ataxia
N- nystagmus
I - intention tremours
S- slurred or staccato speech
H - hypotonia /heel shin test

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6
Q

most common primary adult brain tumour

A

glioblastoma

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7
Q

most common childhood brain tumour

A

GRADE 1 ASTROCYTOMA

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8
Q

how would a grade 1 pilocytic astrocytoma present in children

A

evidence of raised ICP - falling behind in school
walking on tiptoes

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9
Q

brain biopsy showing rosenthal fibres- corkscrew eosinophilic bundle

A

grade 1 astrocytoma (pilocytic)

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10
Q

treatment of grade 1 astrocytoma

A

surgery is curative

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11
Q

grade III astrocytoma called

A

anaplastic astrocytoma

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12
Q

GRade III astrocytoma prognosis

A

2 year median survivial

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13
Q

solid tumours with central necrosis and a rim that enhances with contrast

A

gliobastoma multiforme

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14
Q

treatment of gliobalastoma and med surviala

what i sused to treat oedema

A

1 year
tx - surgical with postoperative chemotherapy and/or radiotherapy. Dexamethasone is used to treat the oedema.

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15
Q

hypermethylation of what gene has been linked to improved glioblastoma prognosis

A

MGMT

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16
Q

what type of surgery is performed on gliobastomas

A

fluorescence-guided surgery using 5-ALA

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17
Q

what colou rdoes tumour show up after usign 5-ALA

A

pink

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18
Q

how often is radio given in glioblastoma post -op

A

5 dyas a week for 6 weeks

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19
Q

side effects of radiotherapy

A

drops IQ by 10
skin
hair
tired

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20
Q

what chemo agent is used first line in glioblastoma
what it is then switched to

A

temozolamide - if not respondin after 6 months switch to PCV

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21
Q

where are oligodendromas found

A

frontal lobe

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22
Q

calcifications with ‘fried egg appearance brain biopsy

A

oligodendroma

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23
Q

cancers that most commonly spread to the brain

A

lung
breast
skin. (melanoma)
bowel idney

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24
Q

where do meningiomas originate from

A

arachmoid cap cells

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25
Q

psmammoma bodies on brain biopsy

A

meningioma

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26
Q

what cancer is seen in kids post chemo

A

meningiomas

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27
Q

bilateral acoustic neuromas/vestibular schwannoma assoc with what condition

A

neurofibromatosis II

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28
Q

what three blood tests shoul dbe done for any children with a midline tumour

A

B-HCG
AFP
LDH

will determine if germinoma

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29
Q

Small, blue cells. Rosette pattern of cells with many mitotic figures

A

medulloblastoma

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30
Q

duchennes inheritance pattern

A

x-linked recessive

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31
Q

pathophysiology of Huntingtons

  • what protein is toxic
A

progressive degen of basla ganglia due to abnormally long GLUTAMINE protein that are toxic

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32
Q

in huntingtons what repeats code for gllutamine and how many are seen in a normla unaffected individual

A

CAG - norm 20 repeats

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33
Q

what number of repeats is diagnostic of huntingtons

A

36 CAG repeats

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34
Q

prognosis of huntingtons

A

15-20 years

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35
Q

pathophysiology of duchennes - what type of mutation

A

dystophin deficiency - most commonly deletion

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36
Q

diagnosis of duchennes

A

increased CK
genetics

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37
Q

what type of cardiomyopathy is assoc with duchennes

A

dilated

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38
Q

pathophysiology of spinal muscular atrophy

A

SMN1 deficiency - single nucleotide splices out exon & of SMN1 which is essential for prevention of motor neuron loss

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39
Q

inheritance pattern of spinal muscular atrophy

A

auto recessive

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40
Q

symptoms o fspinal muscular atrophy

A

proximal muscle weakness and wasting
repisratory muscles

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41
Q

what is lost in Spinal muscular atrophy

A

loss of anterior horn cells

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42
Q

what genetic mutations and corresponding chromosomes are implicated in alzheimers

A

Amyloid precurosr protein (APP) - chromo 21
presenilin 1 - chromo 14
presenilin 2 - chromo 1

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43
Q

what apopprotein is linked to susceptiability to alzheimer and what does it encode for

A

apoprotein E allele E4 - encodes a cholesterol transport protein

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44
Q

macroscopic pathological changes in alzheimer

A

wide spread cerebral atrophy - partic cortex and hippocampus

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45
Q

microscopic changes in alzheimers

A

type A Beta- amyloid plaques and intraneuronal neurofibrillary tangles cause by abnormal aggregation of the tau protein

hyperphosphorylation of the tau protein has been linked to AD

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46
Q

what neurotrasnmitter is there a deficit of in alzheimers

A

acetylcholine

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47
Q

non-parma management of alzheimers

A

-‘a range of activities to promote wellbeing that are tailored to the person’s preference’
- group cognitive stimulation therapy for patients with mild and moderate dementia

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48
Q

pharma management of alzheimers

A

mild - mod
cholinesterase inhibitors - e.g donepezil, rivastigmine and galantamine

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49
Q

second line alzheimers treatment

A

memeantine - NMDA inhib

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50
Q

when is donepezil contra indicated n alzheimers

A

if bradycardic

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51
Q

where is morphine metabolised

A

liver by glucorondiation

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52
Q

what is morphine excreted by

A

kidney

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53
Q

what is codeine metabolised by

A

liver

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54
Q

what pain medication is safe in severe renal impairement

A

alfentinil, buprenoprihne and fentanyl

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55
Q

1st line management of trigemnal neuralgia

A

carbamazapine

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56
Q

what is the cushings reflex

A

extreme HTN and bradycardia often pre-terminal event

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57
Q

what occurs in a diffuse axonal injury

A

result of mechanical shearing following deceleration, causing disruption and tearing of axons

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58
Q

scar formation of astrocytes is called

A

gliosis

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59
Q

what MAP can autoregulation in brain no longer compensate for

A

50mmHg

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60
Q

what is a watershed area in the brain

A

area between two arterial territories

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61
Q

first line investigation for suspect stroke

A

non contrast CT

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62
Q

scoring system for sctroke

A

ROSIER score

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63
Q

what medication should be given as soon as haemorhaggic stroke ruled out

A

300mg aspirin

64
Q

what is the criteria for alteplase use in storke

A

haemorrhagic excluded
less than 4.5 hrs from onset

65
Q

contra indications to thrombylysis in stroke

A

LP in last 7 days
pregnancy
GI haemorrhage in preceeding 3 weeks
intracranial neoplasm
prev haemorhhagic stroke
oesophageal varices

66
Q

when should thrombectomy be offered

A

if within 6-24 hrs of stroke involving the PROXIMAL ANTERIOR CIRCULATION

67
Q

when should thrombectomy be offered

A

if within 6-24 hrs of stroke involving the PROXIMAL ANTERIOR CIRCULATION

OFFER THROMBYLSIS TOO IF <4.5 HRS

68
Q

second prevention medications after ischaemic stroke

A

clopidogrel
aspirin + MR dypiridamole if clop not tolerated

69
Q

what level of carotid stenosis would warrent an carotid endartectomy following TIA

A

> 70%

70
Q

defitnition of a TIA

A

a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction. REF

71
Q

most common site of thrombotic cerebral infarct

A

MCA

72
Q

most common site of orgin in emboli in stroke

A

ICA or aortic arch

73
Q

what aneurysms can cause haemorhagic stroke

A

charcot - bouchard aneurysm

74
Q

where do most berry aneurysms occur

A

ICA

75
Q

most common cause of subarachnoid haemorrhage

A

head trauma

76
Q

first line investigation for subarachnoid haemorrhag

A

non contrast CT

77
Q

when should an LP be done in suspect subarachnoid

A

if a CT that was done more than 6 hrs after presentation is normal do an LP

78
Q

what time perios after onset of sympotoms should LP be done in subarachnoid haemorrhage and wy

A

min 12 hours to allow xanthochromia (RBC breakdown) to occur

79
Q

what LP findings suggest sub arachnoid haemorrhage

A

increased or normal opening pressure and xanthchromia

80
Q

what are UMN symptoms

A

increased tone (spascitiyt)
hyperrelfexia
weakness

81
Q

what are LMN symptoms

A

decreased tone
muscle wasting
fasiulations
diminished refelxes

82
Q

symptoms of progressive supranuclear palsy

A

parkinsonism
falls
vertical gaze palsy - patients complain of difficulty reading of descending stairs

83
Q

IX after seizure

A

EEG and MRI

84
Q

features of parkinsons

A

bradykinesia, tremor and rigidity

85
Q

are parkinsons symptoms symmetrical

A

no they are classically asymmetrical

86
Q

autonomic dysfucntion seen in parkinsons

A

postural hypotension

87
Q

dx of parkinsons

A

clinically
-if young can do a DAT i.e. under 40

88
Q

what is seen under microscope in parkinsons

A

lewy bodies

89
Q

first line treatment of parkinsons if motor symptoms predominate

A

Levodopa

90
Q

what type of drug is levodopa combined with to prevent peripheral metabolisation of levadopa to dopamine outside Brain

A

decarboxylase inhibitor e.g. cabidopa or benserazide

91
Q

if a patient with parkinsons is admitted to hospital and cannot take their levadopa what should be done

A

dopamine agonist patch as rescue medication to prevent acute dystonia

92
Q

what should be obtained prior to starting a dopamine agonist and why

A

echo, ESR, creatinine and chest x-ray
dopamine receptor agonists (bromocriptine, cabergoline) have been associated with pulmonary, retroperitoneal and cardiac fibrosis

93
Q

drug class options in parkinsons

A

dopamine agonisst
MOA- B inhib
LEVADOPA
COMT - inhibitors

94
Q

examples of dopamine agonsitis used in parkinsons

A

ropinerole, pramipexole, apomorphine

95
Q

examples of MAO-B inhibitors

A

selegeline, rasagaline

96
Q

what scan is used to differentiate parkinsonism from dystonia

A

DAT scan

97
Q

what eye symptoms do kids with hydrocephalus present with

A

sunsetting eyes - can see alot of whites at the top

98
Q

types of hydrocephalus

A

communicating
non-communicating (obstructive)

99
Q

causes of obstructive hydrocephalus

A

tumours,
SAH
developmental abnormalities (e.g. aqueduct stenosis).

100
Q

causes of non obstructive hydrocephalus

A

choroid plexus tumour (very rare))
failure of reabsorption at the arachnoid granulations (e.g. meningitis or post-haemorrhagic).

101
Q

triad of symptoms in normal pressure hydrocephalus

and treatment

A

dementia
gait disturbance
incontinenece

weird, wet, wobbly

VP shunt

102
Q

what is hydrocephalus ex vacuo

A

increase in CSF secondary to brain loss e.g. alzheimers

103
Q

meningitis organisms in neonates

A

group B strep - from mum
e.coli
listeria

104
Q

causes of viral meningitis

A

coxsachie
mumps
HSV
HIV
measels

105
Q

treatment of viral meningitis

A

suppoertive
aciclovir if suspect seocndary to HSV

106
Q

what is Waterhouse-Friderichsen syndrome

A

adrenal insufficiency secondary to adrenal haemorrhage

107
Q

can patients with meningococcal septicaemia have an LP

A

no is contraindicated

108
Q

what should be done for investigations for meningococcal septicaemia

A

cultures and PCR

109
Q

management of children under 3 months with meningitis

A

IV amoxicillin adn Iv cefotaxime

110
Q

management of children >3months with meningitis

A

Iv cefotaxime or ceftriazone

111
Q

what shoudl be given in meningits if >50

A

cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)

112
Q

when shoudl dexamethasone be avoided in meningitis

A

septic shock, meningococcal septicaemia, or if immunocompromised, or in meningitis following surgery’ or children < 3 months

113
Q

what should be given in suspect meningococcal disease in community

A

IM benpen

114
Q

what is a coup and contra coup injury

A

coup - injury at point of impact
contra-coup - injury at opposite side of brain

115
Q

what is injured in subdural heamoatoma

A

bridging veins

116
Q

most common subtype of MND

A

ALS - amyotrophic lateral sclerosis

117
Q

median survival of MND

A

3 years after onset

118
Q

most common presentation of ALS

A

asymmetrical limb weakness

119
Q

symptoms of MND

are the eyes involved

A

asymmetrical limb weakness
mixed UMN and LMN symps
wastiing of the hands and tibialis
fasiculations

NO SENSORY SYMPTOMS or extra ocular muscle symptoms

120
Q

finidings on nerve conduction studies in MND

A

Normal motor conduction - excludes neuropathy

121
Q

treatment of MND

A

Riluzole - extends life by 3 months

122
Q

what is used to treat respiratory weakness in MND

A

BiPaP at night

123
Q

what dementia is MND associated with

A

Frontotemporal dementia

124
Q

what tests are done in MND and how is diagnosis achieved

A

nerve conduction studies - normal
electrophysioloigy - dewer impluses increased amplituted
MRI - exclude cord compresssion

is a Dx of exclusion

125
Q

how to you distinguish rigidity from spascitity

A

rigidity felt throughout movement
no increase with speed

126
Q

what is ballism

A

extreme form of chorea that involves swinging movements

127
Q

what is syndenhams chorea

A

self limiting chorea seen in children following GABHS infection

128
Q

causes of chorea

A

huntingtons, wilsons, syndenhams, drugs, basal ganglia lesion, anti phospholipid syndrome

129
Q

what is a hypnic jerk and what clinical sign s it an example fo

A

jump as you fall asleep
myoclonus

130
Q

causes of predom sensory peripheral neuropathy

A

diabetes
Leprosy
Vit B12 deficiency
alcoholism
uraemia

131
Q

causes of predom motor periph neuropathy

A

guillane barre
charcot marie tooth

132
Q

what infection often triggers Guillain barre

A

campylobacteur

133
Q

characteristic feature of guillain barre

A

progressive, symmetrical weakness of all the limbs.

134
Q

most common inital feature of guillain barre

A

back and leg pain

135
Q

what direction does weakness tend to progress in guillain barre

A

ascending - legs first

136
Q

what investigaitions are done in guillain barre

why is one done ?

A

LP and nerve conduction studies

LP - to rule out infectious mimics e.g. HIV CMV

137
Q

what nerve conduction study results would be expected in guillain barre

A

decreased motor nerve conduction velocity (due to demyelination)
prolonged distal motor latency
increased F wave latency

138
Q

what type of disease is GBS

A

autoimmune

139
Q

most common hereditary peripheral neuropathy

A

charcot marie tooth

140
Q

physical manifestation i charcot marie tooth

A

high arched foot
champagne bottle calf

141
Q

pathophysiology of MS

A

autoimmune antibodies agains myelin of CNS

142
Q

most common form of MS

A

relapsing remitting

143
Q

what vitamin deficiency is linked to MS

A

vitamin D

144
Q

what is the most significant symptoms in those presenting wiht MS

A

lethargy

145
Q

visual symptoms in MS

A

optic neuritis
optic atrophy
Uhthoffs phenomenon
internuclear opthalmoplegia

146
Q

what is Uhthoffs phenomenon and when is it seen

A

seen in MS

worsening of vision following rise in body temperature

147
Q

what is Lhermitte’s syndrome

A

paraesthesiae in limbs on neck flexion

seen in MS

148
Q

what drug can be used to treat fatigue in MS

A

amantadine

149
Q

what is seen in CSF in MS

A

IgG oligoclonal bands

150
Q

what is used to treat acute relapses of MS and duration

A

IV or oral mthylpred for 5 days

151
Q

treatment of spascity in MS

A

baclofen

152
Q

example of DMARD in MS

A

natalizumab, tecfidera

153
Q

what GCS warrants a CT in under 1 hour

A

<13

154
Q

how many episodes of vomiting warrant a Ct in under 1 hour

A

> 1

155
Q

when should immediate head CT be done

A

LOC or amnesia with any of

  • traumtic injury mechanism
  • > 65
  • coagulopathy
156
Q

what focal head injury presents with a lucid interval

A

extradural heamatoma

157
Q

if MND presents without bulbar symptoms (dysphagia, brisk jaw refelx, tongue wasting) what test should be doen and why

A

MRI to exclude spinal cord compression

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