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Phase 3A > Neuro > Flashcards

Neuro Flashcards

1
Q

what are the names of cells that produce myelin in the CNS?

A

oligodendrocytes

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2
Q

what are the names of cells that produce myelin in the PNS?

A

schwann cells

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3
Q

which nervous system does MS affect?

A

central

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4
Q

what is the most common presentation of MS?

A

optic neuritis

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5
Q

what are 5 signs of upper motor neurone lesions?

A

Inspection - No significant wasting
Tone - Increased (spasticity/rigidity) + Ankle Clonus
Power - Pyramidal (extensors weaker in arms, flexors weaker in legs)
Reflexes - Hyperreflexia
Plantars - Upgoing (Babinski)

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6
Q

What are 5 signs of lower motor neurone lesions?

A

Inspection - Fasciculations + Wasting
Tone - Reduced (or normal)
Power - reduced in affected nerve distribution
Reflexes - reduced or absent

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7
Q

what are 2 eye signs of MS?

A

optic neuritis (pain on eye movement and temporary vision loss to one eye)

Eye movement abnormalities (Internuclear opthalmoplegia or conjugate lateral gaze disorder - 6th CN palsies)

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8
Q

what are 4 motor signs of MS?

A

Bells palsy
horners syndrome
limb paralysis
incontinence

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9
Q

what are 4 sensory symptoms of MS?

A

triegeminal neuralgia
Numbness
Paraesthesia
Lhermitte’s sign

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10
Q

what is Lhermitte’s sign? What condition does it signify?

A

MS

Electric shock sensation that travels down spine into limbs when flexing neck (due to disease in DCML of cervical spine)

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11
Q

what is Uhtoff’s phenomenon?

A

worsening symptoms of demyelinating disorders (MS) when the body becomes overheated hot weather or hot showers

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12
Q

what are 2 coordination symptoms of MS?

A

sensory ataxia (due to loss of proprioception +ve romberg)
cerebellar ataxia

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13
Q

what is the mcdonald criteria for MS diagnosis?

A

2 or more episodes of central nervous system damage disseminated in time and space

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14
Q

What is one episode of an MS like attack called?

A

clinically isolated syndrome

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15
Q

what are 3 patterns of disease in MS?

A

relapsing-remitting
secondary progressive (starts relapsing-remitting then progresses)
Primary progressive

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16
Q

what 2 investigations can be done to diagnose MS?

A

MRI brain and spinal cord
Lumbar puncture

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17
Q

what is seen on LP in someone with MS?

A

oligoclonal bands in the CSF

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18
Q

what is seen on LP in someone with MS?

A

oligoclonal bands in the CSF

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19
Q

what are 4 key features of optic neuritis?

A

Central scotoma (enlarged blindspot)
pain on movement
impaired colour vision
relative afferent pupillary defect

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20
Q

what is the treatment for acute MS relapse?

A

Methylprednisolone 500mg orally OD for 5 days
OR
1g IV daily for 3-5 days (in severe cases)

(plasma exchange can be used in V severe disability)

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21
Q

What is the ongoing treatment for MS?

A

Immunomodulators and Biologcal therapy

Interferon beta
Glatiramer
Teriflunomide

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22
Q

What medications can be used to treat neuropathic pain in MS?

A

amitriptyline or gabapentin

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23
Q

what medication can be used to treat urge incontinence in MS?

A

anticholinergics - tolterodine or oxybutynin

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24
Q

what medications can be used to treat spacticity in MS?

A

baclofen
gabapentin

Physio

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25
Q

What is the pathophysiology of parkinson’s disease?

A

progressive reduction in the dopamine of the basal ganglia leading to disorders of movement

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26
Q

where is dopamine produced in the brain?

A

substantia nigra

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27
Q

what is are 6 features of benign essential tremor?

A

Symmetrical
5-8 Hz (5-8 times a second)
improves at rest
Worse with intentional movement
No other parkinsons features
Improves with alcohol

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28
Q

what are 6 features of parkinson tremor?

A

pill rolling
asymmetrical (starts unilaterally)
4-6 Hz (times a second)
worse at rest and with distraction
improves with intentional movement
no change with alcohol

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29
Q

what are 3 motor symptoms of parkinsons? (core diagnostic)

A

(Unilateral) tremor
(cogwheel) rigidity
bradykinesia - movements slows and gets smaller

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30
Q

what are 5 manifestations of bradykinesia in parkinsons?

A

handwritting gets smaller (micrographia)
Shuffling gait
Difficulty initiating movement
Difficulty in turning
reduced facial movement and expressions (hypomimia)

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31
Q

what are 5 non-motor symptoms of parkinsons?

A

Depression
sleep disturbance and insomnia
anosmia
cognitive impairment and memory problems
Postural hypotension

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32
Q

what is multiple system atrophy?

A

degeneration in multiple systems in the brain - causes parkison’s like symptoms as well as autonomic and cerebellar dysfunction

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33
Q

what are 4 symptoms of autonomic dysfunction?

A

postural hypotension, constipation, abnormal sweating and sexual dysfunction

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34
Q

what is the treatment in dysfunctional essential tremor?

A

propanalol

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35
Q

what is the 1st line investigation for parkinsons?

A

dopaminergic trial

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36
Q

What is the first line treatment of parkinsons?

A

Levodopa (co-beneldopa)

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37
Q

what are 4 treatment options for parkinsons?

A

Levodopa
Dopamine agonist
Monoamine oxidase B (MAO-B) inhibitors
COMT inhibitors (extends life of levodopa)

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38
Q

what are 2 dopamine agonists?

A

Cabergoline
Pergolide

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39
Q

what are 2 monoamine oxidase B inhibitors?

A

Selegiline
Rasagiline

inhibits enzyme that breaks down dopamine

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40
Q

what are 8 side effect of levodopa?

A

dyskinesia
impulsive and compulsive behaviours
wearing off
dry mouth
anorexia
palpitations
postural hypotension
psychosis

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41
Q

when medication shouldn’t be prescribed with levodopa?

A

iron - reduces absorption of levodopa

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42
Q

what are the 4 diagnostic criteria for lewy body dementia?

A

Fluctuating cognition with pronounced variation in attention and alertness
Recurrent visual hallucinations
REM sleep behaviour disorder
1+ key feature(s) of Parkinsonism

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43
Q

what protein are lewy bodies made up of?

A

alpha-synuclein

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44
Q

what is the first line pharmacological treatment for lewy body dementia?

A

acetylcholinesterase inhibitors

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45
Q

what are 3 examples of acetylcholinesterase inhibitors?

A

Donpezil
Rivastigmine
galantamine

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46
Q

what medication can be used to treat REM sleep disorder in lewy body dementia?

A

Clonazepam

or melatonin

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47
Q

what is the most common cause of dementia?

A

Alzheimer’s disease

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48
Q

what is the 2nd most common cause of dementia?

A

Vascular dementia

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49
Q

what scan should be done in all patients presenting with dementia?

A

MRI head

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50
Q

what is the first line treatment for vascular dementia?

A

Aspirin

(clopidogrel 2nd line)

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51
Q

what is the definition of dementia?

A

a chronic progressive neurodegenerative diseasecharacterised by global, non-reversible impairement in cerebral functioning

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52
Q

what is the pathophysiology of alzheimers disease?

A

excess of beta-amyloid deposited in plaques along neurones
aggregation of tau proteins in neurofibrillary tangles

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53
Q

what is the 1st line pharma management of alzheimers?

A

Acetylcholinesterase inhibitors - donepezil, galantamine and rivastigmine

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54
Q

what medication is indicated in severe alzheimers?

A

Memantine (N-methyl-D-aspartate antagonist)

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55
Q

what is Bell’s palsy?

A

sudden acute onset unilateral facial palsy of the facial nerve which fully resolves within 72 hours

may have hyperacusis (find noises loud) due to stapedius muscle paralasis

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56
Q

which of bells palsy or stroke are forehead sparing?

A

Stroke is forehead sparing

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57
Q

What is the first line treatment for bells palsy?

A

corticosteroids and eye care (within 72 hours)

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58
Q

what can be a complication of bells palsy?

A

keratoconjuctivitis sicca

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59
Q

what classes as a TIA?

A

a sudden onset focal neurological deficit which completely resolves within 24 hours of onset

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60
Q

what scale can be used to assess for urgent need of thrombolysis?

A

National institute of health stroke scale

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61
Q

what is the immediate management of TIA? (2)

A

aspirim 300mg initially then 75mg OD
Refer to specialist to be seen within 24 hours

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62
Q

How long from presentation can alteplase be given for stroke?

A

up to 4.5 hours

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63
Q

How long from presentation can thrombectomy be considered for ischaemic stroke?

A

<6 hours

24 hours if effecting large artery can be considered

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64
Q

What is the first line treatment for stroke within 4.5 hours?

A

IV alteplase

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65
Q

What is the first line treatment for stroke from hours 6-24?

A

thrombectomy

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66
Q

what scale is used to measure neurological disability?

A

Modified Rankin scale

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67
Q

what is the first line investigation in stroke?

A

CT head (non-enhanced)

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68
Q

what is the most common cause of extradural haemorrhage?

A

skull trauma

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69
Q

what blood vessel is most commonly ruptured to cause extradural haemorrhage?

A

middle meningeal artery (MMA)

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70
Q

what kind of haematoma is visible on CT in extradural haemorrhage?

A

biconvex and (usually) does not cross suture lines

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71
Q

what is the most common cause of subdural haemorrhage?

A

sheering of bridging veins which empty the ventral sinuses

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72
Q

what two populations are at great risk of subdural haematomas?

A

alcoholics
elderly people

due to brain atrophy there is more room for expansion of the haematoma prior to symptoms

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73
Q

what kind of haematoma is visible on CT in subdural haemorrhage?

A

crescent (sickle) shaped haematoma which can cross suture lines

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74
Q

what is the textbook presentation of subarachnoid haemorrhage?

A

sudden onset ‘thunderclap’ headache which peaks in severity within 1-5 minutes and lasts more than an hour. Also may be with vomiting, photophobia and non-focal neurological signs

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75
Q

what are 3 surgical options for subdural haematoma?

A

Burr hole craniotomy and suction irrigation
Trauma craniotomy
Hemicraniotomy and duraplasty

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76
Q

what medication is given insubarachnoid haemorrhage to prevent vasospasm?

A

nimodipine (calcium channel blocker)

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77
Q

what is the most common cause of a subarachnoid haemorrhage?

A

rupture of berry (intracranial saccular) aneurysm

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78
Q

what are 5 genetic conditions that increase risk of subarachnoid haemorrhage?

A

Ehlers-danlos syndrome
marfans syndrome
autosomal dominant polycystic kidney disease
neurofibromatosis type 1
pseudoxanthoma elasticum

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79
Q

what is the surgical treatment of subarachnoid haemorrhage?

A

1 - endovascular coiling
surgical clipping

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80
Q

what is the CT presentation of subarachnoid haemorrhage?

A

pooling of blood usually around the circle of Willis or in the sylvian fissure

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81
Q

what are 2 early complication of giant cell arteritis?

A

vision loss
stroke

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82
Q

what are 5 symptoms of GCA?

A

severe unilateral headache around temple and forehead
scalp tenderness (brushing hair)
jaw claudication
blurred or double vision
painless complete sight loss

May also have fever, aches, fatigue, wt loss, loss appetite

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83
Q

what cells are found on temporal artery biopsy in GCA?

A

multinucleate giant cells

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84
Q

what are 2 diagnostic tests for GCA?

A

raised ECS (>50 mm/h usually)
temporal artery biopsy

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85
Q

what are 4 non-diagnostic investigations that can be used for GCA?

A

FBC - may have normocytic anaemia and throbocytosis
LFTs - can have raised alk phos
CRP raised
Duplex USS of temporal artery has hypoechoic halo sign

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86
Q

what is the management of GCA?

A

1- Prednisolone 40-60mg until symptoms resolve

aspirin 75mg OD
PPI - for gastric prevention

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87
Q

what are 3 late complications of GCA?

A

relapse
steroid related complication
stroke
aortitis - aortic aneurysm and dissection

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88
Q

How long does a migraine usually last?

A

4-72 hours

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89
Q

what are 7 characteristic of a migraine?

A

Moderate to severe intensity
Pounding or throbbing
Usually unilateral (can be bilateral)
photophobia
phonophobia
with or without aura
nausea and vomiting

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90
Q

what are 4 different types of aura?

A

sparks in vision
blurring vision
lines across vision
loss of different visual fields

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91
Q

what is a hemiplegic migraine?

A

migraine with motor symptoms that can mimic stroke
symptoms include - hemiplegia, ataxia and changes in consciousness

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92
Q

what are some triggers for migraine?

A

CHOCOLATE

CHeese, chocolate and caffeine
Oral Contraceptive pill (and menstruation)
Alcohol (OH) + dehydration
Anxiety (+ stress)
Travel
Exercise

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93
Q

what is the acute management of migraine?

A

Triptans - sumatriptan 50mg
+ Paracetamol/NSAIDs

Antiemetics (metoclopramide)

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94
Q

how do triptans work?

A

5HT receptor agonists (serotonin receptor)

act on smooth muscles in arteries to cause vasoconstriction
act on peripheral pain receptors to inhibit activation
reduce neuronal activity in CNS

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95
Q

what is prophylactic management of migraine?

A

Propanalol
Topiramate (teratogenic)
amitriptyline

acupuncture

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96
Q

what migraine prophylactic medication is teratogenic?

A

Topirimate - causes cleft lip/palate

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97
Q

what are the 3 branches of the trigeminal nerve?

A

Ophthalmic (V1)
Maxillary (V2)
Mandibular (V3)

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98
Q

How long does trigeminal neuralgia last?

A

seconds to hours

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99
Q

what are 3 features of trigeminal neuralgia?

A

intense facial pain
electricity like shooting pain
Triggered by cold weather, spicy food, caffeine and citrus fruits

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100
Q

what is the 1st line treatment for trigeminal neuralgia?

A

carbamezapine

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101
Q

what are 8 symptoms of cluster headache?

A

Unilateral
Clusters of attacks for 4-12 weeks followed by remission for at least 3 months
15 mins to 3 hours

red, swollen watery eye
pupil constriction (miosis)
Ptosis
runny nose
facial sweating

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102
Q

what are 4 triggers for cluster headache?

A

alcohol
strong smells
sleep/circadian disruption
weather changes

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103
Q

what are 5 risk factors for cluster headache?

A

male
FHx
head injury
smoking
drinking

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104
Q

what is the acute management of cluster headaches?

A

Triptans sub cut (sumatriptan - 6mg SC)
High flow O2

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105
Q

what is the prophylaxis of cluster headache?

A

verapamil

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106
Q

what monitoring is needed with verapamil

A

ECG, BP, LFTs

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107
Q

headache redflags

A

fever, photophobia, neck stiffness
new neurological symptoms
dizziness
visual disturbance
sudden onset occipital headache
worse on cough or strain
postural changes
vomiting
wakes from sleep
pregnancy
trauma

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108
Q

what is the triad of horner’s syndrome?

A

Ptosis
miosis
anhydrosis

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109
Q

what is the pathophysiology of Horner’s syndrome?

A

damage to the sympathetic nervous system supplying the face

sympathetic nerves from spinal cord pass through sympathetic ganglion in base of neck to be post-ganglionic nerves and travel back into the head alongside the internal carotid

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110
Q

what are 2 methods of investigating horner’s syndrome?

A

cocaine eye drops - should usually dilate pupil - not in horners
adrenaline eye drops - won’t dilate normal pupil but will dilate in horners

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111
Q

what are 4 central causes of Horner’s?

A

4 Ss
Stroke
MS
Swelling (tumours)
Syringomyelia - cysts in spinal cord

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112
Q

what are 4 pre-ganglionic lesions that can cause horners?

A

4Ts
tumour
trauma
thyroidectomy
top rib (extra cervical rib)

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113
Q

what are 4 post-ganglionic lesions that can cause horners?

A

4Cs
carotid aneurysm
carotid artery dissection
cavernous sinus thrombosis
cluster headache

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114
Q

what is the most common cause of bacterial meningitis in adults?

A

1 - Neisseria meningitidis

2 - streptococcus pneumoniae

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115
Q

what does neisseria meningitidis look like?

A

gram negative (pink) diplococci

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116
Q

what causes the petechial rash in meningitis?

A

disseminated intravascular coagulopathy (DIC) and subcutaneous haemorrhages

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117
Q

what is the most common cause of bacterial meningitis in neonates?

A

Group B strep (strep aglactiae)

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118
Q

what is Kernig’s test?

A

for meningeal irritation in meningitis

patient lies on back, hip and knee flexed to 90 degrees then straighten knee

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119
Q

what is brudzinski’s test?

A

for meningitis

patient flat on back, flex their neck to their chest - pos if causes involuntary flexion of hips and knees

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120
Q

what medication can be given in GP for suspected bacterial meningitis?

A

IM (or IV) benzylpenicilin

<1 year - 300mg
1-9 years - 600mg
>10 years - 1200mg

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121
Q

what blood test can be done for meningitis?

A

meningococcal PCR - quicker than blood cultures

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122
Q

what is the treatment for meningitis in <3 months?

A

Cefotaxime + amoxicillin (listeria cover)

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123
Q

what is the treatment for meningitis in >3 months?

A

ceftriaxone

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124
Q

what non-antibiotic meds can be given in bacterial meningitis?

A

steroids - Dexamethasone QDS > 3 months

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125
Q

what is the prophylactic for meningitis contacts?

A

ciprofloxacin single dose

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126
Q

what is the incubation period of meningitis usually?

A

7 days

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127
Q

what is the 3 most common causes of viral meningitis?

A

Herpes simplex virus
Enterovirus
Varicella zoster virus

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128
Q

where does the spinal cord end?

A

L1-2

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129
Q

what level is a lumbar puncture taken at?

A

L3-4

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130
Q

what is the LP picture in bacterial meningitis?

A

cloudy
high protein
low glucose
high neutrophils
+ve culture

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131
Q

what is the LP picture in viral meningitis?

A

clear
normal (may be mildly raised) protein
Normal glucose
High lymphocytes
+ve PCR

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132
Q

what is the LP picture in fungal meningitis?

A

Clear
Mildly raised WBC
raised protein
normal glucose
-ve culture and PCR

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133
Q

what are 5 complications of meningitis?

A

hearing loss
seizures and epilepsy
congnitive impairement and learning disability
memory loss
focal neurological deficits

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134
Q

what is the most common cause of encephalitis in adults?

A

HSV

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135
Q

what is a non-infective cause of encephalitis?

A

autoimmune encephalitis

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136
Q

what are 4 risk factors for encephalitis?

A

extremes of age
immunodeficiency
viral infection
animal or insect bite

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137
Q

what are 6 symptoms of encephalitis?

A

Altered consciousness
altered cognition
unusual behaviour
acute onset focal neurological symptoms
acute onset focal seizures
Fever

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138
Q

what medication can be used to treat HSV and varicellar zoster?

A

aciclovir

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139
Q

what medication can be used to treat CMV?

A

ganciclovir

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140
Q

what are 3 infections particularly associated with GBS?

A

campylobacter jejuni
CMV
EBV

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141
Q

what is the pathophysiology of GBS?

A

B cells create antibodies against antigens on pathogen of proceeding infection which match proteins on the neurones and cause them to be attacked. This is called molecular mimicry

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142
Q

what are 4 features of GBS?

A

symmetrical ascending weakness
reduced reflexes
loss of sensation or neuropathic pain
can progress to cranial nerves

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143
Q

what is the criteria for clinical diagnosis of GBS?

A

Brighton criteria

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144
Q

what is the 1st line management of GBS?

A

IV Ig

145
Q

what is the leading cause of death in GBS?

A

PE - given VTE prophylaxis

146
Q

what is the most common motor neurone disease?

A

Amyotrophic lateral sclerosis - ALS

147
Q

what is the second most common MND?

A

progressive bulbar palsy

148
Q

what is the pathophysiology of MND?

A

progressive degeneration of upper and lower motor neurones

149
Q

what medication can be used to prolong survival in ALS?

A

Riluzole

150
Q

what tumour is linked to myasthenia gravis?

A

thymoma

151
Q

what is the pathophysiology of myasthenia gravis?

A

autoimmune antibodies to Ach receptors at neuromuscular junction of motor nerves bind to receptors and block triggering which would lead to muscle contraction

152
Q

what antibodies are tested for in myasthenia gravis?

A

acetylcholine receptor antibodies
muscle specific kinase antibodies
LRP4 antibodies

153
Q

what is a diagnostic test for myasthenia gravis?

A

edrophonium test - increases Ach at NMJ causing relief of weakness

154
Q

what are 5 treatment options for myasthenia gravis?

A

reversible acetylcholinesterase inhibitors - pyridostigmine or neostigimine
immunosupression
thymectomy
rituximab
eculizumab

155
Q

what is the treatment of myasthenic crisis?

A

Immunomodulatory therapies - IV Ig or plasma exchange

156
Q

what is the most common type of neurofibromatosis?

A

type 1

157
Q

what chromosome is the gene that causes neurofibromatosis type 1 on?

A

chromosome 17 - codes for tumour suppressor protein

158
Q

what is the inheritance pattern of neurofibromatosis?

A

autosomal dominant

159
Q

what is the diagnostic criteria for neurofibromatosis 1?

A

CRABBING
Cafe au lait spots (6+ over 5mm kids and 15mm adults)
Relative with NF1
Axillary or inguinal freckles
BB - Bony dysplasia - Bowing of long bone
Irish hamartomas - 2+ yellow/brown spots on iris
Neurofibromas 2+ or 1 plexiform neurofibroma
Glioma of optic nerve

160
Q

what chromosome is the neurofibromatosis type 2 gene found on?

A

chromosome 22

161
Q

what kind of tumours does neurofibromatosis type 2 lead to?

A

shwannomas

162
Q

what tumour is neurofibromatosis 2 most associated with?

A

acoustic neuromas

163
Q

what is an acoustic neuroma?

A

benign tumour of schwann cells surounding auditory nerve

also called vestibular schwannomas

164
Q

where do acoustic neuromas occur?

A

cerebellopontine angle

165
Q

what is the presentation of acoustic neuromas? (5)

A

unilateral sensorineural hearing loss
unilateral tinnitus
vertigo
absent corneal reflex
facial palsy

166
Q

what is the gold standard investigation for acoustic neuroma?

A

MRI

167
Q

what nerves are effected in bulbar palsy?

A

CN9,10,11,12

168
Q

what is the function of CN1?

A

olfactory nerve
smell

169
Q

what is the function of CN2?

A

optic nerve
Vision

170
Q

what is the function of CN3?

A

oculomotor
Eye movement (up, nasally, down, inferior oblique)

171
Q

what is the function of cranial nerve 5?

A

trigeminal
V1 - ophthalmic - scalp, forehead and nose sensation
V2 - maxillary - cheek, lower eyelid, nasal mucosa, upper lip, upper teeth and palate sensation
V3 - jaw, lower teeth, anterior 2/3 tongue sensation, muscles of mastication

172
Q

what is the function of CN6?

A

Abducens
lateral rectus movement

173
Q

what is the function of CN7?

A

facial nerve

sensation to ear
taste in anterior 2/3 tongue, hard and soft palate
muscles of facial expression
lacrimal, submandibular and sublingual glands and mucous glands

174
Q

what is the function of CN8?

A

vestibulocochlear

hearing and balance

175
Q

what is the function of CN9?

A

glossopharyngeal

taste and sensation posterior 1/3rd tongue
parotid gland
elevation of larynx and pharynx (stylopharyngeus muscle)

176
Q

what is the function of CN10?

A

vagus

sensation external ear, larynx, pharynx
taste from epiglottis
smooth muscle of pharynx and larynx

177
Q

what is the function of CN11?

A

spinal accessory

trapezium and sterocleidomastoid innervation

178
Q

what is the function of CN12?

A

hypoglossal

intrinsic and extrinsic tongue muscles

179
Q

what are 4 causes of bulbar palsy?

A

brainstem stroke or tumour
degenerative disease (MND)
Autoimmune disease (GBS)
Genetic disease - kennedy disease

180
Q

what causes pseudobulbar palsy?

A

disease of corticobulbar tracts due to cerebrovascular events, MS, MND, neurosyphilis etc that causes bulbar symptoms along with exaggerated jaw jerk and emotional lability

181
Q

what are 7 causes of cerebral palsy?

A

antenatal - maternal infection, trauma in pregnancy
perinatal - birth asphyxia, pre-term birth
postnatal - meningitis, severe neonatal jaundice, head injury

182
Q

what are 4 types of cerebral palsy?

A

spastic - hypertonia (damage to UMNs)
dyskinetic - muscle tone control problems with abnormal movements (damage to basal ganglia)
Ataxic - coordination problems (damage to cerebellum)
Mixed

183
Q

what are 6 presentations of cerebral palsy?

A

failure to meet milestones
increased/decreased tone
hand preference before 18 months
problems with coordination, speech or walking
feeding or swallowing problems
learning difficulties

184
Q

what medications may someone with cerebral need?

A

muscle relaxants for spasticity and contractures - baclofen
antiepileptics
glycopyrronium bromide - excessive drooling

185
Q

what is the grading system for hypoxic-ischaemic encephalopathy grade called?

A

Sarnat staging

186
Q

what are 3 features of mild hypoxic ischaemic encephalopathy?

A

poor feeding, irritability, hyperalertness
resolves within 24 hours
normal prognosis

187
Q

what are 3 features of moderate hypoxic ischaemic encephalopathy?

A

poor feeding, lethargy, hypotonic and seizures
can resolve in weeks
up to 40% develop cerebral palsy

188
Q

what are 3 features of severe hypoxic ischaemic encephalopathy?

A

reduced consiousness, apnoea, flaccidity and reduced or absent reflexes
up to 50% mortality
90% cerebral palsy

189
Q

what is a possible treatment of hypoxic ischaemic encephalopathy?

A

therapeutic hypothermia - cool down core temp of baby on ICU for 72 2hours which reduced inflammation and neurone loss after acute hypoxic injury

190
Q

what is the inheritance pattern of muscular dystrophy?

A

X-linked recessive

191
Q

what is the name of the sign in muscular dystrophy where people will use their hands and knees to push themselves up due to proximal muscle weakness?

A

Gower’s sign

192
Q

what is gower’s sign for?

A

muscular dystrophy

193
Q

what causes duchennes mucular dystrophy?

A

defective dystrophin gene on x-chromosome
Dystrophin holds muscles together at cellular levels

194
Q

what is the average age of presentation for duchennes MD?

A

3-5 years - presents with weakened pelvic muscles

195
Q

what is the life expectancy of duchennes?

A

25-35 years

196
Q

when medication can be given to slow the progression of duchennes MD?

A

oral steroids
creatine suplemmentation

197
Q

what is Beckers MD?

A

less severe than duchennes
presentation 8-12 years
require wheelchairs late 20s-30s

198
Q

what is myotonic dystrophy?

A

usually presents in adulthood

progressive muscle weakness
prolonged muscle contractions
cataracts
cardiac arrhythmias

199
Q

what is facioscapulohumeral muscular dystrophy?

A

usually presents in childhood with weakness around face progressing to shoulders and arms
classic initial symptoms - sleeping with eyes slightly open, weakness pursing lips

200
Q

what is oculopharyngeal muscular dystrophy?

A

presents in late adulthood with weakness of ocular muscles and pharynx
typically presents with - bilateral ptosis, restricted eye movement, swallowing problems

201
Q

what is limb girdle musclar dystrophy?

A

usually presents in teenagers with progressive weakness around limb girdles

202
Q

what is emery-dreifuss muscular dystrophy?

A

usually present in childhood with contractures of elbows or ankles
also have progressive weakness and wasting of muscles starting with upper arms and lower legs

203
Q

what is the inheritance pattern for huntingtons?

A

Autosomal dominant

204
Q

what is the genetic error in huntingtons?

A

trinucleotide repeat disorder of the HTT gene on chromosome 4

205
Q

what chromosome is affected in huntingtons?

A

chromosome 4

206
Q

what genetic phenomenon is seen in huntingtons?

A

anticipation

207
Q

what is genetic anticipation?

A

sucessive generations have more trinucleotide repeats resulting in earlier onset and increased severity of disease

208
Q

what are 4 symptoms of huntingtons disease?

A

Cognitive. behavioural and mood changes
eye movement disorders
speech and swallow difficulties
Chorea

209
Q

what is the life expectancy of huntingtons post diagnosis?

A

15-20 years

210
Q

what are 3 medications that can be used for chorea in huntingtons?

A

Benzos - tetrabenazine
Antipsychotics
Amantadine

211
Q

what causes Creutzfeldt-Jakob disease?

A

Prions

212
Q

what is the general life expectancy after presentation of someone with CJD?

A

<1 year

213
Q

what are 5 symptoms of prion disease?

A

sudden onset cognitive impairment and decline
Ataxia
Myoclonus
Psychiatric symptoms
parkinsonism

214
Q

what are 4 ways prion disease can be passed on?

A

Genetically
Contaminated blood products
Contaminated surgical instruments
Consumption of contaminated beef

215
Q

what is a specific test that can be done for CJD?

A

real time quaking induced conversion of the CSF

216
Q

what do the nerves of the cauda equina supply?

A

sensation to lower limbs, perineum, bladder and rectum
Motor supply to lower limbs, anal and urethral sphincters
Parasympathetic control of bladder and rectum

217
Q

what are 5 causes of cauda equina?

A

Herniated disc
tumours
spondylolisthesis (displacement of vertebra)
Abscess
Trauma

218
Q

what are 9 red flags of cauda equina?

A

Lower back pain
Saddle anesthesia
loss of sensation to bladder and rectum
Urinary retention or incontinence
Faecal incontinence
Bilateral sciatica
Bilateral/severe motor weakness of legs
Reduced anal tone
sexual dysfunction

219
Q

what is the management of cauda equina?

A

Lumbar decompression surgery

220
Q

what is the treatment for metastatic spinal cord compression?

A

high dose dexamethasone
Analgesia

Surgery
radio/Chemo

221
Q

what is a key feature of the pain in metastatic spinal cord compression?

A

Back pain worse on coughing or straining

222
Q

what is the first line investigation for a metastatic spinal cord compression?

A

Gandolinium enhanced MRI Spine

223
Q

what are 3 different types of spinal stenosis?

A

central - narrowing of central spinal canal
lateral - narrowing of nerve root canals
foramina - narrowing of intervertebral foramina

224
Q

what are 5 causes of spinal stenosis?

A

Congenital
degenerative changes
Herniated discs
thickening of ligamentum falvum/posterior longitudinal ligament
Spinal fractures
spondylolisthesis
tumours

225
Q

what exacerbates central spinal stenosis?

A

Standing up straight and walking

226
Q

what relieves spinal stenosis?

A

bending forwards and resting

227
Q

what is anterior cord syndrome?

A

incomplete spinal cord injury due to infarct of the anterior 2/3rds of the spine often because of flexion injuries to C spine

228
Q

what is the presentation of anterior cord syndrome?

A

impaired pain and temperature sensation with intact vibration, proprioception and light touch
Motor deficits are also present

229
Q

what are 3 causes of anterior cord syndrome?

A

Iatrogenic (throacic/abdo surgery)
Trauma
Hypo perfussion/ischaemia of the anterior spinal artery

230
Q

what is the presentation of brown sequard syndrome?

A

paralysis, loss of proprioception and vibration on the side of the lesion and loss of pain and temperature on the contralateral side

231
Q

what is a radiculopathy?

A

damage to the nerve root - pinched/trapped nerve

232
Q

what examination can be done for eliciting sciatica pain?

A

Straight leg raise
sciatic stretch

233
Q

what is the first line management of sciatica?

A

Amitriptyline
Duloxetine

234
Q

which nerves form the sciatic nerve?

A

L4-S3

235
Q

what cancers most commonly metastasise to bone?

A

Prostate
Renal
Thyroid
Breast
Lung

236
Q

what medication can be given for back spasms?

A

benzodiazepams - diazepam => less than 5 days course

237
Q

what are 5 symptoms of diabetic neuropathy?

A

peripheral sensation loss - glove and stocking
Peripheral pain - burning/prickling
reduced ankle reflexes
painless injuries
Erectile dysfunction

238
Q

what can be used to treat painful diabetic neuropathy?

A

gabapentin/pregabalin

++ Glycaemic control!

239
Q

what is narcolepsy?

A

chronic condition of disrupted sleep wake cycle and REM sleep intrusion into wakeful state

240
Q

what is the classic tetrad of narcolepsy?

A

excessive daytime sleepiness
cataplexy
sleep paralysis
hypnagogic/hypnopompic hallucinations

241
Q

what is the management of narcolepsy?

A

Sleep hygiene and lifestyle changes, trigger avoidance

Sodium oxybate - for cataplexy
Modafinil - for excessive daytime sleepiness

242
Q

what are 4 causes of acute transverse myelitis?

A

Infection
Vaccination
NMO - Neuromyelitis optica
MOG - Myelin Oligodendrocyte Glycoprotein

243
Q

what nutrients affect spinal cord functioning?

A

B12
copper

244
Q

How does NOS affect B12?

A

effects of B12 blocked by NO though there is enough B12 in the body

245
Q

what nutrients affect spinal cord functioning?

A

B12
copper

246
Q

what are 5 causes of acute transverse myelitis?

A

Infection
Vaccination
MS
NMO - Neuromyelitis optica
MOG - Myelin Oligodendrocyte Glycoprotein

246
Q

How does NOS affect B12?

A

causes functional deficiency of B12 => cannot be converted to active form

247
Q

what are the 3 categories of GCS?

A

Eye response
verbal response
motor reponse

248
Q

what are the GCS levels for eye response?

A

1 - no eye opening
2 – to pain
3 - to verbal command
4 - spontaneously

249
Q

what are the GCS levels for verbal response?

A

1 - no response
2 - incomprehensible sound
3 - inappropriate words
4 - confused
5 - orientated

250
Q

what are the GCS levels for motor response?

A

1 - no response
2 - extension to pain
3 - flexion to pain
4 - withdrawal from pain
5 - localised pain
6 - obeys commands

251
Q

what is charcot marie tooth disease?

A

genetic condition that causes peripheral motor and sensory deficits which usually presents <10 years but can present later in life depending on the type

252
Q

what are 7 classical features of charcot marie tooth?

A

high foot arches - pes cavus
disal muscle wasting and inverted champagne bottle legs
weakness in lower legs - particularly ankle dorsiflexion
weakness in hands
reduced tendon reflexes
reduced muscle tone
peripheral sensory loss

253
Q

what are 5 possible causes of peripheral neuropathy?

A

ABCDE

alcohol
B12 deficiency
Cancer and CKD
Diabetes and Drugs
Every vasculitis

254
Q

what are 3 medications that can cause peripheral neuropathy?

A

isoniazid
amiodarone
cisplatin

255
Q

what are 4 features of lambert-eaton myasthenic syndrome?

A

Progressive muscle strengthening
Limb girdle weakness
Hyporeflexia
autonomic symptoms - dry mouth, impotence, difficulty urinating

256
Q

what condition most typically occurs with lambert-eaton syndrome?

A

small cell lung cancer

causes antibodies against voltage-gated calcium channels in presynaptic terminals of the NMJ

257
Q

what is central cord syndrome?

A

incomplete cord injury caused by trauma to the cervical spine leading to weakness or neurological symptoms worse in the upper > lower limbs

258
Q

what nerve is compressed in carpal tunnel?

A

median nerve

259
Q

what is the conservative treatment of carpal tunnel?

A

6 weeks of

night wrist splint
corticosteroid injection into carpal tunel
hand exercises and mobalisation techniques

260
Q

what are 5 presentations of labert-eaton syndrome?

A

proximal muscle weakness
intraoccular muscle weakness - double vision
levator muscle weakness - ptosis
oropharyngeal muscle weakness - dysphagia
autonomic dysfunction - dizziness, impotence, dry mouth, blurred vision

261
Q

what is the treatment for lambert-eaton syndrome?

A

1 - amifampridine

imunosuppresion
IVIG
plasmapheresis

262
Q

what are hamartomas?

A

benign neoplastic growths

263
Q

what condition are hamartomas seen in?

A

tubular sclerosis

264
Q

what genetic mutations cause tubular sclerosis?

A

TSC1 gene on chromosome 9 - codes for hamartin
TSC2 gene on chromosome 16 - codes for tuberin

265
Q

what are 6 skin signs seen in tubular sclerosis?

A

ash leaf spots
shagreen patches - thickened, dimpled, pigmented patch of skin
angiofibromas - small skin coloured or pigmented papules over nose and cheeks
subungual fibromata - circular painless lumps growing from nail bed
cafe au lait spots
poliosis - isolated patch of white hair

266
Q

what are 2 neurological features of tubular sclerosis?

A

epilepsy
learning disability and developmental delay

267
Q

what are 5 non-neuro signs of tubular sclerosis?

A

rhabdomyomas of heart
gliomas
polycystic kidneys
lymphagioleimyomatosis
retinal hamartomas

268
Q

damage to white nerve causes winging of the scapula?

A

spinal accessory - CN11

269
Q

what is the most common cause of foot drop?

A

common peroneal nerve injury

270
Q

what is the CSF picture in viral encephalitis?

A

raised WBCs
HSV +ve PCR

271
Q

what is the treatment for herpes encephalitis?

A

IV acyclovir 10mg/kg every 8 hours for 14 days (21 days if immunocompromised)

272
Q

what is the most common viral cause of encephalitis?

A

HSV

273
Q

what is the most common cause of autoimmune encephalitis?

A

N-methyl D-aspartate receptor antibody encephalitis

274
Q

what scale is used for stroke?

A

national institute of health stroke scale (NIHSS)

275
Q

what is a mild NIHSS stroke?

A

1-5

276
Q

what is a moderate NIHSS stroke?

A

5-14

277
Q

what is a severe NIHSS stroke?

A

15-24

278
Q

what is a very severe NIHSS stroke?

A

> 25

279
Q

what is the management for TIA or minor stroke if thrombolysis/thrombectomy are not appropriate?

A

dual anti-platelet - aspirin 300mg followed by 75mg daily + clopidogrel 300mg followed by 75mg daily

280
Q

what 5 investigations should be done for stroke?

A

CT
MRI
ECG
carotid doppler

281
Q

what is the management of moderate/severe stroke if thrombectomy/thryombolysis are not indicated?

A

aspirin 300mg then 75mg daily for 2 weeks until starting antiplatelet therapy - clopidogrel

282
Q

what is CSF absorbed by?

A

arachnoid granules

283
Q

what is the most common cause of hydrocephalus?

A

aqueductal stenosis

284
Q

what are 4 congenital causes of hydrocephalus?

A

aqueductal stenosis
arachnoid cysts - blood csf outflow
arnold-chiari malformations - cerebellum herniates through foramen magnum
Chromosomal abnormalities and congenital malformations

285
Q

what are 5 signs of hydrocephalus in babies?

A

rapid increasing head circumference
bulging anterior fontanelle
poor feeding and vomiting
poor tone
sleepiness

286
Q

what is the management for hydrocephalus?

A

vetriculoperitoneal shunt

287
Q

what are 5 ventriculoperitoneal shunt complications?

A

infection
blockage
excessive drainage
intraventricular haemorrhage during surgery
outgrowing them

288
Q

what are 3 features of normal pressure hydrocephalus?

A

gait apraxia

cognitive impairment

urinary frequency/incontinence/urgency - also sometimes foecal

289
Q

what is the management for normal pressure hydrocephalus?

A

ventriculoperitoneal shunt is suitable for surgery

290
Q

what is the presentation of ME? (8)

A

persistent disabling fatigue
post exertional malaise
unrefreshing sleep
congnitive and autonomic dysfunction
myalgia
arthralgia
headaches
sore throat and lymph nodes (no lymphadenopathy)

291
Q

what are 5 risk factors for brain abcess?

A

sinusitis/otitis media
dental procedure
meningitis
recent head/neck/neuro surgery
HIV/immunocompromised

292
Q

what on MRI with contrast in brain abcess?

A

ring enhancing lesion

293
Q

what is the management of brain abcess?

A

IV vancomycin
IV Metronidazole
IV ceftriaxone

SURGERY

294
Q

what is mononeuritis multiplex?

A

progressive motor and sensory deficits in the distribution of specific peripheral nerves commonly caused by vasculitis, hypersensitivity reactions or infection.

295
Q

what is an investigations for mononeuritis multiplex?

A

electromyogram

296
Q

what is the management for mononeuritis multiplex?

A

corticosteroids - pred 1mg/kg/day BO

+/- immunosupression - oral cyclophosphamide

297
Q

what are 5 symptoms of malaria?

A

fever
chills
sweats
headache
myalgia

298
Q

what is the 1st line investigation for malaria?

A

giemsa stained blood film

299
Q

what is the most life threatening malaria infection?

A

plasmodium flaciparum

300
Q

what mosquitos cause malaria?

A

female anopheles

301
Q

what is the 1st line management of uncomplicated malaria?

A

hydroxychloroquine

302
Q

what is the 1st line management of complicated malaria?

A

artesunate IV

303
Q

what is wernicke’s aphasia?

A

receptive aphasia causing sentences to not make sense and comprehension to be impaired

304
Q

where is wernicke’s area?

A

superior temporal gyrus of dominant hemisphere

305
Q

what blood vessel supplies wernicke’s area?

A

inferior devision of (usually) left middle cerebral artery

306
Q

what is broccas aphasia?

A

expressive aphasia causing halting speech and impaired repetition with normal comprehension

307
Q

where is broccas area?

A

inferior frontal gyrus of dominant hemisphere

308
Q

what blood vessel usually supplies broccas area?

A

superior division of the (usually) left MCA

309
Q

what is conduction aphasia?

A

due to stroke affecting arcuate fasiculus (connection between wernickes and broccas). Fluent speech with impaired repetition

310
Q

which tumours most commonly metastasise to brain?

A

lung (most common)
breast
bowel
skin (namely melanoma)
kidney

311
Q

what is the most common primary brain tumour in adults?

A

glioblastoma multiforme

312
Q

what does glioblastoma multiforme look like on imaging?

A

solid tumours with central necrosis and a rim that enhances with contrast. Disruption of the blood-brain barrier and therefore are associated with vasogenic oedema.

313
Q

what cells do meningiomas arise from?

A

arachnoid cap

314
Q

what genetic condition is associated with bilateral acoustic neuroma?

A

neurofibromatosis type II

315
Q

what is the most common primary brain tumour in children?

A

Pilocytic astrocytoma

316
Q

what phenomena are seen in occipital lobe focal seizures?

A

visual flashers or floaters

317
Q

what phenomena are seen in parietal lobe focal seizures?

A

sensory - parasthesia

318
Q

what phenomena are seen in frontal lobe focal seizures?

A

head/leg movements, posturing, jacksonian march, post-ictal weakness (todds paresis)

319
Q

what phenomena are seen in temporal lobe focal seizures?

A

pre-ictal aura
automatisms

320
Q

what is the GCS scoring?

A

MoVE - 6,5,4

321
Q

what is the MOA of memantine?

A

NMDA receptor antagonist

322
Q

what are 2 side effects of donepezil?

A

contraindicated in bradycardia
can cause insomnia

323
Q

what dermatome is the thumb and first finger?

A

C6 - make a 6 with left hand thumb and first finger

324
Q

what dermatome is the nipple?

A

T4 - teat pore

325
Q

what dermatome is the umbilicus?

A

BellybuT-TEN = T10

326
Q

what dermatome is the inguinal ligament?

A

L1 - Li

327
Q

what dermatome is the knee caps?

A

ALL Fours - L4

328
Q

what dermatome is the big toe and foot dorsum?

A

L5 - largest of 5 toes

329
Q

what dermatome is little toe?

A

S1 - smallest one

330
Q

what dermatome is the genitalia?

A

S2/3

331
Q

what are 3 side effects of dopamine receptor agonists?

A

pulmonary, retroperitoneal and cardiac fibrosis
impulse control
excessive daytime sleepiness

332
Q

what is autonomic dysreflexia?

A

In patients with spinal injury at or above T6 - response to painful stimuli that causes unbalanced physiological response - extreme hypertension, flushing, sweating (above level of lesion), agitation and extreme hypertension

333
Q

what is the most common cause of autonomic dysreflexia?

A

faecal impaction or urinary retention

334
Q

what is the management of autonomic dysreflexia?

A

removal/control of the stimulus and treatment of any life-threatening hypertension and/or bradycardia

335
Q

what are 8 side effects of carbamezapine?

A

P450 enzyme inducer
dizziness and ataxia
drowsiness
headache
visual disturbances (especially diplopia)
Steven-Johnson syndrome
leucopenia and agranulocytosis
hyponatraemia secondary to syndrome of inappropriate ADH secretion

336
Q

what are 5 causes of foot drop?

A

common peroneal nerve lesion
L5 radiculopathy
sciatic nerve lesion
superficial or deep peroneal nerve lesion
CNS lesion (stroke etc)

337
Q

what examination findings indicate peroneal nerve injury?

A

weakness of foot dorsiflexion and eversion. Reflexes normal

338
Q

what examination findings indicate L5 radiculopathy?

A

weakness of hip abduction

339
Q

what is the gold standard investigation for venous sinus thrombosis?

A

MRI venogram

340
Q

what is lateral medullar syndrome and it’s 6 features?

A

Occurs due to occlusion of posterior inferior cerebellar artery (PICA)

Ataxia
Nystagmus
ipsilateral dysphagia, facial numbness, CN palsy
Contralateral - limb sensory loss

341
Q

What is cushing’s triad of raised ICP?

A

widening pulse pressure
bradycardia
irregular breathing

342
Q

what is the management of raised ICP?

A

head elevation by 30 degrees
IV manitol
controlled hyperventilation
removal of CSF

343
Q

what does occlusion of the retinal artery cause?

A

Amaurosis fugax

344
Q

what does occlusion of the basillar artery cause?

A

locked in syndrome

345
Q

what is the presentation of wernickes encephalopathy?

A

nystagmus or ophthalmoplegia
Ataxia
encephalopathy - confusion, disorientation
peripheral sensory neuropathy

346
Q

what causes wernicke’s encephalopathy?

A

Thiamine B1 deficiency

alcoholism
persistant vomiting
stomach cancer
dietary deficiency

347
Q

what are examples of 5-HT3 antagonists?

A

Ondansetron
Palonesetron

Anti-emetics used in chemo

348
Q

what are 2 side effects of ondansetron?

A

prolonged QT + ventricular tachycardia
constipation

349
Q

what are 2 symptoms of a posterior cerebellar stroke?

A

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

350
Q

what are 2 signs of webbers syndrome (infarct of branches of the posterior cerebral artery that supply midbrain)?

A

Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

351
Q

what artery is affected in lateral pontine syndrome?

A

Anterior inferior cerebellar artery

352
Q

what are of lateral pontine syndrome?

A

Ipsilateral: facial paralysis and deafness
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

353
Q

what scale measures disability?

A

Barthel index

354
Q

what quick stroke assessment scale is used by medical professionals?

A

Rossier

355
Q

when is statin therapy started after stroke?

A

cholesterol >3.5

wait 48 hours to avoid haemorrhagic transformation

356
Q

what is the 1st line secondary prevention of stroke?

A

Aspirin - 75mg
clopidogrel - 75mg

357
Q

what is the 2nd line secondary prevention of stroke?

A

Aspirin + modified release dipyridamole

358
Q

what is the management of idiopathic intracranial hypertension?

A

1 - loose weight
2 - Acetazolamide
3+ - Lumboperitoneal shunt, Optic nerve sheath fenestration, Ventriculoperitoneal shunt

Phase 3A (7 decks)

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