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Year 3 > Neuro > Flashcards

Neuro Flashcards

1
Q

What is the classic histology of a medulloblastoma

A

Small, blue cells with rosette patterns

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2
Q

Which CN does not carry any parasymp fibres?

A

2

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3
Q

Which allelle has increased risk of developing alzheimers

A

E4

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4
Q

What characterises syncope from seizures

A

Short post-ictal period- quick recovery

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5
Q

Vision worse going down the stairs

A

4th nerve palsy- limited depression, adduction of eye and persistent dipolopia

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6
Q

What signs would you see on examination of a Lower Motor Neurone lesion

A

Hypotonia and hyporeflexia

Because these are anterior horn cells so abolishes voluntary and reflex responses of the muscle

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7
Q

What is associated with early onset alzheimers?

A

Amyloid precursor protein

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8
Q

Which cells are destroyed in MS

A

Oligodendrocytes- responsible for the myelin production in the CNS

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9
Q

What is Broca’s dysphasia and what part of the brain does it affect?

A

Speech is non-fluent, comprehension normal, repetition impaired- affects the inferior frontal gyrus

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10
Q

What is Wernicke’s dysphasia and what part of the brain does it affect?

A

Inability to grasp the meaning of spoken words and sentences is impaired.

Speak normal words fluently but doesn’t make sense with a jumble of words. Affects the superior temporal gyrus

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11
Q

What brain lobe would be affected in touch perception/asterognosis

A

Parietal

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12
Q

Which nerve damage causes weakness of foot dorsiflexion

A

Common peroneal

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13
Q

What lobe of the brain is affected in touch perception

A

Parietal

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14
Q

What would occlusion of the anterior cerebral artery cause?

A

Contralateral hemiparesis and sensory loss with the lower extremity being more affected than the upper -> supplies the medial side of the cerebral hemisphere

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15
Q

What would occlusion of the posterior cerebral artery cause?

A

Contralateral hemianopia with macular sparing -> supply of blood to occipital lobe is blocked so visual processing is lost

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16
Q

What would occlusion of the middle cerebral artery cause

A

Supplies the motor and sensory cortices more likely to affect upper limbs than lower.

Unilateral droop of the face.
Language centres affected if stroke on dominant side

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17
Q

What is Weber’s syndrome?

A

When branches of the posterior cerebral artery are occluded -> ipsilateral CN 3 palsy, contralateral weakness of upper and lower extremity

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18
Q

Locked in syndrome is damage of which artery?

A

Basilar

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19
Q

What lobes does the tentorium cerebelli seperate

A

Occipital lobe

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20
Q

What lobe lesion may cause acalculia?

A

Parietal lesion

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21
Q

Unilateral cerebellar lesions cause problems on which side of the body

A

Ipsilateral

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22
Q

What are the afferent and efferent limbs of the corneal reflex

A

Afferent- opthalmic
Efferent- facial

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23
Q

What part of the dura mater seperates the cerebral hemispheres?

A

The falx cerebri

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24
Q

Which CN is affected in nystagmus?

A

CN VIII (vestibulocochlear)

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25
Q

What are astrocytes involved in?

A

Physical repair, form the blood-brain barrier, remove excess potassium ions, provide physical support

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26
Q

Infarcts in which lobes cause superior and inferior quadrantanopia?

A

PITS- parietal inferior, temporal superior (on contralateral side

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27
Q

Hallucinations occur in seizures of which lobe?

A

Temporal

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28
Q

Damage to what part of the thalamus causes hearing impairment?

A

Medial geniculate nucleus

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29
Q

What is myasthenia gravis?

A

Fatiguable, painless, muscle weakness that improves with rest

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30
Q

Degeneration of which neurotransmitters cause Huntingdon’s disease?

A

ACh and GABA

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31
Q

In a hypoglossal nerve lesion the tongue will deviate to which side?

A

The affected side

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32
Q

What can lacunar strokes cause?

A

Isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

Strong association with hypertension

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33
Q

In vagus nerve lesions which side will the uvula deviate too?

A

Contralateral side of lesion

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34
Q

Describe lateral medullary syndrome/Wallenbergs

A

Following the occlusion of the posterior inferior cerebellar artery.

Cerebellar features: ataxia, nystagmus

Brainstem features: ipsilateral- dysphagia, facial numbness, cranial nerve palsy
Contralateral: limb sensory loss

DANVAH mnemonic- dysphagia, ipsilateral Ataxia, ipsilateral nystagmus, Vertigo, Anaesthesia, ipsilateral Horner’s syndrome

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35
Q

What is the pathophysiology behind myasthenia gravis

A

Autoimmune condition of the neuromuscular junction where antibodies are made against Ach receptors.

75% of patients have a thymoma

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36
Q

What is the tx for myasthenia gravis?

A

Acute: pyridostigmine, IV immunoglobulin or thymectomy

Long term: steroids eg pred+ azathioprine

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37
Q

What is the ix for myasthenia gravis?

A

Bloods- Ach receptors antibodies
CT chest for thymoma
EMG: single fibre

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38
Q

What tract processes crude touch? Where do they cross the spinal cord?

A

The anterior spinothalamic tract- cross at the spinal segment they enter

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39
Q

What tract carries fine touch, proprioception and vibration

A

Dorsal collumns

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40
Q

What tracts is responsible for pain and temp sensation?

A

Lateral Spinothalamic tract

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41
Q

Most common cause of meningitis in adults?

A

Strep Pneumoniae

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42
Q

What nerve promotes secretion from the parotid gland?

A

glossopharyngeal

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43
Q

What receptors do opiods act on?

A

Delta, Mu and Kappa
Bradycardia, bradypnoea and pinpoint pupils classic findings in an overdose

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44
Q

What are upper motor neurone signs?

A

Muscle weakness, spasticity, hyperreflexia and clonus

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45
Q

What are lower motor neurone signs?

A

Originate in the anterior horn of the spinal cord so asymmetric weakness, flaccid paralysis, fasciculations, hyporeflexia and muscle atrophy

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46
Q

First line treatment for migraine with N+V?

A

NSAID/paracetamol + antiemetic eg sumitriptan

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47
Q

What is a contraindication to a lumbar puncture?

A

Raised ICP

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48
Q

What are absence seizures?

A

Usually in children- patient stares blankly then abruptly returns to normal.

Mx- sodium valproate or lamotrigine

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49
Q

What the signs of primary lateral sclerosis?

A

Progressive and bilateral upper motor neuron weakness

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50
Q

What resp measurement should be monitored in guillian-barre syndrome?

A

Forced Vital Capacity

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51
Q

How does a subarachnoid haemorrhage present?

A

A severe sudden onset occipital headache. May have stiff neck, decreased consciousness and focal neurological deficit

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52
Q

Presentation of a cluster headache

A

Unilateral peri-orbital headaches with ipsilateral ptosis, lacrimation, conjunctival injection and rhinorrhea.

Happen in clusters with silent periods in between

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53
Q

What 5HT3 anatagonist can make parkinsons symptoms worse?

A

Metoclopramide

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54
Q

Signs of internuclear opthalmoplegia

A

Failure to adduct eye on affected side and nystagmus in contralateral side

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55
Q

What drug can used to reduce raised ICP?

A

Mannitol

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56
Q

What is spared in stroke

A

The forehead- indicates lower motor neuron problem

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57
Q

First line prophylactic treatment of migraine?

A

Amitriptyline

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58
Q

Are extradural haemoatomas supra or infratentorial?

A

Supra

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59
Q

What is the first step of ix in suspected stroke

A

non-contrast CT head

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60
Q

What to do next if ischaemic stroke is suspected?

A

Loading dose of aspirin and considered thrombolysis

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61
Q

What features suggest frontal lobe epilepsy?

A

Head/leg movements
Post ictal weakness
Jacksonian march (clonic movements travelling proximally)

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62
Q

What can be given to lower mortality in confirmed bacterial meningitis

A

Dexamethasone IV

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63
Q

What does a pyramidal pattern of muscle weakness mean?

A

In Upper Limb: extensors weaker than flexors
In Lower Limb: flexors weaker than extensors

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64
Q

What is neologism?

A

Making up new words or phrases

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65
Q

What is the most common cause of encephalitis?

A

Usually viral caused by herpes simplex 1

66
Q

Thunderclap headache is associated with what?

A

Subarachnoid Haemorrhage

67
Q

What are symptoms of a subdural haemorrhage

A

Fluctuating levels of consciousness and progressive neurology

68
Q

Classic CT sign of a subdural haemorrhage

A

Cresent shaped collection of blood

69
Q

Characteristics of a extradural haemorrhage

A

Head injury with deterioration in consciousness followed by a lucid interval.

70
Q

Where is the bleed from an extradural haemorrhage usually from?

A

The middle meningeal artery or vein -> blood accumulates between the bone and dura mater

71
Q

First line tx of tonic clonic seizures

A

Sodium Valproate and lamotrigine (women)

72
Q

What does +ve rombergs test indicate?

A

Dorsal column dysfunction (visual input is required for proprioceptive deficits)

73
Q

In a cerebellar syndrome is Romberg’s test positive or negative?

A

Positive

74
Q

Characteristics of a tonic-clonic seizure?

A

Loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) episodes.

Associated tongue biting, incontinence, groaning and irregular breathing

Prolonged post ictal period

75
Q

Characteristics of an atonic seizure

A

Brief lapses in muscle tone causing the patient to fall, not more than 3 mins, consciousness is retained

76
Q

Characteristics of a myoclonic seizure

A

Present as sudden brief muscle jerks of a limb, trunk or face

77
Q

What are upgoing plantars a feature of?

A

An upper motor neuron lesion on the affected side

78
Q

What do cholinesterase inhibitors do?

A

Maintain higher levels of acetylcholine to attach to nicotinic acetylcholine receptors to facilitate muscle contraction -> alleviates muscle weakness (used in myasthenia)

79
Q

An INR greater than what is a contraindication for thrombolysis?

A

INR >1.7

80
Q

A blood pressure greater than what is a contraindication for thrombolysis?

A

180/110

81
Q

What is the acute tx of a migraine?

A

NSAID (aspirin, naproxen, ibuprofen), antiemetic if gastroparesis, triptans (5HT agonist) eg sumitriptan, rizatriptan, eletriptan

82
Q

What is the prophylaxis of a migraine?

A

1st- amitriptyline or propanolol
2nd- topiromate/valproate
3rd- pizotifen

83
Q

What secondary treatment should be commenced post stroke in a patient with atrial fibrillation?

A

Warfarin or DOAC

84
Q

What secondary treatment should be commenced post stroke in a patient?

A

Clopidogrel for long term antiplatelet therapy

85
Q

What is guillain barre syndrome?

A

Progressive, symmetrical, distal weakness associated with flaccidity and hyporeflexia (LMN signs) on a background of a recent viral illness.

86
Q

What is the main surgical intervention for subarachnoid haemorrhage?

A

Endovascular coiling

87
Q

What is the Cushings Reflex, what does it result in?

A

A physiological response to raised ICP.

Increased blood pressure, decreased heart rate and irregular breathing

88
Q

Describe the mechanism of the Cushing’s reflex

A

Raised ICP caused sympathetic and parasympathetic nervous systems to be activated.

In the first stage sympathetic > parasympathetic so greater blood flow resistance and hypertension and heart rate.

Barareceptors in the aortic arch detect this and triggers the parasymp response via the vagus nerve -> slows heart rate

Increased pressure on the brainstem can also can irregular breathing

89
Q

Treatment for encephalitis

A

IV aciclovir

90
Q

What are the features of corticobasal degeneration

A

Parkinsonian features, apraxia (unable to do tasks when asked to)

91
Q

DANISH mnemonic for cerebellar stroke/syndrome dysfunction

A

Dysdiadochokinesia (inability to perform rapid alternating movements)
Ataxia
Nystagmus
Intention tremor (tremor during voluntary movement eg finger nose test)
Slurred speech
Hypotonia

92
Q

What is the brains main inhibitory neurotransmitter

A

GABA- acts of gaba receptor

93
Q

What is the brains main excitatory neurotransmitter?

A

glutamate acts on the NDMA receptor

94
Q

What are automatisms?

A

Semicoordinated, repetitive motor activities associated with impaired awareness. eg lip smacking, grabbing, plucking

95
Q

What type of seizures are automatisms seen in?

A

Temporal Lobe

96
Q

What drugs can worsen symptoms of myasthenia gravis?

A

Beta blockers, certain antibiotics eg gentamicin, lithium

97
Q

What are the three aspects of the Bamford criteria for a total anterior circulation infarct?

A
  1. Unilateral hemiparesis or hemisensory loss
  2. Higher cognitive dysfunction eg dysphasia or hemispatial neglect
  3. Homonymous hemianopia
98
Q

What is a posterior circulation syndrome stroke (POCS) and its criteria

A

Damage to the area of brain supplied by posterior circulation eg cerebellum or brainstem

One of the following for dx:
- Cranial nerve palsy and a contralateral motor/sensory deficit
-Bilateral motor/sensory deficit
-Conjugate eye movement disorder (e.g. horizontal gaze palsy)
-Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
-Isolated homonymous hemianopia with macular sparing

99
Q

What is a lacunar stroke (LACS)

A

Subcortical stroke (in deep part of brain) that occurs secondary to small vessel disease. No loss of higher cerebral function eg dysphasia

100
Q

What is the diagnostic criteria for a lacunar stroke?

A

One of the following needs to be present for a diagnosis of a LACS:

-Pure sensory stroke
-Pure motor stroke
-Sensori-motor stroke
-Ataxic hemiparesis (weakness and ataxia on the same side)

101
Q

From what time of symptom onset should thrombolysis be given for ischaemic stroke?

A

4.5 hours

102
Q

Mx of essential tremor

A

Propanolol

103
Q

Hyperattenuation would suggest which kind of stroke?

A

Haemorrhagic

104
Q

Hospital treatment of status epilpticus?

A

Lorazepam twice within 5-10 mins of last dose then phenytoin

105
Q

What nerves are affected in pseudobulbar palsy and what does it cause?

A

CN 9,10+12

Causes swallowing and speech difficulties

106
Q

What is the test for impairment of motor function in the muscles served by the L5 nerve root?

A

Power of dorsiflexion of the big toe

107
Q

What is the test for impairment of motor function in the muscles served by the L4 nerve root?

A

Foot inversion

108
Q

What is the test for impairment of motor function in the muscles served by the L3 nerve root?

A

Knee extension

109
Q

What is the test for impairment of motor function in the muscles served by the L2 nerve root?

A

Hip flexion

110
Q

What would a lacunar stroke result in?

A

Pure motor dysfunction

111
Q

An UMN lesion affects which tract

A

The pyramidal/corticospinal tract

112
Q

A TAC stroke affects what vessels

A

Contralateral anterior and middle cerebral

113
Q

A basal ganglia/extrapyramidal pathway leads to what features?

A

Parkinsonism/hypokinesis traits
Or hyperkinesis eg huntington’s chorea

114
Q

Features of myotonic dystrophy?

A

Dysarthria, frontal balding, strong grip

115
Q

Progressive muscle atrophy MND affects which motor neurones?

A

Only lower motor neurones

116
Q

Spinal ALS MND affects what neurones?

A

Simultaneous upper and lower motor neurones

117
Q

Primary lateral sclerosis affects which motor neurones?

A

Upper motor neurones

118
Q

Main function of vestibulospinal tract

A

Activate the anti-gravity extensor muscles

119
Q

Main function of the tectospinal tract?

A

Reflex to visual and auditory stimulus

120
Q

Main function of reticulospinal tract?

A

Control of breathing and cardiac control

121
Q

Where does the tectospinal tract originate and end?

A

Superior colliculus of the midbrain and extends down the cervical spine

122
Q

Describe a subflacine herniation

A

-When one half of the cerebrum herniates across
the midline.
-cause compression of the anterior cerebral artery
-lead to motor and/or sensory weakness.

123
Q

Describe cerebellar tonsillar herniation

A

-Cerebellum moves inferiorly
-Compresses medulla
-Lead to resp distress/death

124
Q

Describe central herniation

A

Central part of the brain inferiorly compresses brainstem

125
Q

Describe transcalvarial herniation

A

Defect in skull and brain herniates out

126
Q

1st+2nd line treatment for generalised tonic clonic seizure?

A

1st:Sodium valproate or lamotrogine
2nd: levetiracetam or topiramate

127
Q

1st line treatment for absence seizures?

A

Ethosuximide or sodium valproate

128
Q

1st +2nd line treatment for myoclonic seizures?

A

1st-Sodium Valproate
2nd- Levetiracetam

129
Q

Treatment for focal seizure

A

Lamotrigine/carbamazepine

130
Q

1st+2nd line treatment for unclassified seizures?

A

1st-sodium valproate
2nd-Lamotrigine/topiramate

131
Q

What the mechanism of action of metoclopromide?

A

D2 receptor antagonist therefore can block extra-pyramidal pathway leading to side effects such as acute dystonia and chronically tardive dyskinesias

132
Q

Triad of juvenile myoclonic epilepsy?

A

Myoclonic jerks, absence seizures and generalised tonic-clonic seizures

133
Q

First line treatment in status epilepticus?

A

Buccal midazolam or Rectal diazepam (benzodiazopines)

134
Q

Treatment for trigeminal neuralgia?

A

Carbamazepine, gabapentin, pheytoin

135
Q

What is the caution with topiramate?

A

Contraindicated in pregnancy, need very effective contraception- can impair the effectiveness of hormonal contraceptions.

136
Q

How does Brown Sequard syndrome arise?

A

Due to hemisection of spinal cord. Anatomical disruption of nerve fibre tracts in one half of spinal cord

137
Q

Pathophysiology of brown sequard syndrome?

A

Ipsilateral weakness + loss of fine touch, joint proprioception and vibration as fibres decussate in the medulla.

Contralateral loss of pain and temp sensation as fibres of spinothalamic tract decussate in spinal cord

138
Q

Which antibiotic can reduce seizure threshold?

A

Quinolones such as ciprofloxacin

139
Q

What is the secondary prevention of stroke?

A

Clopidogrel 75mg once daily (alternatively aspirin plus dipyridamole)
Atorvastatin 20-80mg (not started immediately – usually delayed at least 48 hours)
Blood pressure and diabetes control
Addressing modifiable risk factors (e.g., smoking, obesity and exercise)

140
Q

What would MRI of MS show?

A
  • Periventricular lesions
  • Discrete white matter abnormalities
  • Areas of focal demyelination
  • Active inflammatory plaques can be distinguished from inactive ones by using a contrast agent
141
Q

Ix for trigeminal neuralgia?

A

MRI head

142
Q

Tx for trigeminal neuralgia?

A

Carbamazepine first line, gabapentin, phenytoin

143
Q

Foot drop is damage to which nerve

A

Common peroneal nerve

144
Q

What is given after thrombolysis in ischemic stroke if presenting within 4.5 hours of symptoms?

A

Aspirin 24hrs after treatment with alteplase for a period of 2 weeks once repeat CT has excluded new haemorrhagic stroke

145
Q

If hyperacute treatments are not offered in stroke what is given?

A

Aspirin 300mg orally once daily for two weeks

146
Q

In temporal lobe epilepsy which structure could be damaged and what symptoms would it result in?

A

Hippocampus can cause long term deficits in memory

147
Q

Features of Wernicke’s Encephalopathy

A
  • Ataxia
  • Confusion
  • Ocular abnormalities: this can include gaze-evoked nystagmus, spontaneous upbeat nystagmus, and horizontal or vertical ophthalmoplegia
148
Q

Aetiology of myotonic dystrophy

A

Genetic mutation leading to trinucleotide repeats in DMPK gene

149
Q

What is obstructive or non-communicating hydrocephalus?

A

When flow of CSF blocked along one or more narrow passages connecting the ventricles leading to dilation of more upstream ventricles eg third and fourth

150
Q

What is communicating hydrocephalus?

A

CSF can exit the ventricular system but absorption impaired- commonly due to problems in the subarachnoid space such as haemorrhage

151
Q

Symptoms of hydrocephalus?

A

Early morning headaches, N+V, lethargy and visual disturbances

152
Q

How long after a TIA or stroke should a patient not drive

A

1 month if satisfactorily recovered

153
Q

What is conductive dysphasia?

A

Presents with fluent speech but an inability to repeat words.

154
Q

What is dysarthria?

A

Inability to coordinate the muscles of speech leading to problems with articulation. They have no problem producing speech but do not pronounce the words well

155
Q

What is global aphasia?

A

Inability to understand, repeat, and produce speech.

156
Q

First line investigation for MS

A

MRI brain and spine with contrast

157
Q

How does progressive supranuclear palsy present?

A

Parkinsonism and vertical gaze palsy (hard to look up)

More symmetric and tremor negative parkinsonism

158
Q

Ix for a TIA

A

-MRI to look for alternative pathologies
-Carotid ultrasound
-Echo: to look for carotid thrombus
-24hr tape for atrial fibrillation
-Blood tests for glucose and lipids

159
Q

Gold standard ix for cervical myelopathy?

A

MRI of cervical spine

160
Q

Where does the lateral corticospinal tract decussate and what does it innervate?

A

Decussates in medulla
Innervates the distal/appendicular muscles

161
Q

Where does the anterior corticospinal tract decussate and what does it innervate?

A

Decussates in spinal cord at segmental level
Innervates trunk and axial muscles

Year 3 (12 decks)

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