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finals > Neuro > Flashcards

Neuro Flashcards

1
Q

Alzheimers on imaging

A

mesial temporal lobe atrophy

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2
Q

anterior cerebral artery stroke

A

contralateral hemiparesis & sensory loss

Lower extremeties > upper extrem

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3
Q

Total anterior circulation infarct (TACI)

A

(middle and anterior cerebral)

1 unilat hempiparesis +/- hemisensory loss of face arms and legs

2 homonopious hemaonpia

3 higher cognative dysfxn ie dysphagia

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4
Q

anterior inferior cerebellar
lateral pontine

A

sudden onset vertigo & vom

ipsilateral facial paralysis and deafness

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5
Q

aphasia where is brocas and what time

presenation

suppilied by

A

expressive ie speech made then sent here

inferior frontal gyrus

normal comprehension
speech non fluent
repetition impaired

Superior dividion of MCA

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6
Q

aphasia where is wernickes

suplied by

presentation

A

speech made here then sent to brocas
superior temporal gyrus

inferior MCA

not normal comprehension
speech no sense, word substitution and nedograms
but fluent
‘word salad’

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7
Q

condustion aphasia where

and presentation

A

stroke in connection of arcuate fasiculus

speech fluent but poor
pt aware of errors
normal comprehension

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8
Q

global aphasia
where
presentation

A

large lesion affecting all 3

servere expressive and receptive aphasia

may still be able to communicate with gestures

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9
Q

true seizures may show compared to pseudoseizures

A

prolactin increase 10-20min after

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10
Q

parksinons path

A

loss of dopaminergic neruons in substantia nigra = loss of excitatory signal

less dopamine (d2) = less GABA (inhibitory) = increased movement

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11
Q

parkinsons tx

A

Motor sx impacting QOL = levodopa-carbidopa

Motor sx not yet impacting = Dop agonist ie ropinirole
MAO-B inhib ie selegiline

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12
Q

essential tremor presentation n tx

A

no tremor at rest
worsens with movement

propanolol

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13
Q

cerebellar lesion tremor

A

no tremor at rest

worsens w movement gets worse w intention ie closer u get

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14
Q

huntingtons ix

A

genetic testing - CAG repeats in HTT allele

CT/MRI
atrophy (caudate striatal frontal)
dilated lateral ventricles

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15
Q

huntingtons tx

A

supportive and sx tx

counselling n support for pt and family

psychiatric - SSRIs, ECT, antipsychotics,CBT

Chorea - benzos

Bradykinesia/rigidity - Dopamine agonists, levodopa

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16
Q

Spinal stenosis presentation

A

Bilateral

burning, lightening pain of thighs and bum

worse on upright - better when leaning forward or climbing stairs

(proximal pseudoclaudication that is positional!)

[peripheral cause would be distal legs too and not positional)

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17
Q

syringomyelia path and ix, sx and tx

associated with

A

pockets of CSF cysts in spinal cord

ix - MRI

sx - back pain (neck shoulders arms)
loss of pain and temp which progresses to motor sx ie weakness and wasting esp hands and arms

(bc spinothalamic )

Tx - Surgery

associated w chiari malformation (cerebeller tonsils protrude from foramen magnum

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18
Q

normal pressure hydrocephalus path presenation

ix

tx

A

normal ICP but hydrocephalus

Wet wobbly weird
(incontinence, ataxia, demetia)

ix
CT - hydrocephalus
LP - no raised ICP but improvement of Sx after

tx surgical shunt

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19
Q

picks disease

A

FTD dementia

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20
Q

lewy body pathway n presentation

A

Lewy bodies in substantia nigra

fluctuating changes in cognition - cycles get progressively shorter
w lucid period - can be v distressing for pt bc insight

acute delirium and hallucinations

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21
Q

alzheimers tx

A

cholinesterase inhib

donezepil n rivastigmine

severe = memantine

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22
Q

CJ disease (mad cow)

A

prions accumulation

young rapid dementia myoclonus

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23
Q

Reversible causes of dementia

A

b12 def
hypothyroid
electrolyte abnormality (CKD)
syphilis
Normal pressure hydrocephalus
anaemia

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24
Q

Anterior spinal artery occlusion

A

bilateral spastic paresis
loss of pain and temp

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25
Q

when does cushings reflex happen why

what is it

A

happens in increased ICP to maintain peripheral perfusion

opposite of hypovol shock vitals ie

increase BP (HTN)
decrease HR
wide pulse pressure

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26
Q

Bitemporal hemanopia if upper quad worse then lower

A

pituatry tumor

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27
Q

bitemporal hemanopia

lower quad worse than upper

A

craniopheningoma

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28
Q

pontine haemorrahe cause and presentation

A

life threatening emergency
chronic HTN complication

reduced GCS
quadraplegia
miosis
absent horizontal eye movements

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29
Q

extradural haemorhage

A

middle meningeal artery

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30
Q

MCA stroke presentation

A

contralateral paralysis and sensory loss of face and upper limbs

aphasia if infarct in dominant hemisphere

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31
Q

bells palsy

A

no foreheard sparing (bc LMN)

loss of taste anterior 2/3 tongue

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32
Q

wilsons neuro sx

A

copper deposition in cerebellum = dysarthria and wide based gait

in basal ganglia = tremor and rigidity (parkinsonism)

also psych sx ie anxiety depression bipolar

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33
Q

wilsons diagnostic test

A

24hr urine collection

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34
Q

L5 root lesion

A

reduced ankle eversion and inversion and dorsiflexion

sensory loss over big toe

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35
Q

pundendal nerve block what nerve fibres and palpate where

A

fibres S2,S3,S4

palpate ischial spine transvaginaly

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36
Q

GCS

eyes

A

Eyes open spontaneously – 4
Eyes open to speech – 3
Eyes open to pain – 2
Eyes do not open – 1

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37
Q

GCS

verbal

A

Orientated – 5
Confused – 4
Inappropriate words – 3
Inappropriate sounds – 2
No verbal response – 1

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38
Q

GCS
motor

A

Obeys commands – 6
Localises pain – 5
Withdraws from pain – 4
Abnormal flexion – 3
Abnormal extension – 2
No response – 1

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39
Q

Charcot marie tooth disease (CMT)

A

hereditary peripheral neuropathy

distal weakness, such as foot drop and pes cavus (high foot arch)

distal atrophy

loss of senstation maybe tingling and numbess

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40
Q

stroke no driving for how long

A

4 weeks

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41
Q

duchenne muscular dystrophy tx

A

steroids

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42
Q

brown sequard

A

hemisection of cord

ipsilateral loss of vibration and proprioception and hemiplegia

contralateral pain and temp

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43
Q

pinealoma

A

slowgrowing tumor of pineal gland

may press on midbrain cerebral aqueduct = non communicating hydrocephlaus

if compress edinger westphal nuclei = mydriasis (pupil dilation)

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44
Q

had two epsiodes of seizure both resolved but now having another seizure

A

IV phenytoin

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45
Q

LP spinal level and to which space

A

L3/L4 (cord ends at L1/L2)

into subarachnoid space

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46
Q

spontanous intracranial hypotension

A

postural headache worse when standing/sitting - relieved by laying down

Extrathecal leakage of CSF

diagnosed CT myelogram

Tx epidural blood patch

common cause = LP

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47
Q

loss of vision right upper quad of both eyes

A

left inferior optic radiation

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48
Q

bacterial meningitis CSF

A

CSF pressure raised

protein raised

glucose low

polymorphs

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49
Q

MMSE score

A

out of 30
<26 abnormal
20-26 mind dementia
10-20 moderate dementia

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50
Q

degenerative cervical myelopathy (DCM)
what is it

A

progressive degen of spinal cord in cervical
- associated w age related changes in spine and caused by wear and tear over time
leads to compression and damage of spinal cord

Age related changes
- herniated discs between vertebae (bulge/herniate -= compress cord)
- Osteophytes (abnormal bony outgrowths= same)
- Ligament thickening (ligs in spine thicken = same)

ix MRI
tx decompressive surgery

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51
Q

Homonymous quadrantopia

A

PITS
parietal = inferior
Temporal = superior

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52
Q

webers syndrome

A

Stroke of Posterior cerebral artery

ipsilateral oculomotor palsy (bc CN3 runs close to PCA in midbrain)
contralateral hemiparesis

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53
Q

assessing stroke in acute setting

A

exclude hypoglycaemia

then ROSIER
score>0 = stroke likely

54
Q

paroxsysmal hemicrania vs cluster headache

A

PH =
Duration = shorter 2-30mins (not 15m-3h)
freq= more -sometimes more than 10 (1-3times a day)
Time = anytime even night (circadian same time evryday during night)
tx = indomethacin (o2, triptans, verapamil)

55
Q

Abx causing ICH

A

tetracycines

56
Q

ICH Sx

A

Papilloedema (sx =transient vision loss)
early morning headaches which improve in day (bc horizontal laying = increases pressuremore)

57
Q

progressive supranuclear palsy

A

parkinsonism AND

cant move eyes up and down and slurred speech

58
Q

GBS diagnosis

A

LP- shows increased protein and normal white cel count after 1-2 weeks

59
Q

amaurosis fugax path

A

ipsilateral stroke of retinal/ophthalmic artery

60
Q

PICA (posterior inf cerebellar artery)
lateral medullary syndrome

A

cerebellar signs (ataxia nystagmus dysphagia)
contralateral sensory loss upper and lower limb
ipsilateral facial sensory loss and horners syndrome

61
Q

lhermittes sign

A

tingling in hands when neck flexed (MS)

62
Q

Uhthoffs phenomenon

A

worsening of vision following rise in body temp (MS)

63
Q

bladder dysfxn in MS pt n mx

A

urgency incontinence overflow

get ultrasound KUB first 4 bladder emptying

lots of residual = intermittent self cath
no sig residual volume = anticholernergics may improve

64
Q

oscillopsia in MS

A

visual fields appear to oscillate
tx = gabapentin

65
Q

chronic SDH on CT

A

hypodense (dark)
crescent shaped, not limited by suture lines

66
Q

juvenile myoclonic epilepsy (janz syndrome)

A

teenage yrs (12-16) MC in girls

infrequent generalised seizures in the morning/after sleep deprivation
daytime absences
sudden shock like myoclonic seizures (may develop before seizures)

tx sodium valp

67
Q

locked in syndrome artery n pt

A

basillar artery

3 main presentations;
- acute decreased GCS and advanced motor sx
- insidious gradual deterioration in GCA n motor sx with sudden subsequent advanced decrease in both
- herald hemiparesis w asx headache n vision changes prior to onset of permenant loss of motor symptoms

68
Q

Branches of posterior cerebral artery which supply midbrain (Webers)

A

ipsilateral oculomotor CN3 palsy
contralateral weakness of upper and lower extrem

69
Q

myathenia crisis mx

A

IV ig and plasmapharesis

70
Q

wernickes encephalopathy triad snd tx

A

confusion (encephalopathy)
ataxia
nystagmus/ophthalmoplegia (lateral rectus palsy)

chronic alcoholics

tx = Pabrinex (IV B1/C vit)

71
Q

complication of wernickes encephalopathy

A

if left untreated by thiamine - may develop to korsakoffs

ie triad + antero&retrograde amnesia
Confabulation

72
Q

What meds can excerbate MG

A

beta blockers

73
Q

glioblastoma on imaging n prognosis

A

solid tumors w central necrosis n rim that enhances with contrast
disrupts blood brain barrier therefore asx w vasogenic oedema

MC primary brain tumor poor prog <1yr

74
Q

Glioblastoma on histology and tx

A

pleomorphic tumor cells border necrotic areas

TX - surgucal w post op chemo/radio
dexameth for oedema

75
Q

meningioma what is it

A

2nd MC primary brain tumor

usually benign, extrinsic tumors of central nervous sytem
arise from arachnoid cap cells of meninges and typically located next to dura

cause sx of compression rather than invasion

76
Q

meningioma location and histology, investigation

A

falx cerebri, superior sagittal sinus, convexity or skull base

histology: spindle cells in concentric whorls and calcified psammoma bodies

ix; CT = contrast enhancement & MRI

tx; will involve either observation, radiotherapy or surgical resection

77
Q

migraine tx

A

acute = triptan + (NSAID or paracetamol)
Proph = topiramate or propanol

avoid top in women childbearing age

78
Q

temporal lobe seizures

A

with or without LOC

Aura:
- Rising epigastric sensation
- deja vu
- sometimes hallucinations; auditory/gustatory/olfactory

seizures last 1 min;
- automatisms ie lip smacking, grabbing, plucking

79
Q

nerves affected during axillary discection

A

intercostobrachial nerves

= impair sensation in axilla

80
Q

smiths fracture

A

reverse colles ie fall on back of hand with wrist flexed = broken distal radius moved towards palmar side

median nerve affected = thenar muscle loss of function = cant oppose thumb

81
Q

supracondylar fracture

A

fall on outstretched hands in kids esp = humerus brake just above condyles

= median nerve affected - loss of pronation

82
Q

carotid endarterectomy in pt w TIA

A

considered if carotid artery stenosis> 70% on contralateral side to sx

83
Q

early sign of brain mets

A

CN6 palsy (lateral rectus)

= medially pointed eye + horizontal diplopia (excerbated by reading)

84
Q

subacute degeneration of spinal cord cause and presentation

A

b12 def = impairment of dorsal columns, lateral corticospinal trats and spinocerebellar tracts

dorsal = distal symmetrical sensory loss in legs more than arms (tingling/burning)
+ impaired propioception and vib

LCST = hyperreflex, spaciity muscle weakness
UMN signs in legs first
brisk knee reflexes
absent ankle jerks
extensor plantars

SCT = sensory ataxia - gait abnormal
+ve rombergs

85
Q

PCA stroke

A

contralateral homonymous hemanopia w macular sparing

visual agnosia (cant recognise objects)

86
Q

how long no drive after first unprovoked/isolated seizure if brain imaging and EEG normal

A

6 months

87
Q

phenytoin side affects

A

peripheral neuropathy - glove and stocking distribution
gingival hyperplasia
lymphadenopathy

88
Q

what should you always do before giving folate

A

replace b12 - otherwise precipitate subacute degen of spinal cord

89
Q

klumpkes paralysis

A

damage to t1
traction injury

= loss of intrinsic hand muscles (no thumb adduction and inger abduction)
loss of sensation of medial epicondyle

90
Q

temporal arteritis vision testing for what complications

A

anterior ischaemic neuropathy (most)
temp vision loss (amaurosis fugax)
diplopia

permenant vision loss often sudden !!!

91
Q

temporal arteritis what is anterior ischaemic neuropathy

fundo

A

occlusion of posterior ciliary artery (branch of opthalmic artery) ->
ischaemia of optic head

fundoscopy -> swollen pale disc and blurred margins

92
Q

frontal lobe siezure

A

(motor)

head/leg movements
posturing
post ictal weakness
jacksonion march

93
Q

parietal lobe seizure

A

(sensory)
paraesthesia

94
Q

occipital lobe seizure

A

(visual)

floaters/flashes

95
Q

radial nerve injury (root) how and what

A

c5-T1

fracture of humeral shaft

= wrist drop

impaired wrist extension and
impaired sensation over dorsal aspect of 1st and 2dnd metocarpal bones

96
Q

fracture of olecranon

A

ulnar nerve injury

claw hand

hyperexten of metocarpalphalyngeal joints
flexion at distal and proximal interphalangeal joints of 4th n 5th digits
radial deviation of wrist
sensory loss to palmar and dorsal medial 1.5 fingers

97
Q

supracondylar fracture

A

ulnar nerve damage

98
Q

axillary nerve damage present

A

flattened deltoid
impaired shoulder abduction

99
Q

causes of axillary nerve damage

A

frac of humeral neck
or proximal humerus

100
Q

how would you differentiate brain abcess from high grade tumor ie glioblastoma

A

abcess = restricted diffusion on diffusion weighted imaging

101
Q

Homonymous quadrantopia superior lesion

A

Superior = temporal

therefore
lesion of inferior optic radiation in temp lobe (meyersloop)

102
Q

Homonymous quadrantopia inferior lesion

A

inferior = parietal

lesion of superior optic radiation in parietal lobe

103
Q

migraine precip factors

A

CHOCOLATE

Chocolate
hangovers
orgasms
cheese/caffeime
Oral pill
lie ins
alcohol
travel
exercise

104
Q

where does HSV encephalitis affect

A

temporal lobe (medial)

ie = aphasia

also intferior frontal lobe

seen on CT

105
Q

HSV encephalitis tx ans what may you see on EEG

A

IV aciclovir

lateralised periodic discharges at 2Hz

106
Q

Jarisch-Herxheimer reaction and tx

A

Fever, rash, chills and headache occurs following antibiotic administration for syphilis (24hrs)

supportive tx and antipyretic (use paracetamol)

107
Q

symptomatic chronic subdural bleeds

A

burr hole evacuation

108
Q

lumbar spinal stenosis ix and tx

A

MRI showing canal narrowing

tx = laminectomy

109
Q

neuroleptic malignant syndrome and serotonin syndrome both sx

A

drug reaction

tachycardia, inc BP

pyrexia sweating

muscle rigidity

both tx iv fluids and benzos

110
Q

neuroleptic malignant syndrome over serotonin

A

caused by antipsychotics

slower onset ie hours -days

reduced reflexes, lead pipe rigidity

normal pupils

111
Q

neuroleptic malignant severe cases tx

A

dantrolene

112
Q

serotonin syndrome over neuro mal

A

caused by ssri, moai, mdma, norval psychoactive stimulants

faster onset (hours)

increased reflexes, clonus, dilated pupils

113
Q

mc of severe serotonin syndrome

A

cyproheptadine
chlorpromazine

114
Q

features of lithium tox

A

course tremor (fine tremor = in therapeutic range)
hyperreflexia
acute confusion
polyuria
seizure
come

115
Q

lithium tox tx

A

mild -mod = volume recuss w saline

severe = haemodialysis

116
Q

bacterial meningitis LP

A

opening pressure up
turbid
inc wbcs neutrophuls
low glucose
high protein

117
Q

viral meningitis LP

A

normal pressure
clear
wbc lymphocytes
normal glucose
high protein

118
Q

neoplastic spinal cord compression cause

A

lung breast prostate

119
Q

neoplastic spinal cord compression features

A

back pain worse on lying down and coughing
lower limb weakness
sensory loss and numbless

above l1 = UMW signs in legs
below L1 = lmn signs in legs and perianal numbness

120
Q

neoplastic spinal cord compression ix and tx

A

urgent MRI 24 hrs

high dose oral dex
urgent onco assessment for radiotherapy or assessment

121
Q

CT head SAH

A

blood appears white (hyperdense)
will be mixed with CSF
this will be interhemispheric fissure, basal ganglia and ventricles

122
Q

CT normal in SAH next ix

A

LP
Xanthrochromia

123
Q

what four bones meet at pterion

A

parietal
temporal
sphenoid
frontal

124
Q

extradural arterial or venous

A

arterial (middle meningeal)

125
Q

subdural arterial or venous

A

venous

126
Q

extradural CT

pther fx

A

len shapes biconvex

midline shift
compression of ventricles

127
Q

causes of seizure

A

space occupying lesion
hypoglycaemia
alcohol/withdrawal
benzo withdrawal
hepatic enceph
infection ie menin n eceph
trauma head injury

128
Q

advice for seisures while waiting

A

avoid heavy machinerv
shower instead od bath
watch out alcohol/drugs/sleep deprivation
when to call ambulance

129
Q

median nerve muscles

A

LOAF

lateral 2 lumbricals

thenar mucles:
opponens pollicus
abductor pollicus
flexor pollicis brevis

130
Q

carpal tunnel ix

A

electromyography

131
Q

why carbidopa

A

peripehal dopa-carboxylase inhib

reduces periph breakdown = reduces SE and less levodopa needed

132
Q
A

finals (28 decks)

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