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Phase 4 > 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 4 risk factors for MS?

A

FHx and genetics
EBV infection
Smoking
Low vitamin D

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6
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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7
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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8
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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9
Q

what are 4 motor signs of MS?

A

Bells palsy
horners syndrome
limb paralysis
incontinence

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10
Q

what are 4 sensory symptoms of MS?

A

triegeminal neuralgia
Numbness
Paraesthesia
Lhermitte’s sign

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11
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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12
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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13
Q

what are 2 coordination symptoms of MS?

A

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

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14
Q

what is the mcdonald criteria for MS diagnosis?

A

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

Demonstrated on MRI

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15
Q

What is one episode of an MS like attack called?

A

clinically isolated syndrome

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16
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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17
Q

what 2 investigations can be done to diagnose MS?

A

MRI brain and spinal cord - gadolinium enhanced T2 weighted
Lumbar puncture

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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 is seen on LP in someone with MS?

A

oligoclonal bands in the CSF

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20
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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21
Q

what can be seen o/e in optic neuritis?

A

Pale optic disk
internuclear ophthalmoplegia

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22
Q

what are 7 causes of optic neuritis?

A

MS
Sarcoidosis
SLE
Syphilis
Measles and Mumps
Neuromyelitis optica
Lyme disease

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23
Q

what is the management of optic neuritis?

A

High dose corticosteroid - pred or methylpred

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24
Q

what is the treatment for acute MS relapse?

A

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

(plasma exchange can be used in V severe disability)

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25
Q

What is the ongoing treatment for MS?

A

Immunomodulators and Biologcal therapy

Natalizumab
Ocrelizumab
Fingolimod
Beta-interferon
Glatiramer acetate

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26
Q

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

A

amitriptyline or gabapentin

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27
Q

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

A

anticholinergics - tolterodine or oxybutynin

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28
Q

what medications can be used to treat spacticity in MS?

A

baclofen
gabapentin

Physio

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29
Q

what are 5 complications of MS?

A

Neuro - spasticity, fatigue, cognitive impairment, dysphagia
Mental health
Osteoporosis
VTE
Bladder and bowel dysfunction

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30
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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31
Q

where is dopamine produced in the brain?

A

substantia nigra

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32
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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33
Q

what is the movement disorder diagnostic criteria for essential tremor?

A

Isolated bilateral tremor
>3 years
May have other tremor locations
No other neurological signs

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34
Q

what is the treatment of essential tremor?

A

1 - propranolol - 40-160mg BD/TDS
OR
primidone - 50mg OD up to 750mg

gabapentin and benzos can also be used

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35
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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36
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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37
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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38
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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39
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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40
Q

what are 4 symptoms of autonomic dysfunction?

A

postural hypotension, constipation, abnormal sweating and sexual dysfunction

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41
Q

what is the 1st line investigation for parkinsons?

A

dopaminergic trial

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42
Q

What is the first line treatment of parkinsons?

A

Levodopa (co-beneldopa)

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43
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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44
Q

what are 2 dopamine agonists?

A

Cabergoline
Pergolide

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45
Q

what are 2 monoamine oxidase B inhibitors?

A

Selegiline
Rasagiline

inhibits enzyme that breaks down dopamine

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46
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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47
Q

when medication shouldn’t be prescribed with levodopa?

A

iron - reduces absorption of levodopa

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48
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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49
Q

what protein are lewy bodies made up of?

A

alpha-synuclein

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50
Q

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

A

acetylcholinesterase inhibitors

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51
Q

what are 3 examples of acetylcholinesterase inhibitors?

A

Donpezil
Rivastigmine
galantamine

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52
Q

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

A

Clonazepam

or melatonin

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53
Q

what medications should not be used in lewy body dementia?

A

1st generation antipsychotics

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54
Q

what is the most common cause of dementia?

A

Alzheimer’s disease

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55
Q

what is the 2nd most common cause of dementia?

A

Vascular dementia

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56
Q

what are 3 classes of medications which can cause confusion?

A

Anticholinergics - oxybutuninin, solifenacin, tolterodine
Antihistamines
Tricyclic antidepressants

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57
Q

what are 5 neurological conditions that can cause confusion?

A

Brain tumours
parkinsons
huntingtons
progressive supranuclear palsy
Normal pressure hydrocephalus

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58
Q

what are 4 endocrine conditions that can cause confusion?

A

Hypothyroid
Adrenal insufficiency
Cushing’s
Hyperparathyroid (+ hypercalcaemia)

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59
Q

what are 2 nutritional deficiencies that can cause confusion?

A

B12
Thiamine

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60
Q

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

A

MRI head

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61
Q

what specialist assessment can be used to assess memory?

A

ACE-III
Addenbrooke’s cognitive examination III

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62
Q

what is the presentation of vascular dementia?

A

Dementia symptoms with stepwise progression due to vascular events

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63
Q

what criteria can be used to diagnose vascular dementia?

A

NINDS-AIREN criteria

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64
Q

what is the first line treatment for vascular dementia?

A

Aspirin

(clopidogrel 2nd line)

Optimise CVD risk factors

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65
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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66
Q

what are the 4As of dementia?

A

Aphasia
Amnesia
Apraxia - loss of learned tasks
Agnosia - inability to recognise objects/people

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67
Q

what counts as early onset dementia?

A

<65 years

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68
Q

how long do dementia symptoms have to be present for diagnosis?

A

6 months

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69
Q

presence of what gene increases risk of dementia?

A

apolipoprotein (APOE) E4

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70
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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71
Q

what is the 1st line pharma management of alzheimers?

A

Acetylcholinesterase inhibitors - donepezil, galantamine and rivastigmine

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72
Q

what medication is indicated in severe alzheimers?

A

Memantine (N-methyl-D-aspartate antagonist)

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73
Q

what class is memantine?

A

N-methyl-D-aspartate (NMDA) antagonist

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74
Q

what is fronto-temporal dementia?

A

a progressive dementia usually commencing in early age with slow progressive changes of character and social deterioration followed by impairment of intellect, memory and language functions with apathy euphoria and occasionally extrapyramidal phenomena

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75
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 paralysis, altered taste and dry mouth

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76
Q

which of bells palsy or stroke are forehead sparing?

A

Stroke is forehead sparing

Bells palsy is lower motor neurone

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77
Q

What is the first line treatment for bells palsy?

A

Prednisolone and eye care (within 72 hours)

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78
Q

what can be a complication of bells palsy?

A

keratoconjuctivitis sicca

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79
Q

what classes as a TIA?

A

a sudden onset focal neurological deficit which completely resolves within 24 hours of onset
OR
A transient episode of neurological dysfunction caused by a focal brain, spinal cord or retinal ischaemia without acute infarction

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80
Q

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

A

National institute of health stroke scale

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81
Q

what is the immediate management of TIA? (2)

A

aspirin 300mg initially then 75mg OD

Refer to specialist to be seen within 24 hours

MRI - including diffusion weighted and blood sensitive sequences

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82
Q

what is the long term management of TIA?

A

DAPT
1 - Aspirin 300mg then 75mg for first 21 days
PLUS
Clopidogrel 300mg then 75mg indefinitely

2 - Aspirin + MR dipyridamole if clopi contraindicated

PPI cover
Statins - atorvastatin 80mg

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83
Q

what modality should be used for carotid imaging after a non-disabling stroke in the carotid teritories?

A

Carotid duplex US
OR
MR/CT angiography

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84
Q

what criteria need to be met for carotid enarterectomy?

A

> 50% stenosis (American guidelines)

70% stenosis (European guidelines)

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85
Q

How long from presentation can alteplase be given for stroke?

A

up to 4.5 hours

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86
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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87
Q

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

A

IV alteplase

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88
Q

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

A

thrombectomy

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89
Q

what scale is used to measure neurological disability?

A

Modified Rankin scale

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90
Q

what is the first line investigation in stroke?

A

CT head (non-enhanced)

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91
Q

what is the most common cause of extradural haemorrhage?

A

skull trauma

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92
Q

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

A

middle meningeal artery (MMA)

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93
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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94
Q

what is the most common cause of subdural haemorrhage?

A

sheering of bridging veins which empty the ventral sinuses

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95
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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96
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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97
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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98
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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99
Q

what medication is given insubarachnoid haemorrhage to prevent vasospasm?

A

nimodipine (calcium channel blocker)

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100
Q

what is the most common cause of a subarachnoid haemorrhage?

A

rupture of berry (intracranial saccular) aneurysm

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101
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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102
Q

what is the surgical treatment of subarachnoid haemorrhage?

A

1 - endovascular coiling
surgical clipping

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103
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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104
Q

what are 2 early complication of giant cell arteritis?

A

vision loss
stroke

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105
Q

what is the most common ocular complication of GCA?

A

Anterior ischaemic optic neuropathy

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106
Q

what might be seen on fundoscopy in GCA?

A

swollen pale disc and blurred margins

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107
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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108
Q

what are 5 diagnostic criteria for GCA?

A

> 50 years
New onset headache
Temporal artery abnormalities - tenderness on palpation, decreased pulsation
ESR >50 mm/h
Abnormal temporal artery biopsy

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109
Q

what condition is associated with GCA?

A

Polymyalgia rheumatic

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110
Q

what cells are found on temporal artery biopsy in GCA?

A

multinucleate giant cells
Granulomas

-ve does NOT rule out GCA

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111
Q

what are 2 diagnostic tests for GCA?

A

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

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112
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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113
Q

what can be seen on temporal artery US in GCA?

A

halo sign

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114
Q

what is the management of GCA?

A

1- Prednisolone 40-60mg OD until symptoms resolve

Aspirin 75mg OD
PPI - for gastric prevention
Bisphosphonates - bone protection on steroids

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115
Q

what is the management for GCA in patients with visual symptoms or jaw claudication?

A

500-1000mg methylprednisolone

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116
Q

what are 3 late complications of GCA?

A

relapse
steroid related complication
stroke
aortitis - aortic aneurysm and dissection

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117
Q

what are 4 different types of migraine?

A

Migraine without aura
Migraine with aura
silent migraine (aura, no headache)
Hemiplegic migraine

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118
Q

How long does a migraine usually last?

A

4-72 hours

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119
Q

what are 7 characteristic of a migraine?

A

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

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120
Q

what is the international headache society criteria for migraine?

A

5 attacks with:

Headache 4-72 hours

At least 2 of - unilateral, pulsating, moderate or severe, aggravated by routine physical activity

At least one of - nausea and vomiting OR photophobia and phonophobia

Not attributed to another disorder

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121
Q

what are 4 most common different types of aura?

A

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

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122
Q

what is a hemiplegic migraine?

A

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

Can be autosomal dominantly inherited - Familial hemiplegic migraine

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123
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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124
Q

what is the acute management of migraine?

A

Triptans - sumatriptan 50mg
+ Paracetamol/NSAIDs

Antiemetics (metoclopramide)

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125
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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126
Q

what are 3 contraindications to triptans?

A

HTN
coronary artery disease
previous stroke, TIA or MI

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127
Q

what triptans are offered in predictable menstrual migraine?

A

Frovatriptan 2.5mg BD
Zolmitriptam 2.5mg BD/TDS

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128
Q

what type of triptans are offered to 12-17 year olds?

A

Nasal triptans

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129
Q

what is prophylactic management of migraine?

A

Propanalol - 80-160mg OD
Topiramate (teratogenic)
amitriptyline

acupuncture

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130
Q

what migraine prophylactic medication is teratogenic?

A

Topirimate - causes cleft lip/palate

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131
Q

what are the 3 branches of the trigeminal nerve?

A

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

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132
Q

How long does trigeminal neuralgia last?

A

seconds to hours

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133
Q

what are 3 features of trigeminal neuralgia?

A

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

Associated with MS

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134
Q

what are 7 red flags for trigeminal neuralgia?

A

Sensory changes
Deafness or ear problems
Hx of skin or oral lesion
Pain in ophthalmic division
Optic neuritis
FHx of MS
<40 years at onset

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135
Q

what is the 1st line treatment for trigeminal neuralgia?

A

carbamezapine 100mg PO OD/BD

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136
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 2 hours

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

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137
Q

what are 4 triggers for cluster headache?

A

alcohol
strong smells
sleep/circadian disruption
weather changes

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138
Q

what are 5 risk factors for cluster headache?

A

male
FHx
head injury
smoking
drinking

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139
Q

what is the acute management of cluster headaches?

A

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

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140
Q

what is the prophylaxis of cluster headache?

A

verapamil 80mg PO TDS

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141
Q

what monitoring is needed with verapamil

A

ECG, BP, LFTs

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142
Q

what is chronic tension type headache?

A

> 15 days a month

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143
Q

what are 3 management options for chronic tension type headaches?

A

10 sessions of acupuncture over 5-8 weeks

Low dose amitriptyline

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144
Q

what are headache redflags?

A

Meningisms
Sudden onset occipital headache
New/changed headache >50
New neurological symptoms
Recent head trauma
Worse on valsalva, or lying
Worse on standing (CSF leak)
Household similar (CO)
Pregnant
current or past malignancy

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145
Q

what are 2 medications that increase risk of medication overuse headache?

A

Triptans
Opioids

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146
Q

what is the management of medication overuse headache?

A

withdraw analgesia abruptly or slowly if opioids

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147
Q

what is the triad of horner’s syndrome?

A

Ptosis
miosis
anhydrosis

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148
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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149
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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150
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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151
Q

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

A

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

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152
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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153
Q

what feature can be seen in congenital horners syndrome?

A

Heterochromia - different coloured irises

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154
Q

how can you differentiate between different causes of horners?

A

Central - anhidrosis of face, arm , trunk

Pre-ganglionic - anhidrosis of face

Post-ganglionic - no anhidrosis

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155
Q

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

A

1 - Neisseria meningitidis

2 - streptococcus pneumoniae

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156
Q

what does neisseria meningitidis look like?

A

gram negative (pink) diplococci

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157
Q

what causes the petechial rash in meningitis?

A

disseminated intravascular coagulopathy (DIC) and subcutaneous haemorrhages

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158
Q

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

A

Group B strep (strep aglactiae)

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159
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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160
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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161
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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162
Q

what blood test can be done for meningitis?

A

meningococcal PCR - quicker than blood cultures

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163
Q

what is the treatment for meningitis in <3 months?

A

Cefotaxime + amoxicillin (listeria cover)

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164
Q

what is the treatment for meningitis in >3 months?

A

ceftriaxone

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165
Q

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

A

steroids - Dexamethasone QDS > 3 months

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166
Q

what is the prophylactic for meningitis contacts?

A

ciprofloxacin single dose

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167
Q

what is the incubation period of meningitis usually?

A

7 days

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168
Q

what is the 3 most common causes of viral meningitis?

A

Herpes simplex virus
Enterovirus
Varicella zoster virus

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169
Q

where does the spinal cord end?

A

L1-2

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170
Q

what level is a lumbar puncture taken at?

A

L3-4

171
Q

what is the LP picture in bacterial meningitis?

A

cloudy
high protein
low glucose
high neutrophils
+ve culture

172
Q

what is the LP picture in viral meningitis?

A

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

173
Q

what is the LP picture in fungal meningitis?

A

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

174
Q

what are 5 complications of meningitis?

A

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

175
Q

what is the most common cause of encephalitis in adults?

A

HSV

176
Q

what is a non-infective cause of encephalitis?

A

autoimmune encephalitis

177
Q

what are 4 risk factors for encephalitis?

A

extremes of age
immunodeficiency
viral infection
animal or insect bite

178
Q

what are 6 symptoms of encephalitis?

A

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

179
Q

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

A

aciclovir

180
Q

what medication can be used to treat CMV?

A

ganciclovir

181
Q

what are 3 infections particularly associated with GBS?

A

campylobacter jejuni
CMV
EBV

182
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 leading to demyelingation. This is called molecular mimicry

183
Q

what are 4 features of GBS?

A

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

184
Q

what is the criteria for clinical diagnosis of GBS?

A

Brighton criteria

185
Q

what is seen on LP in GBS?

A

Raised protein
normal cell count
normal glucose

186
Q

what are 2 investigations for GBS?

A

Nerve conduction studies
lumbar puncture

187
Q

what antibody is often present in GBS?

A

Anti-ganglioside antibodies

188
Q

what is the 1st line management of GBS?

A

IV Ig

189
Q

what is the leading cause of death in GBS?

A

PE - given VTE prophylaxis

190
Q

what is Miller-fisher syndrome?

A

Variant of GBS
Opthamoplegia, areflexia, ataxia - typically affecting eye muscles first
Descending paralysis

191
Q

what are 4 types of motor neurone disease?

A

Amyotrophic lateral sclerosis
Primary lateral sclerosis - UMN signs only
Progressive muscular atrophy - LMN signs only
progressive bulbar palsy

192
Q

what is the most common motor neurone disease?

A

Amyotrophic lateral sclerosis - ALS

193
Q

what is the second most common MND?

A

progressive bulbar palsy - primarily affects muscles of talking and swallowing - tongue wasting and fasiculations - worst prognosis

194
Q

what is the pathophysiology of MND?

A

progressive degeneration of upper and lower motor neurones

195
Q

what muscles are never affected in MND?

A

external ocular muscles

196
Q

what are nerve conduction studies like in MND?

A

NORMAL

197
Q

what medication can be used to prolong survival in ALS?

A

Riluzole

198
Q

what tumour is linked to myasthenia gravis?

A

thymoma - prolongs like around 3 months

199
Q

what is the best way to support nutrition in MND?

A

PEG feeding

200
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

201
Q

what are 3 ways to elicit fatiguability in myasthenia gravis?

A

repeated blinking - leads to ptosis
prolonged upward gazing leads to diplopia
repeated abduction of arm on one side leads to unilateral weakness

202
Q

what are 6 medications that can exacerbate myasthenia gravis?

A

penicillamine
quinidine, procainamide
beta blockers
lithium
phenytoin
antibiotics - gent, macrolides, quinolones, tetracyclines

203
Q

what antibodies are tested for in myasthenia gravis?

A

acetylcholine receptor antibodies
muscle specific kinase antibodies
LRP4 antibodies

204
Q

what is a diagnostic test for myasthenia gravis?

A

edrophonium test - increases Ach at NMJ causing relief of weakness

205
Q

what are 4 tests for myasthenia gravis?

A

rapid nerve stimulation
single fibre electromyography
serological antibody testing
CT or MRI chest for thymoma

206
Q

what are 5 treatment options for myasthenia gravis?

A

reversible acetylcholinesterase inhibitors - pyridostigmine or neostigimine

immunosupression - prednisolone or axithioprine

thymectomy
MAN - rituximab, eculizumab

207
Q

what are 3 side effects of acetycholinesterase inhibitors?

A

abdo cramps
diarrhoea
excessive salivation

208
Q

what is the treatment of myasthenic crisis?

A

Immunomodulatory therapies - IV Ig or plasmapheresis

may need NIV if respiratory muscle affected

209
Q

what are 3 complications of myasthenia gravis?

A

myasthenia crisis
resp infections and aspiration pneumonia
thymoma

210
Q

what is the most common type of neurofibromatosis?

A

type 1

211
Q

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

A

chromosome 17 - codes for tumour suppressor protein

212
Q

what is the inheritance pattern of neurofibromatosis?

A

autosomal dominant

213
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

214
Q

what chromosome is the neurofibromatosis type 2 gene found on?

A

chromosome 22

215
Q

what kind of tumours does neurofibromatosis type 2 lead to?

A

shwannomas

216
Q

what tumour is neurofibromatosis 2 most associated with?

A

acoustic neuromas

217
Q

what nerves are effected in bulbar palsy?

A

CN9,10,11,12

218
Q

what is the function of CN1?

A

olfactory nerve
smell

219
Q

what is the function of CN2?

A

optic nerve
Vision

220
Q

what is the function of CN3?

A

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

221
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

222
Q

what is the function of CN6?

A

Abducens
lateral rectus movement

223
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

224
Q

what is the function of CN8?

A

vestibulocochlear

hearing and balance

225
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)

226
Q

what is the function of CN10?

A

vagus

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

227
Q

what is the function of CN11?

A

spinal accessory

trapezium and sterocleidomastoid innervation

228
Q

what is the function of CN12?

A

hypoglossal

intrinsic and extrinsic tongue muscles

229
Q

what are 4 causes of bulbar palsy?

A

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

230
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

231
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

232
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

233
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

234
Q

what medications may someone with cerebral need?

A

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

235
Q

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

A

Sarnat staging

236
Q

what are 3 features of mild hypoxic ischaemic encephalopathy?

A

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

237
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

238
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

239
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

240
Q

what is the inheritance pattern of muscular dystrophy?

A

X-linked recessive

241
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

242
Q

what is gower’s sign for?

A

muscular dystrophy

243
Q

what causes duchennes mucular dystrophy?

A

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

244
Q

what is the average age of presentation for duchennes MD?

A

3-5 years - presents with weakened pelvic muscles

245
Q

what is the life expectancy of duchennes?

A

25-35 years

246
Q

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

A

oral steroids
creatine suplemmentation

247
Q

what is Beckers MD?

A

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

248
Q

what is myotonic dystrophy?

A

usually presents in adulthood

progressive muscle weakness
prolonged muscle contractions
cataracts
cardiac arrhythmias

249
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

250
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

251
Q

what is limb girdle musclar dystrophy?

A

usually presents in teenagers with progressive weakness around limb girdles

252
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

253
Q

what is the inheritance pattern for huntingtons?

A

Autosomal dominant

254
Q

what is the genetic error in huntingtons?

A

trinucleotide repeat disorder of the HTT gene on chromosome 4

255
Q

what chromosome is affected in huntingtons?

A

chromosome 4

256
Q

what genetic phenomenon is seen in huntingtons?

A

anticipation

257
Q

what is genetic anticipation?

A

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

258
Q

what are 4 symptoms of huntingtons disease?

A

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

259
Q

what is the life expectancy of huntingtons post diagnosis?

A

15-20 years

260
Q

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

A

Benzos - tetrabenazine
Antipsychotics
Amantadine

261
Q

what causes Creutzfeldt-Jakob disease?

A

Prions

262
Q

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

A

<1 year

263
Q

what are 5 symptoms of prion disease?

A

sudden onset cognitive impairment and decline
Ataxia
Myoclonus
Psychiatric symptoms
parkinsonism

264
Q

what are 4 ways prion disease can be passed on?

A

Genetically
Contaminated blood products
Contaminated surgical instruments
Consumption of contaminated beef

265
Q

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

A

real time quaking induced conversion of the CSF

266
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

267
Q

what nerve roots supply control of ureteral and anal sphincters?

A

S2,3,4 keeps shit of the floor

268
Q

what are 8 causes of cauda equina?

A

Herniated disc
tumours
Degenerative lumbar canal stenosis
Abscess
Haematoma
Trauma
spondylolisthesis (displacement of vertebra)

269
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

270
Q

what type of signs are present in cauda equina?

A

Lower motor neurone

271
Q

what 2 categories can cauda equina be seperated into?

A

CE with retention
Incomplete cauda equina

272
Q

what is the management of cauda equina?

A

Urgent MRI

Lumbar decompression surgery - decompressive laminectomy

Dexamethasone if due to tumour

273
Q

what is the treatment for metastatic spinal cord compression?

A

high dose dexamethasone (8-16mg)
Analgesia

Surgery
radio/Chemo

274
Q

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

A

Back pain worse on coughing or straining

275
Q

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

A

Gandolinium enhanced MRI Spine

276
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

277
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

278
Q

what exacerbates central spinal stenosis?

A

Standing up straight and walking

279
Q

what relieves spinal stenosis?

A

bending forwards and resting

280
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

281
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

282
Q

what are 3 causes of anterior cord syndrome?

A

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

283
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

284
Q

what is a radiculopathy?

A

damage to the nerve root - pinched/trapped nerve

285
Q

what examination can be done for eliciting sciatica pain?

A

Straight leg raise
sciatic stretch

286
Q

what is the first line management of sciatica?

A

Amitriptyline
Duloxetine

287
Q

which nerves form the sciatic nerve?

A

L4-S3

288
Q

what cancers most commonly metastasise to bone?

A

Prostate
Renal
Thyroid
Breast
Lung

289
Q

what medication can be given for back spasms?

A

benzodiazepams - diazepam => less than 5 days course

290
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

291
Q

what can be used to treat painful diabetic neuropathy?

A

gabapentin/pregabalin

++ Glycaemic control!

292
Q

what is narcolepsy?

A

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

293
Q

what is the classic tetrad of narcolepsy?

A

excessive daytime sleepiness
cataplexy
sleep paralysis
hypnagogic/hypnopompic hallucinations

294
Q

what is the management of narcolepsy?

A

Sleep hygiene and lifestyle changes, trigger avoidance

Sodium oxybate - for cataplexy
Modafinil - for excessive daytime sleepiness

295
Q

what are 4 causes of acute transverse myelitis?

A

Infection
Vaccination
NMO - Neuromyelitis optica
MOG - Myelin Oligodendrocyte Glycoprotein

296
Q

what nutrients affect spinal cord functioning?

A

B12
copper

297
Q

How does NOS affect B12?

A

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

298
Q

what nutrients affect spinal cord functioning?

A

B12
copper

299
Q

what are 5 causes of acute transverse myelitis?

A

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

300
Q

How does NOS affect B12?

A

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

301
Q

what are the 3 categories of GCS?

A

Eye response
verbal response
motor reponse

302
Q

what are the GCS levels for eye response?

A

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

303
Q

what are the GCS levels for verbal response?

A

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

304
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

305
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

306
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

307
Q

what are 5 possible causes of peripheral neuropathy?

A

ABCDE

alcohol
B12 deficiency
Cancer and CKD
Diabetes and Drugs
Every vasculitis

308
Q

what are 3 medications that can cause peripheral neuropathy?

A

isoniazid
amiodarone
cisplatin

309
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

310
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

311
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

312
Q

what nerve is compressed in carpal tunnel?

A

median nerve

313
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

314
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

315
Q

what is the treatment for lambert-eaton syndrome?

A

1 - amifampridine

imunosuppresion
IVIG
plasmapheresis

316
Q

what are hamartomas?

A

benign neoplastic growths

317
Q

what condition are hamartomas seen in?

A

tubular sclerosis

318
Q

what genetic mutations cause tubular sclerosis?

A

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

319
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

320
Q

what are 2 neurological features of tubular sclerosis?

A

epilepsy
learning disability and developmental delay

321
Q

what are 5 non-neuro signs of tubular sclerosis?

A

rhabdomyomas of heart
gliomas
polycystic kidneys
lymphagioleimyomatosis
retinal hamartomas

322
Q

damage to white nerve causes winging of the scapula?

A

spinal accessory - CN11

323
Q

what is the most common cause of foot drop?

A

common peroneal nerve injury

324
Q

what is the CSF picture in viral encephalitis?

A

raised WBCs
HSV +ve PCR

325
Q

what is the treatment for herpes encephalitis?

A

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

326
Q

what is the most common viral cause of encephalitis?

A

HSV

327
Q

what is the most common cause of autoimmune encephalitis?

A

N-methyl D-aspartate receptor antibody encephalitis

328
Q

what scale is used for stroke?

A

national institute of health stroke scale (NIHSS)

329
Q

what is a mild NIHSS stroke?

A

01-May

330
Q

what is a moderate NIHSS stroke?

A

May-14

331
Q

what is a severe NIHSS stroke?

A

15-24

332
Q

what is a very severe NIHSS stroke?

A

> 25

333
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

334
Q

what 5 investigations should be done for stroke?

A

CT
MRI
ECG
carotid doppler

335
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

336
Q

what is CSF absorbed by?

A

arachnoid granules

337
Q

what is the most common cause of hydrocephalus?

A

aqueductal stenosis

338
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

339
Q

what are 5 signs of hydrocephalus in babies?

A

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

340
Q

what is the management for hydrocephalus?

A

vetriculoperitoneal shunt

341
Q

what are 5 ventriculoperitoneal shunt complications?

A

infection
blockage
excessive drainage
intraventricular haemorrhage during surgery
outgrowing them

342
Q

what are 3 features of normal pressure hydrocephalus?

A

Wet, Whacky, Wobbly

gait apraxia (disturbance)

cognitive impairment

urinary frequency/incontinence/urgency - also sometimes foecal

343
Q

what are 5 secondary causes of normal pressure hydrocephalus?

A

Subarachnoid haemorrhage
Meningitis
Traumatic brain injury
Intracranial tumours
Ventricular shunting or LP

344
Q

what can be seen on imaging in normal pressure hydrocephalus?

A

Enlarged 4th ventricle
Absence of sulcal atrophy

345
Q

what is the management for normal pressure hydrocephalus?

A

ventriculoperitoneal shunt if suitable for surgery

346
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)

347
Q

what are 5 risk factors for brain abcess?

A

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

348
Q

what on MRI with contrast in brain abcess?

A

ring enhancing lesion

349
Q

what is the management of brain abcess?

A

IV vancomycin
IV Metronidazole
IV ceftriaxone

SURGERY

350
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.

351
Q

what is an investigations for mononeuritis multiplex?

A

electromyogram

352
Q

what is the management for mononeuritis multiplex?

A

corticosteroids - pred 1mg/kg/day BO

+/- immunosupression - oral cyclophosphamide

353
Q

what are 5 symptoms of malaria?

A

fever
chills
sweats
headache
myalgia

354
Q

what is the 1st line investigation for malaria?

A

giemsa stained blood film

355
Q

what is the most life threatening malaria infection?

A

plasmodium flaciparum

356
Q

what mosquitos cause malaria?

A

female anopheles

357
Q

what is the 1st line management of uncomplicated malaria?

A

hydroxychloroquine

358
Q

what is the 1st line management of complicated malaria?

A

artesunate IV

359
Q

what is wernicke’s aphasia?

A

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

360
Q

where is wernicke’s area?

A

superior temporal gyrus of dominant hemisphere

361
Q

what blood vessel supplies wernicke’s area?

A

inferior devision of (usually) left middle cerebral artery

362
Q

what is broccas aphasia?

A

expressive aphasia causing halting speech and impaired repetition with normal comprehension

363
Q

where is broccas area?

A

inferior frontal gyrus of dominant hemisphere

364
Q

what blood vessel usually supplies broccas area?

A

superior division of the (usually) left MCA

365
Q

what is conduction aphasia?

A

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

366
Q

which tumours most commonly metastasise to brain?

A

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

367
Q

what is the most common primary brain tumour in adults?

A

glioblastoma multiforme

368
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.

369
Q

what cells do meningiomas arise from?

A

arachnoid cap

370
Q

what genetic condition is associated with bilateral acoustic neuroma?

A

neurofibromatosis type II

371
Q

what is the most common primary brain tumour in children?

A

Pilocytic astrocytoma

372
Q

what phenomena are seen in occipital lobe focal seizures?

A

visual flashers or floaters

373
Q

what phenomena are seen in parietal lobe focal seizures?

A

sensory - parasthesia

374
Q

what phenomena are seen in frontal lobe focal seizures?

A

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

375
Q

what phenomena are seen in temporal lobe focal seizures?

A

pre-ictal aura
automatisms

376
Q

what is the GCS scoring?

A

MoVE - 6,5,4

377
Q

what is the MOA of memantine?

A

NMDA receptor antagonist

378
Q

what are 2 side effects of donepezil?

A

contraindicated in bradycardia
can cause insomnia

379
Q

what dermatome is the thumb and first finger?

A

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

380
Q

what dermatome is the nipple?

A

T4 - teat pore

381
Q

what dermatome is the umbilicus?

A

BellybuT-TEN = T10

382
Q

what dermatome is the inguinal ligament?

A

L1 - Li

383
Q

what dermatome is the knee caps?

A

ALL Fours - L4

384
Q

what dermatome is the big toe and foot dorsum?

A

L5 - largest of 5 toes

385
Q

what dermatome is little toe?

A

S1 - smallest one

386
Q

what dermatome is the genitalia?

A

S2/3

387
Q

what are 3 side effects of dopamine receptor agonists?

A

pulmonary, retroperitoneal and cardiac fibrosis
impulse control
excessive daytime sleepiness

388
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

389
Q

what is the most common cause of autonomic dysreflexia?

A

faecal impaction or urinary retention

390
Q

what is the management of autonomic dysreflexia?

A

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

391
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

392
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)

393
Q

what examination findings indicate peroneal nerve injury?

A

weakness of foot dorsiflexion and eversion. Reflexes normal

394
Q

what examination findings indicate L5 radiculopathy?

A

weakness of hip abduction

395
Q

what is the gold standard investigation for venous sinus thrombosis?

A

MRI venogram

396
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

397
Q

What is cushing’s triad of raised ICP?

A

widening pulse pressure
bradycardia
irregular breathing

398
Q

what is the management of raised ICP?

A

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

399
Q

what does occlusion of the retinal artery cause?

A

Amaurosis fugax

400
Q

what does occlusion of the basillar artery cause?

A

locked in syndrome

401
Q

what is the presentation of wernickes encephalopathy?

A

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

402
Q

what causes wernicke’s encephalopathy?

A

Thiamine B1 deficiency

alcoholism
persistant vomiting
stomach cancer
dietary deficiency

403
Q

what are examples of 5-HT3 antagonists?

A

Ondansetron
Palonesetron

Anti-emetics used in chemo

404
Q

what are 2 side effects of ondansetron?

A

prolonged QT + ventricular tachycardia
constipation

405
Q

what are 2 symptoms of a posterior cerebellar stroke?

A

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

406
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

407
Q

what artery is affected in lateral pontine syndrome?

A

Anterior inferior cerebellar artery

408
Q

what are of lateral pontine syndrome?

A

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

409
Q

what scale measures disability?

A

Barthel index

410
Q

what quick stroke assessment scale is used by medical professionals?

A

Rossier

411
Q

when is statin therapy started after stroke?

A

cholesterol >3.5

wait 48 hours to avoid haemorrhagic transformation

412
Q

what is the 1st line secondary prevention of stroke?

A

Aspirin - 75mg
clopidogrel - 75mg

413
Q

what is the 2nd line secondary prevention of stroke?

A

Aspirin + modified release dipyridamole

414
Q

what is the management of idiopathic intracranial hypertension?

A

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

415
Q

what is status epilepticus?

A

a single seizure >5 mins
>2 seizures in a 5 minute period without regaining consciousness between

416
Q

what is the management of status epilepticus?

A

A-E
1 - Benzodiazepines
2 - Antiepileptics

417
Q

what is the 1st line management of status epilepticus?

A

1 - PR diazepam - 10mg (ADULTS) /buccal midazolam 10mg (ADULTS)

1 - IV Lorazepam 4mg (ADULTS)

2 - repeat dose IV lorazepam after 10 mins

418
Q

What is the 2nd line management of status epilepticus?

A

IV Levetiracetam
IV phenytoin
IV sodium valproate

Alert on call anaesthetist

419
Q

what is the management of refractory status epilepticus?

A

> 45 minutes

induction of GA or IV phenobarbital

420
Q

what are 6 risk factors for status epilepticus>

A

epilepsy
poor compliance with anti-epileptics
alcoholism
recreational drug use
previous neuronal injury
Electrolyte imbalance

421
Q

what are 4 complications of status epilepticus?

A

Arrythmias and cardiac arrest
respiratory failure and aspiration pneumonia
hyperkalaemia
hypoglycaemia
memory impairment

422
Q

How long does fatigue have to occur for to diagnose chronic fatigue syndrome?

A

3 months of fatigue affecting mental and physical functioning more than 50% of the time

423
Q

what are 11 tests for people presenting with fatigue?

A

FBC
U+E
LFT
Glucose
TFT
ESR
CRP
Calcium
CK
Ferritin
coeliac screen
urinalysis

Phase 4 (22 decks)

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