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neuro Flashcards

1
Q

what does the Oxford Stroke Classification (also known as the Bamford Classification) assess

A
  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
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2
Q

what arteries are involved in Total anterior circulation infarcts and what Bamford score is required

A

involves middle and anterior cerebral arteries
all 3 are required

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3
Q

what arteries are involved in Partial anterior circulation infarcts and what Bamford score is required

A

involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
2

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4
Q

what arteries are involved in lacunar infarcts

A

involves perforating arteries around the internal capsule, thalamus and basal ganglia

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5
Q

what do lacunar infarcts present with?

A

presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

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6
Q

what arteries are involved in Posterior circulation infarcts

A

vertebrobasilar

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7
Q

what does POCI present with

A
  1. cerebellar or brainstem syndromes
  2. loss of consciousness
  3. isolated homonymous hemianopia
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8
Q

what can myelodysplastic syndrome develop into

A

AML

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9
Q

pick bodies/cells

A

frontotemporal dementia

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10
Q

what mutation causes huntingtons disease

A

CAG expansion on chromosome 4

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11
Q

Progressively worsening headache with higher cognitive function impaired?

A

urgent CT

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12
Q

Ptosis + dilated pupil

A

CN III Palsy

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13
Q

ptosis + constricted pupil

A

Horner’s

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14
Q

A wide-based gait with loss of heel to toe walking is called

A

an ataxic gait

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15
Q

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

A

chronic subdural haematoma

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16
Q

Hyperdense crescentic-shaped collection not limited by suture lines

A

acute subdural haematoma

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17
Q

Hyperdense lentiform (biconvex) shaped collection limited by suture lines

A

extradural haematoma

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18
Q

Hyperdense collections around the basal cisterns and sulci

A

subarachnoid haemorrhage

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19
Q

Hyperdense material in the lateral ventricle

A

intraventricular haemorrhage

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20
Q

vertigo, hearing loss, tinnitus and an absent corneal reflex

A

vestibular shwannoma

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21
Q

flaccid weakness and hyporeflexia following an infection

A

Guillan - barre

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22
Q

roughened patches of skin over lumbar spine (Shagreen patches)

A

tuberous sclerosis

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23
Q

wernickes encelopathy symptoms (CAN OPEN)

A

Confusion
Ataxia
Nystagmus
Ophthamoplegia
PEripheral
Neuropathy

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24
Q

what muscles are usually spared in MND

A

Ocular

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25
Q

Headache linked to Valsalva manoeuvres

A

raised icp until proven otherwise => CT

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26
Q

what nerves are associated with vestibular schwanomma

A

V, VII and VIII

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27
Q

treatment for generalised tonic clonic seizures

A

males: sodium valproate
females: lamotrigine or levetiracetam

young girls or woman who dont want to be pregnant may be offered valproate

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28
Q

treatment for focal seizures

A

first line: lamotrigine or levetiracetam

second line: carbamazepine, oxcarbazepine or zonisamide

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29
Q

treatment for abscence seizures (petit mal)

A

first line: ethosuximide

second line:
male: sodium valproate
female: lamotrigine or levetiracetam

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30
Q

what treatment may exacerbate absence seizures

A

carbamazepine

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31
Q

treatment for myoclonic seizures

A

males: sodium valproate
females: levetiracetam

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32
Q

treatment for tonic or atonic seizures

A

males: sodium valproate
females: lamotrigine

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33
Q

treatment for bells palsy

A

oral prednisolone + artificial tears

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34
Q

Anterior or middle cerebral artery stroke →

A

numbness, sudden muscle weakness

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35
Q

Broca’s area (left frontal lobe) →

A

slurred speech

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36
Q

Wenicke’s area (left temporal lobe) →

A

difficulty understanding speech

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37
Q

Posterior cerebral artery stroke →

A

effects vision

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38
Q

ROSIER is a clinical scoring tool based on clinical features and duration for what

A

stroke in ER

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39
Q

what is the most common cause of TIA

A

microemboli

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40
Q

sudden transient loss of vision in one eye

A

Amaurosis fugax - likely ICA stenosis

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41
Q

bacterial meningitis in neonates

A

Listeria monocytogenes, group B Streptococci, E. coli

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42
Q

bacterial meningitis age 10-65

A
  • Ages 10 to 21: Neisseria meningitidis, Streptococcus
    pneumoniae
  • ­Age over 21: Streptococcus pneumoniae, Neisseria
    meningitidis
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43
Q

bacterial meningitis in over 65s

A

Streptococcus pneumoniae, Listeria monocytogenes

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44
Q

bacterial meningitis in immunosuppressed

A

Listeria monocytogenes

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45
Q

bacterial meningitis in Neurosurgery/ head trauma:

A

Staphylococcus, Gram negative
bacilli (Klebsiella pneumoniae, E.coli, Pseudomonas aeruginosa)

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46
Q

bacterial meningitis in Fracture of the cribiform plate:

A

Streptococcus pneumoniae

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47
Q

is bacterial or viral meningitis more common

A

viral

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48
Q

pathophysiology of acute bacterial meningitis

A
  • The pia-arachnoid is congested with polymorphs
  • A layer of pus forms
  • adhesions may form, causing cranial nerve palsies and hydrocephalus
  • Cerebral oedema occurs in any bacterial meningitis
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49
Q

pathophysiology of meningitis due to Chronic infection (e.g. TB)

A
  • The brain is covered in a viscous grey–green exudate with numerous meningeal tubercles
  • Adhesions are invariable
  • Cerebral oedema occurs in any bacterial meningitis
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50
Q

pathophysiology of viral meningitis

A
  • In viral meningitis there is a predominantly lymphocytic inflammatory cerebrospinal fluid (CSF) reaction without pus formation, polymorphs or adhesions
  • There is little or no cerebral oedema unless encephalitis develops
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51
Q

Headache, fever and focal neurology

A

brain abscess

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52
Q

what type of haematoma does alcoholism increase the risk of

A

subdural

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53
Q

migraine prophylaxis in asthmatic

A

topiramate (propanolol is contraindicated)

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54
Q

raised ICP treatment

A

weight loss
carbonic anhydrase inhibitors e.g. acetazolamide

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55
Q

scale that measures disability or dependence in activities of daily living in stroke patients

A

barthel index

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56
Q

give CSF findings for viral meningitis commenting on appearance, protein, glucose, WCC and culture

A

Clear, normal or slightly raised protein, glucose normal, high lymphocytes, culture negative

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57
Q

give CSF finding for bacterial meningitis commenting on appearance, protein, glucose, WCC and culture

A

cloudy, high protein, low glucose, high neutrophils, culture - bacteria

58
Q

when should lumbar puncture be avoided

A

signs of severe sepsis or a rapidly evolving rash
severe respiratory/cardiac compromise
significant bleeding risk
signs of raised intracranial pressure

59
Q

restless, fatigue, insomnia, depression, parkinsonism side effects

A

metoclopramide

60
Q

GI, tremor, unsteadiness, tremor, teratogenic (NTD) side effects

A

sodium valproate

61
Q

N+V, dizziness, unsteadiness, headache, confusion, double vision side effects

A

carbemazepine

62
Q

Steven Johnson syndrome (rash), careful in pregnancy/breast feeding

A

lamotragine

63
Q

dry mouth, diarrhoea, metallic taste, tremor, weight gain, water retention, hypothyroidism, blood test 7 days after starting

A

lithium

64
Q

agranulocytosis + myocarditis – regular blood checks!

A

clozapine

65
Q

weight gain atypical antipsychotic

A

olanzapine

66
Q

tardive dyskinesia, akathisia
* Tardive dyskinesia is most fatal = may be irreversible = fine vermicular movements of the tongue. Choreoathetoid movements, chewing and pouting of jaw

A

 Typical antipsychotics

67
Q

list some typical antipsychotics

A

chlorpromazine/haloperidol/thioridazine/ fluphenazine/zuclopentixol

68
Q

what group of side effects do typical antipsychotics cause

A

extra-pyramidal

69
Q

toxicity can cause cerebellar symptoms

A

phenytoin

70
Q

fine touch, proprioception and vibration – cross at medulla – run posteriorly

A

dorsal column

71
Q

______ can be used as treatment for MND – anti-glutamate – slows symptoms but is not a treatment

A

riluzole

72
Q

pain and temperature – cross at spinal level – run from medial to anterior

A

spinothalamic

73
Q

behaviour and speech problems, slowly progressive

A

 Frontotemperal/Picks

74
Q

hallucination and parkinsonism, REM sleep disorder, fluctuation on a daily basis – loss of ACh producing neurons

A

 Lewy body disease

75
Q

stepwise progression, memory and personality problems, emotional instability – history of vascular disease

A

vascular dementia

76
Q

sudden onset - post infectious (group A strep/rheumatic fever) (autoimmune) cause of chorea (or tics)

A

o Sydenhams chorea

77
Q

butterfly pattern on caudate nucleus?

A

huntingtons

78
Q

what treatment reduces chorea

A

tetrabenazine

79
Q

Treatment of lewy body dementia

A

anticholinesterase inhibitor – rivastigmine/ donepezil

80
Q

management for mild to moderate alzheimer’s

A

acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)

81
Q

when should the 2nd line treatment for alzheimers (memantine an NMDA glutamate receptor antagonist) be used ?

A
  • intolerance to ACTHI’s
  • add on therapy
  • monotherapy in severe disease
82
Q

rapid progression, autonomic features – impotence/incontinence, postural hypotension, cerebellar + pyramidal signs – rigidity is worse than tremor (aka Shy-Drager syndrome)

A

multiple system atrophy

83
Q

weird, wet, wobbly – confusion, incontinence, ataxis and treatment

A

normal pressure hydrocephalus - treat with shunt

84
Q

rugby player trauma of pterion of temporal bone – damage to middle meningeal artery – lucid interval then deterioration – lemon shape on CT – blood between bone and dura mater

A

extradural

85
Q

elderly or alcoholic with fragile veins – banana on CT – don’t remember trauma – slow onset deterioration – blood between dura and arachnoid mater

A

subdural

86
Q

sudden onset headache with N+V – FH of CKD – saccular berry aneurysm rupture at bifurcation – CT shows blood under arachnoid – LP after 12 hours shows xanthochromia (yellow) – risk of vasospasm, rebleeding, seizures, hyponatraemia – treat with nimodipine and surgical clipping

A

SAH

87
Q

Part of brain that controls fevers and temperature being set to a higher level

A

hypothalamus

88
Q

Neck flexion → electric shocks in trunk/limbs

A

 Lhermitte’s Sign (MS)

89
Q

worsening of MS symptoms when overheated

A

Uhtoffs sign (MS)

90
Q

antibody against Pre-synaptic Ca channel – squamous cell lung cancer

A

lambert-eaton syndrome

91
Q

Autoimmune destruction of post synaptic nicotinic AChR – leading to ptosis and fatigueable muscle weakness of proximals – common in 2 peaks, 20-30s and 60+

A

myasthaenia gravis

92
Q

myasthaenia gravistreatment

A

pyridostigmine (anti ACh inhibitor) and thymectomy

93
Q

purposeless movement that flit and flow and appear restless

A

chorea

94
Q

huntingtons outline

A

CAG repeat on chromosome 4 – movement + mood + dementia – autosomal dominant!!!

95
Q

cause of foot drop

A

L4/L5 disc herniation – compressing L5!

96
Q

Cranial nerve that travels to the parotid gland then branches off into its 5 branches

A

facial nerve - CN VII

97
Q

thumb + 2 fingers – carpal tunnel syndrome

A

median

98
Q

pinky + 1.5 = cubital tunnel syndrome

A

ulnar

99
Q

wrist drop and back of arm

A

radial

100
Q

anterior arm

A

musculocutaneous

101
Q

demylination of midbrain causes

A

holmes tremor

102
Q

vertical gaze palsy, postural instability, falls, (pseudobulbar symptoms – speech, swallowing)

A

progressive supranuclear palsy

103
Q

early autonomic features (impotence, incontinence, postural hypotension), cerebellar + pyramidal signs, rigidity

A

multiple system atrophy

104
Q

fluctuating cognition with visual hallucination and early dementia and parkinsons

A

LBD

105
Q

poor prognosis signs for MS

A

Older, male, motor signs at onset, early relapses, many MRI lesions and axonal loss

106
Q

Lymphocytic pleocytosis is found in

A

tuberculosis meningitis

107
Q

Tau proteins and amyloid proteins are found in

A

Alzheimer’s

108
Q

Xanthochromia is found in a

A

subarachnoid haemorrhage

109
Q

ALS is highly associated with

A

frontotemporal dementia

110
Q

Muscle fasciculations and weakness correspond to

A

LMN
signs

111
Q

increased tone and brisk reflexes signal

A

UMN signs.

112
Q

Progressive muscular atrophy presents only with

A

LMN signs

113
Q

primary lateral sclerosis presents only with

A

UMN signs

114
Q

Progressive Bulbar and pseudobulbar palsy is caused by damage to cranial
nerves _________

A

9,10 and 12 and presents with dysphagia

115
Q

reduced jaw and gag reflexes and tongue fasciculations

A

Bulbar palsy

116
Q

slow speech and brisk jaw reflex.

A

pseudobulbar palsy

117
Q

Akathisia

A

inability to remain still

118
Q

occurs when one half of the cerebrum herniates across
the midline. It can cause compression of the anterior cerebral artery and lead
to motor and/or sensory weakness.

A

A subflacine herniation

119
Q

occurs when the cerebellum moves inferiorly and
compresses the medulla which can lead to respiratory distress and death.

A

A cerebellar tonsillar herniation

120
Q

occurs when the central part of the brain is inferiorly
compressed towards the brainstem.

A

A central herniation

121
Q

is where there is a defect within the skull and a part of
the brain herniates out through that opening.

A

A transcalverial herniation

122
Q

is the genetic
phenomenon which causes each generation to develop the disease at an
earlier age.

A

anticipation

123
Q

is the transmission of traits from one generation to
another.

A

Heritability

124
Q

is the proportion of individuals carrying a particular allele
of a gene (genotype) that also express the phenotype.

A

Penetrance

125
Q

is the
transfer and incorporation of foreign DNA into a host genome.

A

Transformation

126
Q

what can be prescribes alongside SSRI’s to reduce side effects

A

Mirtazapine - an atypical
antidepressant

127
Q

neutropenic sepsis treatment

A

piperacillin and tazobactam

128
Q

meningitis treatment

A

ceftriaxone + dexamethasone

ceftriaxone allergic give chloramphenicol and vanc.

129
Q

Widespread cerebral atrophy

A

alzheimers

130
Q

Alpha-synuclein cytoplasmic inclusions

A

LBD

131
Q

café au lait spots, benign tumour of nerve and fibrous tissue

A

neurofibroma

132
Q

 scanning speech, intention tremor and nystagmus

A

charcots triad

133
Q

atrophy of caudate and putamen

A

huntingtons

134
Q

Foot drop (especially post hip replacement)

A

sciatic nerve

135
Q

Raised CK

A

muscular dystrophy

136
Q

Racoon/panda eyes

A

basal skull fracture

137
Q

Alzheimer’s diagnosis

A

MMSE

138
Q

lewy body diagnosis

A

DAT scan

139
Q

picks disease diagnosis

A

CT

140
Q

vascular dementia diagnosis

A

SPECT

key stuff (7 decks)

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