Neuro

Question 1

TACS stroke and criteria

Answer 1

Total Anterior Circulation Stroke

Limbs, eyes, brain function (dysphasia/visuospatial)

All three of the following need to be present for a diagnosis of a TACS:

Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 2

Characteristic feature of tuberous sclerosis

Typical features

Neuro features

How do u get it?

Answer 2

The characteristic feature is the development of hamartomas, which are benign tissue growths. Hamartomas cause problems based on the location of the lesion. They commonly affect the:

Skin
Brain
Lungs
Heart
Kidneys
Eyes

Skin features include:

Ash leaf spots (depigmented areas of skin shaped like an ash leaf)
Shagreen patches (thickened, dimpled, pigmented patches of skin)
Angiofibromas (small skin-coloured or pigmented papules that occur over the nose and cheeks)
Ungual fibromas (circular painless lumps that slowly grow from the nail bed and displace the nail)
Cafe-au-lait spots (light brown “coffee and milk” coloured flat pigmented lesions on the skin)
Poliosis (an isolated patch of white hair on the head, eyebrows, eyelashes or beard)

Neurological features include:

Epilepsy
Learning disability
Brain tumours

autosomal dominant genetic condition

Question 3

partial anterior circulation stroke (PACS) criteria

Answer 3

Two of the following need to be present for a diagnosis of a PACS:

Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)*
*Higher cerebral dysfunction alone is also classified as PACS.

Question 4

posterior circulation syndrome (POCS)

Answer 4

One of the following need to be present for a diagnosis of a POCS:

Cranial nerve palsy and a contralateral motor/sensory deficit
Bilateral motor/sensory deficit
Conjugate eye movement disorder (e.g. horizontal gaze palsy)
Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
Isolated homonymous hemianopia

Question 5

lacunar stroke (LACS)

Answer 5

subcortical stroke that occurs secondary to small vessel disease. There is no loss of higher cerebral functions (e.g. dysphasia).

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

Pure sensory stroke
Pure motor stroke
Sensori-motor stroke
Ataxic hemiparesis

Question 6

B. Burgdorferi is what?

Answer 6

Lyme disease

Question 7

What is Bell’s palsy?

Answer 7

7th cranial nerve, facial nerve palsy. (Forehead affected)

Question 8

What is Bell’s palsy?

Answer 8

7th cranial nerve, facial nerve palsy. (Forehead affected)

Question 9

What is horners syndrome?

Answer 9

Interruption of the sympathetic supply to the face: ptosis(droopy eye), miosis(constricted pupil), anahidrosis(lack of sweat)

Question 10

Third nerve palsy looks like what and what would be the keen thing for us to rule out?

Answer 10

Eye down and out. Rule out brain annuyerism

Question 11

Dizziness could be due to what vessel stenosis/occlusion?

Answer 11

Vertebral, as they supply the cerebellum which is responsible for balance

Question 12

Amaurosis fugax and what is it associated with

Answer 12

Temporary loss of vision in one eye

Carotid artery stenosis, want to do sometching about it asap because it can lead to a huge stroke.

Question 13

Sister if Mary josef nodule is where and what is it a sign of?

Answer 13

Red/purple lump in belly button. Sign of ovarian cancer so it needs to be ultrasounded

Question 14

How can you pin down timeframes?

Answer 14

=patient hx
Collateral hx
Notes
Important event eg did you have this at. Christmas

Question 15

What are the scores for he MRC scale

Answer 15

0 **no contraction **
1 contraction, no movement
2 movement, not overcoming gravity
3 active movement that can over come gravity
4 active muscle movement against gravity
5 normal muscle strength

Start off by assessing if they can overcome gravity

Question 16

Lmn elision eg myopathy where seen

Answer 16

Shoulders and hips

Question 17

What is a pyramidal pattern of weakness and is it a sign of umol or lil?

Answer 17

Upper motor lesion:
Flexion stronger than extension arms
Legs extension better than flexion

Question 18

What things do you need to work through in surgical sieve

Answer 18

5I 3-Scotland
Where “3-Scotland” relates to the three top killers in Scotland.

I: infection
I: inflammation
I: immune
I: iatrogenic
I: idiopathic
1: vascular/cardiovascular
2: cancer
3: trauma

Question 19

Fasiculation umn or lmn sign and what likely?

Answer 19

Lmn sign and often mnd (both upper and lower motor neuron signs j

Question 20

Causes of black out

Answer 20

cardiac
Syncope
Vasovagal
Aortic stenosis
Arrhythmia
Postural hypotension
Dis function.

endo
Low blood sugar

brain
Epilepsy
Rare (collie cyst, migraine but might cause vasovagal)

Mind
Psychologically mediated: panic attack/disociation (non epileptic attack, pseudoseizure)

Metabolic

Question 21

How to tell the difference between epileptic seizures and dissociative seizures

Answer 21

Dissociative ; grandmal , seizure like BUT has consciousness
Prolonged unconsciousness

Question 22

What is a colloid cyst?

Answer 22

Pedunculated cyst that can flop and block cns fluid outflow

Question 23

Argument with partner then black out. What is that indicative of ?

Answer 23

Dissociative seizures

Question 24

Generalised tonic clinic seizure timeframe

Vs

Dissociated seizures

Answer 24

Fitting 2-5 minutes
Unresponsive with obstructive breathing 2 minutes
Confused for 30 minutes

Longer seizure time, come to rapidly following. If they happen a lot they can be variable

Question 25

Tonic clinic seizure treatment following first seizure

Answer 25

Non meds following first seizure unless reason eg glioblastoma

Question 26

Cardiac syncope typical course

Answer 26

30-60seconds
Suddenly awake and conscious

Question 27

Temporal lobe seizure

Answer 27

Lip smacking, finger movements eg picking , rising sensation in abdomen (weird abdomen sensations)

Typically vacant/staring

Often have emotional component

Question 28

Do people always remember post ictal?

Answer 28

Not always, often don’t

Question 29

Malingering vs facticious disorders

Answer 29

Malingering = wanting to make up symptoms for own gain eg insurance claim

Facticious = psychiological they have a bizarre reason to make up symptoms

Question 30

What is globus

Answer 30

Ent. - functional feeling of lump in throat and struggle to swallow

Question 31

How can we use thresholds to explain functional neurological problems

Answer 31

The threshold is the level at which input from nerves reaches concious level

Eg normally don’t take in all the stimulus from the environment eg trousers on legs, but now in functional disorders your concious,y getting input from other centres.

Can also have sub cincious activity go to the concious mind which can break down the task, eg physios getting people with a functional abnormal gait to do something whilst walking as it takes it back to the unconscious

Question 32

What features point u towards functional disorders

Answer 32

Symptoms that don’t fit together

Dissociative symptoms

Other functional symptoms

Multiple other diagnoses which could be functionallly related eg appendectomy with normal appendix

Examinations
-inconsistent findings
-not in-line with structural disease inc. flapping/collapsing weakness. Also tremor following rhythm of what the other hand is doing.
-incompatible with understanding of normal physiology or anatomy

Question 33

What is hoovers sign

Answer 33

Test weak leg extension
Test strong leg flexion and the weak leg extension will become strong

Question 34

Functional vs non visual field defect eg retinitispigmentosum

Answer 34

Organic = still see in cone shape (see wider further away) even if visual field it reduced

Functional = tubular visual field