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2A - Stuff i just cannot remember > Neuro 2 > Flashcards

Neuro 2 Flashcards

1
Q

65-M presents with 12hr Hx sudden headache + difficulty walking (balance problem). He feels nauseous and has vomited. His speech is slurred.

Likely diagnosis? Cardinal symptoms?

A

Cerebellar stroke

Cardinal symptoms:

  • ataxia
  • headache
  • vertigo
  • vomiting
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2
Q

Pt presents with complete paralysis of facial muscles on one side.

Mouth droop, flattened nasolabial fold, cannot close eye, smoothened brow.

Likely diagnosis?

A

CNVII Palsy

  • ipsilateral side
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3
Q

Pt presents with dizziness, and feel faint when they get up from standing. They are on medication for their recently diagnosed BPH.

Likely diagnosis and cause?

A

Postural Hypotension 2o to Tamsulosin

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4
Q

65-M presents complaining of a Hx sudden headache + difficulty walking (balance problem). He felt nauseous and has vomited. He noticed his speech was slurred. This resolved within 1 hour.

Likely diagnosis? Cardinal symptoms?

A

TIA

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5
Q

Presentations of Subarachnoid haemorrhage

A

Sudden thunderclap headache, 10/10 severity

Neck stiffness, meningism

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6
Q

Pt presents with stroke symptoms. Full acute management plan?

A

ABCDE

Within 4.5hr window:

  1. CT Head (within time-frame)

If confirmed Ischaemic stroke:

  1. IV Alteplase (within time-frame)
  2. Thrombectomy
    • w/in 6hr anterior circulation
    • w/in 12hrs posterior circulation
  3. a) 2wks Aspirin 300mg
    b) Long-term Clopidogrel
  4. Carotid US, CT Angiography, Echo.

CI to Alteplase: head trauma, GI/brain bleed, recent surgery, normal BP, plt count, INR

If confirmed Haemorrhagic stroke (ICH, SAH):

  1. SAH - Nimodipine, IV fluid
  2. Endovascular coiling, stent, Decompressive hemicraniectomy
  3. Serum toxicology screen (cocaine)
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7
Q

Chronic stroke management

A

HALTSS

Hypertension*, 2-wks after

Antiplatelet - Clopidogrel. If Ischaemic, 2o to AF then Warfarin/ Rivaroxaban

Lipid-lowering - Atorvastatin

Tobacco - stop smoking
Sugar - Diabetes screening
Surgery - if ipsilateral carotid stenosis >50% > carotid endarterectomy

*No benefit in lowering acutely :: reduces brain perfusion UNLESS malignant

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8
Q

Focal seizure of the frontal lobe presentations

A

MOTOR features

  • posturing
  • pedalling of legs
  • Jacksonian march
  • behavioural change
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9
Q

Myoclonic seizure

A

Sudden jerk of limb, face, trunk; violent, disobedient limb

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10
Q

Tonic seizure

A

Sudden limb stiffness

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11
Q

Jason is a 34yr old builder. He developed sudden intense back pain at work + weakness and sensory loss in both limbs

Likely diagnosis? Possible underlying causes?

A

Spinal Cord compression
- BILATERAL sensory loss

Possible causes:

  • disc herniation
  • congenital stenosis
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12
Q

Subarachnoid haemorrhage mx

A

IV Fluid + Nimodipine (Ca2B - reduces vasospasms - reduces cerebral ischaemia)

Endovascular coiling, intravascular stent

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13
Q

Subdural haemorrhage mx

A

ABCDE + IV Mannitol

Burr-twist irrigation/ craniotomy

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14
Q

Extradural haemorrhage mx

A

ABCDE + IV Mannitol

Clot evac/ ligation

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15
Q

Drug used to lower intracranial pressure

A

Mannitol

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16
Q

Which artery is commonly affected in an extradural (epidural) haemorrhage?

A

Middle meningeal artery

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17
Q

Main types of seizures, presentations and their proportions

A

Primary generalised (40%)

  • LOC
  • BILATERAL, SYMMETRICAL

Partial/focal (60%)
- depends on lobe location

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18
Q

Epilepsy causes

Epilepsy RF

A

Epilepsy causes:
2/3 IDIOPATHIC.
Tumour, stroke, cortical scarring.

Epilepsy RF:
FHx, abnormal cerebral perfusion, cocaine

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19
Q

Epilepsy management

  • uncomplicated
  • F child-bearing age
A

1L Valproate

If F child-bearing age - LAMOTRIGINE

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20
Q

Simple vs Complex partial seizure

A

Complex affects awareness

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21
Q

Temporal partial/focal seizure px

A

Lip smacking, chewing, fiddling

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22
Q

Frontal partial/focal seizure px

A

Motor: Jacksonian, peddling,

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23
Q

Parkinson’s RF

Parkinson’s associations

A

55 - 65 M, pesticide exposure

Associated with LEWY-BODY dementia

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24
Q

Parkinson’s diagnosis

Parkinson’s management

A

Clinical diagnosis - response to L-dopa

Mx: MDT care

  1. Levodopa + Co-Careldopa
  2. Cabergoline/Rantipole - DA agonist
  3. Selegline - MAO-B inhibitor
  4. Entacaopone - COMT i
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25
Q

Parkinson’s presentations

Parkinson’s pathophysiology

A

Resting tremor
Bradykinesia
Cogwheeling

Rigidity, foot drop, insidious onset

Pathophysiology: reduced DA in Substantia Nigra

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26
Q

Migraine management

What should you avoid?

A

Prophylaxis: Propranolol, Topiramate, TCAs, Bockulinum toxin A

Acute attack:
NSAIDs, Paracetamol > Triptan. Metoclopramide (antiemetic)

Avoid opiates and the pill

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27
Q

Cluster headache management

A

Prophylaxis:
Verapamil

Acute attack:
High flow O2 > Nasal Triptan

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28
Q

Trigeminal neuralgia mx

A

Carbamazepine

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29
Q

Tension headache triggers

A

Stress, sleep deprivation, hunger, anxiety, eye strain

NOT DEHYDRATION

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30
Q

Tension headache mx

A

Avoid triggers
Aspirin
Paracetamol, NSAIDs

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31
Q

Multiple Sclerosis pathophysiology

A

MS

CD4-mediated demyelinating condition affecting oligodendrocytes > gliosis + neuronal damage

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32
Q

Multiple Sclerosis presentations + demographic

A

F 20-40, NORTHERN latitude (SWEDEN), HLA-DRB1

1) Optic neuritis - one blurry eye
2) Pyramidal weakness - upper limb extensors + leg flexors
3) Sensory phenomena

Spastic paraparesis + numbness + declining cognition + UMN signs

Lhermitte’s sign

Sensory WORSE in SHOWER

33
Q

MS Investigations

A

MCDONALD CRITERIA

CSF - oligoclonal bands/ IgG

GOLD: MRI Brain + Spinal Cord - Demyelinating lesions (ventricles)

Gadolinium-enhanced hyperintensity of ventricles

34
Q

MS Management

A

Acute relapse: Methylprednisolone

Chronic relapse-remitting: Interferon-B, Fingolimod, Natalizumab

35
Q

MND Investigations + Diagnosis

A

El Escorial Criteria

EMG nerve condition studies

36
Q

Kerning’s sign indicates

A

Meningitis - severe hamstring stiffness

37
Q

Encephalitis presentations

Encephalitis mx

What can you prescribe for seizures?

A

Looks like meningitis + Stroke
- meningism + fever + ALTERED MENTAL STATUS + seizure

Mx:
primary: IV Benzylpenicillin

Hospital: IV Ceftriaxone + ACICLOVIR (HSV1) (2wks)

Anticonvulsants: Phenytoin

38
Q

Encephalitis common cause

Encephalitis ix

A

HERPES SIMPLEX VIRUS 1 (HSV1)

Bloods/ culture, CSF, Viral PCR, CT/MRI

39
Q

SE Acyclovir

A

Fatigue, GI disturbance, photosensitivity, rash

40
Q

Alzheimer’s px

Alzheimer’s Ix

A

Memory loss, speech/ motor deficit, personality change, disorientation

1L: MMME + Blessed Dementia Scale
GOLD: CT - cortical atrophy

Mx:

  1. Acetylcholinesterase inhibitor - Donezpil/ Rivastigmine
  2. CSF amyloid-beta monitoring

“see friends, play board-game”

41
Q

Acetylcholinesterase inhibitor uses

Examples

A

Myasthenia Gravis + Alzheimer’s disease

Donepezil, Rivastigmine

42
Q

Alzheimer’s complications

A

Aspiration pneumonia 2o to dysphasia, UTI

43
Q

Alzheimer’s pathophysiology

A

Beta-amyloid peptide accumulation > AMYLOID PLAQUES + NEUROFIBRILLARY/TAU TANGLES, lost ACh, Tau

44
Q

Frontotemporal dementia (aka Pick’s) px

Associations?

A

Younger, semantic dementia (teacher can’t spell)

Personality change, episodic memory loss, lowered inhibitions

Associated with MOTOR NEURONE DISEASE

45
Q

Pick’s disease diagnosis

A

Port-mortem - TAU proteins stain with silver

Causes FRONTOTEMPORAL DEMENTIA

46
Q

Vascular dementia px + aetiology

A

CVD/ stroke aetiology - HTN + Focal signs

Px: Stepwise:

  1. visual disturbance
  2. UMN
  3. Attention deficit
  4. Depression
  5. Emotional disturbance
47
Q

Lewy Body Dementia px

Association

A

Fluctuating, cognitive impairment, visual hallucinations

+ Parkinsonism

PARKINSON’S DISEASE association

48
Q

Lewy body dementia mx

A

Acetylcholinesterase inhibitors

49
Q

Most common type of brain tumour

A

Glioma - #1 = Astrocytoma

50
Q

Common sites which metastasis TO brain

A

Lung, breast, skin , kidney, GI

51
Q

Brain tumour px

Brain tumour Ix

A

Raised ICP

  • headache
  • drowsy
  • nausea

Local effects

Ix: Neuro exam
GOLD: Brain CT/MRI

52
Q

Most affected vessel in GCA?

A

Carotid artery

53
Q

GCA Investigations

A

American College of Rheum Classification

GOLD: Temporal Artery Biopsy, ^ESR/CRP

54
Q

GCA Management

A

High dose steroid, low dose aspirin, tocilizumab

55
Q

SC Compression px

A

Contralateral UMN signs + Back pain

Paresis + Sensory loss

+ Bladder/ bowel dysfunction if lumbar lesion

56
Q

SC Compression Ix

SC Compression Mx + Mx for underlying malignancy

A

Acute SCC emergency = Immediate WHOLE SPINE MRI

Mx: Surgical decompression w/in 48hrs

If Malignancy - IV Dexamethasone

57
Q

Types of SC Compressions

A

Cauda Equina Syndrome

Brown-Sequard Syndrome

58
Q

Cauda Equina Syndrome Presentations

A

SADDLE PARASTHESIA, bladder/ bowel dysfunction

Lower back pain, absent ankle reflex

59
Q

Brown-Sequard Syndrome presentations

A

Isilateral:

  • hemiplegia
  • loss of proprioception + vibration

Contralateral:
Loss of pain + temperature

60
Q

Common peroneal nerve palsy px

L5 Radiculopathy px

A

Common peroneal nerve: Foot drop + affects ankle eversion

L5 Radiculopathy: Foot drop + affects ankle inversion

61
Q

Myasthenia Gravis investigations

Mx

A

Clinical, TFT, crushed ice test (ptosis)

ACh_R Ab + MuSK

Tensilon Test

Mx:
- Acetylcholinesterase inhibitors - pyridostigmine

CT Chest - Thymoma??

62
Q

Causes of peripheral neuropathy

A

Diabetes Mellitus

B12 deficiency
Lead poisoning
Trauma

63
Q

Huntington’s disease Pathophysiology

Presentations

Ix

A

Ppx: CAG repeats > TOO MUCH DA

Px: Chorea, cognitive decline, hyperkinesia, incoordination, depression

Ix: CAG Repeat Testing +

MRI/CT - basal ganglia lesions

Differential:
- Wilson’s (Copper - Liver biopsy, rings in eyes)

64
Q

Wilson’s presentations

Ix

A

Rings in eyes

Similar to Parkinsons/Huntingtons

Ix: Liver Biopsy (copper)

65
Q

Huntington’s Disease Mx for:

  • Chorea
  • Psychosis
  • Jerk
A

Chorea: Tetrabenazine

Psychosis: Haloperidol

Jerk: Risperidone

66
Q

Guillain-Barre Syndrome presentations

Ix

Mx (+ DVT prophylaxis)

A

Viral > Neuro
- TOES to NOSE weakness
distal > proximal

Ix: Bloods, LP (protein), spirometry, ECH

EMG - slow conduction

Mx: Plasma exchange + IV Ig (AVOID corticosteroids).

DVT prophylaxis: LMW Heparin

67
Q

Lambert-Eaton Syndrome

RF, Px, Ix, Mx

A

RF Malignancy, AI, smoking

Px: GRADUAL proximal limb weakness, dry mouth, dysarthria

Ix: Ab against Voltage-gated Ca Channel

Mx: Plasma exchange, IV Ig, Amifampridine

68
Q

Define amaurosis Fugax

A

Painless temporary vision loss

69
Q

Charcot-Marie-Tooth

Ix

A

Progressive peripheral neuropathy + PES CAVUS + FOOT DROP /slapping

Ix: EMG - symmetrical change

GOLD: CMT mut

70
Q

Duchenne Muscular Dystrophy

Ix

A

<3, delayed motor milestone, lower limb weakness, GOWER’s sign

Ix: Muscle biopsy - absent dystrophin

71
Q

Wernicke’s Encephalopathy

Define
Px

A

Thiamine (B1) deficiency due tp alcohol abuse/ GI surgery

Px: Confusion, ataxia, ophthalmoplegia, asterixis

Mx: Pabrinex - IV Thiamine + Mg Supplement

72
Q

Depression screening tool

A

PHQ-9

73
Q

ABCD2 score parameters

A 
Age >60 
BP >140/ >90 
Clinical - speech, weak, sleep disturbance
Duration <1hr (1), >2hr (2)
DM
74
Q

Signs of radial nerve damage

A

Can’t open fist

BEST muscles

75
Q

Signs of Median nerve damage

A

Carpal Tunnel

Precision grip muscles - LOAF

76
Q

Signs of Ulnar nerve damage

A

Vulnerable to elbow trauma

CLAW sign

77
Q

Signs of axillary nerve damage

A

Weak shoulder abduction

78
Q

Differentiate between Myasthenia Gravis and Lambert Eaton Syndrome

A

Myasthenia Gravis:

  • Muscle fatigue worsens with exercise
  • EMG - decremental (muscle response goes down)

Lambert Eaton:

  • Muscle fatigue improves with exercise
  • EMG - Incremental (muscle response goes up)
  • Autonomic: incontinence, dry mouth, low libido
79
Q

Antiphospholipid syndrome

Px, Ix, Mx

A

ANTIPHOSPHOLIPID SYNDROME

Px: thromboses, preg-related morbidity (miscarriage)

Ix: Antiphospholipid Ab + (2, 12 wks apart)

  • Lupus anticoag
  • Anticardiolipin Ab
  • Anti-B2-Glycoprotein I Ab

Mx: Dalteparin (UF/LMW Heparin) AND Warfarin AND Vit K Antagonist

AND aspirin if prior thrombosis

2A - Stuff i just cannot remember (19 decks)

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