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YEAR 3 & 5 CORE CONDITIONS > Neuro 2 > Flashcards

Neuro 2 Flashcards

1
Q

What are some risk factors for meningitis?

A

CSF shunts/dural defects - staphylococcal

Spinal procedures (epidurals) - Pseudomonas

Splenectomy/sickle cell - encapsulated organisms

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2
Q

What are the main causes of bacterial meningitis per age category?

A

Neonates

  • Group B strep
  • L. monocytogenes
  • E. coli

Infants

  • H. influenzae
  • N. meningitides
  • S. pneumoniae

Adults
- same as infants

Elderly

  • S. pneumoniae
  • L. monocytogenes
  • TB
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3
Q

What are the main organisms causing hospital acquired meningitis?

A
  • Klebsiella pneumoniae
  • E. coli
  • S. aureus
  • Pseudomonas aeroginosa
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4
Q

What are some non-infective causes of meningitis?

A 
Malignant cells
Drugs - NSAIDs, trimethoprim
Sarcoidosis
SLE
Behcet's disease
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5
Q

What are some early features of meningitis?

A 
Headache
Fever
Leg pains
Cold hands and feet
Abnormal skin colour
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6
Q

What features make up ‘meningism’?

A
  • Neck stiffness
  • Photophobia
  • Kernig’s sign = pain and resistance on passive knee extension with hip fully flexed
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7
Q

What indicates invasive meningococcal disease?

A
  • Petechial rash that is non-blanching (use glass test to check)
  • Signs of shock: prolonged cap refill, hypotension, tachycardia
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8
Q

What haematological disorder can be secondary to meningitis? What blood levels would indicate this?

A

DIC (disseminated intravascular coagulation)

Low fibrinogen levels - used up all your fibrinogen to make many little clots
Raised D-dimer - released from the many little clots
Low platelets - used up all the platelets to make clots

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9
Q

What is another sign that may be positive in meningitis?

A

Brudzinski’s sign = hips flex on bending head forwards

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10
Q

What is the first line in managing meningitis?

A

Take blood cultures

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11
Q

What is the management for meningitis after taking blood cultures?

A
  • IV antibiotics
  • Dexamethasone 10mg IV to reduce meningism
  • Airway support
  • Fluid resuscitation
  • LP (do this before IV antibiotics only if they are stable)
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12
Q

Describe the CSF analysis in bacterial, viral + TB meningitis

A

Bacterial

  • Cloudy, turbid appearance
  • > 1.5g/L protein (normal 0.2-0.4)
  • Low glucose
  • Neutrophils ++++

Viral

  • Clear appearance
  • Normal protein
  • Normal glucose
  • Lymphocytes ++++

TB

  • Cob-web like appearance
  • > 1.5g/L protein
  • Low glucose
  • Lymphocytes ++++
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13
Q

What antibiotic should GPs give for meningitis?

A

IM benzylpenicillin

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14
Q

What is the blind/empirical therapy for meningitis?

A

IV ceftriaxone (3rd generation cephalosporin)

If atypical pathogens, add IV amoxicillin
If Listeria spp, add gentamicin

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15
Q

Name some triggers of migraines

A

CHOCOLATE

Chocolate
Hangovers
Orgasms
Cheese/caffeine
Oral contraceptives
Lie-ins
Alcohol
Travel
Exercise
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16
Q

Who are migraines more common in?

A

Women - particularly of reproductive age (potential link with hormones)

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17
Q

How does a migraine present?

A

Prodromal symptoms

  • Hours/days
  • Yawning
  • Cravings
  • Sleep or mood changes

Aura

  • Visual
  • Somatosensory - paraesthesiae
  • Motor - dysarthria, ataxia, hemiparesis
  • Speech - dysphasia

Headache

  • Unilateral, pulsating headache
  • Can wake patient in the night
  • Nausea + vomiting (only once or twice)
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18
Q

What is the prophylactic treatment of migraines?

A
  • Propanolol
  • Amitryptiline
  • 12 weekly botulinum toxin injections in chronic migraines
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19
Q

How do you treat a migraine during an attack?

A
  1. Simple analgesic with anti-emetic e.g. paramax = combination preparation
    of ibuprofen + prochlorperazine
  2. Triptans = 5-HT1 (serotonin) receptor agonist
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20
Q

When are triptans contraindicated?

A 
IHD
Coronary spasm
Uncontrolled hypertension
Recent lithium
SSRIs - can induce serotonin syndrome
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21
Q

What defines episodic and chronic tension headache?

A 
Episodic = <15 days of each month
Chronic = >15 days of each month
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22
Q

Describe a tension headache

A

Bilateral ‘tight band’ headache that comes from neck and shoulders and occurs later in the day

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23
Q

What usually causes a tension headache?

A
  • Stress
  • Anxiety/depression
  • Poor posture
  • Muscle tightness
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24
Q

What is a big risk factor for cluster headaches?

A

Smoking

Males (5:1)

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25
Q

Describe a cluster headache

A

Sudden onset of excruciating pain around one eye that lasts 15-180 min
Excessive watering, redness and swelling of the eye
Occurs at the same time each day for about 6-12 weeks

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26
Q

What might you see on examination of a cluster headache?

A

Ptosis and miosis

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27
Q

What is first line treatment for a cluster headache?

A

High flow oxygen - 100% O2 for 15min via non-rebreathe mask

Sumatriptan SC (contraindicated in coronary artery disease)

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28
Q

What can be given for prophylaxis of cluster headaches?

A

Verapamil
Corticosteroids
Lithium

29
Q

List the red flags for a brain tumour

A
  • Papilloedema
  • New seizure
  • Headache with cancer/neurofibromatosis/immunodeficiency - Change in consciousness/confusion
  • New onset cluster headache
30
Q

What is the 2nd most common neurodegenerative disorder after Alzheimer’s?

A

Parkinson’s disease

31
Q

What is the pathophysiology of Parkinson’s disease?

A

Loss of dopaminergic neurons in the substantia nigra

32
Q

What is the extrapyramidal triad of Parkinsonism?

A
  1. Tremor - ‘pill-rolling’, 4-6Hz resting tremor
  2. Hypertonia - cogwheel rigidity during pronation/supination
  3. Bradykinesia - slow to initiate movement, festinating gait, decreased arm swing, expressionless face
33
Q

What type of dementia mimics Parkinsonism?

A

Lewy-body dementia

34
Q

Name some differential diagnoses for Parkinsonism

A
  1. Lewy-body dementia - MMSE
  2. Multiple system atrophy - would have poor response to levodopa
  3. Progressive supranuclear palsy
  4. Benign essential tremor - ask them to draw something
35
Q

What can cause drug-induced Parkinsonism and how can you tell difference from Parkinson’s disease?

A

Parkinson’s disease is asymmetrical; drug-induced more likely to be symmetrical

Psychosis tranquilisers

  • Phenothiazines
  • Thioxanthes
  • Butyrophenones

Metoclopramide = anti-emetic

36
Q

Describe a Parkinsonian gait

A

Hesitant - difficulty initiating + turning
Shuffling - reduced stride length
Festinating - walks faster and faster to not fall over
Lack of arm swing
Stooped posture
Unsteadiness

37
Q

What signs would you see on examination of Parkinson’s disease?

A
  • Babinski’s sign
  • Hypomimia = mask like face with reduced blinking
  • Glabella tap = Myerson’s sign - blinking fails to cease with tapping on forehead
  • Quiet voice
  • Cogwheel rigidity
  • Bradykinesia - slow at opening and closing thumb + forefinger
  • Postural hypotension
38
Q

What investigation can you do to diagnose Parkinson’s disease?

A

PET scan with fluorodopa to localise dopamine deficiency in basal ganglia

39
Q

What type of drug are Sinemet and Madopar?

A

Levodopa = dopamine precursor
With dopa-decarboxylase inhibitor (carbidopa) to prevent peripheral conversion to dopamine which reduces nausea and lowers the dose required

40
Q

What are some side effects of levodopa? What does this mean in terms of prescribing it?

A
  • Dyskinesia
  • Dystonia (painful)
  • Psychosis
  • Nausea + vomiting

The efficacy reduces over time, which requires much larger doses –> more side effects.
Start levodopa late i.e. over 70 years old or when Parkinson’s seriously affects life

41
Q

What drugs can be used earlier in life to delay starting levodopa?

A
  • Dopamine agonists e.g. Ropinirole

- Monoamine-oxidase-B inhibitors e.g. rasagiline/selegiline

42
Q

Why are Ergot-derived dopamine agonists not used as first-line treatment of Parkinson’s?

A

They can cause fibrotic reactions

43
Q

What are some side effects of dopamine agonists?

A
  • Compulsive behaviour e.g. gambling, hypersexuality
  • Drowsiness
  • Nausea
  • Hallucinations
44
Q

Name some inherited congenital myopathies

A
  1. Duchenne’s muscular dystrophy - X-linked recessive
  2. Becker’s muscular dystrophy - X-linked recessive
  3. Facioscapulohumeral (FSHD) - autosomal dominant
  4. Myotonic dystrophy - autosomal dominant
45
Q

What symptoms/signs distinguish myopathy from neuropathy?

A

Myopathy = gradual onset of symmetrical weakness

  • difficulty combing hair or climbing stairs
  • preserved tendon reflexes
  • no paraesthesia or bladder problems
  • no fasciculations
46
Q

What symptoms distinguish the different types of myopathy?

A
  • Rapid onset = toxic, drug or metabolic myopathy
  • Fatigue/increased weakness with exercise = myasthenia
  • Spontaneous pain at rest = inflammatory myopathy
  • Pain on exercise = metabolic myopathy
  • Oddly firm muscles (due to infiltrations with fat/connective tissue) = Duchenne’s muscular dystrophy
47
Q

Name an inherited metabolic myopathy

A
  • McArdle’s = glycogen storage disorder
48
Q

What can cause an acquired immunological myopathy?

A
  • Polymyositis
  • SLE
  • Rheumatoid arthritis
  • Polyarteritis noda
  • Polymyalgia rheumatica
49
Q

What kind of gait is seen in proximal myopathy?

A

Waddling gait = wide-based gait with toe walking. Swaying but symmetrical.

50
Q

How does Duchenne’s present?

A 
Presents around 4 years old
Clumsy walking
Difficulty standing 
Respiratory failure
Pseudohypertrophy in calves (deposition of fat and connective tissue)
51
Q

What are some signs of facioscapulohumeral muscular dystrophy?

A
  • Onset at 12-14 years old
  • Weakness of face - can’t puff out cheeks; ‘ironed-out’ expression
  • Weak upper limbs
  • Foot drop
  • Winging of scapula
  • Scoliosis
  • Anterior axillary folds
  • Horizontal clavicles
52
Q

What bloods should be done in proximal myopathy?

A

Creatinine kinase - level may be 50-100x normal
Renal function + U&Es
Serum myoglobin

53
Q

What further investigations can be done for proximal myopathy?

A

Muscle biopsy
Genetic testing
Electromyography to rule out neurogenic cause

54
Q

What causes multiple sclerosis?

A

Autoimmune condition where repeated episodes of inflammation of nervous tissue in the brain and spinal cord lead to loss of the myelin sheath

55
Q

What virus is multiple sclerosis sometimes linked to?

A

EBV - antibodies produced by B cells + T cells directed against EBV nuclear antigens may be redirected to attack CNS myelin due to molecular mimicry

56
Q

Who is more likely to get MS?

A

Females in their 30s

Caucasians

57
Q

How does MS usually first present?

A

Unilateral optic neuritis - pain on eye movement and rapid decrease in central vision

58
Q

How are the eye movements affected by MS?

A
  • Double vision - weakness of lateral rectus muscle

- Symmetrical horizontal jerking nystagmus

59
Q

What criteria is used for diagnosing MS?

A

McDonald criteria

60
Q

How do you describe the course of MS?

A

Relapsing-remitting course
Initially there is full recovery between relapses
With time, remission is incomplete so disability accumulates

61
Q

If MS affects the autonomic system, how would this present?

A
  • Loss of control over bladder
  • Faecal incontinence
  • Impotence
  • Loss of thermoregulation - sweating, pyrexia, hypothermia
62
Q

What would be seen on an MRI of MS?

A
  • Periventricular lesions
  • White matter abnormalities

MRI is sensitive but not specific for plaque detection

63
Q

What would be found on CSF analysis in MS?

A

Increased IgG

Increased protein

64
Q

How do you treat an acute flare of MS?

A

Prednisolone 500mg/day for 5 days (with omeprazole)

65
Q

What is used in mild/moderate relapsing-remitting MS?

A

DMARDs e.g. dimethyl fumarate or monoclonal antibodies (alemtuzumab)

66
Q

What is transverse myelitis?

A

Seen in MS

Loss of motor, sensory. autonomic, reflex and sphincter function below the level of a lesion

67
Q

What is Uhthoff’s phenomenon?

A

Seen in MS

Worsening of symptoms in the heat e.g. hot bath

68
Q

What is the acute management of status epilepticus?

A

Lorazepam, then lorazepam again, then phenytoin

lorry lorry funny

YEAR 3 & 5 CORE CONDITIONS (30 decks)

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