Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

third year > Neuro > Flashcards

Neuro Flashcards

1
Q

define multiple sclerosis

A

an autoimmune inflammatory condition causing demyelination of the white matter of the CNS. In order to make a diagnosis there must be at least 2 attacks (plaques of axonal loss and gliosis) separated in time and space.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

there are 3 different types of MS, what are they?

A

Relapse-remitting (80%)
Secondary progressive
Primary progressive (20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

which area of the CNS does MS show a predilection for which areas of the CNS

A 
optic nerve
periventricular white matter
corpus callosum
brainstem
cerebellum
spinal cord
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the average age of onset for MS

A

20-40 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

which two pathological processes happen in MS

A

inflammation (therapies target this)

neurodegeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

which environmental factors are associated with MS?

A

Sunlight - MS more common in those born in May in northern hemisphere, low level of it D
Diet
Infection- EBV! also infectious mononucleosis
Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Bilateral internuclear opthalmoplegia is suggestive of what?

A

MS
it is nystagmus of the ABducted side when there is weakness of eye ADduction
It indicates that there is a lesion in the medial longitudinal fasciculus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is L’hermittes sign

A

electrical bolt like sensations on flexion of the neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is pseudoathetosis

A

tremor when eyes shut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is Uhthoff’s phenomenon

A

reversible conduction block when there is a change in body temp or fatigue (e.g. after hot bath or exercise)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what preclinical evidence is required to make the diagnosis of MS

A

MR - inflammation and change in 2 diff places at 2 diff times
CSF- minimal mononuclear pleocytosis and Oligoclonal IgG bands (60% will have on first attack, 90% in MS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What treatment strategies are therefor MS

A 
symptomatic control
disease modifying (anti-inflammatory)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what must be ruled out before the prescription of steroids in acute neuroinflammatory responses

A

infection
fatigue
heat related symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how does alemtuzumab work?

A

it is an antibody which binds to B and T cells causing their destruction, it is thought that this resets the immune system.
However patients can develop other autoimmune conditions (ITP, thyroid, Goodpastures) and it is also expensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what 6 signs are consistent with motor neurone disease

A

1) no sensory loss
2) no sphincter disturbance
3) a mixture of upper and lower motor neurone signs
4) slow insidious onset
5) little impact on higher executive functioning
6) bulbar involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what would you do to confirm a diagnosis of MND

A

EMG - you would look for large compound muscle action potentials

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

which other system is important to monitor in patients presenting with dysarthria

A

the respiratory system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

which neurological conditions can present with dysarthria

A 
Parkinsons
Cerebellar pathology (staccato speech)
Bulbar (LMN nasal speech)
Pseudobulbar (UMN donald duck speech)
MG (fatiguable LMN)
MND
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what might a new onset of 3rd nerve palsy on a background of headache prompt you to think about

A

aneurysm of the posterior communicating artery as it presses on the free edge of the tantrum and therefore disrupts the 3rd nerve.
These patients require an urgent CT angiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the difference between cerebellar nystagmus and vestibular nystagmus

A

cerebellar nystagmus will be in all directions

vestibular nystagmus is always horizontal and goes away from the lesion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why should patients who suffer with migraines take analgesics right at the beginning of their headaches

A

gastric stasis occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what might you see on LP to provide evidence of SAH

A

xanthochromia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

which type of headache might be treated with caffeine

A

Sudden intracranial hypotension
It can be given intravenously
Sometimes a “blood patch” is used which is an injection of autologous blood into the spinal epidural space.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the three types of head ache (broadly speaking)

A

primary
secondary (organic)
cranial neuralgias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the Munro-Kellie Hypothesis
there is limited space within the skull, therefore at a certain pressure there is a point of decompression and therefore herniation can occur
26
what three processes might cause increased intracranial pressure
increase in brain volume (SOL/oedema) increase in CSF volume (IIH) decrease in venous drainage (CVST)
27
over what time period does papilloedema occur
days of raised ICP
28
6th nerve palsies might be misleading as to their pathologies because of what?
it could be a False Localising Sign | Cn 6 has a long south to north intracranial course therefore can be stretched by increased ICP
29
what effect does posture have on headaches caused by increased intracranial pressure
they are worse if supine (i.e. they are worse in the morning)
30
what is cushing's triad
increased BP decreased HR and RR all aims to restore cerebral blood flow
31
what are the features of low pressure headaches
worse on standing associated with vomiting false localising signs in Cn 6,7,8 as become stretched as brain prolapses distally
32
which causes of meningitis produce what with regard to WBCs on CSF after LP
bacterial 1000s; viral 100s inflam/malig 10s
33
how might SAH present
sudden thunderclap headache which peaks within 2 minutes
34
what management options are available to IIH
``` often self limiting, WEIGHTLOSS repeated lumbar puncture acetazolamide (carbonic anhydrase inhibitor which works as a diuretic) thiazide diuretics ventriculoperitoneal shunt optic nerve sheath fenestration ```
35
can hemiplegia present as a part of migrane
very rarely as a part of an autosomal dominant condition, it should however be thoroughly investigated
36
which cranial nerve is thought to cause the pain experinced in migrane
Cn V trigeminal nerve
37
what should be used in the acute management of migrane
analgesics: - high does aspirin (900mg) - NSAIDS - brufen 600mg or naproxen 250-500mg - triptans (5HT1 agonist - should not use if history of ischaemic heart disease) An antiemetic should also be prescribed NICE recommends a triptan and aspirin
38
which medications might be used for the prophylaxis of migrane
- propanolol (avoid in asthma, may cause fatigue and sleep disturbance) - amitriptyline (titrated up in 10mg/week to 30-50mg; avoid in the elderly, causes sedation and has anti-muscarinic effects) - topiramate (carbonic anhydrase inhibitor, can increase risk of renal calculi, causes fatigue and weightloss, can blur thinking) - valproate (also causes weight gain and tremor) - venlafaxine (dizziness and sedation, also acts as an antidepressant)
39
are there any diagnostic tests which confirm tension type headaches
no difficult to distinguish from mild migrane pain is usually mild-mod, bilateral and has tight banding sensations and pressure behind the eyes often co-morbid with depression
40
what treatment options are available to tth
simple analgesics - avoid overuse physical treatments can be useful such as massage, ice packs and relatation TCAs may be useful if frequent/chronic
41
what is the biggest risk factor for chronic daily headache?
analgesic overuse
42
what are the features of cluster headaches
tend to affect mostly males aged between 20 and 40 excruciating unilateral retro-orbital pain which lasts between 15 minutes and 3 hours. Parasympathetic autonomic activation may happen on the same side (red eye, lacrimation) transient horner's syndrome may occur patients tend to be agitated and may pace about these episodes tend to occur in clusters (hence name) and often wake patients at night it is more common in smoker although tend not to ease upon smoking cessation high rate of suicide amongst sufferers
43
what is the management of cluster head aches
acute: - sc sumatriptan (quick acting) - high flow O2 prophylaxis: - steroids may terminate clusters quicker - verapamil in high doses - require ECG monitoring - lithium
44
which drugs may be associated with IIH
tetracyclines and vitamin A supplements
45
what is the normal opening pressure of a lumbar puncture
18-20cm for normal weight | may be >25cm in IIH
46
what soft signs might be visible on imaging of IIH
flattening of the globe dilated optic sheath partially empty sella
47
hyperacusis can occur from compression of which cranial nerve
Cn VII nerve to stapedius
48
what is the main risk factor for developing trigeminal neuralgia
hypertension
49
what is thought to cause trigeminal neuralgia
tends to start in 6th or 7th decades thought to be caused by compression of the trigeminal nerve near the pons by an actatic vascular loop. In younger patients can be caused by MS and cerebellopontine angle tumors
50
what is Hutchinson's rule
if the tip of the nose is involved in herpes zoster, then there is a higher risk of corneal keratitis
51
the forehead is spared in which type of motor neurone lesion: upper or lower?
UPPER!!!
52
Bell's palsy is the most common cause of Cn VII LMN, but what are the other causes?
``` Trauma: base of skull fractures Viral: Ramsey Hunt (look for zoster vesicles in the ear) Cancer (esp if bilateral) Lyme disease Sarcoid Mumps Otitis media ```
53
what are the likely causes to bilateral facial weakness
UMN - stroke or SOL | LMN - 23% Bell's; sarcoid, GBS, lymes disease, meningitis, bilateral neurofibromas
54
which two conditions is Bell's palsy associated with
pregnancy and diabetes
55
What is the treatment for Bell's Palsy
prednisolone within 72hrs | eye care
56
what is Marcus Gunn syndrome
a synkinesis | jaw winking is cause by miswiring of nerves
57
what are the peripheral causes of vertigo
BPPV (movement induced, Hallpike to diagnose, Eply to treat) vestibular neuritis (sudden onset horizontal nystagmus) meniere's (low frequency hearing loss, aural fullness, tinnitus) drugs (aminoglydosides) trauma
58
what are some of the central causes of vertigo?
MS vascular event tumour (esp in children) migrane (most common, may have nystagmus)
59
which clinical test can be used to investigate vestibular neuritis
head impulse test
60
which symptoms would vestibular disease produce
horizontal nystagmus, hearing loss tinnitus
61
which symptoms would cerebellar disease cause
dysarthria nystagmus asymmetric signs
62
which symptoms woudl brainstem disease cause in the context of vertigo and balance
cranial nerve signs VERTICAL beating nystagmus long tract signs Horner's syndrome
63
which symptoms would dorsal root ganglion disease cause in the context of impaired balance
areflexia positive Romberg's upper = lower limb
64
which symptoms would peripheral nerve disease produce in the context of balance disorder
areflexia positive Romberg's Loss of sensory modalities (weakness)
65
which symptoms would dorsal column disease cause in the context of balance disorders
positive Romberg's loss of vibrational sense L'Hermitte's
66
lesions in a cerebellar hemisphere would produce which signs
``` intention tremor past pointing poor heel shin co-ordination dysdiadochokinesia nystagmus towards side of lesion dysarthria ```
67
lesions in the cerebellar vermis would produce which signs
ataxic gait truncal ataxia eye closure will not affect balance
68
why should patients be given thiamine alongside IV glucose in emergency situation
can precipitate wernickes phenomenon
69
what is Friedreich's ataxia and how does it present
trinucleotide repeat disorder (AR) present with young onset. Ataxia, peripheral neuropathy, arflexia, up going plantars, optic atrophy associated with cardiacmyopathy
70
how can you differentiate between monocular and binocular diplopia
if it goes away when one eye is covered it is BINOCULAR (ie there is a neurological cause) if it does NOT go away when one eye is covered it is MONOCULAR (the cause is optical or psychogenic)
71
what are the features of ocular MG
- eye movement disorder in the absence of pain and pupil involvement - variable symptoms - ptosis - eyelid closure weakness - diplopia without opthalmoplegia
72
lesions in the parapontine reticular formation causes what
lateral gaze palsy
73
roughly outline the nuclei for Cn IX and X
motor and sensory - solitary nucleus and spinal trigeminal nucleus visceral - nucleus ambiguus
74
what are the symptoms of bulbar disease
``` LMN signs nasal speech absent jaw jerk palatal weaknes and nasal regurgitation of food reduced gag reflex wasted fasiculating tongue ```
75
what are the symptoms of pseudobulbar disase
``` UMN signs slow monotonous speech brisk jaw jerk dysphagia brisk gag reflex small immobile spastic tongue emotional lability ```
76
what is Kennedy's disease
X linked recessive bulbar disease which affects youngm en
77
which tests identify dysarthria at different sites
huh - glottal ta - anterior tongue ka - posterior tongue pa - labial
78
dopamine is synthesized in which area of the ventral midbrain
substantia nigra | ventral tegmental area
79
there are direct and indirect motor pathways, excitation of each on produces what
direct - movement | indirect - decreased movement
80
which compound selectively distroys dopamine neurones
MPTP
81
what is compulsivity
prerformance of repetitive behaviours with the goal of reducing or preventing ANXIETY or DISTRESS, not to provide pleasure or gratification
82
what is impulsivity
predisposition toward rapid, unplanned reaction to either internal or ecternal stimuli WITHOUT REGARD FOR NEGATIVE CONSEQUENCES
83
what are impulse control disorders
failure to resist an umpulse, drive or tmeptation to perform an act that is harmful to the person or others
84
what are the cardinal motor symptoms of parkinson's disease?
bradykinesia tremor at rest (better when moving) - Pill rolling tremor rigidity postural instability the motor symptoms are ASYMMETRICAL
85
what are the non-motor features of PD
``` sleep disturbance (poor sleep quality, REM sleep disorder, daytime somnolence) autonomic dysfunction neuropsychiatric ( apathy, depression, psychosis, 80% will have dementia in 10 yrs) ```
86
which drugs might cause secondary parkinsonism
metoclopramide | anti-psychotics
87
name two types of atypical Parkinson's
progressive supranuclear palsy (no tremor, impaired saccadic eye movements, postural instability) multiple system atrophy (parkinsonism, autonomic features, cerebellar, pyramidal UMN signs)
88
which drugs can cause tremor
salbutamol sodium valproate caffeine
89
which medications must L-dopa be combined with
dopa decarboxilase as l-dopa is metabolised outside the brain to DA (which cannot cross the BBB)
90
what are the early side effects of L dopa
nausea, hypotension, discoloured urine (bright orange!)
91
what are the late s/e of l-dopa
dyskinesias | neuropsychiatric
92
why should you never stop L-dopa suddenly
neuroleptic malignant syndrome can develop
93
when would you used dopamine agonists
to delay using L-dopa in younger patients | to supplement L-dopa in complex disease
94
what are the major side effects of dopamine agonists
somnolence, nausea and hallucinations Impulse control disorders
95
when woudl you used Apomorphine
in complex phase of Parkinson's disease when oral medication is failing administered S/c, can cause low BP confusion and hallucinations
96
what are COMT inhibitors
inhibit the enzyme catechol-o-methyltransferase, which degrades dopamine used in complex phase of parkinsons
97
what are the side effects of COMT inhibitors
same are L-dopa, can raise liver enzymes diarrhoea
98
what is Rasagiline
MAO-B inhibitor (increases L-dopa in striatum) | used in young and mild disease
99
which layer of the adrenal cortex produces cortisol
zona fasciculata
100
which enzyme catalyses the final step of cortisol synthesis
11 beta-hydroxysteroid dehydrogenase
101
what are the metabolic actions of cortisol
CHO - gluconeogensis and glyconenolysis protein - increased catabolism fat- lipolysis and inhibits leptin bone - inhibits osteoblasts and decreases collagen synthesis
102
which two things (other than ACTH) can stimulate the adrenal cortex to produce cortisol
angiotensin II potassium
103
whata re the anti-inflammatory actions of cortisol
1) decrease activation of macrophages and T-cells 2) increased synthesis of annexin-1 3) inhibit release of inflammatory mediators
104
what are the main functions of mineralocorticoids
regulate water and electrolyte balance | endogenous example is aldosterone
105
what are the unwanted effects of cortisol treatment
``` suppression of response to infection or injury Cushing's syndrome Osteoporosis Hyperglycaemia Muscle wasting inhibition of growth in children Eurphoria, depression and psychosis glaucoma raised ICP cataracts ```

third year (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions