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Core Conditions > Neuro > Flashcards

Neuro Flashcards

1
Q

Bacterial meningitis: what exudate covers the brain in chronic infection?

A

Viscous, grey-green exudate with meningeal tubercles

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2
Q

Bacterial meningitis: pia-arachnoid becomes invaded by what? What does this cause?

A

Polymoprhs - produce pus that forms adhesions leading to cranial nerve palsies and hydrocephalus

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3
Q

Viral meningitis: Inflammation caused by what?

A

Infiltration of lymphocytes

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4
Q

Viral meningitis: pus/no pus?

A

No pus

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5
Q

Bacterial meningitis: causative organisms (2)

A

Neisseria meningitides and Strep. pneumoniae - combined (70%)

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6
Q

Viral meningitis: causative organisms

A

Enterovirus, poliomyelitis, mumpmps, HSV, HIV, EBV, CMV

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7
Q

Fungal meningitis: causative organisms (2)

A

cryptococcus neoformans, candida albicans

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8
Q

Meningism: signs (3)

A

Neck stiffness, photophobia, Kernig’s sign

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9
Q

Type of rash in meningitis

A

Petechial, non-blanching (may only be 1 or 2 spots)

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10
Q

Triad of signs in meningitis

A

Headache, neck stiffness, fever

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11
Q

Differentials of meningitis

A 
SAH
Migraine
Intracranial mass lesion
Epilepsy
Cerebral malaria
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12
Q

Meningitis: investigations

A

FBC, U&Es (WBC dec. = immunocompromised), LFT, glucose, co-ag screen, cultures, throat swabs, serology, lumbar puncture if GC5 15 and no Sx of increase ICP and no focal neurology, CXR is signs of TB

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13
Q

Treatment of viral meningitis (1)

A

Acyclovir

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14
Q

Treatment of pneumococcal meningitis

A

Dexamethasone + ABx

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15
Q

Treatment of TB meningitis

A

Rifampicin, isoniazid and pyrazinamide
& ABx
For 9 months

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16
Q

Prophylactic treatment of contacts

A

Rifampicin/ciprofloxacin

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17
Q

If <55, treat bacterial meningitis with

A

cefotaxime

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18
Q

If >55, treat bacterial meningitis with

A

cefotaxime & ampicillin

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19
Q

% of population that have reported migraine Sx

A

> 20%

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20
Q

Most common type of primary headache

A

Tension headache

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21
Q

Symptoms of tension headache

A 
Radiation to back of head, neck and eyes
Band-like pressure
Non-pulsatile
Without vomiting or sensitivity to movement
Typically last 4-6h
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22
Q

Causes of tension headache

A 
Stress
Sleep deprivation
Bad posture
Hunger
Eye strain
Muscle tension
Microvascular irritation
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23
Q

Prevention/Rx of tension headache

A

Keep hydrated, use stress management techniques, reduce alcohol intake, improve posture
OTCs - paracetamol, ibuprofen
Tricyclic ADs in severe cases

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24
Q

Type of headache that lasts for hours/days with generalised, band-like pain, with depression as a common accompaniment

A

Chronic (benign) recurrent headache

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25
Q

IC lesions stretching meninges, increasing CSF pressure, causing cerebral oedema and vomiting, cause what type of headaches?

A

Pressure headaches - worse when lying down, straining, coughing and sneezing

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26
Q

Scalp tenderness

A

Giant cell arteritis

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27
Q

headache lasting weeks/months

A

Trauma headache

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28
Q

Type of headache with SAH

A

Severe, sudden onset

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29
Q

Facial pain

A

Cluster headache

30
Q

Triggers of Migraine

A

CHOCOLATE

Chocolate, Hangobers, Orgasms, Cheese, OCP, Lie-ins, Alcohol, Tumult, Exercise

31
Q

Prodrome

A

Symptoms preceding a migraine or an epileptic seizure by hours/days: yawning, cravings, mood/sleep changes

32
Q

Aura

A

Symptoms preceding migraine/epileptic seizure by minutes and perhaps persisting during: visual cascading, distorting, scotoma, hemianopia, paraesthesia, ataxia, ophthalmoplegia, dysphasia, flashes of light, tingling, numbness

33
Q

Headache that feels like the head is splitting (hemicranial)

A

Migraine

34
Q

Clinical triad of Parkinsonism:

A

1) Pill-rolling tremor (worst at rest)
2) Cogwheel rigidity
3) Bradykinesia

35
Q

Pathology of Parkinsonism

A

Mitochondril DNA dysfunction causing degeneration of DA neurons in the substantia nigra - associated with Lewy Bodies

36
Q

Neuropsychiatric complications of PD

A

Depression, dementia and psychosis

37
Q

Pharmacological treatment of PD

A

Levodopa and/or decarboxylase inhibitor

38
Q

Parkinson Plus Syndrome: Red flags

A 
Early postural instability
Vertical gaze palsy
Early autonomic features
Fluctuating cognition (LB dementia)
Akinetic rigidity involving one limb
39
Q

Symmetrical disease of proximal muscle fibres resulting in weakness

A

proximal myopathy

40
Q

Usually monosymptomatic e.g. unilateral optic neuritis, numbness/tingling in limbs, leg weakness, brainstem/cerebellar problem

A

MS

41
Q

Poor prognostic signs of MS (6)

A 
Older
Female
Axonal loss
Motor signs at outset
Many MRI lesions
Many relapses early on
42
Q

Cause of demyelination in MS

A

T-cell mediated immune response

43
Q

Rx of MS

A

Steroids: methylprednisolone (shortens relapses)
Interferons - reduce relapse and lesion accumulation
MAb - alemtuzumab - better than IFN, acts against T cells

44
Q

Criteria for diagnosing MS

A

McDonald: heavily reliant on MRI
>2 attacks with >2 lesions
>2 attacks with 1 lesion
1 attack with >2 lesions
1 attack and 1 lesion (monosymptomatic presentation)
Insidious neurological progression suggestive of MS (primary progressive)

45
Q

Partial seizure

A

focal onset with features referable to a part of one hemisphere

46
Q

Simple seizure

A

Awareness unimpaired

47
Q

Complex seizure

A

Awareness impaired

48
Q

Simple partial seizure

A

awareness unimpaired, no post-ictal Sx

49
Q

Complex partial seizure

A

Awareness impaired, may have aura, if temporal lobe then will have post-ictal confusion, if frontal lobe, rapid recovery

50
Q

Partial seizure with secondary generalisation

A

Most common type of partial seizure (66%)

Electrical disturbance starts focally and spreads widely, typically causing a convulsive seizure

51
Q

Primary generalised seizure

A

simultaneous onset of electrical discharge throughout the cortex, with no localising features

52
Q

Absence seizure

A

Brief pause (10s), more common in childhood

53
Q

Tonic clonic seizure

A

LoC, limb stiffening (tonic) and jerking (clonic)

Post-ictal confusion and drowsiness

54
Q

Myoclonic seizures

A

Sudden jerk of limbs, face or trunk - pt. may be thrown to ground or have disobedient limb

55
Q

Atonic (kinetic) seizure

A

Sudden loss of muscle tone leading to fall

No LoC

56
Q

Infantile spasms

A

Commonly associated with tuberous sclerosis

57
Q

Stroke:

A

Syndrome of rapid onset of cerebral deficit (usually focal), lasting >24h or leading to death - no cause other than vascular

58
Q

Completed stroke

A

Deficit has become maximal (6h)

59
Q

Minor stroke

A

Pt. recovers with minor deficit/ no deficit (usually within a week)

60
Q

Stroke in evolution

A

Progression during the first 24h

61
Q

Biggest cause of stroke

A

Thromboembolic infarction (ischaemic stroke) - 80%

62
Q

CHADS2 score

A 
Congestive HF (1)
Hypertension (BP >140/90) (1)
Age (>75) (1)
DM (1)
S2 prior stroke, TIA or thromboembolism
63
Q

Signs of cerebral infarct

A 
50%
Contralateral sensory loss/hemiplegia
Dysphasia
Homonymous hemianopia
Visuo-spatial deficit
64
Q

Signs of brainstem infarct

A

25%
Quadriplegia
Disturbance of gaze/vision
Locked-in syndrome

65
Q

Signs of lacunar infarct

A

25%
Basal ganglia, internal capsule, thalamus & pons
5 syndromes: ataxic hemiparesis, pure motor, pure sensory, sensorimotor, dysarthria/clumsy hand
Cognition/consciousness are in tact unless thalamic stroke

66
Q

TIA risk scoring:

A

ABCD2
Age >60 (1)
BP >140/90 (1)
Clinical features - unilateral weakness (2), speech disturbance without weakness (1)
Duration of Sx (>1h (2), 10-59mins (1))
DM (1)
Score of 4 or more - referral to neurologist

67
Q

Carpal tunnel syndrome signs

A

Median n. compression
Nocturnal tingling and pain in hand/forearm, followed by weakness of thenar muscles and sensory loss in palm
Positive Tinnel’s and Phalen’s test

68
Q

Ulnar nerve compression signs

A

Cubital tunnel in elbow following recurrent pressure or fracture
Weakness and wasting of ulnar-innervated muscles leading to clawing of the hand and sensory loss

69
Q

Radial nerve compression signs

A

Compressed against humerus causing wrist drop and weakness

Recovery in 1-3 months

70
Q

Common peroneal nerve palsy signs

A

Compression against head of fibula
Foot drop and ankle eversion
Patch of numbness on antero-lateral border, dorsum of foot and/or lower shin
Usually recover within several months

71
Q

Guillan-Barre syndrome signs

A

Polyneuropathy
Usually demylinating but sometimes azonal
Paralysis 1-3 weeks following infection
Antibody production against peripheral nerves
May progress to complete paralysis
15% ar eleft disabled or die

72
Q

Treatment for presentation of headache, pyrexia, neck stiffness and altered mental state

A

SUSPECT MENINGITIS

Give benzylpenicillin 1.2g (IV/IM) immediately

Core Conditions (5 decks)

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