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phase 2 > Neuro > Flashcards

Neuro Flashcards

1
Q

Functional divisions of the motor nerves

A

Somatic, branchial or autonomic

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2
Q

Functional divisions of the sensory nerves

A

Somatic, autonomic or special

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3
Q

Where are somatic nerves found in the embryo

A

Spread throughout

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4
Q

Where are autonomic nerves found in the embryo

A

Arise in the most primitive parts. No conscious control. Smooth and cardiac muscle and glands.

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5
Q

Define dermatome

A

area of skin supplied by a single spinal nerve

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6
Q

Define myotome

A

volume of muscle supplied by a single spinal cord

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7
Q

What function does the corticospinal tract supply

A

Rapid, skilled, voluntary movement

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8
Q

What function does the rubrospinal tract supply

A

Facilitates flexors, inhibits extensors

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9
Q

What function does the vestibulospinal tract supply

A

Facilitates extensors, inhibits flexors

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10
Q

What function does the tectospinal tract supply

A

Truncal reflexes from sight

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11
Q

What sensation do the fasciculus gracilis and cuneatus provide

A

Touch, vibration and conscious joint/muscle

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12
Q

What sensation do the spinocerbellar tracts supply

A

Nonconcious muscle/joint sense

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13
Q

What sensation does the lateral spinothalamic tract supply

A

Pain and temperature

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14
Q

What sensation does the anterior spinothalamic tract supply

A

Light touch and pressure

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15
Q

What sensation does the spinoolivary tract supply

A

proprioception

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16
Q

What sensation does the spinotectal tract supply

A

Spinovisual reflexes

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17
Q

In brown sequard at T10 you will get ipsilateral loss of

A

Tactile discrimatin, vibration, proprioception and spastic paralysis

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18
Q

In brown sequard at T10 you will get contralateral loss of

A

Pain and temperature and impaired tactile sense

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19
Q

At what level does the spinal cord stop

A

L1

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20
Q

Where does the basilar artery lie

A

The anterior surface of the pons

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21
Q

Which arteries contribute to the posterior circulation

A

The vertberal arteries

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22
Q

What does the posterior circulation supply

A

The brainstem, cerebellum and back of hemispheres

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23
Q

What supplies the lateral surface of the hemispheres

A

Middle cerebral artery

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24
Q

What supplies the median surface of the hemispheres

A

Anterior cerebral artery

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25
Q

From the internal carotid where do blood clots tend to go

A

The middle cerebral artery as they want to go straight

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26
Q

Where are the meningeal vessels

A

In the extradural space

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27
Q

Where are bridging veins

A

They cross the subdural space

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28
Q

Where does the circle of willis lie

A

In the subarachnoid space

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29
Q

Are there any vessels deep to the pia mater

A

No. It forms part of the blood brain barrier

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30
Q

What is a parenchymal haemorrhage

A

A intracerebral haemorrhage

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31
Q

Bleeding from which artery causes an extradural haemorrhage

A

Middle meningeal artery

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32
Q

Shape of an extramural haemorrhage on imaging

A

Convex

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33
Q

What causes an extradural haemorrhage

A

Trauma to middle meningeal artery causes bleeding between the dura mater and the brain

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34
Q

What causes a subdural haemorrhage

A

Bleeding from the bridging veins, especially in small brains. Pressure slowly builds

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35
Q

What is the shape of a subdural haemorrhage on imaging

A

Crescent shaped

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36
Q

What is a subarachnoid haemorrhage

A

Rupture of the arteries forming the circle of willis,often because of berry aneurysms

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37
Q

What is a thunderclap headache suggestive of

A

Subarachnoid haemorrhage

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38
Q

What is a berry aneurysm

A

Weakening outpouching of the circle of willis

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39
Q

Which stroke has death of cells in a small area, with a well defined area and no recovery

A

Embolic

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40
Q

Which stroke has a large area affected, conmpression of the internal capsule and possible complete recovery

A

Haemorrhagic

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41
Q

Anterior segment of the internal capsule

A

Sensory

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42
Q

Posterior segment of the internal capsul

A

Sensorimotor

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43
Q

The pituatry tumours are likely to affect the…

A

optic chiasm

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44
Q

Why do you get forehead sparing

A

Facial has bilateral supply to forehead but contralateral to the rest of the face

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45
Q

Define meningitis

A

Inflammation of the meninges

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46
Q

Define encephalitis

A

Inflammation of the brain

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47
Q

Define encephalopathy

A

Reduced level of consciousness/diffuse disease of brain substance

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48
Q

Define neuropathy

A

Damage to peripheral nerves.

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49
Q

Infective causes of neuropathy

A

Diptheria, guillan-barre, leprosy, rabies

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50
Q

Define mononeuritis multiplex

A

Inflammation and damage to 2 or more individual nerves

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51
Q

Infective causes of mononeuritis multiplex

A

HIV, leprosy, lyme, Hep A

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52
Q

Define polyradiculopathy

A

Damage to multiple nerve roots

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53
Q

Infective causes of polyradiculopathy

A

HIV and CMV/syphilis/HMV

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54
Q

Define myelitis

A

Inflammation of the spinal cord

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55
Q

Define meningoencephalitis

A

Inflammation of the brain and meninges

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56
Q

Clinical signs of meningeal irritation

A

Reduced GCS, headache, stiff neck, papilloedema. Kernigs and Brudzinskis signs

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57
Q

What is kernigs sign

A

Hip at 90 degrees, cant extend leg

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58
Q

What is Brudzinskis sign

A

Passive neck flexion= leg and thigh flexion

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59
Q

What is papilloedema

A

Swelling of the optic disc on fundoscopy

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60
Q

Which vertebrae are epidurals normally entered between

A

L3 and L4

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61
Q

Which vertebrae are lumbar punctures normally done between

A

L4 and L5 (or L3/4 or L5//S1)

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62
Q

Side effects of lumbar puncture

A

Headache, paraesthesia, CSF leak, damage to spinal cord, cerebral herniation and death

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63
Q

When should you CT before lumbar puncture

A

60+, immunocompromised, history of CNS disease, new onset, decreasing consciousness, focal neurological signs, papilloedema, atypical history

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64
Q

What does xanthochromia mean

A

Blood stained

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65
Q

Causes of natural immunossupression/immunocompromised

A

Pregnancy, diabetes, chronic alcoholics age>60

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66
Q

Bacterial causes of menigitis in neonates

A

E coli, GroupB strep, listeria monocytogenes

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67
Q

What gram and shape is Ecoli

A

Gram negative bacilli

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68
Q

What gram and shape is Group B strep

A

Gram positive cocci

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69
Q

What gram and shape is listeria monocytogenes

A

Gram positive bacilli

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70
Q

What gram and shape is neisseria meningitidis

A

Gram negative diplococcus

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71
Q

What gram and shape is strep pneumoniae

A

Gram negative diplococcus

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72
Q

What gram and shape is haemophilus influenzae

A

Gram negative coccobacilli

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73
Q

What is meningitis prophylaxis of contacts for influenzae

A

Only need prophylaxis if havent had Hib, inform public health

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74
Q

What is meningitis prophylaxis of contacts for pneumococcal

A

No prophylaxis needed, consider pneumococcal vaccine, inform public health

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75
Q

What is meningococcal meningitis prophylaxis of contacts

A

Ciprofloxacin as prophylaxis for household contacts

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76
Q

What is the most common cause of viral meningitis

A

Enterovirus

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77
Q

What test is used to identify viruses

A

PCR

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78
Q

Sympoms of encephalitis

A

Fever, headache, lethargy and behavioural change

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79
Q

Trismus is a symptom of tetanus, what is trismus

A

Lock jaw

80
Q

Opsithotonus is a symptom of tetanus, what is opsithotonus

A

Sustained muscle contraction

81
Q

Should you lumbar puncture in suspected meningitis

A

Normally yes but not if signs of raised intercranial pressure or sepsis or rapidly evolving rash

82
Q

Define epileptic seizure

A

Paroxysmal event in which changes of behaviour, sensation or cognitive processes are caused by excessive, hypersynchronous neuronal discharges in the brain

83
Q

Define nonepileptic seizure

A

Paroxysmal event in which changes of behaviour, sensation or cognitive processes are caused by mental processes associated with psychological distress

84
Q

Tongue biting, head turning, muscle pain, LOC >5mins, cyanosis and postictal confusion are suggestive of which type of seizure

A

Epileptic

85
Q

Prolonged upright position, sweating prior to LOC, nausea, pre* symptoms and pallor are signs of which type of seizure

A

Syncope

86
Q

Pelvic thrusting, long duration, ictal crying, change in amplitude but not frequency (poorly observed normally) is suggestive of

A

Non epileptic seizure

87
Q

First line treatment for focal epilepsy

A

Carbamazepine or iamotrigine

88
Q

First line treatment for absence epilepsy

A

Valproate or iamotrigine

89
Q

What is curative epilepsy surgery for refractive epilepsy

A

Resective surgery or hemispherectomy

90
Q

What is palliative epilepsy surgery for refractive epilepsy

A

Tractotomy or Vagal nerve electrostimulation

91
Q

At what level do the common carotid arteries bifurcate

A

C3-4 with internal carotid more posterior

92
Q

What can lead to anastamoses in the internal carotid

A

Persisting embryonic vessels

93
Q

Petrous ICA branches

A

Corticotympanic artery to the middle/inner ear and the vidian artery which can connect to ECA

94
Q

When do blood clots cause the worst strokes

A

When it is an end artery, like the M1 segment of the middle meningeal artery

95
Q

Where in the brian is effected by the worst strokes

A

Deep brain structures with end arterial supply like the lentiform nucleus, caudate nucleus and internal capsule

96
Q

In which compartment do childhood tumours tend to be

A

Intratentorial

97
Q

In which compartment do adult tumours tend to be

A

Supratentorial

98
Q

What are the clinical manifestations of CNS tumour

A

Loss of function, seizures and raised ICP

99
Q

Is temporal lobe epilepsy more likely to be caused by which grade cancer

A

Low grade

100
Q

Define astrocytic tumour

A

Tumour which shows differentiation towards astrocytes

101
Q

What are the two types of astrocytic tumours

A

Diffuse astrocytomas (Grades 2,3,4) and other eg pliocytic (grade 1)

102
Q

Oligodendroma diagnostic test

A

Using FISH to see 1p19q deletion and IDH 1 mutant

103
Q

What are rosenthal fibres suggestive of

A

Pilocytic ostrocytoma

104
Q

Optic nerve fibre cancers

A

Pilocytic ostrocytomas

105
Q

Medulloblastoma signs of aggression

A

Large cells, N-MYC and C-MYC

106
Q

Medulloblastoma signs of better prognosis

A

Desmoplastic in infants and Wnt molecular marker

107
Q

Which tumours metastasise to the brain

A

Lung, breast, melanoma, GI tract and kidney

108
Q

What causes raised intracranial pressure

A

Anything which causes an mass within the cranial cavity. Trauma, stroke, infection

109
Q

Where should you look to spot mass effect

A

Sylvian fissure and thalamus

110
Q

How does the brain initially compensate for raised intracranial pressure

A

Reducing CSF

111
Q

What will happen when the occulomotor nerve is compromised

A

Pupil dilation as it was the only parasympathetic supply

112
Q

What is a missile head injury

A

Where there is penetration of the skull or brain

113
Q

What is a primary head injury

A

Due to immediate biophysical forces of trauma

114
Q

What is a secondary head injury

A

Presenting some time after the traumatic event

115
Q

What is aerocele

A

Air getting into the brain

116
Q

What is a contusion

A

A superficial bruise of the brain

117
Q

What is a lasceration

A

A tear

118
Q

What is an cut

A

An incised wound with a neat edge

119
Q

Which type of haemorrhage is caused by damage to bridging veins

A

Subdural haematoma

120
Q

What is a superficial haemorrhagic brain injury from

A

Contusion

121
Q

What is a deep haemorrhagic brain injury from

A

Diffuse axonal injury

122
Q

What does the impact of inner surface of the skull and the brain cause

A

Contusion

123
Q

What is the result of differential movement of brain tissue

A

Shearing, traction and compressive stresses which damage blood vessels and axons

124
Q

What is a coup

A

Superficial ‘bruise’ at the site of impact

125
Q

What is a contrecoup

A

Superficial ‘bruise’ away from the site

126
Q

What is a contusion

A

A superficial bruise of the brain

127
Q

What is difffuse axonal injury

A

A clinicopathological syndrome of widespread axonal damage (inc brainstem)

128
Q

What are retraction balls

A

Areas on microscopy where following traumatic axonal injury the protein has built up when azon flow was interrupted

129
Q

Long term signs of traumatic axonal injury

A

Corpus callosum thinning, myelin pallor, frontal lobe glydeine contusion

130
Q

Three causes of brain swelling

A

Congestive brain swelling (vasodilation), vasogenic oedema (extravasation), cytotoxic oedema (increased water)

131
Q

How is congestive brain swelling caused

A

Lose ability to regulate blood supply to the brain, results in vasodilation

132
Q

Three things which increase the risk of hypoxia-ischaemia

A

Hypoxia, hypotension and raised intracranial pressure

133
Q

Which cells are susceptible to hypoxia-ischaemia

A

Large neurones (central cortex) and purkinje cells

134
Q

Define traumatic brain injury

A

Brain injury which results in loss of consciousness

135
Q

How does MS prevalence change with latitude

A

Nearer equator is associated with a lower risk

136
Q

What is the main cause of the inflammation in MS

A

Activated autoreactive T lymphocytes

137
Q

Which cells maintain the myelin in the CNS

A

Oligodendrocytes

138
Q

Where is the most common site of MS

A

Periventricular in the brain

139
Q

What is the most common cause of Brown-Sequard syndrome

A

MS

140
Q

MS pattern 1 pathology is mediated by

A

Macrophages

141
Q

MS pattern 2 pathology is mediated by

A

Antibodies

142
Q

Define primary progressive MS

A

Disease progression from onset with occasional plateaus and temporary minor improvements allowed

143
Q

Define secondary progressive MS

A

Initial relapsing-remitting disease course followed by progression with or without occasional plateaus, remissions and relapses

144
Q

What are the two essential diagnostic criteria for MS

A

1) two or more CNS lesions disseminated in time and space 2) exclusion of conditions giving a similar clinical picture

145
Q

What is an EP test

A

Measures the electrical activity of the brain and spinal cord

146
Q

In MS a lumbar puncture is done, looking for which protein in the CSF

A

Oligoclonal IgG

147
Q

What are the two phases of MS

A

inflammatory stage and degenerative stage

148
Q

What is unusual about fatigue in MS

A

It is exacerbated by heat and made better by cool

149
Q

Which basal ganglia diseases are “hardware problems” with something mechanically wrong

A

Parkinsons disease and huntingtons disease

150
Q

Which basal ganglia diseases are “software problems” without something mechanically wrong

A

Essential tremor, dystonia and tourettes

151
Q

Presentation of parkinsons

A

Assymetrical at first. With gradual worsening. Tremor, stiffness, dull ache joint pain, reduced arm swing, problems doing up buttons and writing smaller.

152
Q

What causes rigidity

A

Extrapyramidal disease

153
Q

What causes spasticity

A

Upper motor neurone disease

154
Q

Three cardinal features of parkinsons disease

A

Brady/akinesia, tremor, rigidity

155
Q

What is the walking like in parkinsons

A

Small stepped gait, stooped posture, reduced armswing, L>r

156
Q

How do you assess a rest tremor

A

Hands should be at rest and limp

157
Q

How do you assess an action tremor

A

Hold the hands straight forward

158
Q

What does symmetrical action tremor suggest

A

Essential tremor disease

159
Q

Where is the lesion to cause an intention tremor

A

Cerebellum

160
Q

Where is the disease to cause bradykinesia

A

Basal ganglia

161
Q

How does bradykinesia present

A

Decreasing amplitude and accuracy of repetitive movements

162
Q

What are the three types of tremor

A

Rest, action, intention

163
Q

What are the two common pathological signs of parkinsons disease

A

Lewys bodies and loss of dopaminergic neurones

164
Q

How can the reduced dopamine supply to the striatum seen in parkinsons disease be imaged

A

DaTSCAN (innit)

165
Q

What are four factors which cause cell loss in the substantia nigra

A

Inherited factors, environmental factors, oxidative stress and mitochondrial dysfunction

166
Q

What are inherited factors which cause parkinsons

A

Susceptibility factors and parkinson genes

167
Q

What are enviromental factors which cause parkinsons

A

Risk factors and toxin induced

168
Q

What are the two aims of parkinsons disease treatment

A

Symptomatic relief through higher dopamine levels. Increase availability of dopamine, slow dopamine loss.

169
Q

Anticholinergics side effects

A

Cognition, confusion, systemic

170
Q

What is on dyskinesias

A

Hyperkinetic, choreiform movements whenever drugs work

171
Q

What is off dyskinesias

A

Fixed, painful dystonic posturing, typically on feet when drugs dont work

172
Q

What should you look out for signs of alongside neural conditions

A

Depression

173
Q

Do you get incontinence in parkinsons

A

NO

174
Q

What shouldnt be present in early PD

A

Incontinence, dementia, symmetry, fails

175
Q

What are incontinence, dementia and magnetic gait suggestive of

A

Normal pressure hydrocephalus

176
Q

How can normal pressure hydrocephalus be treated

A

A shunt to the abdomen

177
Q

Huntingtons disease cardinal features

A

Chorea , dementia, psychiatric problems, positive family history

178
Q

What is chorea

A

Jerky involuntary movements

179
Q

Examples of psychiatric problems

A

Personality change, depression and psychosis

180
Q

What is generalised dystonia

A

A syndrome of sustained muscle contraction

181
Q

What is the key sign of 3rd nerve palsy

A

Fixed dilated pupil

182
Q

Define ataxia

A

Loss of full control of body movements, limb unsteadiness

183
Q

Three features of cerebellar disease

A

Ataxia, nystagmus and deficit on the same side as the cerebellar lesion

184
Q

Define nystagmus

A

Rapid eye movements

185
Q

Which cranial nerves are associated with the brainstem

A

3-12

186
Q

What is the reticular activation system

A

Periaqueductal grey matter on the floor of the fourth ventricle

187
Q

What is the reticular activating system responsible for

A

Alertness, sleep/wake, REM/non REM, respiratory centre, cardiovascular drive

188
Q

What colour is bone on CT

A

White

189
Q

What colour is bone on MRI

A

Black

190
Q

How can you treat a non functioning eye

A

Prisms/squint surgery

191
Q

How can you treat corneal injury

A

Eye drops and lubricant/ gold weight/ lateral tarsorrhaphy

192
Q

How can you treat a non functioning smile

A

Cross facial nerve graft

193
Q

How can you treat a non functioning swallow

A

NG tube/ Tracheostomy/ Percutaneous enterogastrostomy (PEG)

194
Q

How can you treat a non functioning voice

A

Vocal cord injection

195
Q

Disorders affecting the brainstem

A

Tumour, inflammatory, metabolic, trauma, spotaneous haemorrhage, infarction and infection

196
Q

Criteria for brainstem death

A

Pupils, corneal reflex, caloric vestibular reflex, cough reflex, gag reflex, respirations and response to pain

phase 2 (17 decks)

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