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Phase 2 > NEURO > Flashcards

NEURO Flashcards

1
Q

Is the eye supplied by the internal or external carotids

A

Internal carotid - opthalmic branch

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2
Q

What does the external carotid supply

A 
Scalp - temporal artery 
Face - facial artery
Maxilla - maxilla artery 
Tongue - lingual artery
Glands - superior thyroid artery
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3
Q

Anterior cerebral artery stroke signs

A

Contralateral weakening, sensory, motor loss in legs

Weak symptoms potentiall in arma

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4
Q

Middle cerebral artery stroke signs

A

Contralateral weaking, sensory, motor loss in arms and face

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5
Q

Posterior cerebral artery stroke

A

Contralateral visual field loss - macular sparing

eg. R hem = left homonymous hemianopia

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6
Q

The internal cartoids supply…..

A

The anterior 2/3 of cerebral hemispheres and basal ganglia

Post cerebral artery is mainly supplied by basilar (i.e. vertebral artieries)

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7
Q

What causes horners syndrome

A

Damage to sympathetic innervation to the pupil = dont get dilator contraction (so dilated pupil) - only get parasympathetic innervation = small, constricted pupil
Vascular event in basilar artery could cause this bc of ischemia to descending hypothalamic nerves to cervical ganglia

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8
Q

List some signs of lateral medullary syndrome
(where one of the vertebral arteries is blocked, and so the lateral medulla is ischemic plus you lose supply to the inferior cerebellar surface

A 
Vertigo
Vomitting
Horners syndrome 
Nystagmus 
Ipsilateral ataxia
soft palate paralysis
Dysphagia
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9
Q

Signs of vertebrobasilar occlusion

A
  1. Visual changes (inferior cerebral surfaced - PA)
  2. Brainstem/ CN signs - hiccups (vagus), coma, horners syndrome, any CN change, vertigo
  3. Cerebellar signs - ataxia, nystagmus, vertigo
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10
Q

Outline the protocol for investigating and managing a suspected stroke

A
  1. Confirm it is a suspected stroke (with usual sympt and signs)
  2. Brief med history - identify any diseases or causes that could cause bleeding - sickle cell, TTP, haemophillia etc, are they on anticoagulants for cardiac disease? Have they ever had an MI or PVD? IHD? Diabetic?
  3. CT scan (w/in 1 hour) to rule out haemorrhagic stroke
  4. Once haemorrhagic ruled out, and if <4.5 hours from onset -> Aspirin, 300mg loading + thrombolysis - alteplase
  5. Second CT within 24 to identify any bleeds
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11
Q

What is the primary prevention of stroke

A 
Lower BP
Control diabetes - blood sugar
Cholesterol control - statin 
Quit smoking 
Diet and exercise
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12
Q

Secondary prevention of stroke

A

Antiplatelet meds - eg clopidogrel
Anticoagulants - for cardio (AF causes)
Control usual risk factors (hyptn etc)
Statins

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13
Q

What is a sign of cardiac causes of stroke on CT

A

bilateral infarcts

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14
Q

List some of the cardiac causes of stroke, what percentage of strokes do these cause

A 
30%
AF - thrombus thrown from atria
VF - thrombus thrown from ventricle 
MI - cardiogenic shock - thrombus thrown from ventricle
Valve defect/ prosthetic valve
Infective endocarditis

IHD & anticoagulants - warfarin - may cause bleed
IHD & antiplatelets - may cause bleed

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15
Q

What percentage of pts with a TIA go on to have a stroke within 1 week

A

1 in 12

~8%

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16
Q

Define stroke

A

Stroke is defined as “a clinical syndrome, caused by cerebral infarction or
haemorrhage, typified by rapidly developing signs of focal and global disturbance of
cerebral functions lasting more than 24 hours or leading to death

17
Q

Define TIA

A

”an acute loss of cerebral or ocular
function with symptoms lasting less than 24 hours caused by an inadequate
cerebral or ocular blood supply as a result of low blood flow, ischaemia, or
embolism associated with disease of the blood vessels, heart or blood”

18
Q

When should you suspect stroke

A

Acute onset
Focal neurological deficit, lasting 24 hours
Cannot be explained by hypoglycaemia or other stroke mimics

19
Q

How would you assess a TIA risk of becoming a stroke

A

Assess Risk Using ABCD2 Score
A — Age: 60 years of age or more (1 point)
B — BP (at presentation) 140/90 mm Hg or greater (1 point)
C — Clinical features
Unilateral weakness, 2 points
Speech disturbance without weakness, 1 point.
D — Duration (60 minutes or longer, 2 points, 10–59 minutes, 1 point)
D — presence of diabetes: 1 point.

> 4 - high risk of early stroke, assessed by specialist within 24 hours
6 strongly predicts stroke within 2 days
Other factors: AF, TIA while anticoagulate, more than 1 TIA within a week

Below 4 - specialist referral within 7 days 
Start statin (e.g. simvastatin 40 mg)
Antiplatelet drug (unless they are taking an anticoagulant):
Clopidogrel 300mg (off-label use) or aspirin 300mg *
Treat BP (if raised)
No driving until seen by a specialist (when definitive guidance will be given)
20
Q

What type of intracranial haemorrhage is associated with a lucid interval

A

Epidural haemorrhage/ haematoma

May last a few hours or days

21
Q

What are the risk factors for sub arachnoid haemorrhage

A 
Berry aneurysm
Smoking
Alcohol misuse 
Hypertension
Bleeding disorders 
Family history
Coarction of the aorta
22
Q

Symptoms of subarachnoid haemorrhage

A 
Thunderclap headache
Vomitting (brainstem compression)
Collapse (brainstem compression)
Seizures (brainstem compression)
Coma (Reticular formation)
Drowsiness (Frontal lobe/ brainstem)
23
Q

What are common sites of herniation in the brain

A

Cigulate, uncus, tonsils

24
Q

How would you identify the type of MS patient had from the history

A

Relapsing and remitting
Disease period followed by complete recovery, or with some residual deficit. Periods between disease are defined by no disease progression.
Primary progressive.
No relapse. Patient has disease all the time. No periods of disease free state. Progressive.
Secondary progressive.
Relapse and remitting course followed by progressive.
Progressive and relapsing.
Disease is always present and progressive. Periods of remittance after a exacerbation but it does not go back to baseline and continues to progress between relapse.

25
Q

List some defining features of MND

A 
No sensory loss
Fasiculations
Foot drop
Proximal myopathy 
Pyramidal drift
No eye involvement
No sphincter involvement
26
Q

What would be required to make a definitive diagnosis of ALS

A

Upper and lower MN signs in 3 separate regions

27
Q

List some differentials for MND

A

Hereditary spastic paralegia
Polyneuropathies
MS

28
Q

What are the signs of an UMN lesion

A

everything goes up
positive babinski’s sign
hyper reflexive
increased muscle tone (spasticity w/ pyramidial)

29
Q

What medical treatment can be given for MND

A

Riluzole

30
Q

What disease is commonly associated with MS

A

Frontotemporal dementia

31
Q

What are the causes of MND

A

Largely unknown
Genetic
Pathogenic immune response

32
Q

What is the commonest peripheral neuropathy

A

Symmetrical

33
Q

List the common mononeuropathies

A 
Carpal tunnel syndrome (median nerve)
Ulnar neuropathy (entrapment at the cubital tunnel)
Peroneal neuropathy (entrapment at the fibular head)

Cranial mononeuropathies (III or VII cranial nerve palsy)

- idiopathic
- immune mediated
- ischemic
34
Q

List the symptoms of a motor mononeuropathy

A 
Fasiculations
Paralysis
Weakness 
Atrophy 
pes cavus
35
Q

What is L-dopa prescribed with?

A

Co-careldopa

L dopa + dopa-decarboxylase inhibitor

36
Q

What are the three cardinal symptoms of parkinsons

A

Bradykinesia
Hypertonia - Rigidity - (+ tremor = cog wheel)
Resting tremor - pill-rolling

37
Q

Signs of cauda equina

A

Loss of bladder or bowel control - do PR to check sphincter tone
Back pain, radiating down legs
Asymmetrical, atrophic, areflexive paralysis of the legs
Sensory loss in root distrubution
Decreased sphincter control

Phase 2 (12 decks)

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