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Year 5 > neuro > Flashcards

neuro Flashcards

1
Q

what PMHx may suggest ischaemic stroke?

A

AF
previous TIA
carotid bruit

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2
Q 
hemiparesis
hemiplegia
reflexes reduced
hemianopia
aphasia (if dominant hemisphere affected)
ask about L/R handedness
A

cerebral hemisphere stroke- middle cerebral artery

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3
Q

eye problems predominant

A

posterior circulation infarct

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4
Q

LOC, locked in syndrome

diplopia, nystagmis

A

brain stem ischaemia

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5
Q

stroke- localised symptoms, pure motor/ sensory / ataxia, intact cognition + consciousness

A

lacunar infarct

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6
Q

suggestive of haemorrhagic stroke

A

bleed tendency/ anticoagulation
worsening symptoms
reduced GCS
severe headache

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7
Q

time limit for alteplase following ischaemic stroke

A

4.5 hours

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8
Q

ABCD2

A

TIA- indicates risk of further stroke
Age >60
BP >140/90
Clinical features- unilateral weakness (2)/ speech only (1)
Duration >60
DM
if 4+ start aspirin 300mg and specialist review in 24hours, if less then still 300mg and review in 1 week

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9
Q

ROSIER score

A

acutely to distinguish between stroke and stroke mimics

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10
Q

what is the most common cause of stroke

A

ischaemic

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11
Q

amaurosis fugax

A

sudden loss of vision in one eye- curtain, caused by infarct in retinal artery/ anterior TIA

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12
Q

prognosis after TIA

A

30% will have stroke, 15% MI

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13
Q

what level of carotid artery stenosis would require endarterectomy

A

> 60%

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14
Q

stroke- weak leg +/- shoulder on contralateral side

A

anterior cerebral artery infarct

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15
Q

long term secondary stroke prevention

A

aspirin 75mg OD, clopidogrel if can’t tolerate aspirin
dipyridamole if confirmed ischaemic
warfarin if AF
RFs

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16
Q

3 most common pathogens causing meningitis infants

A

neisseria meningitidis
strep pneumoniae
Hib- Hib < common in older/ adults

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17
Q

gram negative coccobaccilus meningitis

A

Hib

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18
Q

gram negative cocci meningitis

A

neisseria meningitidis

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19
Q

gram positive cocci meningitis

A

strep pneumoniae

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20
Q

Kernig’s sign

A

flex the hip, with the knee flexed. Now extend the knee. Positive test if there is spasm of the hamstrings.
meningitis

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21
Q

Brudzinski sign

A

passively flex the neck. Positive test if there is flexion of the hip and/or knee.
meningitis

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22
Q

signs of raised ICP

A

reduced GCS
papilloedema
high BP/ low HR
focal neuro signs

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23
Q

non-infective causes of meningism

A

leukaemia
lymphoma
Breast cancer

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24
Q

which is the most common cause of meningitis

A

viral (2/3)

echovirus/ mumps/ EBV, VZV, HSV/ influenza

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25
Q

Bacterial meningitis tx

A

3rd generation cephalosporin (cefotaxime)

treat household contacts with rifampicin

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26
Q

2 causes of subarachnoid haemorrhage

A

aneurysm rupture
AV malformations
(trauma)

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27
Q

diseases that increase risk of berry aneurysms

A

PCKD, co-arctation of aorta, Ehlers-Danlos

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28
Q

pathology of brain injury in SAH

A

haemorrhage stops -> vasospasm-> secondary ischaemia, secondary acute hydrocephalus

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29
Q

if suspect SAH but CT -ve what is next investigation?

A

LP

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30
Q

what can help to prevent secondary ischaemia in SAH

A

nimodipine

31
Q

1st line in status epilepticus

A

4mg lorazepam IV, repeat after 10 mins. if no response ?add phenobarbitone (must have ECG)
buccal midazolam if no IV

32
Q

CN I

A

olfactory

33
Q

CN II

A

optic

34
Q

CN III

A

oculomotor: motor- SR/ MR/ IR/ IO/ Levator palpabrae

parasympathetic- ciliary muscle/ pupil constriction

35
Q

CN IV

A

trochlear- SO

36
Q

CN V

A

trigeminal- sensory

motor- muscles of mastication

37
Q

CN VI

A

abducens- motor to LR

38
Q

CN VII

A

facial motor to muscles of expression, sensory to ant 2/3 tongue
parasympathetic to salivary and lacrimal glands

39
Q

CN VIII

A

vestibulocochlear sensory

40
Q

CN IX

A 
glossopharyngeal- sensory to middle ear, sinuses, posterior 1/3 tongue and pharynx
motor styropharyngeous (swallow)
parasympathetic- salivary glands
41
Q

CN X

A

vagus
sensory- pharynx/ larynx/ oesophagus, aortic bodies, thoracic/ abdo viscera
motor- soft palate- speech and swallow
parasympathetic - CV/ GI/ resp

42
Q

CN XI

A

accessory motor to sternomastoid and trapezius

43
Q

CN XII

A

hypoglossal

motor to tongue

44
Q

fixed dilated pupil and ptosis

A

CN III injury

45
Q

injury to CN IV causes

A

down and in deviation

46
Q

injury to CN VI

A

eye deviated medially

47
Q

unilateral face weakness

unable to show teeth, screw eye and raise eyebrow on affected side

A

Bell’s palsy- ?viral induced facial nerve palsy

48
Q

how would you distinguish between UMN and LMN lesion in suspected Bell’s palsy?

A

UMN forehead spared- stroke

LMN Bells palsy

49
Q

treatment of Bell’s palsy

A

self resolve, steroids most effective in first 72 hours

50
Q

assymetrical raising of uvula?

A

CN X

51
Q

deviation of tongue

A

CN XII

52
Q

Mnemonic for peripheral nerve lesions

A 
DAVID
DM
Alcoholism
Vit deficiency (B12)
Infective/ Inherited- GBS/ Charcot Marie Tooth
Drugs- isoniazid
53
Q

mechanisms of peripheral nerve degenaration

A 
demyelination- GBS
axonal degeneration- toxic
wallerian degeneration- axon crushed/ cut
compression- carpal tunnel syndrome
infarction- DM
infiltration- malignancy, inflammation
54
Q

compression of which nerve causes carpal tunnel

A

median by flexor retinaculum

55
Q

signs of median nerve compression

A

wasting of thenar eminence
paraesthesia of lateral 3.5 fingers
pain/ tingling in lateral 3 fingers

56
Q

phalen’s test

A

hold wrist in flexed position for up to 2 mins, exaggerates symptoms of carpal tunnel

57
Q

Tinel’s test

A

Tap over medial aspect of inside wrist induces tingling

58
Q

management of carpal tunnel

A 
splint + NSAIDs
hydrocortisone injection (1 month)
surgical decompression
59
Q

clearly defined history of trauma- subdural or extradural

A

extradural

60
Q

where does bleeding come from in subdural

A

bridging veins

61
Q

crescent of blood on CT head

A

subdural

62
Q

how is ICP relieved in subdural/ exrtadural haemorrhage

A

Irrigation / evacuation / Burr hole craniostomy/ craniotomy

63
Q

where does bleeding come from in extradural

A

middle meningeal artery/ vein

64
Q

lemon shaped blood not crossing suture lines on CT head

A

extradural

65
Q

appearance of symptoms in subdural vs extradural

A

subdural- symptoms fluctuate over time

exradural lucid period up to 24 hours then progressive worsening

66
Q

which cells are damaged in MS

A

oligodendrocytes

67
Q

MS- Mostly UMN/ LMN signs

A

UMN- optic nuritis, afferent pupillary defect, sensory (numbness/ paraesthesia)/ autonomic (urinary incontinence, constipation, sexual dysfunction), cerebellar ataxia, fatigue

68
Q

end-stage MS

A

spastic ataxia
brainstem signs
dementia

69
Q

dx of MS

A

1+ Attack

plaques on MRI

70
Q

Management of acute MS

A

steroids methylprednisolone to induce remission

71
Q

preventing relapse in MS

A

B interferon

72
Q

Lehrmitte’s sign

A

on voluntary flexing of the head, there is an electric shock sensation travelling down the spine and into the limbs- MS

73
Q

Uthoff’s phenomenon

A

signs worse on hot day or after exercise- MS

74
Q

urinary incontinence in MS

A

when residual volume is >100ml, manage with oxybutinin, or self-catheterisation

Year 5 (12 decks)

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