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4th Year SB > Neuro > Flashcards

Neuro Flashcards

1
Q

Bitemporal hemianopia, upper quadrant > lower quadrant

A

inferior chiasmal compression, commonly a pituitary tumour

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2
Q

Bitemporal hemianopia, lower quadrant > upper quadrant

A

superior chiasmal compression, commonly a craniopharyngioma

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3
Q

Patient able to speak clearly post stroke, but content unrelated to questions. Ask them to repeat a series of phrases, which they are unable to do. Where is the lesion?

A

Wernicke’s aphasia is due to a lesion of the superior temporal gyru

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4
Q

What is Wernicke’s aphasia

A
  • receptive aphasia
  • due to a lesion of the superior temporal gyrus
  • results in patients being able to produce fluent speech, but comprehension and repetition is impaired.
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5
Q

What is Broca’s aphasia

A
  • lesion of the inferior frontal gyrus
  • Speech is non-fluent, laboured, and halting
  • Comprehension is normal
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6
Q

what is Lambert Eaton Syndrome and what cancer is it associated with

A

NMJ disorder due to the auto-immune destruction of pre-synaptic calcium channels

associated with small cell lung cancer

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7
Q

Patient w/ fever, headache and altered mental status - diagnosis and Ix (plus what is buzzword for what is seen on Ix)

A

Encephalitis

LP - increased lymphocytes
MRI - temporal lobe encephalitis

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8
Q

what is most common cause of encephalitis

A

HSV

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9
Q

Mx of encephalitis

A

IV aciclovir

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10
Q

Patient with headache, neck stiffness, photophobia and rash

A

Meningitis

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11
Q

common causes of meningitis (neonates, children, 21+, elderly, open head trauma, HIV)

A 
Neonates – Group B strep/Listeria/E.Coli
Children – H.influenza 
10 to 21 = meningococcal
Adults/Elderly – pneumococcal/Listeria
Open head trauma – staph aureus

HIV – cryptococcal meningitis

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12
Q

Ix for meningitis and results

A

LP

  • Viral – clear fluid, lymphocytes, normal glucose, normal/slightly raised protein
  • Bacteria – cloudy, neutrophils, low glucose, high protein
  • TB – lymphocytes, low glucose, high protein

CT scan

Blood Cultures

Throat swab

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13
Q

Mx for meningitis - plus if listeria is suspected, if pen allergic and TB specific Tx

A

IV Ceftriaxone 2g bd + Dexamethasone 10mg QDS

IF LISTERIA suspected = Add Amox or Ampicillin

If PEN ALLERGIC = IV Chloramephenicol w/ Vancy

TB = RIPE therapy for 12 months

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14
Q

where is the location of the bleed in a subdural haemorrhage

A

between the dura and the arachnoid

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15
Q

Ix for SAH

A

Non contrast CT head

LP 12 hours after onset

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16
Q

Mx for SAH

A

Nimodipine

Endovascular coiling/clipping

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17
Q

complications of SAH

A 
Rebleeding
SIADH
Hydrocephalus
Ischaemia
Seizures
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18
Q

what is signs of Total Anterior Stroke

A

Hemiplegia +/- hemisensory loss
Homonymous Hemianopia
Cortical signs

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19
Q

Signs of partial anterior stroke

A

1/3 out of TAS

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20
Q

what is signs of lacunar stroke

A

Unilateral weakness +/- sensory deficit

NO cortical signs

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21
Q

sings of posterior occipital stroke

A

Cerebellar/Brainstem syndrome

Isolated visual deficit

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22
Q

what Sx do you get with an anterior cerebral artery occlusion

A

contralateral leg

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23
Q

what Sx do you get with an middle cerebral artery occlusion

A

Contralateral hemiparesis and hemisensory loss (esp of face arm)

Contralateral homonymous hemianopia

If dominant hemisphere affected – dysphasia
If non dominant hemisphere affected – visuo-spatial disturbance eg cannot dress, gets lost

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24
Q

what Sx do you get with an posterior cerebral artery occlusion

A

Contralateral homonymous hemianopia often with macular sparing

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25
Q

Ix for strokes

A 
Bloods
ECG
Urgent non-contrast CT
- Ischaemic vs Haemorrhage
- Remember CT can be normal in Ischaemic strokes!
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26
Q

Mx for strokes

A

Aspirin 300mg if CT shows no haemorrhage

If atherosclerosis - start clopidogrel
If cardioembolic – start warfarin/newer anticoagulants
Secondary prevention

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27
Q

what are causes for mononeutritis multiplex i.e. 2+ peripheral nerves in disparate areas of bofy

A

WARDS PLC

Wegners
Amyloidosis
Rheumatoid
Diabetes
SLE
PAN
Leprosy
Carcinomatosis
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28
Q

what is important to monitor in Guillen Barre Syndrome

A

FVC - worried about resp failure leading to death

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29
Q

what infection is guillen barre associated with

A

campylobacter

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30
Q

what is Todd’s palsy

A

temporal seizure that causes weakness

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31
Q

Tx for focal seizures

A

1st - carbamazepine

2nd - lamotrigine

32
Q

what is Sx of a simple (awareness) focal seizure

A

Focal motor/sensory/autonomic
No post-ictal symptoms
E.G one limb jerking

33
Q

what is Sx of a complex focal seizure

A

Frontal/Temporal Lobe
Automatisms
Post-ictal confusion

34
Q

Tx for generalised seizures

A

Sodium Valproate

Lamotrigdine

35
Q

what is definition of status epilepticus

A

A single seizure or serial seizures lasting more than 5 minutes, or two or more seizures without a return of consciousness between seizures

36
Q

initial Tx of status epilepticus

A

Lorazepam 4mg IV

[Midazolam 10mg buccally or Diazepam 10−20 mg given rectally if pre-hospital]

Repeat after 5 mins

37
Q

further Tx of status epilepticus

A

Within 30 minutes:
Phenytoin 18mg/kg IV at 50mg/min with ECG monitoring orSodium valproate 20-30mg/kg IV at 40mg/min if ECG monitoring or phenytoin is not available

38
Q

if question talks about soft cheese or France what is it implying

A

Listeria infection

i.e. might be causing meningitis

39
Q

what are the accessory muscles [sternocleidomastoid and trapezius] supplied by

A

CN XI = Accessory nerve

40
Q

damage to what nerve can cause hoarseness

A

recurrent laryngeal branch of the vagus nerve

41
Q

Nerve supplying quadriceps

A

femoral nerve (L2-L4)

42
Q

nerve supply lateral of thigh

A

lateral femoral cutaneous nerve (L2-L3)

43
Q

nerve that can be injured when did IM injection at the buttock

A

sciatic nerve (L4 to S3)

44
Q

if there is a lesion affecting CN XII where will the tongue point

A

Twelve = Tongue points Towards lesion (TTT)

45
Q

what is DCML responsible for and in what neuropathy is it lost first in

A

fine touch (tactile sensation), vibration and proprioception

diabetic neuropathic

46
Q

what is the Anterior spinothalamic tract responsible for

A

crude touch and pressure.

47
Q

what is the lateral spinothalamic tract responsible for

A

pain and temperature

48
Q

prophylaxis for meningitis

A

Prophylaxis – MENINGOCOCCAL meningitis = rifamipicin/ciprofloxacin

49
Q

ankle jerk reflex

A

S1

50
Q

knee jerk reflex

A

L4

51
Q

triceps reflex

A

C7

52
Q

biceps reflex and supinator reflex

A

C5-C6

53
Q

Sx of ALS

A

weakness, UMN signs and LMN signs

54
Q

Sx of PLS

A

UMN signs only
distal muscle groups more than proximal
marked spastic leg weakness
pseudo-bulbar palsy [forehead spared]

55
Q

Sx of progressive muscular atrophy

A

LMN signs only
weakness
distal muscle groups more than proximal

56
Q

Sx of bulbar palsy

A

LMN lesion of CN IX-XII

tongue weakness
wasting with fasciculations
drooling
dysphagia

57
Q

triad of sx in parkinsons

A

tremor
rigidity
bradykinesia

58
Q

1st line Mx for parkinsons with motor symptoms affecting QOL

A

levodopa

59
Q

where is affected in myasthenia gravis

A

post-synaptic antibodies to ACh receptors

Sx occur when ACh reduced to 30% of normal

60
Q

1st line for MG

A

acetylcholinesterase inhibitor

= Pyridostigmine

61
Q

where is affected in lambert eaton syndrome

A

associated in SCLC

antibodies to pre-synpatic calcium channels

62
Q

sx of anterior cerebral artery stroke

A

weakness or numbness/hemiparesis in contralateral arm and leg [legs more than arms]

63
Q

sx of middle cerebral artery stroke

A

weakness or numbness/hemiparesis in contralateral arm and leg [arms more than legs]

aphasia

contralateral homonymous hemianopia

64
Q

sx of posterior cerebral artery stroke

A

contralateral homonymous hemianopia with macular sparing

65
Q

sx of lacunar stroke

A

pure motor , or pure sensory, or ataxia

66
Q

stroke of locked in syndrome

A

basilar artery

67
Q

1st line Ix for stroke

A

Non contrast CT

68
Q

Mx for stroke

A

Once hemorrhagic stroke ruled out

1st = 300mg Aspirin 
2nd = thrombolysis (anteplase) can only be done within 4.5 hours from onset
69
Q

secondary prevention for stroke

A

1st line = clopidogrel 75mg daily + Atrovastatin 80mg

[note patient will be on Aspirin 300mg for the first two weeks post stroke]

If Clopidogrel not tolerated = aspirin + MR Dipyridamole

Lifelong

70
Q

nerve roots of ulnar nerve and what action can test it

A

C7 - T1

peace sign

71
Q

nerve roots of radial nerve and what action can test it

A

C5 - T1

thumbs up

[get wrist drop if compressed]

72
Q

nerve roots of median nerve and what action can test it

A

C6 - T1

ok sign

73
Q

nerve roots of phrenic nerve

A

C3 - C5

74
Q

nerve roots of common fibular nerve and signs of compression

A

L4 - S1

foot drop

weak dorsiflexion/eversion, reduced sensation over dorsum of foot

75
Q

nerve roots of tibial nerve and signs of compression

A

L4 - S3

weak plantarflexion/inversion, reduced sensation over plantar of foot

76
Q

nerve roots of sciatic nerve and signs of compression

A

L4 - S3

weak hamstrings, numbness and tingling down the back of the leg

4th Year SB (22 decks)

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