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Finals Revision > Neuro > Flashcards

Neuro Flashcards

1
Q

Different kinds of neurological examination?

A

Upper limb, lower limb, cranial nerves, DANISHP, GALS

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2
Q

What makes the CNS?

A

Brain, spinal cord, brainstem

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3
Q

What is the function of the brainstem

A

Control respiratory drive, cranial nerve function, houses beginning of spinal cord

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4
Q

What makes the PNS?

A

Outside of the brain and spinal cord: cranial nerves, spinal nerves and their roots and branches, peripheral nerves and neuromuscular junctions

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5
Q

Where does the PNS start?

A

anterior horn cells

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6
Q

What is PNS functionally divided into?

A

Somatic nervous system (control of body wall- skin (sensory), skeletal muscles (motor)) and autonomic nervous system

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7
Q

What is the motor control system crudely split into?

A

pyramidal (corticospinal+corticobulbar) tract, extrapytamidal tracts (incl. basal ganglia), cerebellum

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8
Q

Function of the pyramidal tract?

A

skilled, intricate, organised movements

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9
Q

How does defective pyramidal tract present?

A

loss of voluntary movement, bradykinesia, rigidity, tremor, chorea

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10
Q

Function of the extrapyramidal tract?

A

fast, fluid, involuntary movements

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11
Q

How does defective extrapyramidal tract?

A

bradykinesia, rigid, tremor, chorea

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12
Q

How does defective cerebellum present?

A

Dysdidokinesia, Ataxia, Nystagmus, Inattention tremor, Slurred speech, Hypotonia, Past pointing

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13
Q

Sensory tracts in the spine?

A

spinothalamic, dorsal columns

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14
Q

Motor tracts in the spine?

A

corticospinal, corticobulbar tracts

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15
Q

Cardinal signs of UMN lesions?

A

hypertonia, upgoing plantars, hyperreflexia, weakness (vague and present in LMN lesions as well)

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16
Q

Cardinal signs of LMN lesions?

A

hypotonia, hyporeflexia, wasting, fasciculations

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17
Q

Is the sensory cortex mainly posterior/anterior?

A

posterior

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18
Q

Is the motor cortex mainly posterior/anterior?

A

anterior

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19
Q

Function of frontal lobe?

A

executive functions: reasoning, planning, complex. Broca’s area

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20
Q

Function of occipital lobe?

A

visual processing

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21
Q

Function of temporal lobe?

A

language, Wernicke’s, auditory stimuli, memory, speech

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22
Q

Function of parietal lobe?

A

movement, orientation, recognition

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23
Q

Neurological symptoms to ask about in Hx?

A

weakness, memory, sensation, involuntary movements, low GCS

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24
Q

What do unilaterla symptoms suggest? Bilateral?

A

uni: brain pathology, bi: spine pathology

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25
Q

What kind of pathology would cause acute neuro symptoms?

A

traumatic, bleeds

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26
Q

What kind of pathology would cause chronic neuro symptoms?

A

inflammatory, genetic

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27
Q

3 primary causes of peripheral neuropathy?

A

diabetes, B12 deficiency, alcohol

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28
Q

Main way of differentiating meningitis and encephalitis?

A

encephalitis presents with confusion

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29
Q

Primary causes of encephalitis?

A

herpes, post-infectious/autoimmune, voltage gated channelopathies?

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30
Q

Syndromes affecting spinal cord?

A

MS, Brown Sequard, Myelopathy, MSCC

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31
Q

Which cranial nerves arise from the brainstem? Which come from the cerebrum?

A

3-12 from brainstem, 1/2 from cerebrum

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32
Q

Where does the olfactory nerve run?

A

from nose->past cribiform plate->olfactory bulb->frontal/temporal lobes

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33
Q

How do you test olfactory nerve?

A

scratch and sniff cards/smelling salts- each one in isolation

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34
Q

Causes of bilateral anosmia?

A

Parkinson’s, nasal trauma, smoking, congenital ciliary dysmotility syndromes, Aura before migraine/epilepsy

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35
Q

Causes of unilateral anosmia?

A

Mucus blocekd nostril, head trauma, subfrontal meningioma

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36
Q

Where does the sensory information optic nerve run?

A

retina->optic nerve->optic chiasm->optic tract->lateral geniculate->striate cortex

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37
Q

How do you test acuity for optic nerve? How do you correct for refractory error?

A

From 6m ask to read Snellen Chart (with glasses if needed). Repeat the test with pinhole to correct for refractory error

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38
Q

If can’t use Snellen chart what do use instead?

A

counting fingers->hand movements->perception to light->no perception to light

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39
Q

If NPL, what could be the cause? How do you test?

A

Cataracts, no red reflex

40
Q

Causes of visual loss in the cornea?

A

Glaucoma (acute angle closure), herpetic keratitis (emergency from HSV1), blepharitis (usually bacterial/scalp dandruff), corneal abrasion (trauma)

41
Q

What forms the anterior chamber of the eye? What’s it filled with?

A

Inner surface of the cornea to the iris, filled with aqueous humour

42
Q

What anterior chamber problems can cause visual loss?

A

Iritis, hyphaema (blood pooling in eye due to trauma), hypopyon (leukocytic exudate poolin in eye, from corneal ulcer or Behcets for example)

43
Q

Problems affecting lens?

A

Cataracts e.g. from congenital rubella syndrome, acquired

44
Q

Problems affecting vitreous humour/chamber?

A

Haemorrhage (diabetic retinopathy, trauma, retinal tear/detachment), vitritis

45
Q

Problems affecting retina?

A

Central retinal artery/vein occlusion, macula degeneration, retinal detachment, macular oedema, hypertensive retinopathy

46
Q

How would you detect retinal artery occlusion?

A

Cherry red spot (pale retina with red spot at point of occlusion)

47
Q

What causes a stormy sunset appearance on fundoscopy?

A

Central retinal vein occlusion

48
Q

What causes retinal detachment?

A

Tear in the retina which allows vitreous humour behind it- vitreous membrane detachment, inflammatory, trauma

49
Q

Causes of visual loss due to optic nerve?

A

Optic neuritis (MS), ischaemic optic neuropathy (like temporal arteritis), papilloedema

50
Q

Causes of visual loss affecting optic chiasm?

A

Pituitary tumour , meningioma, craniopharyngioma

51
Q

Causes of visual loss affecting optic tract?

A

Stroke, tumour, abscess

52
Q

Causes of visual inattention?

A

Stroke, head injury

53
Q

Where is the lesion in monocular blindness? Causes?

A

Distal to optic chiasm: damage to the eye/blood supply/optic nerve

54
Q

Causes of tunnel vision?

A

glaucoma, retinal damage

55
Q

Causes of bitemporal hemianopia?

A

pituitary adenoma/macroadenoma, craniopharyngoma, suprasellar meningioma

56
Q

Causes of enlarged blindspot?

A

papilloedema

57
Q

Cause homonymous hemianopia?

A

Behind optic chiasm: stroke, tumour

58
Q

Causes of superior homonymous quadrantonopia?

A

Lesion in temporal lobe white matter

59
Q

Causes of inferior homonymous quadrantonopia?

A

Lesion in parietal lobe white matter

60
Q

Muscle controlling pupil constriction?

A

Sphincter pupillae in iris

61
Q

Muscle controlling pupil dilation?

A

dilator pupillae in iris

62
Q

Light reflex pathway?

A

Retinal fibres->Pretectal nucleus->Edinger-Westphal nuclei->preganglionic fibres->ciliary ganglion->postganglionic fibres->sphincter pupillae

63
Q

What is RAPD?

A

rapid afferent pupillary defect: initial dilation of both pupils when light shone in affected eye

64
Q

What is the accomodation reflex?

A

Coordinated changes in vergence, miosis, lens shape (accomodation)

65
Q

Path of accomodation reflex?

A

CN II (afferent arm of reflex)->superior centres (interneuron)->CNIII (efferent arm of reflex)

66
Q

Path of pupil dilation by sympathetic system?

A

1st neuron (Hypothalamus->centre of Budge)-> 2ns neuron (apical pleura->superior cervical ganglion in neck)->3rd neuron (superior cervical ganglion to sphincter pupillae)

67
Q

Causes of RAPD?

A

optic neuropathy (optic neuritis, compressive lesions), gross retinal pathology (central retinal vein occlusion, retinal detachment), optic chiasm and tract lesions (infarcts, demyelination)

68
Q

Triad of Horner’s syndrome?

A

ptosis, anhydrosis, miosis

69
Q

What is light-near dissociation?

A

absent/delayed light reflex but normal accomodation reflex

70
Q

What are these nerves respectively named?

A

Oculomotor, trochlear, abducens

71
Q

Motor functions of CN III?

A

All extrinsic eye muscles except lateral rectus and superior oblique: levator palpebrae superioris, superior rectus, medial rectus, inferior rectus, inferior oblique

72
Q

2 nuclei of CN III?

A

Oculomotor nucleus and Edinger-Westphal nuclei

73
Q

Autonomic function of CN III?

A

parasympathetic supply to sphincter pupillae of iris/ciliary muscles

74
Q

Motor function of CN IV?

A

contralateral superior oblique

75
Q

What is unique about CN IV?

A

thinnest CN, longest course, only CN to arise from dorsal brainstem

76
Q

Function of CN VI?

A

Ipsilateral rectus muscle

77
Q

What centre controls horizontal eye movements?

A

horizontal gaze centre in pontine paramedian reticular formation.

78
Q

What centre controls vertical eye movements?

A

vertical gaze centre in the rostal interstitial nucleus of the median longitudinal fasciculus

79
Q

Clinical features of CN III palsy?

A

ptosis, down and out, opthalmoplegia in all directions other than lateral/inferior

80
Q

What would mydriasis in a CN III palsy suggest?

A

As the nerves for constriction are quite superficial, this helps to distinguish ‘compressive’ from medical palsies

81
Q

Causes of CN III palsy?

A

Main 2: Microvascular, intracranial aneurysms. Other: trauma, tumours, demyelination, vasculitis, congenital

82
Q

Clinical features of CN IV palsy?

A

vertical diplopia, slight external rotation of affected eye, hypertropia

83
Q

Causes of CN IV palsy?

A

mainly due to head trauma, then microvascular disease. Other: congenital, others

84
Q

Clinical features of CN VI palsy?

A

inability to abduct the affected eye, diplopia

85
Q

Causes of CN VI palsy?

A

microvascular lesions most common. other: meningeal infection, aneurysm, inflammatory processes

86
Q

3 areas that a lesion can occur leading to combined nerve palsies?

A

cavernous sinus, orbit, superior orbital fissure

87
Q

Definition?

A

An autoimmune T-cell mediated hypersensitivity reaction leading to demyelination of the CNS

88
Q

Epidemiology?

A

More common in women (3:1), temperate climates, average age of onset 20-40 years

89
Q

Aetiology- genetic factors?

A

HLA-DR2, HLADRB1*15

90
Q

Aetiology- environmental factors?

A

sunlight, vitamin D deficiency associated

91
Q

Presenting symptoms- sensory?

A

tingling and numbness

92
Q

Introduction- how much should patient be exposed?

A

top off or vest

93
Q

What can you ask patient to do whilst you inspect them?

A

pronator drift

94
Q

What features are characteristic of LMN lesions on inspection?

A

wasting and fasciculations

95
Q

What does spastic posturing suggest on inspection?

A

UMN lesion

96
Q

What scars might you see on inspection?

A

musce biopsy or nerve biopsy

Finals Revision (9 decks)

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