Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals Revision > Neuro > Flashcards

Neuro Flashcards

1
Q

What are lateralising signs?

A

Reflect a problem with 1 hemisphere versus the other

  • Inattention
  • Gaze paresis
  • Upper limb drift with arms outstretched and eyes closed
  • Slower localising/flexion response 1 side
  • Asymmetric motor response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of Coma

A

AEIOUTIPS

  • Acidosis/Alcohol
  • Epilepsy
  • Infection- HSE/Meningitis
  • Overdose
  • Uraemia
  • Trauma to head- SAH
  • Insulin- hyper/hypo/DKA
  • Psychogenic
  • Stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Who can diagnose brainstem death?

A

2 medical practitioners who have been registered for at least 2 years, at least one consultant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What conditions need to be met in order to diagnose brainstem death?

A

Body temp > 34
MAP > 60 with no hypoxia
Acidaemia or alkalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the criteria for brainstem death?

A

Pupils fixed & dilated & unresponsive
No corneal reflex
Oculovestibular reflexes absent- no eye mvmts on injection of ice cold water into ear
No motor responses by adequate stimulation
No cough reflex to bronchial stimulation
No evidence of spontaneous respiration or respiratory effort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of brainstem death

A

Tumour, MS, metabolic (central pontine myelonecrosis), trauma, spontaneous haemorrhage, infarction, infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Causes of cerebellar syndrome

A

MS, stroke, tumour, drugs (eg phenytoin), thiamine deficiency, paraneoplastic, hypothyroidism, infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Signs of cerebellar syndrome

A 
DANISH
- Dysdiadokinesia
- Ataxia
- Nystagmus
- Intention tremor
- Slurred speech
- Hypotonia
(reduced reflexes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What type of gait is seen in cerebellar syndrome?

A

Broad-based gait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define epilepsy

A

Recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Causes of epilepsy

A

Idiopathic

SOL, stroke, vascular malformation, tuberous sclerosis, SLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Localising features of epilepsy

A

Temporal- automatisms, deja vu, emotional disturbance, taste/smell, auditory hallucinations
Frontal- motor features, motor arrest, speech arrest, post-ictal Todd’s palsy
Parietal- sensory disturbance, motor symptoms
Occipital- visual phenomena

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

A person has epilepsy with the following features: automatisms, deja vu, emotional disturbance, taste/smell, auditory hallucinations.
What lobe is the epilepsy affecting?

A

Temporal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

A person has epilepsy with the following features: motor features, motor arrest, speech arrest, post-ictal Todd’s palsy.
What lobe is the epilepsy affecting?

A

Frontal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A person has epilepsy with the following features: visual phenomena.
What lobe is the epilepsy affecting?

A

Occipital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

A person has epilepsy with the following features: sensory disturbane and motor symptoms.
What lobe is the epilepsy most likely affecting?

A

Parietal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are myoclonic seizures?

A

Seizures involving sudden jerk of a limb, face or trunk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are atonic seizures?

A

Seizures where there is sudden loss of muscle tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Management of generalised tonic-clonic seizures?

A

Sodium Valproate
Lamotrigine
Carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Management of absence seizures

A

Sodium Valproate/Lamotrigine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which drug should be avoided in management of tonic/aclonic/myoclonic seizures?

A

Carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management of partial seizures

A

Carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How long should somebody not drive after a seizure?

A

Avoid driving until 1 year seizure-free

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Side effects of Carbamazepine

A

Leukopenia, diplopia, blurred vision, impaired balance, rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Side effects of Lamotrigine

A

Diplopia, blurred vision, photosensitivity, tremor, agitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Side effects of Sodium Valproate

A

VALPROATE:

  • Appetite lost
  • Liver failure
  • Pancreatitis
  • Reversible hair loss
  • Oedema
  • Ataxia
  • Teratogenic/Tremor/Thrombocytopenia
  • Encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which anti-epileptic should be used in pregnancy?

A

Lamotrigine

Supplement with folic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is status epilepticus?

A

Non-self-limiting manifestation of epileptic seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the most common cause of status epilepticus in in people without epilepsy?

A

Alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Stages of status epilepticus

A

T0: seizure starts
T1: point at which seizure is not self-limiting
T2: point at which there will be some physiological damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Management of status epilepticus

A 
IV Benzodiazepine - Diazepam
Oxygen
Bloods for hypoglycaemia/hypercalcaemia
Cultures
Sodium valproate to prevent further seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are psychogenic non-epileptic seizures?

A

Episodes of movement, sensation or experience that resemble epileptic seizures but without ictal cerebral dischaarges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Typical features of psychogenic non-epileptic seizures

A 
Eyes closed
Partially responsive
Very prolonged
Gradual onset
Can be emotional
Violent thrashing
Usually tired post-seizure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Gold standard for diagnosis of psychogenic non-epileptic seizures

A

Video electroencephalogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Management of psychogenic non-epileptic seizures

A

CBT, Hypnotherapy, anti-anxiety/depressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is primary vs secondary head injury?

A

PRIMARY: damage at time of impact
SECONDARY: injury as a result of changes following primary insult eg oedema, haematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the criteria for C-spine immobilisation?

A
  • GCS < 15 at any point
  • Neck pain/tenderness
  • Focal neurological deficit
  • Paraesthesia in extremities
  • Any other clinical suspicion of C-spine injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Criteria for CT head within 1 hour

A
  • GCS < 13 initially or < 15 after 2hrs
  • Suspected open/depressed skull #
  • Signs of basal skull #
  • Post-traumatic seizure
  • > 1 episode vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Signs of basal skull fracture

A 
Echymosis behind ear (battle sign)
Epistaxis
Subconjunctival haemorrhage
Periorbital haemorrhage (raccoon eyes)
Loss of sensation to face
Haemotympanum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Define stroke

A

Sudden onset of focal neurological signs of presumed vascular origin lasting > 24hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Risk factors for stroke

A

Hypertension, hypercholesterolaemia, smoking, diabetes, obesity, alcohol, carotid artery disease, recreational drugs eg cocaine, age, male, FH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the most common site of ischaemic stroke?

A

Middle cerebral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the different classifications in Bamford Stroke classification?

A

Total Anterior Circulation Stroke
Partial Anterior Circulation Stroke
Posterior Circulation Stroke
Lacunar Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is a Total Anterior Circulation Stroke as defined by Bamford Stroke classification?

A

ALL of…

  1. Unilateral weakness +/- sensory deficit
  2. Homonymous Hemianopia
  3. Higher cerebral dysfunction- dysphasia, visuospatial disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is a Partial Anterior Circulation Stroke as defined by Bamford Stroke classification?

A

2 of…

  1. Unilateral weakness +/- sensory deficit
  2. Homonymous Hemianopia
  3. Higher cerebral dysfunction- dysphasia, visuospatial disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is a Posterior Circulation Stroke as defined by Bamford Stroke classification?

A

1 of…

  1. Cerebellar or brainstem syndromes
  2. Loss of consciousness
  3. Isolated homonymous hemianopia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is a Lacunar Stroke as defined by Bamford Stroke Classification?

A

No evidence of higher cerebral dysfunction and 1 of…

  1. Unilateral weakness +/- sensory deficit
  2. Pure sensory stroke
  3. Ataxis hemiparesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Investigations of Stroke

A

CT head scan within 24hrs of onset
MRI head if unsure/possible haemorrhagic
Carotid Dopplers if anterior circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Management of Stroke (ischaemic)

A

Aspirin
Thrombolysis- Alteplase <4.5hrs
Thrombectomy if NIHSS score > 10
Anticoagulation from 2wks after event

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Management of Stroke (haemorrhagic) in a person on Warfarin

A

Reverse Warfarin:

  • Vitamin K takes 6-8hrs
  • Prothrombinex-VF if immediate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Features of Tension Headache

A 
Generalised headache- bilateral pressure + tightness around head
Non-pulsating
No nausea
Spreads into or arises from neck
Mild-moderate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Most common trigger of tension headaches

A

Stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How long do tension headaches typically last?

A

30 mins - 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Management of tension headaches

A
  1. Simple analgesia + reassurance
  2. Alternative to NSAID eg Naproxen
  3. Alternative therapies eg Acupuncture
  4. Amitriptylline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Which is the only headache more common in men?

A

Cluster headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Risk factors for cluster headache

A

Alcohol, smoking, brain injury, FH, histamine, GTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Features of cluster headache

A

Severe unilateral orbital, supraorbital, temporal pain
Lasting 15 mins - 3hrs
Abrupt onset and cessation
Associated with lacrimation, nasal congestion, rhinorrhoea, miosis, ptosis, eyelid oedema
Can’t sit still

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Management of cluster headache (acute)

A

Subcut Sumatriptan
100% O2
Topical lidocaine IN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Prevention of cluster headache

A

During cluster: Prednisolone, Ergotamine

Prevention of cluster: Verapamil, Lithium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is Hydrocephalus?

A

Accumulation of CSF within the brain –> raised ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the aetiology of Hydrocephalus?

A

Accumulation of CSF within the brain –> raised ICP
Due to obstruction of ventricular drainage
Pus- bacterial meningitis
Blood- SAH or intraventricular haemorrhage
Posterior fossa tumours
Spina Bifida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Investigations of Hydrocephalus

A

CT/MRI

LP CONTRAINDICATED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Management of Hydrocephalus

A

CSF diversion- external ventricular drain, CSF shunt etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Causes of raised Intracranial pressure

A

Mass- haematoma, tumour, abscess
Oedema
Increased CSF
Increased cerebral blood volume- vasodilatation, venous obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Presentation of raised intracranial pressure

A

Headache, vomiting, diplopia, blurred vision, drowsiness, papilloedema, limitation of upward gaze, fixed dilated pupil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Management of raised intracranial pressure (immediate)

A

Mannitol- osmotic diuresis

Burr hole/craniotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is cushing’s triad?

A

Signs of raised intracranial pressure

  1. Hypoventilation
  2. Bradycardia
  3. Hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is the equation for cerebral perfusion pressure?

A

Cerebral perfusion pressure = MAP - intracranial pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is Syncope?

A

Transient global cerebral hypoperfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Types of syncope (3)

A
  • Reflex- vasovagal, situational, carotid sinus hypersensitivty
  • Cardiogenic- arrhythmias, cardiac ischaemia, structural heart disease
  • Orthostatic hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Investigations of syncope

A

ECG, CT/MRI, EEG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

GCS Scoring

A 
Eye opening /4
1. None
2. To pain
3. To voice
4. Spontaneously 
Verbal response /5
1. None
2. Groans
3. Inappropriate words
4. Confused speech
5. Orientated
Motor response /6
1. None
2. Extension to pain
3. Flexion to pain
4. Withdraws from pain
5. Localises to pain
6. Obeys commands
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Describe MRC Power grading

A 
0 = no muscular contraction
1 = visible muscular contraction but no mvmt
2 = mvmt at joint but not against gravity
3 = mvmt against gravity but not resistance
4 = mvmt against some resistance but not full strength
5 = full strength
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Describe reflex grading

A 
0 = Absent
1 = Hypoactive 
2 = Normal
3 = Brisk/Hyperactive
4 = Markedly hyperactive with clonus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Causes of UMN signs

A

Tumour, masses, inflammation, MS, stroke, myelopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

UMN signs

A

Spastic gait
Hypertonia
Hyperreflexia
Babinski- upgoing plantars
Ankle clonus
Hoffman’s sign (flicking middle finger makes index finger twitch)
Pyramidal weakness- flexors > extensors in arms, opposite in legs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Causes of LMN signs

A

GBS, peripheral neuropathy, myasthenia gravis, meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

LMN signs

A 
Flaccid weakness
Hyporeflexia
Hypotonia
Fasciculations
Wasting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q 
Nerve root for the following reflexes:
Biceps 
Triceps
Knee jerk
Ankle jerk
A

Biceps- C5/6
Triceps- C6/7
Knee jerk- L3/4
Ankle jerk- S1

80
Q

What is the dorsal column medial lemniscal pathway responsible for?

A

Fine touch
Vibration
Proprioception

81
Q

What is the anterior spinothalamic pathway responsible for?

A

Crude touch

Pressure

82
Q

What is the lateral spinothalamic pathway responsible for?

A

Pain

Temperature

83
Q

What is the spinocerebellar pathway responsible for?

A

Proprioception

84
Q

What is the pyramidal tract responsible for?

A

Voluntary muscle control of body and face

85
Q

What are the extra-pyramidal tracts responsible for?

A

Involuntary and automatic control of muscle

86
Q

What is the vestibulo-spinal tract responsible for?

A

Balance + posture

87
Q

What are the extra-pyramidal tracts?

A
  1. Vestibulospinal
  2. Reticulospinal
  3. Rubrospinal
  4. Tectospinal
88
Q

What is the reticulospinal tract responsible for?

A

Voluntary movements and muscle tone

89
Q

What is the rubrospinal tract responsible for?

A

Fine control of hand movements

90
Q

What is the tectospinal tract responsible for?

A

Movements of head in response to visual stimuli

91
Q

What are the 12 Cranial nerves?

A
  1. Olfactory
  2. Optic
  3. Oculomotor
  4. Trochlear
  5. Trigeminal
  6. Abducens
  7. Facial
  8. Vestibulocochlear
  9. Glossopharyngeal
  10. Vagus
  11. Accessory
  12. Hypoglossal
92
Q

What is the function of the Olfactory nerve?

A

Smell

93
Q

What is the function of the Optic nerve?

A

Visual acuity, colour vision, visual fields, visual inattention

94
Q

What is the function of the Oculomotor nerve?

A

Eye movements

Pupil constriction

95
Q

What is the function of the Trochlear nerve?

A

Superior oblique- depresses and internally rotates the eye

96
Q

What are the components of the Trigeminal nerve?

A

Opthalmic, maxillary and mandibular branches

97
Q

What is the function of the Abducens nerve?

A

Lateral rectus- abducts

98
Q

What is the function of the Facial nerve?

A

Motor to face, taste to anterior 2/3 tongue

99
Q

What is the function of the Vestibulocochlear nerve?

A

Hearing

100
Q

What is the function of the Vagus nerve?

A

Motor to palate

101
Q

What is the function of the Accessory nerve?

A

Sternocleidomastoid + trapezius

102
Q

What is the function of the Hypoglossal nerve?

A

Tongue motor

103
Q

Red Flags of Headache

A
  • Thunderclap
  • Jaw claudication
  • Atypical dural- >1hr or motor weakness
  • Associated with postural change/coughing
  • New onset headache with Hx of cancer
  • Unilateral red eye
  • Rapid progression of neuro deficit/cognitive impairment/personality change
  • Hx of HIV/immunosuppression
  • New onset headache age > 50
  • Waking from sleep
  • Worsening over weeks or longer
104
Q

Features of migraine

A 
\+/- aura
Unilateral, pulsating, moderate pain
N&amp;V
Photophobia/Phonophobia
Lasts 4-72hrs untreated
105
Q

Triggers for migraine

A 
CHOCOLATE
Chocolate
Hangovers
Orgasms
Cheese
OCP
Lie-ins
Alcohol
Tumult (loud noise)
Exercise
(Menstruation + stress)
106
Q

Management of migraines

A
  1. Simple analgesia + Sumatriptan
  2. Propranolol +/- Amitriptylline
  3. Topiramate
107
Q

Management of nausea and vomiting in migraine

A

Metoclopramide

108
Q

Organism causing Meningococcal disease

A

Neisseria meningitidis

109
Q

Risk Factors for meningitis

A

Young, immunosuppression, smoking, spinal procedures, diabetes, crowding

110
Q

Most common cause of meningitis

A

Viral infection

111
Q

Presentation of Meningitis

A 
Non-blanching petechial/purpuric rash
Cold extremities, skin mottling
Fever
Neck stiffness
Bulging fontanelle
Photophobia
Kernig's sign
Brudzinski's sign
112
Q

What is Kernig’s sign?

A

Seen in Meningitis

Pain and resistance on passive knee extension with hips fully flexed

113
Q

What is Brudzinski’s sign?

A

Seen in Meningitis

Hips flex on bending head forward

114
Q

What is tested on Lumbar puncture in Meningitis?

A

WCC, Gram stain, Glucose, protein, lactate, culture, Meningococcal + Pneumococcal PCR

115
Q

What does lumbar puncture show in bacterial meningitis? (appearance, opening pressure, WBC, glucose, protein)

A 
A: Cloudy/turbid
Opening pressure elevated
WBC elevated > 100- primarily lymphocytes
Glucose low
Protein elevated
116
Q

What does lumbar puncture show in viral meningitis? (appearance, opening pressure, WBC, glucose, protein)

A 
A: Clear
Opening pressure normal (or elevated)
WBC elevated- primarily lymphocytes
Glucose normal
Protein elevated
117
Q

hat does lumbar puncture show in fungal meningitis? (appearance, opening pressure, WBC, glucose, protein)

A 
A: Clear or cloudy
Opening pressure elevated
WBC elevated
Glucose low
Protein elevated
118
Q

hat does lumbar puncture show in TB meningitis? (appearance, opening pressure, WBC, glucose, protein)

A 
A: Opaque, if left settles to form a fibrin web
Opening pressure elevated
WBC elevated
Glucose low
Protein elevated
119
Q

Management of meningitis

A

Immediate: IM Benzylpenicillin
Viral: Aciclovir for herpes/encephalitis, Ganciclovir for CMV
Bacterial: Ceftriaxone IV 7 days
Dexamethasone

120
Q

Management of close contacts in meningitis

A

Ciprofloxacin/Rifampicin

121
Q

Risk factors for a brain tumour

A

Ionising radiation, immunosuppression, Neurofibromatosis, Tuberous sclerosis, Li-Fraumeni syndrome

122
Q

What are the most common primary sites of brain mets?

A 
Brain Mets Can Kill Lots
Breast
Melanoma
Colon
Kidney
Lung
123
Q

Clinical features of brain tumour

A 
Headaches worse in the morning
N&amp;V
Seizures
Focal neurological deficits
Behavioural change
Papilloedema
Raised ICP
124
Q

Investigation of suspect brain tumour

A

Urgent MRI within 2 weeks

125
Q

Management of brain tumour

A

Surgical resection
External beam radiotherapy- 1st line for mets
Chemo
Corticosteroids for raised ICP

126
Q

What is the first line treatment for brain mets?

A

External beam radiotherapy

127
Q

Differentials of a ring-enhancing lesion on CT brain

A

DR MAGICAL
D: demyelinating disease (classically incomplete rim of enhancement)
R: radiation necrosis or resolving haematoma
M: metastasis
A: abscess
G: glioblastoma
I: infarct (subacute phase), inflammatory - neurocysticercosis (NCC), tuberculoma
C: contusion
A: AIDS
L: lymphoma (this appearance more common in immunocompromised)

128
Q

Define vertigo

A

An illusion of movement, of the patient or surrondng, always worsened by movement

129
Q

Causes of vertigo

A

Central: MS, migraine, alcohol, acoustic neuroma, cerebellar infarct
Peripheral: Labyrinthitis, Vestibular neuritis, BPPV, Meniere’s, Ototoxicity

130
Q

General Management of vertigo

A

Prochlorperazine, Cyclizine, Promethazine

131
Q

What is the most common cause of vertigo?

A

Benign Paroxysmal Positional Vertigo

132
Q

What is the peak age for Benign Paroxysmal Positional Vertigo?

A

Age 40-60

133
Q

What is the aetiology behind Benign Paroxysmal Positional Vertigo?

A

Otoliths detach and stimulate hair cells

134
Q

Causes of Benign Paroxysmal Positional Vertigo

A

Idiopathic

Head injury, post-viral, surgery

135
Q

Presentation of Benign Paroxysmal Positional Vertigo

A

Episodes of vertigo provoked by head movement
Worse to one side
Attacks sudden onset and last 20-30 seconds
Resolve once head is kept still
Worse in mornings
Nausea

136
Q

Diagnosis of Benign Paroxysmal Positional Vertigo

A

Dix-Hallpike maneouvre

137
Q

Management of Benign Paroxysmal Positional Vertigo

A

Epley maneouvre

Self-limiting in weeks

138
Q

Can people drive with Benign Paroxysmal Positional Vertigo?

A

Only once symptoms controlled

139
Q

Causes of encephalitis

A

HIV, Herpes simplex, CMV, TB, Lyme disease, parasite

140
Q

Presentation of encephalitis

A

Classic triad:

  1. Fever
  2. Headache
  3. Altered mental status
141
Q

Management of encephalitis

A

Urgent hospital admission

Aciclovir IV

142
Q

What risk score is used for risk of stroke after TIA?

A 
ABCD2 score
Age > 60
BP > 140/90
Clinical features:
- Unilateral weakness (2)
- Speech disturbance (1)
Duration:
- > 60 mins (2)
- 10-60 mins (1)
- < 10 mins (0)
Diabetes (1)
143
Q

What is ABCD2 score?

A 
Risk of stroke after TIA:
Age > 60
BP > 140/90
Clinical features:
- Unilateral weakness (2)
- Speech disturbance (1)
Duration:
- > 60 mins (2)
- 10-60 mins (1)
- < 10 mins (0)
Diabetes (1)
144
Q

What is a TIA?

A

Sudden onset of focal neurological signs of vascular origin lasting < 24hrs

145
Q

Investigations after TIA

A

MRI
Carotid dopplers
24hr ECG

146
Q

Management of TIA

A

Aspirin
Clopidogrel if high-risk
Carotid endarterectomy + stenting for 70-99% stenosis

147
Q

What is the most common aetiology of a subarachnoid haemorrhage?

A

Rupture of a saccular/berry aneurysm in the circle of willis

148
Q

Risk factors for subarachnoid haemorrhage

A

Hypertension, smoking, cocaine, alcohol, PKD, Ehler-Danlos, coarctation of the aorta

149
Q

Presentation of subarachnoid haemorrhage

A 
Thunderclap headache
Sudden death/reduced GCS
Meningism
Seizures
Can have 3rd nerve palsy and extensor plantar response
150
Q

Investigations of subarachnoid haemorrhage

A

CT then angiography

LP- xanthochromia

151
Q

Lumbar puncture findings in SAH

A

Xanthochromia

152
Q

Management of Subarachnoid haemorrhage

A

Nimodipine for vasospasm
Surgical clipping, endovascular coiling
Ventricular drainage

153
Q

Causes of Extradural haemorrhage

A

Traumatic: fractured temporal/parietal bone after trauma to temple- damage to middle meningeal artery/vein
Non-traumatic: coagulopathy, thrombolysis, vascular malformation

154
Q

What is the aetiology of traumatic extradural haemorrhage?

A

Fractured temporal/parietal bone after trauma to temple –> damage to middle meningeal artery/vein

155
Q

Presentation of extradural haemorrhage

A

Trauma to head –> LOC –> lucid interval after which patient deteriorates
Headache, N&V, seizures, raised ICP, Cushing’s triad, Unequal pupils, CSF otorrhoea/rhinorrhoea with tear of dura

156
Q

Investigations of extradural haemorrhage

A

X-ray skull- shows fracture

CT- haematoma/air- biconvex/lentiform

157
Q

Management extradural haemorrhage

A

ABC, fluids
Mannitol for raised ICP
Burrholes

158
Q

What is the most common aetiology of subdural haemorrhage?

A

Traumatic- tearing of bridging veins- mainly rapid deceleration of head (RTA)

159
Q

Causes of subdural haemorrhage

A

Rapid deceleration of head in RTA
Shaken baby
Non-traumatic- vascular malformations, meningitis

160
Q

Risk factors for subdural haemorrhage

A 
Cerebral atrophy (elderly)
Alcoholism
161
Q

Presentation of subdural haemorrhage

A

Acute LOC then lucid interval then LOC when haematoma forms

Chronic progressive symptoms 2-3wks later

162
Q

Investigations of subdural haemorrhage

A

CT for acute, with contrast if subacute - crescent shaped haematoma

163
Q

Management of subdural haemorrhage

A

ABC
Emergency craniotomy + clot evacuation
Burr holes

164
Q

Which disease is associated with temporal arteritis?

A

Polymyalgia rheumatica

165
Q

Presentation of temporal arteritis

A 
Pain with eating/brushing hair
Temporal headache
Scalp tenderness, facial pain
Jaw claudication
Fever, Malaise
166
Q

Features of temporal arteritis on examination

A

On palpation of the temporal artery- absent, beaded pulse, tender and enlarged

167
Q

Investigations for temporal arteritis

A

Raised ESR

Temporal artery biopsy: predominance of mononuclear cells or granulomatous inflammation, multinucleated giant cells

168
Q

What is found on temporal artery biopsy in temporal arteritis?

A

Predominance of mononuclear cells or granulomatous inflammation, multinucleated giant cells

169
Q

Management of temporal arteritis

A

40mg Prednisolone daily
60mg if claudication or visual Sx
Low dose aspirin + PPI

170
Q

3 Key features of Parkinsonism

A
  1. Resting tremor
  2. Rigidity
  3. Bradykinesia
171
Q

What is the aetiology of Parkinson’s in the brain?

A

Lewy bodies + neuronal cell death in the pars compacta of substantia nigra causing slowing of the basal ganglia

172
Q

What is the average age of onset of Parkinson’s?

A

Age 60yrs

173
Q

What 2 things reduce the risk of Parkinson’s?

A
  1. Smoking

2. Caffeine

174
Q

Causes of peripheral neuropathy

A

DAVID:

  • Diabetes Mellitus
  • Alcohol
  • Vitamin deficiency (B12/B1) / Vasculitis
  • Immune- Guillain-Barre / Inherited- Charcot-Marie-Tooth
  • Drugs- Isoniazid, Vincristine
175
Q

Patient has hyperacute limb and facial weakness, pronator drift and upgoing plantars, what is the pathology?

A

Vascular
UMN
In the brain
–> Stroke

176
Q

Patient has insidious onset weakness in both legs, with a sensory level, upgoing plantars and brisk reflexes, what is the pathology?

A

Compression/degeneration
UMN
In the spine
–> Spinal tumour

177
Q

Patient has insidious onset sensory change in the hand (lateral 3 fingers), wasting, what is the pathology?

A

Compression/degeneration
LMN
Peripheral nerve
–> Carpal tunnel syndrome

178
Q

Patient has subacute onset weakness in both shoulders and thighs and a raised CK, what is the pathology?

A

Inflammatory
Muscle problem
–> Polymyositis

179
Q

Causes of seizure

A 
Hypoglycaemia
Alcohol withdrawal
Metabolic disturbance
Infection (meningitis/encephalitis)
Stroke
Neoplasm
Drug overdose/toxicity
Inadequate anticonvulsant levels
180
Q

Investigations of seizure

A 
FBC, U&amp;E, LFT, Ca2+, MG2+, glucose, clotting
ECG
Toxicology?
ABG?
CT head?
181
Q

Management of a seizure- <5mins

A

Time, monitor, oxygen, supportive care

182
Q

Management of a seizure- >5mins

A 
Benzodiazepines:
- IV Lorazepam 4mg
- Buccal/IM Midazolam
- PR Diazepam
If unresponsive- load on anticonvulsant- Levetiracetam
183
Q

Neurological examination findings in Parkinson’s

A
  1. Inspection: mask-like facies, tremor (asymmetrical coarse pill-rolling resting tremor)
  2. Tone: increased, cogwheel rigidity
  3. Gait: shuffling, loss of arm swing, difficulty turning
  4. Voice: slow, faint, monotonous speech
  5. Bradykinesia
    Power, coordination, sensation and reflexes all normal
184
Q

Options for a NBM Parkinson’s patient

A

Timing of Parkinson’s meds is critical

  1. NG tube insertion for meds
  2. Rotigotine patch
185
Q

Which anti-emetics are safe to use in Parkinson’s?

A

Domperidone and Ondansetron are safe
Prochlorperazine and Metochlopramide contraindicated
Cyclizine can worsen symptoms

186
Q

What drugs are contraindicated in myasthenia gravis?

A

MANY
Beta blockers
Many antibiotics
Psych drugs

187
Q

Management of Vestibular neuritis

A

Vestibular sedatives- Betahistine

Will resolve in a few days

188
Q

What is the time frame of onset of Vestibular neuritis?

A

Subacute onset over a few hours

189
Q

Presentation of Meniere’s disease

A

Vertigo
N&V
Associated with hearing loss, tinnitus and sense of fullness in ear

190
Q

What does audiogram show in Meniere’s disease?

A

Low-frequency hearing loss

191
Q

Management of Meniere’s disease

A

Decrease sodium intake

Thiazides

192
Q

Contraindications to thrombolysis in stroke

A 
Haemorrhage
High BP
Major surgery
Anticoagulants
Recent stroke
Seizure at onset
Head injury
193
Q

What investigation needs to be done after thrombolysis?

A

CT 24hrs after thrombolysis to exclude haemorrhage before starting aspirin

194
Q

What type of stroke must somebody have to be considered for thrombectomy?

A

Anterior circulation large vessel occlusion

195
Q

How long after a stroke can somebody not drive for?

A

1 month then may need further assessment

Finals Revision (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions