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year 3 > Neuro > Flashcards

Neuro Flashcards

1
Q

Origin of pyramidal treacts

A

Cerebral cortex

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2
Q

Origin of extrapyramidal tracts§

A

Brain stem

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3
Q

What is the function of the pyramidal tract

A
  1. Responsible for voluntary control of musculature of body and face
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4
Q

What is the function of the extrapyramidal treacts

A

Responsible for involuntary and autonomic control of musculature such as muscle tone, balance, posture and locomotion

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5
Q

Describe the pathway of the pyramidal tracts

A
  1. Medullary pyramids of medulla oblongata and divide into corticospinal and cotricobulbar tracts
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6
Q

where do the lateral and anterior corticospinal tract decussate

A

Lateral - medulla

Anterior - Remains ipsilateral and decussates in cervical and thoracic segmental levels

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7
Q

Name the four extrapyramidal tracts

A
  1. Vestibulospinal
  2. Reticulospinal
  3. Rubrospinal
  4. Tectospinal
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8
Q

Where do the vestibule and reticule decussate

A

They do not, ipisilateral

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9
Q

Where to the rub and tectospinal decussate

A

They do decussate, contralateral

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10
Q

What cranial nerve is not part of the PNS

A

Optic nerve

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11
Q

What forms the PNS system

A
  1. Somatic

2. Autonomic

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12
Q

How many spinal nerves are found in the somatic nervous system,

A 
31 total
C = 8
T = 12
L = 5
S = 5
Coccyx = 1
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13
Q

How would you take a muscle weakness history

A
  1. Onset
  2. Distribution
  3. Variability
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14
Q

UMN vs LMN

A

Bulk normal vs Reduced bulk
Tone increased vs Normal or decreased Tone
Strength decreased vs strength decreased
Fasciculations absent vs present
Reflexes increased vs decreased or absent
Biceps spastic, extensor relaxed vs biceps relaxed, extensors spastic
Spastic weakness vs Flaccid weakness

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15
Q

Describe the characteristics of peripheral neuropathy

A
  1. Starts in legs/longer nerves
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16
Q

Risk factors for peripheral neuropathy

A
  1. Deficiency (B12/folate)
  2. Diabetes
  3. Alcohol/Toxins/Drugs
  4. Leprosy
  5. Amyloidosis
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17
Q

What is mono neuritis multiplex

A
  1. painful, asymmetrical sensory and motor neuropathy
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18
Q

What causes mono neuritis multiplex

A
  1. Vasculities

2. Connective tissue disorders

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19
Q

Example of mononeuropathy

A

Carla tunnel syndrome

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20
Q

Investigations for neuropathy

A
  1. Vasculitic screen
  2. EMG/NCS
  3. CSF study
  4. Imaging and nerve biopsy
  5. Neuropathy screen
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21
Q

What is a neuropathy screen

A
  1. FBC, ESR
  2. U+e, glucose, TFT, CRP, serum electrophoresis
  3. B12 Folate
  4. Anti Gliadin, HIV
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22
Q

How is inflammatory neuropathy treated (e.g. GBS)

A

Predinsolone with steroid sparing azathioprine

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23
Q

How is vasculitic neuropathy treated

A
  1. Predinsolone with immunosuppressant cyclophosphamide.
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24
Q

What can cause GBS

A
  1. Campylobacter infection
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25
Q

Clinical features of GBS

A
  1. <6 weeks signs of ascending paralysis/areflexia
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26
Q

Investigations for GBS

A
  1. NCS demyelinating

2. LP, raised CSF protein

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27
Q

How is GBS treated

A

IvIg or plasmapheresis

Monitor pulse and BP
Monitor FVC

Resp weakness: ABCDE

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28
Q

Clinical Feature son MG

A
  1. Proximal limb weakness
  2. Weakness of neck and face (head drop and ptosis)
  3. Extraocular (complex diplopia)
  4. Bulbar palsy (speech and swallow)
  5. Curtain sign
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29
Q

MG Investigations

A
  1. AChR antibodies
  2. Tension test
  3. CT Thorax
  4. FVC - rep problems
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30
Q

MG treatment

A
  1. ACh esterase inhibitors - pyridostigmine
  2. Azathioprine
  3. Thymectomy
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31
Q

What is a myasthenic crisis

A
  1. Severe weakness of resp muscles
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32
Q

How is myasthenic crisis treated

A
  1. Anaesthetist review
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33
Q

MND investigations

A
  1. LP
  2. NCS/EMG
  3. MRI
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34
Q

What three things are assessed on the GCS

A
  1. EYE
  2. MOTOR
  3. VERBAL
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35
Q

Most common cause of status eplieplticus in adults

A
  1. SUbtehrapeutic anticonvulsant levels and strokes
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36
Q

What classifies states epilepticus

A

Lasts more than 30 minutes

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37
Q

Partial vs total anterior circulation infarcts

A

Total (3 symptoms), partial (2 symptoms)

Unilateral hemiparesis
Homonymous hemianopia
Dysphagia etc

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38
Q

Clinical features of lacunar infarcts

A
  1. UNILATERAL WEAKNESS
  2. PURE SENSORY STROKE
  3. ATAXIC HEMIPARESIS
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39
Q

What is lateral medullary syndrome

A
  1. Disruption to posterior inferior cerebellar artery
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40
Q

Signs of lateral medullary syndrome

A

Isi: ataxia, nystagmus, dysphagia, facial numbness, horner’s
contra: Limb sensory loss

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41
Q

Antithrombotic therapy for TIA

A
  1. CLOPIDOGREL

if contraindicated: ASPIRIN and DIPYRIDAMOLE

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42
Q

Acute management of Cluster headaches

A
  1. 100% oxygen

2. Sumatriptan

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43
Q

Prophylaxis of cluster headaches

A

Verapamil

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44
Q

How is wernicek’s encephalopathy treated

A
  1. Pabrinex (IV B/C)
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45
Q

Clinical features of Wernicke’s

A
  1. Confusion
  2. Ataxia
  3. Nystagmus/Opthalmoplegia
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46
Q

After a TIA, does the DVLA need to be informed

A

1 month driving no need to inform DVLA

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47
Q

Clinical Features of Charcot-marie tooth disease

A
  1. Starts at puberty
  2. Distal muscle wasting, pes clavus and clwaed toes
  3. Foot drop, leg weakness first features
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48
Q

Clinical Features of MND

A
  1. Fasciculations
  2. Wasting of small hand muscles
  3. Absence of sensory signs/synmptoms

DOES NOT AFFECT OCULAR MUSCLES

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49
Q

How is MND diagnsoed

A
  1. EMG: Shows reduced action potential with increased amplitude
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50
Q

Clinical Features of Tuberous Sclerosis

A
  1. Depigmented ‘ash-leaf’ spots which fluoresce under UV lights
  2. Roughened patches over lumbar spine
  3. Butterfly distribution of adenoma sebaceous
  4. Cafe-au-lait-spots

Neurological features:

  1. Developmental delay
  2. Epilepsy
  3. Intellectual impairment

Lung cysts, polycystic kidneys, gliamatous changes in brain, rhabdomyomas of the heart

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51
Q

Treatment of MG

A

Neostigmine

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52
Q

What artery commonly contributes to extra-dural haematomas

A
  1. Middle Meningeal artery
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53
Q

Clinical features of bell’s palsy

A
  1. LMN palsy
    Forehead affected
    Post-auricular pain, altered taste, dry eyes and hyperacusis
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54
Q

How is bells palsy treated

A
  1. Prednisolone
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55
Q

Clinical Feature of adhesive capsulitis

A
  1. EXTERNAL ROTATION is most painful, of the shoulder
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56
Q

Clinical Features of Degenerative cervical myelopathy

A
  1. Loss of motor function
  2. Pain
  3. Loss of sensation
  4. Loss of autonomic (urinary and faecal)
  5. Hoffman’s sign
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57
Q

What is hoffman’s sign

A
  1. Reflex test in fingers - positive if flicking one finger on hand causes twitching of others
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58
Q

How is degenerative cervical myelopathy diagnosed

A

MRI of cervical spine

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59
Q

Treatment of DMC

A
  1. Refer to neurosurgery or spinal surgery asap - decompressive surgery
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60
Q

What is Uhtoff’s phenomenon

A

Worsening of vision following rise in temperature

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61
Q

Three visual changes in MS

A
  1. Optic neuritis
  2. Optic atrophy
  3. Internuclear opthalmoplegia
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62
Q

Sensory changes in MS

A
  1. Pins/needles
  2. Numbness
  3. Trigmeninal neuralgia
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63
Q

What is Lhermitte’s syndrome

A
  1. Paraesthesia in limbs on neck flexion
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64
Q

Cerebellar changes in MS

A
  1. Ataxia(usually in acute relapse)

2. Tremor

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65
Q

In trauma, clear fluid is commonly seen dripping through the nose, how can we test if its CSf

A

1, Check for glucose

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66
Q

How long doe sit take for xanthochromia to show

A

12 Horus

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67
Q

What is Weber’s syndrome

A
  1. Ipsilateral III palsy

2. Contralateral weakness

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68
Q

What is pontine heamorrhage

A
  1. Complication secondary to chronic hypertension
  2. Quadriplegia
  3. Reduced GCS score
  4. Miosis
  5. Absent horizontal eye movements
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69
Q

Thrombectomy usually only should be done within 6Hours, when can we extend this to 24 hours

A
  1. IF CT Perfusion indicates substantial salvageable brain tissue present
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70
Q

Most common complication following meningitis

A
  1. Sensorineural hearing loss
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71
Q

Clinical features of common perineal nerve palsy

A
  1. Weakness of foot dorsiflexion
  2. Weakness of foot eversion
  3. Weakness of extensor hallicus longs
    Sensory loss over lower lateral aspect of leg or dorm of foot
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72
Q

When is carotid endarterectomy recommended in TIAs and strokes

A

If they have already suffered a TIA or stroke due to carotid issues before or 50% greater occlusion of arotids

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73
Q

Clinical features of resting tremour

A
  1. Affects vocal cords and hands

Goes away when resting

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74
Q

What is the most important cause of status eplieotuicum that needs to be drawn out

A

HYPOXIA and HYPOGLYCAEMIA

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75
Q

First line treatment of status epliepticum

A

Diazepam or Lorazepam

If ineffective then phenytoin or valproate

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76
Q

What disc prolapse causes DCM

A
  1. C4/5
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77
Q

Management of acute ischaemic stroke

A

Aspirin 75mg 2 weeks, then 75mg clopidogrel

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78
Q

Risk factors of MG

A
  1. Thymomas, autoimmune disorders (pernicious anaemia, SLE, RA)
  2. Thymic Hyperplasia
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79
Q

Investigations of MG

A
  1. Single fibre EMG
  2. CT Thorax to exclude thymoma
  3. CK normal
  4. Anti acetylcholine receptors, anti musks
  5. Tension test - IV edrophonium to reduce muscle weakness
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80
Q

Treatment of MG

A
  1. Neostigmine
  2. Prednisolone
  3. Thymectomy
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81
Q

Management of Myasthenic crisis

A
  1. Plasmapheresis

2. Iv Igg

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82
Q

Treatment of acute migraines

A
  1. Triptan + NSAID + Parcetomal
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83
Q

Prophylaxis of migraines

A

Propranolol

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84
Q

Management of trigeminal neuralgia

A

Carbamazepine

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85
Q

What exacerbates pain in bigeminal neuralgia

A

Anything causing light touch: Applying soap, cream, talking, smoking, shaving and brushing teeth

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86
Q

Clinical Features of wernicke’s

A 
CAN OPEN
1. Confusion 
Ataxia
Nystagmus
Ophthalmoplegia
Peripheral
Neuropathy
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87
Q

What is the Cushing reflex

A

Its a [hysiological nervous system response to increased ICP that causes hypertension and bradycardia

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88
Q

What medication is used to treat cerebral oedema in patients with brain tumours

A
  1. DEXAMATHASONE
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89
Q

A lady trips and cannot adduct her fingers, what nerve is affected

A

Ulnar

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90
Q

Risk factors for MS

A
  1. Lack of Vit D
  2. Previous mononucleosis
  3. Smoking
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91
Q

Clinical features of normal pressure hydrocephalus

A
  1. Urinary incontinence
  2. Dementia and bradyphenia
  3. gait abnormality
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92
Q

What is Cataplexy

A
  1. Sudden and transient loss of muscular tone followed by STRONG emotion (laughter, crying being frightened)

Ranges from buckling knees to collapse

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93
Q

What condition is cataplexy commony associated with

A

Narcolepsy

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94
Q

All seizures are treated with valproate except for..?

A

Focal seizures

Give lamotrigine

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95
Q

If a parkinson patient can’t take levodopa orally as they have swallowing difficulties what should be given

A
  1. Dopamine agonist patch
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96
Q

Side effect of valproate

A

Weight gain

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97
Q

Clinical features of RLS

A
  1. Uncontrollable urge to move, symptoms worst at rest/night
  2. Crawling sensation in legs
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98
Q

Why is the oral contraceptive pill contraindicated with migraine

A
  1. INCREASED RISK OF STROKE
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99
Q

A 32 year old rugby player is hit hard on the shoulder and his arm is now pronated and medially roasted, what nerve is affected

A

Brachial trunks C5-6

This is Erb’s palsy

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100
Q

Risk factors of migraine

A 
CHOCOLATE
Chocolate
Hangover
Orgasm
Cheese
Oral contraceptive
lie ins
alcohol 
travel excercise
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101
Q

What improves beingn essential tremour

A

Alcohol

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102
Q

Mechanism of aspirin

A

Inhibits Cox-1, surpassing prostaglandin and thromboxane synthesis

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103
Q

Mechanism of clopidogrel

A

Acts on ADP receptors to prevent platelet aggregation

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104
Q

Mechanism of dipyramidole

A

Increase in cAMP and decreased thromboxane A2

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105
Q

How long can u not drive for after a TIA

A

at least 1 month

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106
Q

Most common cause of SAH

A

Berry aneurysm rupture

Artery venous malformation

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107
Q

Symptoms of SAH

A
  1. Vomiting
  2. Collapsing
  3. Seizures
  4. Drowsiness

SIGNS:
Neck stiffness
Retinal bleeding

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108
Q

Risk factors of SAH

A
  1. Alcohol
  2. Smoking
  3. Increased BP
  4. Bleeding disorders
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109
Q

Management of SAH

A
  1. Neurosurgery referral

Nimodipine

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110
Q

What surgery is used for SAH

A
  1. Endovascular coiling or surgical clipping
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111
Q

Where do most dural venous sinus thrombosis occur

A
  1. Sagital sinus
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112
Q

Features of cortical vein thrombosis

A
  1. Stroke like FOCAL symptoms with seizures

Thunderclap headache

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113
Q

What are simple focal seizures

A

Without impairment of consciousness

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114
Q

What part of the brain do complex seizures arise

A

Temporal, causes post-octal issues (simple do not)

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115
Q

What are absence seizures

A

Brief pauses (e.g. suddenly stops talking mis sentence then continues)

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116
Q

What are tonic-clonic seizures

A
  1. Loss of consciousness - limbs stiffen then jerk

Post-Octal

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117
Q

What are myoclonic seizures

A

Sudden jerk of limb, face and trunk - thrown suddenly to grown

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118
Q

What is an atonic seizure

A

Sudden loss of muscle tone

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119
Q

Clinical features of temporal lobe seizure

A
  1. Primitive oral (lip smacking, chewing or swallowing) or fumbling, fiddling grabbing
  2. Dysphagia
  3. Deja vu
  4. Amotional disturbance (Panic)
  5. Delusional behaviour
  6. Hallucinations
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120
Q

Clinical features of frontal lobe seizures

A
  1. Jacksonian march
  2. Motor arrest
  3. Behavioural disturbances
  4. Speech arrest
  5. Post-ictal todd’s palsy
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121
Q

What is todd’s palsy

A

Weakness in all parts of the body

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122
Q

When can AEDs be stopped

A
  1. Seizure free for more than 2 years, and done slowly over 2-3 months
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123
Q

Triad of parkinsonium

A
  1. Tremor
  2. Hypertonia
  3. Bradykineasia
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124
Q

Clinical features of parkinsonium

A
  1. Autonomic dysfunction (postural hypotension, constipation, urinary frequency, dribbling of saliva) or sleep disturbance
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125
Q

Three syndromes associated with parkinsonism

A
  1. Progressive supra nuclear palsy - early postural instability + false, rigidity of trunk and swallowing problems
  2. Multiple system atrophy - incontinence, rigidity tremor
  3. Portico-Basal degeneration - Akinetic rigidity involving only one limb, sensory loss and apraxia
  4. Lewy body dementia
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126
Q

Risk factors for idiopathic intracranial hypertension

A
  1. Obese females
  2. 30s
  3. Endocrine abnormalities
  4. Drugs
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127
Q

Ho wi s idiopathic intracranial hypertension managed

A
  1. Weight loss
  2. Acetaxolamide
  3. Prednisolone
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128
Q

Clinical feature of bell’s palsy

A
  1. Ipsilateral numbness around ear
  2. Decreased taste
  3. Hypersensitivity to sound
  4. Drooling of saliva
  5. Unilateral sagging of the mouth
  6. Speech ficciculty
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129
Q

Tests for bells palsy

A
  1. Increased Borrelia antibodies in lyme

2. Increased VZV antibodies in Ramsay Hunt Syndrome

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130
Q

What is Ramsay Hunt Syndrome

A
  1. When shingles affects the facial nerve near ear (geniculate ganglion)
  2. Blisters around one ear
  3. Facial weakness or paralysis on same side as affected ear
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131
Q

What does the median nerve supply

A 
LOAF:
Two lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
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132
Q

What causes ulnar nerve palsy

A

Elbow trauma

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133
Q

Signs of ulnar nerve palsy

A
  1. Wasting of medial wrist flexors, interossei (can’t cross fingers)
  2. Medial two lumbricals (claw hand)
  3. Hypothenar eminence wasting
  4. 5th digit abduction weak
  5. Sensory loss)
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134
Q

Signs of radial nerve palsy

A
  1. Wrist finger drop with elbow flexed and arm pronated
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135
Q

Muscles innervated by radial nerve

A 
BEAST
Brachioradialis
Extensors
Abductor pollicis longus
Supinator 
Triceps
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136
Q

What causes brachial palsy

A
  1. Trauma
  2. Radiotherapy
  3. Heavy rucksack
  4. Thoracic outlet compression
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137
Q

What causes phrenic nerve palsy

A
  1. Lung cancer
  2. TB
  3. Thymoma
  4. Myeloma
  5. Infection (HIV, lyme)
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138
Q

What causes lateral cutaneous nerve of thigh palsy

A

Burning thigh pain from trapping under inguinal ligament

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139
Q

What causes sciatic nerve palsy

A

Damaged pelvic tumour or fracture to pelvis or femur

Causes foot drop and loss of sensation lateral knee

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140
Q

Clinical features of common perineal nerve

A
  1. Foot drop
  2. Weak ankle dorsiflexion/eversion
  3. Sensory loss over dorsal foot
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141
Q

Clinical features of tibial nerve palsy

A
  1. Cant stand on tiptoe
  2. Invert foot
  3. Flex toes
  4. Sensory loss over soles
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142
Q

Clinical features of carpal tunnel syndrome

A
  1. Aching pain at night
  2. Paraesthesia in thumb, index and middle fingers
  3. Sensory loss and weakness of abductor policies braves
  4. wasting of thenar eminence
  5. Light touch and 2 point discrimination impaired
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143
Q

Tests for carpal tunnel syndrome

A
  1. Phaeton’s test and Tinel’s test
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144
Q

Treatment for carpal tunnel syndrome

A
  1. Splinting and decompression surgery

2. Steroid injection

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145
Q

What is bulbar palsy

A

LMN where tongue and swallowing muscles are affected, fasciculation tongue

Jaw jerk absent or normal

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146
Q

What causes bulbar palsy

A
  1. GB, polio, MG, syringobulbia
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147
Q

Signs of C4/5 impingement

A
  1. Weak deltoid and supraspinatus; numb elbow decreased supinator jerk
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148
Q

Signs of C5/6 impingement

A
  1. Weak biceps + brachioradialis
  2. Reduced bicep jerk
  3. Numb thumb + index finger
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149
Q

C6/c7 impingement

A
  1. Weak triceps + finger extension
  2. Decreased triceps jerk
  3. Numb middle finger
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150
Q

C7/T1 impingement

A
  1. Weak finger flexors + small muscles of the hand; numb 5th and ring finger
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151
Q

What is Duchenne’s muscular dystrophy

A
  1. 4yrs old - clumsy walking and difficulty standing
  2. resp failure
  3. Pseudohypertrophe in calves
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152
Q

What is backer’s muscular dystrophy

A
  1. Duchenne’s but happens later and better prognosis
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153
Q

Cl,finical features of myotonic dystrophy

A
  1. Distal weakness
  2. Weak sternomastoids
  3. Cataracts
  4. Male frontal blindness
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154
Q

Clinical Features of MG

A
  1. Extroocular
  2. Bulbar
  3. Ptosis
  4. Diplopia
  5. Myasthenia snarl when smiling
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155
Q

Treatment of Lambert Eaton syndrome

A
  1. NEOSTIGMINE or IvIg
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156
Q

What is type 1 neurofibromatosis clinical features

A
  1. Cafe au last spots
  2. Freckling
  3. Nodular neurofibromas on nerve trunks
  4. Lisch nodules (nodules on iris)
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157
Q

Complications of type 1 neurofibromatosis

A
  1. Nerve root compression
  2. GI bleeds
  3. Scoliosis
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158
Q

Difference between type 2 and 1 neurofibromatosis

A
  1. Cafe au last spots fewer

2. Acoustic neuromas characteristic

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159
Q

What is syringomyelia

A
  1. Tubular cavity close to central canal of cervical cord
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160
Q

What causes syringomyelia

A
  1. Blocked CSF circulation
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161
Q

What is arnold chair malformation

A

Cerebellum herniates through foramen magnum

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162
Q

Clinical features of syringomyelia

A
  1. Dissociated sensory loss due to press on the decussation anterolateral spinothalamic pathway in root distribution
  2. Wasting or weakness of hands and claw hands
  3. Horner’s sign
  4. Charcot joints
  5. Chiromegaly (enlarged hand or foot)
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163
Q

What is syringobulbia

A

Brianstem involvement of tubular cavity

Includes nystagmus, tongue atrophy, dysphagia and pharyngeal weakness

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164
Q

Clinical features of meningitis

A
  1. Headache
  2. Fever
  3. Leg pains
  4. Cols hands
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165
Q

Prophylaxis of meningitis

A
  1. Ciprofloxacin
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166
Q

Acute management of meningitis

A
  1. DEXAMATHASONE 10mg IV

2. Ceftriaxone, amoxicillin if immunocompromised

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167
Q

Clinical features of a brain abscess

A
  1. Seizures
  2. Fever
  3. Localising signs
  4. COMA
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168
Q

How is cerebral abscess treated

A

. Treated increased ICP

2. Neurosurgical referral

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169
Q

Causes of cerebral abscess

A
  1. Strep millers - teeth
  2. Bacterial abscess if peripheral
  3. Toxoplasma lesions are deeper (e.g. basal ganglia)
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170
Q

UMN signs

A
  1. Muscle weakness
  2. Spasticity
  3. Clasp knife response
  4. Babinksi sign present
  5. Pronator drift

UMN: Hypertonia, Hyperreflexia, spasticity, clonus

LMN: muscle atrophy, fasciculations, decreased reflexes, decreased tone, placid paralysis

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171
Q

How does the GCSE score work

A 
Eye
1 - no open 
2 - opens in response to pain 
3 - opens in response to voice
4 - opens spontaneously 
Verbal
1 - no sound
2- makes sound
3 - words
4 - confused, disorientated
 5 - orientated, normal
Motor
1 - makes no movement 
2- painful stimuli extension 
3 - abnormal flexion to painful stimuli 
4 - Flexion to painful stimuli 
5 - localises painful stimuli 
6 - obeys command
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172
Q

What is the role of orexin

A
  1. Increasing the activity of wake-promoting regions of the brain
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173
Q

What causes narcolepsy

A

Autoimmune process which damages neutron delivering orexin

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174
Q

Onset of narcolepsy

A

Adolescence and young adulthood

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175
Q

Clinical features of narcolepsy

A
  1. Daytime sleepiness
    Fall asleep with little warning
  2. Improves with napping during the day
  3. VIVID Dreams as they go straight into REM compared to normal people (takes an hour)
  4. Cataplexy
  5. Muscle weakness affecting face, neck and knees
  6. Hypnagogic hallucinations while the patient falls asleep
  7. Hypnopompic hallucinations
  8. Sleep paralysis
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176
Q

What is cataplexy

A

Transient muscle weakness in response to strong emotion

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177
Q

Investigations for narcolepsy

A
  1. Polysomnography
  2. Multiple sleep latency test
  3. EEG, ECG tracing
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178
Q

What is the choroid plexus made from

A

Ependymal cells - produce CSF

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179
Q

What causes normal pressure hydrocephalus

A
  1. When CSF is unable to reach arachnoid granulations normally
    This leeds to slow build up of CSF in ventricles, these dilate causing pressure to normalise
    These press against the corona radiate (part of brain with fibres relaying sensory and motor information between body and cortex)
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180
Q

What is primary vs secondary normal pressure hydrocephalus

A
  1. Idiopathic

2. Damage to arachnoid villi

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181
Q

What causes arachnoid villi damage

A

SAH, meningitis

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182
Q

Clinical signs of Normal pressure hydrocephalus

A
  1. WWW
    Wet
    Wacky
    Wobbly
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183
Q

Long term treatment of normal pressure hydrocephalus

A
  1. Shunting - ventriculoperitoneal shunt
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184
Q

What would be found on an MRi for MS

A
  1. T2 lesions
  2. Periventricular plaques
  3. Dawson fingers
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185
Q

What would be seen in CSF for MS

A
  1. Oligoclonal bands

2. Increased intrathecal synthesis of IgG

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186
Q

What blood test can be used to differentiate between a true seizure and a pseudoseizure

A
  1. PROLACTIN (raised after pseudo seizure)
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187
Q

Clinical features favouring pseudo seizures

A
  1. Pelvic thrusting
  2. Female
  3. Crying after
  4. Gradual onset
  5. Does not occur alone
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188
Q

What is von hippie landau syndrome

A
  1. A condition featuring visceral cysts and benign tumours in any system
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189
Q

Why do people develop a high stepping gait in peripheral neuropathy

A

Compensate for foot drop

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190
Q

What does tolivopontocerebellar atrophy present with

A

Parkinsonism and cerebellar signs

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191
Q

What does progressive supra nuclear palsy present with

A

Parkinsonism and ophthalmoplegia

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192
Q

What does Lewy body dementia present with

A

Parkinsonism and visual hallucinations

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193
Q

First line treatment for trigeminal neuralgia

A

Carabamzepine

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194
Q

First line treatment of essential tremour

A

Propranolol

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195
Q

What is hoover’s sign used for

A

To differentiate between organic and non-organic lower leg weakness

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196
Q

Clinical Features of temporal arteritis

A
  1. Rapid onset, unilateral
  2. Jaw claudication
  3. Tender, palpable temporal artery
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197
Q

What sign can be used to test for MS

A
  1. HOFFMAN’s SIGN (MS is usually only uMN)
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198
Q

What is progressive supra nuclear palsy

A
  1. Starts of with symmetrical impaired balance
  2. Poorly responsive to levodopa
  3. Vertical gaze palsy
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199
Q

What is chair 1 malformation

A
  1. Herniation of cerebellum through foramen magnum
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200
Q

What is syringomyelia

A
  1. Dilation of CSF space in spinal cord- compresses spinothalamic tract decussating in anterior white commissure

Causes loss of sensation of pain, temperature and non-discriminative touch (CAPE-LIKE DISTRIBUTION)

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201
Q

What is conduction (associative) dysphagia

A

Happens in arcuate fasiculus - comprehension good, fluent speech but poor repetition

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202
Q

What medication is used in managing just the tremor in drug-induced parkinsonism

A

Procyclidine

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203
Q

What parkinson drug can cause PF

A

Cabergoline

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204
Q

What do we do with patients who have a GCS of less than 8

A

Immediate review by anaesthetist and intubation/ventilation

Airways IS FIRST PRIORITY

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205
Q

What is first line opioid treatment for neuropathic pain

A

TRAMADOL

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206
Q

What root is thumb + index finger

A

C6

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207
Q

What root is middle finger and palm of hand sensation

A

C7

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208
Q

What root is ring and little finger sensation

A

C8

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209
Q

What is the diagnostic criteria for migraine without aura

A
  1. FIVE ATTACKS
  2. Lasts 4-72 hours
  3. Unitlateral, pulsating, moderate pain, aggravated by physical activity
  4. Nausea/photo/phonophobia
  5. Not attributed to another condition
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210
Q

Clinical features of an acoustic chroma

A
  1. UNILATERAL tinnitus

2. Deafness

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211
Q

Clinical features of labrinthistis

A
  1. Vertigo

2. Hearing loss

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212
Q

Clinical features of low CSF headaches (hypotension)

A

Get worse on standing, improve when lying flat

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213
Q

Investigations for spontaneous intracranial hypotension

A
  1. MRI with gadolinium
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214
Q

What patients other than those with focal seizures should not be prescribed valproate

A

1, Female children

2, Women of childbearing potential

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215
Q

What should be given to patients with absence seizures if valproate is ineffective

A

Ethosuximide

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216
Q

If a patient has a GCSe of 5 or less what should be done to maintain airway

A

Cuffed endotracheal tube

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217
Q

What causes cavernous sinus syndrome

A
  1. Tumours by invasive malignancies
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218
Q

Clinical features of CS syndrome

A
  1. Pain
  2. Ophthalmoplegia
  3. Proptosis
  4. Trigeminal nerve lesion
  5. Horner’ syndrome
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219
Q

What is the blood supply of the cavernous sinus

A
  1. Ophthalmic vein
  2. Superficial cortical vein
  3. Basilar plexus of veins
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220
Q

Drainage fo cavernous sinus

A
  1. Internal jugular vein
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221
Q

Name three diseases in which Lhermitte’s sign is seen

A
  1. subacute degeneration of cord

2. Cervical stenosis

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222
Q

How is carotid artery stenosis diagnosed

A

Duplex ultrasound

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223
Q

What are meningiomas

A

BENIGN tumours from the dura that press on the brain

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224
Q

Where are vestibular schwannomas commonly seen

A
  1. Cerebellopontine angle

Causes facial nerve palsy and hearing loss

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225
Q

What do glioblastomas look like on imaging

A
  1. Solid tumours with central necrosis and a rim enhancing with contrast
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226
Q

What is used to treat oedema from glioblastoma multiform

A

Dexamethasone

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227
Q

What is used as prophylaxis for migraines

A

ACUTE: triptan
PROPHYLAXIS: propranolol

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228
Q

What is the problem giving folate to B12 deficient patients

A

Can cause subacute combined degeneration of the cord

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229
Q

What sign can be used to test for MS

A
  1. HOFFMAN’s SIGN (MS is usually only uMN)
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230
Q

What condition is Alzheimer’s commonly associated with

A

Hydrocephalus ex vacuo (atrophy of cortical tissue causes replacement of cortex by CSF)

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231
Q

What structures in the brain atrophy in Huntington’s and why

A
  1. Caudate Nucleus
  2. Putamen

As there is a loss of GABA-ergic neutrons in the basal gangliaa

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232
Q

What causes Benign paroxysmal positional vertigo

A

Abnormal shifting of calcium crystals within semicircular canals of inner ear

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233
Q

How is BPPV diagnosed

A
  1. Dix-Hallpike maneuver - forces crystals out of the semicircular canals
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234
Q

What is Ramsay-hunt syndrome

A
  1. Herpes Zoster virus invades the ear canal and cause facial nerve palsy in conjunction to blisters in the ear
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235
Q

What is Benedikt syndrome

A

Same as weber’s except has hemiataxia instead of hemiplegia (weber)

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236
Q

What would be seen on an ECG for increased intracranial pressure

A

T wave inversion

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237
Q

Is GVS symmetrical or assymetrical

A

GBS is asymmetrical

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238
Q

How is GBs diagnosed

A

CSF analysis- shows albuminocytologic dissociation

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239
Q

Clinical features of ependymomas

A

Glial tumours that press against anterior commissure - loss of pain and temperature sensation below spina level of lesion

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240
Q

What two substances are found in higher cones in the CSf compared to the blood

A
  1. Creatinine
  2. Mg
  3. Chloride
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241
Q

What part of the dorsal column do the a) sensory information from upper body and b) lower body travel up

A

a) . gracilis fascicle

b) . cuneate fascicle

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242
Q

Describe the journey of the dorsal column-medial leminiscus system

A
  1. Decussate at the medulla by snapping at the nucleus
  2. Decussate ad forms the medial liminiscus
  3. Moves to thalamus at the VPLN
  4. Synapses on 3rd order neurone
  5. Through internal capsule to primary somatosensory cortex
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243
Q

What do the spinothalamic tracts carry

A
  1. Crude touch
  2. Pain
  3. Pressure
  4. Temperature
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244
Q

Describe the pathway of the spinothalamic tract

A
  1. First order neurones synapse at dorsal root ganglion
  2. Move up one or two segments and synapse at second order neurones in dorsal horn
  3. Decussate at anterior spina-thalamic tract (crude touch and pressure) or lateral spinothalamic tract (pain and temperature)
  4. Both lateral and anterior ascend through contralateral spinal cord to contralateral thalamus - VPLN
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245
Q

Describe the pathway of the spinocerebellar tract

A
  1. Synapse at dorsal root ganglion
  2. Either decussate to form ventral spina cerebellar tract or stay dorsal spinocerebellar tract
  3. Synapse at cerebellar peduncle
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246
Q

WHERE do LMN originate

A

Ventral horn

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247
Q

Describe the pathway of the anterior corticospinal tract

A
  1. Internal capsule

2. Cerebral peduncle and decussates at ventral horns

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248
Q

Describe the pathway of the lateral corticospinal tract

A
  1. Internal capsule -> cerebral peduncle -> decussation of pyramids in the medulla -> contralateral
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249
Q

What do the lateral corticospinal tract innervate

A

Extremity muscles

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250
Q

What do the anterior corticospinal tract innervate

A

Muscles of the trunk

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251
Q

What CN are involved in the corticobulbar pathway

A

5,7, (pons) 11,12 (medulla)

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252
Q

What corticobulbar pathways have ipsilateral and contralateral innervation

A
  1. 5

2. 11

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253
Q

Where do extrapyramidal tracts originate from

A

Deep nuclei from brainstem

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254
Q

Role of LATERAL vestibulospinal tract

A

EXTENSORS of the trunk - balance

There are 4 vestibular nuclei

DOES NOT DECUSSATE

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255
Q

Role of medial reticulospinal tract

A

DOES NOT DECUSSATE - goes to extensors for balance

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256
Q

Role of lateral reticulospinal tract

A

Innervate both sides of the body

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257
Q

Role of tectospinal tract

A
  1. Neck movement

THESE DECUSSATE

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258
Q

Where do the rubrospinal tract originate from

A
  1. Red nucleus

THESE DECUSSATE

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259
Q

Does the vetsibulospinal tract decussate

A

No

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260
Q

What drug is used in MND/ALS management

A
  1. Riluzole - prevents stimulation of glutamate receptors
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261
Q

Prognosis of MND

A

Poor: 50% die within 3 years due to respiratory failure

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262
Q

NOTE: Ptosis + dilated pupil = third nerve palsy

Ptosis + constricted pupils (miosis) = horners

A

N/a

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263
Q

Why is DOmperidone given for parkinson’s induced vomiting (from careldopa) compared to other anti-emetics like metochlopramide

A
  1. There rest can cause parkinson’s disease to get exacerbated

DOMPERIDONE does not cross the BBB so has no extra-pyramidal side effects

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264
Q

What characterises an ataxic gait

A

Wide based gait with loss of heel to toe walking

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265
Q

How is confusion, ataxia and ophthalmoplegia symptoms treated in wernicke’s

A

Pabrinex

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266
Q

5 cancers that spread to the brain

A 
LUNG
Breast 
Bowel 
Skin 
Kidney
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267
Q

What causes right homonymous hemianopia with macular sparing

A
  1. Damage to contralateral occipital lobe after infection, durgey, tumour or trauma

The MACULA is spared because it is supplied by the middle cerebral arteries which means it will be cortical related and not the visual tract compression issue (e.g. pituitary gland)

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268
Q

Clinical Features of brown squared syndrome

A
  1. Ipsilateral loss of proprioception/fine touch
  2. Contralateral loss of pain and temperature

This is because DMLS and Corticospinal tracts decussate at medulla so ipsilateral

Spinothalamic tract decussates level of spinal cord

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269
Q

What is optic neuritis

A
  1. VISUAL LOSS with pain on eye movement or direct palpation

Usually resolves on own

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270
Q

What stain is used for neurons

A

Neurofilaments

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271
Q

Where do gliomas from neurofibromatosis type 1 appear

A

Visual (2 is acoustic neuroma)

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272
Q

What is the stellate ganglion

A

Lies at C7 and is used to treat sympathetic-associated pain in head,neck and upper extremities - blocked to stop horner syndrome signs from showing!

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273
Q

What is Benztropine used for

A

Parkinson’s - to relieve resting tremors and rigidity (has no use for bradykinesia)

Side-effectsL Dry mouth/mucous membranes and dilated pupils

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274
Q

What stage of sleep does sleepwalking occur and night terrors/bed wetting

A

N3, REM - all muscle tone is decreased so none of this happens then

N2 - Bruxism

N1 - is light sleep, people don’t really think they’re asleep at this stage

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275
Q

What does the posterior cerebral artery supply

A
  1. Occipital lobe, temporal lobe, thalamus, brainstem, and midbrain

BILATERAL homonymous filed cut

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276
Q

What receptor is responsible for fine touch in the skin

A

Meissner’s corpuscles

PANCINIAN are lower

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277
Q

What is parinaud syndrome

A

Syndrome of pineal gland (tumour) - will show signs of ICP and also can’t lift their gaze

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278
Q

What can cause labyrinthitis

A
  1. HS type 1

2. Upper RTI

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279
Q

Clinical features of labrynthistis

A
  1. VERTIGO
  2. HEARING LOSS
  3. TINNITUS
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280
Q

What drugs cause impulse control problems in people with parkinson’s

A
  1. Dopamine agonists - pramipexole
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281
Q

Two adverse effects of carbamazepine

A
  1. Steven Johnson syndrome
  2. Toxic Epidermal Necrolysis

Happens in Southeasten Asian people more commonly

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282
Q

How do benzodiazepines work

A
  1. Facilitates GABA production
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283
Q

What would be seen on a histological slide in lewy body dementia

A
  1. Alpha synuclein deposits in brian cortex
284
Q

What are risk factors idiopathic intracranial hypertension

A
  1. Young, OBESE women
285
Q

Recap nerve endings from the midbrain, pons and medulla

A

N/a

286
Q

What condition is cerebral amyloidopathy seen

A

Alzheimer’s - causes hemorrhagic strokes

287
Q

What is the onuf’s nucleus

A

nucleus that controls bladder constrictors.

288
Q

What is cholesteatoma

A

Mass of squamous debris in middle ear - causes hearing loss and dizziness

289
Q

Most malignant type of brain tumour

A

Glioblastoma multiforme

290
Q

Histology stain of glioblastoma multiform

A
  1. glial fibrillary acidic protein

Shows central haemorrhage and necrosis

HEADACHES ARE WORSE IN TH MORNING

291
Q

Imagine characteristic of glioblastoma

A

Crosses the midline

292
Q

What is Gerstmann syndrome

A
  1. lesion in the parietal lobe causing AFAR (agraphia, finger agnosia, acacia, right-left confusion) - happens in strokes
293
Q

What is osmotic demyelination syndrome

A
  1. OVERLY rapid correction of hyponatremia can cause water to cross BBB = oedema and reduces astrocytes ability to protect neutrons with foot processes. Thus causing central pontine myelinolysis = locked in syndrome
294
Q

Role of the striatum

A
  1. Receives input from cortex about desired movement and send output to CONTROL SMOOTH MOVEMENT + inhibit undesired movement
295
Q

What makes up the diencephalon

A

Thalamus

Hypothalamus

296
Q

Role of thalamus

A
  1. Receives body information to cerebral cortex and vice versa
297
Q

Role of hypothalamus

A
  1. Regulate body temp
  2. Sleep wake cycle
  3. Eating/drinking
  4. Regulates endocrine hormones
298
Q

Role of he midbrain

A
  1. Hearing
  2. Vision
    3, Motor control
  3. Consciousness
299
Q

Role of the medulla

A
  1. BP
  2. Brwahitng
  3. Swallowing
  4. VOmiting
  5. Digestion
300
Q

What is found int he lateral horns

A
  1. Sympathetic division of the autonomic nervous system (urination/digestion)
301
Q

What cranial nerves come out from the i=midbrain

A
  1. 3 and 4
302
Q

What cranial nerves come out of the pons

A

5,6,7,8

303
Q

What cranial nerves come out from the medulla

A

9,10,11,12

304
Q

Role of the sclera

A
  1. Tough and fibrous to protect structures

2. Anchoring point

305
Q

Muscles that control the size of the pupil

A
  1. Dilator pupillae muscle

2. Sphincter pupillae muscle

306
Q

In which compartment of the eye is the lens found

A
  1. Posterior chamber (with ciliary body)
307
Q

Role of the ciliary body

A

Controls lens shape and bound by suspensory ligaments

308
Q

Role of choroid

A
  1. Blood vessels that supply the eye - absorbs lights to allow light to focus on retina
309
Q

Describe the structure of the retina

A
  1. Ganglion cells -> Bipolar cells -> photoreceptors-> pigmented epithelial cells to be absorbed
310
Q

Properties of RODS

A
  1. Light sensitive (low light condition sensitive)

2. Black and white

311
Q

Properties of cones

A
  1. Less light sensitive

2. Red,green or blue

312
Q

What is the fovea

A
  1. Greated visual acuity in macula
313
Q

What forms the anterior chamber

A

Cornea

Iris

314
Q

What is the aqueous hummor

A
  1. Provides nutrients to lens and cornea

Produced by ciliary epithelium

315
Q

Name the three ear bones

A

Malleus, incus, stapes

316
Q

Role of pinna

A

Directs sound into external acoustic meatus

317
Q

Role of cerumen

A

Stops foreign objects from getting into tympanic membrane (eardrum)

318
Q

What part of the skull is the middle ear located in

A

Temporal bone

319
Q

Roles of the oval and round windows

A

1.

320
Q

Role of the eustachian tube

A
  1. Equalises pressure across tympanic membrane
  2. Protects from reflux of fluids from nasopharynx
  3. Clears out middle ear secretions
321
Q

What does the stapes connects to

A

Oval window -> inner ear

322
Q

What can the inner ear be split into

A 
Membranous labyrinth (ENDOLYMPH) 
Bony Labyrinth (PERILYMPH)

Vestibule: Cochlea hearing and semicircular canals

323
Q

Role of perilymph and endolymph

A

Hearing and balance

324
Q

Three layers of the cochlea

A
  1. Scala vestiboli (oval window) - PERI
  2. Cochlear duct (organ of corti) - ENDOLYMPH
  3. Scala tympani (round window bulges back into middle ear to relief pressure) - PERI
325
Q

What are the two parts of the vestibular apparatus

A
  1. Semicircular canals

2. Saccule and utricle - balance

326
Q

Role of ampulla

A

Detects changes in head rotation (contains hair cells for balance)

327
Q

Role of utricle and saccule

A
  1. Have macular containing balance receptors (detect changes in horizontal or vertcile acceleration)
328
Q

What is a neutrons resting potential

A

-55 mV

329
Q

Describe the process of neutron action potentials

A
  1. Opens voltage gated sodium channels
  2. Influx causes nearby voltage gated sodium channels down the length of axons to open
  3. +40 mV
  4. K+ voltage gated channels open causes K+ to move out
  5. Becomes less positive
  6. Na+/K+ pump moves3 na out and 2K+ into neurone
  7. Hyperpolarisation - all sodium channels now closed causing relative refractory period needs stronger stimulus to be excited
330
Q

What is the absolute refractory period

A
  1. Where no excitation can occur, mans it will go in one direction
331
Q

Role of extrafusal fibres

A
  1. Innervated by ALPHA motor neurones

2. Provide most of the force from cortex - voluntary

332
Q

How do extrafusal muscles attach to bones

A

Golgi tendon organs

333
Q

What fibres make up muscle SPINDLES

A

Intrafusal muscle fibres

Contain contractile proteins only at the ends not in the middle so this doesn’t contract

334
Q

What is contained din the centre of the muscle spindles

A
  1. Nuclei
  2. Type 1a neuron fibres - relay how far and fast the muscles are stretched
  3. Type 2 in outer central how far the muscle is being stretched
335
Q

Role of gamma motor neurons

A

Actin and myosin in edges - causes contraction in intrafusal muscles

336
Q

Describe the stretch reflex

A
  1. Type 1a -> anterior horn -> alpha motor neuron -> extesors
  2. Type 2 -> anterior horn -> INHIBITORY interneuron -> ALPHA motor neurone of flexors

Causes relaxation of flexors and stimulation of extensors - leg kicks out

337
Q

Describe the golgi tendon reflex

A
  1. Golgi tendon organ compressed
  2. Fire off more action potentials
  3. Type 1b -> inhibitory interneuron -> alpha -> biceps

1b -> stimulatory interneuron -> alpha -> triceps

Prevents biceps from being damaged.

338
Q

Direct vs indirect pathway

A

Excitatory vs inhibitory

339
Q

Describe the direct pathway

A
  1. Cortx -> excitatory -> Striatum -> GABA -> Interntal globus pallidus -> less GABA -> thalamus

d1 - excitatory

340
Q

Describe the indirect pathway

A

Cortex -> excitatory -> Striatum -> GABA -> external GP -> Less GABA -> Subthalamic nucleus -> more excitatory projections -> internal GP -> more gaba -> thalamus

d2 - inhibitory

341
Q

What is pseudo dementia

A

Depression related dementia - tend to be distressed/self aware of their cognitive impairment

342
Q

Role of medial temporal lobe

A

Limbic memory circuit (amnesia) - can repeat back phrases and eventually forget after time
Emotional circuits

343
Q

Role of lateral temporal lobe

A

Word ad picture store

344
Q

CF of subcortical dementia

A
  1. Reduced mental processing
  2. Poor attention and retrieval
  3. Apathy
  4. Mood disturbance
  5. Lack of cortical signs
345
Q

CF of alzheimer’s

A 
Medial temporal lobe:
Amnesia
Long term memory fine
Visual and spatial disorientation 
Dysphagia (wernicke's)
Dyscalculia
Dyspraxia
No motor signs as its subcortical
346
Q

CF of vascular dementia

A
  1. Psuedobulbar palsy
  2. Subcortical: mental and physical decline, apathy
  3. Shuffling gait
347
Q

CF of lew body dementia

A
  1. Parkinsonism
  2. Hallucination
  3. Myoclonus - jerks

KEY FEATURE: fluctuating confusion

348
Q

What part of the temporal lobe is found in front temporal dementia

A

LATERAL so no amnesia is seen here

Parkinsons or MND can also be found in these patients

349
Q

What is echolalia

A

Repeating what you’ve said back to me

350
Q

What is logoclonia

A

Stutter - characteristic in alzheimers

351
Q

Investigations for dementia

A
  1. MMSE
  2. Montreal OCA
  3. ACE (adab brooks cog exam)
  4. Neuropsychology, imaging, EEG
352
Q

What is the dost sensitive investigations for confirming location of a stroke

A

MRI scan at day 1 with diffusion weighted imaging

CT on admission will not show ischaemia,especially for small strokes like lacunar

353
Q

Scoring of ABCD2

A
  1. Age over 60
  2. BP (140/90)
  3. Clinical features (unilateral weakness = 2, speech disturbance - 1)
  4. Diabetes
    Duration (2 over 60, 1 less than 60)
354
Q

What risk number on ABCD2 would mean urgent assessment

A

> 3

355
Q

How is anticoagulation reversed

A

Vit K/Beriplex

356
Q

Score system of AF

A
  1. Congestive HF 1
  2. HTN 1
  3. Age > 75 2
  4. DM 1
  5. Stroke/TIA/emoolus 2
  6. Vascular Disease 1
  7. Age 65 to 74 1
  8. Sex (female)1

2 is cut off for anticoags

357
Q

What is the HASSLED criteria

A

Criteria to assess major bleed following anticoags

358
Q

Treatment of a hemorrhagic stroke

A

Reverse coag - IV K/beriplex Maybe

BP lowered

Neurosurgery

359
Q

Common gene cause of MND

A

SOD1 - codes for superoxide dismutase

360
Q

What MND carries the worst prognosis

A

Progressive bulbar palsy

361
Q

Investigations for MND

A
  1. EMG
    2 .MRI
  2. LP
362
Q

Pathophysiology of parkinsons

A

Loss of dopaminergic neurones in substantial nigra (pars compact)

Neurofibrillary tangles from alphasynuclean and ubiquitin

363
Q

CF of huntigtons

A
  1. Chorea
  2. Dementia
  3. Depression/agression
  4. Stiffness, dystonia
  5. Ptosis/eye movements
364
Q

Histology of alzheimers

A

Senile places

Neurofibrillary tangles

365
Q

Treatment of alzheimers

A

Donepezil (Achesterase inhibitors)

Memantine NMDA antagonist

366
Q

How do we test proprioception in a patient

A

Romberg’s test (close eyes)

367
Q

Where is a hemiplegic gait seen

A

UMN lesions: one foot is inverted and smacked around when turning

368
Q

Name two other conditions that has chorea

A
  1. SLE
  2. Wilson’s disease
  3. Pregnancy
369
Q

IF levodopa is causing motor complications, what can be given instead

A

MAO-B inhibitors

370
Q

What are pseudoathetosis movements

A

writhing movements of the fingers (nerve to parietal cortex problem).

371
Q

What is apraxia

A

Inability to execute movements

372
Q

Cells Involved in MS

A

Cd8
Th17
B cells
Maceophages

373
Q

Three impacts of MS on neurones

A

Conduction block

Axon Transection

Demyelination

374
Q

What criteria is used for MS

A

McDonalds criteria:

Dissemination in space

Dissemination in time

No alternative disease that could explain this

375
Q

Clinical signs of subacute degeneration of the spine

A

Presses against dorsal columns so proprioception and vibration gone - babinski sign positive

376
Q

Treatment of neuroleptic malignant syndrome

A

Bromocriptine

377
Q

Name a condition that commonly causes bilateral facial nerve palsy and parotid gland enlargement

A

Sarcoidosis

378
Q

What is post-herpetic neuralgia

A
  1. Happens after shingles re-starts infection
379
Q

Pathophysiology of TS

A
  1. Hamartin-Tuberin protein complex are tumour supressors that attach to mTOR and slow growth in the body
  2. Mutations occur in TSC1 or TSC2
  3. ALters these complex that cant switch of mTOR causing benign HAMARTOMAS forming in any tissues (usually skin, brain and lungs)
380
Q

CLinical Features of TS

A
  1. ANgiofibromas
  2. Subungual fibromas under nails
  3. Ash leaf spots
  4. Cafe au lait spots

KIDNEYS:
Hamartomas on kidneys can cause hamaturia
Flank Pain

LUNGS: Normal lung tissues replaced by cysts
SOB

BRAIN:
Seizurs
LD
Cognitive deficits

Eyes:

Retina

381
Q

Neurofibromatosis type 1 vs type 2

A

1: Extrmeities usually effected, just beneath skin surface and peripheral nerves / axillary nodes
2. Start in childhood
3. Cafe au lait spots on back, buttocks and thighs and increase in number as age
4. Lisch nodules, seizures

Type 2:
Affects brain, spianl cord and cranial nerves
Schwannomas along cranial nerves - acoustic neruomas bilateral

382
Q

4 types of MS

A
  1. Relapse remitting
  2. Secondary progressive MS (starts off Relapse remitting and then just gets worse and worse)
  3. Primary progressive MS
  4. Progressive relapsing MS
383
Q

Treatment of MS

A

Beta type 1b interferon

384
Q

Side-efefcts of L-DOPA

A
  1. On-off phenomenon, wearing off phenomenon
  2. Dyskenesia (uncontrolled movement, involuntary movement due to overexcitation)
  3. Hallucination and confusion as it crosses BBB (DO NOT GIVE IN PSYCHOSIS)
    DOPA decarboxylase is outside BBB - orthostatic hypotension, vomiting diarrhoea, broken into adrenlaine so needs care-ldopa
385
Q

Name a copamine-receptor agonist

A

Bromocriptine: Can cause PF, nausea and vomiting

Switch to ropinerole

386
Q

Name a COMPT inhibitor

A

Entacapone or Tolcapone - used if people develop motor complications (wearing off phenomenon, on-off phenomenon)

387
Q

Name a MAO-B inhibitor

A

Selegiline: Degraded to amhpetamine (excitement, anxiety and insomnia)

388
Q

Surgical methods of Parkinsons

A

Deep-brain stimulation

389
Q

What can exacerbate a myasthenic crisis

A

Bisoprolol

390
Q

Invetsigations for orthostatic hypotension

A
  1. L/S BP
391
Q

What nerve innervates the serratus anterior

A

Long Thoracic Nerve

392
Q

Most common cause of cauda equina

A
  1. Lumbar disc herniation
    Ankylosing sponylitis
    Anterospondylolisthesis
393
Q

Symptoms of cauda equina

A
  1. Ssddle anaesthesia
  2. Bowel and bladder control
  3. One or both legs affected/paraplegia

Sciatci pain

394
Q

Pharmacology od opioids

A
  1. Bind to inhibitory neurones which stop release of GABA, and allows release of serotonin and dopamine instead / decreased sensitivity to pain
395
Q

Side effects of opioids

A
  1. Withdrawal (shivering and anxiety/ raised BP)
  2. Dpeendance
  3. Nausea
  4. VOmiting
  5. Respiratory distress from medulla effects
  6. Pinpoint pupils
  7. Euphoria

Overdose:
Arrythmias
Increases ICP so cannot be given with patients with head injury

396
Q

How is opioid overdose treated

A

Naloxone and give them methadone

397
Q

Name some full opioid agonists and partial agonists

A

Full:
Morphine
Methadone (does not cuase euphoria so used for withdrawal)
Fentanyl (most potent - anaesthetic)

PArtial:
Buprenorphine
Tramadol

398
Q

What drug is used for maagemet of acute MS relapses

A

Methylprednisolone

Fingolimod and Beta-interferon are used to reduce number of relapses - SHould not be started in GP setting

Amantadine can be used for fatigue - baclofen/gabapentin for tremours/spasticity

Oscillopsia - gapapentin

399
Q

What is Stevens/Johnson SYndrome

A

Adverse effect of lamotrigine: happens two months after starting with flu-like illlness and rapid onset of red skin rash

400
Q

Name an autonomic recessive disease that can commonly cause ataxia

A

Friedrich’s ataxia (nystagmus, fast saccadic eye movement)

401
Q

What is localising in GCS

A

Arm is brought above the clavicle when supraorbital pressure is applied, or else its flexing

402
Q

How are subdural haematomas treated

A

Carniotoomy or burr holes at site of haematoma - drain sthem so in chronic subdural haematomas

403
Q

What medication can reverse Benzo overdose

A

Flumanazile

404
Q

Benzo overdose vs opioid

A

Pupils are normal

405
Q

GBS CSF composition

A

High protien and no change in WBC

406
Q

How do we test for brain death

A
  1. Take of ventilators - vagus
  2. Vetibulocochlear reflex
  3. Oculomotor reflex
  4. Gag reflex
407
Q

What causes RAPD

A

Lesion of optic nerve due to glaucoma

408
Q

How is RAPD diagnosed

A

Swinging flashlight test

409
Q

What causes glaucoma

A

Increased ICP: drainage of aqueous humour becomes occluded

410
Q

Symptoms of glaucoma

A
  1. Pain
  2. Red eye
  3. Nausea, vomiting
411
Q

Emergency treatemnt of acute glaucoma

A

You want to costrict the pupil to life it up and away from the aqueous humour drainage hole

Bright room
Pilocarpine (makes pupil smaller)
Beta-blocker drugs to reduce production
Laser surgery

412
Q

Symptoms of vitreous haemorrhage

A
  1. Floaters
  2. Red tinge
  3. Blurring of vision
413
Q

How it retinal detachment repaired

A
  1. Scleral buckle surgery (band around the eye to push retina back where it is supposed to be)
  2. Vitrectomy (go into side of the eye and take out vitreous humour, add gas bubbles to push it back into place)
414
Q

pathophysiology of central retinal vein occlusion

A
  1. DIlation of branch veins - causes cotton wool spots and rettinal haemorrhages
415
Q

How is central retinal vein occlusion treated

A

Anti VEGF

416
Q

Sign and symptoms of central retinal artery occlusion

A

CHARACTERISTIC: red spots in macula and pale optic disc

Macula is upplied, rest of retina is pale

CANNOT BE treated

417
Q

Pathophysiology of anterior iaschaemic optic neuropathy

A
  1. Posterior ciliary artery occlusion - supplies optic nerve head

Caused by temporal arteritis/GCA - jaw claudication

60mg of prednisolone

418
Q

Signs and symptoms of optic neuritis

A
  1. Reduced visual acuity over two day s
  2. Pain on moving eye
  3. Exacerbated by heat
  4. RAPD
  5. Dyschromatopsia (colour blindness)
419
Q

What can cause optic neurtis

A 
B12 defiiency 
MS
CIS
Lymes
Syphilis
HIV

REMEBER THESE - resolves within 6 weeks

420
Q

Investigation of unilateral vision loss

A
  1. Opthalmoscopy
  2. USS
  3. MRI - optic
  4. VEP
  5. Fluoroscein angiography
  6. Tonometry - measures intraocular pressure
  7. USS - vitreous haemorrhage and retinal detachment
421
Q

What is babinski’s sign

A

Dorsiflexion of the big toe on plantar stimulation: indicative of UMN lesions

422
Q

What is Brudzinski’s sign

A

Reflex flexion of the hips when flexion of the neck is forced: Subarachnoid haemorrheages, encephalitis and more importantly meningitis

423
Q

What is the straight leg raise test indicative of

A

Lumbar disc herniation - produces radiating leg pain

424
Q

Conversion disorder vs somatisation

A

Conversion is loss of motor and sensory function usually aused by stress vs changes in motor and sensory presentations which recurr frequently for at least two years.

425
Q

What is a dissociative fugue

A

Sudden and unexpected travel away from one’s home with an inability to recall the past.

426
Q

Use of SSRIs during pregnancy: What are the impacts in the third trimester

A

Persistent pulmonary hypertension

427
Q

What medications should be avoided when prescribing SSRIS

A 
NSAIDs
Warfarin
Aspirin
Triptans
MAOIs
428
Q

First line drugs for PTSD

A

Venlafaxine or SSRIs.

429
Q

What is a common abnormal finding in lithium, corticosteroids and beta blockers in blood check ups

A

Benign leucocytosis (just safety net)

430
Q

What is the first line treatment for diabetic neuropathy

A

Duloxetine

431
Q

Major side effect of Venlafaxine and Duloxetine (SNRIs)

A

Hypertension, must check BP

432
Q

What lack of substance is associated with anxiety

A

Low GABA

433
Q

What antidepressant should be given to those suffering from SSRI erectile dysfunction

A

Buproprion

434
Q

Examination signs of serotonin syndrome

A
  1. Anxiety/Confusion
  2. Hyperreflexia (positive babinski signs with positive ankle clonus)
  3. Muscle rigidity
  4. Tachycardia, leucocystosis
435
Q

What condition usually gives rise to Myasthenic Lambert Eaton Syndrome

A

Small cell lung cancer

436
Q

What condition can result in central retinal artery occlusion

A

Giant Cell Arteritis

437
Q

Innervation of the Superior Oblique Muscles

A

Trochlear Nerve (4)

438
Q

Role of the superior oblique muscle

A

Abducts and medially rotates the eye ball (down and out)

439
Q

Role of the inferior oblique muscle

A

Abducts and laterally rotates the eyeball (up and out)

440
Q

Innervation o the inferior oblique muscle

A

Oculomotor nerve

441
Q

What information does the lateral spinothalamic tract relay

A

Pain and temperature

442
Q

What does the anterior spinothalamic tract convey

A

Crude Tocuh

443
Q

In which Motor Neurone condition is Flaccid Paralysis seen in and in which motor neurone condition is spastic paralysis seen in and why

A

Flaccid = Lower Motor Neurone Disease

Spastic = Upper Motor Neurone Disease

This happens because in UMN, the lower motor neurones become so starved from insufficient firing of impulses, they become hypersensitive and cause sustained contraction

444
Q

Name the three branches of the cavernous sinus

A

Ophthalmic
Maxillary
Mandibular

445
Q

What does the basilar artery supply

A

Brainstem

Cerebellum

446
Q

Three types of strokes

A

Thrombotic
Embolic
Hypoxic

447
Q

Symptoms in anterior vs middle vs posterior cerebral artery strokes

A

Anterior: Feet and Legs

Middles: hands, arm and face
Language centres in the dominant hemisphere

Posterior: Visual Cortex

448
Q

If no blood is seen on a CT of the head, and a subarachnoid haemorrhage is still suspected, what should be done?

A

Lumbar Puncture to check for xanthochromia in the CSF

449
Q

Where do emboli strokes most commonly occur

A

PICA as it’s the first big artery to come off the arteries.

450
Q

Clinical Presentation of a TIA

A 
Amaurosis Fugax (curtain drop vision loss)
Dysphagia
Hemiparesis
Hemisensory disturbances
Diplopia
Vertigo
Vomiting 
Ataxia
451
Q

Symptoms of anterior cerebral stroke

A 
1. Leg and Arm weakness
2 .Gait Apraxia
3. Truncal Ataxia
4. Incontience
5. Drowsiness (as consciousness is in the frontal lobe)
6. Akinetic Mutism (stupor speech)
452
Q

Symptoms of middle cerebral artery strokes

A
  1. Contraletra; arm and leg weakness
  2. Contraleteral Sensory Loss
    Facial Droop
453
Q

symptoms of posterior cerebral artery strokes

A
  1. Contralateral Homonymous Hemianopia
  2. Cortical blindness (eyes are healthy)
  3. Visual agnosia
  4. Prosopagnosia
  5. UNILATERAL HEADACHE (does not happen in the other two)
  6. Vertigo, dysarthria, nausea, vomiting, visual disturbance
454
Q

Contraindications to antiplatlet therapy in a stroke

A 
Recent surgery (last 3 months)
recent arterial puncture
Malignancy
Brain Aneurysm 
Anticoagulation 
Liver Disease
Acute Pancreatitis
Clotting disorder
455
Q

What treatment is given if thrombolysis is contraindicated

A

75mg Aspirin 2 weeks and then 75 mg clopidogrel lifelong

456
Q

Treatment of a stroke, first line

A

IV alteplase (tissue plasminogen activator)

Clopidogrel 24 Horus after thrombectomy

457
Q

What pathology does a hemiplegic gait indicate

A

UMN lesion

458
Q

What does a broad based gait indicate

A

Cerebellar lesion

459
Q

What does a waddling gait indicate

A

Pelvic muscle weakness

460
Q

What are two key Signs of central retinal artery occlusion + treatment

A
  1. Pale Retina
  2. Cherry Red Spot

High Dose Steroids as it’s caused by Giant Cell Arteritis

461
Q

What is a vitreous haemorrhage

A

This is where blood from damaged veins/arteries leaks into the ‘clear’ vitreous fluid that supplies the lens and cornea etc., resulting in floaters

462
Q

What does the facial nerve supply

A
  1. Sublingual, Submandibular and Lacrimal Glands
  2. Stapedius muscle
  3. Supplies taste to anterior 2/3rds of the tongue
463
Q

What infections may cause Bell’s palsy

A

HSV
EBV
VZV

464
Q

Bell’s palsy vs Stroke/Brain Stem ischaemia

A

Remember, the contralateral motor neurone moves from the cortex and supplies the lower half of the face AND upper.

There is a supportive ipsilateral motor neurone that supplies the upper half of the face if the contralateral motor neurone fails.

As strokes are UMN lesions, they usually ONLY cause paralysis of the lower half of the face.

465
Q

What cranial nerves are affected in acoustic neruomas and how does this affect the clinical presentations found

A

8: Vertigo, unilateral hearing loss, tinnitus
5: ABSENT CORNEAL REFLEXES
7: Facial Palsy

466
Q

When is a thrombectomy indicated for an acute ischaemic stroke

A

Within 6 hours onset

OR with IV thrombolysis within 4.5 hours onset

To people who have: CONFIRMED occlusion of anterior circulation infarcts on a CT.

467
Q

When can thrombectomy be offered to people

A

Between 6-24 hours

To people with: CONFIRMED occlusion of the anterior circulation by CT or MRI + if salvageable tissue is present

468
Q

What is the first line treatment for a primal POSTERIOR circulation (basilar, posterior cerebral artery) and how does this differ from managing an anterior circulation

A

POSTERIOR: Thrombectomy + IV Thrombolysis (within 4.5 hours)

Anterior: ^ The same, but just a thrombectomy can be done between 6 and 24 hours if the time frame has passed. A combo of the two can still be done if there is potential to salvage brain tissue

469
Q

What is a common trigger for cluster headaches

A

Alcohol

470
Q

Management of increased ICP and why

A

Controlled Hyperventilation to reduce CO2, causing cerebral vasoconstriction

471
Q

Why do we want to achieve cerebral vasoconstriction in high ICP

A

It lowers ICP

472
Q

TIA vs a stroke

A

TIA = no acute tissue infarction

Stroke = Tissue Innfarction

The definition is no longer time-based, but tissue based.

473
Q

What nerve causes vertical diplopia

A

Trochlear (means vision is worse on looking down) - Trochlear is responsible for down and out movement

474
Q

What cranial nerve is responsible for swallowing

A

Vagus nerve

Lesions will point away from the lesioned nerve as the muscle affected by the nerve lose tone.

475
Q

What formamen do the olfactory nerves pass through

A

Cribriform

476
Q

What foramen does the optic nerve pass through

A

Optic canal

477
Q

What nerves pass through the superior orbital fissure

A

3,4,5 (Ophthalmic), 6

478
Q

What nerve runs through the foramen rotunda

A

V2 (maxillary)

479
Q

What nerve runs through the foramen oval

A

Mandibular nerve

480
Q

What three nerves run through the jugular foramen

A

9,10,11

481
Q

What nerve runs through the hypoglossal canal

A

Hypoglossal nerve

482
Q

Signs of vagus nerve lesion

A
  1. Uvula deviates away from the site of the lesion s

2. Loss of gag reflex

483
Q

Signs of hypoglossal nerve lesions

A
  1. Tongue deviates TOWARDS the side of the lesion
484
Q

Role of the glossopharyngeal nerve

A

TASTE. (posterior 1/3)
Salivation
Swallowing

485
Q

Sign of glossopharyngeal nerve lesions

A
  1. Hypersensitive carotid sinus reflex

2. Loss of gag reflex

486
Q

Signs of Amyotrophic Lateral Sclerosis

A

Mixture of UMn and LMN signs

487
Q

Onset for ALS

A

55 to 75

488
Q

What is internuclear Opthalmoplegia

A

Where the affected eye can’t adduct, and the contralateral eye abducts but with nystagmus = horizontal diplopia

489
Q

What is the main cause of internuclear ophthalmoplegia

A

MS

490
Q

What are contraindications to thrombolysis

A
  1. Previous Intracranial haemorrhead
  2. Seizure at onset of stroke
  3. Suspected SAH
  4. Stroke in past 3 months
  5. LP
  6. GI haemorrheage
  7. Active Bleed
    8/ Pregnancy
  8. Oesophageal varices
  9. Uncontrolled HTN
491
Q

What kind of vision loss is seen in glaucoma

A

There is blunting of the margins of the optic disc, so peripheral field is usually lost rather than central

492
Q

What causes homonymous quadrantanopias

A

PITS (Parietal-Inferior, Temporal-Superior) lesions

492
Q

What causes homonymous quadrantanopias

A

PITS (Parietal-Inferior, Temporal-Superior) lesions

493
Q

What usually causes lower quadrant defects in Bitemporal hemiopia

A

Craniopharyngioma

Pituitary tumours usually cause an upper quadrant defect

494
Q

What kind of pulse pressure is seen in raised ICP

A

Widened pulse pressure

495
Q

Describe the MRC grading

A

0 - No mucle movement
1 - Trace of contraction
2 - Movement at the joint with gravity eliminated
3- Movement against gravity (no resistance)
4- Movement against external resistance
5 - Normal Strength

496
Q

How do we treat spasticity

A

Baclofen

497
Q

What is the cute management of an ISCHAEMIC stroke

A

Aspirin 300mg

498
Q

Treatment of a Brian abscess

A

Ceftriaxone and Metronidazole

499
Q

Side-Effects of Phenytoin

A

Glove-and-stocking numbness and generalised lymphadenopathy

500
Q

How do we treat Restless Leg Syndrome

A

Dopamine Agonists: Ropinerole

501
Q

What is the first line treatment for post-herpetic Neuralgia

A

Duloxetine/Gabapentin or Pregabalin

502
Q

What scale is used to measure disability or dependance in activities of daily living in stroke patients

A

Barthel Scale

503
Q

What is the Rosier Scale

A

used to differentiate acute strokes from stroke mimics

504
Q

What nerve causes an absent corneal reflex

A

Trigeminal nerve

505
Q

What kind of Motor Neurone disease is degenerative cervical myelopathy

A

UMN

506
Q

What is the Weber’s Test

A

Fork on middle of patient’s head: The sound should lateralise to one side

If there’s conductive hearing loss (the fork will sound louder in the deaf ear)

If there is sensorineural hearing loss, the tuning fork will sound louder in the normal ear

507
Q

How do we interpret Rhinne’s test

A

If the patient can hear best when the fork is in the air, then air conduction is better than bone and this is normal.

If tuning fork sounds better on the mastoid, bone conduction is better than ear (positive test)

508
Q

Onset of acoustic neuromas

A

Gradual

509
Q

How long should someone be off after an isolated seizure

A

6 Months (or 12 months if there are abnormalities on imaging)

510
Q

What are the consequences of arnold-chiari malformation

A

Non-communicating hydrocephalus

Syringomyelia

511
Q

What usually causes a pontine haemorrhage

A

Chronic Hypertension

512
Q

What is Anterior cord syndrome

A

An ACUTE onset of pain and temperature loss due to ischaemia in the spinal cord (e.g., Aortic Dissection)

513
Q

What is an indication for Carotid Endarterectomy

A

If the affecting carotid artery is stenosed by over 75%. (e.g., if the symptoms were left sided, the right artery needs to be stenosed by over 75%)

514
Q

Examination signs of Idiopathic Intracranial Hypertension

A

Papilloedema (blunting of the optic disc)
6th Nerve Palsy (Bilateral eye abduction limitation)

This differs from glaucoma which is acute and unilateral. Idiopathic HTN is gradual and bilateral

515
Q

What does a CT show for a subdural haematoma show

A

Crescent (banana shape) - Convex

516
Q

What is the diagnostic investigation for necrotising enterocolitis

A

Abdominal X-RAY!

517
Q

What is pituitary apoplexy

A

This is where there is SEVERE bleeding or loss of blood flow to the pituitary gland

518
Q

What are the two arteries that supply the pituitary glands

A
  1. Superior Hypophyseal Artery

2. Inferior Hypophyseal Artery

519
Q

What usually causes Pituitary Apoplexy

A

Haemorrhage or infarction due to a pituitary adenoma

Pituitary adenomas require more blood = increased BP = raised pressure

This causes a rupture and blood collects in the pituitary gland

Sheehan’s syndrome can cause this, the pituitary gland shrinks and the blood collects within

520
Q

What is the consequence of pituitary gland blood supply rupture

A

Causes pituitary enlargement, and compresses the surrounding structures:

  • Meninges (pain when it’s stretched)
  • Optic chiasm (Bitemporal hemianopia)
521
Q

Symptoms of Pituitary apoplexy

A
  1. Hypoglycaemia
  2. Low BP
  3. Reduced consciousness

Deficiency of Thyroid, GnRh, Growth Hormone and Prolactin (Agalactorrhoea)

522
Q

What is the management of pituitary hypooplexy

A

Requires urgent steroids (Iv Hydrocortisone)

523
Q

What Structure in the brain can cause Diabetes Inspidius and lower bitemporal hemianopia

A

Craniopharyngioma

524
Q

What is he pharmacology of Suxamethonium

A

Neuromuscular blocking drug: depolarises NMD causing muscle contraction and then paralysis (exacerbates MG)

525
Q

What anaesthesia is used for MG

A

Rocuronium (rocks) - Blocks acetylcholine receptors, stopping binding to the neuromuscular junction (exacerbates Mg effect but that’s what makes it effective).

Suxomethonium - Not very effective as it binds to acetyl choline receptors to activate them (causing initial contraction and then paralysis) - but remember, in MG there are antibodies against these receptors so it won’t do much.

526
Q

What drugs can increase the risk of Idiopathic Intracranial Hypertension

A

COMAAR

C - Ciclosporins
O - Oral Contraceptive Pill
M - Mineralocorticosteroids
A - Amiodarone
A - Antibiotics (tetracyclines and Sulfonamides)
R - Retinoic Acid
527
Q

What indicates the use of Dexamethasone over Mannitol

A

Mannitol is exclusively used to reduce ICP, while Dexamethasone is used in Cerebral Oedema

528
Q

How do we diagnose Optic Neuritis

A

MRI Head

529
Q

What is the most important diagnostic for Degerenative Cervical Myelopathy

A

MRI of the Spine

530
Q

A stroke in what artery usually results in expressive aphasia

A

MIDDLE CEREBRAL, not anterior cerebral

531
Q

What drugs can result in overuse headaches

A

Triptans, Opioids and other analgesics

532
Q

Signs of Medication Overuse Headaches

A

Present for 15 days or more per month
Usually come across as tension headaches/migraines. Or a mixture of both

And they can happen in people with pre-existing migraines and tension headaches - the headaches get worse.

533
Q

When would I use an MRI with contrast ve without contrast

A

Contrast is to look FOR something (e.g., tissues, masses)

Non-Contrast is to look at the area (e.g., Fractures, haemorrhage strokes)

534
Q

Describe the frequency of pain felt in cluster headaches

A

Happens once or twice a day, lasting 15 minutes to 2 hours!

Does not necessarily have to have periorbital pain, occurs on the same side, at the same part of the head each time.

535
Q

As both a subdural haematoma and extradural haematoma can present in a head injury, what differentiates the two?

A

Extradural has acute presentations, while subdural haematomas can present 4 weeks after initial trauma.

536
Q

When is Ondansetron the first line treatment for nausea

A

Chemotherapy induced nausea

537
Q

When is Halooperidol the first line treatment for nausea

A

Intracranial causes for Nausea (Raised ICP, tumours)

538
Q

When is Prochlorperazine indicated for nausea

A

Vestibular causes

539
Q

When is metoclopramide indicated for Nausea

A

GI causes

540
Q

When is Levodopa the first line treatment in Parkinson’s Disease

A

If the symptoms as significantly affecting their quality of life

541
Q

What is usually the first line treatment of Parkinson’s

A

We try to save Co-careldopa for later as it’s effective but gets used up quickly.

Consider Dopamine agonists or Monoamine Oxidase B in people who’s quality of life is not being impacted by Parkinson’s

542
Q

Why would Cabergoline or Bromocriptine not be first line treatment for Non-quality of life affected Parkison’s

A

Bromocriptine and Cabergoline are both ergot-derived dopamine agonists which are not recommended for use as first line by NICE.

543
Q

What other drug, apart from anti-psychotics can cause NMS

A

Levodopa - usually if withdrawn in hospital settings (e.g., A and E)

544
Q

What are the signs for a cerebellar lesion

A

IPSILATERAL;

DANISH
D- Dysdiadochokinesia (patients appear drunk)
A - Ataxia (limb or truncal)
N - Nystagmus
I - Intention Tremour
S - Slurred Speech 
H - HYPOTONIA
545
Q

What can cause cerebellar syndrome

A 
Freidrich's Ataxia
Cerebellar haemangioma
Stroke
Alcohol
MS
Hypothyroidism
Phenytoin, lead poisoning
546
Q

What triggers autonomic Dysreflexia

A

Faecal Impaction/ Urinary retention

RF: Immobility, Bed bound, Medications that cause hypo mobility, anal fissures. and GI issues (e.g., Hirschsprung’s disease).

547
Q

What causes a winged scapula

A

Lesions of the long thoracic nerve -> causes a deficit in function of the serrates anterior muscles

It is the protrusion of the scapula: they cannot abduct above the horizontal plane

548
Q

IN the painful arch, was does pain on raising the arm laterally to 120 degrees indicate (pain goes away after 120 degrees)

A

Glenohumeral joint dysfunction (pain usually between 60 and 120 degrees)

549
Q

Pharmacology of Heparin

A

Indirectly inhibits Thrombin and Xa by binding to Antithrombin III

550
Q

What is the role of antithrombin III

A

Binds to Thrombin and Xa, causing their cleavage

551
Q

What is the difference between unfratcioned and fractioned Heparin

A

Unfractionated: Where Heparin is derived physiologically (pig intestines)

two types: HMWH or LMWH

Fractionated: Unfraticonated heparin is where HMWH is depolarised -> LMWH

552
Q

What is the difference in action between HMWH and LMWH

A

Both inhibit Antithrombin III (so less Xa)

However, Only HMWH has an effect on Thrombin inhibition (longer chain to bind to)

553
Q

Types of LMWH

A

-Parins

Dalteparin

Fondaparinux (although this is synthetic derived -> fractionated).

554
Q

When is Heparin usually prefered

A

Acute management of issues in hospitals (as it’s IV)

Chronic: Warfarin or DOACs because they can be taken per orally

555
Q

Side Effects of Heparin

A

Heparin Induced Thrombocytopenia (lower in LMWH)

556
Q

What medication is given to treat nausea from chemotherapy

A

5-HT3 antagonists (ondansetron and granisetron)

557
Q

What is vertical diplopia

A

Vertical diplopia is double vision caused when looking down

558
Q

Role of COMPT inhibitors

A

Reduce the breakdown of levodopa

559
Q

Cluster Headache vs Glaucoma

A

Glaucoma is a sudden onset within hours (a day)

Cluster Headaches happen multiple time (think of their history)

560
Q

What medication can precipitate idiopathic intracranial hypertension

A

tetracyclines (Lymecycline)

561
Q

In what patients is thoracic outlet syndrome more common

A

In patients who do repetitive motions (think swimming)

562
Q

Describe the tremor seen in a Parkinson’s patient

A

A unilateral tremor that improves with movement

563
Q

What is the most common trigger for autonomic dysreflexia

A

faecal Impaction / Urinary Retention

564
Q

What drugs can exacerbate a myasthenia crisis

A 
Penicillamine
Procainamide
Beta-Blockers
Lithium
Phenytoin 
Antibiotics: Genatmycin, Macrolides, Quinolones, tetracyclines
565
Q

What is Progressive Muscular Atrophy

A

Starts with LMN signs in the distal arms and legs

Becomes UMn slowly but surely

566
Q

What is Primary Lateral Sclerosis

A

Just UMN signs everywhere

567
Q

Where do hemangioblastomas ariseCerebellum - shows DANISH signs and FH

A
568
Q

What is Opsoclonus Myoclonus syndrome

A

Irregular saccadic eye movements, myoclonus and truncual titration (wobbly on feet)

Mostly seen in Neuroblastomas

569
Q

Is GBS UMN or LMN

A

UMN - so flaccid!

570
Q

Why can non functioning pituitary adenomas cause an increase in prolactin

A

Due to decreased dopaminergic inhibition - is not found exclusively in prolactinomas

571
Q

What is a watershed stroke

A

An sichaemic stroke between a junction where two arteries meet - can cause bilateral vision loss

572
Q

Symptoms of meningiomas at the base of the anterior cranial fossa

A

Presses against olfactory nerves - loss of smell.

573
Q

Role of medial Geniculate Nucleus

A

Directs auditory attention

574
Q

Role of Lateral Geniculate Nucleus

A

Visual fields

575
Q

What structure increases in size in Glaucoma

A

Cup - to - disc ratio

the cup of the optic disc inflates

576
Q

Myelopathy vs Radiculopathy

A

Myelopathy affects the whole spinal cord (loss of function in both upper and lower limbs)

Radiculopathy - pinched nerve

577
Q

What causes Lateral Pontine Syndrome + Signs

A

Occlusion of the Anterior Inferior Cerebellar artery

Signs: Loss of pain, hearing and ptosis

578
Q

What causes medial medullary syndrome

A

Occlusion of. the anterior spinal artery

Signs: Weakness of upper and lower extremities + hemisensory loss and tongue deviation

579
Q

What causes medial pontine syndrome

A

Occlusion of the paramedic branch of the basilar artery

Leads to Strabismus + Ataxia, slurred speech

580
Q

Signs of Tabes Doralis

A

Remember - literally means pain of the back!

Triad:
Unsteadiness
Urinary Incontinence
Severe Lightening like pains

581
Q

What does orbital cellulitis succeed

A

Bacterial rhinosinusitis (recurrent sinus infections)

582
Q

What is the most common eye pathology that causes a white reflex

A

CATARACTS

583
Q

What is a Hollenhorst plaque

A

A cholesterol embolus present in the retinal artery

584
Q

What prophylaxis is recommended in meningococcal meningitis

A

Ciprofloxacin OR Rifampicin

585
Q

What anti-sickness medication causes Parkinsonism symptoms

A

Metoclopramide

586
Q

Viral Encephalitis vs Bacterial Encephalitis

A

Exactly the same CSF and blood plasma finding (glucose is raised or normal)

However, Encephalitis is more likely if people are behaving bizarrely

587
Q

What drug can be used to treat fatigue in MS

A

Modanafil

588
Q

Symptom specific to Ramsay hunt syndrome

A

Earache and burning sensation in the ear

589
Q

What measure is used to check respiratory disease in GBS

A

FVC

590
Q

What is multifocal motor neuropathy

A

Assymetric lower motor neurone weakness in the upper limbs

No cranial or sensory involvement

591
Q

What happens to reflexes in Brown-Sequard syndrome

A

Become hyperreflexic

592
Q

What scale is used to recognise strokes in an acute environment

A

ROSIER

593
Q

What is the most usual cause for an intracranial haemorrhage (e.g., acute bleeding in the basal ganglia or other parts of the brain)

A

Hypertension

594
Q

When is Dexamthesone indicated in suspected Spinal Cord Compression

A

Cancers that metastasise to the spinal cord - causing spinal cord compression

595
Q

What infection commonly causes spinal cord compression

A

TB

596
Q

When should patients be referred to a TIA clinic after their first episode

A

Within 24 hours, and 300mg Aspirin

597
Q

Second and third line interventions for migraines

A

If beta-blockers are contraindicated, give Amitryptaline

2nd Line: Topiramate/Valproate

598
Q

How should thiamine be always given in Wernicke’s

A

IV

599
Q

Where are lesions in spastic cerebral palsy seen

A

Pyramidal Tracts

600
Q

What structure is affected in MND

A

Ventral Horn

601
Q

What neurone condition commonly occurs after a Respiratory Tract Infection and what are the symptoms

A

Episodes of dizziness - Vestibular Neuritis

602
Q

Benign proximal positional vertigo vs Vestibular Neuritis

A

BPPV has a postural element, while vestibular neuritis is just dizziness

603
Q

What structures are affected din labrynthistis

A

Both branches of cranial 8

604
Q

Clinical Features of Idiopathic Intracranial Hypertension

A

Bilateral, non-pulsatile headache worse in the morning / after lying down or bending forwards.

Morning vomiting

Bilateral Papilloedema, optic nerve ischaemia on fundoscopy

605
Q

What drug can cause IIH

A

COCP

Steroids

606
Q

What usually causes ulnar palsy

A

Cubital Tunnel Syndrome

Or Medial Epicondylitis but that’s usually only if there’s a past history of elbow involvement

607
Q

What is the first line management of a subdural haemorrhage

A

Burr Hole Craniostomy

Second Line: Craniotomy

608
Q

What procedure is considered for extradural haemorrhages

A

Ligation of the damaged blood vessel

609
Q

Firs Line management of a haemorrhagic stroke

A

Administer Prothrombin complex, vit K and Warfarin

610
Q

What is the first line treatment in hospitals for a seizure

A

IV Lorazepam

It’s usually buccal or rectal diazepam outside hospitals

611
Q

When should CTs be arranged within 1 hour

A 
<13 GCS score 
2 hours after injury 
Suspected skull fracture
Signs of basal skull fracture
Post traumatic seizure
612
Q

When should CT heads be used for an extradural haemorrhage

A

> 65 years

History of bleeding or clotting disorders

613
Q

What is Klumpke’s palsy

A

Small hand paralysis with ptosis and sensory disturbances (looks like Horner’s syndrome)

From damage to lower brachial plexus

614
Q

What is seen on a visual acuity test for IIH

A

Enlarged blind spots and constriction of the visual field

615
Q

What is the first line treatment of absence seizures

A

Ethosuxamide OR Sodium Valproate

616
Q

How is Charcot-Marie-tooth inheirted

A

Autosomal Dominant

617
Q

Signs of subacute degeneration of the cord

A

Affects the dorsal columns and lateral corticospinal tract:

Loss of proprioception, vibration, muscle weakness and hyperreflexia

618
Q

What myotome would cause finger abduction weakness

A

T1

619
Q

What endocrinological tumour causes DI

A

Craniopharyngioma - causes Lower bitemporal hemianopia

620
Q

What trunks causes Klumpke’s paralysis

A

C8-T1

621
Q

Where is Broca’s area found

A

Left inferior frontal gyrus

622
Q

What EEG reading is found for a absence seizure

A

3Hz spike and wave

623
Q

If Baclofen does not work for spasticity in MS, what else can be given

A

Gabapentin

624
Q

When should aspirin be offered in an ischaemic stroke

A

Only if hyper-acute treatment can’t be offered, either contraindicated or too late.

300mg.

Otherwise Alteplase + Thrombectomy

625
Q

Which drugs increase the risk of Idiopathic Intracranial Hypertension

A 
COMAAR 
C - Ciclosporins
O - Oral Contraceptive Pill 
M - Mineralocorticosteroids
A - Amiodarone
A 0 Antibiotics (tetracyclines and sulphonamides
R - Retinoic Acid
626
Q

How do we diagnose if internuclear ophthalmoplegia is left or right?

A

Whatever eye that doesn’t abduct properly.

627
Q

In what condition are voltage-gated calcium channel antibodies found in

A

Lambert-Eaton Syndrome

628
Q

What condition shows a DECREASE in motor action amplitude with repetition

A

MG

629
Q

What antibodies are seen in GBS

A

anti-GM1 antibodies

630
Q

In what seizures is lamotrigine the first line anti seizure medication instead of Sodium Valproate

A

Focal
Tonic-clonic
Atonic

631
Q

What triggers absence seizures

A

Children holding their breath

632
Q

What is Meniere’s disease

A

RECURRENT episodes of vertigo, fluctuating hearing loss and tinnitus

633
Q

What antibiotic causes ototoxicity (labyrinthitis-esque symptoms)

A

Aminoglycosides (vancomycin, gentamicin)

634
Q

What medication is given in SAH to reduce vasospasm risks

A

Nimodipine (calcium channel blocker)

635
Q

Treatment of BPPV

A

Epley Maneouvres

636
Q

Describe the flow of CSF

A

Lateral ventricles -> Foramen of Monroe -> third ventricle -> Cerebral aqueduct -> Foramen of Luschka and Magendie -> Subarachnoid Space

637
Q

Other than raised CK, what else is raised in NMS

A

White cell count

638
Q

What is an absolute contraindication to triptans in migraine management

A

A history of ischaemic heart disease

639
Q

What does hyper-attenuation on a CT head indicate for a stroke

A

It’s a haemorrhage stroke

640
Q

When should sumatriptan be taken during a migraine

A

Only once the headache starts, not in the aura phase

641
Q

What artery is occluded to cause locked in syndrome (pontine haemorrhage)

A

The Pons

642
Q

What artery occlusion results in weber’s syndrome

A

Paramedian branches of the basilar and proximal posterior cerebral arteries

643
Q

How long do cluster headaches last

A

4-12 weeks

644
Q

First line management for a TIA

A

300mg Aspirin

Seen by a specialist within 24 hours

Then secondary prevention: Clopidogrel 75mg once daily

645
Q

In what patients does a TIA mean urgent referral to emergency department for imaging

A

Patients on apixaban/warfarin to exclude a haemorrhage stroke. Any suspected haemorrhage stroke requires immediate imaging over anything else

646
Q

Signs of MND on a nerve conduction study

A

Completely normal

647
Q

What can make an essential tremor worse

A

Stress (emotional or physical)

648
Q

Intention vs Essential tremours

A

Essential Tremors happen without intentional movement but WORSEN on intentional movement.

Intention Tremor: They only occur during intentional movement

649
Q

Onset of Degenerative Cervical Myelopathy

A

GRADUAL - over many months to one year

650
Q

What type of motor neurone disease is DCM

A

Upper.

651
Q

How is sumatriptan given in Cluster headaches

A

Subcutaneously

652
Q

What eye is affected din cranial nerve palsies if there is a mass in th ehead

A

Usually the nerve is being compressed by the mass.

653
Q

Other than a loss of vibration and proprioception, what else can be found on examination in subacute degeneration o the cord

A

UMN and LMN signs (absent and present reflexes)

654
Q

Where are meningiomas commonly found

A

Falx cerebri, Superior sagital sinus and Skull base

655
Q

What are hemangioblastomas most commonly associated with

A

von hippie Linda syndrome

656
Q

Treatment for a brain abscess

A

Ceftriaxone and Metronidazole

657
Q

Side effects of topiramate

A

Weight loss + Renal Stones

658
Q

Side Effects of Phenytoin

A

Ataxia
Peripheral Neuropathy
Osteomalacia
Hirsutism

659
Q

What is the most common cause of a oculomotor nerve palsy

A

Diabetes Mellitus

660
Q

Difference in symptoms between a medical and surgical third nerve palsy

A

Surgical (ie., posterior communicating artery aneurysm) is painful

Medical (DM) - is painless

661
Q

In what haematoma is anti-coagulant use a risk factor

A

Sub-dural haematoma

662
Q

BPPV vs Meniere’s

A

BPPV - lasts seconds

Meniere’s - last a few mins to a few hours + history of recurrence

663
Q

What myotome is resposible for big toe extension

A

L5

664
Q

What myotome is resposible for ankle dorsiflexion

A

L4

665
Q

What is a Stokes-Adams Attack

A

A random waiting spell caused by intermittent COMPLETE heart block

666
Q

What antibiotics can increase the risk of idiopathic intracranial hypertension

A

Doxycycline +

667
Q

Signs of diffuse axonal injury

A

Usually in car accidents from rapid acceleration and then deceleration:

  • Unconsciousness
  • Vegetative state
668
Q

What is the role of nimodipine in a Subarachnoid Haemorrhage

A

Prevents vasospasms

669
Q

First line management of a subarachnoid haemorrhage

A

ABCDE

So,

FIrst - Secure aiways
Second - BP control
C - Nimodipine to prevent vasospasms

670
Q

Indications for a CT head within 1 hour

A
  1. GCS <13 on initial assessment
  2. GCS < 15 2 hours post-injury
  3. Any depression of the skull
  4. Signs of basal skull fractures
  5. Seizures
  6. Focal deficits
  7. > 1 episodes of vomiting
671
Q

Indications for a CT head within 8 hours

A
  1. > 65
  2. Any history of bleeding or clotting disorders
  3. Dangerous mechanism of injury
  4. Retrograde amnesia >30 mins
672
Q

If a patient is on warfarin and there is no other indiciations/complications of the head injury, when should a CT head be done

A

Within 8 hours

673
Q

Meningitis vs SAH

A

Meningitis would not have xanthachromia (yellow)

Both have raised WCC/normal glucose

674
Q

A major complication of a pituitary apoplexy

A

SAH

675
Q

When is an LP indicated for SAH

A

If CT of the head is normal. Wait 12 hours and then an LP is taken to check for xanthachromia

676
Q

What arteries are mostly affected in a lacunar stroke

A

Lenticulostriate arteries which supply the basal ganglia

677
Q

Signs of tetanus

A
  1. Rigid Abdomen
  2. Arched back
  3. Clenched Fists
678
Q

Signs of retinitis

A

Similar to Behcet’s disease:

Apthous Ulcers
Reduced visual acuity due to white (pus) infiltrates in the anterior chamber

679
Q

Risk factors of primary open-angle glaucoma

A

African American
Hypothyroidism
Diabetes Mellitus

680
Q

What cells demyelinate in MS

A

Oligodendrocites

681
Q

What myotome is responsible for plantar flexion

A

S1

682
Q

What myotome does dorsiflexion

A

L4

683
Q

What myotome allows for thumb extension

A

C8

684
Q

What is the role of T1

A

Finger Abduction

685
Q

What is usually spared in syringomyelia and why

A

The DMLC, as the ventral part of the spinal cord’s CSF dilates not the posterior prt

686
Q

What cervical levels result in the cape like distribution of pain and temperature loss

A

Syringomyelia: BILATERAL

C4-C6

687
Q

What causes charcot joint in Syringomyelia

A

Repeated trauma to a body part: usually the feet or the shoulders

688
Q

How to diagnose Syringomyelia

A

MRI of the head

689
Q

What is the main cause of syringomyelia

A

Arnold-Chiari Malformation

690
Q

How is Arnold Chiari Malformation treated

A

Posterior Fossa Decompression

691
Q

Signs of an Anterior Spinal Artery infarct

A

DMLC is intact, loss of pain and temperature below that level

692
Q

Risk Factors for intracranial venous thrbosis

A

COCP

Pregnancy

693
Q

Diagnosis of an intracranial venous thrombosis

A

Non contrast CT Head: Hyperdensity in affected sinus

CT Venogram: an empty delta sign

694
Q

What medications can cause ototoxicity

A

Gentamicin
Vancomycin

Loop Diuretics

695
Q

What is Polymyalgia Rheumatica signs

A

Shoulder/hip stiffness >1 hour in the morning + inflammatory pain

Low grade fever, weight loss and malaise

696
Q

Treatment of polymyalgia rheumatica

A

Corticosteroids within 72 hours

697
Q

Polymyalgia rheumatica vs myositis

A

Myositis: Bilateral PROXIMAL muscle weakness but NO pain

Polymyalgia: Pain prominent

698
Q

When is an MRI indicated in people with seizures

A

Where seizures happen after first line meds

Develop epilsepsy before 2

699
Q

What is second line treatment for focal seizures if carbamazepine or Lamotrigine are subtherapeutic

A

Levetiracetem

700
Q

If all treatments are ineffective or not tolerated, what should be done for focal seizures

A

Offer lamotrigine, levetiracetem, carbamazepine or gabapentin as adjunctive treatment

701
Q

If adjunctive treatment for seizures is unsuccessful, what should be done

A

Refer to teriary specialist

702
Q

First line treatment of absence seizures in women

A

Ethosuxamide

703
Q

First line treatment of benign rolandic seizures

A

Lamotrigine

704
Q

What surgery can be done for seizures

A

Vagus nerve stimulation

705
Q

What is characteristic of a parietal lobe seizure

A

Pins and Needles before a generalised tonic clonic seizure

year 3 (25 decks)

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