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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
Clinical features of GBS
1. <6 weeks signs of ascending paralysis/areflexia
26
Investigations for GBS
1. NCS demyelinating | 2. LP, raised CSF protein
27
How is GBS treated
IvIg or plasmapheresis Monitor pulse and BP Monitor FVC Resp weakness: ABCDE
28
Clinical Feature son MG
1. Proximal limb weakness 2. Weakness of neck and face (head drop and ptosis) 3. Extraocular (complex diplopia) 4. Bulbar palsy (speech and swallow) 3. Curtain sign
29
MG Investigations
1. AChR antibodies 2. Tension test 3. CT Thorax 4. FVC - rep problems
30
MG treatment
1. ACh esterase inhibitors - pyridostigmine 2. Azathioprine 3. Thymectomy
31
What is a myasthenic crisis
1. Severe weakness of resp muscles
32
How is myasthenic crisis treated
1. Anaesthetist review
33
MND investigations
1. LP 2. NCS/EMG 3. MRI
34
What three things are assessed on the GCS
1. EYE 2. MOTOR 3. VERBAL
35
Most common cause of status eplieplticus in adults
1. SUbtehrapeutic anticonvulsant levels and strokes
36
What classifies states epilepticus
Lasts more than 30 minutes
37
Partial vs total anterior circulation infarcts
Total (3 symptoms), partial (2 symptoms) Unilateral hemiparesis Homonymous hemianopia Dysphagia etc
38
Clinical features of lacunar infarcts
1. UNILATERAL WEAKNESS 2. PURE SENSORY STROKE 3. ATAXIC HEMIPARESIS
39
What is lateral medullary syndrome
1. Disruption to posterior inferior cerebellar artery
40
Signs of lateral medullary syndrome
Isi: ataxia, nystagmus, dysphagia, facial numbness, horner's contra: Limb sensory loss
41
Antithrombotic therapy for TIA
1. CLOPIDOGREL if contraindicated: ASPIRIN and DIPYRIDAMOLE
42
Acute management of Cluster headaches
1. 100% oxygen | 2. Sumatriptan
43
Prophylaxis of cluster headaches
Verapamil
44
How is wernicek's encephalopathy treated
1. Pabrinex (IV B/C)
45
Clinical features of Wernicke's
1. Confusion 2. Ataxia 3. Nystagmus/Opthalmoplegia
46
After a TIA, does the DVLA need to be informed
1 month driving no need to inform DVLA
47
Clinical Features of Charcot-marie tooth disease
1. Starts at puberty 2. Distal muscle wasting, pes clavus and clwaed toes 3. Foot drop, leg weakness first features
48
Clinical Features of MND
1. Fasciculations 2. Wasting of small hand muscles 3. Absence of sensory signs/synmptoms DOES NOT AFFECT OCULAR MUSCLES
49
How is MND diagnsoed
1. EMG: Shows reduced action potential with increased amplitude
50
Clinical Features of Tuberous Sclerosis
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
51
Treatment of MG
Neostigmine
52
What artery commonly contributes to extra-dural haematomas
1. Middle Meningeal artery
53
Clinical features of bell's palsy
1. LMN palsy Forehead affected Post-auricular pain, altered taste, dry eyes and hyperacusis
54
How is bells palsy treated
1. Prednisolone
55
Clinical Feature of adhesive capsulitis
1. EXTERNAL ROTATION is most painful, of the shoulder
56
Clinical Features of Degenerative cervical myelopathy
1. Loss of motor function 2. Pain 3. Loss of sensation 4. Loss of autonomic (urinary and faecal) 5. Hoffman's sign
57
What is hoffman's sign
1. Reflex test in fingers - positive if flicking one finger on hand causes twitching of others
58
How is degenerative cervical myelopathy diagnosed
MRI of cervical spine
59
Treatment of DMC
1. Refer to neurosurgery or spinal surgery asap - decompressive surgery
60
What is Uhtoff's phenomenon
Worsening of vision following rise in temperature
61
Three visual changes in MS
1. Optic neuritis 2. Optic atrophy 3. Internuclear opthalmoplegia
62
Sensory changes in MS
1. Pins/needles 2. Numbness 3. Trigmeninal neuralgia
63
What is Lhermitte's syndrome
1. Paraesthesia in limbs on neck flexion
64
Cerebellar changes in MS
1. Ataxia(usually in acute relapse) | 2. Tremor
65
In trauma, clear fluid is commonly seen dripping through the nose, how can we test if its CSf
1, Check for glucose
66
How long doe sit take for xanthochromia to show
12 Horus
67
What is Weber's syndrome
1. Ipsilateral III palsy | 2. Contralateral weakness
68
What is pontine heamorrhage
1. Complication secondary to chronic hypertension 1. Quadriplegia 2. Reduced GCS score 3. Miosis 4. Absent horizontal eye movements
69
Thrombectomy usually only should be done within 6Hours, when can we extend this to 24 hours
1. IF CT Perfusion indicates substantial salvageable brain tissue present
70
Most common complication following meningitis
1. Sensorineural hearing loss
71
Clinical features of common perineal nerve palsy
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
72
When is carotid endarterectomy recommended in TIAs and strokes
If they have already suffered a TIA or stroke due to carotid issues before or 50% greater occlusion of arotids
73
Clinical features of resting tremour
1. Affects vocal cords and hands | Goes away when resting
74
What is the most important cause of status eplieotuicum that needs to be drawn out
HYPOXIA and HYPOGLYCAEMIA
75
First line treatment of status epliepticum
Diazepam or Lorazepam If ineffective then phenytoin or valproate
76
What disc prolapse causes DCM
1. C4/5
77
Management of acute ischaemic stroke
Aspirin 75mg 2 weeks, then 75mg clopidogrel
78
Risk factors of MG
1. Thymomas, autoimmune disorders (pernicious anaemia, SLE, RA) 2. Thymic Hyperplasia
79
Investigations of MG
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
80
Treatment of MG
1. Neostigmine 2. Prednisolone 3. Thymectomy
81
Management of Myasthenic crisis
1. Plasmapheresis | 2. Iv Igg
82
Treatment of acute migraines
1. Triptan + NSAID + Parcetomal
83
Prophylaxis of migraines
Propranolol
84
Management of trigeminal neuralgia
Carbamazepine
85
What exacerbates pain in bigeminal neuralgia
Anything causing light touch: Applying soap, cream, talking, smoking, shaving and brushing teeth
86
Clinical Features of wernicke's
``` CAN OPEN 1. Confusion Ataxia Nystagmus Ophthalmoplegia Peripheral Neuropathy ```
87
What is the Cushing reflex
Its a [hysiological nervous system response to increased ICP that causes hypertension and bradycardia
88
What medication is used to treat cerebral oedema in patients with brain tumours
1. DEXAMATHASONE
89
A lady trips and cannot adduct her fingers, what nerve is affected
Ulnar
90
Risk factors for MS
1. Lack of Vit D 2. Previous mononucleosis 3. Smoking
91
Clinical features of normal pressure hydrocephalus
1. Urinary incontinence 2. Dementia and bradyphenia 3. gait abnormality
92
What is Cataplexy
1. Sudden and transient loss of muscular tone followed by STRONG emotion (laughter, crying being frightened) Ranges from buckling knees to collapse
93
What condition is cataplexy commony associated with
Narcolepsy
94
All seizures are treated with valproate except for..?
Focal seizures Give lamotrigine
95
If a parkinson patient can't take levodopa orally as they have swallowing difficulties what should be given
1. Dopamine agonist patch
96
Side effect of valproate
Weight gain
97
Clinical features of RLS
1. Uncontrollable urge to move, symptoms worst at rest/night 2. Crawling sensation in legs
98
Why is the oral contraceptive pill contraindicated with migraine
1. INCREASED RISK OF STROKE
99
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
Brachial trunks C5-6 This is Erb's palsy
100
Risk factors of migraine
``` CHOCOLATE Chocolate Hangover Orgasm Cheese Oral contraceptive lie ins alcohol travel excercise ```
101
What improves beingn essential tremour
Alcohol
102
Mechanism of aspirin
Inhibits Cox-1, surpassing prostaglandin and thromboxane synthesis
103
Mechanism of clopidogrel
Acts on ADP receptors to prevent platelet aggregation
104
Mechanism of dipyramidole
Increase in cAMP and decreased thromboxane A2
105
How long can u not drive for after a TIA
at least 1 month
106
Most common cause of SAH
Berry aneurysm rupture | Artery venous malformation
107
Symptoms of SAH
1. Vomiting 2. Collapsing 3. Seizures 4. Drowsiness SIGNS: Neck stiffness Retinal bleeding
108
Risk factors of SAH
1. Alcohol 2. Smoking 3. Increased BP 4. Bleeding disorders
109
Management of SAH
1. Neurosurgery referral | Nimodipine
110
What surgery is used for SAH
1. Endovascular coiling or surgical clipping
111
Where do most dural venous sinus thrombosis occur
1. Sagital sinus
112
Features of cortical vein thrombosis
1. Stroke like FOCAL symptoms with seizures Thunderclap headache
113
What are simple focal seizures
Without impairment of consciousness
114
What part of the brain do complex seizures arise
Temporal, causes post-octal issues (simple do not)
115
What are absence seizures
Brief pauses (e.g. suddenly stops talking mis sentence then continues)
116
What are tonic-clonic seizures
1. Loss of consciousness - limbs stiffen then jerk Post-Octal
117
What are myoclonic seizures
Sudden jerk of limb, face and trunk - thrown suddenly to grown
118
What is an atonic seizure
Sudden loss of muscle tone
119
Clinical features of temporal lobe seizure
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
120
Clinical features of frontal lobe seizures
1. Jacksonian march 2. Motor arrest 3. Behavioural disturbances 4. Speech arrest 5. Post-ictal todd's palsy
121
What is todd's palsy
Weakness in all parts of the body
122
When can AEDs be stopped
1. Seizure free for more than 2 years, and done slowly over 2-3 months
123
Triad of parkinsonium
1. Tremor 2. Hypertonia 3. Bradykineasia
124
Clinical features of parkinsonium
1. Autonomic dysfunction (postural hypotension, constipation, urinary frequency, dribbling of saliva) or sleep disturbance
125
Three syndromes associated with parkinsonism
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
126
Risk factors for idiopathic intracranial hypertension
1. Obese females 2. 30s 3. Endocrine abnormalities 4. Drugs
127
Ho wi s idiopathic intracranial hypertension managed
1. Weight loss 2. Acetaxolamide 2. Prednisolone
128
Clinical feature of bell's palsy
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
129
Tests for bells palsy
1. Increased Borrelia antibodies in lyme | 2. Increased VZV antibodies in Ramsay Hunt Syndrome
130
What is Ramsay Hunt Syndrome
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
131
What does the median nerve supply
``` LOAF: Two lumbricals Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis ```
132
What causes ulnar nerve palsy
Elbow trauma
133
Signs of ulnar nerve palsy
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)
134
Signs of radial nerve palsy
1. Wrist finger drop with elbow flexed and arm pronated
135
Muscles innervated by radial nerve
``` BEAST Brachioradialis Extensors Abductor pollicis longus Supinator Triceps ```
136
What causes brachial palsy
1. Trauma 2. Radiotherapy 3. Heavy rucksack 4. Thoracic outlet compression
137
What causes phrenic nerve palsy
1. Lung cancer 2. TB 3. Thymoma 4. Myeloma 5. Infection (HIV, lyme)
138
What causes lateral cutaneous nerve of thigh palsy
Burning thigh pain from trapping under inguinal ligament
139
What causes sciatic nerve palsy
Damaged pelvic tumour or fracture to pelvis or femur Causes foot drop and loss of sensation lateral knee
140
Clinical features of common perineal nerve
1. Foot drop 2. Weak ankle dorsiflexion/eversion 3. Sensory loss over dorsal foot
141
Clinical features of tibial nerve palsy
1. Cant stand on tiptoe 2. Invert foot 3. Flex toes 4. Sensory loss over soles
142
Clinical features of carpal tunnel syndrome
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
143
Tests for carpal tunnel syndrome
1. Phaeton's test and Tinel's test
144
Treatment for carpal tunnel syndrome
1. Splinting and decompression surgery | 2. Steroid injection
145
What is bulbar palsy
LMN where tongue and swallowing muscles are affected, fasciculation tongue Jaw jerk absent or normal
146
What causes bulbar palsy
1. GB, polio, MG, syringobulbia
147
Signs of C4/5 impingement
1. Weak deltoid and supraspinatus; numb elbow decreased supinator jerk
148
Signs of C5/6 impingement
1. Weak biceps + brachioradialis 2. Reduced bicep jerk 3. Numb thumb + index finger
149
C6/c7 impingement
1. Weak triceps + finger extension 2. Decreased triceps jerk 3. Numb middle finger
150
C7/T1 impingement
1. Weak finger flexors + small muscles of the hand; numb 5th and ring finger
151
What is Duchenne's muscular dystrophy
1. 4yrs old - clumsy walking and difficulty standing 3. resp failure 4. Pseudohypertrophe in calves
152
What is backer's muscular dystrophy
1. Duchenne's but happens later and better prognosis
153
Cl,finical features of myotonic dystrophy
1. Distal weakness 2. Weak sternomastoids 3. Cataracts 4. Male frontal blindness
154
Clinical Features of MG
1. Extroocular 2. Bulbar 3. Ptosis 4. Diplopia 5. Myasthenia snarl when smiling
155
Treatment of Lambert Eaton syndrome
1. NEOSTIGMINE or IvIg
156
What is type 1 neurofibromatosis clinical features
1. Cafe au last spots 2. Freckling 3. Nodular neurofibromas on nerve trunks 4. Lisch nodules (nodules on iris)
157
Complications of type 1 neurofibromatosis
1. Nerve root compression 2. GI bleeds 3. Scoliosis
158
Difference between type 2 and 1 neurofibromatosis
1. Cafe au last spots fewer | 2. Acoustic neuromas characteristic
159
What is syringomyelia
1. Tubular cavity close to central canal of cervical cord
160
What causes syringomyelia
1. Blocked CSF circulation
161
What is arnold chair malformation
Cerebellum herniates through foramen magnum
162
Clinical features of syringomyelia
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)
163
What is syringobulbia
Brianstem involvement of tubular cavity Includes nystagmus, tongue atrophy, dysphagia and pharyngeal weakness
164
Clinical features of meningitis
1. Headache 2. Fever 3. Leg pains 4. Cols hands
165
Prophylaxis of meningitis
1. Ciprofloxacin
166
Acute management of meningitis
1. DEXAMATHASONE 10mg IV | 2. Ceftriaxone, amoxicillin if immunocompromised
167
Clinical features of a brain abscess
1. Seizures 2. Fever 3. Localising signs 4. COMA
168
How is cerebral abscess treated
. Treated increased ICP | 2. Neurosurgical referral
169
Causes of cerebral abscess
1. Strep millers - teeth 2. Bacterial abscess if peripheral 3. Toxoplasma lesions are deeper (e.g. basal ganglia)
170
UMN signs
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
171
How does the GCSE score work
``` 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 ```
172
What is the role of orexin
1. Increasing the activity of wake-promoting regions of the brain
173
What causes narcolepsy
Autoimmune process which damages neutron delivering orexin
174
Onset of narcolepsy
Adolescence and young adulthood
175
Clinical features of narcolepsy
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
176
What is cataplexy
Transient muscle weakness in response to strong emotion
177
Investigations for narcolepsy
1. Polysomnography 2. Multiple sleep latency test 3. EEG, ECG tracing
178
What is the choroid plexus made from
Ependymal cells - produce CSF
179
What causes normal pressure hydrocephalus
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)
180
What is primary vs secondary normal pressure hydrocephalus
1. Idiopathic | 2. Damage to arachnoid villi
181
What causes arachnoid villi damage
SAH, meningitis
182
Clinical signs of Normal pressure hydrocephalus
1. WWW Wet Wacky Wobbly
183
Long term treatment of normal pressure hydrocephalus
1. Shunting - ventriculoperitoneal shunt
184
What would be found on an MRi for MS
1. T2 lesions 2. Periventricular plaques 3. Dawson fingers
185
What would be seen in CSF for MS
1. Oligoclonal bands | 2. Increased intrathecal synthesis of IgG
186
What blood test can be used to differentiate between a true seizure and a pseudoseizure
1. PROLACTIN (raised after pseudo seizure)
187
Clinical features favouring pseudo seizures
1. Pelvic thrusting 2. Female 3. Crying after 4. Gradual onset 5. Does not occur alone
188
What is von hippie landau syndrome
1. A condition featuring visceral cysts and benign tumours in any system
189
Why do people develop a high stepping gait in peripheral neuropathy
Compensate for foot drop
190
What does tolivopontocerebellar atrophy present with
Parkinsonism and cerebellar signs
191
What does progressive supra nuclear palsy present with
Parkinsonism and ophthalmoplegia
192
What does Lewy body dementia present with
Parkinsonism and visual hallucinations
193
First line treatment for trigeminal neuralgia
Carabamzepine
194
First line treatment of essential tremour
Propranolol
195
What is hoover's sign used for
To differentiate between organic and non-organic lower leg weakness
196
Clinical Features of temporal arteritis
1. Rapid onset, unilateral 2. Jaw claudication 3. Tender, palpable temporal artery
197
What sign can be used to test for MS
1. HOFFMAN's SIGN (MS is usually only uMN)
198
What is progressive supra nuclear palsy
1. Starts of with symmetrical impaired balance 2. Poorly responsive to levodopa 3. Vertical gaze palsy
199
What is chair 1 malformation
1. Herniation of cerebellum through foramen magnum
200
What is syringomyelia
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)
201
What is conduction (associative) dysphagia
Happens in arcuate fasiculus - comprehension good, fluent speech but poor repetition
202
What medication is used in managing just the tremor in drug-induced parkinsonism
Procyclidine
203
What parkinson drug can cause PF
Cabergoline
204
What do we do with patients who have a GCS of less than 8
Immediate review by anaesthetist and intubation/ventilation Airways IS FIRST PRIORITY
205
What is first line opioid treatment for neuropathic pain
TRAMADOL
206
What root is thumb + index finger
C6
207
What root is middle finger and palm of hand sensation
C7
208
What root is ring and little finger sensation
C8
209
What is the diagnostic criteria for migraine without aura
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
210
Clinical features of an acoustic chroma
1. UNILATERAL tinnitus | 2. Deafness
211
Clinical features of labrinthistis
1. Vertigo | 2. Hearing loss
212
Clinical features of low CSF headaches (hypotension)
Get worse on standing, improve when lying flat
213
Investigations for spontaneous intracranial hypotension
1. MRI with gadolinium
214
What patients other than those with focal seizures should not be prescribed valproate
1, Female children | 2, Women of childbearing potential
215
What should be given to patients with absence seizures if valproate is ineffective
Ethosuximide
216
If a patient has a GCSe of 5 or less what should be done to maintain airway
Cuffed endotracheal tube
217
What causes cavernous sinus syndrome
1. Tumours by invasive malignancies
218
Clinical features of CS syndrome
1. Pain 2. Ophthalmoplegia 3. Proptosis 4. Trigeminal nerve lesion 5. Horner' syndrome
219
What is the blood supply of the cavernous sinus
1. Ophthalmic vein 2. Superficial cortical vein 3. Basilar plexus of veins
220
Drainage fo cavernous sinus
1. Internal jugular vein
221
Name three diseases in which Lhermitte's sign is seen
1. subacute degeneration of cord | 2. Cervical stenosis
222
How is carotid artery stenosis diagnosed
Duplex ultrasound
223
What are meningiomas
BENIGN tumours from the dura that press on the brain
224
Where are vestibular schwannomas commonly seen
1. Cerebellopontine angle Causes facial nerve palsy and hearing loss
225
What do glioblastomas look like on imaging
1. Solid tumours with central necrosis and a rim enhancing with contrast
226
What is used to treat oedema from glioblastoma multiform
Dexamethasone
227
What is used as prophylaxis for migraines
ACUTE: triptan PROPHYLAXIS: propranolol
228
What is the problem giving folate to B12 deficient patients
Can cause subacute combined degeneration of the cord
229
What sign can be used to test for MS
1. HOFFMAN's SIGN (MS is usually only uMN)
230
What condition is Alzheimer's commonly associated with
Hydrocephalus ex vacuo (atrophy of cortical tissue causes replacement of cortex by CSF)
231
What structures in the brain atrophy in Huntington's and why
1. Caudate Nucleus 2. Putamen As there is a loss of GABA-ergic neutrons in the basal gangliaa
232
What causes Benign paroxysmal positional vertigo
Abnormal shifting of calcium crystals within semicircular canals of inner ear
233
How is BPPV diagnosed
1. Dix-Hallpike maneuver - forces crystals out of the semicircular canals
234
What is Ramsay-hunt syndrome
1. Herpes Zoster virus invades the ear canal and cause facial nerve palsy in conjunction to blisters in the ear
235
What is Benedikt syndrome
Same as weber's except has hemiataxia instead of hemiplegia (weber)
236
What would be seen on an ECG for increased intracranial pressure
T wave inversion
237
Is GVS symmetrical or assymetrical
GBS is asymmetrical
238
How is GBs diagnosed
CSF analysis- shows albuminocytologic dissociation
239
Clinical features of ependymomas
Glial tumours that press against anterior commissure - loss of pain and temperature sensation below spina level of lesion
240
What two substances are found in higher cones in the CSf compared to the blood
1. Creatinine 2. Mg 3. Chloride
241
What part of the dorsal column do the a) sensory information from upper body and b) lower body travel up
a) . gracilis fascicle | b) . cuneate fascicle
242
Describe the journey of the dorsal column-medial leminiscus system
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
243
What do the spinothalamic tracts carry
1. Crude touch 2. Pain 3. Pressure 4. Temperature
244
Describe the pathway of the spinothalamic tract
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
245
Describe the pathway of the spinocerebellar tract
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
246
WHERE do LMN originate
Ventral horn
247
Describe the pathway of the anterior corticospinal tract
1. Internal capsule | 2. Cerebral peduncle and decussates at ventral horns
248
Describe the pathway of the lateral corticospinal tract
1. Internal capsule -> cerebral peduncle -> decussation of pyramids in the medulla -> contralateral
249
What do the lateral corticospinal tract innervate
Extremity muscles
250
What do the anterior corticospinal tract innervate
Muscles of the trunk
251
What CN are involved in the corticobulbar pathway
5,7, (pons) 11,12 (medulla)
252
What corticobulbar pathways have ipsilateral and contralateral innervation
1. 5 | 2. 11
253
Where do extrapyramidal tracts originate from
Deep nuclei from brainstem
254
Role of LATERAL vestibulospinal tract
EXTENSORS of the trunk - balance There are 4 vestibular nuclei DOES NOT DECUSSATE
255
Role of medial reticulospinal tract
DOES NOT DECUSSATE - goes to extensors for balance
256
Role of lateral reticulospinal tract
Innervate both sides of the body
257
Role of tectospinal tract
1. Neck movement THESE DECUSSATE
258
Where do the rubrospinal tract originate from
1. Red nucleus THESE DECUSSATE
259
Does the vetsibulospinal tract decussate
No
260
What drug is used in MND/ALS management
1. Riluzole - prevents stimulation of glutamate receptors
261
Prognosis of MND
Poor: 50% die within 3 years due to respiratory failure
262
NOTE: Ptosis + dilated pupil = third nerve palsy | Ptosis + constricted pupils (miosis) = horners
N/a
263
Why is DOmperidone given for parkinson's induced vomiting (from careldopa) compared to other anti-emetics like metochlopramide
1. There rest can cause parkinson's disease to get exacerbated DOMPERIDONE does not cross the BBB so has no extra-pyramidal side effects
264
What characterises an ataxic gait
Wide based gait with loss of heel to toe walking
265
How is confusion, ataxia and ophthalmoplegia symptoms treated in wernicke's
Pabrinex
266
5 cancers that spread to the brain
``` LUNG Breast Bowel Skin Kidney ```
267
What causes right homonymous hemianopia with macular sparing
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)
268
Clinical Features of brown squared syndrome
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
269
What is optic neuritis
1. VISUAL LOSS with pain on eye movement or direct palpation Usually resolves on own
270
What stain is used for neurons
Neurofilaments
271
Where do gliomas from neurofibromatosis type 1 appear
Visual (2 is acoustic neuroma)
272
What is the stellate ganglion
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!
273
What is Benztropine used for
Parkinson's - to relieve resting tremors and rigidity (has no use for bradykinesia) Side-effectsL Dry mouth/mucous membranes and dilated pupils
274
What stage of sleep does sleepwalking occur and night terrors/bed wetting
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
275
What does the posterior cerebral artery supply
1. Occipital lobe, temporal lobe, thalamus, brainstem, and midbrain BILATERAL homonymous filed cut
276
What receptor is responsible for fine touch in the skin
Meissner's corpuscles PANCINIAN are lower
277
What is parinaud syndrome
Syndrome of pineal gland (tumour) - will show signs of ICP and also can't lift their gaze
278
What can cause labyrinthitis
1. HS type 1 | 2. Upper RTI
279
Clinical features of labrynthistis
1. VERTIGO 2. HEARING LOSS 3. TINNITUS
280
What drugs cause impulse control problems in people with parkinson's
1. Dopamine agonists - pramipexole
281
Two adverse effects of carbamazepine
1. Steven Johnson syndrome 2. Toxic Epidermal Necrolysis Happens in Southeasten Asian people more commonly
282
How do benzodiazepines work
1. Facilitates GABA production
283
What would be seen on a histological slide in lewy body dementia
1. Alpha synuclein deposits in brian cortex
284
What are risk factors idiopathic intracranial hypertension
1. Young, OBESE women
285
Recap nerve endings from the midbrain, pons and medulla
N/a
286
What condition is cerebral amyloidopathy seen
Alzheimer's - causes hemorrhagic strokes
287
What is the onuf's nucleus
nucleus that controls bladder constrictors.
288
What is cholesteatoma
Mass of squamous debris in middle ear - causes hearing loss and dizziness
289
Most malignant type of brain tumour
Glioblastoma multiforme
290
Histology stain of glioblastoma multiform
1. glial fibrillary acidic protein Shows central haemorrhage and necrosis HEADACHES ARE WORSE IN TH MORNING
291
Imagine characteristic of glioblastoma
Crosses the midline
292
What is Gerstmann syndrome
1. lesion in the parietal lobe causing AFAR (agraphia, finger agnosia, acacia, right-left confusion) - happens in strokes
293
What is osmotic demyelination syndrome
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
Role of the striatum
1. Receives input from cortex about desired movement and send output to CONTROL SMOOTH MOVEMENT + inhibit undesired movement
295
What makes up the diencephalon
Thalamus | Hypothalamus
296
Role of thalamus
1. Receives body information to cerebral cortex and vice versa
297
Role of hypothalamus
1. Regulate body temp 2. Sleep wake cycle 3. Eating/drinking 4. Regulates endocrine hormones
298
Role of he midbrain
1. Hearing 2. Vision 3, Motor control 4. Consciousness
299
Role of the medulla
1. BP 2. Brwahitng 3. Swallowing 4. VOmiting 5. Digestion
300
What is found int he lateral horns
1. Sympathetic division of the autonomic nervous system (urination/digestion)
301
What cranial nerves come out from the i=midbrain
1. 3 and 4
302
What cranial nerves come out of the pons
5,6,7,8
303
What cranial nerves come out from the medulla
9,10,11,12
304
Role of the sclera
1. Tough and fibrous to protect structures | 2. Anchoring point
305
Muscles that control the size of the pupil
1. Dilator pupillae muscle | 2. Sphincter pupillae muscle
306
In which compartment of the eye is the lens found
1. Posterior chamber (with ciliary body)
307
Role of the ciliary body
Controls lens shape and bound by suspensory ligaments
308
Role of choroid
1. Blood vessels that supply the eye - absorbs lights to allow light to focus on retina
309
Describe the structure of the retina
1. Ganglion cells -> Bipolar cells -> photoreceptors-> pigmented epithelial cells to be absorbed
310
Properties of RODS
1. Light sensitive (low light condition sensitive) | 2. Black and white
311
Properties of cones
1. Less light sensitive | 2. Red,green or blue
312
What is the fovea
1. Greated visual acuity in macula
313
What forms the anterior chamber
Cornea | Iris
314
What is the aqueous hummor
1. Provides nutrients to lens and cornea Produced by ciliary epithelium
315
Name the three ear bones
Malleus, incus, stapes
316
Role of pinna
Directs sound into external acoustic meatus
317
Role of cerumen
Stops foreign objects from getting into tympanic membrane (eardrum)
318
What part of the skull is the middle ear located in
Temporal bone
319
Roles of the oval and round windows
1.
320
Role of the eustachian tube
1. Equalises pressure across tympanic membrane 2. Protects from reflux of fluids from nasopharynx 3. Clears out middle ear secretions
321
What does the stapes connects to
Oval window -> inner ear
322
What can the inner ear be split into
``` Membranous labyrinth (ENDOLYMPH) Bony Labyrinth (PERILYMPH) ``` Vestibule: Cochlea hearing and semicircular canals
323
Role of perilymph and endolymph
Hearing and balance
324
Three layers of the cochlea
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
What are the two parts of the vestibular apparatus
1. Semicircular canals | 2. Saccule and utricle - balance
326
Role of ampulla
Detects changes in head rotation (contains hair cells for balance)
327
Role of utricle and saccule
1. Have macular containing balance receptors (detect changes in horizontal or vertcile acceleration)
328
What is a neutrons resting potential
-55 mV
329
Describe the process of neutron action potentials
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
What is the absolute refractory period
1. Where no excitation can occur, mans it will go in one direction
331
Role of extrafusal fibres
1. Innervated by ALPHA motor neurones | 2. Provide most of the force from cortex - voluntary
332
How do extrafusal muscles attach to bones
Golgi tendon organs
333
What fibres make up muscle SPINDLES
Intrafusal muscle fibres Contain contractile proteins only at the ends not in the middle so this doesn't contract
334
What is contained din the centre of the muscle spindles
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
Role of gamma motor neurons
Actin and myosin in edges - causes contraction in intrafusal muscles
336
Describe the stretch reflex
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
Describe the golgi tendon reflex
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
Direct vs indirect pathway
Excitatory vs inhibitory
339
Describe the direct pathway
1. Cortx -> excitatory -> Striatum -> GABA -> Interntal globus pallidus -> less GABA -> thalamus d1 - excitatory
340
Describe the indirect pathway
Cortex -> excitatory -> Striatum -> GABA -> external GP -> Less GABA -> Subthalamic nucleus -> more excitatory projections -> internal GP -> more gaba -> thalamus d2 - inhibitory
341
What is pseudo dementia
Depression related dementia - tend to be distressed/self aware of their cognitive impairment
342
Role of medial temporal lobe
Limbic memory circuit (amnesia) - can repeat back phrases and eventually forget after time Emotional circuits
343
Role of lateral temporal lobe
Word ad picture store
344
CF of subcortical dementia
1. Reduced mental processing 2. Poor attention and retrieval 3. Apathy 4. Mood disturbance 5. Lack of cortical signs
345
CF of alzheimer's
``` Medial temporal lobe: Amnesia Long term memory fine Visual and spatial disorientation Dysphagia (wernicke's) Dyscalculia Dyspraxia No motor signs as its subcortical ```
346
CF of vascular dementia
1. Psuedobulbar palsy 2. Subcortical: mental and physical decline, apathy 3. Shuffling gait
347
CF of lew body dementia
1. Parkinsonism 2. Hallucination 3. Myoclonus - jerks KEY FEATURE: fluctuating confusion
348
What part of the temporal lobe is found in front temporal dementia
LATERAL so no amnesia is seen here Parkinsons or MND can also be found in these patients
349
What is echolalia
Repeating what you've said back to me
350
What is logoclonia
Stutter - characteristic in alzheimers
351
Investigations for dementia
1. MMSE 2. Montreal OCA 3. ACE (adab brooks cog exam) 4. Neuropsychology, imaging, EEG
352
What is the dost sensitive investigations for confirming location of a stroke
MRI scan at day 1 with diffusion weighted imaging CT on admission will not show ischaemia,especially for small strokes like lacunar
353
Scoring of ABCD2
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
What risk number on ABCD2 would mean urgent assessment
>3
355
How is anticoagulation reversed
Vit K/Beriplex
356
Score system of AF
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
What is the HASSLED criteria
Criteria to assess major bleed following anticoags
358
Treatment of a hemorrhagic stroke
Reverse coag - IV K/beriplex Maybe BP lowered Neurosurgery
359
Common gene cause of MND
SOD1 - codes for superoxide dismutase
360
What MND carries the worst prognosis
Progressive bulbar palsy
361
Investigations for MND
1. EMG 2 .MRI 3. LP
362
Pathophysiology of parkinsons
Loss of dopaminergic neurones in substantial nigra (pars compact) Neurofibrillary tangles from alphasynuclean and ubiquitin
363
CF of huntigtons
1. Chorea 2. Dementia 3. Depression/agression 4. Stiffness, dystonia 5. Ptosis/eye movements
364
Histology of alzheimers
Senile places | Neurofibrillary tangles
365
Treatment of alzheimers
Donepezil (Achesterase inhibitors) | Memantine NMDA antagonist
366
How do we test proprioception in a patient
Romberg's test (close eyes)
367
Where is a hemiplegic gait seen
UMN lesions: one foot is inverted and smacked around when turning
368
Name two other conditions that has chorea
1. SLE 2. Wilson's disease 3. Pregnancy
369
IF levodopa is causing motor complications, what can be given instead
MAO-B inhibitors
370
What are pseudoathetosis movements
writhing movements of the fingers (nerve to parietal cortex problem).
371
What is apraxia
Inability to execute movements
372
Cells Involved in MS
Cd8 Th17 B cells Maceophages
373
Three impacts of MS on neurones
Conduction block Axon Transection Demyelination
374
What criteria is used for MS
McDonalds criteria: Dissemination in space Dissemination in time No alternative disease that could explain this
375
Clinical signs of subacute degeneration of the spine
Presses against dorsal columns so proprioception and vibration gone - babinski sign positive
376
Treatment of neuroleptic malignant syndrome
Bromocriptine
377
Name a condition that commonly causes bilateral facial nerve palsy and parotid gland enlargement
Sarcoidosis
378
What is post-herpetic neuralgia
1. Happens after shingles re-starts infection
379
Pathophysiology of TS
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
CLinical Features of TS
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
Neurofibromatosis type 1 vs type 2
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
4 types of MS
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
Treatment of MS
Beta type 1b interferon
384
Side-efefcts of L-DOPA
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
Name a copamine-receptor agonist
Bromocriptine: Can cause PF, nausea and vomiting Switch to ropinerole
386
Name a COMPT inhibitor
Entacapone or Tolcapone - used if people develop motor complications (wearing off phenomenon, on-off phenomenon)
387
Name a MAO-B inhibitor
Selegiline: Degraded to amhpetamine (excitement, anxiety and insomnia)
388
Surgical methods of Parkinsons
Deep-brain stimulation
389
What can exacerbate a myasthenic crisis
Bisoprolol
390
Invetsigations for orthostatic hypotension
1. L/S BP
391
What nerve innervates the serratus anterior
Long Thoracic Nerve
392
Most common cause of cauda equina
1. Lumbar disc herniation Ankylosing sponylitis Anterospondylolisthesis
393
Symptoms of cauda equina
1. Ssddle anaesthesia 2. Bowel and bladder control 3. One or both legs affected/paraplegia Sciatci pain
394
Pharmacology od opioids
1. Bind to inhibitory neurones which stop release of GABA, and allows release of serotonin and dopamine instead / decreased sensitivity to pain
395
Side effects of opioids
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
How is opioid overdose treated
Naloxone and give them methadone
397
Name some full opioid agonists and partial agonists
Full: Morphine Methadone (does not cuase euphoria so used for withdrawal) Fentanyl (most potent - anaesthetic) PArtial: Buprenorphine Tramadol
398
What drug is used for maagemet of acute MS relapses
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
What is Stevens/Johnson SYndrome
Adverse effect of lamotrigine: happens two months after starting with flu-like illlness and rapid onset of red skin rash
400
Name an autonomic recessive disease that can commonly cause ataxia
Friedrich's ataxia (nystagmus, fast saccadic eye movement)
401
What is localising in GCS
Arm is brought above the clavicle when supraorbital pressure is applied, or else its flexing
402
How are subdural haematomas treated
Carniotoomy or burr holes at site of haematoma - drain sthem so in chronic subdural haematomas
403
What medication can reverse Benzo overdose
Flumanazile
404
Benzo overdose vs opioid
Pupils are normal
405
GBS CSF composition
High protien and no change in WBC
406
How do we test for brain death
1. Take of ventilators - vagus 2. Vetibulocochlear reflex 3. Oculomotor reflex 4. Gag reflex
407
What causes RAPD
Lesion of optic nerve due to glaucoma
408
How is RAPD diagnosed
Swinging flashlight test
409
What causes glaucoma
Increased ICP: drainage of aqueous humour becomes occluded
410
Symptoms of glaucoma
1. Pain 2. Red eye 3. Nausea, vomiting
411
Emergency treatemnt of acute glaucoma
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
Symptoms of vitreous haemorrhage
1. Floaters 2. Red tinge 3. Blurring of vision
413
How it retinal detachment repaired
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
pathophysiology of central retinal vein occlusion
1. DIlation of branch veins - causes cotton wool spots and rettinal haemorrhages
415
How is central retinal vein occlusion treated
Anti VEGF
416
Sign and symptoms of central retinal artery occlusion
CHARACTERISTIC: red spots in macula and pale optic disc Macula is upplied, rest of retina is pale CANNOT BE treated
417
Pathophysiology of anterior iaschaemic optic neuropathy
1. Posterior ciliary artery occlusion - supplies optic nerve head Caused by temporal arteritis/GCA - jaw claudication 60mg of prednisolone
418
Signs and symptoms of optic neuritis
1. Reduced visual acuity over two day s 2. Pain on moving eye 3. Exacerbated by heat 4. RAPD 5. Dyschromatopsia (colour blindness)
419
What can cause optic neurtis
``` B12 defiiency MS CIS Lymes Syphilis HIV ``` REMEBER THESE - resolves within 6 weeks
420
Investigation of unilateral vision loss
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
What is babinski's sign
Dorsiflexion of the big toe on plantar stimulation: indicative of UMN lesions
422
What is Brudzinski's sign
Reflex flexion of the hips when flexion of the neck is forced: Subarachnoid haemorrheages, encephalitis and more importantly meningitis
423
What is the straight leg raise test indicative of
Lumbar disc herniation - produces radiating leg pain
424
Conversion disorder vs somatisation
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
What is a dissociative fugue
Sudden and unexpected travel away from one's home with an inability to recall the past.
426
Use of SSRIs during pregnancy: What are the impacts in the third trimester
Persistent pulmonary hypertension
427
What medications should be avoided when prescribing SSRIS
``` NSAIDs Warfarin Aspirin Triptans MAOIs ```
428
First line drugs for PTSD
Venlafaxine or SSRIs.
429
What is a common abnormal finding in lithium, corticosteroids and beta blockers in blood check ups
Benign leucocytosis (just safety net)
430
What is the first line treatment for diabetic neuropathy
Duloxetine
431
Major side effect of Venlafaxine and Duloxetine (SNRIs)
Hypertension, must check BP
432
What lack of substance is associated with anxiety
Low GABA
433
What antidepressant should be given to those suffering from SSRI erectile dysfunction
Buproprion
434
Examination signs of serotonin syndrome
1. Anxiety/Confusion 2. Hyperreflexia (positive babinski signs with positive ankle clonus) 3. Muscle rigidity 4. Tachycardia, leucocystosis
435
What condition usually gives rise to Myasthenic Lambert Eaton Syndrome
Small cell lung cancer
436
What condition can result in central retinal artery occlusion
Giant Cell Arteritis
437
Innervation of the Superior Oblique Muscles
Trochlear Nerve (4)
438
Role of the superior oblique muscle
Abducts and medially rotates the eye ball (down and out)
439
Role of the inferior oblique muscle
Abducts and laterally rotates the eyeball (up and out)
440
Innervation o the inferior oblique muscle
Oculomotor nerve
441
What information does the lateral spinothalamic tract relay
Pain and temperature
442
What does the anterior spinothalamic tract convey
Crude Tocuh
443
In which Motor Neurone condition is Flaccid Paralysis seen in and in which motor neurone condition is spastic paralysis seen in and why
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
Name the three branches of the cavernous sinus
Ophthalmic Maxillary Mandibular
445
What does the basilar artery supply
Brainstem | Cerebellum
446
Three types of strokes
Thrombotic Embolic Hypoxic
447
Symptoms in anterior vs middle vs posterior cerebral artery strokes
Anterior: Feet and Legs Middles: hands, arm and face Language centres in the dominant hemisphere Posterior: Visual Cortex
448
If no blood is seen on a CT of the head, and a subarachnoid haemorrhage is still suspected, what should be done?
Lumbar Puncture to check for xanthochromia in the CSF
449
Where do emboli strokes most commonly occur
PICA as it's the first big artery to come off the arteries.
450
Clinical Presentation of a TIA
``` Amaurosis Fugax (curtain drop vision loss) Dysphagia Hemiparesis Hemisensory disturbances Diplopia Vertigo Vomiting Ataxia ```
451
Symptoms of anterior cerebral stroke
``` 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
Symptoms of middle cerebral artery strokes
1. Contraletra; arm and leg weakness 2. Contraleteral Sensory Loss Facial Droop
453
symptoms of posterior cerebral artery strokes
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
Contraindications to antiplatlet therapy in a stroke
``` Recent surgery (last 3 months) recent arterial puncture Malignancy Brain Aneurysm Anticoagulation Liver Disease Acute Pancreatitis Clotting disorder ```
455
What treatment is given if thrombolysis is contraindicated
75mg Aspirin 2 weeks and then 75 mg clopidogrel lifelong
456
Treatment of a stroke, first line
IV alteplase (tissue plasminogen activator) Clopidogrel 24 Horus after thrombectomy
457
What pathology does a hemiplegic gait indicate
UMN lesion
458
What does a broad based gait indicate
Cerebellar lesion
459
What does a waddling gait indicate
Pelvic muscle weakness
460
What are two key Signs of central retinal artery occlusion + treatment
1. Pale Retina 2. Cherry Red Spot High Dose Steroids as it's caused by Giant Cell Arteritis
461
What is a vitreous haemorrhage
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
What does the facial nerve supply
1. Sublingual, Submandibular and Lacrimal Glands 2. Stapedius muscle 3. Supplies taste to anterior 2/3rds of the tongue
463
What infections may cause Bell's palsy
HSV EBV VZV
464
Bell's palsy vs Stroke/Brain Stem ischaemia
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
What cranial nerves are affected in acoustic neruomas and how does this affect the clinical presentations found
8: Vertigo, unilateral hearing loss, tinnitus 5: ABSENT CORNEAL REFLEXES 7: Facial Palsy
466
When is a thrombectomy indicated for an acute ischaemic stroke
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
When can thrombectomy be offered to people
Between 6-24 hours To people with: CONFIRMED occlusion of the anterior circulation by CT or MRI + if salvageable tissue is present
468
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
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
What is a common trigger for cluster headaches
Alcohol
470
Management of increased ICP and why
Controlled Hyperventilation to reduce CO2, causing cerebral vasoconstriction
471
Why do we want to achieve cerebral vasoconstriction in high ICP
It lowers ICP
472
TIA vs a stroke
TIA = no acute tissue infarction Stroke = Tissue Innfarction The definition is no longer time-based, but tissue based.
473
What nerve causes vertical diplopia
Trochlear (means vision is worse on looking down) - Trochlear is responsible for down and out movement
474
What cranial nerve is responsible for swallowing
Vagus nerve Lesions will point away from the lesioned nerve as the muscle affected by the nerve lose tone.
475
What formamen do the olfactory nerves pass through
Cribriform
476
What foramen does the optic nerve pass through
Optic canal
477
What nerves pass through the superior orbital fissure
3,4,5 (Ophthalmic), 6
478
What nerve runs through the foramen rotunda
V2 (maxillary)
479
What nerve runs through the foramen oval
Mandibular nerve
480
What three nerves run through the jugular foramen
9,10,11
481
What nerve runs through the hypoglossal canal
Hypoglossal nerve
482
Signs of vagus nerve lesion
1. Uvula deviates away from the site of the lesion s | 2. Loss of gag reflex
483
Signs of hypoglossal nerve lesions
1. Tongue deviates TOWARDS the side of the lesion
484
Role of the glossopharyngeal nerve
TASTE. (posterior 1/3) Salivation Swallowing
485
Sign of glossopharyngeal nerve lesions
1. Hypersensitive carotid sinus reflex | 2. Loss of gag reflex
486
Signs of Amyotrophic Lateral Sclerosis
Mixture of UMn and LMN signs
487
Onset for ALS
55 to 75
488
What is internuclear Opthalmoplegia
Where the affected eye can't adduct, and the contralateral eye abducts but with nystagmus = horizontal diplopia
489
What is the main cause of internuclear ophthalmoplegia
MS
490
What are contraindications to thrombolysis
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 9. Oesophageal varices 10. Uncontrolled HTN
491
What kind of vision loss is seen in glaucoma
There is blunting of the margins of the optic disc, so peripheral field is usually lost rather than central
492
What causes homonymous quadrantanopias
PITS (Parietal-Inferior, Temporal-Superior) lesions
492
What causes homonymous quadrantanopias
PITS (Parietal-Inferior, Temporal-Superior) lesions
493
What usually causes lower quadrant defects in Bitemporal hemiopia
Craniopharyngioma Pituitary tumours usually cause an upper quadrant defect
494
What kind of pulse pressure is seen in raised ICP
Widened pulse pressure
495
Describe the MRC grading
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
How do we treat spasticity
Baclofen
497
What is the cute management of an ISCHAEMIC stroke
Aspirin 300mg
498
Treatment of a Brian abscess
Ceftriaxone and Metronidazole
499
Side-Effects of Phenytoin
Glove-and-stocking numbness and generalised lymphadenopathy
500
How do we treat Restless Leg Syndrome
Dopamine Agonists: Ropinerole
501
What is the first line treatment for post-herpetic Neuralgia
Duloxetine/Gabapentin or Pregabalin
502
What scale is used to measure disability or dependance in activities of daily living in stroke patients
Barthel Scale
503
What is the Rosier Scale
used to differentiate acute strokes from stroke mimics
504
What nerve causes an absent corneal reflex
Trigeminal nerve
505
What kind of Motor Neurone disease is degenerative cervical myelopathy
UMN
506
What is the Weber's Test
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
How do we interpret Rhinne's test
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
Onset of acoustic neuromas
Gradual
509
How long should someone be off after an isolated seizure
6 Months (or 12 months if there are abnormalities on imaging)
510
What are the consequences of arnold-chiari malformation
Non-communicating hydrocephalus Syringomyelia
511
What usually causes a pontine haemorrhage
Chronic Hypertension
512
What is Anterior cord syndrome
An ACUTE onset of pain and temperature loss due to ischaemia in the spinal cord (e.g., Aortic Dissection)
513
What is an indication for Carotid Endarterectomy
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
Examination signs of Idiopathic Intracranial Hypertension
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
What does a CT show for a subdural haematoma show
Crescent (banana shape) - Convex
516
What is the diagnostic investigation for necrotising enterocolitis
Abdominal X-RAY!
517
What is pituitary apoplexy
This is where there is SEVERE bleeding or loss of blood flow to the pituitary gland
518
What are the two arteries that supply the pituitary glands
1. Superior Hypophyseal Artery | 2. Inferior Hypophyseal Artery
519
What usually causes Pituitary Apoplexy
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
What is the consequence of pituitary gland blood supply rupture
Causes pituitary enlargement, and compresses the surrounding structures: - Meninges (pain when it's stretched) - Optic chiasm (Bitemporal hemianopia)
521
Symptoms of Pituitary apoplexy
1. Hypoglycaemia 2. Low BP 3. Reduced consciousness Deficiency of Thyroid, GnRh, Growth Hormone and Prolactin (Agalactorrhoea)
522
What is the management of pituitary hypooplexy
Requires urgent steroids (Iv Hydrocortisone)
523
What Structure in the brain can cause Diabetes Inspidius and lower bitemporal hemianopia
Craniopharyngioma
524
What is he pharmacology of Suxamethonium
Neuromuscular blocking drug: depolarises NMD causing muscle contraction and then paralysis (exacerbates MG)
525
What anaesthesia is used for MG
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
What drugs can increase the risk of Idiopathic Intracranial Hypertension
COMAAR ``` C - Ciclosporins O - Oral Contraceptive Pill M - Mineralocorticosteroids A - Amiodarone A - Antibiotics (tetracyclines and Sulfonamides) R - Retinoic Acid ```
527
What indicates the use of Dexamethasone over Mannitol
Mannitol is exclusively used to reduce ICP, while Dexamethasone is used in Cerebral Oedema
528
How do we diagnose Optic Neuritis
MRI Head
529
What is the most important diagnostic for Degerenative Cervical Myelopathy
MRI of the Spine
530
A stroke in what artery usually results in expressive aphasia
MIDDLE CEREBRAL, not anterior cerebral
531
What drugs can result in overuse headaches
Triptans, Opioids and other analgesics
532
Signs of Medication Overuse Headaches
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
When would I use an MRI with contrast ve without contrast
Contrast is to look FOR something (e.g., tissues, masses) Non-Contrast is to look at the area (e.g., Fractures, haemorrhage strokes)
534
Describe the frequency of pain felt in cluster headaches
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
As both a subdural haematoma and extradural haematoma can present in a head injury, what differentiates the two?
Extradural has acute presentations, while subdural haematomas can present 4 weeks after initial trauma.
536
When is Ondansetron the first line treatment for nausea
Chemotherapy induced nausea
537
When is Halooperidol the first line treatment for nausea
Intracranial causes for Nausea (Raised ICP, tumours)
538
When is Prochlorperazine indicated for nausea
Vestibular causes
539
When is metoclopramide indicated for Nausea
GI causes
540
When is Levodopa the first line treatment in Parkinson's Disease
If the symptoms as significantly affecting their quality of life
541
What is usually the first line treatment of Parkinson's
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
Why would Cabergoline or Bromocriptine not be first line treatment for Non-quality of life affected Parkison's
Bromocriptine and Cabergoline are both ergot-derived dopamine agonists which are not recommended for use as first line by NICE.
543
What other drug, apart from anti-psychotics can cause NMS
Levodopa - usually if withdrawn in hospital settings (e.g., A and E)
544
What are the signs for a cerebellar lesion
IPSILATERAL; ``` DANISH D- Dysdiadochokinesia (patients appear drunk) A - Ataxia (limb or truncal) N - Nystagmus I - Intention Tremour S - Slurred Speech H - HYPOTONIA ```
545
What can cause cerebellar syndrome
``` Freidrich's Ataxia Cerebellar haemangioma Stroke Alcohol MS Hypothyroidism Phenytoin, lead poisoning ```
546
What triggers autonomic Dysreflexia
Faecal Impaction/ Urinary retention RF: Immobility, Bed bound, Medications that cause hypo mobility, anal fissures. and GI issues (e.g., Hirschsprung's disease).
547
What causes a winged scapula
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
IN the painful arch, was does pain on raising the arm laterally to 120 degrees indicate (pain goes away after 120 degrees)
Glenohumeral joint dysfunction (pain usually between 60 and 120 degrees)
549
Pharmacology of Heparin
Indirectly inhibits Thrombin and Xa by binding to Antithrombin III
550
What is the role of antithrombin III
Binds to Thrombin and Xa, causing their cleavage
551
What is the difference between unfratcioned and fractioned Heparin
Unfractionated: Where Heparin is derived physiologically (pig intestines) two types: HMWH or LMWH Fractionated: Unfraticonated heparin is where HMWH is depolarised -> LMWH
552
What is the difference in action between HMWH and LMWH
Both inhibit Antithrombin III (so less Xa) However, Only HMWH has an effect on Thrombin inhibition (longer chain to bind to)
553
Types of LMWH
-Parins Dalteparin Fondaparinux (although this is synthetic derived -> fractionated).
554
When is Heparin usually prefered
Acute management of issues in hospitals (as it's IV) Chronic: Warfarin or DOACs because they can be taken per orally
555
Side Effects of Heparin
Heparin Induced Thrombocytopenia (lower in LMWH)
556
What medication is given to treat nausea from chemotherapy
5-HT3 antagonists (ondansetron and granisetron)
557
What is vertical diplopia
Vertical diplopia is double vision caused when looking down
558
Role of COMPT inhibitors
Reduce the breakdown of levodopa
559
Cluster Headache vs Glaucoma
Glaucoma is a sudden onset within hours (a day) Cluster Headaches happen multiple time (think of their history)
560
What medication can precipitate idiopathic intracranial hypertension
tetracyclines (Lymecycline)
561
In what patients is thoracic outlet syndrome more common
In patients who do repetitive motions (think swimming)
562
Describe the tremor seen in a Parkinson's patient
A unilateral tremor that improves with movement
563
What is the most common trigger for autonomic dysreflexia
faecal Impaction / Urinary Retention
564
What drugs can exacerbate a myasthenia crisis
``` Penicillamine Procainamide Beta-Blockers Lithium Phenytoin Antibiotics: Genatmycin, Macrolides, Quinolones, tetracyclines ```
565
What is Progressive Muscular Atrophy
Starts with LMN signs in the distal arms and legs Becomes UMn slowly but surely
566
What is Primary Lateral Sclerosis
Just UMN signs everywhere
567
Where do hemangioblastomas ariseCerebellum - shows DANISH signs and FH
568
What is Opsoclonus Myoclonus syndrome
Irregular saccadic eye movements, myoclonus and truncual titration (wobbly on feet) Mostly seen in Neuroblastomas
569
Is GBS UMN or LMN
UMN - so flaccid!
570
Why can non functioning pituitary adenomas cause an increase in prolactin
Due to decreased dopaminergic inhibition - is not found exclusively in prolactinomas
571
What is a watershed stroke
An sichaemic stroke between a junction where two arteries meet - can cause bilateral vision loss
572
Symptoms of meningiomas at the base of the anterior cranial fossa
Presses against olfactory nerves - loss of smell.
573
Role of medial Geniculate Nucleus
Directs auditory attention
574
Role of Lateral Geniculate Nucleus
Visual fields
575
What structure increases in size in Glaucoma
Cup - to - disc ratio | the cup of the optic disc inflates
576
Myelopathy vs Radiculopathy
Myelopathy affects the whole spinal cord (loss of function in both upper and lower limbs) Radiculopathy - pinched nerve
577
What causes Lateral Pontine Syndrome + Signs
Occlusion of the Anterior Inferior Cerebellar artery Signs: Loss of pain, hearing and ptosis
578
What causes medial medullary syndrome
Occlusion of. the anterior spinal artery Signs: Weakness of upper and lower extremities + hemisensory loss and tongue deviation
579
What causes medial pontine syndrome
Occlusion of the paramedic branch of the basilar artery Leads to Strabismus + Ataxia, slurred speech
580
Signs of Tabes Doralis
Remember - literally means pain of the back! Triad: Unsteadiness Urinary Incontinence Severe Lightening like pains
581
What does orbital cellulitis succeed
Bacterial rhinosinusitis (recurrent sinus infections)
582
What is the most common eye pathology that causes a white reflex
CATARACTS
583
What is a Hollenhorst plaque
A cholesterol embolus present in the retinal artery
584
What prophylaxis is recommended in meningococcal meningitis
Ciprofloxacin OR Rifampicin
585
What anti-sickness medication causes Parkinsonism symptoms
Metoclopramide
586
Viral Encephalitis vs Bacterial Encephalitis
Exactly the same CSF and blood plasma finding (glucose is raised or normal) However, Encephalitis is more likely if people are behaving bizarrely
587
What drug can be used to treat fatigue in MS
Modanafil
588
Symptom specific to Ramsay hunt syndrome
Earache and burning sensation in the ear
589
What measure is used to check respiratory disease in GBS
FVC
590
What is multifocal motor neuropathy
Assymetric lower motor neurone weakness in the upper limbs No cranial or sensory involvement
591
What happens to reflexes in Brown-Sequard syndrome
Become hyperreflexic
592
What scale is used to recognise strokes in an acute environment
ROSIER
593
What is the most usual cause for an intracranial haemorrhage (e.g., acute bleeding in the basal ganglia or other parts of the brain)
Hypertension
594
When is Dexamthesone indicated in suspected Spinal Cord Compression
Cancers that metastasise to the spinal cord - causing spinal cord compression
595
What infection commonly causes spinal cord compression
TB
596
When should patients be referred to a TIA clinic after their first episode
Within 24 hours, and 300mg Aspirin
597
Second and third line interventions for migraines
If beta-blockers are contraindicated, give Amitryptaline 2nd Line: Topiramate/Valproate
598
How should thiamine be always given in Wernicke's
IV
599
Where are lesions in spastic cerebral palsy seen
Pyramidal Tracts
600
What structure is affected in MND
Ventral Horn
601
What neurone condition commonly occurs after a Respiratory Tract Infection and what are the symptoms
Episodes of dizziness - Vestibular Neuritis
602
Benign proximal positional vertigo vs Vestibular Neuritis
BPPV has a postural element, while vestibular neuritis is just dizziness
603
What structures are affected din labrynthistis
Both branches of cranial 8
604
Clinical Features of Idiopathic Intracranial Hypertension
Bilateral, non-pulsatile headache worse in the morning / after lying down or bending forwards. Morning vomiting Bilateral Papilloedema, optic nerve ischaemia on fundoscopy
605
What drug can cause IIH
COCP | Steroids
606
What usually causes ulnar palsy
Cubital Tunnel Syndrome Or Medial Epicondylitis but that's usually only if there's a past history of elbow involvement
607
What is the first line management of a subdural haemorrhage
Burr Hole Craniostomy Second Line: Craniotomy
608
What procedure is considered for extradural haemorrhages
Ligation of the damaged blood vessel
609
Firs Line management of a haemorrhagic stroke
Administer Prothrombin complex, vit K and Warfarin
610
What is the first line treatment in hospitals for a seizure
IV Lorazepam It's usually buccal or rectal diazepam outside hospitals
611
When should CTs be arranged within 1 hour
``` <13 GCS score 2 hours after injury Suspected skull fracture Signs of basal skull fracture Post traumatic seizure ```
612
When should CT heads be used for an extradural haemorrhage
>65 years | History of bleeding or clotting disorders
613
What is Klumpke's palsy
Small hand paralysis with ptosis and sensory disturbances (looks like Horner's syndrome) From damage to lower brachial plexus
614
What is seen on a visual acuity test for IIH
Enlarged blind spots and constriction of the visual field
615
What is the first line treatment of absence seizures
Ethosuxamide OR Sodium Valproate
616
How is Charcot-Marie-tooth inheirted
Autosomal Dominant
617
Signs of subacute degeneration of the cord
Affects the dorsal columns and lateral corticospinal tract: Loss of proprioception, vibration, muscle weakness and hyperreflexia
618
What myotome would cause finger abduction weakness
T1
619
What endocrinological tumour causes DI
Craniopharyngioma - causes Lower bitemporal hemianopia
620
What trunks causes Klumpke's paralysis
C8-T1
621
Where is Broca's area found
Left inferior frontal gyrus
622
What EEG reading is found for a absence seizure
3Hz spike and wave
623
If Baclofen does not work for spasticity in MS, what else can be given
Gabapentin
624
When should aspirin be offered in an ischaemic stroke
Only if hyper-acute treatment can't be offered, either contraindicated or too late. 300mg. Otherwise Alteplase + Thrombectomy
625
Which drugs increase the risk of Idiopathic Intracranial Hypertension
``` COMAAR C - Ciclosporins O - Oral Contraceptive Pill M - Mineralocorticosteroids A - Amiodarone A 0 Antibiotics (tetracyclines and sulphonamides R - Retinoic Acid ```
626
How do we diagnose if internuclear ophthalmoplegia is left or right?
Whatever eye that doesn't abduct properly.
627
In what condition are voltage-gated calcium channel antibodies found in
Lambert-Eaton Syndrome
628
What condition shows a DECREASE in motor action amplitude with repetition
MG
629
What antibodies are seen in GBS
anti-GM1 antibodies
630
In what seizures is lamotrigine the first line anti seizure medication instead of Sodium Valproate
Focal Tonic-clonic Atonic
631
What triggers absence seizures
Children holding their breath
632
What is Meniere's disease
RECURRENT episodes of vertigo, fluctuating hearing loss and tinnitus
633
What antibiotic causes ototoxicity (labyrinthitis-esque symptoms)
Aminoglycosides (vancomycin, gentamicin)
634
What medication is given in SAH to reduce vasospasm risks
Nimodipine (calcium channel blocker)
635
Treatment of BPPV
Epley Maneouvres
636
Describe the flow of CSF
Lateral ventricles -> Foramen of Monroe -> third ventricle -> Cerebral aqueduct -> Foramen of Luschka and Magendie -> Subarachnoid Space
637
Other than raised CK, what else is raised in NMS
White cell count
638
What is an absolute contraindication to triptans in migraine management
A history of ischaemic heart disease
639
What does hyper-attenuation on a CT head indicate for a stroke
It's a haemorrhage stroke
640
When should sumatriptan be taken during a migraine
Only once the headache starts, not in the aura phase
641
What artery is occluded to cause locked in syndrome (pontine haemorrhage)
The Pons
642
What artery occlusion results in weber's syndrome
Paramedian branches of the basilar and proximal posterior cerebral arteries
643
How long do cluster headaches last
4-12 weeks
644
First line management for a TIA
300mg Aspirin Seen by a specialist within 24 hours Then secondary prevention: Clopidogrel 75mg once daily
645
In what patients does a TIA mean urgent referral to emergency department for imaging
Patients on apixaban/warfarin to exclude a haemorrhage stroke. Any suspected haemorrhage stroke requires immediate imaging over anything else
646
Signs of MND on a nerve conduction study
Completely normal
647
What can make an essential tremor worse
Stress (emotional or physical)
648
Intention vs Essential tremours
Essential Tremors happen without intentional movement but WORSEN on intentional movement. Intention Tremor: They only occur during intentional movement
649
Onset of Degenerative Cervical Myelopathy
GRADUAL - over many months to one year
650
What type of motor neurone disease is DCM
Upper.
651
How is sumatriptan given in Cluster headaches
Subcutaneously
652
What eye is affected din cranial nerve palsies if there is a mass in th ehead
Usually the nerve is being compressed by the mass.
653
Other than a loss of vibration and proprioception, what else can be found on examination in subacute degeneration o the cord
UMN and LMN signs (absent and present reflexes)
654
Where are meningiomas commonly found
Falx cerebri, Superior sagital sinus and Skull base
655
What are hemangioblastomas most commonly associated with
von hippie Linda syndrome
656
Treatment for a brain abscess
Ceftriaxone and Metronidazole
657
Side effects of topiramate
Weight loss + Renal Stones
658
Side Effects of Phenytoin
Ataxia Peripheral Neuropathy Osteomalacia Hirsutism
659
What is the most common cause of a oculomotor nerve palsy
Diabetes Mellitus
660
Difference in symptoms between a medical and surgical third nerve palsy
Surgical (ie., posterior communicating artery aneurysm) is painful Medical (DM) - is painless
661
In what haematoma is anti-coagulant use a risk factor
Sub-dural haematoma
662
BPPV vs Meniere’s
BPPV - lasts seconds Meniere’s - last a few mins to a few hours + history of recurrence
663
What myotome is resposible for big toe extension
L5
664
What myotome is resposible for ankle dorsiflexion
L4
665
What is a Stokes-Adams Attack
A random waiting spell caused by intermittent COMPLETE heart block
666
What antibiotics can increase the risk of idiopathic intracranial hypertension
Doxycycline +
667
Signs of diffuse axonal injury
Usually in car accidents from rapid acceleration and then deceleration: - Unconsciousness - Vegetative state
668
What is the role of nimodipine in a Subarachnoid Haemorrhage
Prevents vasospasms
669
First line management of a subarachnoid haemorrhage
ABCDE So, FIrst - Secure aiways Second - BP control C - Nimodipine to prevent vasospasms
670
Indications for a CT head within 1 hour
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
Indications for a CT head within 8 hours
1. >65 2. Any history of bleeding or clotting disorders 3. Dangerous mechanism of injury 4. Retrograde amnesia >30 mins
672
If a patient is on warfarin and there is no other indiciations/complications of the head injury, when should a CT head be done
Within 8 hours
673
Meningitis vs SAH
Meningitis would not have xanthachromia (yellow) Both have raised WCC/normal glucose
674
A major complication of a pituitary apoplexy
SAH
675
When is an LP indicated for SAH
If CT of the head is normal. Wait 12 hours and then an LP is taken to check for xanthachromia
676
What arteries are mostly affected in a lacunar stroke
Lenticulostriate arteries which supply the basal ganglia
677
Signs of tetanus
1. Rigid Abdomen 2. Arched back 3. Clenched Fists
678
Signs of retinitis
Similar to Behcet's disease: Apthous Ulcers Reduced visual acuity due to white (pus) infiltrates in the anterior chamber
679
Risk factors of primary open-angle glaucoma
African American Hypothyroidism Diabetes Mellitus
680
What cells demyelinate in MS
Oligodendrocites
681
What myotome is responsible for plantar flexion
S1
682
What myotome does dorsiflexion
L4
683
What myotome allows for thumb extension
C8
684
What is the role of T1
Finger Abduction
685
What is usually spared in syringomyelia and why
The DMLC, as the ventral part of the spinal cord’s CSF dilates not the posterior prt
686
What cervical levels result in the cape like distribution of pain and temperature loss
Syringomyelia: BILATERAL C4-C6
687
What causes charcot joint in Syringomyelia
Repeated trauma to a body part: usually the feet or the shoulders
688
How to diagnose Syringomyelia
MRI of the head
689
What is the main cause of syringomyelia
Arnold-Chiari Malformation
690
How is Arnold Chiari Malformation treated
Posterior Fossa Decompression
691
Signs of an Anterior Spinal Artery infarct
DMLC is intact, loss of pain and temperature below that level
692
Risk Factors for intracranial venous thrbosis
COCP | Pregnancy
693
Diagnosis of an intracranial venous thrombosis
Non contrast CT Head: Hyperdensity in affected sinus CT Venogram: an empty delta sign
694
What medications can cause ototoxicity
Gentamicin Vancomycin Loop Diuretics
695
What is Polymyalgia Rheumatica signs
Shoulder/hip stiffness >1 hour in the morning + inflammatory pain Low grade fever, weight loss and malaise
696
Treatment of polymyalgia rheumatica
Corticosteroids within 72 hours
697
Polymyalgia rheumatica vs myositis
Myositis: Bilateral PROXIMAL muscle weakness but NO pain Polymyalgia: Pain prominent
698
When is an MRI indicated in people with seizures
Where seizures happen after first line meds Develop epilsepsy before 2
699
What is second line treatment for focal seizures if carbamazepine or Lamotrigine are subtherapeutic
Levetiracetem
700
If all treatments are ineffective or not tolerated, what should be done for focal seizures
Offer lamotrigine, levetiracetem, carbamazepine or gabapentin as adjunctive treatment
701
If adjunctive treatment for seizures is unsuccessful, what should be done
Refer to teriary specialist
702
First line treatment of absence seizures in women
Ethosuxamide
703
First line treatment of benign rolandic seizures
Lamotrigine
704
What surgery can be done for seizures
Vagus nerve stimulation
705
What is characteristic of a parietal lobe seizure
Pins and Needles before a generalised tonic clonic seizure

year 3 (25 decks)

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