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Phase 3a > Neuro > Flashcards

Neuro Flashcards

1
Q

Two signs in meningism

A

Kernigs

Brudzinskis

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2
Q

Clinical picture of optic neuritis

A 
Uhthoffs phenomenon
Pain with eye movements
Other MS signs 
Loss of monocular vision 
RAPD
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3
Q

What does RAPD stand for?

A

Relative afferent pupillary defect

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4
Q

Differentials of weakness

A

MS - optic neuritis ? RR pattern? Uhthoffs?
GB - post GI infection, ascending
MND - upper and lower MN signs
B12 deficiency - distal weakness
Myopathy - proximal weakness
Mononeuropathy - Saturday night palsy (radial)
Stroke (ask about and coats+ heart probs)

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5
Q

Management of encephalitis

A

If viral - acyclovir + nutrition &physio

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6
Q

Acute management of meningitis

A

Assess consciousness
Blood cultures
Abx - vancomycin + cefalosporin
Steroids- dexamethasone

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7
Q

Triad of meningitis Symps

A

Neck stiffness
Fever
Headache

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8
Q

Two viral causes of encephalitis

A

Herpes simplex virus HSV

Varicella zoster virus -VSV

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9
Q

Clinical picture of encephalitis

A

Preceding flu like illness
Memory loss
Fever
Seizures

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10
Q

Contraindications to LP

A

If suspect mass lesion/ RICP
Purpuric/ peticial rash
Anticoagulants

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11
Q

What would LP show in Guillian Barre syndrome

A

Raised protein

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12
Q

What would LP show in bacterial meningitis

A

Raised cell count

Decreased glucose

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13
Q

What are the two types of rash seen in meningococcal (Nisseria meningitidis ) meningitis ?

A

Pupuric
Pecticial

  • non blanching purple spots
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14
Q

Red flag diagnoses of RED EYE

A 
Corneal ulcer
Contact lens related red eye
Acute angle glaucoma 
Scleritis 
Neonatal conjunctivitis
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15
Q

Three ophthalmoscope findings that require urgent attention

A

Retinal detachment
Papilloedema
GCA

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16
Q

5 red flag causes of ptosis

A 
Myasthenia gravis 
Horners syndrome
Stroke
3rd nerve palsy
GCA
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17
Q

Define Bell’s palsy

A

Acute ipsilateral hemiparalysis of the face due to inflammation and swelling of the facial nerve in the facial canal

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18
Q

What is Ramsay hunt syndrome

A

Facial pain (major) and weakness due to herpes zoster virus in the geniculate ganglion. Vesicular eruption in the external auditory meatus.

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19
Q

Describe the pyramidal pattern of weakness

A

Flexors are stronger than extensors in the upper limbs and opposite is true in lower limbs

Pyramidal lesion presents w/
+spasticity
+ hypereflexia
+weakness

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20
Q

What is the extra pyramidal system responsible for ?

A

Balance and posture

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21
Q

What is the main structures involved in the extra pyramidal system

A

Basal ganglia

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22
Q

Give 3 extra pyramidal system disorders

A

PD
Huntington’s
Wilson’s disease

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23
Q

What is dystonia

A

Involuntary painful muscle movements / spasms

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24
Q

Give examples of drugs responsible for drug induced dystonia

A

Antipsychotics
Neuroepilieptics
Levodopa

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25
Q

What is meant by a non organic finding and give examples of potentially non organic diseases

A

A finding that doesn’t have a direct anatomical cause

Lower back pain
Dizziness
Vomiting
Chest pain
Headache
Weakness
Visual disturbance 
Sensory disturbance
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26
Q

Headache differentials

A

Tension / migraine / cluster/ med-overuse
GCA
Meningitis - neck stiffness / fever
RICP - worse in morning +bending/ sneezing
Haemorrhage

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27
Q

What is a myotome

A

Muscles innervated by a spinal root

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28
Q

Define dermatome

A

Area of skin supplied by a nerve root

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29
Q

What movement is C5 responsible for

A

Shoulder abduction.

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30
Q

Where would you test C7 dermatome?

A

Middle finger

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31
Q

Where would you test T1 innervation

A

Inner arm

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32
Q

Where would you test c8 dermatome

A

Little finger

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33
Q

Where would you test c6 dermatome

A

Index finger

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34
Q

What nerve root is responsible for arm flexion

A

C6= elbow flexion

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35
Q

What nerve root is responsible for finger abduction and suggest which nerve and which cord

A

T1
Ulnar
Medial cord

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36
Q

Which nerve root is responsible for elbow extension

A

C7

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37
Q

What myotome is responsible for finger flexion

A

C8

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38
Q

What muscle is responsible for elbow extension ? What nerve innervates this

A 
Biceps 
Musculocutaneous nerve (lateral cord therefore c5/c6)
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39
Q

What muscle is responsible for thumb abduction

A

Abductor pollicis brevis

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40
Q

Three tests for cortical sensation.

A

Two point discrimination
Stereognosis
Graphasthesia

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41
Q

Where do the lateral cerebrospinal neurones decussate?

A

At the medulla

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42
Q

Where do the ventral cerebrospinal neurones decussate?

A

In the ventral horn at the level of exit

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43
Q

What sensory modalities are Carried in the DCML system

A

Fine touch , vibration, proprioception

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44
Q

Where do the neurones of the DCML system decussate ?

A

At the medulla (they ascend ipsilaterally)

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45
Q

What fasiculus does S info from the upper limb travel in

A

Upper limb = cuneate fasciculus

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46
Q

What sensory modalities are carried in the lateral spinothalamic tract?

A

Pain and temperature

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47
Q

What sensory modalities are carried in the anterior spinothalamic tract

A

Crude touch and pressure

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48
Q

At what level do the neurones of the spinothalamic tract cross over ?

A

Level of entry

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49
Q

If a lesion occurs on the R side of the SC which side is proprioception lost on?

A

R side

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50
Q

Injury to the R side of the SC will cause pain and temp loss on which side of the body

A

Left

will lead to loss of pain and temp sensation on the contra lateral side

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51
Q

Classic feature of myasthenia gravis

A

Fatigue-ability or face and neck

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52
Q

What disorders affect the UMN?

A

MS, stroke, MND

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53
Q

In a real bulbar palsy is it the UMN or LMN affected and name a condition where this may happen? How will the jaw jerk reflex present ?

A

LMN

GBS

Absent JJR

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54
Q

In a pseudo- bulbar palsy which neurone is affected upper or lower? And what condition might this occur in? How will the Jaw jerk reflex present

A

Upper

MS

Brisk JJR

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55
Q

What is verbal apraxia

A

Struggle to make movements of speech

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56
Q

A lesion in the DCML can be due to a deficiency in what substance?

A

B12

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57
Q

What is the difference between rigidity and spasticity

A

Spasticity is velocity dependent

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58
Q

4 causes for causes of both UMN & LMN signs

A

Subacute degen of SC due to B12 deficiency
Syphilis
MND
2 diff pathologies

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59
Q

Does polio effect UMN or LMN?

A

LMN

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60
Q

3 signs in horners syndrome

A

Partial ptosis
Miosis
Anhydrosis

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61
Q

What nerve can be compressed at the elbow

A

Ulnar

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62
Q

What nerve commonly causes wrist drop?

A

Radial nerve

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63
Q

In NMJ pathologies what modalities are affected
Motor only
Sensory only
Motor and sensory

A

Motor only

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64
Q

Give the clinical syndrome name for pins and needles caused by nerve root compression I.e. cauda equina

A

Radiculopathy

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65
Q

Give the clinical syndrome name for any disease of the spinal cord

A

Myelopathy

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66
Q

What neuro clinical syndrome could cause visual disturbances and no periods

A

Parasellar syndrome

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67
Q

What conditions would you see when the basal ganglia has
A- too much control
B- too little control

A

A- Parkinson’s

B- chorea

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68
Q

What GCS score would someone who opens their eyes to pain, localises to pain and says inappropriate words achieve

A

10

= moderate brain injury 12-9

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69
Q

What is a lateralising sign a sign of -

A

Inner tension

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70
Q

What sign would you see with a 3rd nerve palsy

A

Fixed dilated pupil

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71
Q

What is the differential of a 3rd nerve palsy

A

A blind eye (here will get contralateral construction w/ pen torch

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72
Q

What activities might a patient report struggling with if they have a myelopathy

A

Zips
Buttons
Keyboards
Phones

Fine hand movements

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73
Q

What myotome / movement is c6 responsible for

A

Biceps (elbow flexion)

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74
Q

What myotome is c7 responsible for

A

Triceps

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75
Q

What dermatome is c7 responsible for?

A

Middle finger

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76
Q

What dermatome is T1 responsible for ?

A

Little finger

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77
Q

What dermatome is c6 responsible for

A

Thumb and index finger

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78
Q

What dermatome is c5 responsible for

A

Skin over deltoid

79
Q

What muscle movement is c5 responsible for

A

Shoulder abduction

80
Q

What movement is c8 responsible for

A

Finger flexion

81
Q

Where would you expect to find a tumour that causes L unsteadyness and hearing loss

A

L cerebellopontine angle

82
Q

How many mls of CFS is produced in 24hours

A

500mls

83
Q

How many music csf can the ventricular system hold

A

20mls

84
Q

What is the total csf volume

A

120mls

85
Q

What is normal pressure of the csf

A

5-15cm

86
Q

3 upper motor neurone signs

A

Hoffmanns
Babinskis
Ankle clonus

87
Q

The median nerve is responsible for thumb abduction. What trunk does the median nerve receive it’s motor innervation from ?

A

Inferior trunk
(Medial cord)
C8/T1

88
Q

What cord does the median nerve receive it’s sensory innervation from ?

A

Superior trunk

Lateral cord

89
Q

What trunk might be damaged if shoulder abduction is not possible

A

Superior trunk

90
Q

What is different about the optic nerve compared to other cranial nerves

A

It is part of the CNS (Hence affected in MS- blurred vision) all other cranial nerves are part of the PNS

91
Q

What does distal weakness suggest?

A

Nerve pathology

92
Q

What does proximal weakness suggest

A

Muscle pathology

93
Q

Name 3 mono neuropathies

A

Ulnar nerve palsy
Radial nerve palsy- Saturday night palsy (compressed at axilla)
Median nerve palsy - carpel tunnel

94
Q

What is carpel tunnel syndrome

A

Compression of the median nerve by the flexor retinaculum

95
Q

Causes on mononeuritis multiplex

A

CT disorders

Vasculitis

96
Q

What is the clinical picture seen in mononeuritis multiplex

A

Painful
Effects many nerves across the body
Asymmetrical
Subacute presentation

97
Q

Name the immunosuppressant classically used to tx vasculitic neuropathies

A

Cyclophosphamide

98
Q

What Alzheimer’s medication is used to treat LBD

A

Rivistigmine

99
Q

What ACEi is used to treat myasthenia gravis

A

Pyridostigmine

100
Q

Name two immunoSs used in vasculitic disease

A

Azothiaprine

Cyclophosphamide

101
Q

Management of GBS resp failure crisis

A 
ABCD
ABG
ECG
Early anaesthetic help
?Infection
Supportive autonomic management 
IVIG
102
Q

What is kernigs sign

A

Painful to straighten a flexed knee when hips are flexed

103
Q

Brudsinskis sign

A

Lift neck up when straighten legs

104
Q

How do you treat tachyC

A

Cardio version

105
Q

How do you treat Bradycardia

A

Pacing

106
Q

How would you treat a vasculitic neuropathy

A

ImmunoSS

Aripiprazole
Cyclophosphamide

107
Q

How would you treat inflammatory neuropathies

A

Steroids - prednisolone

108
Q

What sensation is effected in gluten sensitivity

A

Proprioception

109
Q

Two anterior horn cell diseases

A

MND

Polio

110
Q

Horners presentation

A

Ptosis
Miosis
Anhydrosis

111
Q

If you can’t planar flex your foot which nerve root is affected

A

S1

112
Q

How would an L5 radiculopathy present

A

Foot drop and loss of sensation on big toe and dorsum of foot

113
Q

Commonest cause of cauda equina

A

Prolapsed disc

114
Q

Features of cauda equina

A 
Weak legs
Sexual dysfunction 
Compaction 
Retention 
Pain
Saddle anesthesia
115
Q

Rash in dermatomal pattern=?

A

Shingles

116
Q

Non motor symps of Parkinson’s

A 
Sleep disturbances 
Constipation 
Pain 
Fatigue
Anxiety and depression 
Psychosis
117
Q

Assymetrical features of PD

A

Arm swing
Tremor
Foot drop

118
Q

Tx of benign essential tremor

A

Beta blockers

119
Q

Parkinson tx

A

Levodopa
Co-careldopa
Selegaline

120
Q

Parkinson’s differentials

A

Normal pressure hydrocephalus - exclude w. CT
Multiple systems atrophy
Benign essential tremor- will scribble all over page

121
Q

Tx pathway for SE

A

Pre hospital- rectal Diaz, buccal midaz
Hosp- IV loraz , IV phenytoin
?intubate
IV dextrose
Monitor temp and acidosis
Consider causes - infection, intracranial event
Consider complications - renal damage from circ collapse, rhabdomyalisis, aspiration

122
Q

Pathophysiology of Huntington’s

A

CAG repeats
Huntingtin protein aggregates
Loss of GABA neurones therefore less inhibition of dopamine release

123
Q

What would CT in a Huntington’s pt show

A

Caudate atrophy

Enlarged ventricles

124
Q

Huntington’s differentials

A

BG stroke
Rh fever
Wilson’s disease
SLE

125
Q

What is tetrabenazine

A

Dopamine depleting agent

126
Q

Causes of morning headache

A

Sinusitis
RICP
Sleep apnoea

127
Q

Headache differentials

A 
RICP
Tension/cluster/migraine 
Med over use
Meds in GTN 
NPH
IHH
GCA/ trigeminal neuralgia
SAH
Meningitis
128
Q

Features of RICP headache

A

Worse in morning
Wakes in sleep
Worse on coughing and sneezing
+- papillodema

129
Q

Everything about GCA

A 
Scalp tenderness
Amouris fungax- sudden painless vision loss
Posterior ciliary A
Measure ESR/CRP
Jaw Claudication
130
Q

Tx of migraine

A

Propanol -1st line
Amytriptaline 2nd line
Topirimate
Botox injections

131
Q

Red flags for headache

A 
New onset
Papillodema
RICP
Seizures
LoC
Abnormal neuro exam
132
Q

Headache where you want to rest

A

Migraine

133
Q

Headache where you are restless

A

Cluster

134
Q

Bilateral headache

A

Tension

135
Q

Unilateral headache

A

Migraine
Cluster
Trugeminal neuralgia

136
Q

How many attacks do you need to have for a diagnosis of trigeminal neuralgia

A

3

137
Q

Criteria for migraine

A 
5 attacks
4-72hours
Unilateral throbbing 
Aggravated my physical activity 
Phono/photophobia
N&v
138
Q

Duration of the tension headache

A

30mins -7days

139
Q

Which headache is associated with red eye and lacrimation

Ipsilateral cranial autonomic features

A

Cluster

140
Q

Features of IIH

A 
Over 30
Fat
Fertile - oestrogen 
Visual disturbance 
Headache 
Lp= normal contents but high pressure
Tx = diuretics , CSF shunt , lifestyle mods
141
Q

Tx of GCA

A

Steroids

142
Q

Diagnosis for trigeminal neuralgia

A 
3 attacks 
Unilateral 
In the distribution of trigeminal n
Sharp
Preceded by eating/ shaving
143
Q

Tx for trigeminal neuralgia

A

Carbamazepine
None Opiod pain relief
Surgery

144
Q

What does an NIHSS score of 13 indicate

A

Mild-mod stroke

145
Q

What does an NIHSS score of 22 indicate

A

Severe stroke

146
Q

What is the cut off score on NIHSS for a very severe stroke

A

25

147
Q

What is the stroke classification system and what are the 4 classes

A 
Bamford
TACS
PACS
LACS
POCS
148
Q

Cause of seizure

A

Hyponatremia

Trauma

149
Q

Differentials for vertigo+ deafness

A

Schwannoma

Cerebellopontine angle syndrome

150
Q

Management of SAH

A 
Supportive 
Lp
Ct
Nimodipine 
Reverse anticoagulant 
Endovasc coiling / clipping
151
Q

Differentials for cause of coma

A 
Epilepsy 
Stroke
Drugs/ alcohol
DKA
Addisons crisis
Trauma
152
Q

Fever+ confusion should make you query what

A

Encephalitis

153
Q

Pins and needles suggests what pathology

A

Nerve root compression

154
Q

Problems with small hand movements might suggest pathology where?

A

Spinal cord

155
Q

A lateralising sign suggests what

A

Inner tension

156
Q

Causes of optic neuritis

A

Diabetes
Syphilis
MS

157
Q

Features of optic neuritis

A

Pain w’ eye movement
RAPD
Unilateral visual acuity

158
Q

3rd nerve palsy features

A

Ptosis
Eye down and out
Dilated

159
Q

Fixed Dilated pupil differentiation

A

Death
Blind eye
3rd nerve palsy
Benzos

160
Q

What is the classical presentation of a myelopathy

A

Fine hand movements affected i.e phones , keyboard , buttons , zip

161
Q

How much CSF is produced in a day

A

500ml

162
Q

How much CSF is there at any one time

A

120ml

163
Q

What is the normal pressure of the CSF

A

5-15cm H2O

164
Q

How much CSF can the ventricles hold

A

20ml

165
Q

No corneal reflex = damage to which nerves

A

5i ,7

166
Q

Afferent nerve of corneal reflex

A

Ophthalmic nerve

167
Q

Efferent nerve of corneal reflex

A

Facial

168
Q

Pupillary reflex afferent limb

A

Optic nerve

169
Q

Pupillary reflex efferent limb

A

Occular motor

170
Q

Stroke in the visual cortex would give what presentation

A

Homonymous hemianopia W/ macular sparing

171
Q

Where does the macular receive its blood supply from

A

PCA and MCA

172
Q

What visual presentation might you see in a stroke to the L temporal love

A

R sided homonymous congruent Inferior quadrantopia

173
Q

What type of innervation is there into the edinger-Westfiel nucleus

A

Bilateral

174
Q

Which nerve supplies SO of the eye

A

Trochlear

175
Q

Which nerve supplies LR of the eye

A

Abducens

176
Q

Treatment of Bell’s palsy

A

Corticosteroids

+- antivirals

177
Q

A left sided cortical lesion would effect what area of the face

A

R lower quad

Bilateral innervation to the forehead

178
Q

What is the biggest feature of Ramsay hunt syndrome

A

Pain !!!

Then facial weakness

179
Q

Tx of Ramsay hunt

A

Acyclovir

180
Q

Causes of whole face weakness

A 
GBS
MG 
Bilateral supranuclear lesions 
Lymes disease
Sarcoidosis
181
Q

Tx of trigeminal neuralgia

A

Carbamazepine

182
Q

What classically causes amaourosis fungax

A

GCA

183
Q

What is horners syndrome

A

Damage to the symp nerves that supply the face

184
Q

Causes of B12 deficiency

A

Veganism
Pregnancy
Pernicious anaemia
Mal absorb- coeliac

185
Q

What test will be positive if there is damage to the dorsal columns

A

Rhombergs

186
Q

U&LMNS + glove and stocking paraparesis = what condition

A

Sub acute spinal degen (b12)

187
Q

Investigations to do in epilepsy

A

MRI
EEG
Video EEG
SPECT

188
Q

Cardiac causes of syncope

A 
Long QT- arrhythmia 
Scar from pervious MI
WPW
Brugada
Epsilon waves
Heart blocks 
Valvular
189
Q

Heart block causes of cardiac syncope

A

Trifascicular block
Mobits T2
3rd degree

190
Q

What is trifascicular heart block

A

RBBB
LAD
first degree heart block

191
Q

Name a condition where you would see synchronous jerking and one where you would see asynchronous jerking

A

Synchronous - epilepsy

Assynchronous - syncope

192
Q

You don’t give AE’s in a first seizure what do you give instead

A

Benzos (loraz)

193
Q

5 differentials for black out

A 
Epilepsy 
NEAD
Syncope
HypoG
Hydrocephalus

Phase 3a (7 decks)

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