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Year 3 Conditions > Neuro > Flashcards

Neuro Flashcards

1
Q

Why do chest CT myasthenia gravis

A

Associated with thymic hyperplasia and tumours- common in elderly men

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2
Q

Management bells palsy

A

Oral corticosteroids and anti-virals

Option for surgical decompression

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3
Q

Typical presentation of myasthenia gravis

A 
Muscle weakness that easily tires and improves on exercise 
Ptosis
Diplopia 
Dysphagia 
SOB
Flattened smile
Dysarthria
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4
Q

What can cause bells palsy

A

Post viral infection

Unknown generally

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5
Q

What is a myasthenic snarl

A

Smile looks like a snarl with drooping side of mouth

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6
Q

Symptoms of bells palsy

A

Unilateral facial droop normally either eye or face
Isolated incident
Recent viral infection
No other symtoms

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7
Q

Define myasthenia gravis

A

An uncommon autoimmune condition where antibodies produced against ach receptors on post synaptic membrane of skeletal muscle. Associated with easy fatiguing

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8
Q

What are risk factors for myasthenia gravis

A 
Reduced potassium
Pregnancy
Women OCBA
Elderly men
Certain drugs
Other automimmune conditions
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9
Q

How long does it take blood to appear in CSF post SAH

A

A few hours, only reliably after 12

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10
Q

Investigations for bells palsy

A

Lyme disease test

In cases where complete paralysis of nerve evoked EMG and electroneuronography indicated

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11
Q

What is result of EMG in myasthenia gravis

A

Decremental muscle response over time

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12
Q

Extra symptom of horners

A

Retraction of eyeball into socket

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13
Q

What is xanthochromia

A

Yellow tinge to CSF indicatie of RBC breakdown in CS from a subarach bleed

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14
Q

Signs on examination of myasthenia gravis

A

Ptosis
Extraocular issues
Counting to 50 voice tires
Myasthenic snarl

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15
Q

Risk factors bells palsy

A 
Age 15-45
Nasal flu vaccine
Usual Htn T2DM etc
Cold climate
Hispanic
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16
Q

Differential for bells palsy

A

Lyme disease

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17
Q

What triad of symptoms for horners syndrome

A

Miosis- constriction of pupil
Ptosis- droopy upper eyelid
Anhidrosis- no sweat production on one side of face

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18
Q

What happens if Horners syndrome presents before age of 2

A

If the onset of Horner syndrome is before two years of age, the colored portions of the eyes (irises) may be different colors (heterochromia iridis). In most cases, the iris of the affected side lacks color (hypopigmentation).

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19
Q

What is bells palsy

A

Acute unilateral peripheral facial nerve palsy in patients for whom physical examination and history are otherwise unremarkable

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20
Q

Diagnosis for bells palsy

A

Clinical diagnosis based on absence of any other symptoms and examination signs

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21
Q

Triad of symptoms for horners syndrome

A

Miosis
Ptosis
Anhidrosis

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22
Q

Define horners syndrome

A

Damage to sympathetic supply of one side of face

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23
Q

Tests for myasthenia gravis

A 
Anti ACh-R antibodies
MUSK antibodies- muscle specific tyrosine kinase
Tensilon
EMG
Chest CT
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24
Q

Order of muscles affected in myasthenia gravis

A

Extraocular
Bulbar
Face
Neck

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25
Q

What things do you want to rule out in rapid onset headaches

A

Sub arach
Meningitis
Encephalitis

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26
Q

What can cause rapid onset headaches

A

Sub arach
Meningitis
Encephalitis
Post coital headache

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27
Q

Presentation of sub arach bleed

A 
Sudden onset
Worst headache ever
Often occipital
Focal signs
Decreasing consciousness
Stiff neck
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28
Q

Presentation of meningitis

A

Stiff neck
Photophobia
Fever
Purpuric rash

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29
Q

Main investigation for meningitis

A

LP

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30
Q

Presentation of encephalitis

A

Fever
Strange behaviour
Fits
Reduced consciouness

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31
Q

Urgent investigations for encephalitis

A

Head CT

LP

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32
Q

Causes of subacute/gradual onset headaches

A 
Venous sinus thrombosis
Sinusitis
Intracranial headache
Tropical illness
GCA
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33
Q

Sign on examination of VST

A

Papilloedema

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34
Q

Where is pain in sinusitis

A

Over frontal or maxillary sinuses

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35
Q

How is pain described in sinusitis

A

Dull and constant ache

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36
Q

When is pain worse in sinusitis

A

When bending over or pressure on sinuses

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37
Q

Examples of tropical illnesses causing subacute headache

A

Malaria
Flu like illness
Typhus

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38
Q

When is headache worst in intracranial hypertension

A

When standing up

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39
Q

How are tension headaches described

A

Tight band around head

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40
Q

Are tension headaches pulsatile

A

No

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41
Q

Do tension headaches localise

A

No bilateral

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42
Q

What can accompany tension headaches

A

Scalp tenderness

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43
Q

Would you think malignancy with recurrent headache

A

No

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44
Q

What can cause recurrent headaches

A

Cluster headaches
Migraines
Recurrent meningitis
Trigeminal neuralgia

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45
Q

Causes of recurrent mengingitis

A

HSV

Access to subarach space like skull fracture

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46
Q

What do chronic and progressive headaches indicate

A

Raised ICP

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47
Q

When are raised ICP headaches worse

A

Bending forward
Coughing
Walking
Lying down

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48
Q

Signs of ICP headaches

A 
Vomiting
Papilloedema
Seizures
Odd behaviour
Focalising signs
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49
Q

Things to ask about that precipitate headaches

A 
Sex 
Trauma
Drugs on
Foods
Analgesia
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50
Q

What signs indicate sub or epidural bleed

A

Drowsiness

Lucid signs

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51
Q

When to consider idiopathic intracranial hypertension

A

When imaging rules out SOL in ICP headache

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52
Q

What does pain when chewing suggest

A

Giant cell artheritis

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53
Q

What are signs of giant cell arthritis

A

Palpable pulseless temporal arteries
Jaw claudication tenderness
Subacute headache
Visual difficulties

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54
Q

Where to palpate temporal arteries

A

They run up side of head in front of head and then branches over forehead

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55
Q

Why are temporal arteries pulseless in GCA

A

Temporal arteritis which thickens the arteries

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56
Q

Features of head trauma headache

A

Localised but can be widespread

Can be resistant to analgesia

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57
Q

Extra things to ask about in headache history

A

Drugs- analgesia rebound

Social- recent stress?

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58
Q

How to do headache history

A 
SOCRATES
Drugs
Stress
How often
When in day
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59
Q

What are cluster headaches

A

Attack of severe pain localised to the unilateral orbital, supra-orbital, and/or temporal areas; lasts from 15 minutes to 3 hours

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60
Q

RIsk factors for cluster headaches

A

Male
Smoker
Drinker
Head injury

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61
Q

What can precipitate a cluster headache

A

Alcohol

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62
Q

How long do cluster headache episodes last

A

15-180mins

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63
Q

How often do people get cluster headaches a day

A

once or twice a day- can get nocturnally

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64
Q

How long do clusters of cluster headaches last

A

4-12wks

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65
Q

How long is there between clusters

A

month- 2 years

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66
Q

How to differentiate between clusters and migraines

A

Migraines feel nauseous and dizzy

Cluster get hyperactivity of parasympathetic nervous system and feel agitated

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67
Q

Are cluster headaches unilateral or bilateral

A

Unilateral

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68
Q

Associated signs of cluster headaches

A 
Miosis
Ptosis
Bloodshot eyes
Lacrimation
Rhinorrhoea
Facial flushing
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69
Q

Laboratory finding in GCA

A

Raised ESR

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70
Q

Investigations for cluster headache

A

CT/MRI to rule out other neuro problems
ESR to rule out GCA
Pituitary function

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71
Q

3 cardinal features of cluster headaches

A

Ipsilateral cranial autonomic neuropathy
Trigeminal distribution of pain
Circadian pattern to pain

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72
Q

Signs of hypertension on examinations

A

CXR enlarged heart
Papilloedema
Nephropathy

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73
Q

3 classical migraine presentations

A

An aura for 15-30mins then followed by an unilateral throbbing headache
Isolated aura without headache
Episodic headaches without aura

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74
Q

What can be in prodrome for migraines

A

Yawning
Cravings
Mood changes
Sleep changes

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75
Q

What types of auras can you get with migraines

A

Visual
Motor
Somatosensory
Speech

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76
Q

What can symptoms be in visual auras

A

Jumbling of lines, dots and zigzags
Distorting and melting of surroundings- chaotic vision
Hemianopia

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77
Q

What symptoms tend to accompany episodic headaches

A

Nausea

Photophobia

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78
Q

Acronym for migraine triggers

A

CHOCOLATE

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79
Q

Chocolate triggers for migraines

A 
Chocolate
Hangovers
Orgasm
Cheese and caffeine
Oral contraceptives
Lie ins
Alcohol
Travel
Exercise
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80
Q

How are migraines diagnosed

A

Clinically

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81
Q

If no aura is present how are migraines diagnosed

A

Episodic headches of 4-72 hours with nausea or photophobia
Then 2 of
- pulsatile
- unilateral
- impairs or worsened by routine activity

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82
Q

How does trigemial neuralgia present

A

Sudden stabbing pain in trigeminal areas that can be brief and recurrent
Worse when doing anything that involves moving theit mouth
Can get numbness

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83
Q

Triggers for trigeminal neuralgia

A

Shaving
Chewing
Cleaning teeth
Washing

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84
Q

Define trigeminal neuralgia

A

Trigeminal neuralgia (TN) is a facial pain syndrome in the distribution of ≥1 divisions of the trigeminal nerve without any other neurological deficit.

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85
Q

Investigations for trigeminal neuralgia

A

Oral X-ray- check if problem is from dental cause
MRI- rule out any other pathologies impinging upon trigeminal nerve
Trigeminal reflexes- ask to clench teeth and open mouth against resistance- may deviate to side if muscle weak

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86
Q

Causes of trigeminal neuralgia

A

Any compression on trigeminal nerve
Demylenation- extremely common in MS
Tumours in brain stem or infarcts

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87
Q

Main investigations in acute stroke treatment

A

CXR
ECG
Head CT

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88
Q

When are carotid dopplers done in suspected strokes

A

Not acutely
In TIAs
When has recovered from a stroke nearly
Anterior circulatory stroke

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89
Q

Why do you get aspiration pneumonias post stroke

A

Lack of gag relfex causing aspiration of salvic and gastric contents

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90
Q

Why do you check ESR post TIA

A

Vasculitis can cause TIAs

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91
Q

What test must always be done in case of suspected symptomatic carotid stenosis

A

Carotid doppler

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92
Q

What tests can be done to further evaluate carotid stenosis

A

CT/MRI angiography- convential angiography very rarely used now due to risk of stroke

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93
Q

Investigations for TIAs

A

Carotid doppler
CT/MRI angiography
Echo

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94
Q

Why are echos done for TIAs

A

To look for valvular disease, atrial tumours which can all cause TIAs
Check for LVF as sign of end organ failure secondary to hypertension

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95
Q

Who do we do carotid endartectomy on

A

Patients who are fit and have had a TIA or recovered from a stroke well in the past 6 months

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96
Q

What is cut off level of stenosis for endartectomy

A

Has to be over 70% stenosed

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97
Q

Can you get absence of bruits in severe stenosis

A

Yes

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98
Q

Management principles for TIAs

A

Lifestyle
Hypertension management
Prophylactic anti-platelet agent such as aspirin, clopidogrel

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99
Q

Are reflexes normal in myasthenia gravis

A

Yes

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100
Q

What is the tensilon test

A

Used in suspected myasthenia gravis. A short acting acetylcholinesterase inhibitor is given aswell as saline, in positive myasthenia cases weakness temporarily subsides within a minute

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101
Q

What is danger of tensilon test

A

Can set off a myasthenic crisis

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102
Q

What can happen in myasthenic crisis

A

Arrythmia

Breathing difficulty- can get apnoea

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103
Q

What endocrine organ is associated with myasthenia gravis

A

Thyroid

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104
Q

What can precipitate myasthenic crises

A

Opiates
some antibiotics
β-blockers
Tensilon test

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105
Q

What is amaurosis fugax

A

Sudden onset blindness that can resolve

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106
Q

What artery does GCA tend to affect

A

Branches of external carotid

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107
Q

Important thing to ask about in GCA

A

Pain and aches in muscles

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108
Q

What is name given to constant aches and pains in various muscles

A

Polymyalgia rheumatica

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109
Q

Investigations for GCA

A

ESR and CRP
FBC
Temporal artery biopsy
Temporal artery US

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110
Q

Presentation of MS

A

Attacks of monosymptomatic episodes which can include visual, bladder, cognitive and sensory problems

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111
Q

Common symptoms of MS

A

Bladder- incontinence, urine retention
Sexual- ED
Sensory- tingling and numbness
Cognitive- amnesia, reduced executive functioning
Cerebellum- ataxia, intention tremor, scanning speech
Eye- diplopia, optic neuritis, hemianopia
GI- swallowing and constipation

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112
Q

What can trigger symptoms of MS

A

Heat

Exercise

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113
Q

What is scanning speech

A

Sentences spoken by syllable and with varying tones

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114
Q

What is optic neuritis

A

When optic nerve gets inflammed by any inflammation causing condition such as MS, sarcoid and lyme disease

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115
Q

What is ataxia

A

Inability to coordinate bodys movements

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116
Q

Symptoms of optic neuritis

A

Blurry vision
Painful to move eyes
Loss of colour seen

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117
Q

What is thunderclap headache

A

Very sudden onset headache that reaches max intensity within 10-15 mins

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118
Q

Presentation of sub arach

A 
Thunderclap headache
Drowsiness
Confusion
Nausea
Neck stiffness
Fever
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119
Q

What must always do if reduced GCS in ED

A

Medical emergency so urgent investigations

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120
Q

Investigations for subarach ED in order

A

CT

LP- LOOK FOR XANTHACHROMIA

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121
Q

Most common causes of subarach

A

Berry aneurysms
AV Malformations
Hypertensive haemorrhages
Trauma

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122
Q

Rarer causes of subarach

A

Infection
Anticoagulants
Tumours
Vasculopathy

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123
Q

Investigation for SAH when confirmed

A

Angiogram

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124
Q

Where do SAH tend to affect

A

Circle of willis most commonly anterior and posterior communicating arteries

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125
Q

Treatment plan for SAH

A

Neurosurgery

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126
Q

Investigations for MS

A

MRI

CSF electrophoresis

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127
Q

Findings of MS investigations

A

MRI- white sclerotic plaques

CSF electrophoresis- oligoclonal bands

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128
Q

CSF feature of Guillain Barre syndrome

A

High protein

Normal cell and glucose

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129
Q

What does headache that affects sleeping indicative of

A

Raised ICP

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130
Q

What is fluctuating consciousness indicative of

A

Subdural haematomas

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131
Q

What must be considered in elderly patients with neuro symptoms

A

Frail so susceptible to falls- consider bleeds

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132
Q

How are subdural haematomas classified

A

Based on onset of symptoms
Acute- up to 72 hours
Subacute- 72hours- 20 days
Chronic- over 20 days

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133
Q

How to diagnose subdural bleed

A

Crescent or sickle shaped bleed

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134
Q

What is complication of GBS

A

Respiratory muscle weakness leading to T2 muscle RF

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135
Q

What is GBS

A

Acute demyelinating polyneuropathy that often occurs after an infection

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136
Q

Presentation of GBS

A 
Muscle weakness in legs that ascends with bilateral symptoms
Ascending bilateral parasthesia
Speech difficulties
CN palsys
Autonomic dysfunction
Recent infection
Respiratory difficulty
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137
Q

Management of GBS priority

A

Must monitor FVC

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138
Q

Presentation of anterior cerebral artery stroke

A

Behavioural changes
Weakness of contralateral leg > arm
Mild sensory deficit

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139
Q

Presentation of MCA stroke

A

Contralateral hemiparesis of face > arm > leg
Aphasia
Hemisensory deficits
Loss of contralateral half of visual field

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140
Q

Presentation of PCA stroke

A

Loss of contralateral half of visual field
Sensory deficit
Visual agnosia
Prosopagnosia

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141
Q

Which artery supplies subcortical structures like basal ganglia

A

MCA

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142
Q

What are major features of Lewy body dementia (DLB)

A

Resting tremor
Fluctuating confusion
Hallucinations

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143
Q

What form of dementia presesnts with parkinsonism

A

DLB

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144
Q

Features of parkinsonism

A

resting tremor
postural instability
bradykinesia
rigidity

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145
Q

Alzheimers typical symptoms

A

anterograde amnesia
confusion
changes in personality and mood
difficulty planning

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146
Q

Anterograde amnesia

A

Inability to form new memories

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147
Q

What does frontotemporal dementia with

A

Change in personality or behaviour

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148
Q

What is depresssive pseudodemntia

A

Dementia like symptoms caused by an underlying depression

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149
Q

What in SBA text suggests depressive pseudodementia

A

Recent bereavement or trauma

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150
Q

With GBS what happens to reflexes

A

Reduced as LMN

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151
Q

What are alternative non neurological diagnoses for tingling

A

Hyperventilation

Hypocalcaemia

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152
Q

What does inability to lie flat in GBS suggest

A

T2 RF

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153
Q

Signs of autonomic dysfunction in GBS

A

Palpitations
BP fluctuations
Constipation
Incontinence

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154
Q

How to differentiate between migraine and raised ICP when headache worsened on coughing and exertion

A

For raised ICP they are precipitated by it

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155
Q

What does headache worse when standing up suggest

A

Low ICP

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156
Q

What does headache worse when lying down suggest

A

High ICP

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157
Q

What are common transient visual obscurations seen secondary to increased ICP

A

Black dots appearing in vision in both eyes

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158
Q

What can provoke visual obscurations secondary to raised ICP

A

Bending down or straining

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159
Q

What is amaurosis fugax

A

Transient visual loss that normally only occurs in one eye

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160
Q

Which eyes does optic neuritis normally affect

A

Monocular however can be both sequentially or simultaneously

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161
Q

What are visual signs in migraines

A

Normally positive signs such as zig zags

Evolves over a few minutes

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162
Q

What does optic disc swelling indicate

A

Papilloedema

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163
Q

What are early signs of optic disc swelling

A

Enlarged blind spots

Peripheral constriction of visual fields

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164
Q

What are advanced signs of optic disc swelling

A

Loss of central vision and visual acuity

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165
Q

Pathologies in optic chiasm produce

A

Bitemporal hemianopia

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166
Q

Pathologies posterior to optic chiasm produce

A

Hemianopia

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167
Q

Pathologies in optic nerve produce

A

Monocular visual loss

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168
Q

Risk factors for idiopathic intracranial hypertension

A

Raised BMI
Female
Tetracycline

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169
Q

Cardinal features of parkinsons

A

Unilateral upper limb tremor

Increased tone in all limbs and trunk

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170
Q

When is tremor worse in parkinsons

A

Not being used

Anxious

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171
Q

What is drug treatment for parkinsons

A

Levodopa with dopa decarboxylase inhibitor such as benserazide and carbidopa

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172
Q

What are some causes of parkinsonism

A

Vascular
Psycotic drugs
Depressive states

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173
Q

Which nerve is affected in Ptosis

A

3

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174
Q

Damage to which parts of the nervous system can cause ptosis?

A

CN3
Midbrain
Cervical spine

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175
Q

How to differentiate causes of ptosis

A

Looking at pupil changes
Horners- constricted
NMJ- normal
Cranial nerve palsy- dilated

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176
Q

Name of tumour that causes horners syndrome

A

Pancoast

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177
Q

Features of pancoast tumours

A

Horners
Cough
Weight loss
Wasting of hands in muscle

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178
Q

Sign on examination of neuromuscular weakness causing SOB

A

Raised diaphragm

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179
Q

Is the brain sensitive to pain

A

No it is insensate so all pain felt is by other tissues in skull such as dura, vessels and nerves

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180
Q

Purpose of headache assessment

A

Diagnose headache subtype
Determine cause by excluding secondary cause
Explain diagnosis and rational for treatment
Optimise treatment

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181
Q

Important examinations to always be done with headache

A 
Full neuro exam
Fundoscopy
Meningism
Systemic examns
Temperature
BP
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182
Q

Differentiation between secondary and primary headache

A

Secondary has known causative disorder whereas primary has no causative disorder

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183
Q

Examples of primary headache

A

Cluster headache
Tension headache
Migraine

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184
Q

Examples of secondary headaches

A 
Infection
Vascular
Trauma
ENT causes
Metabolic
ICP
Drug withdrawal
Headache psychiatric disorder
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185
Q

3 headache classifications

A

Primary
Secondary
Cranial neuralgia

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186
Q

Examples of metabolic causes of headache

A

Hyoglycaemia

Hypercalcaemia

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187
Q

Drugs that can cause rebound headaches

A

ETOH
Opiods
Anti-depressants
Tramadol

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188
Q

Headache red flags age

A

Middle aged to elderly

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189
Q

Headache red flags type of onset

A

Abrupt and severe

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190
Q

Headache red flags site

A

Temporal- increasing severity

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191
Q

Headache red flags pattern

A

Alteration in frequency or severity

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192
Q

Headache red flags systemic signs

A

Abnormal examination
Fever
Weight loss

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193
Q

Headache red flags neurological signs

A

LOC
Meningism
Confusion
Focal signs

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194
Q

Headache red flags triggers

A

Posture
Valsalvar
Coughing
Exertion

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195
Q

Headache red flags secondary RFx

A 
Systemic disease
Cancer
HIV
3rd trimester pregnancy
Trauma recently
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196
Q

What is SAH commonly mistaken for

A

Migraine

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197
Q

What proportion of SAH present with only headache

A

1/3

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198
Q

How does CT sensitivity for SAH change over time

A

Over time becomes harder and harder to detect

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199
Q

Investigations for SAH

A

CT within 4 hours ideally

LP after 12 hours to be sure its xanthochromia

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200
Q

When is xanthochromia reliable after onset of headache

A

12 hours-2 weeks

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201
Q

What is name of test used to determine if xanthochromia present

A

Spectrophotometry

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202
Q

Causes of thunderclap headaches

A 
Any stroke
Venous thrombosis
Cervical artery dissection
Meningitis
Vasculitis
Pituitary Apoplexy
SIH
Hypertensive crisis
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203
Q

What is SIH

A

Spontaneous intracranial HTN

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204
Q

Important thing to remember with imaging in thunderclap headache

A

Many of the causes will have normal appearances

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205
Q

Important thing when doing vertigo or dizziness headache

A

Ask patient to tell you what they mean

Dont put words in their mouth

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206
Q

Description of vertigo

A

You feel like the world is moving arounf you and you are moving too in the world

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207
Q

Description of pre-syncope

A

Light headness and visual changes

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208
Q

What is a nystagmus

A

Eye twitching that gives impression of world moving

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209
Q

Areas of brain associated with vertigo

A

Cerebellum

Brain stem

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210
Q

Common peripheral causes of vertigo

A

BPPV
Meniers
Vestibular neuritis

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211
Q

Test for BPPV

A

Dix Hallpike manoeuvre

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212
Q

Problem with Dix Hallpike test

A

Must be done by someone trained in it

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213
Q

How to differentiate between papilloedema and papillitis

A

Papillitis will be associated with pain when moving eyes

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214
Q

Important history qs for diplopia

A 
Onset
Character- what plane?
Dutation
Associated Sx
Triggers/alleviated
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215
Q

Difference between surgical and medical third nerve palsy in terms of cause

A

Medical- ischaemia of nerve

Surgical- pressure on nerve

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216
Q

Difference between surgical and medical third nerve palsy in terms of presentation

A

In surgical you see mydriasis before down and out palsy as parasympathic supply on outside of nerve bundle which will be seen first however in ischaemia it affects centre of bundle first so there is muscle problem before mydriasis

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217
Q

What do you see in third nerve palsy

A

Mydriasis
Down and out eye
Ptosis

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218
Q

Investigations for third nerve palsy

A

Must do brain angiogram to see for aneurysms ischaemia etc

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219
Q

Difference in whats affected between horners and third nerve palsy

A

CN III is Para

Horners is symp

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220
Q

How to diagnose MG

A

Nerve conduction studies
Tensilon
AChR and MUSK ABs
CXR then CT

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221
Q

Tx for MG

A 
ACh inhibitors
Immunosuppression
Plasmapharesis
IVIG
Potential thymectomy
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222
Q

How does MG present

A

Diplopia
Ptosis
Dysphagia
Hyophonia

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223
Q

O/E seen in MG

A

Fatiguability so for example if see when ask to look up struggle to maintain it

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224
Q

How to determine if someone has binocular diplopia

A

Resolved by covering one eye

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225
Q

What causes physiologically binocular diplopia

A

Misalignment between ocular signals

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226
Q

When is EEG only really useful

A

If having a seizure or they just did

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227
Q

What is a seizure

A

Paroxysmal motor, sensory or autonomic event caused by abnormal, excessive and synchronous electrical discharges

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228
Q

What makes a seizure status elipticus

A

Last over 5 minutes, a seizure will normally last less than 5

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229
Q

Whats a convulsion

A

Motor seizure

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230
Q

What is epilepsy

A

Chronic disease of brain predisposing you to recurrent unprovoked seizures

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231
Q

What is normal criteria for epilepsy

A
  • 2 or more unprovoked seizures 24 hours apart
    OR
  • 1 seizure with strong likelihood of another
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232
Q

First classification of seizures

A

General vs focal

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233
Q

Difference between general and focal seizures

A

General affects both hemispheres simultaneously and focal arises from one specific area in one hemisphere or a whole lobe

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234
Q

How are genrealised seizures classified

A

Motor or non motor

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235
Q

What is common in all general seizures

A

LOC

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236
Q

What is classification of motor seizures

A 
Tonic
Clonic
Tonic-clonic
Atonic
Myoclonic
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237
Q

What happens in tonic seizure

A

Stiffening of muscles

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238
Q

What happens in clonic seizures

A

Twitching of muscles

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239
Q

What happens in tonic clonic seizure

A

Stiffening of muscles with twitching

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240
Q

Common other Sx of tonic-clonic seizures

A 
Involuntary scream or cry
Uprolling of eye
Respiration secretions deposited in oropharynx so scream
Tongue biting
Incontinence
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241
Q

What happens after a seizure

A

Patient can be very confused and conciousness impaired- post ictal phase

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242
Q

What is name given to phase after seizure where sleepy

A

Post-ictal phase

NOTE- if unwitnessed can be only sign of seizure

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243
Q

What happens in atonic seizure

A

Sudden loss of tone so collapse

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244
Q

What happens in myoclonic seizure

A

Sudden rapid contractions of muscles often when waking up

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245
Q

Other name for non-motor seizures

A

Absence seizures

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246
Q

Who are absence seizures common in

A

Children and teenagers

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247
Q

What happens in absence seizure

A

Sudden loss of consciouness where no change in postural muscle tone

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248
Q

What can absence seizures be confused with

A

ADHD as teachers think they are just staring into space

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249
Q

How are focal seizures classified

A

Simple partial

Complex partial

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250
Q

Difference between simple and complex partial seizures

A

Simple doesnt impair consciousness

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251
Q

What are complex partial seizures followed by

A

Post ictal phase

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252
Q

What can focal seizures be

A

Motor, sensory or autonomic

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253
Q

What can often precede focal seizure

A

Auras

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254
Q

Common Sx of auras seizures

A 
Chewing
Lipsmacking
Eyeblinking
Weird smells
Feelings of fear or deja vu
Rising sensations in abdo
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255
Q

What seizure can precede the other

A

Focal can have secondary general ones

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256
Q

Common symptoms of focal seizures

A

Unilateral shaking

Turning head to one side

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257
Q

What is todds paresis

A

After a focal seizure you can have a focal weakness on a side of the body

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258
Q

Pnemonic for causes of seizures

A

VITMAINS

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259
Q

Causes of seizure

A 
Vascular
Infectious
Trauma and toxins
Autoimmune
Metabolic
Idiopathic- epilepsy
Neoplasm
Psycogenic seizures
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260
Q

Common toxins causing seizure

A

Cocaine OD
Ampthetamine OD
Alcohol withdrawal

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261
Q

Which medications can cause seizures

A

Isoniazid- TB

Bupropion

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262
Q

Infectious causes of neurological pathology

A

Menigitis
Encephalopathy
Abcess

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263
Q

Autoimmune causes of seizure

A

SLE

Vasculitis

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264
Q

Metabolic causes of seizures

A 
Hyponatraemia
Hypocalcaemia
Glycaemic
Hyperthyroid
Thiamine deficiency
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265
Q

Why should seizures be considered in females

A

Pre-eclampsia

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266
Q

DDx of seizure

A

TIA
Migraine
Syncope
Vertigo

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267
Q

When diagnosing seizure what would procede syncope

A

Light headedness

Sweating

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268
Q

Who has psycogenic seizures

A

History of trauma or abuse

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269
Q

What differentiates psycogenic seizures

A

Retained awareness

Plevic thrusting

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270
Q

What differentiates TIA from seizure

A

TIA lasts a long time with Sx of stroke

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271
Q

What makes you think vertigo over seizure

A

Position they were in

Lasts minutes to days

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272
Q

When taking seizure history what is first thing must consider

A

First time?

If not first then epilepsy so check if medication adequate

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273
Q

Workup for first time seizure

A 
FBC
Electrolytes
LFT
Glucose
Tox screen
Pregnancy test
ECG for syncope DDx
Head CT
LP if infection
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274
Q

Imporant 2 questions to ask when doing a neuro history

A

Where is the pathology?

What is the type of problem?

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275
Q

Possibilities for location of neuro problem

A 
Brain
Spinal chord
Nerve root
Peripheral nerve
NMJ
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276
Q

What are possibilities for causes of neuro problems

A 
Vascular
Infection
Inflammation
Toxic
Tumour
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277
Q

What will make you think of a brain pathology

A

Contralateral loss
Hypertonia
Hyperreflexia

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278
Q

What will make you think of a spinal chord pathology

A

Bilateral sensory or motor loss

Sensory loss up to a certain point

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279
Q

What will make you think of radiculopathy

A

Loss of sensation in a dermatome

Loss of power in all movements supplied by one nerve

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280
Q

What will make you think of a mononeuropathy

A

Sensory or motor loss in specific distribution of one nerve

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281
Q

What will make you think of a polyneuropathy causing sensory loss

A

Glove and stocking distribution

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282
Q

Cerebellar signs

A 
Ataxia
Coordination
Dysdiadochokinesia
Intention tremor
Speech slurred and scanning
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283
Q

Way to remember cerebellar signs

A

DANISH

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284
Q

Causes of infectious peripheral neuropathy

A

HIV

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285
Q

Causes of metabolic peripheral neuropathy

A

Diabetes
B12 deficiency
Uaraemia
Hypothyroidism

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286
Q

Causes of toxic peripheral neuropathy

A

Alcohol

Drugs

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287
Q

Causes of malignant peripheral neuropathy

A

Paraneoplastic

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288
Q

Peripheral neuropathy with macrocytic anaemia

A

B12 deficiency

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289
Q

Peripheral neuropathy with raised GGT

and MCV

A

Alcohol

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290
Q

Peripheral neuropathy with high TSH

A

Hypothyroidism

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291
Q

Peripheral neuropathy with elevated urea

A

Uraemia

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292
Q

Peripheral neuropathy with chronic infection/ inflammation or myeloma

A

Amyloidosis

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293
Q

How can myelomas cause peripheral neuropathies

A

Producing many Ig

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294
Q

Inflammatory causes of peripheral neuropathy

A

Vasculitis
CTD
Inflammatory demyelinating neuropathy

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295
Q

Hereditary cause of peripheral neuropathy

A

Hereditary motor sensory neuropathy

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296
Q

Fundoscopy finding MS

A

Papillitis

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297
Q

Presentation of papillitis

A

Blurred vision

Pain on eye movement

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298
Q

What is paraparesis

A

Partial weakness of legs

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299
Q

Causes of vascular spastic paraparesis

A

Blockage of anterior spinal arteries

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300
Q

Causes of infective paraparesis

A

HIV

Tuberculoma

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301
Q

Metabolic cause of spastic paraparesis

A

B12 deficiency

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302
Q

Inflammatory cause of spastic paraparesis

A

Transverse myelitis

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303
Q

What is meralgia parasthetica

A

Compression of lateral femoral cutaneous nerve

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304
Q

Presentaion of meralgia parasthetica

A

Pain on anterolateal thigh

Parasthesia there too

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305
Q

Common radiculopathy example

A

Sciatica

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306
Q

What is sciatica

A

Compression of lumbosacral nerve

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307
Q

Presentation of sciatica

A

Pain in buttock that radiates down the leg below the knee

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308
Q

What can cause nerve root compressions

A

Disc herniation

Spinal canal stenosis

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309
Q

Treatment of meralgia parasthetica originally

A

Reassuring the pt
Advising to avoid tight garments
Lose weight

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310
Q

Tx of meralgia parasthetica if worsens

A

Carbamezapine

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311
Q

Triad of parkinsons

A

Tremor
Rigidity
Bradykinesia

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312
Q

Lewy body dementia Sx

A

Parkinsons
Dementia
Hallucinations

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313
Q

What would cause confusion after moving to a new house

A

CO poisoning

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314
Q

Ddx confusion

A 
Degenerative
Hypoglycaemia
Vascular- bleeds
Infection- pneumonia
Inflammatory
Malignancy
Metabolic- drugs, LFTs, UandEs,
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315
Q

Metabolic causes confusion

A 
Encephalopathy
Hypocalcaemia
Hygolycaemia
Hyponatraemia
Vitamin defiecencies
Endocrinopathies
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316
Q

AMTS

A 
DOB
Age
Time
Year
Place
Address
Who am I
Prime minister
Second WW
Count back from 20
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317
Q

Signs of meningitis

A

Fever
Menigism
Kernigs sign

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318
Q

What is kernigs sign

A

Flex knee and hip to 90 degrees from trunk and try to straighten leg

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319
Q

What is GCA associated with extra skull

A

Polymyalgia rheumatica
Shoulder girdle pain
Stiffness around trunk

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320
Q

What is polymyalgia rheumaica

A

Pain in stiffness in muscles around the trunk so shoulders hips etc

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321
Q

What must do immediately with GCA

A

Steroids
ESR check
Biopsy

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322
Q

Immediate management of someone who had stroke over 4.5 hours ago

A

Aspirin 300mg
Swallow screen
Maintain hydration and oxygenation etc

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323
Q

Treatment for TIA

A

Aspirin
ECG, Echo
Doppler

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324
Q

Long term TIA management

A

RF management

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325
Q

What dont you do in TIA tx

A

Treat BP acutely unless severe

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326
Q

Management of GBS

A

Cardiac monitor
FVC checked
IVIG

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327
Q

Simple criteria for collpase

A

Glucose
Cardiac- arryhtmia, outflow obstruction, postural hypotension, vasovagal
Seizure

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328
Q

What can cause brain abcess in frontal lobe

A

Sinusitis compication

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329
Q

Things to rule out after nasal trauma

A

Skull fracture can lead to blood behind ear and under
eyes
Septal haematoma

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330
Q

What can be complication of EBV in nose

A

Cancer especially in south east asians

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331
Q

Things to look out for inspection of neck examination

A

Voice changes
Scars
Lumps
Systemic signs such as exopthalmos or chachexia

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332
Q

What to do in palpation of examination of neck

A

Lymph nodes
Feel thyroid- get them to swallow water looking for movements of lumps. Also stick tongue out
Feel neck lumps if present and exmaine them

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333
Q

How to examine a neck lump

A

3s - site, size, skin
3c- colour, contour, consistency
3t- tenderness, temperature, transillumination
2f- fluuctuance, fixed
Pulsatile? Expansile? Auscultation for bruits

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334
Q

How does lymphadenopathy feel in infective causes

A 
Firm 
Tender
Mobile
Warm 
Red
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335
Q

How does lymphadenopathy feel in invasive causes

A

Firm
Non-tender
Tethered

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336
Q

Investigations for invasive lymphadenopathy

A

FBC, ESR, CRP
Virology, Mantoux
CXR and other imaging
Fine needle aspiration

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337
Q

What bacteria normally invade ascites

A

Gram neg

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338
Q

What condition are antimitochondrial abs elevated in

A

Primary billiary cirrhosis

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339
Q

On biospy what are steatosis and mallorys hyaline indicative of

A

Alcoholic steatosis

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340
Q

Some causes of travellers diarrorhoea

A

Giardia

Amoebiasis

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341
Q

How does crohns appear on CT

A

Thickened bowel

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342
Q

Management of crohns

A

Steroids

Enteral feeding

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343
Q

Blood indicators of UC

A

CRP

Albumin

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344
Q

What happens to albumin in UC flare ups

A

Down

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345
Q

Treatment for acute UC

A

High dose IV corticosteroids

Heparin prophylaxis

346
Q

Why is heparin given in UC treatment

A

UC very prothrombotic

347
Q

Tx for toxic megacolon

A

IV ABx

Urgent surgery referral

348
Q

Extra colonic features UC

A 
Arthralgia
Erythema nodosum
Pyoderma gangrenosum
Uveitis
Episcleritis
Heaptic inflammatory associations
349
Q

What is Pyoderma gangrenosum

A

Skin pustules and nodules that appear all over

350
Q

What is vertical transmission

A

Mother to foetus

351
Q

What Hep is hep D transmitted with

A

Hep B

352
Q

Transmission of hep A

A

Faeco-oral

353
Q

Transmission of hep B

A

Blood borne so transfusions, vertical and needles from tattoos, injection etc

354
Q

Transmission of hep C

A

Blood borne so transfusions, vertical and needles from tattoos, injection etc

355
Q

Transmission of hep D

A

Co-infection with B so blood borne

356
Q

Transmission of hep E

A

Faeco-oral

357
Q

Complications of Hep C

A

Cirrhosis
Hepatocellular carcinoma
Mesangiocapillary glomerulonephritis

358
Q

What is used to monitor Hep C treatment response

A

RNA level

359
Q

What should be measured prior to Hep C treatment

A

Viral load

Virus genotype

360
Q

Causes of bitemporal hemianopia

A

Neoplastic
Pituitary adenoma
Cranipharyngioma
Glioma of chiasm

Non neoplastic
Cysts of dermoid and epidermoid
Sarcoid
Aneurysm

361
Q

Where is lesion if unilateral eye loss of vision

A

Optic nerve of that eye

362
Q

Where are homonymous hemianopia lesions

A

Optic tract

363
Q

Where can quadrantopia lesions be

A

Optic radiation

364
Q

Where does optic tract run from

A

Optic chiasm to geniculate nucleus

365
Q

Caues of intra cerebral bleed

A

HTN
Rupture of aneurysm or AVM
Necrosis of vessel from tumour of infection
Cerebral venous thrombosis

366
Q

Causes of intracerebral haemorrhage in young ppl

A

AVM

Aneurysm

367
Q

What is an AVM

A

Arterio venous malformation- goes straight from artery to vein without going through arterioles from venules going from high to low pressure

368
Q

What is indicated when have no awareness of any stimulus or neglect

A

Right side- parietal

369
Q

What is a dysconjugate gaze

A

Diplopia

370
Q

What is used to as thrombolysis in stroke

A

Alteplase

371
Q

What condition are cafe au lait spots seen in

A

Neurofibromatosis

372
Q

What arteries are affected in GCA jaw claudication

A

Mandibular branch of external carotid

373
Q

What arteries are affected in GCA scalp tenderness and headache

A

Superficial temporal of EC

374
Q

What arteries are affected in GCA in diplopia and visual field loss

A

Posterior ciliary arteries
Diplopia- optic muscles nerves
VIsual field loss- retinal arteries

375
Q

5 diagnostic criteria GCA

A 
Over 50
New onset headache
ESR over 50
Pulsatile or tender temporal artery
Biopsy finding granuloma or mononuclear cell infiltration
376
Q

What does mixture of upper and lower signs suggest

A

MND

377
Q

What is brown sequard syndrome

A

Hemisection of spinal chord

378
Q

Presentation of brown sequard syndrome

A

Ipsilateral paralysis and loss of fine touch

Contralateral temp and pain loss

379
Q

Tx for MS

A

Steroid course

380
Q

What are better prognostic factors for MS

A 
Onset under 25
Initial presentation of optic neuritis or sensory- ataxia very bad prognosis
Long interval between relapses
Fewer lesions on MRI
Male
381
Q

What sex is cluster headache more common

A

Male

382
Q

Difference in mood during cluster headache and migraine

A

Cluster headache feel anxious so up and about

Migraine want to curl up in ball

383
Q

Meningitis investigations

A

CT
LP
blood cultures

384
Q

Primary care meningitis treatment

A

IV benzylpenicillin

385
Q

Secondary care meningitis tx

A

IV ceftriaxone and IV amoxicillin

386
Q

Acute management of migraine

A

Simple analgesia

Triptans

387
Q

Migraine prevention medications

A

Trigger avoidance
Propanolol
Topiramate
Amitriptyline

388
Q

Immediate stroke management

A

300mg aspirin and stop anticoagulants

CT head

389
Q

Investigationsf or cause of stroke

A

Echo
ECG
Carotid doppler

390
Q

Difference in decline between alzheimers and vascular dementia

A

Alzheimers is progressive decline whereas vascular is stepwise

391
Q

Drug treatments for alzheimers

A

Donepezil

Memantine

392
Q

Triad of LBD

A

Dementia
Hallucinations
Parkinsonism

393
Q

Features of depressive pseudodementia

A

Low mood

Disinterested

394
Q

Features of frontotemporal dementia

A

Personality changes

395
Q

Cardinal symptoms of parkinsons

A

Bradykinesia
Tremor at rest
Rigidity
Postural instability

396
Q

Some common symptoms seen in parkinsons (other than cardinal)

A

Insomnia
Hypomimia
Depression
Autonomic dysfunction

397
Q

What is hypomimia

A

Reduced showing of facial expressions

398
Q

2 treatment paths for parkinsons

A

Overall aim is to increase dopamine at substantia nigra

  • L Dopa and peripheral DOPA-decarboxylase inhibitor (co-beneldopa)
  • dopamine agonists
399
Q

Examples of dopamine agonists

A

Ropinirole
Pramipexole
Apomorphine

400
Q

How to tell difference between rigidity and spasticity

A
  • In spasticity there is only resistance to movement in one direction such as in arm will be only stiff in flexion but easier in other direction
  • rigidity wont be affected by speed of movement but in spasticity will be more noticable when move arm faster
401
Q

Difference in site of lesion for spasticity and rigidity

A

Spasticity in corticospinal tract whereas rigidity in extrapyramidal tract

402
Q

Causes of spasticity

A

Anyhting affecting corticospinal tract

  • Stroke
  • Spinal chord compression
  • MND
403
Q

Causes of rigidity

A

Anything affect extrapyramidal tracts like basal ganglia

- mainly parkinsons

404
Q

Anatomy of meninges surrounding brain and location of vessels

A 
Skull
Artery
Dura
Arachnoid mater
Pia mater
405
Q

What happens in extradural bleeds physiologically

A

Trauma causes tearing of middle meningeal artery, blood collects between dura and skull

406
Q

Clinical presentation of extradural bleed

A

History of trauma
Transiet LOC
Lucid interval
Ongoing headache and reduced consciousness

407
Q

What happens in subdrual bleeds physiological

A

Tearing of bridging veins between subdural space and subarach space-
venous blood accumulates between dura and arachnoid mater

408
Q

Clinical presentation of acute subdural bleed

A

Reduced consciousness

Severe focal neurology

409
Q

Clinical presentation of chronic subdural bleed

A

Little or no history of head trauma

Reduced consciousness and severe focal neurology

410
Q

Which groups of people are very susceptible to subdural bleeds

A

Elderly

Alcoholics as their bridging veins become very weak

411
Q

What type of lesion is upgoing plantars

A

UMN

412
Q

What type of lesion is pronator drift

A

UMN

413
Q

What type of lesion is fasiculations and fibrillations

A

LMN

414
Q

LMN causes of lesion

A

MND
Trauma
Polio

415
Q

UMN causes of lesion

A

MND
MS
SOL
Stroke

416
Q

What medical syndromes could confused be

A 
Delirium
Dementia
Mental impairment
Psychosis
Receptive dysphasia
Expressive dysphasia
417
Q

What is delirium

A

Acute impairment in cognitive ability with impaired consciousness

418
Q

What is dementia

A

A chronic progressive impairment in cognitive ability with intact consciousness

419
Q

What is psychosis

A

Disorder of thought and perception

420
Q

Where is damage in receptive dysphasia

A

Wernickes area

421
Q

Where is damage in expressive dysphasia

A

Brocas area

422
Q

If patient has confusion what should you do first

A

Assess ABC then do AMTS.
Can also differentiate between expressive and receptive dysphasia
Check if in any pain

423
Q

How would you differentiate between expressive and receptive dysphasia

A

Get them to follow a 3 step command- receptive

Can they name 3 common objects- expressive

424
Q

Questions for AMTS

A 
Give them an address
Orientation in time
1. What time is it
2. What year is it
3. How old are you
Orientation in space
4. Where are you
Long term memory
5. What is your DOB
6. When did WW2 end
7. Who is PM
Orientation in person
8. Who am I
Short term memory
9. count back from 20
10. Can you remember address i gave you
425
Q

Qs for collateral confusion history

A

Normal state?
Time course of confusion
Drug history

426
Q

Surgical sieve for confusion

A 
Infection
Neoplastic
Vascular
Immune
Trauma
Endocrine
Drugs
Metabolic
Degenerative
427
Q

Infective causes of confusion

A 
Chest infection
UTI
Encephalitis
Brain abscess
Sepsis
428
Q

Vascular causes of confusion

A

Stroke

MI causing hypoperfusion

429
Q

Trauma causes of confusion

A

Extradural

Subdural

430
Q

Endocrine causes of confusion

A

HHS
DKA
Any thyroid problem

431
Q

Drug causes of confusion

A

Intoxication or withdrawal from opioates, alcohol or psych meds
Overuse of diuretics, digoxin and thyroid meds

432
Q

What accounts for 30% of confusion cases

A

Drug toxicity

433
Q

Metabolic causes of confusion

A 
hypoxia
Hypercapnia
Hypercalcaemia
Sodium or any electrolyte imbalances
Hypoglycaemia
Vit B12 or folate deficiencies
434
Q

“Other” causes of confusion

A

Hypothermia

First time presentation of dementia

435
Q

Vital signs to look out for in confusion assessment

A 
Pulse and RR- tachypnoea and tachycardia infection
BP- hypoperfusion, cushing reponse
Fever- underlying infection, sepsis?
Sats- hypoxia can cause confusion
Blood glucose- HHS, DKA or hypo?
436
Q

What is cushing repsonse

A

Occurs in raised ICP- bradycardia with HTN

437
Q

Examination of confused patient

A 
Obvs going to be difficult but look out for these
Consciousness- GCS
Septic focus
Pupils
Focal neurology
Needle tracks
Asterixis
Bitten tongue or shoulder dislocation
Breath for alcohol
438
Q

When confused what will you look for in spetic screen

A

Chest- crackles
UTI- tenderness, urinalysis
Cellulitis
Meningitis- neck stiffness, photophobia

439
Q

What will dilated pupils in confusion suggest

A

Cocaine or TCA OD
Hypoxia
Hypothermia
Post ictal

440
Q

What will pinpoint pupils in confusion suggest

A

Opiates or barbiturate OD

441
Q

What does asterixis in confusion suggest

A

Hypercapnia
Hepatic encephalopathy
Uraemia

442
Q

What to smell for in breath

A

Alcohol
Fetor hepaticus
Uraemic fetor
Fruity- DKA

443
Q

What is fetor hepaticus

A

Musty smelling breath from breakdown failure of liver

444
Q

What is uraemic fetor

A

Urine smelling breath from renal failure due to excretion failure

445
Q

Septic screen investigations for confusion

A 
FBC
CRP
Blood cultures
Urinalysis
Mid stream urine sample for urine cultures
CXR
446
Q

Metabolic screen investigations for confusion

A 
ABG
U&Es
TFTs
LFTs
Thiamine
Haemitinics
447
Q

What to look for in FBC confusion

A

WCC confusion

Anaemia may contribute to hypoxia

448
Q

What to look for in urinalysis confusion

A

Leukocyte esterase
Nitrites
**Positive predictor for UTI is only if both are raised
Glucose or ketones may suggest diabetic complications

449
Q

Important thing to remember in urinalysis obtaining method

A

Should be midstream, in and out catheter sample or suprapubic catheter
Important as first part of micturition normally contaminated

450
Q

What to look for CXR confusion

A

Infection sign

Cardiomegaly- HF causing hypoperfusion

451
Q

What to look for in ABG confusion

A

Uraemia, DKA and some toxins cause metabolic acidosis

Hypercapnia

452
Q

Main investigations for confusion

A

Spetic screen
Metabolic screen
ECG
Tox screen

453
Q

Why does infection not always present with fever in old people

A

Temperature regulation is poor

454
Q

What are two main risk factors for MS

A

Smoking

Vit D deficiency

455
Q

What are 3 causes of sudden onset eye pain

A

Acute glaucoma
Anterior uveitis
Optic neuritis

456
Q

Typical MS patient in SBAs

A

White female 20-40

457
Q

What is uthoffs phenomena

A

MS symptoms worse after exercise or in the heat

458
Q

In what condition do you see scanning dysarthria

A

MS

459
Q

Examinations findngs MS

A 
Nystagmus 
INO
Facial parasthesia
Intention tremor
UMN signs
Scanning dysarthria
460
Q

Is radiology needed for MS diagnosis

A

No just need two separate attacks lasting more than 24hours at least 1 month apart

461
Q

Good differentials for MS

A

B12 deficiency
Transverse myelitis
SLE

462
Q

Common infections that precede GBS

A 
HIV
EBV
CMV
Mycoplasma
Campylobacter
**** important in history to ask about recent infections sx like diarrorhoea fever cough etc
463
Q

What type of signs do you get in MS

A

UMN

464
Q

What type of signs do you get in MS

A

LMN

465
Q

Important investigations for GBS to do admission

A

ECG- autonomic dysfunction leads to arrythmias
Assess postural BP
FVC
NCS

466
Q

Presentation of cauda equina syndrome

A 
Bilateral sciatica
Saddle anaesthesia
Bowel bladder dysfunction
Sexual dysfunction
Back pain
Parasthesia in sacral and lumbar deramtomes
467
Q

What does pain eased by leaning forward in cauda equina syndrome suggest

A

Spinal chord stenosis is cause

468
Q

Investigations for Cauda equina

A

Urgent MRI

Do DRE

469
Q

What are examination findings of cauda equina syndrome

A 
LMN signs
DRE
- saddle anaesthesia
- reduced sphincter tone
Palpable bladder
470
Q

If patient with CES has bladder dysfunction what should you immediately do

A

Catheterise

471
Q

What is progression of alcohol withdrawal

A

Agitation(6hrs)–>hallucinations(12hrs)–>seizures(36hrs)–>delirium tremens(48hrs)

472
Q

What is delirium tremens

A

State of complete altered mental state following alcohol withdrawal

473
Q

Presentation of delirium tremens

A 
Seizures 
Agitated
Hallucinations
Sweating
Tremor
474
Q

What should do if believe patient is an alcoholic or is suffering from alcohol withdrawal

A

Ask CAGE questions

475
Q

What are questions should ask in CAGE questionnaire

A

Have you ever felt if should Cut down on drinking
Does it Annoy you if people tell you you drink too much
Have you ever felt Guilty about your drinking
Have you ever had an Eye opener when wake up to ease hangover or settle nerves

476
Q

Further questions for suspected alcoholics

A

DSM-V

477
Q

Blood findings in alcohol withdrawal

A

VBG- resp alkalosis from agitated hyperventilation
FBC-low plts, increase in MCV (very common blood findings of alcos)
U&Es
LFTS and clotting

478
Q

Management of alcohol withdrawal

A 
Oral diazepam-> IV lorezapam
If that doesnt work propofol or phenolbarbital
Pabrinex
Glucose
Supportive care
479
Q

What can be used on ward to sedate patient

A

Haloperidol- 30-60mins

Lorezapam- 5-10mins

480
Q

Post operaition confusion DDx

A

Sepsis from infection
Hypoxia- anaemia from blood loss, PE, atelectasis, opiates depress resp center
Electrolyte imbalances- AKI, intra and postoperative fluid replacement
Alcohol withdrawal

481
Q

What functions are tested in MMSE

A 
Language expression and reception
Orientation in time and space
Calculation
Long and short term memory
Visuospatial ability
482
Q

What is acute confusion state defined as

A

Observable impaired attention, awarenss and cognition of sudden onset. Is interchangeable with delirium

483
Q

Features of korsakoffs syndrome

A

Amnesia

Confabulation

484
Q

Indications for immediate CT

A 
GCS<13 on admission
GCS<15 2 hrs after admission
Post traumatic seizure
Focal neurological deficit
Vomiting more than once
Suspected skull fracture
485
Q

Why dont we give everyone a CT

A

Large dose of radiation

486
Q

In UMN lesions which muscle groups tend to be affected more

A

Extensors in arms

Flexors in legs

487
Q

Inspection signs of UMN lesions

A

Contractures

Disuse atrophy

488
Q

Inspection signs of LMN lesions

A

Wasting
Fasiculations
Fibrillations

489
Q

What does a pronator drift suggest about lesion

A

Contralateral pyramidal lesions

490
Q

Nerve root for shoulder abduction and specific nerve

A

C5

Axillary

491
Q

Nerve root for shoulder adduction and specific nerve

A

C6/7

Thoracodorsal

492
Q

Muscle

involved in shoulder abduction

A

Deltoid primarily

493
Q

Muscle involved in shoulder adduction

A

Teres major
Lat dorsi
Pec major

494
Q

Nerve root for elbow flexion and specific nerves

A

C5/6
Musculocutaneous
Radial

495
Q

Nerve root for elbow extension and specific nerve

A

C7

Radial

496
Q

Specific muscles used in elbow flexion

A

Biceps brachii
Coracobrachialis
Brachialis

497
Q

Specific muscles used in extension of elbow

A

Triceps brachii

498
Q

Specific nerve root for wrist extension and nerve

A

C6

Radial

499
Q

Specific nerve root for wrist flexion and nerve

A

C6/7

Median

500
Q

Specific nerve root for finger extension and nerve

A

C7

Radial

501
Q

Specific nerve root for finger abduction and nerve

A

T1

Ulnar

502
Q

Nerve root and nerve used for thumb abduction

A

T1

Median

503
Q

Muscles used finger extension

A

Extensor digitorum

504
Q

Muscles used finger abduction

A

First dorsal interosseous

Abductor digiti minimus

505
Q

Muscle used for thumb abduction

A

Abductor policis brevis

506
Q

What does pendular reflex indicate

A

Cerebellar disease

507
Q

Nerve root tested in biceps reflex

A

C5/6

508
Q

Nerve root tested triceps reflex

A

C7

509
Q

Nerve root tested supinator reflex

A

C5/6

510
Q

What is dysmetria

A

Poor coordination

511
Q

What does positive rombergs suggest

A

Sensory dysfunction- proprioceptive/vestibular problem

512
Q

What does positive trendelenburg test show

A

Myopathy of gluteus medius or gluteus minimus

513
Q

What is a positive trendelenburg test

A

If raise leg and the hip on that side drops it suggests myopathy of muscles on standing leg

514
Q

Nerve root and specific nerve tested for in hip flexion

A

L1/2

Iliofemoral

515
Q

Nerve root and specific nerve tested for in hip extension

A

L5/S1

Sciatic

516
Q

Muscle tested for in hip flexion

A

Iliopsoas

517
Q

Muscle tested for in hip extension

A

Gluteus maximus

518
Q

Muscle tested for in leg extension

A

Quadriceps

519
Q

Muscle tested for in leg flexion

A

Hamstring

520
Q

Nerve root and specific nerve tested for in leg extension

A

L3/4

Femoral

521
Q

Nerve root and specific nerve tested for in leg flexion

A

S1

Sciatic

522
Q

Nerve root and specific nerve tested for in foot dorsiflexion

A

L4/5

Deep peroneal

523
Q

Nerve root and specific nerve tested for in foot plantarflexion

A

S1/2

Tibial

524
Q

Muscle tested for in ankle dorsiflexion

A

Tibialis anterior

525
Q

Muscle tested for in ankle plantarflexion

A

Gastrocnemius

Soleus

526
Q

Muscle tested for in BIG TOE EXTENSION

A

Extensor hallucis longus

527
Q

Nerve root and specific nerve tested for in big toe extension

A

L5

Deep peroneal

528
Q

What does broad stance suggest

A

MS lesion

Cerbellar vermis damage

529
Q

What does instability of stance when walking suggest

A

Cerebellar dysfunction- will lean towards side of lesion

530
Q

What does reduced and absent arm movements suggest when walking

A

Parkinsons

531
Q

What does small short shuffling steps suggest

A

Parkinsons

532
Q

What does high stepping foot suggest

A

Weakness of dorsiflexors- damage to peroneal nerve

533
Q

What is term for high stepping foot

A

Foot drop

534
Q

What does difficulty doing heel to toe test suggest

A

Sensory ataxia
Cerebellar problems
Weakness of flexors

535
Q

DANISH

A 
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Scanning speech
Hypotonia
536
Q

Pnemonic to remember parkinsons main symptoms

A

TRAP

537
Q

How to examine bradykinesia

A

Finger tapping- force decreases over time

Writing on page- text shrinks across page called mircographia

538
Q

Signs of bradykinesia

A

Hypomimia
Hypophonia
Micrographia

539
Q

Signs of tremor in parkinsons

A

Pin-rolling tremor where are rolling pin in hand

540
Q

Signs of rigidity in parkinsons

A

Cogwheel tremor

541
Q

What do you find on examination of spasticity

A

Initial resistance but then after becomes easy- clasp knife phenomena

542
Q

What is difference between cog wheel and lead pipe rigidity

A

In lead pipe rigidity there will be resistance for the duration of flexion
Whereas in cogwheel rigidity there is resistance at certain points for the duration of flexion

543
Q

What do you see leadpipe rigidity in

A

Neuroleptic malignant syndrome

544
Q

When patient presents with weakness what is important to ascertain

A

Whether is actually sensory, ataxia or too painful

545
Q

When patient presents with weakness what is first way to classify symptoms

A

Onset- acute, subacute or chronic

546
Q

What is likely to cause acute limb weakness

A

Trauma or vascular causes

547
Q

What is likely to cause subacute limb weakness

A

Progressive demyelination or SOL

548
Q

What is likely to cause chronic onset limb weakness

A

Slow growing tumour or MND

549
Q

What is likely to cause sudden onset weakness

A

Ischaemia- stroke, spinal chord infarction, acute limb ischaemia
Spinal chord- prolapse, fracture, transection
Non-ischaemia brain- todds paresis, hypoglycaemia, migraine

550
Q

What is likely to cause subacute onset weakness

A

Brain- SOL, MS(can also affect spinal chord)
Inflammatory- MS, GBS, TM
Infective/toxic- poliomyelitis, botulism, tetanus

551
Q

Gradual onset weakness causes

A

Spinal chord- spinal canal stenosis, Vit B12 deficiency
Peripheral nerve- DM, vasculitis, alcohol, B12, uraemia, hypothyroidism, myeloma
NMJ- MG, Lambert eaton syndrome
MND

552
Q

How to differentiate between disc prolapse and spinal canal stenosis as cause for CES

A

Disc prolapse acute onset

Stenosis- chronic

553
Q

Important questions to ask about with limb weakness

A 
Exact time of onset
Speech or visual disturbances
Headache
Back pain
Seizure or LOC
Trauma or fall recently
Risk factors for stroke
554
Q

Limb weakness with back pain

A

Spinal chord prolapse, infarct, abscess or trauma
GBS
Transverse myelitis

555
Q

Risk factors to ask with stroke

A

AF
Previous stroke
SLE
Atherosclerotic factors

556
Q

What percent of brocas and wernickes area of left handers are on left side

A

80%

557
Q

What lobe is wernickes and brocas area in

A

Brocas is in frontal

Wernickes is in temporal

558
Q

What does eye deviation show about side of lesion in weakness

A

If eyes deviate towards side of weaknesss lesion is in brainstem
If eyes deviate away suggests that lesion is in cortical area

559
Q

What is further support for alcohol withdrawal

A

Drug and Alcohol Liaison Specialist (DALS)
Community services (e.g alcoholics anonymous)
Therapy

560
Q

How to investigate severity of alcohol withdrawal

A

CIWA-Ar scale (Clinical Institute Withdrawal Assessment from Alcohol Revised scale)

561
Q

Physiologically what causes alcohol withdrawal

A

Glutamate upregulation

562
Q

If patient has LMN motor signs but sensory pathways intact what does this suggest

A

Probably either a NMJ problem or muscular lesion

563
Q

If patient has LMN motor signs but sensory pathways are not intact what does this suggest

A

Probably either peripheral nerve damage or nerve root

564
Q

If there are UMN signs what does intact spinothalamic suggest

A

Just the dorsal columsn that have been affected

565
Q

If there are UMN signs but only pain and temperature pathways are affected what does this suggest

A

That dorsal columns are intact and only anterior spine is affected- probable spinal artery infarct

566
Q

What is carried in dorsal columns

A

Light touch and proprioception

567
Q

What is carried in spinothalamic

A

Pain and temperature

568
Q

What are motor signals carried in

A

Corticospinal

569
Q

What are only anterior pathways affected in anterior spinal artery infarction

A

Pain and temperature

570
Q

What are causes of brown sequard syndrome

A

trauma
ischaemic
Infective- TB
Inflammatory- MS

571
Q

What are causes of transverse myelitis

A

Inflammatory- MS, NOSD, SLE, Sjogrens, Sarcoid
Infective- post viral or bacterial infection
Post vaccine

572
Q

2 most common causes of transverse myelitis

A

MS

NOSD

573
Q

What is NOSD

A

Neuromyelitis optic spectrum disorders

574
Q

Presentation of transverse myelitis

A

Ascending distal weakness and parasthesia
Toilet dysfunction
Back pain

575
Q

What are signs on examination of transverse myelitis

A

UMN bilateral

Bilateral parasthesia

576
Q

What is L’hermitte sign

A

Neck flexion leads to tingling in limbs- sign of TM

577
Q

What is McArdles sign

A

Neck flexion leads to increase in limb weakness

578
Q

Investigations for TM and results

A

MRI to look for chord lesions
MS tests
LP- increased WCC
(increased neutrophil for NOSD)

579
Q

Where to look for scars in CN exam

A

Behind the ear

580
Q

What test can be used to test for spatial neglect

A

Hold hands out to side and ask which hands are moving

581
Q

What should happen in accommadation reflex

A

Eyes should converge and constrict

582
Q

What is abnormal RAPD test

A

Abnormal eye will look dilated compared to normal eye

583
Q

What does abnormal RAPD show

A

Optic nerve problem- normally optic neuritis

584
Q

What affects the blind spots in eyes

A

Swollen optic disc either from optic neuritis, papilloedema

585
Q

What can cause medical 3rd nerve palsy

A

Iscahemia
DM
Vasculitis

586
Q

What does spatial neglect on one side suggest

A

Parietal lobe issue

587
Q

If there is complete blindness in one eye what does this suggest about lesion site

A

Optic nerve problem

588
Q

Muscles supplied in eyebrow raising

A

Frontalis

Orbicularis

589
Q

With facial weakness what does this suggest about stroke location

A

MCA

590
Q

When do most TIAs resolve within

A

1 hour

591
Q

What could FBC show in suspected stroke

A

Polycythaemia- ischaemic
Thrombocytosis- ischaemic
Thrombocytopenia- haemorrhage

592
Q

Blood tests for suspected stroke

A

FBC- platelets, polycythaemia
Glucose
Cotting- coagulopathy, haemophilia

593
Q

In strokes what is important in blood clotting results

A

Looking for coagulopathies, haemophilias

594
Q

How long after thrombolysis should patient be given antiplatelet therapy

A

24 hours

595
Q

In acute setting of strkoe what are risks you are worried about and how would they be managed

A

Recurrent stroke- LMWH can be used
DVT- stockings, trying to get to mobilise, LMWH
Pressure ulcers management

596
Q

How should stroke patient be assessed over days following on from stroke

A 
GCS
Swallow- ?NG
Speech and language
Visual fields as prone to falls if affected
Gait- safe to walk or not?
597
Q

Drug treatment long term for stroke

A

Clopidogrel
Statin
ACEi if HTN

598
Q

What should BP target be in diabetics

A

120/80

599
Q

What happens physiologically in TIAs

A

Clots form but plasmin system able to dissolve them

600
Q

What scoring system is done on TIA patients to determine when go to TIA clinic

A

ABCD2

601
Q

What is most important part of TIA management

A

Identify cause and sort that out

602
Q

Main things done in TIA clinic

A

Assess whether stroke has properly resolved
Then assess RFx- HTN, diabetes, hyperlipidaemia, smoking, AF
Carotid artery stenosis

603
Q

Post any occlusive episode in brain of AF nature in origin what drug should patient be started on

A

Anticoagulation

604
Q

When prescribing an anticoagulation what must be considered

A

The risk of bleeding especially in the elderly

Therefore need to do chadvasc and hasbled

605
Q

Is there any point in givng an aspirin for someone who had a TIA of AF origin

A

No as is an antiplatelet

606
Q

What can cause chord compression

A

Disc herniation

SOL including tumour, abscess, cyst or haematoma

607
Q

If lost sensation from belly button downwards what is spinal chord lesion and vertebral level

A

T10 is chord level but then vertebral level will be higher up at T6

608
Q

What is INO

A

Internuclear opthalmoplegia

609
Q

Where is INO lesion

A

Medial longtitudal fasiculus

610
Q

Most likely cause of INO

A

MS especially in younger people but in older people think of stroke

611
Q

What happens in INO on examination

A

Assuming is right sided lesion
When look to left (adducting right eye), right eye movement is slowed and saccadic nystagmus seen however when converge eyes there is no problem

612
Q

If had optic neuritis then how will optic nerve function in future

A

RAPD will be seen in future due to damage

613
Q

What happens physiologically in MS

A

T cells destroy myelin sheath

614
Q

3 main investigations for MS and what they will show

A

LP- oligoclonal bands
MRI- white lesions
Visually evoked potentials- can measure activation of visual cortices after visual stimulus so will see delayed activation on eye that has been affected by optic neuritis

615
Q

Are oligoclonal bands specific to MS

A

No

616
Q

What are some contraindications for thrombolysis

A 
Haemorrhage on CT
After 4.5 hours
Seizure on onset of stroke
Stroke or head injury recently 
Major surgery or trauma within 2 weeks
Thrombocytopenia
INR above 1.7
617
Q

What is froments sign indicative of

A

Ulnar nerve palsy

618
Q

What does para- prefix mean

A

Lower limbs

619
Q

What does mono- prefix mean

A

One limb

620
Q

What does tetra and quadra- prefix mean

A

All 4 limbs

621
Q

What is difference between limb hemiparesis and full body hemiparesis

A

Full body affects the face aswell

622
Q

What can cause a limb hemiparesis

A

Smt affecting all of cerebral motor cortex
Smt affecting the corona radiata, internal capsule or pons
Cervical vertebral prolapse

623
Q

What could cause a paraparesis

A

Brain- parasagittal meningioma
Bilateral motor spinal tracts- chord compression
Cauda equina
Bilateral lumbosacral plexus- GBS

624
Q

What could cause a tetraplegia

A

Traumatic injury to cervical spine

Demyelinating disease such as GBS

625
Q

What tends to cause proximal muscle weakness

A

NMJ- MG, eaton lambert syndrome
Muscle problems- polymyositis
Hyperparathyroidism
Drugs such as statins

626
Q

Physiologically what happens in polymyositis

A

Muscle cells are attacked by CD8 cells due to molecular mimicry mechanism

627
Q

What conditions are associated with polymyositis

A

RA

Sjogrens

628
Q

Which muscles does polymyositis tend to affect

A

Proximal- hips and shoulders

629
Q

What can polymyositis present with difficulty doing

A

Walking
Combing hair
Lifting off of chair
Swallowing

630
Q

Diagnosis of polymyositis

A

Measure muscle enzymes like aldolase and creatine kinase
Muscle specific antibodies- anti Jo 1
EMG
Muscle biopsy

631
Q

Endocrine causes of proximal myopathy

A

COT

Cushings, osteomalacia, thyrotoxicosis

632
Q

If ataxic what must consider as 3 possible sites of lesion

A

Vestibular system
Cerebelleum or brain stem
Proprioception pathways

633
Q

How do problems with vestibular system present

A

Unilateral unsteadiness and disequilibrium with associated nausea and vomiting

634
Q

Most common causes of vestibular system ataxia

A

Drugs and alcohol

Must consider meniers

635
Q

What is somatotrophic distribution of cerebellum

A

Trunk controlled centrally and limbs more peripherally

636
Q

What is central part of cerebellum

A

Vermis

637
Q

What do lesions to vermis cause

A

Lead to truncal or gait ataxia- wide stance appearing drunk

638
Q

What happens in lesions of cerebellar hemispheres

A

Dysmetria
Dysdiadokochinesia
Scanning dysarthria

639
Q

What is dysmetria

A

Difficulty judging distance

640
Q

What is vestibulocerebellum knowns as

A

Flocculondular lobe

641
Q

What do problems with flocculondular lobe lead to

A

Postural instability

Impaired eye movement

642
Q

Common pathologies affecting cerebellum

A 
Stroke
Tumour
Alcohol
Demyelination
Genetic disorders
643
Q

What is sensory ataxia

A

Problem with proprioceptiom

644
Q

What is inability to stand still with eyes closed a sign of

A

Sensory ataxia

645
Q

How do people with sensory ataxia walk

A

Stomping feet as dont know how high to lift feet

Stumble when in dark as lose sensory input

646
Q

Some causes of sensory ataxia

A

B12 defic
MS
Diabetes
Anything causing neuropathy of proprioception

647
Q

Top causes of seizure in young person- metabolic

A

Hypocalcaemia
Hyponatraemia
Hypoglycaemia
Hypokalaemia

648
Q

What happens in brain SOL on CT

A

Cerebral oedema leading to midline shift

649
Q

Most common tumour in brain

A

Metastases
In men from lung
In women from breast

650
Q

Cauda equina syndrome

A

When tail of spinal chord is affected

651
Q

What is reflex can do for bulbar presentation to determine if UMN or LMN

A

Jaw jerk

652
Q

Who does MG normally present in

A

Younger women or older people

In older people tend to present less with opthalmoplegia and ptosis

653
Q

Symptoms worse late in evenings

A

MG

654
Q

What is the tensilon test

A

Give Achesterase inhibitor

In MG sx will improve

655
Q

What comes first in progression of alzheimers

A

Language and memory then personality

656
Q

Extra pyramidal signs on examination

A

Pronator drift
Rigidity
Resting tremor

657
Q

Causes of mixed UMN and LMN signs

A

Compresssion of spinal chord
Subacute spinal chord degeneration
MND

658
Q

What causes subacute spinal chord degneration

A

B12 degeneration

659
Q

Who are stomping gaits seen in

A

Diabetics

660
Q

Who is high stepping gait seen in

A

Peroneal nerve damage

661
Q

Who is hemiplegic gait seen in

A

UMN damage

662
Q

What is seen in hemiplegic gait

A

Person circumducts their foot as cant flex hip
Arm on that side may also be damaged with flexed arm and hand
Flexors in arm and extensors in leg the strongest

663
Q

Pathophysiology of BPPV

A

Calcium carbonate crystals in semicircular canals gets dislodged sending misinformation about heads position leading to vertigo

664
Q

Presentation of BPPV

A

Vertigo triggered by movement

In history must elicit when started

665
Q

What is important thing to bear in mind with brainstem

A

Wont just be one pathology as is so smalled

666
Q

What is presentation of Menieres

A

Tinnitus
Hearing loss
Sensation of increased pressure in ear
Vertigo lasting mins to hours

667
Q

Presentation of vestibular neuritis

A

Vertigo
Tinnitus
Sensation of increased pressure in ear

668
Q

Difference between vestibular neuritis and Menieres

A

Only in menieres hearing loss

669
Q

Vertigo in migraine sufferes

A

Have an increased incidence that can occur with or without

670
Q

Where is the blood in SAH

A

In the sulci and fissures

671
Q

What signs on CT are indicative of severe bleed

A

Midline shift

Intraventricular bleeding

672
Q

Where are lesions in memory loss

A

Temporal lobe but has to be bilateral lesion

673
Q

Symptoms of posterior circulation stroke

A

Ataxia
Nystagmus
Hemianopia

674
Q

CSF finding of viral meningitis

A

High protein

Lymphocytosis

675
Q

CSF finding of bacterial meningitis

A

Low glucose
Neutropenia
Slightly high protein

676
Q

CSF finding of TB meningitis

A

Slightly high protein
Low glucose
Lymphocytosis

677
Q

CSF finding of fungal meningitis

A

Slightly high protein
Low glucose
Lymphocytosis

678
Q

Difference between bacterial and viral meningitis

A

Bacterial much worse that can lead to sepsis

679
Q

What are neurofibromas

A

Fibrinous tumours growing from nerves

680
Q

What is neurofibromatosis

A

A genetic condition leading to non-cancerous growths

681
Q

What are faulty genes in neurofbromatosis

A

In type 1 NF1- Chr 17

In type 2 NF2- Chr 22

682
Q

What is inheritance of neurofibromatosis

A

Autosomal dominant

683
Q

Which nerves does neurofibromatosis affect

A

Those in extremeties and skin but can be along peripheral nerves and spinal nerves

684
Q

Where are cafe au lait spots seen

A

Back, buttocks and thighs- normally appear in first year of life

685
Q

In lower limb where does wasting occur first

A

Medial thigh

686
Q

What does tender muscles suggest

A

Myositosis

687
Q

What tends to be pathognomonic for MND

A

Bulbar involvement

688
Q

What can mimic limb claudication

A

Spinal canal stenosis

689
Q

When is spinal canal stenosis easier

A

Flexing

Easier sitting

690
Q

When is only time pred can be given in bells palsy

A

First 72 hrs

691
Q

What is it called when herpes zoster causes bells palsy

A

Ramsay hunt syndrome

692
Q

What is ramsay hunt syndrome

A

Herpes zoster virus causes shingles

693
Q

Symptoms of ramsay hunt syndrome

A

7th nerve palsy
Loss of earing in ear
Painful rash on face

694
Q

Management of bells palsy

A

Tape eyes shut due to risk of corneal ulceration

695
Q

How is amaurosis fugax described

A

Painless closing of eye

696
Q

Differentials for amaurosis fugax

A

TIA- retinal artery occlusion

GCA

697
Q

How does retinal artery occlusion present on fundoscopy

A

Oedema

Cherry red macula

698
Q

Retinal vein occlusion on fundoscopy

A

Retinal haemorrhages

Cotten wool spots

699
Q

How is acute glaucoma described

A

See haloes around everything

700
Q

What causes spinal canal stenosis

A

Spondylosis

701
Q

What makes spinal canal stenosis worse

A

Walking downhill- anything that extends spine

702
Q

Which nerves does MG only affect

A

Motor

703
Q

Which sensory pathways are most commonly affected in diabetic neuropathy

A

Pain

Vibration

704
Q

What are some common infective neuropathies

A

Lyme disease

Leprosy

705
Q

What happens to sleep in parkinsons

A

REM sleep affected means muscles arent paralysed

706
Q

What do parkinsons patients do in sleep

A

Act it out

Scream

707
Q

Neuro causes of collapse

A

Seizure

Parkinsons->postural hypotension

708
Q

Autonomic dysfunctions of parkinsons

A

Post hypotensions
Sexual dysfunction
Constipation

709
Q

Whoa re medication overuse headaches common in

A

Migraine sufferers

710
Q

Main danger of epilepsy

A

Status ellipticus

711
Q

What is phenytoin used routinely for

A

Epilepsy

712
Q

What is protocol when patient seizing

A 
Diazepam/lorezapam
Diazepam
Phenytoin
Phenobarbital
Intubate and give general anaesthetic
713
Q

What does someone do in a complex partial seizure

A

Automatisms of useless activities like chewing, lipsmacking, picking things up or fumblinf around
Will have no recognition as starts in temporal lobe generally

714
Q

What is rough guidance for C4 dermatome

A

Above shoulders

715
Q

What is rough guidance for T4 dermatome

A

Nipples

716
Q

What is rough guidance for T10 dermatome

A

Umbilicus

717
Q

What is rough guidance for L1 dermatome

A

Pockets

718
Q

What is rough guidance for L3 dermatome

A

Knees

719
Q

How to determine between a myopathy and MG

A

Test for fatiguability
Count down from 100
Squat repeatedly
Abduct and adduct shoulders

720
Q

What is lambert eaton syndrome

A

Paraneoplastic syndrome where ABs formed against K+ channels

721
Q

What is weird about LEMS

A

Strength improves on exercise

722
Q

How to differnetite MG from LEMS

A

EMG

723
Q

What conditions are associated with MG- will be in history potentially

A 
CTD
T1DM
Graves
Hahimotos
Pernicious anaemia
724
Q

What is tinels sign

A

Tap a nerve and it will tingle- indicative of a compressed nerve

725
Q

What is hoffmans sign

A

Flick middle finger and thumb will contract in an UMN disease

726
Q

How is dementia diagnosed truly

A

On biopsy

727
Q

What can be signs on imaging of dementia

A

Infarcts

Atrophy

728
Q

5 most common sources of brain mets

A 
Melanoma
Colon
Lung
Breast
Kidney
729
Q

How can primary brain tumours be classified

A

Axial or extra-axial

730
Q

What are axial brain tumours

A

Tumours of the brain matter itself

731
Q

Examples of axial brain tumours

A

Astrocytoma
Oligodendrogliomas
Ependymomas
Medulloblastomas

732
Q

What are glioblastomas

A

Grade 4 astrocytoma

733
Q

What are ependymomas tumours of

A

Cells lining ventricles

734
Q

What are extra axial brain tumour examples

A

Meningioma
Vestibular schwannoma
Pituitary adenoma
Haemangioma

735
Q

What do vestibular schwannomas compress

A

CN 7 and 8

736
Q

What level does spinal chord end in adults vs children

A

Adults L1/2

Children L2/3

737
Q

Procedure for an LP

A

Trace line between 2 PSIS called tuffiers line

738
Q

Indications of an LP

A

Diagnostic- infection, MS, GBS, SAH

Therapeutic- IIH, intrathecal drugs

739
Q

Which intra thecal drugs are often fiven

A

Haematological drugs in children

740
Q

Contraindications of LP

A

Raised ICP
Increased bleeding risk
Infection at site
Cardiorespiratory distress

741
Q

Risks of LPs

A

Headache due to intracranial hypotension
Infection at site
Nerve root pain

742
Q

Raised ICP signs

A 
Headache worse when lying down
Nausea in am
Blurry vision
Fundoscopy
Cushings peptic ulcer
Cushing reflex
743
Q

What is a cushings ulcer

A

When ICP puts pressure on vagus nerve causing excess acid production

744
Q

Headache with epigastric pain

A

Raised ICP leading to cushings ulcer

745
Q

Causes of ICP

A

SOL- haematoma, abscess, tummour or cyst
Cerebral oedmea- trauma or lesion
Increased blood flow to brain
Increased CSF volume

746
Q

Causes of raised ICP due to increased blood flow

A

Drugs
Malignant HTN
Superior vena cava obstruction
Venous sinus thrombous

747
Q

Which drugs can increase ICP

A

GTN

Viagra

748
Q

In what modality is CSF white

A

T2 weighted MRI

749
Q

How to treat cluster headache acutely

A

High flow oxygen

Nasal or subcut triptans

750
Q

What can give ring-enhancing lesions on CT in brain

A

Abscess
Toxoplasmosis
MS
Tumour

751
Q

What condition is trigeminal neuralgia commonly seen in

A

MS

752
Q

Pathophysiology of trigeminal neuralgia

A

Compression of nerve by artery or vein loop in majority of cases
10% tumours, MS, skull base abnormalities
HTN is a risk factor

753
Q

In babies what is likely to cause meningitis

A

E.coli

Group B strep

754
Q

In children what is likely to cause meningitis

A

Strep pneumoniae

H. influenzae

755
Q

What causes meningitis in young people

A

Neisseria meningitidis

756
Q

What causes meningitis in the elderly

A

Listeria monocytogenes

Strep pneumoniae

757
Q

What viruses cause meningitis

A

Enteroviruses, HSV, VZV and HIV

758
Q

Which type of organism most commonly causes meningitis

A

Virus also is less severe

759
Q

How does meningococcal disease present

A

Rapid onset fever and malaise then signs of sepsis and meningitis with a non blanching rash

760
Q

What causes meningococcal disease

A

Neisseria meningitides

761
Q

Risk factors for meningitis

A

Crowded places as spread via resp droplets
Extremes of age
Infections of head/face including sinusitis and mastoiditis

762
Q

Signs on examination of meningitis

A

Kernigs sign
Brudzinskis sign
Petecial non-blanching
Fever, sepsis

763
Q

What is brudzinskis sign

A

Flexion of neck while knees and hips flexed too

764
Q

How does CSF look in bacterial meningitis

A

Turbid and cloudy

765
Q

How does CSF look in viral meningitis

A

Clear

766
Q

How does CSF look in TB meningitis

A

Fibrin web

767
Q

What are WCC described as in CSF neutrophils

A

Polymorphs

768
Q

What are WCC described as in CSF lymphocytes

A

Mononuclear

769
Q

What are investigations for meningitis you order

A

LP is most important but should do CT first if contraindications
2 sets of blood cultures

770
Q

What would make you do a CT before a LP in meningitis

A 
Seizures
Papilloemeda
LOC
Immunocompromised
Focal neurology
771
Q

Complications of meningitis

A

Hearing loss
Sepsis
Impaired mental statement
Encephalitis

772
Q

Management of meningitis at GP

A

IM benzylpenicillin

773
Q

Management of meningitis A&E

A

IV ceftriaxone
Acyclovir if viral

Then do cultures and target antibiotics
Consider IV dexamethasone

774
Q

What is encephalitis

A

Inflammation of the brain parenchyma

775
Q

What type of organism causes encephalitis typically

A

Viral

776
Q

Viral causes of encephalitis

A 
HSV
CMV
EBV
HIV
Measles
777
Q

Non viral causes of encephalitis

A 
Lyme disease
Legionella
Bacterial meningitis
TB
Malaria
778
Q

Presentation of encephalitis

A 
Viral podrome
Fever
Headache
Altered mental state
Seizures
Focal neurology
779
Q

Altered mental states seen in encephaliitis

A

Memory disturbances
Personality changes
Psyciatric manifestations
LOC

780
Q

Investigations for encephalitis

A

MRI
LP- look for signs similar to meningitis
EEG
Blood cultures

781
Q

What is seen on imaging of encephalitis

A

Oedema and hyperintense lesions

782
Q

What exacerbates ICP headaches

A

Coughing and sneezing
Exercise
Lying down

783
Q

What is the cushing reflex

A

Increased SBP
Irregular breathing
Bradycardia

784
Q

What is cheyne stokes respiration

A

Progressively deeper and sometimes faster followed by a gradual decrease that results in apnoea

785
Q

What is cheyne stokes respiration seen in

A 
HF
Stroke
Hyponatraemia
TB
Brain tumours
786
Q

Differnece on non contrast CT between acute and chronic subdurals

A

In acute the blood appears white

787
Q

Who are acute subdurals normally seen in

A

Young people after severe trauma

788
Q

Who are chronic subdurals normally seen in

A

Elderly

789
Q

Surgical management of subdurals

A

Burr holes or craniotomy

790
Q

Conservative management for small acute subdurals

A 
Admit, observe and monitor 
Prophylactic anti-epileptics
ICP monitoring
Correct coagulopathies
Lower ICP
791
Q

Management of subdural

A

ABCDE
Neurosurgery
If under 10mm and is no significant dysfunction then observe
If large or significant neuro dysfunction surgery

792
Q

RFs for SAH

A

PCKD
Alcohol
Smoking
HTN

793
Q

What type of CT do you use on the head

A

Non contrast

794
Q

ECG finding of SAH

A

Long QT

795
Q

CT sensitivty for SAH in first 12 hours

A

98

796
Q

Which cells do medulloblastomas arise from

A

Immature embyonal cells

797
Q

What puts peoples at greater risk of developing meningioma

A

Neurofibromatosis

798
Q

How would frontal lobe tumour present

A

Personality changes
Apathy
Intellect impaired

799
Q

How does a vestibular schwannoma present

A

Progressive deafness

800
Q

Investigations for brain tumour

A

CT- quick
MRI- better resolution
CXR and CT to look for mets
Biopsy to be definitive

801
Q

How to do froments sign

A

Hold piece of paper between thumb and fingers.

Normally the thumb should be flat however in ulnar nerve palsy the PIP is flexed

802
Q

What is cause of epilepsy

A

Genetic predisposition to seizures commonly genetic deformities in NMDA and GABA channels

803
Q

What is excitatory NT and receptor in brain

A

Glutamate

NMDA

804
Q

What is inhibitory NT and receptor in brain

A

GABA

GABA

805
Q

What is method of action of benzos

A

Enhance GABA transmission

806
Q

Examlpes of anticonvulsants used in epilepsy

A

Lamotrigine
Sodium valproate
Carbamezapine

807
Q

In simple partial seizures what often happens

A

Either jerking

Or strange sensations or weird smells and tastes

808
Q

How can epilepsy be managed

A

Anti convulsants
Surgery to remove area of brain causing damage
Nerve stimulation- vagus often
Ketogenic diet

809
Q

What diet is often recommended in epilepsy

A

Keto

810
Q

If epilepsy patient goes into status elipticus what could it be

A 
Poor compliance to meds- check levels
Metabolic causes- glycaemic, U&Es
Drugs- alcohol, amphetamines, cocaine
Hypoxia
Infection- encephalitis, meningitis
SOL- abscess, tumour
Vascular- vasculitis, AV malformation
811
Q

Anaesthetic often given to terminate seizures

A

Theopentone

812
Q

What is the triad for normal pressure hydrocephalus

A

Gait ataxia
Urinary incontince that progress to include faeces
Dementia

813
Q

Presentation of NPH

A

Gait ataxia
Urinary incontince that progress to include faeces
Dementia
Can get headache occasionally especially at night (ICP)

814
Q

What is pathophysiology of communicating hydrocephalus

A

There is problem with reabsorptio of CSF into veins or rarely failure of production of CSF
NO OBSTRUCTION

815
Q

What can cause communicating hydrocephalus

A

Haemorrhage
Meningitis
Tumours
Venous thrombosis

816
Q

Where does fluid accumulate in communicating hydrocephalus

A

In ventricles

In subarachnoid spcae

817
Q

What happens in non communicating hydrocephalus

A

CSF flow obstruction from SOL most of time

818
Q

4 types of hydrocephalus

A

Communicating
Non communicating
NPH
Congenital

819
Q

Presentation of communicating and non communicating hydrocephalus

A

Blurred vision
Unsteady gait
6th nerve palsy

820
Q

Sign on examination of NPH

A

Babinskis
UMN
Parkinsonism

821
Q

CT and MRI findings of hydrocephalus

A

Increased size of ventricles

Tumour

822
Q

Investigations of hydrocephalus

A

CT/MRI- increased ventricle size, potenital tumour causing obstruction
LP- opening pressure increased

823
Q

Who does NPH occur in

A

Elderly

824
Q

What would cause inceased opening pressure in meningitis LP

A

Communicating hydrocephalus as impaired reuptake

825
Q

If someone has a facal nerve palsy what are 4 examinations must carry out

A

Motor function
Otoscopy
Palpate parotids
Schirmers test for lacrimation

826
Q

What are most tumours of the parotid

A

Benign 80% with 80% pleomorphic adenoma

827
Q

What can cause bells palsy

A

Ramsey hunt syndrome
Parotid tumour
Lyme disease
Vestibular schwannoma

828
Q

How does a vestibular schwannoma present

A

Hearing loss

Tinnitus

829
Q

What are breast cysts development most commonly associated with

A

Hormones- often with start of menopause

830
Q

What are fibroadenomas most commonly associated with

A

Hormones

831
Q

How does inflammatory breast cancer appear

A

Mastitis or abscess

832
Q

How is inflammatory breast cancer often diagnosed

A

Think is abscess or mastitis so give Abx- rash then refractory to these

833
Q

What are key features on examination of inflammatory breast cancer

A

Warmth
Erythema
Peau d’orange
Early lymph node involvement

834
Q

If cancer is suspected what biopsy technique is preferred

A

Core biopsy> FNA

835
Q

What is blood marker for breast cancer

A

Ca 15-3

836
Q

How does breast cancer appear on mammogram

A 
Spiculated mass
Parenchyma distortion
Skin thickening
Calcification
Axillary lymph nodes
837
Q

How does breast cancer appear on US

A

Ill defined hypoechoic mass
Halo from oedema
Axillary lymph nodes
Acoustic shadowing

838
Q

Management of bells palsy

A

Prednisolone if within 72 hours

Consider aciclovir

839
Q

How long do do migraines last

A

2-72 hours in children

4-72 hours in adults

840
Q

What is a scotoma

A

Change in vision where see something

841
Q

In chronic tension headaches what is used as prophylaxis

A

Amitriptyline

842
Q

Causes of tremor

A 
Parkinsons
Huntingtons
Essential tremor
Drug induced tremor
Hyperthyroidism
Enhanced physiological tremor
Anxiety
Caffeine
843
Q

Most common cause of cellulitis

A

Strep pyogenes

Staph aureus

844
Q

How is cellulitis classified

A

Class 1- no systemic signs
Class 2- pts have comorbid conditions affecting recovery
Class 3- pts have accompanying limb threatening illnesses and signs of systemic infection like confusion and tachycardia
Class 4- severe sepsis and infection

845
Q

Treatment for class 1 cellulitis

A

Oral abx in outpatient setting

846
Q

Treatment for class 2 cellulitis

A

Oral or IV abx in outpatient setting

847
Q

Treatment for class 3 cellulitis

A

Hospitilisation for IV abx

848
Q

Treatment for class 4 cellulitis

A

ITU

849
Q

Management of cellulitis at home

A

Oral abx
Simple analgesia
Elevate leg
Keep it moisturised to prevent infection and help healing

850
Q

When would you do X ray in gout

A

If chronic disease that is especially untreated

851
Q

What can be seen on x ray of gout

A

Punched out lytic region

852
Q

Acute mangement of subdural

A

ALS protocol
Watch out for cervical spine injury
Osmotic diuresis if raised ICP
Burr holes or craniotomy

853
Q

Management of chronic subdural

A

If symptomatic do burr holes or craniotomy

854
Q

What are complications of subdural

A

Permenant focal neurology to area affected
Raised ICP
Cerebral oedema
Post op complications- seizures, abscess, meningitis

855
Q

Treatment of peripheral neuropathy in DM

A

Duloxetine

856
Q

What causes hypotonia

A

Cerebellar and LMN lesions

857
Q

Cancer causes of peripheral neuropathy

A

Myeloma

Paraneoplastic syndrome

858
Q

What is papillitis

A

Optic neuritis

859
Q

TIA management

A 
Aspirin
Dont treat BP 
ECG
Echo
Carotid doppler
RF management
860
Q

What are global t wave inversion seen in

A

Brain herniation

861
Q

What are cerebral t waves

A

T wave inversion seen globally due to brian herniation

862
Q

In MND what muscles are spared

A

Ocular

Year 3 Conditions (33 decks)

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