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Neuro big topics Flashcards

1
Q

define TIA

A

transient, reversible neurological phenomenon lasting <24 hours with complete clinical recovery

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2
Q

causes of TIA

A

thromboembolism from carotids
cardioembolism
hyperviscosity

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3
Q

define amaurosis fugax

A

retinal artery embolism, causing sudden transient loss of vision in one eye

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4
Q

DDx TIA

A

hypoglycaemia
migraine aura
focal epilepsy

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5
Q

TIA Ix

A 
carotid doppler
CT brain (existing infarcts)
Echocardiogram (cardiac cause of embolism)
Erythrocyte sedimentation rate
serum glucose
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6
Q

scoring system to estimate risk of stroke following TIA?

A 
ABCD2
1     age >60
1     BP >140/90
clinical features
2    unilateral weakness
1     speech disturbance w/o weakness
duration
1     10-59 mins
2    >60 mins
1     diabetes
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7
Q

treatment of TIA

A

control risk factors:

  • blood pressure (antihypertensive regimen)
  • cholesterol (statins)
  • diabetes
  • stop smoking

antiplatelets
- clopidogrel + aspirin

carotid endarterectomy

driving

  • avoid for 1 month
  • inform DVLA
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8
Q

effects of anterior cerebral artery stroke?

A

front and medial cerebrum superior humunculus thus:

  • leg weakness/sensory disturbance
  • gait apraxia
  • incontinence
  • drowsiness
  • akinetic mutism (damage to cingulate gyrus)
  • face SPARING
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9
Q

effects of middle cerebral artery stroke?

A

most common artery affected

  • contralateral arm and leg weakness/sensory disturbance
  • hemianopia (optic radiation)
  • aphasia - difficulty comprehending (wernicke’s area in dominant temperoparietal lobe) and formulating speech (broca’s area in dominant frontol lobe)
  • facial DROOP
  • visuospatial disturbance
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10
Q

effects of posterior cerebral artery stroke?

A
  • contralateral homonymous hemianopia with macular sparing
  • cortical blindness
  • visual agnosia (cant interpret what seeing)
  • prosopagnosis (cant recognise faces)
  • colour naming and discrimination
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11
Q

effects of poster circulation stroke?

A

supplies brainstem, cerebellum and occipital lobes

  • motor deficits (hemiparesis/facial paresis)
  • dysarthria (slow/slurred speech)
  • vertigo
  • nystagmus
  • dysdiadochokinesia
  • altered consciouness
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12
Q

investigations for stroke?

A
  • urgent CT/MRI brain
    to distinguish ischaemic and haemorrhagic
  • serum glucose
  • coagulation tests
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13
Q

treatment of ischaemic stroke

A

thrombolysis (IV alteplase) if <4.5 hours after onset of symptoms –> alteplase = tissue plasminogen activator

risk management

  • antiplatelets: aspirin + clopidogrel
  • statins
  • AF –> warfarin
  • BP

post-stroke referral:

  • speech and language therapy
  • physio
  • occupational therapy
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14
Q

risk factors for stroke? modifiable and non-modifiable

A

modifiable:

  • HYPERTENSION
  • smoking
  • lack of exercise
  • obesity
  • diabetes
  • hyperlipidaemia

non-modifiable

  • ethnicity (black/asian)
  • age
  • male
  • family history
  • atrial fibrillation
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15
Q

what must always be excluded in DDx for stroke?

A

hypogycaemia

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16
Q

contraindications of thrombolysis in stroke?

A
  • past CNS bleed
  • > 4.5 hours since symptom onset
  • seizures at presentation
  • uncontrolled blood pressure
  • recent lumbar puncture
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17
Q

What might be the cause of crossed signs? ie left arm weakness and right mouth droop

A

BRAINSTEM LESION

  • crossed signs not involving brainstem would require 2 separate cortical lesions on both hemispheres
  • facial involvement suggests lesion abve spinal cord
  • CNs affected on same side as lesion (LMN signs), and corticospinal tract affected before it decussates at medulla (UMN signs)
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18
Q

LMN CN7 palsy (Bell’s palsy) vs UMN CN7 palsy (stroke)?

A

bells palsy = LMN lesion thus NO forehead sparing

stroke = UMN CN7 lesion this FOREHEAD SPARING

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19
Q

primary and secondary causes of haemorrhagic stroke?

A

primary:

  • hypertension (Charcot-Bouchard aneurysm –> affects basal ganglia)
  • lobar (cerebral amyloid angiopathy)

secondary:

  • metastases/tumour
  • arteriovenous malformation
  • anticoagulants (warfarin)
20
Q

treatment of haemorrhagic stroke

A

control BP –> B-blocker

warfarin antidote –> beriplex

21
Q

cause of subarachnoid haemorrhage?

A

rupure of circle of willis due to:

  • saccular/Berry aneurysm rupture
  • arteriovenous malformation
22
Q

risk factors subarachnoid haemorrhage?

A 
smoking
alcohol
hypertension
family history
polycystic kidney disease
23
Q

signs and symptoms of subarachnoid haemorrhage?

A

symptoms:

  • sudden onset thunderclap headache
  • vomiting
  • seizures
  • photophobia
  • drowsiness

signs:

  • kernig’s sign
  • neck stiffness
  • sentinel headache
24
Q

investigations of subarachnoid haemorrhage?

A
  • CT brain –> star-shaped blood pooling, hydrocephalus

- lumbar puncture (wait 12 hours) –> xanthochromia

25
DDx subarachnoid haemorrhage?
meningitis | migraine
26
management of subarachnoid haemorrhage?
refer all to neurosurgeon nimodipine (CCB to control BP) endovascular coiling
27
patho of parkinsons and histological features?
degeneration of dopaminergic neurones on substantia nigra pars compacta associated with lewy bodies
28
features of parkinsons
1) pill-rolling tremor, worse at rest, unilateral 2) rigidity 3) bradykinesia (slow to initiate movement, monotonous hypophonic speech, micrographia) 4) postural instability - gait (reduced arm swing on one side, shuffling)
29
premotor features of parkinsons
- anosmia (reduced smell sense) - depression - REM sleep disorders - urinary urgency - constipation - visual hallucinations
30
management of parkinsons
early: - ropinirole (dopamine-2 agonist) - selegiline (monoamine oxidase-B inhibitor) late: - co-beneldopa (levodopa with decarboxylase inhibitor)
31
subtypes of motor neurone disease
- amyotrophic lateral sclerosis --> UMN + LMNs affected - progressive bulbar palsy --> UMN + LMNs of CN 9-12 - primary lateral sclerosis --> UMNs affected - progressive muscular atrophy --> LMNs affected
32
key features of MND
- muscular atrophy - UMNs and LMNs both affected - paralysis - loss of motor control - preservation of mental awareness - NO sensory/sphincter disturbance (vs MS and polyneuropathies) - NO eye movement involvement (vs MG)
33
pathology of MND
degeneration and loss of neurones in motor cortex, CN nuclei and anterior horn cells
34
diagnostic investigations for MND
1) electromyography/nerve conduction studies 2) clinical features - increased creatinine kinase - lumbar puncture
35
diagnostic criteria for MND
el escorial
36
treatment of MND
- riluzole (antiglutaminergic)
37
localisation of lesions: - cortical lesion - internal capsule - brainstem - spinal cord
- cortical lesion = contralateral weakness over large area - internal capsule = complete contalateral hemiparesis - brainstem = bilateral weakness, involves CN, bulbar involvement - spinal cord
38
what is amyotrophic lateral sclerosis
events in the ALS-frontotemperal dementia locus
39
archetypal patient
- over 40 - stumbling gait - foot drop - proximal myopathy - weak grip - weak shoulder abduction (cant wash hair) - speech/swallowing --> aspiration pneumonia UMN signs: - spasticity - brisk reflexes - upgoing plantars LMN signs: - wasting - tongue fasciculations - hypotonia
40
patho of multiple sclerosis
discrete plaques of demyelination at multiple CNS sites due tp CD-4 T-cell mediated immune response, leading to axonal loss and progressive symptoms (relapsing and remitting)
41
key features of MS
ALWAYS UMN AFFECTED optic involvement - unilateral optic neuritis brainstem lesions: - diplopia - vertigo - nystagmus - facial numbness - swallowing difficulty spinal cord involvement - abnormal gait - bladder dysfunction - numbness/tingling in limbs - spastic leg weakness - Lhermittes = electric shock feeling down spine/limbs Uhthoffs = symptoms worsened by heat/exercise
42
risk factors of MS
family history human t-lymphotropic virus-1 decreased vitamin D exposure (temperature climates)
43
investigations of MS
- lumbar puncture = +ve for oligoclonal bands on CSF - visual evoked potential = slow signal transmission (due to demyelination) - MRI = exclude other causes - examination = UMN signs only Dx = MRI + clinical features
44
diagnostic criteria of MS
McDonald Criteria MRI + clinical features
45
DDx MS
cauda equina prolapsed disc spinal cord infarct
46
Tx of MS
acute (shorten relapse) = methylprednisolone chronic (prevent relapse): - interferon beta-1a - azathioprine spasticity = baclofen (GABAb analogue) pain = carbamazepine

Phase 2a (5 decks)

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