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Lottie's DPD 2 > Neuro (Dr Halse) > Flashcards

Neuro (Dr Halse) Flashcards

1
Q

Which parts of the nervous system are UMN?

A

CNS - Cortex, pyramidial decussation, brain stem and spinal cord

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2
Q

In which type of disease if forehead spared?

A

UMN

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3
Q

Why is forehead spared in UMN?

A

Bicortical innovation

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4
Q

If visual fields are affected, what part of the brain can NOT be involved and why?

A

Brainstem - the visual pathway does not go through the brain stem

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5
Q

What does dysarthria mean?

A

Slow speech

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6
Q

What is Hoffman’s sign?

A

Involuntary flexion of of thumb when nail flicked

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7
Q

What is age of onset of MND?

A

50-70 yrs old

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8
Q

Describe the onset of MND

A

INSIDIOUS

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9
Q

Where is the lesion in MND?

A

Degeneration of anterior horn cells and UMNs in spinal cord

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10
Q

Is MND UMN or LMN?

A

BOTH - can start with one but will eventually get both

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11
Q

Does MND affect sensory or motor or both?

A

Motor only

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12
Q

What is PC of ALS?

A

Unilateral limb motor problems eg foot drop

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13
Q

What is cluster of signs in ALS?

A

Fasiculations, wasting, brisk reflexes and up going plantars

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14
Q

What is the other type of MND?

A

Bulbar MND

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15
Q

PC of bulbar MND?

A

Dysarthria and dysphagia

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16
Q

Why are these the PC of bulbar MND?

A

The lower CNs eg 9,10,11,12 pass over the bulbar medulla

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17
Q

Signs O/E of bulbar MND?

A

Dysarthria, tongue wasting, fasiculations, brisk jaw reflexes Some limb Sx

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18
Q

Which is more rapidly progressive of bulbar or ALS?

A

Bulbar - die in 2 years

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19
Q

How do you diagnose MND?

A

CLINICALLY Nerve conduction study / EMG can help

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20
Q

Why do you do imaging in MND?

A

Rule out other causes

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21
Q

Define MS

A

Damage of CNS that is disseminated in time and space

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22
Q

What causes MS?

A

T cells attack myelin coating CNS

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23
Q

Is MS familial?

A

Partly - 20% have blood relative with it

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24
Q

List environmental triggers of MS

A

Low Vit D EBV exposure Smoking Extremes of latitude (far away from equator) Obesity in adolescence

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25
What is visible on MRI of MS patient?
Plaques
26
List potential Sx of MS
Fatigue, vision problems, bladder / bowel problems Sensory or motor changes
27
List signs of MS O/E
Spasticity Gait / balance / coordination problems Speech / swallowing problems Tremor
28
List common PC of MS
Loss / reduction in vision in one eye Pain on moving eye (optic neuritis) Double vision Sensory disturbances / weakness Balance problems Lhermitte's syndrome
29
What is Lhermitte's syndrome?
Altered sensation travelling down back when patient bends neck forward
30
What are sensory disturbances / weakness in MS called?
Transverse myelitis
31
How is MS diagnosed?
Clinically - through Hx and diagnosis
32
What are Ix of MS?
MRI / LP / visual evoke potentials
33
What is seen in LP of MS?
Immunoglobulins
34
What is seen in MRI of MS?
Plaques
35
Where are neuronal tracts in the brain?
Subcortex
36
Where do the plaques occur in the brain in MS?
Corpus callosum
37
What is the age of onset for MS?
\<40
38
Describe the 4 disease patterns of MS
Progressive relapsing remitting Secondary progressive Primary progressive Relapsing remitting
39
Mx of MS?
Annual neuro review MDT IV steroids if relapsing B-interferon (disease modifying agent) when in remitting phase
40
How do you diagnose PD?
Clinically
41
Describe pathophysiology of PD
Substantia nigra degeneration causes dopamine deficiency in striatum
42
What type of Sx do you get in PD?
Motor
43
List triad of PD
Bradykinesia Tremor Rigidity
44
What type of rigidity is present in PD?
Lead pipe rigidity - same as when you flex or extend
45
List other sequalae of PD
Postural instability, shuffling gait, bent over, quiet voice, slow movement
46
List causes of Parkinsonism
Progressive supranuclear palsy Multiple system atrophy
47
List other features of progressive supranuclear palsy
Imapired gaze, balance, dysarthria
48
List other features of Multiple system atrophy
Autonomic issues, urinary problems, orthostatic hypotension
49
List drugs that can cause parkinsonism
Antipsychotics, antiemetics (reduce dopamine)
50
How do you distinguish PD from parkinsonism?
PD is unilateral PD has no atypical features PD pts are not on / will have not had neuepileptics PD responds to L dopa
51
List Tx for PD
L-dopa (best)
52
Is PD Tx symptomatic or neuroprotective?
Symptomatic
53
List side effects of L DOPA
Non motor = nausea, orthostasis, sleepiness, halluncinations Motor = dyskinesia
54
What happens with drug side effects as disease progresses?
Gets worse - more ON-OFF fluctuations, more dyskinesias, more falls Non motor more prominent - dementia and hallucinations
55
Upper limb flexed. Lower limb extended and has to be swung around to walk. What type of gait is this?
Hemiplegic
56
Patient can't see R half of both visual fields. Where is the lesion?
Left occipital lobe
57
Pt has diplopia. R eye doesn't adduct but L eye adducts and jerks. Dx?
Intranuclear opthalmoplegia in MS
58
Sx of cerebellar syndrome?
DANISH Dysarthria Ataxia Nystagmus Inattemtion tremor Slurred speech Hypotonia
59
Dizziness in morning when sitting up. Room spins when pt moves their head. Dx?
BPPV
60
Gold standard test for BPPV?
Dix-hallpike manoeuvre
61
Double vision in evenings. Voice fades when in consultation. Reflexes present. Key feature and Dx?
Fatigability - myasthenia gravis
62
Where is the problem in MG?
NMJ
63
Mx of MG?
Ach-esterase inhibitors
64
L side facial weakness with forehead sparing. Dx?
R middle cerebral artery territory stroke
65
Weakness in R arm and leg. Increasingly difficult to find words in last 2 weeks. Dx?
Cerebral metastases
66
Sudden weakness in L arm and leg. When asked to smile, R side of mouth droops. Where is lesion?
Right brainstem (called cross signs as face isn't doing the same as body - typical of brainstem)
67
Normal face and arms. Both legs 2/5 power with brisk reflexes and babinskis. Where is lesion?
Spinal cord
68
Weakness in both legs. Sensory level at umbilicus. Where is lesion?
T10
69
Dermatome location of back of head?
C2
70
Dermatome location of shoulder?
C4
71
Dermatome location of 3rd finger?
C7
72
Dermatome location of nipple?
T4
73
Dermatome location of umbillicus?
T10
74
Dermatome location of hip?
L2
75
Dermatome location of big toe?
L5
76
Dermatome location of little toe?
S1
77
What is the gait in PD?
Narrow based gait
78
Prev LRTI. CN and upper limbs normal. Power 3/5 ankles, 4/5 hips and absent reflexes, mute plantars. Dx?
GBS
79
Acute dizziness. Fast beat nystagmus to L and L dysdiadokinesia. Where is stroke lesion?
LEFT cerebellum (cerebellum is ipsilateral)
80

Lottie's DPD 2 (10 decks)

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