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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
Q

What is visible on MRI of MS patient?

A

Plaques

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26
Q

List potential Sx of MS

A

Fatigue, vision problems, bladder / bowel problems Sensory or motor changes

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27
Q

List signs of MS O/E

A

Spasticity Gait / balance / coordination problems Speech / swallowing problems Tremor

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28
Q

List common PC of MS

A

Loss / reduction in vision in one eye Pain on moving eye (optic neuritis) Double vision Sensory disturbances / weakness Balance problems Lhermitte’s syndrome

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29
Q

What is Lhermitte’s syndrome?

A

Altered sensation travelling down back when patient bends neck forward

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30
Q

What are sensory disturbances / weakness in MS called?

A

Transverse myelitis

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31
Q

How is MS diagnosed?

A

Clinically - through Hx and diagnosis

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32
Q

What are Ix of MS?

A

MRI / LP / visual evoke potentials

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33
Q

What is seen in LP of MS?

A

Immunoglobulins

34
Q

What is seen in MRI of MS?

A

Plaques

35
Q

Where are neuronal tracts in the brain?

A

Subcortex

36
Q

Where do the plaques occur in the brain in MS?

A

Corpus callosum

37
Q

What is the age of onset for MS?

A

<40

38
Q

Describe the 4 disease patterns of MS

A

Progressive relapsing remitting Secondary progressive Primary progressive Relapsing remitting

39
Q

Mx of MS?

A

Annual neuro review MDT IV steroids if relapsing B-interferon (disease modifying agent) when in remitting phase

40
Q

How do you diagnose PD?

A

Clinically

41
Q

Describe pathophysiology of PD

A

Substantia nigra degeneration causes dopamine deficiency in striatum

42
Q

What type of Sx do you get in PD?

A

Motor

43
Q

List triad of PD

A

Bradykinesia

Tremor

Rigidity

44
Q

What type of rigidity is present in PD?

A

Lead pipe rigidity - same as when you flex or extend

45
Q

List other sequalae of PD

A

Postural instability, shuffling gait, bent over, quiet voice, slow movement

46
Q

List causes of Parkinsonism

A

Progressive supranuclear palsy

Multiple system atrophy

47
Q

List other features of progressive supranuclear palsy

A

Imapired gaze, balance, dysarthria

48
Q

List other features of Multiple system atrophy

A

Autonomic issues, urinary problems, orthostatic hypotension

49
Q

List drugs that can cause parkinsonism

A

Antipsychotics, antiemetics (reduce dopamine)

50
Q

How do you distinguish PD from parkinsonism?

A

PD is unilateral

PD has no atypical features

PD pts are not on / will have not had neuepileptics

PD responds to L dopa

51
Q

List Tx for PD

A

L-dopa (best)

52
Q

Is PD Tx symptomatic or neuroprotective?

A

Symptomatic

53
Q

List side effects of L DOPA

A

Non motor = nausea, orthostasis, sleepiness, halluncinations

Motor = dyskinesia

54
Q

What happens with drug side effects as disease progresses?

A

Gets worse - more ON-OFF fluctuations, more dyskinesias, more falls

Non motor more prominent - dementia and hallucinations

55
Q

Upper limb flexed. Lower limb extended and has to be swung around to walk. What type of gait is this?

A

Hemiplegic

56
Q

Patient can’t see R half of both visual fields. Where is the lesion?

A

Left occipital lobe

57
Q

Pt has diplopia. R eye doesn’t adduct but L eye adducts and jerks. Dx?

A

Intranuclear opthalmoplegia in MS

58
Q

Sx of cerebellar syndrome?

A

DANISH

Dysarthria

Ataxia

Nystagmus

Inattemtion tremor

Slurred speech

Hypotonia

59
Q

Dizziness in morning when sitting up. Room spins when pt moves their head. Dx?

A

BPPV

60
Q

Gold standard test for BPPV?

A

Dix-hallpike manoeuvre

61
Q

Double vision in evenings. Voice fades when in consultation. Reflexes present. Key feature and Dx?

A

Fatigability - myasthenia gravis

62
Q

Where is the problem in MG?

A

NMJ

63
Q

Mx of MG?

A

Ach-esterase inhibitors

64
Q

L side facial weakness with forehead sparing. Dx?

A

R middle cerebral artery territory stroke

65
Q

Weakness in R arm and leg. Increasingly difficult to find words in last 2 weeks. Dx?

A

Cerebral metastases

66
Q

Sudden weakness in L arm and leg. When asked to smile, R side of mouth droops. Where is lesion?

A

Right brainstem (called cross signs as face isn’t doing the same as body - typical of brainstem)

67
Q

Normal face and arms. Both legs 2/5 power with brisk reflexes and babinskis. Where is lesion?

A

Spinal cord

68
Q

Weakness in both legs. Sensory level at umbilicus. Where is lesion?

A

T10

69
Q

Dermatome location of back of head?

A

C2

70
Q

Dermatome location of shoulder?

A

C4

71
Q

Dermatome location of 3rd finger?

A

C7

72
Q

Dermatome location of nipple?

A

T4

73
Q

Dermatome location of umbillicus?

A

T10

74
Q

Dermatome location of hip?

A

L2

75
Q

Dermatome location of big toe?

A

L5

76
Q

Dermatome location of little toe?

A

S1

77
Q

What is the gait in PD?

A

Narrow based gait

78
Q

Prev LRTI. CN and upper limbs normal. Power 3/5 ankles, 4/5 hips and absent reflexes, mute plantars. Dx?

A

GBS

79
Q

Acute dizziness. Fast beat nystagmus to L and L dysdiadokinesia. Where is stroke lesion?

A

LEFT cerebellum (cerebellum is ipsilateral)

80
Q
A

Lottie's DPD 2 (10 decks)

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