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Phase 3a > neuro/geris > Flashcards

neuro/geris Flashcards

1
Q

what are the likely causes of delirium

A

infection
hypo/hyper Na, K, Ca
metabolic
drug related
cerebral
constipation/retention
pain

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2
Q

what medications are associated with delirium

A

zopiclone
benzos
opiates
anticholinergic type drugs
parkinsons medications

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3
Q

what drugs can you give to a patient becoming agitated

A

benzodiazapines
haloperidol

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4
Q

what is the difference between hyper and hypo active delirium

A

hyper = agitation, restlessness, sometimes aggressiveness
hypo = motor retardation, apathy, slowing of speech, appear to be sedated

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5
Q

what are the common symptoms of a stroke in the carotid territory

A

weakness of face, leg, arm
amaurosis fugax
impaired languaged

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6
Q

what are the common symptoms of a stroke in the posterior circulation

A

dysarthria
dysphagia
diplopia
dizziness
ataxia
diplegia (stiffness, weakness on one side of the body)

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7
Q

what are the common symptoms of a stroke in the anterior circulation

A

contralateral weakness
contralateral sensory loss
dysarthria
dysphasia
homonymous hemianopia
higher cortical dysfunction

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8
Q

what 3 symptoms are needed to classify a total stroke

A

unilateral weakness and/or sensory deficit of face, arm and leg
homonymous hemianopia
higher cerebral dysfunction

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9
Q

what is a lacunar infarction

A

occlusion of deep penetrating arteries
affects small volume of subcortical white matter

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10
Q

what is the underlying process behind a lacunar infarction

A

arterial wall disorganisation
microatheroma
lipohyalinosis

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11
Q

how are the points allocated for best eye opening response in Glasgow coma scale

A

spontaneously
to speech
to pain
none

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12
Q

how are the points allocated for best verbal response in Glasgow coma scale

A

orientated in time/place/person
confused
inappropriate words
incomprehensible sounds
none

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13
Q

how are points allocated for best motor response in the Glasgow coma scale

A

obeys command
localises to pain
flexes to pain
extends to pain
none

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14
Q

what is the C6 myotome

A

elbow flexion

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15
Q

what is the C6 dermatome

A

thumb

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16
Q

what is the C6 reflex

A

biceps

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17
Q

what is the C7 myotome

A

elbow extension

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18
Q

what is the C7 dermatome

A

middle finger

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19
Q

what is the C7 reflex

A

triceps

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20
Q

what is the myotome for C8/T1

A

thumb extension and finger flexion

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21
Q

what is the dermatome for C8/T1

A

medial hand and forearm

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22
Q

what is the myotome for L5

A

dorsiflexion

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23
Q

what is the dermatome for L5

A

big toe, dorsum

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24
Q

what is the myotome for S1

A

plantar flexion

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25
Q

what is the dermatome for S1

A

small toe, side of foot, sole of foot

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26
Q

what is the reflex for S1

A

ankle jerk

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27
Q

what rate is CSF produced at

A

500ml/24 hours

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28
Q

what is the capacity of the ventricular system

A

20ml

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29
Q

what is the normal CSF pressure

A

5-15cm

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30
Q

what are the symptoms of raised ICP/hydrocephalus

A

headache
vomiting
visual disturbance
gait
unsteadiness

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31
Q

what are the signs of raised ICP/hydrocephalus

A

drowsiness
papilloedema
limitation of upward gaze
reduced visual acuity

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32
Q

what is the origin of the pyramidal tracts

A

cerebral cortex

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33
Q

what is the function of the pyramidal tracts

A

responsible for voluntary control of musculature of body and face

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34
Q

what do the pyramidal tracts split into

A

corticospinal and corticobulbar tracts

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35
Q

where does the corticospinal tract divide

A

caudal part of the medulla

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36
Q

what does the corticospinal tract divide into

A

anterior and lateral

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37
Q

what route does the lateral corticospinal tract take

A

decussates at medulla, terminates in ventral horn

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38
Q

what route does the anterior corticospinal tract take

A

remains ipsilateral, decussates/terminates in the cervical and upper thoracic segmental levels

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39
Q

what are the corticobulbar tracts composed of

A

upper motor neurones of the cranial nerves

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40
Q

what do the corticobulbar tracts control

A

muscles of the head, face and neck

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41
Q

where is the origin of the extrapyramidal tracts

A

brainstem

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42
Q

what is the function of the extrapyramidal tracts

A

responsible for involuntary and autonomic control

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43
Q

what are the 4 extrapyramidal tracts

A

vestibulospinal
reticulospinal
rubrospinal
tectospinal

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44
Q

which extrapyramidal tracts provide ipsilateral innervation

A

vestibulospinal
reticulospina;

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45
Q

which extrapyramidal tracts provide contralateral innervation

A

rubrospinal
tectospinal

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46
Q

what can cause optic neuritis

A

CIS
MS
Infection e.g. limes, HIV, syphillis
B12 defieincy

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47
Q

what are first line drugs for treating benign essential tremor

A

propanolol
primidone

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48
Q

what investigation can help differentiate between benign essential tremor and early Parkinson’s and why

A

DAT scan
binds to dopamine transporters on dopaminergic neurone which can identify nigrostriatal degeneration

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49
Q

what test is important in a myasthenia crisis

A

forced vital capacity

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50
Q

what causes friedreichs ataxia

A

atrophy of the dorsal root ganglia and thinning of the dorsal roots

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51
Q

how is papilitis differentiated from papilloedema of raised ICP

A

vision loss in papilitis

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52
Q

how can you differentiate a fixed dilated pupil caused by a squeeze on parasympathetic fibres of the 3rd nerve from a blind eye

A

test for an indirect pupillary reflex

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53
Q

what pattern of weakness is typically associated with myopathies

A

proximal
asymmetrical

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54
Q

when a nerve gets ‘squashed’, what is the general sequence of damage to the nerve in regards to motor and sensory demyelination and axonal loss

A

sensory demyelination, sensory axonal loss, motor demyelination, motor axonal loss

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55
Q

what causes a wrist drop

A

compression of the radial nerve at the spiral groove of the humerus

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56
Q

what are the 2 ways foot drop can occur

A

compression of the peroneal nerve at the neck of the fibular
L4/5 radiculopathy

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57
Q

2 commonest causes of generalised axonal neuropathy in the UK

A

diabetes
alcohol

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58
Q

what are the features of an ataxic gait

A

wide based
falls
can’t walk heel to toe
often worse in dark or when eyes closed

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59
Q

what is the dose of aspirin given for a stroke and how long is this continued for

A

300mg, continued for 2 weeks

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60
Q

gold standard imaging for a stroke

A

diffusion weighted MRI

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61
Q

what medication is given for secondary prevention of a stroke

A

75mg of clopidogrel
80mg of atorvastatin

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62
Q

what is ruptured in a subdural haemorrhage and what does it look like on CT

A

bridging veins
crescent shaped, not limited by cranial sutures

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63
Q

in what patients are subdural haemorrhages most often seen

A

elderly or alcoholics

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64
Q

what is ruptured in an extradural haemorrhage and what does it look like on cT

A

middle meningeal artery in temper-parietal region
biconvex shape, limited by cranial sutures

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65
Q

what is the typical history of an extradural haemorrhage

A

young person, head injury, ongoing headache, improvement in neurological status than rapid decline

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66
Q

what is the typical history of an extradural haemorrhage

A

young person, head injury, ongoing headache, improvement in neurological status than rapid decline

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67
Q

what do you get in a 6th cranial nerve palsy

A

internuclear opthalmoplegia
conjugate lateral gaze disorder

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68
Q

what is given to treat an MS relapse

A

500mg Methylprednisolone

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69
Q

what is Ramsay hunt syndrome

A

caused by varicella zoster virus, causes a unilateral lower motor neurone facial nerve palsy, painful and tender vesicular rash in ear

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70
Q

when do you typically see Lambert Eaton syndrome

A

in patients with small cell lung cancer

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71
Q

what is the pathophysiology behind Lambert eaton syndrome

A

immune system releases antibodies against voltage gaited calcium channels in small cell lung cancer cells, also target calcium channels in the pre-synaptic terminals of neuromuscular junction. less acetylcholine released, less muscle contraction

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72
Q

presentation of Lambert eaton syndrome

A

proximal muscle weakness - notably of legs and eyes
diplopia, ptosis and dysphagia

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73
Q

what is post-tetanic potentiation

A

patients with Lambert eaton syndrome have reduced tendon reflexes. reflexes become temporarily normal after a period of strong muscle contraction

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74
Q

treatment for Lambert eaton syndrome

A

amifampridine

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75
Q

what is Charcot Marie tooth

A

inherited disease - typically autosomal dominant affecting peripheral motor and sensory nerves - dysfunction in myelin or axons

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76
Q

classical features of Charcot Marie tooth disease

A

pes cavus - high foot arches
distal muscle wasting - ‘inverted champagne bottle legs’
loss of ankle dorsiflexion

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77
Q

what are other causes of peripheral neuropathy other than Charcot Marie tooth disease

A

A - alcohol
B - vitamin B12 deficiency
C - Cancer and Chronic Kidney Disease
D - Diabetes and Drugs (amiodarone, isoniazid, cisplatin)
E - Every vasculitis

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78
Q

what is the presentation of Guillain-Barre syndrome

A

symmetrical ascending weakness
reduced reflexes
peripheral loss of sensation or neuropathic pain
may progress to cranial nerves and cause facial weakness

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79
Q

what criteria can be used to diagnose Guillain Barre syndrome

A

brighton

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80
Q

what is neurofibromatosis

A

genetic condition causing benign nerve tumours

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81
Q

how is neurofibromatosis type 1 caused

A

mutations in NF1 gene on chromosome 17. codes for protein called neurofibromin which is a tumour suppressor gene

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82
Q

diagnosis for neurofibromatosis

A

2 out of the following CRABBING
- Cafe au lait spots > 5mm in children, 15mm in adults
- Relative with NF1
- Axillary or inguinal freckling
- Bony dysplasia like Bowing of a long bone or sphenoid wing dysplasia
- Iris hamartomas
- Neurofibromas
- Glioma of optic nerve

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83
Q

how is neurofibromatosis type 2 caused

A

found on chromosome 22. codes for protein called merlin which is a tumour suppressor gene particularly in Schwann cells

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84
Q

what is commonly associated with neurofibromatosis type 2

A

bilateral acoustic neuromas

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85
Q

what is tuberous sclerosis

A

genetic condition whose characteristic features are the production of hamartomas

86
Q

what are the 2 mutations of tuberous sclerosis

A

TSC1 gene on chromosome 9 which codes for hamartin
TSC2 gene on chromosome 16 which codes for tuberin

87
Q

skin signs seen in tuberous sclerosis

A

ash leaf spots
shagreen patches
angiofibromas
subungual fibromata
cafe au lait spots
poliosis

88
Q

classical presentation for tuberous sclerosis

A

epilepsy and skin features

89
Q

how to differentiate a presentation of foot drop in L5 radiculopathy and a common perineal palsy

A

in peroneal palsy eversion is affected whereas in radiculopathy there is weakness in ankle inversion

90
Q

what is the nerve and muscle likely affected if a patient had a ‘claw hand’

A

radial nerve and hypothenar muscle

91
Q

what is the first line treatment for trigeminal neuralgia

A

carbemazepine

92
Q

typical effect on an ischaemic stroke in the anterior circulation

A

contralateral lower limb weakness

93
Q

typical effect on an ischaemic stroke in the middle circulation

A

hemiparesis of lower contralateral face, speech impairment, contralateral weakness

94
Q

typical effect of an ischamic stroke in the posterior circulation

A

acute vision loss, memory loss

95
Q

typical presentation of progressive bulbar palsy

A

dysarthria, dysphagia, nasal regurgitation of fluids and choking - LMN lesions

96
Q

factors that would indicate a pathogen in CSF sample is bacterial rather than viral

A

increased neutrophils, increased protein levels, decreased glucose, cloudy appearance

97
Q

contraindications for performing a lumbar puncture

A

raised ICP, coagulopathy, focal neurology, infection at site of LP, decreased GCS

98
Q

appearance of cells from temporal biopsy in giant cell arteritis

A

multinucleate giant cells

99
Q

would would happen to someone who suddenly stopped taking prednisolone

A

adrenal crisis

100
Q

acute treatment for cluster headache

A

100% O2
sumatriptan

101
Q

prophylaxis for cluster headache

A

verapamil

102
Q

most common infectious cause of encephalitis

A

herpes simplex virus type 1

103
Q

diagnostic test for encephalitis

A

lumbar puncture with CSF viral PCR testing

104
Q

what nerve palsy would cause a down and out appearance

A

occulomotor

105
Q

what nerve palsy would cause an adducted eye

A

abducens

106
Q

what areas are protected from chemotherapy

A

CNS and testes1

107
Q

where is the lesion that causes gait ataxia

A

cerebellar vermis

108
Q

preferred test for patient with suspected TIA

A

diffusion weighted MRI

109
Q

Diagnostic test for Guillain barre

A

lumbar puncture

110
Q

what would you see in lumbar puncture for Guillain barre

A

normal wcc, raised protein

111
Q

what drugs can worsen myasthenia graves

A

beta blockers

112
Q

what is Weber’s syndrome

A

ventral midbrain syndrome
ipsilateral CN III palsy and contralateral hemiparesis

113
Q

what is Creutzfeldt-Jakob disease

A

rapidly progressing neurological condition caused by prion proteins

114
Q

features of CJD

A

myoclonus
dementia

115
Q

what is seen on EEG in CJD

A

Biphasic high amplitude sharp waves

116
Q

what is seen on MRI in CJD

A

hyper intense signals in basal ganglia and thalamus

117
Q

how do you differentiate between Parkinsons and multiple system atrophy

A

MSA will have unilateral symptoms and autonomic dysfunction e.g. postural hypotension, erectile dysfunction

118
Q

what is a pituitary apoplexy

A

sudden enlargement of the pituitary - usually macroandenoma, secondary to haemorrhage or infarction

119
Q

diagnostic investigation for pituitary apoplexy

A

MRI

120
Q

what is given in pituitary apoplexy

A

IV hydrocortisone

121
Q

preferred way to support nutrition in MND

A

peg

122
Q

what can you get if you have had an injury at or above C6

A

autonomic dysreflexia

123
Q

what can be the trigger for autonomic dysreflexia

A

urinary retention
faecal impaction

124
Q

presentation of autonomic dysreflexia

A

extreme hypertension
flushing and sweating above lesion
agitation

125
Q

what blood test can differentiate between a true seizure and a pseudoseizure

A

prolactin

126
Q

when can you consider stopping anti-epileptic drugs

A

if seizure free > 2 years and weaned over 2-3 months

127
Q

where is the lesion causing lateral medullary syndrome

A

posterior inferior cerebellar artery

128
Q

symptoms of lateral medullary syndrome

A

cerebellar signs
ipsilateral facial numbness
Horner’s syndrome
contralateral sensor loss

129
Q

what would you give pre-hospital in status epilepticus

A

PR diazepam
buccal midazolam

130
Q

what is narcolepsy associated with

A

HLA-DR2

131
Q

features of narcolepsy

A

typical onset - teenage years
hypersomnolence
cataplexy
sleep paralysis
vivid hallucinations when going to sleep/waking up

132
Q

investigation for narcolepsy

A

multiple sleep latency EEG

133
Q

management of narcolepsy

A

daytime stimulants - modafinil
night-time sodium oxybate

134
Q

what would a CT show in herpes simplex encephalitis

A

temporal lobe changes

135
Q

management for idiopathic intracranial hypertension

A

acetazolamide and advise weight loss

136
Q

what do you give is clopidogrel is contraindicated/not tolerated

A

modified release dipyridamole

137
Q

Cushings triad

A

hypertension
bradycardia
wide pulse pressure

138
Q

investigation for acoustic neuroma

A

MRI of cerebellopontine angle

139
Q

is bells palsy an upper or lower motor neurone lesion

A

lower

140
Q

where would a lesion be if a patient were presenting as being ‘locked in’

A

basilar

141
Q

how long does a cluster headache typically last

A

15 minutes to 2 hours

142
Q

what do you get in Brown Sequard syndrome

A

ipsilateral weakness and loss of proprioception/vibration
contralateral loss of pain/temperature

143
Q

what is Brown Sequard a result of

A

lateral hemisection of the spinal cord

144
Q

where would the lesion be in an inferior homonymous quadrantanopia

A

superior optic radiations in parietal lobe

145
Q

where would the lesion be in a superior homonymous quadrantanopia

A

inferior optic radiations in temporal lobe - Meyers loop

146
Q

what does a painful 3rd nerve palsy indicate

A

posterior communicating artery aneurysm

147
Q

triad of normal pressure hydrocephalus

A

dementia/bradyphrenia
urinary incontience
gait abnormality - similar to Parkinsons

148
Q

what is likely to be seen on MRI in normal pressure hydrocephalus

A

ventriculomegaly without sulcal enlargement

149
Q

what is cataplexy

A

sudden and transient loss of muscular tone caused by a strong emotion e.g. laughter

150
Q

what would you give for chemotherapy induced nausea

A

ondansetron

151
Q

what type of dementia is associated with MND

A

frontotemporal

152
Q

what is Arnold-Chiari malformation

A

downward displacement/herniation of the cerebellar tonsils through the foramen magnum

153
Q

features of Arnold-Chiari malformation

A

non-communicating hydrocephalus
headache
syringomyelia

154
Q

how is carotid artery stenosis diagnosed

A

duplex ultrasound

155
Q

what score measures disability or dependance on ADLs after a stroke

A

Barthel index

156
Q

most common complication following meningitis

A

sensorineural hearing loss

157
Q

what type of headache responds to indomethacin

A

paroxysmal hemicrania

158
Q

what can cause subacute degeneration of the spine

A

replacing folate deficiency before replacing vitamin B12

159
Q

when would you see an empty delta sign on venography

A

sagittal sinus thrombosis

160
Q

what artery is affected in amaurosis fugax

A

retinal or ophthalmic

161
Q

what nerve is damaged if you can’t abduct your thumb

A

median

162
Q

what nerve is damaged if you can’t extend your wrist

A

radial

163
Q

what nerve is damaged if you have weakness of ring/little fingers

A

ulnar

164
Q

first line investigations for suspected acoustic neuroma

A

audiogram and gadolinium-enhanced MRI head

165
Q

triad of lewy body dementia

A

REM sleep disorder, falls and hallucinations

166
Q

deterrent from drinking alcohol treatment

A

disulfiram

167
Q

what type of hallucination is most suggestive of delirium tremens

A

lillputian

168
Q

what is Charcot neurological triad

A

symptoms associated with MS
dysarthria
nystagmus
intention tremor

169
Q

criteria for diagnosing MS

A

mcdonald

170
Q

scoring criteria for ALS

A

El escoria

171
Q

1st line management in spinal cord compression

A

dexamethasone

172
Q

1st line for generalised tonic-clonic seizures

A

males - sodium valproate
females - lamotrigine/levetericetam

173
Q

1st line for focal seizures

A

lamotrigine or levetericetam

174
Q

2nd line for focal seizures

A

carbamazepine

175
Q

1st line for absence seizures

A

ethosuximide

176
Q

2nd line for absence seizures

A

male - sodium valproate
females - lamotrigine or levetericetam

177
Q

what anti epileptic medication may trigger absence seizures

A

carbamazepine

178
Q

1st line for myoclonic seizures

A

males - sodium valproate
females - levetericetam

179
Q

1st line for tonic/atonic seizures

A

males - sodium valproate
females - lamotrigine

180
Q

common side effect of triptan use

A

tightening of chest/throat

181
Q

what is syringomyelia

A

collection of CSF within spinal cord

182
Q

what is the most common type of brain tumour

A

metastases

183
Q

what types of cancer often metastasise to the brain

A

lung
bowel
breast
kidney
skin

184
Q

most common primary brain tumour in adults

A

glioblastoma

185
Q

prognosis of glioblastoma

A

poor around a year

186
Q

imaging of a glioblastoma

A

solid tumours with central necrosis
rim that enhances with contrast

187
Q

histology of glioblastoma

A

pleomorphic tumour cells border necrotic area

188
Q

treatment/management of glioblastoma

A

surgery with chemo/radiotherapy
dexamethasone to treat oedema

189
Q

what is the second most common primary brain tumour in adults

A

meningioma

190
Q

what are meningiomas

A

typically benign
arise from arachnoid cap cells of the meninges and are next to dura

191
Q

where are meningiomas typically located

A

falx cerebri
superior saggital sinus
convexity or skull base

192
Q

what is seen on histology in a meningioma

A

spindle cells in concentric whorls and calcified psammoma bodies

193
Q

what is seen on histology in a vestibular schwannoma

A

Antoni A or B patterns
Verocay bodies

194
Q

what is the most common brain tumour in children

A

pilocytic astrocytoma

195
Q

what is seen on histology in a pilocytic astrocytoma

A

Rosenthal fibres
(corkscrew eosinophilic bundle)

196
Q

what is a medulloblastoma

A

aggressive paediatric brain tumour that arise from the infratentorial compartment and spreads through the CSF

197
Q

seen on histology in medulloblastoma

A

small, blue cells
rosette pattern of cells with many mitotic figures

198
Q

what is an ependymoma

A

commonly seen in the 4th ventricle

199
Q

what is seen on histology in an ependymoma

A

perivascular pseudorosettes

200
Q

what is an oligodendroma

A

benign slow growing tumour common in frontal lobes

201
Q

what is seen on histology in an olgodendroma

A

calcifications with fried egg appearance

202
Q

what is an haemangioblastoma

A

vascular tumour of cerebellum associated with VHL

203
Q

what is seen on histology in a haemangioblastoma

A

foam cells and high vascularity

204
Q

what is a craniopharyngioma

A

most common paediatric supratentorial tumour
solid/cystic tumour of seller region derived from remnants of Rathke’s pouch

205
Q

how could a cranipharyngioma present

A

hormonal disturbance
symptoms of hydrocephalus
bitemporal hemianopia

206
Q

1st line treatment for autoimmune encephalitis

A

corticosteroid e.g. pred
IvIg

207
Q

2nd line treatment for autoimmune encephalitis

A

rituximab
plasma exchange

208
Q

where is the lesion to cause Wernickes aphasia

A

superior temporal gyrus

209
Q

what is an ergot and non-ergot derived dopamine agonist

A

ergot - bromocriptine
non-ergot - ropinerole

210
Q

what has been damaged in syringomyelai

A

anterior white comissure due to compression of the spinothalamic tracts

211
Q

what does riluzole do

A

prevents stimulation of glutamate receptors

212
Q

MS investigation

A

MRI with contrast

Phase 3a (7 decks)

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