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Rabiah's 3a > Neuro + Geris > Flashcards

Neuro + Geris Flashcards

1
Q

Idiopathic intracranial HTN RF

A

young, overweight females
preg
drugs (cocp, steroids, tcas, retinoids/ vit a, lithium)

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2
Q

MS symptoms and signs

A

Charcot’s triad = dysarthria, intention tremor, nystagmus

LOSSNUB
lhermitte’s sign (electric shock radiating down back)
optic neuritis
spasticity (brisk reflexes)
sensory symptoms
nystagmus, double vision, vertigo
uhthoff’s phenomenon (excacerbated by heat)
bladder+sexual dysfunction

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3
Q

old macdonald classification for MS

A

demyelination plaques disseminated in time and space

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4
Q

MS RF

A

EBV exposure in early life
younger (20-40 yrs)
women
further away from equator
HLA-DR2

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5
Q

MS Ix

A

MRI brain and spinal cord with contrast = active white lesions

CSF lumbar puncture with electrophoresis = oligoclonal IgG bands

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6
Q

MS tx

A

no cure

short course steroids - IV methylprednisolone

reduce relapse - IV natalizumab / mab

tremor - b blocker

spacsticity - baclofen, gabapentin, diazepam

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7
Q

what nerve for bell’s palsy

A

7 - facial nerve

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8
Q

forehead affected in bell’s?

A

yes
it’s a lower motor neuron palsy

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9
Q

bell’s tx

A

oral prednisolone within 72 hrs onset

lubricant for eyes if dry

if no improvement after 3 weeks, urgent ENT referral

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10
Q

causes of bilateral facial nerve palsy

A

sarcoidosis
GBS
lyme disease
bilateral acoustic neuromas

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11
Q

causes of unilateral facial nerve palsy that affect the forehead

A

LMN:
bell’s
ramsay hunt syndrome
acoustic neuroma
parotid tumours
HIV
Diabetes mellitus

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12
Q

causes of unilateral facial nerve palsy that spare the forehead

A

stroke
MS

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13
Q

ischaemic stroke short and long term tx

A

thrombolysis (IV altepase) within 4.5 hrs

thrombectomy within 6 hrs, 24 hrs if signs indicate there is salvageable tissue

2 weeks aspirin 300mg

then long-term anticoag - clopidogrel or direct thrombin/ factor Xa inhibitor

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14
Q

what is the Barthel index

A

measures disability or dependence in ADLs in stroke pts

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15
Q

ACA stroke effect

A

contralateral hemiparesis and sensory loss

worse lower extremities than upper

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16
Q

MCA stroke effect

A

contralateral hemiparesis and sensory loss

worse upper extremities than lower

contralateral homonymous hemianopia

aphasia

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17
Q

PCA stroke effect

A

contralateral homonymous hemianopia with macular sparing

visual agnosia

(visual effects bc supplies posterior brain)

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18
Q

weber’s syndrome lesion effect

A

ipsilateral CNIII palsy
contralateral weakness of upper and lower extremity

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19
Q

posterior inferior cerebellar artery (wallenberg or lateral medullary syndrome) lesion effect

A

ipsilateral facial pain and temp loss
contralateral limb/torso pain and temp loss
ataxia nystagmus
extra sudden onset vomiting and vertigo

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20
Q

anterior inferior cerebellar artery (lateral pontine syndrome) lesion effect

A

similar to wallenberg’s
ipsilateral facial paralysis and deafness
extra decreased lacrimation (e.g. salivation and loss of taste anterior 2/3 tongue)

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21
Q

retinal / opthalmic artery lesion effect

A

amourosis fugax

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22
Q

basilar artery lesion effect

A

locked in syndrome

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23
Q

temporal focal seizure pres

A

aura (rising epigastric sensation or deja vu)
~1 min
automatism (lip smacking, grabbing, pulling at clothes)

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24
Q

frontal lobe seizure pres

A

head/ leg movements
posturing
post-ictal weakness
jacksonian march (clonic movements travelling proximally)

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25
parietal lobe seizure pres
paraesthesia
26
occipital lobe seizure pres
floaters/ flashes
27
generalised tonic clonic seizure tx
males - sodium valproate females - lamotrigine or levetiracetam
28
focal seizures tx
1st = lamotrigine or levetiracetam 2nd = carbamezapine, oxcarbazepine or zonisamide
29
absence seizures tx
1st = ethosuximide 2nd males = sodium valproate, females = lamotrigine or levetiracetam NOT carbamezapine (excacerbates it)
30
myoclonic seizures tx
males = sodium valproate females = levetiracetam
31
tonic or atonic seizures tx
males = sodium valproate females = lamotrigine
32
seizures ix
1st EEG 2nd MRI
33
status epilepticus definition
a single seizure lasting > 5 mins or >= 2 seizures within a 5-min period without person returning to normal between them
34
status epilepticus tx
- Med emergency! Priority is termination of seizure activity - ABCDE - 1st pre-hosp setting = PR diazepam or buccal midazolam - In hosp = IV lorazepam, up to 2 doses - If ongoing, 2nd = IV phenytoin, levetiracetam or sodium valproate infusion - If no response and >45 mins of onset, induct general anaesthesia
35
what happens with UMN MND
everything goes up = increased muscle tone hyperreflexia positive Babinski pyramidal drift
36
what happens with LMN MND
everything goes down reduced muscle tone (flacid) hyporeflexia muscle wasting trouble breathing fasciculations
37
Pres: Amyotrophic lateral sclerosis Primary lateral sclerosis Progressive muscular atrophy Progressive bulbar palsy
Amyotrophic lateral sclerosis = UMN+LMN, muscle atrophy and spasticity, ocular muscles spared, asymmetric limb weakness, most common Primary lateral sclerosis = UMN only Progressive muscular atrophy = LMN only Progressive bulbar palsy = UMN + LMN, trouble swallowing/ speech, worst prognosis will be in middle aged >40 yr old men
38
MND tx
no cure - most die within 3 yrs due to resp failure oral riluzole (sodium channel blocker inhibiting gulatamate release) spasticity = baclofen dysphagia = ng/peg drooling = oral amitryp joint pain = analgesics
39
MND associated with what dementia
frontotemporal
40
40
parkinson's pres
TRAP tremor rigidity akinesia postural instability shuffling gait increased urinary freq constipation sleep disturbances masked facies micrographia hypophonia
41
parkinsons RF
genetic - alpha synuclein and parkin genes male older non-smoker infections or toxin induced
42
levodopa SE
dyskinesias at peak dose (dystonia, chorea, athetosis [involuntary writhing movements]
43
dopamine agonists e.g. Robinirole and Bromocriptine SEs
impulsivity/ obsessive
44
MAO-B inhibitors e.g. Selegiline SE
hypotension
45
what med for nausea and vomiting in parkinsons
domperidone (doesn’t cross blood brain barrier and doesn’t exacerbate symptoms like the dom peri alcohol, causes vomiting and you can't PARK your car
46
normal pressure hydrocephalus triad
Urinary incontinence, Dementia, Gait abnormality (hydro - Wet, wobbly, wacky)
47
normal pressure hydrocephalus imaging shows
ventriculomegaly in absence/ out of proportion of sulcal enlargement
48
normal pressure hydrocephalus tx
ventriculoperitoneal shunting
49
WE triad
ophthalmoplegia/ nystagmus, ataxia and enceph
50
WE can turn into? How does it present?
Korsakoff’s syndrome antero + retrograde amnesia and confabulation in addition to classic symptoms
51
migraine precipitating factors
CHOCOLATE (Choc, Hangovers, Orgasms, Cheese, Caffeine, COCP, Lie-ins, Alcohol, Travel, Exercise
52
migraine tx / prophylaxis
Acute migraine: Triptan + NSAID/ paracetamol Prophylaxis: Topiramate or Propranolol For those between 12-17 yrs, consider nasal triptan instead of oral
53
cluster headache tx / prophylaxis
acute - SC triptan + 100% O2 unless if CVD or HTN, just give O2 and poss intranasal lidocaine proph - 1st verampil, 2nd lithium or steroids
54
trigem neuralgia tx
1st = carbamazepine 2nd = phenytoin, gabapentin
55
Kernig's sign?
unable to extend leg at knee when thigh is flexed
56
Brudinski's sign?
when neck is flexed, the patient will flex hips and knees
57
SAH ix
CT without contrast = star/ spider pattern, blood (berry aneurysms) LP = bloody and xanthochromia (yellow/straw coloured)
58
subdural haemorrhage pres and ix
headache, drowsiness, confusion (bridging veins) long latent period (60ish days) after an injury, usually elderly NO LOC crescent / sickle shaped on CT DONT LP bc ICP
59
extradural haemorrhage pres and ix
acute head injury (usually fractured temporal bone with middle meningeal artery bleed) followed by loss of consciousness / lucid interval rapid ct = convex/ lemon DONT LP bc ICP
60
cushing's reflex to ICP
bradycardia HTN wide pulse pressure
61
CN1 lesion
anosmia
62
CN2 lesion
visual defect depending on location of lesion Marcus Gunn pupil
63
CN3 palsy
fixed dilated pupil down and out ptosis
64
CN4 palsy
head tilt to correct exotortion vertical diplopia when looking down trouble walking down stairs
65
CN6 palsy
abducted eyes horizontal diplopia
66
CN3,4,6 palsy
non-functioning eye
67
CN5 palsy
jaw deviates to side of lesion loss of corneal reflex
68
CN8 palsy
hearing impairment vertigo+lack of balance
69
CN7 palsy
facial drop + weakness anterior 2/3 tongue
70
CN9, CN10 palsy
gag reflex issues swallowing issues vocal issues uvula deviated away from lesion posterior 1/3 tongue
71
CN11 palsy
sternocleidomastoid + trapezius muscles - can't shrug shoulders or shake head to contralateral side
72
CN12 palsy
tongue deviates to side of lesion
73
MG pathophys
autoimmune disease against nicotinic ACh receptors in neuromuscular junctions type 2 reaction
74
MG pres
weakness fatigue of eyes - ptosis, diplopia bulbar - dysphagia, dysarthria proximal limbs improves after rest
75
MG related to what tumour
thymic tumour
76
MG ix
AChR, MUSK antibody assay tensilon test (edrophorium test) Low FVC
77
MG and crisis tx
1st oral pyridostigmine + immunosupression (prednisolone) If myasthenia crisis - resp muscles too weak - IV immunoglobulin + plasmaphereisis
78
Lambert Eaton associated with what cancer
Small cell lung cancer
79
Lambert Eaton vs MG
LE: small cell lung cancer association/ hx, proximal limb weakness with absent reflexes, weakness improves with exercise MG: worse with exercise/ after a long day
80
GBS pres
progressive onset distal limb weakness symmetrical and over around 4 weeks after infection by Campylobacter jejuni (hx resp or GI infections) loss of reflexes lower back pain postural hypotension Miller Fisher - variant affecting eyes - ophthalmoplegia and ataxia
81
GBS drawing
4 swans (type 4 autoimmune reaction, schwann cells affected) entering a camp (campylobacter) decorated with ivy (IViG tx) and a GB flag (GB) with a fishing rod resting by it (Fisher variant)
82
what is Subacute combined degen of spinal cord and pres
vit B12 def impairment of: Dorsal columns (distal tingling/ burning/ symmetrical sensory loss, legs more than arms) Lateral corticospinal tracts (muscle weakness, hyperreflexia, spasticity, brisk knee reflexes, absent ankle jerks, extensor plantars) And Spinocerebellar tracts (sensory ataxia – gait abnormalities, positive Romberg’s sign) hx of recurrent falls, poss NOS inhalation, worse w folate supplements
83
CMT mode of inheritance
autosomal dominant
84
CMT pres
distal limb wasting and weakness, legs progressive over years high arched feet - Pes Cavus 'inverted champagne bottles'
85
syringomyelia pres
- ‘Cape-like’ (neck, shoulders, arms) loss of temperature and pain (e.g. pts who accidentally burn their hands without realising) - Spastic weakness lower limbs - Neuropathic pain - Upgoing plantars - Scoliosis is a complication if untreated
86
syringomyelia ix
- Full spine MRI with contrast to exclude tumour or tethered cord - Brain MRI to exclude Chiari malformation
87
syringomyelia strongly associated with
Chiari malformation
88
horner's pres
- Miosis (small pupil) - Ptosis (droopy eyelids) - Enophthalmos (sunken eye) - Anhidrosis (loss of sweating one side)
89
Causes of falls
- Drugs - MSK - Syncope - Stroke/ TIA - Postural hypotension - Vertigo - Neurological - Hypoglycaemia - Poor environment - Visual impairment - Dementia
90
delirium / acute confusional state tx
0.5mg IM or oral Haloperidol except in lewy body dementia, can cause parkinsonism, instead IM lorazepam
91
causes of delirium and results of a confusion screen
pain infection constipation urinary retention metabolic (hyperca, hypoglyc, hyperglyc, dehydration) meds (opioids) hypoxia confusion screen: TSH (hypothyroid), B12 (def), folate (def), glucose (hypoglyc), bone profile (hyperca)
92
what is STOPP
identifies meds where risk outweighs therapeutic benefits in certain conditions
93
what is START
identifies meds that should be used for certain conditions in pts >65 yrs
94
alzheimer's tx
1st Ach inhibitor (donepezil or rivastigmine or galantamine) 2nd memantine (NMDA antagonist) for those who can’t tolerate the above or have severe alzheimers
95
Another name for Restless legs syndrome and its tx
Willis-Ekbom disease tx = ropinirole
96
BPPV dx and tx
Dix-Hallpike manouevre Epley manouevre
97
Cerebellar DANISH stands for?
Dysdiadochokinesis (patients can appear Drunk) Ataxia Nystagmus (horizontal) Intention tremor Slurred speech Hypotonia
98
Key pres in GCA?
headache scalp tenderness jaw claudication amourosis fugax age >50 yrs High ESR
99
Gold std ix for GCA
Temporal artery biopsy
100
GCA associated with what condition
polymyalgia rheumatica
101
GCA tx
high dose steroid (prednisolone) IV if signs of vision loss
102

Rabiah's 3a (4 decks)

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