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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
Q

parietal lobe seizure pres

A

paraesthesia

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26
Q

occipital lobe seizure pres

A

floaters/ flashes

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27
Q

generalised tonic clonic seizure tx

A

males - sodium valproate
females - lamotrigine or levetiracetam

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28
Q

focal seizures tx

A

1st = lamotrigine or levetiracetam
2nd = carbamezapine, oxcarbazepine or zonisamide

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29
Q

absence seizures tx

A

1st = ethosuximide
2nd males = sodium valproate, females = lamotrigine or levetiracetam

NOT carbamezapine (excacerbates it)

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30
Q

myoclonic seizures tx

A

males = sodium valproate
females = levetiracetam

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31
Q

tonic or atonic seizures tx

A

males = sodium valproate
females = lamotrigine

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32
Q

seizures ix

A

1st EEG
2nd MRI

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33
Q

status epilepticus definition

A

a single seizure lasting > 5 mins or >= 2 seizures within a 5-min period without person returning to normal between them

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34
Q

status epilepticus tx

A
  • 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
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35
Q

what happens with UMN MND

A

everything goes up =
increased muscle tone
hyperreflexia
positive Babinski
pyramidal drift

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36
Q

what happens with LMN MND

A

everything goes down
reduced muscle tone (flacid)
hyporeflexia
muscle wasting
trouble breathing
fasciculations

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37
Q

Pres:

Amyotrophic lateral sclerosis

Primary lateral sclerosis

Progressive muscular atrophy

Progressive bulbar palsy

A

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

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38
Q

MND tx

A

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

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39
Q

MND associated with what dementia

A

frontotemporal

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40
Q
A
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40
Q

parkinson’s pres

A

TRAP
tremor
rigidity
akinesia
postural instability

shuffling gait
increased urinary freq
constipation
sleep disturbances
masked facies
micrographia
hypophonia

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41
Q

parkinsons RF

A

genetic - alpha synuclein and parkin genes
male
older
non-smoker
infections or toxin induced

42
Q

levodopa SE

A

dyskinesias at peak dose (dystonia, chorea, athetosis [involuntary writhing movements]

43
Q

dopamine agonists e.g. Robinirole and Bromocriptine SEs

A

impulsivity/ obsessive

44
Q

MAO-B inhibitors e.g. Selegiline SE

A

hypotension

45
Q

what med for nausea and vomiting in parkinsons

A

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
Q

normal pressure hydrocephalus triad

A

Urinary incontinence, Dementia, Gait abnormality (hydro - Wet, wobbly, wacky)

47
Q

normal pressure hydrocephalus imaging shows

A

ventriculomegaly in absence/ out of proportion of sulcal enlargement

48
Q

normal pressure hydrocephalus tx

A

ventriculoperitoneal shunting

49
Q

WE triad

A

ophthalmoplegia/ nystagmus, ataxia and enceph

50
Q

WE can turn into?

How does it present?

A

Korsakoff’s syndrome

antero + retrograde amnesia and confabulation in addition to classic symptoms

51
Q

migraine precipitating factors

A

CHOCOLATE (Choc, Hangovers, Orgasms, Cheese, Caffeine, COCP, Lie-ins, Alcohol, Travel, Exercise

52
Q

migraine tx / prophylaxis

A

Acute migraine: Triptan + NSAID/ paracetamol
Prophylaxis: Topiramate or Propranolol
For those between 12-17 yrs, consider nasal triptan instead of oral

53
Q

cluster headache tx / prophylaxis

A

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
Q

trigem neuralgia tx

A

1st = carbamazepine
2nd = phenytoin, gabapentin

55
Q

Kernig’s sign?

A

unable to extend leg at knee when thigh is flexed

56
Q

Brudinski’s sign?

A

when neck is flexed, the patient will flex hips and knees

57
Q

SAH ix

A

CT without contrast = star/ spider pattern, blood (berry aneurysms)

LP = bloody and xanthochromia (yellow/straw coloured)

58
Q

subdural haemorrhage pres and ix

A

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
Q

extradural haemorrhage pres and ix

A

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
Q

cushing’s reflex to ICP

A

bradycardia
HTN
wide pulse pressure

61
Q

CN1 lesion

A

anosmia

62
Q

CN2 lesion

A

visual defect depending on location of lesion
Marcus Gunn pupil

63
Q

CN3 palsy

A

fixed dilated pupil down and out
ptosis

64
Q

CN4 palsy

A

head tilt to correct exotortion
vertical diplopia when looking down
trouble walking down stairs

65
Q

CN6 palsy

A

abducted eyes
horizontal diplopia

66
Q

CN3,4,6 palsy

A

non-functioning eye

67
Q

CN5 palsy

A

jaw deviates to side of lesion
loss of corneal reflex

68
Q

CN8 palsy

A

hearing impairment
vertigo+lack of balance

69
Q

CN7 palsy

A

facial drop + weakness
anterior 2/3 tongue

70
Q

CN9, CN10 palsy

A

gag reflex issues
swallowing issues
vocal issues
uvula deviated away from lesion
posterior 1/3 tongue

71
Q

CN11 palsy

A

sternocleidomastoid + trapezius muscles - can’t shrug shoulders or shake head to contralateral side

72
Q

CN12 palsy

A

tongue deviates to side of lesion

73
Q

MG pathophys

A

autoimmune disease against nicotinic ACh receptors in neuromuscular junctions

type 2 reaction

74
Q

MG pres

A

weakness
fatigue of eyes - ptosis, diplopia
bulbar - dysphagia, dysarthria
proximal limbs
improves after rest

75
Q

MG related to what tumour

A

thymic tumour

76
Q

MG ix

A

AChR, MUSK antibody assay
tensilon test (edrophorium test)
Low FVC

77
Q

MG and crisis tx

A

1st oral pyridostigmine
+ immunosupression (prednisolone)

If myasthenia crisis - resp muscles too weak - IV immunoglobulin + plasmaphereisis

78
Q

Lambert Eaton associated with what cancer

A

Small cell lung cancer

79
Q

Lambert Eaton vs MG

A

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
Q

GBS pres

A

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
Q

GBS drawing

A

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
Q

what is Subacute combined degen of spinal cord and pres

A

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
Q

CMT mode of inheritance

A

autosomal dominant

84
Q

CMT pres

A

distal limb wasting and weakness, legs
progressive over years
high arched feet - Pes Cavus
‘inverted champagne bottles’

85
Q

syringomyelia pres

A
  • ‘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
Q

syringomyelia ix

A
  • Full spine MRI with contrast to exclude tumour or tethered cord
  • Brain MRI to exclude Chiari malformation
87
Q

syringomyelia strongly associated with

A

Chiari malformation

88
Q

horner’s pres

A
  • Miosis (small pupil)
  • Ptosis (droopy eyelids)
  • Enophthalmos (sunken eye)
  • Anhidrosis (loss of sweating one side)
89
Q

Causes of falls

A
  • Drugs
  • MSK
  • Syncope
  • Stroke/ TIA
  • Postural hypotension
  • Vertigo
  • Neurological
  • Hypoglycaemia
  • Poor environment
  • Visual impairment
  • Dementia
90
Q

delirium / acute confusional state tx

A

0.5mg IM or oral Haloperidol

except in lewy body dementia, can cause parkinsonism, instead IM lorazepam

91
Q

causes of delirium and results of a confusion screen

A

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
Q

what is STOPP

A

identifies meds where risk outweighs therapeutic benefits in certain conditions

93
Q

what is START

A

identifies meds that should be used for certain conditions in pts >65 yrs

94
Q

alzheimer’s tx

A

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
Q

Another name for Restless legs syndrome and its tx

A

Willis-Ekbom disease
tx = ropinirole

96
Q

BPPV dx and tx

A

Dix-Hallpike manouevre
Epley manouevre

97
Q

Cerebellar DANISH stands for?

A

Dysdiadochokinesis (patients can appear Drunk)
Ataxia
Nystagmus (horizontal)
Intention tremor
Slurred speech
Hypotonia

98
Q

Key pres in GCA?

A

headache
scalp tenderness
jaw claudication
amourosis fugax
age >50 yrs
High ESR

99
Q

Gold std ix for GCA

A

Temporal artery biopsy

100
Q

GCA associated with what condition

A

polymyalgia rheumatica

101
Q

GCA tx

A

high dose steroid (prednisolone)

IV if signs of vision loss

102
Q
A

Rabiah's 3a (4 decks)

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