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neuro here we go Flashcards

1
Q

Average age patient presents with Motor Neuron Disease?

A

60

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2
Q

Presenting symptoms with Motor Neuron Disease? (4)

A

Stumbling spastic gait
Foot drop
Weakness- can’t turn door handles
Dysphagia/ aspiration pneumonia

ie mixed UMN and LMN picture

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3
Q

Weeping or giggling inappropriately without mood change. Name symptom?

A

Pseudobulbar affect

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4
Q

What is seen in bulbar palsy, UMN or LMN signs?

A

LMN signs

Disease in cranial nerves

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5
Q

What is seen in pseudobulbar palsy, UMN or LMN signs?

A

UMN signs

Disease in Corticobulbar tract in brain

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6
Q

How do we differentiate Motor Neuron Disease from Multiple Sclerosis?

A

MND has no sensory loss

MS does

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7
Q

How do we differentiate Motor Neuron Disease from Myasthenia?

A

MND does not affect muscles of eye movement

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8
Q

Which drug slows the progression of Motor Neuron Disease?

A

Riluzole

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9
Q

What is the max score in each Glasgow Coma Score domain?

A

Eyes- 4
Verbal- 5
Motor- 6

Extra Value Meal costs £4.56 🍔

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10
Q

GCS 14 usually means?

A

Confused patient

Dementia/ Delirium/ Intoxication/ Concussion

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11
Q

What is the GCS of a confused patient?

A

14

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12
Q

Lowest possible GCS?

A

3

ya dead

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13
Q

Normal GCS?

A

15

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14
Q

What does a GCS of <8 mean? (3 domains)

A

Eyes closed
Non verbal
Some pain response

(requires airway protection!!)

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15
Q

What do patients with a GCS of <8 require?

A

Airway protection

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16
Q

Symptoms of Optic Neuritis? (3)

A

Pain on eye movement
Rapid loss of central vision
+/- colour vision loss

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17
Q

What is optic neuritis a common presentation of?

A

Multiple sclerosis

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18
Q

Oligoclonal bands in CSF but not serum suggest what?

A

CNS inflammation, suggestive of MS

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19
Q

How to treat MS relapse?

A

Methylprednisolone

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20
Q

Examples of disease modifying Multiple Sclerosis drugs?

A 
Dimethyl fumarate (Tecfidera brand)
Immunosuppression (monoclonal antibodies)
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21
Q

What criteria is used to diagnose Multiple Sclerosis?

A

McDonald criteria

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22
Q

Commonest first symptom in Multiple Sclerosis?

A

Vision loss

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23
Q

Sensory symptoms in Multiple Sclerosis? (3)

A

Abnormal sensation
Pins and needles
Can’t feel vibration

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24
Q

Motor symptoms in Multiple Sclerosis? (2)

A

Spastic weakness

Bowel/ bladder weakness

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25
Neuropsychiatric impacts of Multiple Sclerosis?
Low mood | Amnesia
26
Corticospinal tract controls what?
Major spinal pathway involved with voluntary movements
27
What is Uhthoff's phenomenon in Multiple Sclerosis?
Worsening of symptoms with increased temperature Uhthoff- OOF HOT
28
Important fact about chronology of MS lesions?
Disseminated in space and time ie >30 days between relapses, relapses affect different areas
29
Literal meaning of Myasthenia Gravis?
'Grave'/Serious Muscle Weakness
30
What happens in Myasthenia Gravis at cellular level?
Autoimmune attack on post synaptic ACh receptors Fewer receptors> harder to trigger action potential
31
Antibodies in Myasthenia Gravis?
anti- AChR (ACh receptor) | anti- MuSK (Muscle Specific Tyrosine Kinase)
32
Who gets Myasthenia Gravis with anti-MuSK antibodies?
Young women particularly
33
Who gets Myasthenia Gravis?
Women 20-30 | Men 60+
34
First muscle group usually affected in Myasthenia Gravis?
Extraocular muscles
35
First symptoms in Myasthenia Gravis?
Ptosis | Double vision
36
In Myasthenia Gravis, which muscle group is affected after extraocular muscles?
Bulbar
37
Give some bulbar symptoms please (4)
Difficulty swallowing (dysphagia) Slurred, difficult speech (dysarthria) Difficulty chewing Aspirating
38
Describe tendon reflexes in Myasthenia Gravis
Normal Reflex is not enough time to fatigue muscle
39
Why are tendon reflexes normal in Myasthenia Gravis?
Reflex is not enough time to fatigue muscle
40
How to treat relapse of Myasthenia Gravis?
Prednisolone immunosuppression
41
Best long-term drug treatment in Myasthenia Gravis?
Anticholinesterase Inhibitors (-stigmine drugs)
42
Why are anticholinesterase inhibitors useful in Myasthenia Gravis?
Allows ACh to remain in synaptic cleft longer Means action potential can be triggered with the remaining receptors
43
What type of hypersensitivity reaction is Myasthenia Gravis?
Type II
44
Surgical treatment in Myasthenia Gravis?
Thymectomy Can be T-cell mediated
45
Define Myasthenic crisis
Weakness of respiratory muscles during relapse Life threatening!
46
How do we treat Myasthenic crisis? (3)
Ventilate Find and treat cause Plasmapheresis to remove anti-AChR antibody
47
Which neuro disease is nearly inevitable in Down Syndrome?
Alzheimer's Disease
48
In which chromosomal abnormality is Alzheimer's Disease nearly inevitable?
Down Syndrome
49
Global degenerative cognitive decline, not limited to specific domain. Diagnosis?
Alzheimer's Disease
50
Leading genetic cause of Alzheimer's Disease?
Homozygosity for APOE4 allele
51
What neuro disease is there a 2x risk of in Heart Failure?
Alzheimer's Disease
52
What makes diagnosis of Guillain Barré syndrome unlikely?
Asymmetry of weakness | Severe bladder/bowel involvement
53
Treat Guillain Barré syndrome?
IV Immunogloblin
54
What syndrome is characterised by euvolaemic hyponatraemia?
Syndrome of Inappropriate ADH secretion (SIADH)
55
What are the triad of symptoms seen in Viral Meningitis? (3)
Headache Neck stiffness Photophobia
56
What is characterised by headache, neck stiffness and photophobia?
Viral Meningitis
57
What type of inheritance is seen in Neurofibromatosis Type 1?
Autosomal Recessive | Although spontaneous development common
58
What symptoms accompany headache in Subarachnoid Haemorrhage? (4)
Neck Stiffness Vomiting Seizure Loss of consciousness/ collapse
59
Commonest cause of Subarachnoid Haemorrhage?
Ruptured berry aneurysm (80%)
60
Commonest cause of Subarachnoid Haemorrhage, after ruptured berry aneurysm?
Arteriovenous malformation (15%)
61
Drug treatment to reduce vasospasm and bleeding in Subarachnoid Haemorrhage?
Nimodipine (Calcium Channel Blocker)
62
Surgical options in Subarachnoid Haemorrhage? (2)
``` Endovascular coiling (preferred) Surgical clipping (requires craniotomy) ```
63
Commonest cause of death in Subarachnoid Haemorrhage, after primary haemorrhage?
Re-bleeding
64
Treat Acute Subdural Haematoma?
Emergency craniotomy for decompression and homeostasis
65
Treat Chronic Subdural Haematoma?
Burr hole for drainage
66
Main symptom in Subdural Haematoma?
Fluctuating consciousness level
67
Apart from fluctuating consciousness level, list some other symptoms in Subdural Haematoma (4)
Headaches Ataxia Hemiparesis Seizure Due to compressive effects of haematoma
68
What are ataxia symptoms? (3)
Slurring Incoordination Stumbling/falling
69
Drug to reduce ICP?
Mannitol
70
Smoking cessation aid that increased the chance of seizures?
Bupropion
71
What happens if you do a Lumbar Puncture on a patient with raised ICP?
Coning of the Brainstem through the Foramen Magnum
72
Spike Wave abnormality on EEG suggests?
Generalised epilepsy (absence)
73
First line Tx in Primary Generalised Epilepsy?
Sodium Valproate | 'Domestos' of epilepsy
74
Severe side effect of Lamotrigine?
Rash > Steven-Johnson Syndrome
75
First line for focal onset epilepsy?
Carbamazepine
76
Why is Carbamazepine not used in Primary Generalised Epilepsy?
Aggravates it
77
Why are side effects of Sodium Valproate more tolerated in men than women?
Teratogenic> men can't have babies | Hair loss & weight gain> happens anyway to aging men 👴🍔👨‍🦲
78
Sodium Valproate is teratogenic. Name 2 more of its side effects
Hair loss | Weight gain
79
Usual cause of variable decelerations on CTG?
Umbilical cord compression
80
Pain and temperature sensing spinal tract?
Spinothalamic
81
How to definitively diagnose a brain mass?
Biopsy (same as any other mass)
82
Left -Right confusion suggests lesion where?
Dominant Parietal Lobe | eg Left Parietal if they are Right-handed
83
Unilateral pupil mydriasis, unresponsive to light. What type of herniation has occurred?
Uncal herniation
84
First symptom of Uncal herniation
Ipsilateral pupil dilation, unresponsive to light Imagine a weird uncle poking you in the eye?
85
Commonest cause of non-communicating hydrocephalus?
Obstruction/ Stenosis
86
Who gets non-communicating hydrocephalus?
Young children | commonest reason for brain surgery in that age group
87
Raised ICP commonly causes palsy of what nerve?
Abducens, CNVI
88
Why is Abducens CNVI the cranial nerve most susceptible to changes in Intracranial Pressure? (2)
Long intracranial course | Anchored in Dorello's canal ∴ prone to stretching
89
Abducens CNVI nerve palsy is an early sign of what?
Raised ICP
90
Headache associated with runny nose and runny eye on same side?
Cluster headache | autonomic symptoms

Formative Revision (50 decks)

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