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Formative Revision > neuro here we go > Flashcards

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
Q

Neuropsychiatric impacts of Multiple Sclerosis?

A

Low mood

Amnesia

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26
Q

Corticospinal tract controls what?

A

Major spinal pathway involved with voluntary movements

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27
Q

What is Uhthoff’s phenomenon in Multiple Sclerosis?

A

Worsening of symptoms with increased temperature

Uhthoff- OOF HOT

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28
Q

Important fact about chronology of MS lesions?

A

Disseminated in space and time

ie >30 days between relapses, relapses affect different areas

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29
Q

Literal meaning of Myasthenia Gravis?

A

‘Grave’/Serious Muscle Weakness

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30
Q

What happens in Myasthenia Gravis at cellular level?

A

Autoimmune attack on post synaptic ACh receptors

Fewer receptors> harder to trigger action potential

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31
Q

Antibodies in Myasthenia Gravis?

A

anti- AChR (ACh receptor)

anti- MuSK (Muscle Specific Tyrosine Kinase)

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32
Q

Who gets Myasthenia Gravis with anti-MuSK antibodies?

A

Young women particularly

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33
Q

Who gets Myasthenia Gravis?

A

Women 20-30

Men 60+

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34
Q

First muscle group usually affected in Myasthenia Gravis?

A

Extraocular muscles

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35
Q

First symptoms in Myasthenia Gravis?

A

Ptosis

Double vision

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36
Q

In Myasthenia Gravis, which muscle group is affected after extraocular muscles?

A

Bulbar

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37
Q

Give some bulbar symptoms please (4)

A

Difficulty swallowing (dysphagia)
Slurred, difficult speech (dysarthria)
Difficulty chewing
Aspirating

38
Q

Describe tendon reflexes in Myasthenia Gravis

A

Normal

Reflex is not enough time to fatigue muscle

39
Q

Why are tendon reflexes normal in Myasthenia Gravis?

A

Reflex is not enough time to fatigue muscle

40
Q

How to treat relapse of Myasthenia Gravis?

A

Prednisolone immunosuppression

41
Q

Best long-term drug treatment in Myasthenia Gravis?

A

Anticholinesterase Inhibitors (-stigmine drugs)

42
Q

Why are anticholinesterase inhibitors useful in Myasthenia Gravis?

A

Allows ACh to remain in synaptic cleft longer

Means action potential can be triggered with the remaining receptors

43
Q

What type of hypersensitivity reaction is Myasthenia Gravis?

A

Type II

44
Q

Surgical treatment in Myasthenia Gravis?

A

Thymectomy

Can be T-cell mediated

45
Q

Define Myasthenic crisis

A

Weakness of respiratory muscles during relapse

Life threatening!

46
Q

How do we treat Myasthenic crisis? (3)

A

Ventilate
Find and treat cause
Plasmapheresis to remove anti-AChR antibody

47
Q

Which neuro disease is nearly inevitable in Down Syndrome?

A

Alzheimer’s Disease

48
Q

In which chromosomal abnormality is Alzheimer’s Disease nearly inevitable?

A

Down Syndrome

49
Q

Global degenerative cognitive decline, not limited to specific domain. Diagnosis?

A

Alzheimer’s Disease

50
Q

Leading genetic cause of Alzheimer’s Disease?

A

Homozygosity for APOE4 allele

51
Q

What neuro disease is there a 2x risk of in Heart Failure?

A

Alzheimer’s Disease

52
Q

What makes diagnosis of Guillain Barré syndrome unlikely?

A

Asymmetry of weakness

Severe bladder/bowel involvement

53
Q

Treat Guillain Barré syndrome?

A

IV Immunogloblin

54
Q

What syndrome is characterised by euvolaemic hyponatraemia?

A

Syndrome of Inappropriate ADH secretion (SIADH)

55
Q

What are the triad of symptoms seen in Viral Meningitis? (3)

A

Headache
Neck stiffness
Photophobia

56
Q

What is characterised by headache, neck stiffness and photophobia?

A

Viral Meningitis

57
Q

What type of inheritance is seen in Neurofibromatosis Type 1?

A

Autosomal Recessive

Although spontaneous development common

58
Q

What symptoms accompany headache in Subarachnoid Haemorrhage? (4)

A

Neck Stiffness
Vomiting
Seizure
Loss of consciousness/ collapse

59
Q

Commonest cause of Subarachnoid Haemorrhage?

A

Ruptured berry aneurysm (80%)

60
Q

Commonest cause of Subarachnoid Haemorrhage, after ruptured berry aneurysm?

A

Arteriovenous malformation (15%)

61
Q

Drug treatment to reduce vasospasm and bleeding in Subarachnoid Haemorrhage?

A

Nimodipine (Calcium Channel Blocker)

62
Q

Surgical options in Subarachnoid Haemorrhage? (2)

A 
Endovascular coiling (preferred)
Surgical clipping (requires craniotomy)
63
Q

Commonest cause of death in Subarachnoid Haemorrhage, after primary haemorrhage?

A

Re-bleeding

64
Q

Treat Acute Subdural Haematoma?

A

Emergency craniotomy for decompression and homeostasis

65
Q

Treat Chronic Subdural Haematoma?

A

Burr hole for drainage

66
Q

Main symptom in Subdural Haematoma?

A

Fluctuating consciousness level

67
Q

Apart from fluctuating consciousness level, list some other symptoms in Subdural Haematoma (4)

A

Headaches
Ataxia
Hemiparesis
Seizure

Due to compressive effects of haematoma

68
Q

What are ataxia symptoms? (3)

A

Slurring
Incoordination
Stumbling/falling

69
Q

Drug to reduce ICP?

A

Mannitol

70
Q

Smoking cessation aid that increased the chance of seizures?

A

Bupropion

71
Q

What happens if you do a Lumbar Puncture on a patient with raised ICP?

A

Coning of the Brainstem through the Foramen Magnum

72
Q

Spike Wave abnormality on EEG suggests?

A

Generalised epilepsy (absence)

73
Q

First line Tx in Primary Generalised Epilepsy?

A

Sodium Valproate

‘Domestos’ of epilepsy

74
Q

Severe side effect of Lamotrigine?

A

Rash > Steven-Johnson Syndrome

75
Q

First line for focal onset epilepsy?

A

Carbamazepine

76
Q

Why is Carbamazepine not used in Primary Generalised Epilepsy?

A

Aggravates it

77
Q

Why are side effects of Sodium Valproate more tolerated in men than women?

A

Teratogenic> men can’t have babies

Hair loss & weight gain> happens anyway to aging men 👴🍔👨‍🦲

78
Q

Sodium Valproate is teratogenic. Name 2 more of its side effects

A

Hair loss

Weight gain

79
Q

Usual cause of variable decelerations on CTG?

A

Umbilical cord compression

80
Q

Pain and temperature sensing spinal tract?

A

Spinothalamic

81
Q

How to definitively diagnose a brain mass?

A

Biopsy (same as any other mass)

82
Q

Left -Right confusion suggests lesion where?

A

Dominant Parietal Lobe

eg Left Parietal if they are Right-handed

83
Q

Unilateral pupil mydriasis, unresponsive to light. What type of herniation has occurred?

A

Uncal herniation

84
Q

First symptom of Uncal herniation

A

Ipsilateral pupil dilation, unresponsive to light

Imagine a weird uncle poking you in the eye?

85
Q

Commonest cause of non-communicating hydrocephalus?

A

Obstruction/ Stenosis

86
Q

Who gets non-communicating hydrocephalus?

A

Young children

commonest reason for brain surgery in that age group

87
Q

Raised ICP commonly causes palsy of what nerve?

A

Abducens, CNVI

88
Q

Why is Abducens CNVI the cranial nerve most susceptible to changes in Intracranial Pressure? (2)

A

Long intracranial course

Anchored in Dorello’s canal ∴ prone to stretching

89
Q

Abducens CNVI nerve palsy is an early sign of what?

A

Raised ICP

90
Q

Headache associated with runny nose and runny eye on same side?

A

Cluster headache

autonomic symptoms

Formative Revision (50 decks)

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