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year 3. > Neuro Other > Flashcards

Neuro Other Flashcards

1
Q

Most common neuromuscular junction disorder

A

Myasthenia gravis

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2
Q

TIA definition

A

a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, WITHOUT ACUTE INFARCTION (ie no signs of infarction on imaging)

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3
Q

Driving rules for seizures and epilepsy

A

1st seizure: car license- no driving for 6 months, hgv license- no driving for 5 years

Epilepsy: no car driving for 1 yr since last event- iff eeg/mri abnormal. if eeg/mri normal- no driving for 6 months
, HGV- 10 years seizure free off all anticonvulsants b4 u drive

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4
Q

What pill should u not use with anti-convulsants

A

Progesterone only pill

Be careful with contraception in general as anti-convulsants can reduce efficacy of contraceptives

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5
Q

Status epilepsy mx (prehospital and hospital)

A

Stabilise patient

prehospital- PR diazepam/ buccal midazolam

hospital: IV lorazepam, repeat once after 5-10 minutes

if ongoing, start: leviratcetam/phenytoin/sodium valporate

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6
Q

when should a seizure be treated as status epilepticus

A

seizure lasting longer than 5 minutes
or
>=2 seizures within a 5-minute period without the patient returning to normal

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7
Q

What level does the spinal cord end

A

L1/L2

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8
Q

management of status epilepticus if no response within 45 minutes from onset

A

general anaesthesia or phenobarbital (acts on GABA A receptors and increase synaptic inhibition)

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9
Q

What is the dorsal column for and where does it cross the midline
where does the 1,2nd &3rd order neuron synapse

A

aka-fasiculous cutaneous and fasiculus gracilis

(ascending) Fine touch, vibration and propioception

Crosses midline at medulla

1st order- synapses at medulla and crosses to contralteral side
2nd order- synapses in thalamus
3rd order- travels to in somatosensory cortex (post central gyrus)

(3 neurons, 2 synapses)

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10
Q

What is the lateral spinothalamic tract for
When does it cross the midline

A

ascending, Temperature and pain

Crosses at the spinal cord segment

1st order neuron synapses at posterior horn then moves to contralteral side and up sinal cord
2nd order neuron synapses at the thalamus
3rd order neuron travels to post central gyrus

(3 cells, 2 synapses)

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11
Q

Descending pathways split into

A

Pyramidal: Cortiocspinal tract and corticobulbar spinal tract

Extrapyrimidal: rubrospinal, vestibulospinal, reticulospinal, tectospinal

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12
Q

what is the function of the ventral spinothalamic tract

A

(ascending) crude touch and deep pressure

(crude- non discriminative)

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13
Q

Cortico spinal tract

where is decussation

function

A

Voluntary movement of contralateral side of TRUNK and LIMBS

Splits into anterior (15%) and lateral (85%)

Lateral tract decussate at midline of pyramids

Anterior (aka ventral) decussate at the spinal level they innervate.

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14
Q

Where is the motor centre in brain

A

Pre-central gyrus

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15
Q

Where is the sensory centre in the brain

A

Post-central gyrus

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16
Q

brocas: where and function

A

frontal lobe on side of dominant hemisphere

speech production

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17
Q

wernickes: where and function

A

dominant hemisphere , superior temporal gyrus

comprehension, understanding of langauge

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18
Q

Give two examples of drugs that block N type calcium channels

A

pregabalin and gabapentin

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19
Q

give two examples of epilepsy drugs block sodium channels

A

lamotrigine and carbamezapine

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20
Q

give one example of a drug that enhances GABA synthesis

A

sodium valproate

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21
Q

give one example of a drug that targets gaba receptors

A

benzodiazepines

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22
Q

what is the basic function of the GABA system

A

reduces neuronal excitability

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23
Q

Focal seizures: frontal lobe seizure signs/symptoms

A

limb jerking
(frontal lobe contains motor cortex )

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24
Q

focal seizures: temporal lobe signs/symptoms

A

aura: epigastric sensation/ deja vu/ hallucinations (auditory, olfactory etc) and ORAL autoamtisms eg lip smacking

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25
Q

focal seizures: parietal lobe signs/symptoms

A

parasthesia

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26
Q

focal seizures: occipital lobe signs/symptoms

A

floaters/flashers

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27
Q

meningitis vs encephalitis symptoms

A
  • note: meningitis affects meninge layers and encephalitis affects the acc brain therefore encephalitis has more brain related symptoms whilst meningitis is more general

meningitis : neck stiffness, seizure, skin rash

encephalitis: blurred vision, slurred speech, confusion, paralysis, SEIZURES

both: fever

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28
Q

hyperdense vs hypodense haematoma

A

hyper: bright in colour on scan: acute
hypo: dark n scan: chronic

29
Q

common causes of injury for extradural, subdural and subarachnoid haemorrhage

A

extradural- head injury (often pterion), v acute and painful, ruptures middle meningeal artery

subdural- chronic or acute- RFs: anti-coagulants, OLD AGE + low impact trauma, alcoholism,

subarachnoid: most spontaneous cases caused by ruptured berry aneurysm in circle of willis, or severe trauma

30
Q

subdural haemorrhage symptoms

A

subdural: tends to be more chronic. gradually increasing headache and confusion.

assoc.with alcoholics

31
Q

subarachnoid haemorrhage sx

A

Sudden onset Thunderclap headache. Seizures, neurological deficits, loss of consciousness and death may rapidly ensue.
vomit soon after headache
meningism- neck stiffness, positive kernigs sign

32
Q

mechanism of action of triptans

A

act on serotonin receptors (5HT) to induce vasocnstriction which eases the symptomes of migraines

33
Q

headache symptoms: migraine
(8)

A

recurrent, severe, unilateral, throbbing pain

assoc.- nausea, aura, photosensitivity, periods

34
Q

headache symptoms: tension headache

A

recurrent, non disabling, bilateral, ‘tight band’

35
Q

headache symptoms:

cluster headache
(include time frame) (6)

A

duration 15 mins- 2 hrs, intense pain around 1 eye, restless during attack, eyes: redness, lacrimation, lid swelling

36
Q

frontotemporal dementia vs huntingtons disease

A

both: personality change, disinhibition, impulsiveness

difference: huntingtons causes motor disturbance. f.t dementia does not

37
Q

lewy bodies dementia symptoms

A

fluctuating consciousness, hallucinations & sleep disorders.

38
Q

cerebrospinal fluid composition when there is a bacterial infection vs viral

A

glucose low in bacterial (bacteria eat glucose for energy)
glucose high in viral

39
Q

3rd nerve palsy symptoms

A

down and out, dilated pupil

40
Q

what is the most common form of brain tumour

A

metatastic cancer (most commonly from lung)

41
Q

most common primary tumour in adults
- appearance on imaging?

A

gliobastoma multiforme- poor prognosis

  • imaging: solid tumour w/ central necrosis & rim that enhances with contrast. assoc. vasogenic oedema
42
Q

2nd most common primary brain tumour in adults

-histology

A

meningioma- benign

  • histology- spindle cells in concentric whorls and calcified psammoma bodies
43
Q

The most common primary brain tumour in children
- histology

A
  • pilocytic astocytoma
  • rosenthal fibres (corkscrew eosinphillic bundle)
44
Q

pathophysiological hallmarks of alzheimers disease

A

loss of cortical neurons
Tau neurofibillary tangles-
senile plaques- amyloid b

45
Q

what part of the brain affected in alzheimers disease

A

widespread cerebral atrophy, particularly involving the cerebral cortex (grey matter) and hippocampus

gyri narrow, sulci widen, ventricles appear larger

46
Q

huntingtons disease genetics:
(5)

A

autosomal dominant

trinucleotide repeat expansion of CAG-increasesd glutamate

anticipation may be seen

results in degeneration of cholinergic and GABAnergic neurons in the striatum of basal ganglia

due to defect in huntingtin gene on chromosome 4

47
Q

huntingtons symptoms

A

chorea - abnormal involuntary movement disorder

personality changes- irritability, apathy, depression and intellectual impairment

dystonia- abnormal muscle tone- muscle spasm/abnormal posture

saccadic eye movements-

48
Q

multiple system atrophy vs supranuclear palsy vs parkinsons

A

all have parkinsonism
differentiating features:

MLA- autonomic disturbance. eg. postural hypotension, erectile dysfunction

SNP: impairment of vertical gaze

49
Q

main exitatory neuron

A

glutamate

50
Q

main inhibitory neruon

A

gaba

51
Q

simultaneous inhibitory signal and excitatory signal result

A

redueced EPSP (reduced excitatory signal)

52
Q

what do nocioreceptors sense

A

painful stimuli

53
Q

what is adaptation regarding neurotransmission

A

the decrease in action potential frequency with sustained stimulius

54
Q

most common cell in the nervous system

A

astrocyte

55
Q

upper motor neurone lesion
1. muscle wasting?
2. fasiculations?
3. tone
4. weakness or paralysis
5. tendon jerk reflex
6. babinski response

A
  1. yes but to a lesser extent than LMN lesion
  2. no
  3. spastic
  4. yes- inefficient recruitment of alpha motor neuones
  5. hyperflexia
  6. positive (abnormal toe extension)
56
Q

Lower motor neurone lesion
1. muscle wasting?
2. fasiculations?
3. tone
4. weakness or paralysis
5. tendon jerk reflex
6. babinski response

A
  1. yes
  2. yes
  3. flaccid
  4. yes- loss n muscle bulk
  5. reduced or absent
  6. negative- normal toe flexion
57
Q

describe parkinsons tremor

A

reduced on action (resting tremor), unilateral

58
Q

amytrophic lateral sclerosis vs primary lateral sclerosis

A

ALS has both UMN and LMN signs
ALS assoc with frontotemporal dementia and thenar atrophy

Primary lateral sclerosis- only UMN signs

59
Q

pogressive bulbar palsy vs progressive pseudobulbar palsy

A

Progressive Bulbar and pseudobulbar palsy are caused by damage to cranial
nerves 9,10 and 12 and presents with dysphagia.

Bulbar palsy is due to LMN (to nerves 9,10,12) = reduced
jaw and gag reflexes and tongue fasciculations,

but pseudobulbar palsy is UMN lesion to CN 9,10,12=
causes slow speech and brisk jaw reflexes

60
Q

what are the bulbar nerves

A

nerves exiting the medulla oblongata (bulb is the archaic term for medulla)

cranial nerves
IX- glosspharyngeal
X- vagus
XI- accessory
XII - hypoglossal

61
Q

what are the symptoms of juvenile myoclonic epilepsy

A

infrequent generalized seizures, often in morning//following sleep deprivation
daytime absences
sudden, shock-like myoclonic seizure (these may develop before seizures)

62
Q

what nerve innervates anterior 2 thirds of tongue

A

facial

63
Q

what nerve innervates posterior third of tongue

A

glossopharyngeal nerve

64
Q

TIA driving rules-

A

no driving until symptom free 1 month- no need to inform DVLA

65
Q

myoclonic seizure vs tonic clonic

A

myoclonic is less severe- short jerky movements

tonic clonic- whole body involved. sometimes loww os urinary control etc.

66
Q

where are post synaptic neurons found parasympathetic

A

within parasympathetic ganglia which lie near/within target organs

(pregnanglionic cells long/post ganglionic cells short)

67
Q

what is an ataxic gait

A

A wide-based gait with loss of heel to toe walking

typically occurs following cerebral injury

68
Q

finger nose ataxi- where is the lesion

A

cerebllar hemisphere

69
Q

gait ataxia (without finger nose ataxia)- where is the lesion

A

cerbelllar vermis

year 3. (32 decks)

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