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Medicine year 4 - finals prep > Neuro revision > Flashcards

Neuro revision Flashcards

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1
Q

What is syringomyelia?

A

Collection of cerebrospinal fluid within spinal cord

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2
Q

Causes of syringomyelia?

A

Chiari malformation
Trauma
Tumours
Idiopathic

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3
Q

In syringomyelia which sensation is affected?

A

Cape- like loss of temperature sensation, preservation of light touch, proprioception and vibration

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4
Q

Clinical features of syringomyelia?

A

Cape- like loss of temperature sensation
Spastic weakness
Neuropathic pain
Upgoing plantars
autonomic features
Horner’s syndrome
Scoliosis

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5
Q

Treatment for generalised tonic clonic seizures?

A

Males - sodium valproate
Females - lamotrigine or levetiracetam

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6
Q

Treatment for absence seizures?

A

1st line = ethosuximide
2nd = male - sodium valproate
female - lamotrigine/ levetiracetam

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7
Q

Treatment for focal seizures?

A

First line = lamotrigine or levetiracetam
Second line = carbamexapine, oxycarbazepine

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8
Q

Which medication may exacerbate absence seizures?

A

Carbamezapine

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9
Q

What is another name for absence seizures?

A

Petit mal

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10
Q

Treatment for myoclonic seizures?

A

Males - sodium valproate
Females - levetiracetam

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11
Q

Treatment for tonic or atonic seizures?

A

Males - sodium valproate
Females - lamotrigine

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12
Q

What nerves does the sciatic nerve divide into?

A

Tibial and common peroneal nerves

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13
Q

Where does injury often occur in common peroneal nerve lesion?

A

Neck of fibula

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14
Q

Characteristics of common peroneal nerve lesion?

A

Foot drop
Weak foot dorsiflexion, foot eversion
Weak extensor hallucis longus
Sensory loss over dorsum of foot, and lower lateral leg
Wasting of anterior tibial and peroneal muscles

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15
Q

Factors suggesting true epileptic seizure?

A

Tongue biting
Raises serum prolactin

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16
Q

Factors suggesting pseudoseizure?

A

Pelvic thrusting
Family member with epilepsy
Female&raquo_space;
Crying after seizure
Don’t occur when alone
Gradual onset

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17
Q

Classic history - vestibular schwannoma/ acoustic neuroma?

A

Vertigo
Unilateral SNHL
Tinnitus
Absent corneal reflex

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17
Q

Interpretation of Webers?

A

Normal - midline
Conductive - bad ear
SNHL - good ear

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18
Q

Which artery occluded in lateral medullary syndrome/ Wallenberg’s?

A

Posterior inferior cerebellar artery

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19
Q

Cerebellar features of posterior inferior cerebellar artery occlusion/ lateral medullary syndrome?

A

Cerebellar: ataxia, nystagmus

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20
Q

Brainstem features of posterior inferior cerebellar artery occlusion/ lateral medullary syndrome?

A

Ipsilateral: Dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
Contralateral: limb sensory loss

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21
Q

What is Guillain- Barre syndrome?

A

Immune mediated demyelination of peripheral nervous system, often triggered by infection

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22
Q

Which infection often causes GBS?

A

Campylobacter jejuni

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23
Q

What is the characteristic feature of GBS?

A

Progressive, symmetrical weakness of all limbs
Classically ascending weakness
Reduced/ absent reflexes
Few sensory signs/ symptoms

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24
Q

Investigations in GBS?

A

Lumbar puncture - rise in protein, normal WBC count
Nerve conduction studies - dec motor nerve conduction velocity (demyelination)

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25
Q

Parietal lobe lesions?

A

Sensory inattention
Apraxia
Tactile agnosia
Inferior homonymous quadrantanopia

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26
Q

Occipital lobe lesion?

A

Homonymous hemianopia (with macular sparing)
Cortical blindness
Visual agnosia

27
Q

Temporal lobe lesion?

A

Wernicke’s aphasia
Superior homonymous quadrantanopia
Auditory agnosia
Prosopagnosia (difficulty recognising faces)

28
Q

Frontal lobe lesion?

A

Broca’s aphasia (expressive)
Disinhibition
Perseveration
Anosmia
Inability to generate list

29
Q

Cerebellum lesions?

A

Midline - gait and truncal ataxia
Hemisphere lesion - intention tremor, past pointing, dysdiadokinesia, nystagmus

30
Q

Dysdiadochokinesia?

A

Inability to perform rapid alternating muscle movements

31
Q

Cause of brown sequard syndrome?

A

Lateral hemisection of the spinal cord

32
Q

Features of brown squared syndrome?

A

Ipsilateral weakness below lesion
Ipsilateral loss of proprioception and vibration sensation
Contralateral loss of pain and temperature sensation

33
Q

Does unilateral cerebellar lesion cause contra or ipsi- lateral signs?

A

Ipsilateral

34
Q

Symptoms of cerebellar disease?

A

DANISH
D- dysdiadochokinesia,, dysmetria (past- pointing), ‘drunk’
A- ataxia
N- nystagmus
I- intention tremor
S- slurred staccato speech, scanning dysarthria
H - hypotonia

35
Q

GCS - motor response?

A
  1. Obeys commands
  2. Localises to pain
  3. Withdraws from pain/ normal flexion
  4. Abnormal flexion to pain (decorticate posture)
  5. Extending to pain
  6. None
36
Q

GCS - verbal?

A
  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None
37
Q

GCS - eye opening?

A
  1. Spontaneous
  2. To speech
  3. To pain
  4. None
38
Q

What can Lambert- Eaton syndrome be associated with?

A

Small cell lung cancer&raquo_space;>
Breast, ovarian cancer
Independent autoimmune disorder

39
Q

Cause of Lambert- Eaton syndrome?

A

Antibody against presynaptic voltage- gated calcium channels in PNS

40
Q

Features of Lambert- Eaton syndrome?

A

Repeated muscle contractions lead to inc muscle strength
Limb- girdle weakness
Hyporeflexia
Autonomic symptoms

41
Q

EMG in Lambert- Eaton syndrome?

A

Incremental response to repetitive electrical stimulation

42
Q

Management of Lambert- Eaton syndrome?

A

Treat underlying
Immunosuppression e.g. prednisolone +/- azathioprine

43
Q

What is myasthenia gravis?

A

Autoimmune disorder resulting in insufficient functioning acetylcholine receptors

44
Q

What causes myasthenia gravis?

A

Antibodies to acetylcholine receptors seen in 85-90%

45
Q

Key features of myasthenia gravis?

A

Muscle fatigability
Extraocular muscle weakness: diplopia
Proximal muscle weakness
Ptosis
Dysphagia

46
Q

Associations with myasthenia gravis?

A

Thymomas
AI disorders e.g. pernicious anaemia, AI thyroid disorders, rheumatoid, SLE
Thymic hyperplasia

47
Q

Investigations for myasthenia gravis?

A

Single fibre EMG
CK normal
Antibodies to acetylcholine receptors, some + for anti- muscle- specific tyrosine kinase AB’s

48
Q

Management of myasthenia gravis?

A

Long- acting acetylcholinesterase inhibitors - pyridostigmine
Eventually require immunosuppression - prednisolone, azathioprine
Thmectomy

49
Q

Management of myasthenia crisis?

A

Plasmapharesis
IV immunoglobulins

50
Q

Ankle reflex?

A

S1-S2

51
Q

Knee reflex?

A

L3-L4

52
Q

Biceps reflex?

A

C5-C6

53
Q

Triceps reflex?

A

C7-C8

54
Q

What causes subacute combined degeneration of the spinal cord?

A

Vitamin B12 deficiency resulting in impairment of dorsal columns, lateral corticospinal tracts and spinocerebellar tracts

55
Q

Features of subacute combined degeneration of the spinal cord - dorsal column?

A

Distal tingling/burning/sensory loss is symmetrical and tends to affect the legs more than the arms
Impaired proprioception and vibration sens

56
Q

Features of subacute combined degeneration of the spinal cord - lateral corticospinal tract?

A

Muscle weakness, hyperreflexia, and spasticity
upper motor neuron signs typically develop in the legs first
Brisk knee reflexes
absent ankle jerks
extensor plantars

57
Q

Features of subacute combined degeneration of the spinal cord - spinocerebellar tracts?

A

Sensory ataxia - gait abnormalities
Positive Romberg’s sign

58
Q

Anterior cerebral artery stroke?

A

Contralateral hemiparesis and sensory loss, lower extremity > upper

59
Q

Middle cerebral artery stroke?

A

Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

60
Q

Posterior cerebral artery stroke?

A

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

61
Q

Weber’s syndrome/ branches of posterior cerebral artery that supply midbrain?

A

Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

62
Q

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg’s syndrome)

A

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

63
Q

Anterior inferior cerebellar artery (lateral pontine syndrome)?

A

Similar to Wallenberg’s
Ipsilateral: facial paralysis and deafness

64
Q

Lacunar stroke?

A

Isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
Strong assoc. w/ hypertension
Basal ganglia, thalamus, internal capsule

Medicine year 4 - finals prep (2 decks)

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