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Phase 3a > Neuro (things I forget) > Flashcards

Neuro (things I forget) Flashcards

1
Q

What is the most common cause of brain metastases?

A

Lung tumours

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2
Q

What are the clinical features of degenerative cervical myelopathy?

A
  • Pain
  • Loss of motor function = weakness/stiffness/impaired gait/etc.
  • Loss of sensory function = numbness
  • Loss of autonomic function = incontinence
  • Hoffman’s sign = reflex test - gently flick one finger on patient’s hand –> reflex twitching of other fingers on same hand
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3
Q

What are the clinical features of adhesive capsulitis?

A
  • ‘Frozen shoulder’ - stiffness/pain in shoulder
  • External rotation affected more
  • Freezing phase –> adhesive phase –> recovery phase
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4
Q

What is L’hermitte’s sign?

A

Seen in patients with MS - electric shock sensations after flexion of neck

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5
Q

What is Uhthoff’s phenomenon?

A

Seen in patients with MS - temporary worsening of symptoms due to heat sensitivity e.g. getting into bath

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6
Q

What diagnostic criteria is used for multiple sclerosis?

A

McDonald’s Criteria

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7
Q

What are the investigations for MS?

A

Diagnosis requires demonstration of lesions disseminated in time and space
- MRI = periventricular plaques/high signal T2 lesions
CSF = oligoclonal bands

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8
Q

What is the management for MS?

A

Acute relapse = high dose steroids e.g. oral/IV methylprednisolone

Reducing risk of relapse = natalizumab/ocrelizumab/fingolimod/beta-interferon/glatiramer acetate

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9
Q

What is the most common complication of meningitis?

A

Sensorineural hearing loss

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10
Q

What is the management for migraines?

A

Acute attack = sumatriptan and NSAID/paracetamol

Prophylaxis = topiramate/propranolol (preferred in women of child-bearing age)

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11
Q

What is the commonest cause of sporadic encephalitis?

A

Herpes simplex encephalitis

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12
Q

What are the investigations and management for encephalitis?

A
  • CSF = lymphocytosis/elevated protein/PCR (for HSV/VZV/enteroviruses)
  • MRI = medial temporal and inferior frontal changes
  • IV aciclovir
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13
Q

What are the clinical features of temporal lobe seizures?

A
  • Aura
  • Hallucinations/flashbacks/deja vu
  • Anxiety
  • Automatisms
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14
Q

What are the clinical features of frontal lobe seizures?

A

Jacksonion march motor disturbances

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15
Q

What is the main distinguishing feature between seizures and syncope?

A

Seizure - confusion after recovery

Syncope - rapid recovery

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16
Q

What are the clinical features of Parkinson’s?

A
  • Bradykinesia/tremor/rigidity
  • Difficulty initiating movement
  • Postural instability
  • Unilateral symptoms
  • Pill rolling tremor
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17
Q

What is a complication of cabergoline?

A

Dopamine agonist used in Parkinson’s - may cause interstitial lung disease/pulmonary complications

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18
Q

What are the clinical features of progresssive supranuclear palsy?

A

A.k.a ‘Parkinson Plus syndrome’

  • Postural instability
  • Impairment of vertical gaze
  • Parkinsonism
  • Cognitive impairment
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19
Q

What are the clinical features of essential tremors?

A
  • Postural tremor - worse if arms outstretched
  • Improved by alcohol and rest
  • Most common cause of head tremor (titubation)
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20
Q

What is the management for essential tremor?

A

Propranolol

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21
Q

What is autonomic dysreflexia and what are the clinical features?

A

Occurs in patients who have had a spinal cord injury at/above T6

Commonly triggered by faecal impaction/bladder distension

  • Severe HTN
  • Bradycardia
  • Pounding headache
  • Flushing/sweating above level of lesion
  • Cool/pale skin below level of lesion
  • Agitation
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22
Q

Describe the difference between Broca’s and Wernicke’s aphasia?

A

Broca’s:
- Frontal lobe
- Difficulty speaking fluently e.g. limited words at a time/halting/effortful
- Able to understand speech and read

Wernicke’s:
- Superior temporal gyrus (responsible for language comprehension)
- Speech is fluent but makes little sense and/or includes nonsense
- Person doesn’t realise they’re speaking nonsense

Global:
- Affects both areas
- Can only produce a few recognisable words
- Understand very little/no spoken language

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23
Q

What are the clinical features of Bell’s palsy and what is the management?

A
  • Lower motor neuron facial nerve palsy - forehead affected
  • Post-auricular pain
  • Altered taste
  • Dry eyes
  • Hyperacusis
  • Oral prednisolone
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24
Q

What is the first line management and common side effect for Parkinson’s?

A

Levodopa - synthetic dopamine

  • ‘Wearing-off phenomenon’ = experiencing symptoms towards end of dose and prior to next dose
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25
Q

What are the clinical features of Guillain-Barre syndrome?

A
  • History of gastroenteritis
  • Progressive symmetrical ascending weakness of limbs
  • Reduced/absent reflexes
  • Mild sensory symptoms
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26
Q

What is used to measure disability/dependence in activities of daily living in stroke patients?

A

Barthel Index:
- Feeding
- Bathing
- Grooming
- Dressing
- Bowel control
- Bladder control
- Toilet use
- Transfers (bed to chair/chair to bed)
- Mobility on level surfaces
- Stairs

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27
Q

Which part of the brain is commonly affected in Alzheimer’s?

A

Widespread cerebral atrophy mainly involving the cortex and hippocampus

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28
Q

What will a LP show in patients with Alzheimer’s?

A
  • Beta amyloid plaques
  • Tau protein neurofibrillary tangles
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29
Q

What is the first line management for Alzheimer’s?

A

Acetylcholinesterase inhibitors e.g. donepezil/rivastigmine/galantamine

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30
Q

What is the first line management for myasthenia gravis?

A

Long acting acetylcholinesterase inhibitors e.g. pyridostigmine/neostigmine

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31
Q

What is the management for myasthenia crisis?

A

IV immunoglobulins and plasmapheresis

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32
Q

What is the typical presentation of idiopathic intracranial hypertension and what is the management?

A

Obese, young female with headaches and blurred vision - acetazolamide (carbonic anhydrase inhibitor)

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33
Q

What is status epilepticus?

A
  • Single seizure lasting >5 minutes
    OR
  • 2 seizures within a 5 minute period without the patient returning to normal between them
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34
Q

What is the management for status epilepticus?

A
  • ABC
  • Benzodiazepines = IV lorazepam (community setting = PR diazepam/buccal midazolam)
  • Can give IV lorazepam twice
  • Second line = levetiracetam/phenytoin/sodium valproate
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35
Q

What is the classic presentation of spinal stenosis?

A
  • Back pain with associated leg/buttock pain
  • Relieved with flexion and worsened with extension
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36
Q

What are the clinical features of a basal skull fracture?

A
  • Haemotympanum (accumulation of blood within middle ear)
  • Panda eyes
  • CSF leakage from ear/nose
  • Battle’s sign (bruising over the mastoid process)
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37
Q

What management is contraindicated in basal skull fractures?

A

Insertion of NG tube - risk of CNS entry through cribriform plate

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38
Q

Describe the epidemiology of MND

A
  • Amyotrophic lateral sclerosis is most common followed by progressive bulbar palsy
  • Typical patient = man in 60s
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39
Q

What is the management for MND?

A
  • ALS = riluzole
  • Respiratory care (non-invasive ventilation - BIPAP)
  • PEG nutrition
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40
Q

What are the clinical features of normal pressure hydrocephalus?

A

Hakim’s triad:
- Difficulty walking
- Poor bladder control
- Cognitive impairment

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41
Q

What is the investigation for normal pressure hydrocephalus?

A

MRI = ventriculomegaly without sulcal enlargement

42
Q

What is Meniere’s disease and what is the management?

A

Balance disorder caused by excess fluid in labyrinth
- Acute attacks = buccal/IM prochlorperazine
- Prophylaxis = betahistine and vestibular rehabilitation exercises

43
Q

Describe neurofibromatosis type 2

A

Autosomal dominant condition characterised by development of vestibular schwannomas - hearing loss/tinnitus/balance problems

44
Q

What cranial nerves are affected by vestibular schwannomas (acoustic neuromas) and what do they cause?

A
  • CN V = absent corneal reflex
  • CN VII = unilateral facial numbness
  • CN VIII = vertigo and unilateral hearing loss
45
Q

Describe stroke - posterior inferior cerebellar artery

A

a.k.a Wallenberg/lateral medullary syndrome

  • Ipsilateral loss of temperature sensation and facial pain
  • Contralateral limb/torso pain and temperature loss
  • Ataxia
  • Nystagmus
  • Ipsilateral Horner’s
46
Q

Describe stroke - anterior inferior cerebellar artery

A

a.k.a lateral pontine syndrome

  • Ipsilateral facial paralysis
  • Ipsilateral deafness
  • Ipsilateral loss of temperature sensation and facial pain
  • Contralateral limb/torso pain and temperature loss
  • Ataxia
  • Nystagmus
47
Q

Describe stroke - anterior cerebral artery

A
  • Contralateral hemiparesis and sensory loss
  • Lower extremities worse
  • Incontinence
  • Personality changes
48
Q

Describe stroke - middle cerebral artery

A
  • Contralateral hemiparesis and sensory loss
  • Upper extremities worse
  • Contralateral homonymous hemianopia
  • Aphasia
49
Q

Describe stroke - posterior communicating artery

A
  • Contralateral homonymous hemianopia with macular sparing
  • Visual agnosia
50
Q

Describe stroke - Weber’s syndrome (branches of posterior cerebral artery that supply midbrain)

A
  • Ipsilateral CN III palsy
  • Contralateral weakness
51
Q

Describe stroke - retinal/ophthalmic artery

A

Amaurosis fugax

52
Q

Describe stroke - basilar artery

A

Locked-in syndrome

53
Q

Describe stroke - lacunar

A
  • Associated with HTN
  • Basal ganglia/thalamus/internal capsule

-Isolated hemiparesis/hemisensory loss/hemiparesis with limb ataxia

54
Q

What is needed after a patient has a TIA?

A

Specialist referral within 24 hours for diffusion weighted MRI - show area of ischaemia but not infarction

55
Q

What eye symptoms would you see in each cranial nerve palsy?

A

Oculomotor (CN III) = eye deviates down and out/ptosis/dilated pupil

Trochlear (CN IV) = impaired downward gaze/vertical diplopia/eye deviates upwards and outwards

Abducens (CN VI) = impaired abduction/horizontal diplopia

56
Q

Where do homonymous quadrantanopias affect?

A

Inferior - parietal
Superior - temporal

57
Q

What side effects may be associated with antiparkinsonian medications?

A

Dopamine receptor agonists e.g. ropinirole/cabergoline = risk of inhibition disorders

58
Q

What are the types of multiple system atrophy and what are the features?

A

MSA-P (predominant parkinsonian features) and MSA-C (predominant cerebellar features)

  • Parkinsonism
  • Autonomic disturbance e.g. ED/postural hypotension/atonic bladder
  • Cerebellar signs
59
Q

What is a pontine haemorrhage and what are the clinical features?

A

Life-threatening condition that occurs as a complication secondary to chronic HTN

  • Reduced GCS score
  • Quadriplegia
  • Miosis
  • Absent horizontal eye movements
60
Q

What do the ulnar/median/radial nerve supply sensation to?

A

Ulnar = medial 1 1/2 fingers

Median = palmar aspect of thumb and lateral 2 1/2 fingers (and fingertips)

Radial = dorsal aspect of thumb and lateral 2 1/2 fingers

61
Q

What will a radial nerve palsy cause?

A

‘Saturday night palsy’ - wrist drop

62
Q

What is the common peroneal nerve also known as and what will a lesion cause?

A

Common fibular nerve - weakness of foot dorsiflexion and foot eversion

63
Q

If a patient suffers from foot drop and weak dorsiflexion, it may indicate there is spinal nerve root
compression of which nerve?

A

L5

64
Q

How can you differentiate between a seizure and a pseudoseizure?

A

Prolactin

65
Q

What is the Cushing reflex?

A

A physiological nervous system response to increased ICP

  • Bradycardia
  • Irregular breathing
  • Wide pulse pressure
66
Q

How might raised ICP be investigated?

A

Headache worsened by valsalva manoeuvres e.g. blowing into empty syringe/coughing/lying down –> CT head

67
Q

What is venous sinus thrombosis?

A

Thrombotic obstruction of cerebral veins and/or dural sinuses - thrombus reduces venous drainage and increases ICP –> headache, diplopia, nausea and seizures

68
Q

What is a common differential diagnosis for TIA?

A

Hypoglycaemia –> focal neurological symptoms (bilateral symptoms)

69
Q

What is Bell’s palsy and what is the management?

A

Acute, unilateral, idiopathic paralysis of facial nerve

Oral prednisolone within 72 hours (and eye care e.g. lubricating eye drops)

70
Q

What vessel is affected in extradural haematomas and what is the classic presentation?

A

Ruptured middle meningeal artery (temporal region)

  • Features of raised ICP
  • Initial brief loss of consciousness
  • Lucid interval
  • Second deterioration
71
Q

What vessel is affected in subdural haematomas and what is the classic presentation?

A

Ruptured bridging veins between cortex and venous sinuses (frontal or parietal lobes)

  • Slower onset of symptoms
  • Fluctuating consciousness/confusion
72
Q

What investigation can be done afterwards to confirm a subarachnoid haemorrhage and what will it show?

A

Lumbar puncture 12 hours after onset of symptoms

  • Breakdown products of RBCs e.g. bilirubin (xanthochromia)
  • Normal or raised opening pressure
73
Q

What is a common complication of subarachnoid haemorrhage?

A

SIADH –> hyponatraemia

74
Q

What haemorrhage is a common cause of neonatal deterioration?

A

Intraventricular haemorrhage

75
Q

What is Ramsay-Hunt syndrome and what are the clinical features?

A

Reactivation of VZV in geniculate ganglion
- Tinnitus
- Vertigo
- Facial paralysis
- Loss of taste
- Dry eyes

76
Q

What 6 things are checked to confirm brain death?

A
  • Pupillary reflex
  • Corneal reflex
  • Oculo-vestibular reflex
  • Cough reflex
  • Response to supra-orbital pressure
  • No spontaneous respiratory effort
77
Q

What is chiari malformation?

A

Herniation of cerebellar tonsils through foramen magnum - causes symptoms by compressing the brainstem

78
Q

What is chiari malformation associated with and what are the features?

A

Sryingomelia - dilation of CSF space within spinal cord due to disturbed CSF flow at foramen magnum

  • Loss of sensation of pain, temperature and non-discriminative touch
79
Q

What nerve is common affected by humeral shaft fractures and what does it cause?

A

Radial nerve - wrist drop

80
Q

What nerves are responsible for the biceps reflex?

A

C5-C6

81
Q

What are the features of trigeminal neuralgia and how does it differ from a common differential?

A

Sharp, unilateral, electric shock-like facial pain triggered by chewing or touching affected area on face - continuous throbbing, aching pain

Similar to temporal arteritis but this would have temporal artery tenderness

82
Q

What is the management for trigeminal neuralgia?

A

First line = carbamazepine

83
Q

What is the management for alcohol withdrawal?

A

Benzodiazepines e.g. chlordiazepoxide

BUT

give lorazepam in liver cirrhosis as it isn’t metabolised through liver-dependent oxidative pathways

84
Q

What is subacute degeneration of the spinal cord and what are the clinical features?

A

Caused by vitamin B12 deficiency which affects the lateral corticospinal tracts, dorsal column and spinocerebelllar tracts

  • Signs of peripheral neuropathy
  • Loss of proprioception, vibration and fine touch in legs
  • Spastic weakness in legs
  • Abnormal gait
  • Positive Romberg’s test
  • Absent ankle jerks/extensor plantars
85
Q

Describe the GCS

A

Eye response = /4
Verbal response = /5
Motor response = /6

Overall = /15

86
Q

Describe the GCS - eye response

A

4 = spontaneous
3 = to speech
2 = to pain
1 = none

87
Q

Describe the GCS - verbal response

A

5 = orientated
4 = confused
3 = words
2 = sounds
1 = none

88
Q

Describe the GCS - motor response

A

6 = obeys commands
5 = localises to pain
4 = withdraws from pain
3 = flexion to pain
2 = extension to pain
1 = none

89
Q

What is a common compliation of subarachnoid haemorrhages and what is the management?

A

Rebleeding of intracranial aneurysm –> aneurysm coiling

90
Q

What is Stevens-Johnson syndrome and what are the clinical features?

A

Skin/mucosa reaction to some medications e.g. lamotrigine/penicillin/NSAIDs

  • Maculopapular rash with vesicles or blisters
  • Systemic involvement
91
Q

What is diffuse axonal injury anwhat is the best investigation?

A

Occurs when the head is rapidly accelerated or decelerated
- Multiple haemorrhages
- Diffuse axonal damage in white matter

  • MRI
92
Q

What is an ataxic gait?

A
  • Wide-based gait
  • Inability to coordinator lower limbs to walk in heel-to-toe fashion
93
Q

What is pituitary apoplexy and what are the clinical features?

A

Sudden enlargement of pituitary tumour secondary to haemorrhage or infarction

  • Sudden onset headache
  • Vomiting
  • Neck stiffness
  • Visual field defects
  • Features of pituitary insufficiency e.g. hypotension
94
Q

What is Lambert-eaton syndrome associated with?

A

Small cell lung cancer

95
Q

What are the clinical features of Horner’s syndrome?

A

Unilateral:
- Anhidrosis
- Miosis
- Ptosis
- Enophthalmos

96
Q

What is mydriasis?

A

Opposite of miosis - dilated pupil

97
Q

What is the most common genetic mutation associated with Charcot-Marie-Tooth disease and what are the clinical features?

A

PMP22 dupplication

  • Foot drop
  • High arched feet
  • Distal muscle weakness/atrophy
  • Hyporeflexia
98
Q

Describe myotonic dystrophy

A
  • Typical onset 20-30
  • Affects skeletal, cardiac and smooth muscle
  • Autosomal dominant trinucleotide repeat disorder
  • Myotonic facies
  • Frontal balding
  • Bilateral ptosis
  • Cataracts
  • Dysarthria
99
Q

Describe Friedreich’s ataxia

A
  • Typical onset 10-15
  • Autosomal recessive trinucleotide repeat disorder
  • Absent ankle jerks/extensor plantars
  • Cerebellar ataxia
  • Optic atrophy
  • Spinocerebellar tract degeneration
100
Q

Describe benign paroxysmal positional vertigo

A
  • Vertigo triggered by change in head position
  • Investigation = Dix-Hallpike manoeuvre
  • Management = Epley manoeuvre (Brandt-Daroff exercises at home)
101
Q

Describe thoracic outlet syndrome

A
  • Nerves/blood vessels in thoracic outlet (space between collarbone and 1st rib) are compressed
  • Pain/numbness/tingling/weakness in arm
  • Adson’s test = radial pulse diminishes with head rotation and deep breathing

Phase 3a (21 decks)

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