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Stage 3: FOCP > Neuro week: emergencies, scenarios > Flashcards

Neuro week: emergencies, scenarios Flashcards

1
Q

DIFFERENTIAL DIAGNOSES

  • ascending peripheral polyneuropathy
  • muscle atrophy
A

Guillain Barre

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2
Q

Cause of neuropathy

  • ascending
  • descending
A
  • ascending: Guillain Barre

- descending: botulism

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3
Q

Which part of nervous system does B12 deficiency usually affect

A

Dorsal columns

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4
Q

What is Ramsey Hunt syndrome

A

Shingles (HZV) affecting facial nerve

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5
Q

Range of GCS score

A

3 to 15

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6
Q

Movement ranking in GCS

A 
6 = Follows commands
5 = Localises to pain
4 = Withdraws from pain (but not at exact point eg squirming away)
3 = Flexion response to pain
2 = Extension response to pain
1 = No response
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7
Q

Verbal ranking in GCS

A 
5 = Appropriate speech
4 = Confused speech
3 = Inappropriate speech
2 = Groans
1 = Nothing
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8
Q

Eye movements ranking in GCS

A 
4 = Spontaneous
3 = Opens eyes to voice
2 = Opens eyes to pain
1 = Nothing
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9
Q

Classical Meningitis triad

A
  1. Headache
  2. Fever
  3. Neck stiffness
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10
Q

Describe Kernig’s

A
  • flex hip to 90degrees, passively extend knee

- stretches meninges, causes neck pain

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11
Q

Describe Brudzinski

A
  • passively flex neck

- causes involuntary hip flexion

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12
Q

How is bacterial meningitis treated

  • in community
  • in hospital
A

Community: IV/IM benzyl-penicillin

Hospital: IV 3rd gen cephalosporin

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13
Q

WHICH TYPE OF MENINGITIS

  • elevated neutrophils (polymorphs)
  • lymphocytes lower than neutrophils
  • high protein
  • low glucose
A

Bacterial

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14
Q

WHICH TYPE OF MENINGITIS

  • elevated neutrophils (polymorphs)
  • elevated lymphocytes
  • high protein
  • low glucose
A

Fungal/ TB

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15
Q

WHICH TYPE OF MENINGITIS

  • slightly elevated neutrophils (polymorphs)
  • elevated lymphocytes
  • normal protein
  • normal glucose
A

Viral

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16
Q

Most important complication of temporal arteritis

A

Irreversible blindness

17
Q

Which CN are affected when a pt presents with the following

What’s the diagnosis

  • Diplopia on R lateral gaze yesterday, now cannot move eye
  • R eyelid drooping
  • R eye looks oedematous
  • R ptosis, mydriasis (dilated pupil)
  • R eye down & out
  • Decreased sensation R forehead
A

CN 3, 5 opthalmic branch, 6 affected

Diagnosis: cavernosus sinus thrombosis

18
Q

What is considered low glucose in CSF

A

Less than 30% of serum level glucose

19
Q

Explain the pathology in spondylosis

A
  • Constant abnormal pressure from joint subluxation, sports, poor posture
  • Narrowing of 2 adjacent vertebrae, resulting in compression of nerve root
20
Q

Radiculopathy (pinched nerve) symptoms in spondylosis

A
  • Severe pain in neck, shoulder, arm, back, leg
  • muscle weakness
  • paresthesia
21
Q

Myelopathy (spinal cord injury symptoms in spondylosis)

A
  • Global weakness
  • gait dysfunction
  • loss of balance
  • loss of bladder/ bowel control
22
Q

Pathophysiology of myasthenia gravis

A

Antibodies destroy nicotinic Ach receptors at NMJ

prevents nerve impulses from triggering muscle contractions

23
Q

Common first symptoms of myasthenia gravis

A

Eye related symptoms

Ptosis, diplopia

24
Q

Pattern of weakness with myasthenia gravis

A

Worsens during exertion, improves after rest

25
Q

How is myasthenia gravis treated

A

Ach-esterase inhibitors

26
Q

Most common viral cause of

  • meningitis
  • encephalitis
A

Meningitis: enterovirus
Encephalitis: HSV

27
Q

Differentiate symptoms of meningitis vs encephalitis

A

Meningitis has more severe flu like symptoms.
Encephalitis has more mild symptoms.

Focal neurological symptoms are more likely to be encephalitis than meningitis

28
Q

Why do you look for BILIRUBIN in lumbar puncture to diagnose SAH

A

Bilirubin is sign of broken down RBC. Use it to check how long blood cells have been in CSF

29
Q

Where is lumbar puncture performed

A

L4/5

30
Q

Contraindications for lumbar puncture

A
  • Signs of raised ICP (acute seizure, papilloedema, focal signs)
  • immunocompromised
  • coagulopathy
  • trauma/infection at site of needle insertion

Stage 3: FOCP (47 decks)

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