NeuroGerries Flashcards
1
Q
what s the pathologgy bednd altzemers
A
The underlying pathophysiology involves brain atrophy, amyloid plaques, neurofibrillary tangles of tau protien reduced cholinergic activity and neuroinflammation.
2
Q
what are teh symptoms of lewy body dementa
A
visual hallucinations, delusions, REM sleep disorders and fluctuating consciousness.
parkinsonsm
3
Q
frontotemporal dementa summary and presentaton
A
rarer type that notably affects people at a younger age (starting aged 40-60). It mainly affects the frontal and temporal lobes. The initial presentation typically involves abnormalities in behaviour, speech and language. It can be familial (inherited
4
Q
what are 4 scorng systens for dementa
A
MOCA - montreal cogntve assesment - out of 30, 26 and above is normal
ACE III - addenbrook cogntve examnaton - out of 100 below is bad
6-CIT
GPCOG
5
Q
what are behavoural and psychologcal symptoms of dementa?
A
- Depresson
- Anxety
- Agresson
- Agtaton
- Dsnhbton
- Delusosn
- Sleep dsturbalnce
- Hallucnatons
6
Q
medcaton for altzemers and th drug class
A
- Donepezil and rivastgmne - acetylcholinesterase nhbtors
Memantne - moderate to severe (bocs glutamate)
7
Q
treatment for BPSSD (behavourla and psychologcal symtpms of demena)
A
- Risperdone or halperdol
Coping stragerges - excercse anmal therapy, dancing, lots of sunlight, reasureance, worry beads, but down on alcool and caffne n the evenng
8
Q
dfferental dagnoss for dementa
A
- Medcatons with an anticholinergic affect
- Trcyclc antidepressants
- Depression
- Psychosis
- Delerm
- Bran tuour
- Oparnsosn dsease
- Hunntngtons dsease
- Hypothyrodsm
- Adrenal nsurfcancy
- Cushngs syndrome
- Hyperparathyodism
Thiamine and B12 deficiency
9
Q
parkinson vs essental tremor Hz
A
parsnson - 3-5 hz
BET - -6-12
10
Q
causes of cerebral palsy
A
antenatal - HSV, TORCH, ntrautrine stroke,
birth - hypoxic encephalopthic ischemia, shoulder dystocia, cor prolapse, maternal heamorage
Post - menngtts, trauma, sezures, kerncterus, hypoglycemia.
11
Q
causes of horners syndrome
A
MS
bran tuour
aprcla lung caner - pancost tuour
thyrod mass
caavernous snus thromboss
mgranses and cluster headacehs
trauma
nfecton
bleedng
12
Q
what are teh ascendng tracts and where do they decussate
A
Spinothalamic (also known as anterolateral)
- Anterior - crude touch and pressure
- Lateral - temperature and pain
Decussate in the spinal cord - 1-2 levels about entering!!
DCML - (made up of cuneurs and gracilis)
Fine touch and proprioception
Decussate in the medulla
13
Q
what are teh descendng tracts and where do they decussate
A
Pyramidal tracts
From the cerebral cortex, responsible or voluntary control of body musculature . Ths can furtehr be dvded nto cortcospnla and cortcobulbar .
80% of frbres decussate at the medulla.
Extrapyramidal tracts
From the bran stem carrg nvoluntatry and autonmc muscle controll sch as tone balance posture and locomoton
DOES NOT DECUSSATE.
14
Q
what s teh causes of anteror cord syndrome
A
normally a thromboss n teh anteror spnal artery
crush njury
vascultus
sevre hypotenton
15
Q
ey presentton of anteror cord syndrome
A
imparemtns n pain and temp senssaton (spino thalamc)
propriocepton and fine touch preserved (DCML preserved)
motor impacted
- Impairments in pain and temperature sensation, vibration and proprioception are preserved
- Bilateral Motor deficits at and below the level of injury
- flaccid paraplegia or tetraplegia below the lesion.
- Flaccidity and absent reflexes, reflexes gradually return
- Acute back pain at the level of the injury
- Temp and pain sensation alteration 2-3 segments bowel injury
Sudden loss of muscle strength and movement controll
16
Q
tets and treat,ent for antior cord syndrome
A
- MRI - pencil like hyper intenseties
- Lumbar puncture
- Anticoagulants
- Antiplatelets and thromboprophylaxis
- Fever and glycemic control help
17
Q
symptoms to menieres
A
triad: vertigo, hearing loss, tinnitus
feelings of fullness in ear
40-50 yrs old
can comein lusters with long breaks
imbalance
spntanous nystagmus attacks
unexpkained falls withouth LOC
imbalance
18
Q
causes of menieres
A
excessive endolyph in teh labrynth cauing higher pressure and disruptin sensory signals - endolymphatic hydrope
19
Q
treatments of menieres
A
prochlorperazine
antihistamines:
cyclizine
cinnarizine
promethazine
betahistine can be used as a prophylaxis
20
Q
what s narcopelsy
A
rare condton where teh bran looses ts ablty to regulate sleep wae cyclees leadng to fallng asleep
21
Q
what s cataplexy
A
Cataplexy is a sudden loss of muscle tone and power in response to strong emotion - it always and only occurs as part of narcolepsy .
there s a loss of orexn
22
Q
key presentatons of narcolepsy
A
- Excessive daytime sleepiness
- Disrupted nighttime dreams
- Cataplexy - collapse causes my muscle atonia in response to sudden emotion such as laughter or surprise
- Hypangoic hallucination - dream like hallucinations
Sleep paralysis - * Excessive daytime sleepiness - Disrupted nighttime dreams
- Cataplexy - collapse causes my muscle atonia in response to sudden emotion such as laughter or surprise
- Hypangoic hallucination - dream like hallucinations
Sleep paralysis -
23
Q
test for narcolepsy
A
polysomopraphy
multiple sleep lateny test
CSF orexin levels
24
Q
treatment for narcolepsy
A
- Good sleep hygine
- Scheduled naps
- Monadinil, dexamphetamine, methylphenidate, and pitolisant.
- Antidepressants for calaplexy (chloipramins, SSRI, venlfaxin
Sodium oxybate: potent sedative: improves nocturnal sleep quality, EDS, and cataplexy.
25
what are 5 mononeuropathys
* Median - loss of precision grip and sensory loss over radial 3 and a half fingers
* Ulnar - cannot cross over fingers. Elbow trauma s the cause
* Radial nerve - wrist and finger drop. Inability to open the fist
* Brachial plexus - weakness and paraesthesia in the arm - trauma, radiotherapy, long heavy rucksack wearing
Common peroneal - foot drop sensory loss over dorsum of the foot
26
define neurodibroatosis
Genetic condistion where benign neuromas developthougout the nervous system. They can causes neurologicla and structural problems. Type 1 was is more common than 2.
* Type 1 is found on chromosone 17 and is autosomal domminant. It codes for neurobibromin woch is a tumous surpressor protien.
* Type 2 is chromonsone 22 for the protien called merlin, a tumour surpressor cell important in schwann cells. Particularly associated with acoustic neuromas.
27
preseantoian of neurofibromatosis
* Café au lait spots
* Relatve with NF1
* Auxllery freelng
* Bony dyspalsa (bowing of long bones)
* Iris hamartomas (yellow spots on iris)
* neurofibromas
Glioma of the optic pathway
bilateral acoustic neuromas is nearly always type 2
28
complications of neurofibratomas
* Migranes
* Epilepsy
* Retina artery stenosis
* Learning disablity #
* ADHD
scoliosis of spine
* Brain tumous
* Gastrointestinal stromal tumour
Malignanat nerve sheath tumours
29
featires, diadnosis snad treatment for noral pressure hydrocephalous
apraxia
incontinacne
dementi a
lumbar puncture - notnal pressure, if you take some off teh sypots shoudl improve
CSF - ventriculoperitonal shunt
30
casue and presenttion of a cavernous venous sinus thrombosis
infectio
acute sinusitis
prothrombotic ocndition
sharp severe headaceh
swelling and bulgign around eye
eye pain
fevr
headaceh wose on lying down
high temp
ptosis
31
tests and treatment fr cavsoub venosu snus thromboempblsm
FBC
contrast CT
contast MRI
antibiotics - high doese
cp amox and gentamicin
herparin
dexamethasone
32
what are teh dfferent types of spnal bfda
occulta - some of teh vertebra not completely closed
menngocele - protruson of teh meningies and CSF through teh spine
myelomeningiocele - open spinla cord - potrusion of nerves outside
33
management of spinal bifida and compliacations
surgery
baby but in prone position and overed with saline dressifn
bracing
meningitis
pressure sores
urological involvemtns
hydrocephalus
PE
sepsis
epilepsy
34
defien labrytnthitis
inflamation of teh bony labrynth of teh ear. cna be caused yb bacterual infection secondary to otitis media or meningitis
35
key presentation of labrynthitis
acute onset vertigo
heraing loss
tinitus
36
management of labrynthitis
* Same as vestibular neruoniris
* Procholperazine
* Antihistamines - cyclizine, promethazien
Antiobiotics If baceriaal causes
37
what examination distinguishes between perioheral and central vertigo
HINTS
38
what is uncal herniation and its symotons
raised intercranial presure causes part of ethbrian to slide down
causes headache, ausea, confutision,
compressios of cranial never 3 - papilloedema, down and out eye, loss of counsioousness.
39
what is cusings triad
raised intercranial pressure
bradycrdia
respiratory depression
hypertention/widedned pulse pressure
40
duchenes muscul\r dystrophy
Duchenne's
* Defective dystrophin on x chromosone
* Presents aoru 3-5 yeasr wth weaness n muscels about the pelvis
* Progressive untill all muscles are affected
* Wheelchair bound by the me theyr are a teenager
* 25-35 years prognosis
* Oral steroids can slow progression
* Creatine can inporve muscle strength
41
beckers musclar dystrophy
Beckers
* Dytrophin agau s affceted but less sever;y
* Less predicatable than duchenes
* Symptoms start at 8-12 years
* Require wheelchair at 20-30s
* Able to walk with assistance
42
myotonic muscualr dystrphy
Myotonic dystrophy
* Genetic condition that presents in adulthood
* Progressive muscles weakness
* Prolonged muscle contractions - unable to let go after shaking your hand
* Cateracts
* Cardiac arrhythmias
43
what medcaton for trgemonal neuralga
carbamazapne
44
what scale s used to asses ndependance
barthels
45
what are causes of fall
* Cardiac - arrhythmias
* Neurological seizure, stroke, peripheral neuropathy
* Vasovagal
* Intoxication/alcohol/medication
* Benign paroxysmal positional vertigo
* Infection - resp or urinary
* Environmental - poor lighting/ uneven surface
Mechanical fall
46
what questons do you need to as to a fall paten n gerres
* Palpitation s
* Dizziness
* Loss of consciousness
* Tounge biting
* Incontinence
* Head bang
* Onset
* Pervious episodes
* Medications
* Alchohol and drugs
Injuries?
47
investgatons for Falls
* Cardio and resp examination
* GALS
* ECG
* Lying and standing BP
* Urine dipstic
* Neuro observations - every 15 mins for an hour, every 30 mins for 2 hours, every hour for 2 hours
* U and e - dehydration
* CRP and WCC - infection
* CK - rhabdomyolysis
* X rays
* CT/MRI head potentially
ACTH test for postural hypertention secondary to adrenal insurficancy
48
what are risk factors of malnutrton
hospitalsation
polypharmacy
social isolation
mentla health issues
cognitive issues - confusion
49
what is the scoring system for malnutrition
MUST score - malnutrition universal screening tool
fortfied drnks can be prescrbed
50
list non accidental injuries
* Metaphyseal fractue (bucket handel fracture)
* Rib fractures - particualrly posterior ribs
* Skull fractre - depressed fracture, non pariatal fractre
* Scapular fractures
* Sternal fractures
* Outer third clavicle fracutres
Shoulder dislocation
51
what are teh rsk facotrs for pressure sores
* Seirouly ill
* Recent surgery
* Underwriht
* Swollen, sweaty or broken skin
* Poor circulaion
* Preblems feeling sensation or pain
* Mobility issues
Smoking
52
wjat are teh treatmetns for pressure ulcers
* Hydrocolloid dressing - gel that enourages new skin growth aroud the ulcer
* Alginate dression - seweed, speeds upteh healing
Dietry supplenent - protien, zinc, vitamin C to help accelerate the wound healing
debridement:
ultrasodn
laser
surgical
maggot
53
what is teh most common skin cancer
Basal cell carcinoma
followed by squamous cell
54
general assesmnet of skin lesion for cancer
ABCDE
Assymetry
boarder
Colour
diameter
evolution
55
treatment for broken hip
intracapsular fracture - intenral fixation or hemiarthroplasty
extrcapsluar - non union is rare so dynamic hipscrem
56
risk factor for hypothermia
secondary hypothermia - medical illness ower it
malnutrition
hypoglycaemia
vasodilation burns
trauma to CNS
Ms
parkinosns
medications
57
key presentations of hypothermia
shivering
slurred speech
sloe resp rate
fatigue
legarthy
apathy
decreased consiocuness
cyanotic appearance
vital signs depressed
J wave on ECG
58
managememt of hypothermai
warm humidified oxygen and warm blankets
warmed iV fluids
peritnoeal lavance
heamodialysis
59
define hyperthermia and its symoms
medical emergacy where core body temperature is over 40 degrees
heat exhaustion is mild to moderate
slightly elevated temperature with mild neurological symptoms such as thirst, weakness, dizziness, syncope
60
hyperactove vs hypoactve delerium
hyperactive - increased confusion
hallucinations ir delusions, sleep disturbance, being less co-operative
hypoactive -poor concentration, being less aware, reduced mobility, reduced appetitie
61
causes of delerium
pain, infection, nutitoin, constipation, hydration, medication enviromental change
62
treatments for delerium
haloperidol or loraapam or agitation
mminimise sensor defecits
continuity of caregivers
clocks and calanders to imoorve ortiantation
personal itetms and phtograpsh
DONT - catheterise, oiverstumulare, oversedate
63
what scale s used for palliatve care assesment
karnofsky performance status - out of 100
64
what are the signs of a patient dying
* sleeping more than 50% of the day
* Feeling tired when awake
* Eating and drinking less - loosing appetite
* Getting out of bed less or not atall
Small activities use up the majority of their energy
65
what are teh anticipatory medications
analgesia - morphine sulphate or oxycodone
antiemetic - haliperidol
ancitiolytic - midazolam
antisecretory - hyoscine butylbromide
66
what are teh indications for a syringe driver
needing 2 or more doses in 24 hours
67
68
symptoms f MS
LOSS NB
Lhermitts sign
optic neuritis
spacicity
sensory symptms
nystagmus
bladder and sexual dysfunction
69
guillian barre treatment
IV immunoglobulins
Plasam exchange
VTE -
70
myasthenia gravis test
lumbar puncture
TENSILLION TEST - GIVE EDROPHONIUM (ACETYLCHONINESTERASE INHIBITOR) AND SEE IF TEHY IMPROVE
electormyograpy
CT /MRI of thymus to look for enlagrment
71
what os teh criteria for MS diagnosis
2 CNS lesiosons disseminated in space and time
#mcdonald
72
treatment of lambert eaton
prednisolone
plasmapheresis
pryedistigmine
73
sympoms of lambert eaton
GETS BETTER WITH USE
gait difficultie s
ptosis
lurred sleech
dysphagai
parasympathetic - urinaty, consipation, impotetncw, diziness and fatigue
74
what is charcot marie tooth
group of inherited disase affecting peripheral motor and sensory nerves. teh sheah and erve itself can be affected
can be autosomal dominant
75
charcot marie tooth [resentations
Pes cavus
Hammer toes
Claw hand
Thickened palpable nerves
* Redued muscle tone
* Peripheral sensry loss
* Tinglilign and birnig sensation in hands and feet
* Neuropathic pain
Tinelging in hadns and feet
76
treatment for bells palsy
prednsolone
lubrcatng eye drops
77
treatment of MND
riluzole
78
alcohol wothdrawl acute medication
chlordiapoxide!! - long acting benzodiazapine
79
how long does neuroepileptic malignant syndrome take to come on and and what is teh path behind it
Antipsychotics - tyicla especially
4-14 days withtin staring antisphchotic
dopamine D2 receptor antagonism:
Dopamine D2 receptor blockade: This blocks the dopamine receptors in the brain, which can lead to:
Muscle rigidity: This occurs in the nigrostriatal pathways and spinal cord
Hyperthermia: This occurs in the hypothalamus, where the dopamine receptors are blocked, and the body's heat-dissipating mechanisms are impaired
Mental status changes: This occurs due to autonomic nervous system dysregulation
80
signs of neuroepileptic sundroem
* Alted mental state
* Rigidity
* Fever
* Dysautonomia - leading to hyperthermia
* Rigidity
* Delerium
* Fluctuation bp
* Tachycardiac
* Fever
* Sweating
* Extrapyramidal side effects
* Creatin kinase - very high
First 2 weeks of stating antipschotics
81
what are teh treatments for parkinsons
LDOPA and perpheral decarboxylase nhbtor - (cobenladopa - madopa) (co-careledopa - sinemet)
dopamne agonsts - bromocrptne cabergolne
monoamne oxdase B nhbtor - seleglne rasaglne
catchecl o methytransferase enzyme - etacapone . ths slows down the breadown of ldopa n the bran
82
alcohol wothdrawl medcatons
chordazapoxde - long term benzo for acue
disulfuram - makes alcohol dsgustng
acamprotase - less cravbngs
nalreoxoe - maes alcohol less enjoyable
83
test for temporatl arteritis
ESR raised
temporal artery biopsy - skip lesions may be presant
84
symptoms of temporal arteritis
>60
rapid onset
headaceh
jaw claudiaction
visual loss.blurring
tender palpable artery
LINKED WITH POLYMYALGIA RHEUMATICA!!
mornign stifness
muscles ahcin
legarthy, depression, low grade fever, night sweats
85
treatment of temporal arteritis
high dose pred if no vision loss
if vision loss - IV methylprednisolone
same dya opthamology review
oeteoporosis cover if longer term sterois
86
diabetic neuropathy pain treatment
amitryptiline
gabapentin
pregalbli
duloxatine
tramadol
capsicin
pain management clinics
87
cauda equina symotoms, investigations and management
leg pain
sciatica
reduced anal tone #
saddle parasthesisa
incontinanace
MRI
surgica deompression
88
treatment of myasthenia gravis
pyridostigmine
prednisolone
thymectomy
acute:
plasmapheresis IVIg
89
assocation to MG
thymic hyperplasia - CT of thorax
autoimmne disorders
90
synotons of charcot marie tooth
pes cavus - high arch foot
champegne bottle legs
peripheral sensosry loss
weakness in hands and legs
reduced muscle tone and relfexes
foot drop!!!
91
peripheral neuropathy causes
A-E
alcohol
B12 deficiancy
cancer and charcot marie tooth
diabeties and drgs - isoniziad
every vasculitis
92
