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3A :0 > NeuroGerries > Flashcards

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.

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2
Q

what are teh symptoms of lewy body dementa

A

visual hallucinations, delusions, REM sleep disorders and fluctuating consciousness.

parkinsonsm

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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

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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

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5
Q

what are behavoural and psychologcal symptoms of dementa?

A
  • Depresson
  • Anxety
  • Agresson
  • Agtaton
  • Dsnhbton
  • Delusosn
  • Sleep dsturbalnce
  • Hallucnatons
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6
Q

medcaton for altzemers and th drug class

A
  • Donepezil and rivastgmne - acetylcholinesterase nhbtors
    Memantne - moderate to severe (bocs glutamate)
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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
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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

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9
Q

parkinson vs essental tremor Hz

A

parsnson - 3-5 hz
BET - -6-12

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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.

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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

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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

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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.

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14
Q

what s teh causes of anteror cord syndrome

A

normally a thromboss n teh anteror spnal artery

crush njury
vascultus
sevre hypotenton

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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

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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
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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

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18
Q

causes of menieres

A

excessive endolyph in teh labrynth cauing higher pressure and disruptin sensory signals - endolymphatic hydrope

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19
Q

treatments of menieres

A

prochlorperazine

antihistamines:
cyclizine
cinnarizine
promethazine

betahistine can be used as a prophylaxis

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20
Q

what s narcopelsy

A

rare condton where teh bran looses ts ablty to regulate sleep wae cyclees leadng to fallng asleep

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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

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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 -
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23
Q

test for narcolepsy

A

polysomopraphy
multiple sleep lateny test
CSF orexin levels

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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.
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25
Q

what are 5 mononeuropathys

A
  • 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
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26
Q

define neurodibroatosis

A

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.
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27
Q

preseantoian of neurofibromatosis

A
  • 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

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28
Q

complications of neurofibratomas

A
  • Migranes
  • Epilepsy
  • Retina artery stenosis
  • Learning disablity #
  • ADHD
    scoliosis of spine
  • Brain tumous
  • Gastrointestinal stromal tumour
    Malignanat nerve sheath tumours
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29
Q

featires, diadnosis snad treatment for noral pressure hydrocephalous

A

apraxia
incontinacne
dementi a

lumbar puncture - notnal pressure, if you take some off teh sypots shoudl improve

CSF - ventriculoperitonal shunt

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30
Q

casue and presenttion of a cavernous venous sinus thrombosis

A

infectio
acute sinusitis
prothrombotic ocndition

sharp severe headaceh
swelling and bulgign around eye
eye pain
fevr
headaceh wose on lying down
high temp
ptosis

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31
Q

tests and treatment fr cavsoub venosu snus thromboempblsm

A

FBC
contrast CT
contast MRI

antibiotics - high doese
cp amox and gentamicin
herparin
dexamethasone

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32
Q

what are teh dfferent types of spnal bfda

A

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

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33
Q

management of spinal bifida and compliacations

A

surgery

baby but in prone position and overed with saline dressifn
bracing

meningitis
pressure sores
urological involvemtns
hydrocephalus
PE
sepsis
epilepsy

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34
Q

defien labrytnthitis

A

inflamation of teh bony labrynth of teh ear. cna be caused yb bacterual infection secondary to otitis media or meningitis

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35
Q

key presentation of labrynthitis

A

acute onset vertigo
heraing loss
tinitus

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36
Q

management of labrynthitis

A
  • Same as vestibular neruoniris
  • Procholperazine
  • Antihistamines - cyclizine, promethazien
    Antiobiotics If baceriaal causes
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37
Q

what examination distinguishes between perioheral and central vertigo

A

HINTS

38
Q

what is uncal herniation and its symotons

A

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
Q

what is cusings triad

A

raised intercranial pressure

bradycrdia
respiratory depression
hypertention/widedned pulse pressure

40
Q

duchenes muscul\r dystrophy

A

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
Q

beckers musclar dystrophy

A

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
Q

myotonic muscualr dystrphy

A

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
Q

what medcaton for trgemonal neuralga

A

carbamazapne

44
Q

what scale s used to asses ndependance

A

barthels

45
Q

what are causes of fall

A
  • 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
Q

what questons do you need to as to a fall paten n gerres

A
  • Palpitation s
  • Dizziness
  • Loss of consciousness
  • Tounge biting
  • Incontinence
  • Head bang
  • Onset
  • Pervious episodes
  • Medications
  • Alchohol and drugs
    Injuries?
47
Q

investgatons for Falls

A
  • 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
Q

what are risk factors of malnutrton

A

hospitalsation
polypharmacy
social isolation
mentla health issues
cognitive issues - confusion

49
Q

what is the scoring system for malnutrition

A

MUST score - malnutrition universal screening tool

fortfied drnks can be prescrbed

50
Q

list non accidental injuries

A
  • 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
Q

what are teh rsk facotrs for pressure sores

A
  • Seirouly ill
  • Recent surgery
  • Underwriht
  • Swollen, sweaty or broken skin
  • Poor circulaion
  • Preblems feeling sensation or pain
  • Mobility issues
    Smoking
52
Q

wjat are teh treatmetns for pressure ulcers

A
  • 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
Q

what is teh most common skin cancer

A

Basal cell carcinoma
followed by squamous cell

54
Q

general assesmnet of skin lesion for cancer

A

ABCDE

Assymetry
boarder
Colour
diameter
evolution

55
Q

treatment for broken hip

A

intracapsular fracture - intenral fixation or hemiarthroplasty

extrcapsluar - non union is rare so dynamic hipscrem

56
Q

risk factor for hypothermia

A

secondary hypothermia - medical illness ower it
malnutrition
hypoglycaemia
vasodilation burns
trauma to CNS
Ms
parkinosns
medications

57
Q

key presentations of hypothermia

A

shivering
slurred speech
sloe resp rate
fatigue
legarthy
apathy
decreased consiocuness
cyanotic appearance
vital signs depressed

J wave on ECG

58
Q

managememt of hypothermai

A

warm humidified oxygen and warm blankets
warmed iV fluids
peritnoeal lavance
heamodialysis

59
Q

define hyperthermia and its symoms

A

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
Q

hyperactove vs hypoactve delerium

A

hyperactive - increased confusion
hallucinations ir delusions, sleep disturbance, being less co-operative

hypoactive -poor concentration, being less aware, reduced mobility, reduced appetitie

61
Q

causes of delerium

A

pain, infection, nutitoin, constipation, hydration, medication enviromental change

62
Q

treatments for delerium

A

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
Q

what scale s used for palliatve care assesment

A

karnofsky performance status - out of 100

64
Q

what are the signs of a patient dying

A
  • 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
Q

what are teh anticipatory medications

A

analgesia - morphine sulphate or oxycodone
antiemetic - haliperidol
ancitiolytic - midazolam
antisecretory - hyoscine butylbromide

66
Q

what are teh indications for a syringe driver

A

needing 2 or more doses in 24 hours

67
Q
A
68
Q

symptoms f MS

A

LOSS NB

Lhermitts sign
optic neuritis
spacicity
sensory symptms
nystagmus
bladder and sexual dysfunction

69
Q

guillian barre treatment

A

IV immunoglobulins
Plasam exchange

VTE -

70
Q

myasthenia gravis test

A

lumbar puncture
TENSILLION TEST - GIVE EDROPHONIUM (ACETYLCHONINESTERASE INHIBITOR) AND SEE IF TEHY IMPROVE

electormyograpy
CT /MRI of thymus to look for enlagrment

71
Q

what os teh criteria for MS diagnosis

A

mcdonald

2 CNS lesiosons disseminated in space and time

72
Q

treatment of lambert eaton

A

prednisolone
plasmapheresis
pryedistigmine

73
Q

sympoms of lambert eaton

A

GETS BETTER WITH USE

gait difficultie s
ptosis
lurred sleech
dysphagai
parasympathetic - urinaty, consipation, impotetncw, diziness and fatigue

74
Q

what is charcot marie tooth

A

group of inherited disase affecting peripheral motor and sensory nerves. teh sheah and erve itself can be affected
can be autosomal dominant

75
Q

charcot marie tooth [resentations

A

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
Q

treatment for bells palsy

A

prednsolone
lubrcatng eye drops

77
Q

treatment of MND

A

riluzole

78
Q

alcohol wothdrawl acute medication

A

chlordiapoxide!! - long acting benzodiazapine

79
Q

how long does neuroepileptic malignant syndrome take to come on and and what is teh path behind it

A

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
Q

signs of neuroepileptic sundroem

A
  • 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
Q

what are teh treatments for parkinsons

A

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
Q

alcohol wothdrawl medcatons

A

chordazapoxde - long term benzo for acue

disulfuram - makes alcohol dsgustng
acamprotase - less cravbngs
nalreoxoe - maes alcohol less enjoyable

83
Q

test for temporatl arteritis

A

ESR raised
temporal artery biopsy - skip lesions may be presant

84
Q

symptoms of temporal arteritis

A

> 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
Q

treatment of temporal arteritis

A

high dose pred if no vision loss

if vision loss - IV methylprednisolone

same dya opthamology review

oeteoporosis cover if longer term sterois

86
Q

diabetic neuropathy pain treatment

A

amitryptiline
gabapentin
pregalbli
duloxatine

tramadol
capsicin
pain management clinics

87
Q

cauda equina symotoms, investigations and management

A

leg pain
sciatica
reduced anal tone #
saddle parasthesisa
incontinanace

MRI

surgica deompression

88
Q

treatment of myasthenia gravis

A

pyridostigmine
prednisolone
thymectomy

acute:
plasmapheresis IVIg

89
Q

assocation to MG

A

thymic hyperplasia - CT of thorax
autoimmne disorders

90
Q

synotons of charcot marie tooth

A

pes cavus - high arch foot
champegne bottle legs
peripheral sensosry loss
weakness in hands and legs
reduced muscle tone and relfexes
foot drop!!!

91
Q

peripheral neuropathy causes

A

A-E
alcohol
B12 deficiancy
cancer and charcot marie tooth
diabeties and drgs - isoniziad
every vasculitis

92
Q
A

3A :0 (8 decks)

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