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Phase 3a - Geriatrics > Neurological > Flashcards

Neurological Flashcards

1
Q

Define stroke.

A

Stroke is a neurological emergency caused by an interruption of blood supply to the brain, leading to cell death.

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2
Q

Stroke is the ______ leading cause of death globally.

A

Second.

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3
Q

True/False: Ischaemic strokes account for 85% of all strokes.

A

true

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4
Q

What are the two main types of stroke?

A

Ischaemic stroke and haemorrhagic stroke.

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5
Q

Haemorrhagic strokes are caused by ______ or ______.

A

Intracerebral haemorrhage; subarachnoid haemorrhage.

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6
Q

True/False: A transient ischaemic attack (TIA) is considered a mini-stroke.

A

true

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7
Q

List three modifiable risk factors for stroke.

A

Hypertension, diabetes mellitus, smoking.

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8
Q

Non-modifiable risk factors for stroke include ______, gender, and family history.

A

Age.

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9
Q

True/False: Atrial fibrillation significantly increases the risk of ischaemic stroke.

A

true

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10
Q

What is the acronym used to recognize stroke symptoms?

A

FAST: Face drooping, Arm weakness, Speech difficulties, Time to call emergency services.

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11
Q

Sudden onset of unilateral weakness, sensory loss, or ______ are common features of stroke.

A

Visual disturbance.

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12
Q

True/False: Aphasia is more common in strokes affecting the left hemisphere.

A

true

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13
Q

What is the first-line imaging modality for suspected stroke?

A

Non-contrast CT scan.

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14
Q

MRI is more sensitive than CT for detecting ______ stroke.

A

Ischaemic.

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15
Q

True/False: Carotid Doppler ultrasound is used to assess stenosis in the carotid arteries.

A

true

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16
Q

What is the first-line treatment for acute ischaemic stroke within 4.5 hours of symptom onset?

A

Thrombolysis with alteplase.

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17
Q

Mechanical ______ may be performed for large vessel occlusion strokes.

A

Thrombectomy.

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18
Q

True/False: Antiplatelet therapy, such as aspirin, is started immediately after thrombolysis.

A

False. It is started 24 hours after thrombolysis.

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19
Q

What is the immediate goal in managing haemorrhagic stroke?

A

Lowering blood pressure and managing intracranial pressure.

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20
Q

______ is used to reverse anticoagulation in haemorrhagic stroke patients.

A

Vitamin K or prothrombin complex concentrate.

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21
Q

True/False: Surgery is rarely needed for haemorrhagic strokes.

A

False. Surgery may be needed to evacuate haematomas.

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22
Q

Name three measures for secondary prevention of stroke.

A

Antiplatelet therapy, anticoagulation for atrial fibrillation, and lifestyle modifications.

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23
Q

Statins are recommended for patients with a history of ______ stroke.

A

Ischaemic.

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24
Q

True/False: Blood pressure control is crucial in preventing recurrent strokes.

A

true

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25
Q

List two common complications following a stroke.

A

Dysphagia and post-stroke depression.

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26
Q

Post-stroke ______ is a condition characterized by loss of motor function on one side of the body.

A

Hemiplegia.

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27
Q

True/False: Seizures can occur as a late complication of stroke.

A

true

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28
Q

What is the primary feature of frontotemporal dementia (FTD)?

A

Early-onset dementia with predominant changes in behavior and language.

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29
Q

Name two clinical variants of frontotemporal dementia.

A

Behavioral variant FTD and Primary Progressive Aphasia (PPA).

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30
Q

What are common behavioral symptoms of frontotemporal dementia?

A

Apathy, disinhibition, compulsive behavior, and loss of empathy.

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31
Q

What are the key language deficits in Primary Progressive Aphasia (PPA)?

A

Difficulty with speech production, comprehension, or naming objects.

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32
Q

What genetic mutations are associated with FTD?

A

Mutations in the MAPT, GRN, or C9ORF72 genes.

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33
Q

What imaging findings are typical in frontotemporal dementia?

A

Atrophy of the frontal and/or temporal lobes on MRI.

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34
Q

What is the prognosis of frontotemporal dementia?

A

Progressive with an average survival of 8-10 years from symptom onset.

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35
Q

How is frontotemporal dementia managed?

A

Symptom-focused management with support for patients and caregivers.

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36
Q

T/F: Frontotemporal dementia primarily affects memory in the early stages.

A

False – it primarily affects behavior and language.

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37
Q

T/F:Frontotemporal dementia is the most common dementia in individuals under 60.

A

true

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38
Q

T/F:Cognitive behavioral therapy is the mainstay treatment for FTD.

A

False – there is no curative treatment; management focuses on symptoms.

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39
Q

T/F:Behavioral variant FTD is often misdiagnosed as a psychiatric disorder.

A

true

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40
Q

Frontotemporal dementia is often associated with __________ and __________ mutations.

A

MAPT; C9ORF72.

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41
Q

The two main variants of frontotemporal dementia are __________ and __________.

A

Behavioral variant FTD; Primary Progressive Aphasia.

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42
Q

Neuroimaging of FTD shows __________ lobe atrophy and sometimes __________ lobe involvement.

A

Frontal; temporal.

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43
Q

What is the role of multidisciplinary teams in FTD management?

A

To provide comprehensive care addressing behavioral, cognitive, and caregiver needs

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44
Q

Why is early diagnosis important in FTD?

A

To initiate symptom management and provide family counseling.

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45
Q

How does FTD differ from Alzheimer’s Disease?

A

FTD has early behavioral and language changes, while Alzheimer’s typically starts with memory loss.

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46
Q

What is vascular dementia?

A

A type of dementia caused by reduced blood flow to the brain, leading to cognitive decline due to ischemic or hemorrhagic brain damage.

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47
Q

What are common risk factors for vascular dementia?

A

Hypertension, diabetes, smoking, hyperlipidemia, atrial fibrillation, and a history of stroke or transient ischemic attacks (TIAs).

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48
Q

Vascular dementia is primarily caused by _________ blood flow to the brain.

A

Reduced

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49
Q

A history of __________ or transient ischemic attacks increases the risk of vascular dementia.

A

Stroke

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50
Q

True or False: Vascular dementia is the most common type of dementia.

A

False (It’s the second most common after Alzheimer’s disease).

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51
Q

True or False: Cognitive impairment in vascular dementia is always sudden.

A

False (It can develop suddenly or progress gradually depending on the underlying pathology).

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52
Q

What diagnostic tests are commonly used to identify vascular dementia?

A

MRI or CT imaging to detect vascular damage, cognitive tests like the MMSE, and assessing cardiovascular risk factors.

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53
Q

What findings on imaging might support a diagnosis of vascular dementia?

A

Evidence of multiple infarcts, white matter changes, or lacunar infarcts.

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54
Q

How is vascular dementia managed?

A

Managing underlying risk factors (e.g., controlling blood pressure, glucose lipids), antiplatelet therapy if indicated, and cognitive rehabilitation.

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55
Q

Which lifestyle changes are recommended for vascular dementia prevention and management?

A

Smoking cessation, regular exercise, a healthy diet, and managing hypertension and diabetes.

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56
Q

True or False: Vascular dementia has a slower progression compared to Alzheimer’s disease.

A

False (It often progresses in a stepwise manner due to repeated vascular events).

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57
Q

What is Alzheimer’s disease?

A

A progressive neurodegenerative disorder characterized by memory loss, cognitive decline, and behavioral changes, caused by abnormal accumulation of beta-amyloid plaques and neurofibrillary tangles.

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58
Q

What are common early symptoms of Alzheimer’s disease?

A

Short-term memory loss, difficulty finding words, misplacing items, and subtle personality changes.

59
Q

Which protein accumulates in the brain in Alzheimer’s disease?

A

Beta-amyloid plaques and tau protein tangles.

60
Q

What are the risk factors for Alzheimer’s disease?

A

Advancing age, family history, Down syndrome, APOE ε4 allele, cardiovascular disease, and a history of head trauma.

61
Q

True or False: Alzheimer’s disease accounts for about 60-80% of all dementia cases.

A

true

62
Q

True or False: Alzheimer’s disease is reversible if diagnosed early.

A

False (It is a progressive and irreversible disease).

63
Q

True or False: The APOE ε4 allele is associated with an increased risk of Alzheimer’s disease.

A

true

64
Q

Alzheimer’s disease is caused by abnormal accumulation of _________ plaques and __________ tangles in the brain.

A

beta-amyloid; tau protein.

65
Q

The main neurotransmitter affected in Alzheimer’s disease is __________.

A

acetylcholine.

66
Q

Alzheimer’s disease primarily affects the ___________ lobe early in the disease.

A

temporal.

67
Q

What cognitive tests are commonly used to assess Alzheimer’s disease?

A

Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Addenbrooke’s Cognitive Examination (ACE-III).

68
Q

What imaging findings support a diagnosis of Alzheimer’s disease?

A

MRI or CT showing hippocampal atrophy; PET scans showing hypometabolism in the temporal and parietal lobes.

69
Q

What pharmacological treatments are available for Alzheimer’s disease?

A

Acetylcholinesterase inhibitors: Donepezil, Rivastigmine, Galantamine.
NMDA receptor antagonist: Memantine (moderate to severe cases).

70
Q

True or False: Pharmacological treatment can cure Alzheimer’s disease.

A

False (Treatment can slow progression and manage symptoms but is not curative)

71
Q

What non-pharmacological interventions are recommended for Alzheimer’s disease?

A

Cognitive stimulation therapy, occupational therapy, caregiver support, and lifestyle modifications (e.g., regular exercise, social engagement).

72
Q

True or False: Alzheimer’s disease progresses more rapidly in younger patients.

A

true

73
Q

What is the average life expectancy after an Alzheimer’s diagnosis?

A

8-10 years, but it can vary widely depending on the age of onset and comorbidities.

74
Q

What is Lewy Body Dementia (LBD)?

A

A progressive neurodegenerative disorder characterized by the presence of Lewy bodies in the brain, causing cognitive decline, parkinsonism, visual hallucinations, and fluctuating cognition.

75
Q

What are Lewy bodies?

A

Abnormal aggregates of alpha-synuclein protein found in the brain, particularly in LBD and Parkinson’s disease.

76
Q

What are the core clinical features of Lewy Body Dementia?

A

Cognitive fluctuations.
Visual hallucinations.
Parkinsonism (bradykinesia, rigidity, tremor).

77
Q

How does Lewy Body Dementia differ from Alzheimer’s disease?

A

LBD presents with prominent visual hallucinations, fluctuating cognition, and motor symptoms early in the disease course, unlike Alzheimer’s.

78
Q

True or False: Lewy Body Dementia commonly coexists with Parkinson’s disease.

A

true

79
Q

True or False: Memory impairment is an early and dominant feature of Lewy Body Dementia.

A

False (Early symptoms include visual hallucinations and motor symptoms, with memory impairment occurring later).

80
Q

True or False: Neuroleptic sensitivity is a hallmark feature of Lewy Body Dementia.

A

true

81
Q

Lewy Body Dementia is associated with abnormal aggregation of the __________ protein.

A

alpha-synuclein.

82
Q

Common neuropsychiatric symptoms in Lewy Body Dementia include __________ and __________.

A

hallucinations; delusions.

83
Q

Lewy Body Dementia is characterized by cognitive __________, which involves periods of good and poor cognitive function.

A

fluctuations.

84
Q

What imaging techniques are used in diagnosing Lewy Body Dementia?

A

MRI: To rule out other causes of dementia.
DaTSCAN: Demonstrates reduced dopamine transporter activity.

85
Q

True or False: Definitive diagnosis of Lewy Body Dementia requires post-mortem examination.

A

true

86
Q

DaTSCAN imaging in Lewy Body Dementia reveals __________ dopamine transporter uptake.

A

Reduced

87
Q

What is the mainstay of pharmacological management for Lewy Body Dementia?

A

Acetylcholinesterase inhibitors (e.g., rivastigmine) for cognitive symptoms.

88
Q

Why must antipsychotics be used cautiously in Lewy Body Dementia?

A

Neuroleptic sensitivity can cause severe side effects, including worsening of motor symptoms or neuroleptic malignant syndrome.

89
Q

What medications can help manage parkinsonian symptoms in LBD?

A

Levodopa, though it may worsen hallucinations or psychosis.

90
Q

What is the typical prognosis of Lewy Body Dementia?

A

Progressive cognitive and motor decline, with an average life expectancy of 5–8 years after diagnosis.

91
Q

True or False: Lewy Body Dementia progresses faster than Alzheimer’s disease.

A

true

92
Q

What is Parkinson’s Disease?

A

A progressive neurodegenerative disorder caused by the loss of dopaminergic neurons in the substantia nigra.

93
Q

List the cardinal motor features of Parkinson’s Disease.

A

Bradykinesia, resting tremor, rigidity, postural instability

94
Q

What is the pathophysiology of Parkinson’s Disease?

A

Degeneration of dopaminergic neurons in the substantia nigra leading to a deficiency of dopamine in the basal ganglia.

95
Q

What are non-motor symptoms of Parkinson’s Disease?

A

Depression, constipation, anosmia, REM sleep behavior disorder, cognitive decline, and autonomic dysfunction.

96
Q

True or False: The tremor in Parkinson’s Disease is typically an intention tremor.

A

False (It is a resting tremor).

97
Q

True or False: Parkinson’s Disease is associated with alpha-synuclein aggregates called Lewy bodies.

A

true

98
Q

True or False: Postural instability occurs early in the course of Parkinson’s Disease

A

False (It occurs later).

99
Q

Parkinson’s Disease is caused by the degeneration of __________ neurons in the __________.

A

dopaminergic; substantia nigra.

100
Q

The three main classes of drugs used to treat Parkinson’s Disease are __________, __________ agonists, and __________ inhibitors.

A

levodopa; dopamine; MAO-B.

101
Q

The tremor in Parkinson’s Disease is described as a __________ tremor and commonly affects the __________.

A

resting; hands.

102
Q

What are the clinical diagnostic criteria for Parkinson’s Disease?

A

Bradykinesia plus at least one of resting tremor or rigidity, and response to dopaminergic therapy.

103
Q

True or False: MRI is routinely used to diagnose Parkinson’s Disease.

A

False (Diagnosis is clinical, but MRI may exclude other causes).

104
Q

A clinical diagnosis of Parkinson’s Disease is supported by a positive response to __________.

A

Levodopa.

105
Q

What is the first-line treatment for Parkinson’s Disease in patients under 70 years of age?

A

Dopamine agonists or monoamine oxidase-B inhibitors.

106
Q

What is the role of levodopa in Parkinson’s Disease treatment?

A

It is the most effective symptomatic treatment, often combined with carbidopa or benserazide to prevent peripheral metabolism.

107
Q

Name two surgical options for Parkinson’s Disease management.

A

Deep brain stimulation and lesioning procedures (e.g., pallidotomy).

108
Q

True or False: Anticholinergics are used in Parkinson’s Disease to manage tremor.

A

true

109
Q

What is the typical progression of Parkinson’s Disease?

A

Gradual worsening of motor and non-motor symptoms, with increasing disability over years.

110
Q

True or False: Parkinson’s Disease is curable.

A

False (It is a progressive, incurable condition).

111
Q

The average time from diagnosis to significant disability in Parkinson’s Disease is about __________ years.

A

37179

112
Q

What is Benign Paroxysmal Positional Vertigo (BPPV)?

A

A vestibular disorder caused by displaced otoliths in the semicircular canals, leading to brief episodes of vertigo triggered by head movement.

113
Q

What are the common symptoms of BPPV?

A

Episodic vertigo lasting seconds to minutes, triggered by changes in head position, with nausea but no hearing loss or tinnitus.

114
Q

What is the most common cause of BPPV?

A

Idiopathic; other causes include head trauma and vestibular neuritis.

115
Q

True or False: BPPV is associated with tinnitus and hearing loss.

A

False (BPPV typically does not involve tinnitus or hearing loss).

116
Q

True or False: BPPV symptoms resolve spontaneously in many cases within weeks to months.

A

true

117
Q

True or False: The Dix-Hallpike maneuver is used to diagnose BPPV.

A

true

118
Q

The diagnosis of BPPV is confirmed by the __________ maneuver, which elicits vertigo and __________ nystagmus.

A

Dix-Hallpike; positional.

119
Q

The Epley maneuver is a __________ technique used to reposition displaced __________.

A

canalith-repositioning; otoliths.

120
Q

BPPV most commonly affects the __________ semicircular canal.

A

Posterior

121
Q

What clinical test is used to diagnose BPPV?

A

Dix-Hallpike maneuver.

122
Q

Describe the findings in the Dix-Hallpike test for BPPV.

A

Reproducible vertigo with delayed onset of positional nystagmus that fatigues.

123
Q

What is the first-line treatment for BPPV?

A

The Epley maneuver.

124
Q

True or False: Medications such as antihistamines and benzodiazepines are the mainstay of BPPV treatment.

A

False (Treatment primarily involves physical maneuvers).

125
Q

If BPPV symptoms persist or recur, patients may require repeated __________ or referral for __________ testing.

A

repositioning maneuvers; vestibular function.

126
Q

How long does it typically take for BPPV to resolve spontaneously?

A

Weeks to months.

127
Q

True or False: BPPV has a high recurrence rate.

A

true

128
Q

What is delirium?

A

An acute and fluctuating disturbance of consciousness and cognition, often reversible and caused by an underlying medical condition.

129
Q

List common precipitating factors for delirium.

A

Infection, medications, dehydration, electrolyte imbalance, hypoxia, metabolic disturbances, and trauma.

130
Q

What are the two main subtypes of delirium?

A

Hyperactive (restlessness, agitation) and hypoactive (lethargy, drowsiness).

131
Q

True or False: Delirium is more common in younger adults than in older adults.

A

False (Delirium is more common in older adults).

132
Q

True or False: Hypoactive delirium is harder to recognize than hyperactive delirium.

A

true

133
Q

True or False: The Confusion Assessment Method (CAM) is a diagnostic tool for delirium.

A

true

134
Q

The hallmark feature of delirium is __________ and __________ onset of symptoms.

A

acute; fluctuating.

135
Q

The __________ assessment is commonly used to screen for delirium.

A

Confusion Assessment Method (CAM).

136
Q

Common reversible causes of delirium include __________ and __________ imbalances.

A

infections; electrolyte.

137
Q

What are the key features in the Confusion Assessment Method (CAM)?

A

Acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness.

138
Q

How is delirium differentiated from dementia?

A

Delirium has an acute onset and fluctuates, while dementia is chronic and progressive.

139
Q

What is the mainstay of delirium management?

A

Identifying and treating the underlying cause.

140
Q

Name non-pharmacological strategies for managing delirium.

A

Reorientation, ensuring adequate hydration and nutrition, correcting sensory deficits, and maintaining a calm environment.

141
Q

True or False: Antipsychotics are first-line treatment for all cases of delirium.

A

False (Antipsychotics are reserved for severe agitation or distress).

142
Q

True or False: Delirium can increase the risk of long-term cognitive decline.

A

true

143
Q

What is the prognosis for delirium if the underlying cause is treated?

A

Delirium is often reversible, but recovery may take weeks to months, especially in older adults.

Phase 3a - Geriatrics (7 decks)

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