Neurological

Question 1

What are the symptoms of a classical migraine?

Answer 1

Unilateral headache with aura of flashing lights or zigzag lines and photophobia

Question 2

What is the difference between a classical migraine and a common migraine?

Answer 2

classical has aura

Question 3

What are they symptoms of a cluster headache?

Answer 3

• Pain over one eye (or over the temple) lasting for minutes to hours, -can wake at night (alarm clock headache) - lacrimation - rhinorrhea -flushing of the forehead, -occurring in bouts that last several weeks a few times a year or less.

Question 4

What is the likely cause of a headache over the occiput and associated with neck stiffness ?

Answer 4

cervical spondylosis

Question 5

What are the symptoms of raised intracranial pressure?

Answer 5

-generalised headache -worse in the morning -drowsiness or vomiting

Question 6

What are the symptoms that suggest meningitis?

Answer 6

-Gradual onset -generalized headache associated -photophobia - fever - stiff neck

Question 7

What are the symptoms suggestive of temporal arteritis?

Answer 7

-over 50 -persistent unilateral headache (temporal area) -tenderness over the temporal artery - blurring of vision/diplopia suggests temporal arteritis -Jaw claudication

Question 8

Symptoms of acute sinusitis?

Answer 8

-Headache - pain or fullness behind the eyes/cheeks/forehead

Question 9

Symptoms of subarachnoid hemorrhage ?

Answer 9

• dramatic and usually instantaneous onset of severe headache - localised but becomes generalised - neck stiffness

Question 10

What are the symptoms of a tension headache?

Answer 10

-bilateral -frontal/occipital/temporal -sensation of tightness -hours and recurs often. - not made worse by walking. -no associated symptoms such as nausea, vomiting, weakness or paraesthesias (tingling in the limbs), and the headache does not usually wake the patient at night from sleep.

Question 11

What are the types of siezures?

Answer 11

Question 12

What is the most common type of epilepsy?

Answer 12

Temporal Lobe

Question 13

What is an aura?

Answer 13

simple focal seizure and it may resolve spontaneously or may spread and lead to loss of consciousness.

often preceeds generalised siezure

Question 14

What causes epilepsy in children and adults?

Answer 14

Children: developmental abnormalities and is often genetic

Adults: genetic basis, or may be the result of trauma, tumour or stroke

Question 15

What is epilespy?

Answer 15

epilepsy is the condition of being affected by seizures; seizures are the epileptic events

Question 16

What is vertigo?

Answer 16

perceived sense of motion, of the surroundings or the person him- or herself

• may interefer in ability to stand or walk
• can have nausea, vomiting, pallor, sweating and headache

Question 17

What is Ménière’s disease?

Answer 17

Intermittent vertigo and tinnitus with hearing los

Question 18

What can pins and needles in limbs indicate?

Answer 18

• nerve entrapment
• peripheral neuropathy
• sensory pathway involvement at any level

Question 19

At which locations can sensation and weakness be effected?

Answer 19

Nerve root, spinal cord and cerebral abnormalities

Question 20

What is a lower motor neurone lesion?

Answer 20

Any damage that occurs along the tract from the spinal cord/brainstem (anterior horn) to the muscle.

• Lesion between anterior horn and muscle
• Muscle atrophy
• Flaccid paralysis
• No superficial reflex response
• Absence tendon reflex
• Fasciculations
• ‘-’ planter repsonse

Question 21

What is a upper motor neurone lesion?

Answer 21

• Lesion above anterior horn (spinal cord/brainstem)
• No/minimal muscle wasting
• Hyperactive deep tendon reflex (no input/regulation) e.g. patella
• Diminished or absent superficial reflex
• Increase in muscle tone

Question 22

What are the other 3 types of motor issues apart from UMNL/LMNL?

Answer 22

1. Muscle disease causes weakness in a particular muscle or group of muscles. There is wasting and decreased tone, and the reflexes are reduced or absent.
2. •Disease at the neuromuscular junction (e.g. myasthenia gravis) causes generalised weakness, which worsens with repetition. The reflexes and tone are often normal.
3. Non-organic weakness (e.g. due to hysteria) causes a non-anatomical pattern of weakness in association with normal tone and power and, unless there has been prolonged disuse, normal muscle bulk.

Question 23

What is a tremor?

Answer 23

rhythmical movement. can be slow or fast.

3 Hz and 5 Hz. Rapid tremors are faster than 10 Hz.

resting, postural or action

Question 24

What drugs are associated with nuerological presentations?

Answer 24

Antihypertensives

• Therapeutic use: reduction of risk of stroke
• Side effects: postural dizziness, syncope, depression (methyldopa)

Antiplatelet drugs and anticoagulants

• Therapeutic use: reduction of risk of stroke
• Side effect: cerebral haemorrhage

Statins

• Therapeutic use: reduction in stroke risk
• Side effect: myopathy

Major tranquillisers

• Therapeutic use: treatment of psychoses
• Side effects: ataxia, sedation, Parkinsonian tremor

Other neurological symptoms associated with drugs

• Headache: nitrates, sildenafil
• Deafness: aminoglycoside antibiotics, aspirin, frusemide
• Peripheral neuropathy: amiodarone, isoniazid, metronidazole
• Non-Parkinsonian tremor: lithium, sodium valproite, bronchodilators, amphetamines
• Dysphagia: bisphosphonates
• Confusion and loss of memory: major and minor tranquillisers, anticholinergic drugs (e.g. amitriptyline)
• Seizures: pethidine

Question 25

when vision is involved what is most likely to reduce?

Answer 25

visual acurity

Question 26

Visual hallucinations such as flashing lights and distortions of vision are called positive visual symptoms and occur with?

Answer 26

migraine, retinal detachment or as the aura of an epileptic seizure.

Question 27

How is visual acuity most commonly tested?

Answer 27

Snellens chart

• 6/6. line 6 at 6 meters.

if not able to have patient move to 3m or use a pinhole.

if not able to have patient look at fingers and say how many are up.

if not assess if they can see light

•detects abnormality of the lens, cornea, fundus or optic nerve pathway

Question 28

What are some examples of sudden bilateral and sudden unilateral loss of visual acurity?

Answer 28

• Bilateral: bilateral occipital lobe infarction, bilateral occipital lobe trauma, bilateral optic nerve damage (as with methyl alcohol poisoning) and somatisation or conversion reaction.
• retinal artery or vein occlusion, temporal arteritis

Question 29

examples of gradual blindness?

Answer 29

cataracts, acute glaucoma, macular degeneration, diabetic retinopathy (vitreous haemorrhages), bilateral optic nerve or chiasmal compression, and bilateral optic nerve damage—for example, tobacco amblyopia (blindness due to retinal disease).

Question 30

How are visual fields assessed?

Answer 30

Confrontation: The normal visual field reaches 180º in the horizontal plane (160º for monocular vision) and 135º in the vertical plane.

1. sitting 1 m away, cover one eye with examiner mirroring patient
2. starting outside visual field bring finger in until pt can see it, can also use finger count.
3. repreat on other eye

upper and lower, temporal and nasal fields should be checked

Test 2.

one eye at a time shield eye and check in peripheral which finger is wiggling (hold at periphery and wiggle either side for patient to identify L or R).

Test 3.

covering one eye at a time start and periphy with examiner mirroring and move objetc/finger towards centre. if examiner sees before pt indicates some sort of visual neglect.

Test 4.

Blind spot . sit equal distance, move hatpin away from pt until blind spot reached. compare to own.