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Phase 3a - Neurology > Neurological Syndromes > Flashcards

Neurological Syndromes Flashcards

1
Q

What is Wernicke’s Encephalopathy?

A

A neurological disorder caused by thiamine (vitamin B1) deficiency, often associated with alcohol misuse.

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2
Q

True/False: Wernicke’s Encephalopathy only occurs in chronic alcoholics.

A

False. It can also occur in malnutrition, prolonged vomiting, or after bariatric surgery.

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3
Q

Wernicke’s Encephalopathy is characterized by the classic triad of ______, ______, and ______.

A

Confusion, ataxia, and ophthalmoplegia.

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4
Q

What is the underlying cause of Wernicke’s Encephalopathy?

A

Thiamine deficiency leading to impaired glucose metabolism in the brain.

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5
Q

Thiamine is a cofactor for enzymes involved in ______ metabolism.

A

Glucose

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6
Q

True/False: Wernicke’s Encephalopathy primarily affects the cerebellum.

A

False. It mainly affects the thalamus, mammillary bodies, and brainstem.

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7
Q

List three key risk factors for Wernicke’s Encephalopathy.

A

Chronic alcohol misuse, malnutrition, and hyperemesis gravidarum.

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8
Q

True/False: Bariatric surgery is a risk factor for Wernicke’s Encephalopathy.

A

t

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9
Q

Patients on ______ nutrition are at risk of developing Wernicke’s Encephalopathy if thiamine supplementation is inadequate.

A

Total parenteral.

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10
Q

What is the classic triad of Wernicke’s Encephalopathy?

A

Confusion, ataxia, and ophthalmoplegia.

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11
Q

True/False: All patients with Wernicke’s Encephalopathy present with the classic triad.

A

False. The full triad is present in only about one-third of cases.

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12
Q

In Wernicke’s Encephalopathy, ______ refers to uncoordinated movements and difficulty with balance.

A

Ataxia

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13
Q

How is Wernicke’s Encephalopathy diagnosed?

A

Clinically, based on history, risk factors, and symptoms. Imaging may show characteristic changes.

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14
Q

True/False: MRI is the imaging modality of choice for diagnosing Wernicke’s Encephalopathy.

A

t

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15
Q

MRI findings in Wernicke’s Encephalopathy include hyperintensities in the ______ bodies and periventricular regions.

A

Mammilary

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16
Q

What is the first-line treatment for Wernicke’s Encephalopathy?

A

Intravenous thiamine administration.

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17
Q

True/False: Oral thiamine is adequate for initial treatment of Wernicke’s Encephalopathy.

A

False. Intravenous thiamine is required.

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18
Q

What condition may develop if Wernicke’s Encephalopathy is not treated promptly?

A

Korsakoff syndrome.

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19
Q

True/False: Symptoms of Wernicke’s Encephalopathy are always reversible with treatment.

A

False. Delayed treatment can lead to irreversible damage.

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20
Q

Korsakoff syndrome is characterized by severe ______ impairment and confabulation.

A

Memory

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21
Q

What are the hallmark features of normal pressure hydrocephalus (NPH)?

A

Memory loss, personality changes, gait disturbances, and urinary incontinence.

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22
Q

How is normal pressure hydrocephalus treated?

A

With a ventriculoperitoneal shunt, which can lead to recovery if diagnosed early.

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23
Q

What is normal pressure hydrocephalus (NPH)?

A

A condition characterized by abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain, causing the classic triad of gait disturbance, cognitive impairment, and urinary incontinence.

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24
Q

The triad of symptoms in NPH includes ______ disturbance, ______ impairment, and urinary ______.

A

Gait, cognitive, incontinence.

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25
Q

True/False: Normal pressure hydrocephalus always presents with elevated intracranial pressure.

A

False. The intracranial pressure is usually normal.

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26
Q

What causes normal pressure hydrocephalus?

A

Impaired resorption of CSF at the arachnoid granulations, leading to ventricular dilation.

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27
Q

In NPH, the ______ ventricles are enlarged, compressing surrounding brain tissue.

A

Lateral

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28
Q

Describe the typical gait disturbance in NPH.

A

Magnetic gait: short, shuffling steps with difficulty initiating movement.

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29
Q

True/False: Cognitive impairment in NPH often resembles dementia.

A

t

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30
Q

The urinary incontinence seen in NPH is often described as ______ incontinence.

A

Urge

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31
Q

What imaging modality is used to diagnose NPH?

A

MRI or CT brain showing ventricular enlargement disproportionate to cortical atrophy

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32
Q

A ______ tap test involves removing CSF and assessing for symptom improvement, supporting a diagnosis of NPH.

A

Lumbar

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33
Q

True/False: Elevated intracranial pressure on lumbar puncture confirms the diagnosis of NPH.

A

False. The pressure is normal.

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34
Q

What is the mainstay of treatment for NPH?

A

Ventriculoperitoneal (VP) shunt placement to drain excess CSF.

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35
Q

True/False: Gait disturbance in NPH is the symptom most likely to improve with treatment

A

t

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36
Q

Patients undergoing shunt placement should be monitored for complications such as ______ or ______.

A

Infection, over-drainage.

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37
Q

What factors affect the prognosis in NPH?

A

Early diagnosis and timely treatment are associated with better outcomes.

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38
Q

True/False: Cognitive symptoms of NPH are fully reversible with treatment in all cases.

A

False. Cognitive symptoms may be less likely to improve.

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39
Q

What is Chronic Fatigue Syndrome (CFS)?

A

A complex, chronic condition characterized by persistent and disabling fatigue lasting at least 6 months, not alleviated by rest, and often accompanied by other symptoms such as pain, sleep disturbances, and cognitive dysfunction.

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40
Q

True/False: Chronic Fatigue Syndrome is more common in men than women.

A

False. It is more common in women.

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41
Q

Chronic Fatigue Syndrome is also referred to as ______.

A

Myalgic Encephalomyelitis (ME).

42
Q

What are the proposed mechanisms behind Chronic Fatigue Syndrome?

A

Dysregulation of the immune system, neuroendocrine dysfunction, and central nervous system abnormalities.

43
Q

Risk factors for Chronic Fatigue Syndrome include a history of ______ illness, stress, and genetic predisposition.

A

Viral

44
Q

List some key symptoms of Chronic Fatigue Syndrome

A

Persistent fatigue.
Post-exertional malaise.
Sleep disturbances.
Cognitive dysfunction (“brain fog”).
Muscle and joint pain.
Headaches.
Dizziness and orthostatic intolerance.

45
Q

True/False: Fatigue in Chronic Fatigue Syndrome improves with rest.

A

False. The fatigue is not alleviated by rest.

46
Q

Cognitive impairment in CFS is often referred to as “______ fog.”

A

Brain

47
Q

What is the diagnostic criteria for Chronic Fatigue Syndrome?

A

Persistent fatigue lasting ≥6 months, not explained by other conditions, with ≥4 of the following: post-exertional malaise, unrefreshing sleep, cognitive impairment, sore throat, tender lymph nodes, muscle pain, joint pain, or headaches.

48
Q

True/False: Diagnosis of CFS is made primarily by laboratory tests.

A

False. It is a clinical diagnosis based on exclusion of other conditions.

49
Q

What investigations are performed to rule out other causes of fatigue in suspected CFS?

A

Full blood count (FBC).
Thyroid function tests (TFTs).
Serum electrolytes.
Liver function tests (LFTs).
C-reactive protein (CRP).
Vitamin B12 and folate levels.
Glucose testing.

50
Q

Thyroid function tests help rule out ______ as a differential diagnosis for fatigue.

A

Hypothyroidism.

51
Q

What are the main management strategies for CFS?

A

Symptom management: pain relief, sleep hygiene.
Graded exercise therapy (GET).
Cognitive behavioral therapy (CBT).
Supportive care and education.

52
Q

True/False: Graded exercise therapy is controversial in managing CFS.

A

True. It has mixed evidence and can worsen symptoms in some patients

53
Q

Patients with CFS should be educated to avoid ______-exertion, as this can exacerbate symptoms.

A

over

54
Q

What is the prognosis for Chronic Fatigue Syndrome?

A

Variable; some patients improve over time, but many experience chronic or relapsing symptoms.

55
Q

True/False: There is currently a cure for Chronic Fatigue Syndrome.

A

False. There is no cure, but symptoms can be managed.

56
Q

What is delirium?

A

Delirium is an acute, fluctuating disturbance of consciousness and cognition, often triggered by an underlying medical condition or external factor.

57
Q

True/False: Delirium is more common in younger individuals

A

False. It is more common in older adults.

58
Q

Delirium is characterized by ______ onset and fluctuating symptoms.

A

acute

59
Q

List some risk factors for delirium.

A

Advanced age.
Cognitive impairment or dementia.
Sensory impairment (e.g., vision or hearing loss).
Severe illness or infection.
Polypharmacy.
Alcohol use or withdrawal.

60
Q

True/False: Polypharmacy is a significant risk factor for delirium.

A

t

61
Q

______ impairment, such as vision or hearing loss, can predispose patients to delirium.

A

Sensory

62
Q

What are some common causes of delirium?

A

Infections (e.g., urinary tract infections, pneumonia).
Medications (e.g., opioids, benzodiazepines).
Dehydration and electrolyte imbalance.
Hypoxia.
Alcohol withdrawal.
Pain and sleep deprivation.

63
Q

True/False: Hypoxia is a rare cause of delirium.

A

False. Hypoxia is a common cause.

64
Q

Common medication-related causes of delirium include ______ and benzodiazepines.

A

Opiods

65
Q

What are the clinical features of delirium?

A

Fluctuating consciousness.
Impaired attention and focus.
Disorientation.
Hallucinations (often visual).
Agitation or lethargy.
Sleep-wake cycle disturbances.

66
Q

True/False: Hallucinations in delirium are typically auditory.

A

False. They are often visual.

67
Q

Sleep-wake cycle disturbances are common in patients with ______.

A

Delirium.

68
Q

What are the three types of delirium?

A

Hyperactive: agitation, restlessness.
Hypoactive: lethargy, reduced responsiveness.
Mixed: fluctuates between hyperactive and hypoactive states.

69
Q

True/False: Hypoactive delirium is often underdiagnosed.

A

t

70
Q

Mixed delirium alternates between ______ and ______ states.

A

Hyperactive; hypoactive.

71
Q

What tool is commonly used to diagnose delirium?

A

The Confusion Assessment Method (CAM).

72
Q

True/False: CAM includes assessment of acute onset, inattention, disorganized thinking, and altered consciousness.

A

t

73
Q

The ______ Assessment Method (CAM) is widely used to diagnose delirium.

A

Confusion

74
Q

What are the key steps in managing delirium?

A

Identify and treat the underlying cause.
Optimize the environment (e.g., lighting, noise reduction).
Provide reassurance and reorientation.
Consider low-dose antipsychotics (e.g., haloperidol) if agitation is severe.

75
Q

True/False: Benzodiazepines are first-line treatment for delirium.

A

False. Antipsychotics are used if needed; benzodiazepines are generally avoided unless for alcohol withdrawal.

76
Q

Management of delirium focuses on identifying and treating the ______ cause.

A

underlying

77
Q

What is the prognosis for patients with delirium?

A

Delirium is reversible if the underlying cause is treated, but it is associated with increased morbidity and mortality, especially in older adults.

78
Q

True/False: Delirium can cause permanent cognitive decline.

A

True, in some cases, particularly in those with pre-existing dementia.

79
Q

Delirium is associated with increased ______ and ______ in older adults.

A

Morbidity; mortality.

80
Q

What is Guillain-Barré Syndrome (GBS)?

A

GBS is an acute, immune-mediated polyneuropathy characterized by ascending muscle weakness and areflexia, often triggered by infections.

81
Q

True/False: Guillain-Barré Syndrome is caused by direct infection of the peripheral nerves.

A

False. It is an autoimmune reaction often triggered by infection.

82
Q

Guillain-Barré Syndrome is mediated by the ______ immune response targeting peripheral nerves.

A

Autoimmune

83
Q

Name some common triggers of Guillain-Barré Syndrome.

A

Campylobacter jejuni infection.
Cytomegalovirus (CMV).
Epstein-Barr virus (EBV).
Influenza virus.
Vaccinations (rare).

84
Q

True/False: Campylobacter jejuni is the most common trigger of GBS.

A

t

85
Q

The most common bacterial trigger of GBS is ______.

A

Campylobacter jejuni.

86
Q

Describe the clinical presentation of Guillain-Barré Syndrome.

A

Ascending symmetrical muscle weakness.
Areflexia (loss of reflexes).
Sensory symptoms (e.g., paresthesia, numbness).
Autonomic dysfunction (e.g., tachycardia, labile blood pressure).
Cranial nerve involvement (e.g., facial weakness).

87
Q

True/False: Weakness in Guillain-Barré Syndrome typically progresses in a descending pattern.

A

False. It progresses in an ascending pattern.

88
Q

The hallmark feature of Guillain-Barré Syndrome is ______ symmetrical weakness with areflexia.

A

Ascending.

89
Q

What investigations are used to diagnose GBS?

A

Lumbar puncture: elevated CSF protein with normal white cell count (albuminocytologic dissociation).
Nerve conduction studies: evidence of demyelination.
Blood tests: rule out differential diagnoses.

90
Q

A lumbar puncture in GBS typically shows elevated CSF protein and a high white cell count.

A

False. White cell count is typically normal.

91
Q

Elevated ______ levels with normal white cell count on lumbar puncture suggest GBS.

A

CSF protein.

92
Q

What are the key components of Guillain-Barré Syndrome management?

A

Supportive care: respiratory support if required.
Immunotherapy: IV immunoglobulin (IVIG) or plasma exchange.
Monitor autonomic and respiratory function.

93
Q

True/False: Oral steroids are the first-line treatment for Guillain-Barré Syndrome.

A

False. Steroids are not effective in GBS.

94
Q

The two main immunotherapy treatments for GBS are IVIG and ______ exchange.

A

Plasma.

95
Q

What is the prognosis of Guillain-Barré Syndrome?

A

Most patients recover fully within weeks to months, but some may experience persistent weakness or fatigue. Mortality is around 5% due to complications.

96
Q

True/False: The majority of Guillain-Barré Syndrome patients recover fully.

A

t

97
Q

Persistent ______ or fatigue may occur in some GBS patients after recovery.

A

Weakness

98
Q

List complications associated with GBS.

A

Respiratory failure.
Autonomic dysfunction (e.g., arrhythmias, blood pressure instability).
Deep vein thrombosis (DVT) due to immobility.

99
Q

True/False: Autonomic dysfunction in GBS can lead to life-threatening complications.

A

t

100
Q

Immobility in GBS increases the risk of ______ thrombosis.

A

Deep vein

Phase 3a - Neurology (18 decks)

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