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Station 5 > Neurology > Flashcards

Neurology Flashcards

1
Q

Essential examination in headache?

A

Neck stiffness
Photophobia
Can do Kernigs signs
Brief Neurological examination incl cerebellar signs and cranial nerves

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2
Q

Findings on LP in bacterial meningitis?

A

Low glucose, high protein, organism identified, high neutrophils

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3
Q

Findings on LP in viral meningitis?

A

Normal glucose and protein. Mononuclear cells.

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4
Q

What would you include in your examination of a patient with syncope?

A

Brief cardio exam: Pulse, HS. Look for PPM or ICD scar.
Ask for LS B/P.
Brief neurological exam: pronator drift, reflexes, eye movements

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5
Q

Investigations in undifferentiated syncope?

A

ECG or longer monitoring
Echo
Tilt test if orthostatic hypotension considered
EEG and MRI head if seizure suspected

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5
Q

Investigations in undifferentiated syncope?

A

ECG or longer monitoring
Echo
Tilt test if orthostatic hypotension considered
EEG and MRI head if seizure suspected

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6
Q

What should be advised in orthostatic hypotension? (4)

A

Careful from sitting to standing
Salt and water replacement
Support stockings
Medication review- occasionally add fludrocortisone.

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7
Q

In what condition would this be found and how are they likely to present?

A

Tuberous sclerosis, likely to present with Seizures, also cystic lung disease, kidney disease and learning difficulties.

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8
Q

Name these lesions and where they would be found?

A

Ash leaf, in tuberous sclerosis. Generally found on the trunk.

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9
Q

Name this finding and the other skin complaints found in tuberous sclerosis?

A

This is adenofibromas
Ash leaf spots
Periungal fibromas
Shagreen patch (commonly found on back)

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10
Q

Aside from the skin changes in tuberous sclerosis what other findings might there be on examination?

A

Renal enlargement secondary to PKD, signs of dialysis or transplant.
Cystic lung disease.
Seizures- signs of anti epileptic treatment (gum hypertrophy and hirsutism)

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11
Q

What investigations would you consider in tuberous sclerosis?

A

CT/MRI brain
Echo
Abdominal USS
CT thorax if cystic lung disease suspected

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12
Q

Inheritance of tuberous sclerosis?

A

Autosomal dominant

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13
Q

What are these (2 conditions) and how many do you need for a diagnosis of this condition?

A

Neurofibromas, need >2.

Cafe au lait spots >6

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14
Q

What are the skin manifestations associated with neurofibromatosis? (3)

A

Cafe- au- lait
Cutaneous neurofibromas
Axillary freckling

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15
Q

As well as skin manifestations what would you examine for in neurofibromatosis? (4)

A

BP- associated with phaeo and renal artery stenosis.
Lungs- fibrosis (fine inspiratory crackles)
Enlarged palpable nerves
Signs of antiepileptic use

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16
Q

What is the inheritance of neurofibromatosis and of the two types which presents with the classical skin lesions?

A

Autosomal dominant
Type 1 presents with the classical peripheral form and type 2 presents with b/l acoustic neuromas and sensorineural hearing loss.

17
Q

What are the features of this condition?

A

Ptosis
Enophthalmos (sunken eye)
Anhydrosis
Small pupil (miosis)

18
Q

Name 3 causes of Horners sydrome?

A

Pancoast tumour (apical lung tumour)
MS secondary to demyelination in the brainstem
Syringobulbia
Brainstem stroke

19
Q

What is a Holmes- Adie pupil?

A

Moderately dilated pupil with poor response to light and a sluggish response. Associated with loss of deep tendon reflexes. More common in females.

20
Q

What is this and what is its association?

A

Argyll robinson pupil.
Small irregular pupil with accommodates but doesn’t react to light. Atrophied and depigmented iris. Typically associated with neurosyphilis but can also be secondary to DM.

21
Q

Causes of third nerve palsy?

A

Medical: mononeuritis multiplex- DM, vasculitis, malignancy
Midbrain infarction
Midbrain demyelination (MS)
Surgical: Posterior communicating artery aneurysm
Cavernous sinus thrombosis/tumour (may also affect 4,5 and 6)

22
Q

In a third nerve palsy how can you demonstrate that 4th nerve is working?

A

Ask look towards the nose and the eye with intort (rotate towards the nose) which indicates 4th nerve is working.

23
Q

What might give you a clue that a patient has a fourth nerve palsy?

A

Controls superior oblique, in a right nerve palsy the patient with turn their head to the left and vice versa.
Issues on looking down.

24
Q

What is the cause of this appearance and which muscle does it supply?

A

Sixth nerve palsy- lateral rectus.

25
Q

Pneumonic for causes of a pale disc?

A 
Pressure (tumour, glaucoma) 
Ataxia (Freidrich's ataxia) 
Lebers 
Dietary (low b12) and degenerative: retinitis pigments 
Ischaemia- central retinal vein occlusion 
Syphilis and other infections 
Cyanide and other toxins 
Sclerosis (MS)
26
Q

What is foster Kennedy syndrome?

A

Papilloedema in one eye with optic atrophy in the other caused by direct pressure of the tumour.

27
Q

Name 4 causes of this appearance?

A

Glaucoma
Optic neuritis secondary to MS
Retinal artery occlusion
Retinitis pigmentosa

28
Q

RF for age related macular degeneration?

A

Family history, white, age and smoking.

WET A MD can be treated with VEGF- refer to opthalmology.

29
Q

Usual history in retinitis pigmentosa?

A

Progressive loss of vision. Begins with reduced night vision then peripheral vision. Most are registered blind by age of 40.
No treatment but Vitamin A may slow progression.

30
Q

Causes of tunnel vision? (3)

A

Retinitis pigmentosa
Papilloedema
Glaucoma

31
Q

What does this image demonstrate?

A

Pale disc with cherry red macula as in retinal artery oclusion.

32
Q

Which medical conditions may cause retinal artery occlusion? (3)

A

Thromboembolic secondary to AF
Plaque rupture in carotid stenosis
Inflammation secondary to GCA.

33
Q

Causes of retinal vein occlusion (4 H’s)

A

HTN
Hyperviscocity (myeloma)
High intraocular pressure (glaucoma)
Hyperglycaemia (diabetes)

34
Q

Side effects of dopamine agonists? (3)

A

Drowsiness -usually wears off once you are stable on the medications
Hallucinations
Impulsivity

35
Q

What are the common side effects of Levodopa? (4)

A

Becomes less effective over time.
Dyskinesia
On-off symptoms
Impulsivity.

36
Q

How does MAO-B affect levodopa side effects?

A

Get worse because MAO-B strengthens the effect of Levodopa.

37
Q

Management of migraine

A

If presenting over the age of 55, with focal neurology or with red flags of SOL then further investigation is required.
Simple analgesia with antiemetics is often enough.
2nd line includes triptans (can be given nasally, SC or PO)
Can use propranolol and topiramate for migraine prophylaxis
Good sleep Hygiene and regular exercise
Trigger avoidance
Avoid against use of COCP

38
Q

On examining a patient with headache which specific signs should be checked to rule out raised ICP.

A

6th nerve palsy
Field defect
Papilloedema

39
Q

What are the risks to a foetus with anti epileptic therapy?

A

Neural tube defect
Neurodevelopmental disorder
Congenital malformation: GU, cardiac and craniofacial

Station 5 (12 decks)

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