Neurology Flashcards
With damage to the thoracic vertebrae on the right side what sensation will be lost in the left leg?
- Temperature
- Pain
- Crude touch
With damage to the thoracic vertebrae on the right side what sensation will be lost in the right leg?
- fine touch
- vibration
- proprioception
What are the features of lateral medullary syndrome?
Ataxia Dysarthria Dysphagia Ipsilateral Horners ipsilateral pain and temp loss on face contralateral pain and temp loss in body
What are the neurological presentation of basilar artery occlusion?
1) Locked in syndrome
- quadriparesis
- preserved consciousness and ocular movements
2) sudden death
3) loss of consciousness
What artery is involved in lateral medullary syndrome?
right or left posterior inferior cerebellar artery (artery is on same side as symptoms in face)
What artery will cause lateral pontine syndrome?
anterior inferior cerebellar artery
How are haemorrhage strokes treated?
- no aspirin or thrombolysis
- neurosurgical and neuropathy-critical care evaluation
- protect airway
- admit to neurology ICU
What is the treatment for ischaemic stokes?
- Aspirin 300mg orally
- IV alteplase (for thrombolysis providing within 4.5hr of onset)
How long after stroke onset is thrombolysis still first line management?
4.5 hours
Which stroke patients will receive thrombolysis?
- onset within 4.5 hours
- confirmed to not be hameorrhagic with imaging
When should a BP lowering medication be given to patients with haemorrhage stroke?
Only if BP greater than 140 systolic (as lowering BP can worsen cerebral perfusion)
What is the first line long term pharmacological therapy for stroke?
clopidogrel 75mg once daily + statin (e.g. Atrovastatin 80 mg once daily)
What are the risk factors for TIA?
- A-fib
- previous CV problems
- alcohol
- Migraines
- hyperlipideamia
- Diabetes
What are sulfonylurea drugs a risk factor for?
hypoglycaemia
How does bleeding present on CT?
Hyper-density
How is an extradural haemotoma likely to present?
- trauma
- loss of consciousness
- often have lucid interval between loss of consciousness
- deterioration common after lucid interval
How does a extradural haemotoma present on CT?
lentiform shaped heterogeneous hyper dense extra axial collection adjacent to left squamous temporal bone
How will subdural haematomas usually present?
- elderly patients
- on anticoagulants
- sub-acute confusion
- neurological deficit
- after minor fall
How does sub-arachnoid haemorrhage present?
- thunderclap headache
- photophobia
- meningism (+ neck stiffness)
How would ischaemic stoke show on CT?
cortical hypo-density associated with loss of grey white matter differentiation in vascular territory
What does smudge cells on a blood film indicate?
chronic lymphocytic leukaemia
What is the diagnostic test for leukaemia?
bone marrow biopsy and immune-phenotyping
What is first line diagnostic testing for pancytopenia?
1) blood film
2) bone marrow profile
What is treatment for patients in T2 respiratory failure?
(low O2 high CO2)
- non-invasive ventilation
- doxapram last line
What are the subunits of the mediastinum?
- superior mediastinum (first rib > T4)
- anterior mediastinum (T4 > T9, Sternum > ant pericardium)
- posterior mediastinum (T4 > T12, post pericardium > spine)
- middle mediastinum (T4-9, Lateral border = either side pericardium)
What blood cells are most likely to be raised in bacterial infection?
neutrophils
What blood cells are most likely to be raised in viral infection?
Lymphocyte
What blood cells are most likely to be raised in fungal infection?
eosinophil
What blood cells are most likely to be raised in protozoan infection?
monocyte
What are the gram positive cocci?
staphylococci
streptococci (inc enterococci)
What are the gram negative cocci?
Neisseria meningitidis
Neisseria gonorrhoea
mortadella catarrhalis
What are the gram positive rods?
actinomycete bacillus anthracis clostridium diphtheria Listeria monocytogenes
What are bacteria if they are not neg cocci, pos rods or positive cocci?
neg rods
What cranial nerve would be damaged if pupils are fixed and dilated?
oculomotor
What nerve would be damaged if horizontal diplopia and eye pulled toward nose?
abducens
What muscle does the abducens nerve innervate?
lateral rectus muscle
What nerve would be damaged with vertical diplopia and head tilt?
trochlear
What nerve would be damaged with pain on eye movements and central scotoma?
Optic
What would typical pancreatitis pain present as?
severe
radiating to back
left lumbar
What is Grey turners sign?
purple colourisation caused by retroperitoneal haemorrhage
What are the most common causes of acute pancreatitis?
Gallstones and alcohol
What is the mnemonic for acute pancreatitis causes?
GET SMASHED Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion venom Hypertriglyceridaemia ERCP Drugs
What are the treatment options for C.Diff?
1) vancomycin
2) Fidaxomicin
3) Metrinidazole
What are the symptoms of C.diff infection?
- Diarrhoea
- abdominal pain
- ## raised WBC
What is the corneal reflex?
eye blinks in response to wool touching eye ball
What nerve provides sensory innervation to the eye?
trigeminal
Where would a lesion result in Wernicke’s aphasia?
Superior temporal gyrus
Where would a lesion result in Broca’s aphasia?
inferior frontal gyrus
How is speech affected in Wernicke’s aphasia?
sentences don’t make sense, words substituted but speech is fluent (word salad)
Comprehension impaired
How is speech affected in Broca’s aphasia?
speech non-fluent, laboured and halting, repetition impaired
What is Dresslers syndrome?
autoimmune mediated pericarditis which occurs 2-6 weeks after MI
What complication is the most common cause of death for patient after MI?
Cardiac arrest (patient develops V-Fib)
Why can MI cause cardiogenic shock?
if ventricular myocardium damaged during MI, ejection fraction can reduce enough for development of cariogenic shock
What is the treatment for chronic heart failure?
loop diuretics to decrease fluid overload
ACE inhibitors and beta blocker
What are the most common arrhythmias which develop post-MI?
V-Fib
Ventricular tachycardia
Bradyarrhythmia due to AV block
What are the symptoms of pericarditis?
pleural pain worse on lying down, presence of pleural rub and pericardial effusion on echocardiogram
What are the possible complications post-MI?
- Cardiac Arrest
- Cardiogenic shock
- chronic heart failure
- arrhythmias
- pericarditis
- LV aneurysm
- LF free wall rupture
- ventricular septal defect
- acute mitral regurgitation
What enzyme does warfarin act on?
Epoxidase reductase which prevents reduction of vitamin K to active hydroquinone form
When is warfarin used?
1) mechanical heart valves
2) 2nd line after DOAC for:
- venous thromboembolism
- atrial fibrillation
What is the target INR for warfarin patients?
2.5 usually (INR only stable after a few days)
What structures are contained within the carotid sheath?
carotid artery
internal jugular vein
vagus nerve
What are the opioid receptors?
- Mu (responsible for analgesia)
- Kappa (responsible for cognitive effects)
- Delta (increase analgesia and respiratory depression)
What receptor does morphine bind to?
Mu
What is the most common side effect of iron supplements?
Constipation
What is the most common side effect of CCBs?
ankle swelling
What drug causes a dry cough?
ACE inhibitors
What is the most common side effect of antimuscarinic medications?
Urinary retention
What substances increase iron absorption?
Vit C and gastric acid
What is the most common meningitis causing organism in adults?
1) streptococcus pneumonia
2) neisseria meningitidis
3) Listeria monocytogenes
4) Haemophilus Influenza type B
How can you differentiate between bacterial meningitis and viral?
Viral = fever Bacterial = lumbar puncture with turbid fluid, raised opening pressure and low glucose
What is the most common cause of meningitis in infants > 3month?
E.coli
What is the most common cause of meningitis in children younger than 6?
Haemophilus Influenza B
How can you differentiate between stroke and Bells palsy?
If forehead is also paralysed more likely Bells Palsy
Which nerve palsy is Bells?
Facial = 7
What are the different respiratory controls?
- respiratory centres
- chemoreceptors
- lung receptors
- muscles
What are the different respiratory centres?
1) medullary respiratory centre
2) Apneustic centre
3) Pneumotaxic centre
