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Neurology Flashcards

1
Q

signs of upper motor neurone lesion

A

Increased tone
Brisk reflexes
Muscle weakness
Spasticity (eg Clasp knife)
Positive Babinski sign
Clonus
Pronator drift

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2
Q

Positive Babinkski sign:

A

large toe extends and there is abduction of the other toes

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3
Q

signs of lower motor neurone lesion

A

Hyporeflexia/ areflexia
Hypotonia/ atonia
Flaccid muscle weakness or paralysis
Fasciculations
Muscle atrophy

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4
Q

The most common presentation of multiple sclerosis

A

Optic neuritis (demyelination of the optic nerve and loss of vision in one eye.)

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5
Q

Lhermitte’s sign

A

electric shock sensation that travels down the spine and into the limbs when flexing the neck.It is caused by stretching the demyelinated dorsal column in MS

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6
Q

Main symptoms of MS

A

Visual: nystagmus, optic neuritis, diploplia
Central: fatigue, cognitive impairment, depression
Throat: dysphagia
Speech: dysarthria
MSK: weakness, spasms, ataxia
Sensation: pain,parasthesia
Bowel: incontinece diarrhoea
Urinary: incontinence , freq, retention

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7
Q

MS Ix

A

MRI can show lesions
LP can detect oligoclonal bands in CSF

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8
Q

MS disease modification treatments

A

injectables such as beta-interferon and glatirameroral new agents such as dimethyl fumarate, teriflunomide and fingolimod
Biologics such as natalizumab and alemtuzumab.

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9
Q

MS relapse treatment

A

methylprednisolone:
500mg orally daily for 5 days

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10
Q

MS symptomatic treatments

A

Exercise
Neuropathic pain- amitriptyline or gabapentin
Depression- SSRIs
Urge incontinence - anticholinergic medications such as tolterodine or oxybutynin
Spasticity- baclofen, gabapentin and physio
Modafinil and exercise therapy - fatigue
Sildenafil - erectile dysfunction
Clonazepam- tremor

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11
Q

Features of 3rd nerve palsy (Oculomotor)

A

Pupil dilated/mydriasis ( loss of parasympathetic tone of ciliary body)
Drooping eyelid/ptosis ( loss of of innervation to levator palpebrae superioris muscle)
Eye down and out ( loss of superior and medial and inferior rectus muscles)

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12
Q

Features of 4th nerve palsy (trochlear)

A

vertical diplopia when looking inferiorly

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13
Q

Features of 6th nerve palsy (abducens)

A

Results in unopposed adduction of the eye (by the medial rectus muscle), resulting in a convergent squint.

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14
Q

Features of Hypoglossal nerve palsy

A

atrophy of the ipsilateral tongue and deviation of the tongue when protruded towards the side of the lesion

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15
Q

Features of Horner syndrome

A

Ptosis
Miosis (constricted pupil)
anhidrosis (lack of sweat)

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16
Q

Paraplegic/spastic gait

A

bilateral hip circumduction ,scissoring gait, slow

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17
Q

Causes of paraplegic/ spastic gait

A

MS
CP
Spinal cord lesion

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18
Q

apraxic gait

A

unable to lift legs despite normal power, glued to floor, difficulty igniting, shuffling but normal arm swing, UMN signs, problems turning

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19
Q

Causes of apraxic gait

A

Normal pressure hydrocephalus (NPH)
Dementai
Cerebrovascular disease

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20
Q

Ataxic gait

A

Uncoordinated wide based, unsteady as if they were drunk, worse with eyes shut

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21
Q

Causes of ataxic gait

A

Cerebellar
Alcohol

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22
Q

Hemiparetic gait

A

Knee hyperextension, hip circumducts and drags leg, UMN signs, elbow may be flexed

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23
Q

Myopathic gait

A

Waddling, leaning back lordosis, abdomen sticking out

(causes: proximal myopathy, musculodystrophy)

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24
Q

Sensory gait

A

Stamping, broad base, Romberg positive

causes: diabetes, b12 deficiency, medication

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25
Dorsal column lesion
Loss vibration and proprioception Tabes dorsalis(form of neurosyphilis), SACD (Subacute combined degeneration)
26
Spinothalamic tract lesion
Loss of pain, sensation and temperature
27
Central cord lesion
Flaccid paralysis of the upper limbs
28
Infarction spinal cord
Dorsal column signs (loss of proprioception and fine discrimination
29
Cord compression
UMN signs -bladder urge, , Hyperreflexia Malignancy Haematoma Fracture pain Worse on lying down Sensor deficits
30
Brown-sequard syndrome
Hemisection of the spinal cord Ipsilateral paralysis Ipsilateral loss of proprioception and fine discrimination Contralateral loss of pain and temperature
31
Guillain-Barré Syndrome
causes acute, symmetrical, ascending weakness and can also cause sensory symptoms. It is usually triggered by an infection
32
Guillain-Barré Syndrome features
Lower motor neurone signs in the lower limbs (hypotonia, flaccid paralysis, areflexia). peripheral loss of sensation or neuropathic pain Cranial nerve signs
33
Guillain-Barré Syndrome Ix
Nerve conduction studies (reduced signal through the nerves) (due to demyelination) Lumbar puncture for CSF
34
Guillian barre lumbar puncture findings
raised protein with a normal white cell count and glucose
35
Guillain-Barré Syndrome Mx
IV immunoglobulins Plasma exchange (alternative to IV IG) Supportive care VTE prophylaxis
36
Clinical presentation Bulbar palsy
damage to cranial nerves supplying speech and swallowing, LMN signs like tongue wasting, fasciculations
37
Which cranial nerves does bulbar palsy affect
9, 10 and 12 glossopharyngeal and vagus--> absent gag reflex hypoglossal --> tongue fasciculation
38
Pseudobulbar palsy
damage to cortex that innervates these cranial nerves, UMN signs eg brisk jaw jerk ,upper motor neuron lesion of cranial nerves IX, X and XII.
39
Management of absence seizures
Sodium Valproate or Ethosuximide
40
Myasthenia gravis
auto-immune disease characterised by antibodies against the nicotinic acetylcholine receptors on muscle fibres. This limits the ability of acetylcholine to cause muscle contraction.
41
Myasthenia gravis clinical features
weakness affecting limb muscles, extra-ocular muscles (drooping eyelids, diplopia), facial muscles (difficulty smiling or chewing), and bulbar muscles (change in speech or difficulty swallowing). symptoms are worse after prolonged movement or at the end of the day.
42
Myasthenia gravis Ix
Blood test for serum nicotinic acetylcholine receptor antibody and muscle-specific tyrosine kinase antibodies CT of the chest (65% have thymic hyperplasia, 12% have a thymoma ( a benign growth of the thymus gland.) nerve stimulation
43
Management of myasthenia graves
conservative: MDT medical:immunosuppressive therapy (such as steroids, given acutely) and anticholinesterase inhibitors (such as pyridostigmine or neostigmine) which inhibit the breakdown of acetylcholine in the synaptic cleft surgical: thymectomy
44
Features of common peroneal nerve lesion
foot drop weakness of foot dorsiflexion weakness of foot eversion weakness of extensor hallucis longus sensory loss over the dorsum of the foot and the lower lateral part of the leg wasting of the anterior tibial and peroneal muscles
45
What is motor neurone disease
Disorder that affects both UMN and LMN without causing sensory involvement
46
Tx motor neurone disease
Riluzole can slow the progression of the disease and extend survival by a few months in ALS. Non-invasive ventilation (NIV) used at home to support breathing at night Treat pain and spasticity Drooling may be helped by anticholinergics (including the TCAs), and eventually supportive feeding via an NG or PEG Secretions can be helped by carbocysteine, hyoscine patches, botox in saliva glands Choking can be helped with buccal midazolam
47
White cell count in bacterial meningitis
High neutrophil count
48
White cell count in viral meningitis
High lymphocyte count
49
Glucose in bacterial meningitis
Low
50
Glucose in viral meningitis
high
51
Protein in bacterial meningitis
High
52
Protein in viral meningitis
mildly raised or normal
53
Most common bacterial causes of meningitis in >3 y
Neisseria meningitidis Streptococcus pneumoniae Haemophilus influenzae
54
Most common bacterial causes of meningitis in neonates
Streptococcus agalactiae (Group B streptococcus), Escherichia coli, S pneumoniae Listeria monocytogenes.
55
Meningitis triad
photophobia, neck stiffness, headache, GCS normal (unless unresponsive)
56
most common cause of infectious encephalitis
Herpes Simplex Virus (HSV) Other causes include: CMV, Adenovirus, Influenzavirus,tb, Listeria Fungal eg cryptococcosis,
57
Encephalitis triad
headache altered GCS/confusion fever
58
Bilateral medial temporal lobe involvement on MRI is strongly supportive of
a diagnosis of encephalitis LP with CSF analysis also needed for dx
59
Tx encephalitis
IV aciclovir and IV ceftriaxone to cover for bacterial infections.
60
Tx autoimmune encaphilitis
steroids and intravenous immunoglobulin plasma exchange
61
most common lower motor neuron facial palsy
Bell’s palsy. no forehead sparing like what would occur in a UMN lesion (stroke)
62
Cause of Sub-acute combined degeneration of the cord
complication of vitamin B12 deficiency caused by degeneration both the dorsal columns and corticospinal tracts
63
SADC clinical presentation
Romberg’s positive sensory ataxia brisk knee jerks and up-going plantars, but absent ankle jerks (probably due to distal sensory loss). peripheral neuropathy, optic atrophy and cognitive impairment haematological manifestations
64
Drugs causing a peripheral neuropathy
amiodarone isoniazid vincristine nitrofurantoin metronidazole
65
Causes of sensory peripheral neuropathies
ABCDE: Alcohol B12/Folate Chronic Renal Failure Diabetes Mellitus Everything Else (!) - Vasculitis and Paraneoplastic
66
Charcot Marie Tooth Syndrome
AD,affects both the sensory and motor nerves of the peripheral nervous system, though motor problems are often more prominent clinically patients present (usually in puberty) with symptoms affecting the feet, later progressing to involve the hands
67
Charcot marie tooth clinical features
thickening and enlargement of the nerves symmetrical distal muscular atrophy (champagne bottle legs, and claw hand), pes cavus (high-arched feet). Patients can present with lower motor neuron signs in all limbs and reduced sensation (more pronounced distally).
68
diabetes mellitus mononeuritis multiplex clinical features
acute, unilateral, and severe thigh pain followed by anterior muscle weakness and loss of knee reflex. pupil-sparing third nerve palsy, associated with foot drop
69
Superior oblique moves eye
down and in
70
Inferior oblique
moves eye up and out
71
Cauda equina symptoms
LMN pattern - areflexia, full bladder/incontinence reduced lower limb sensation and increased weakness severe back pain impotence. “saddle” anaesthesia
72
Causes of caudal equine syndrome
Disc herniation (most common cause) eg L5/S1 and L4/L5 level Trauma – including vertebral fracture and subluxation Neoplasm Infection – e.g. discitis or Potts disease Chronic spinal inflammation – e.g. ankylosing spondylitis Iatrogenic e.g. haematoma secondary to spinal anaesthesia
73
DANISH
The features of cerebellar dysfunction can be remembered by the acronym DANISH: Dysdiadochokinesia (an inability to perform rapid alternating hand movements) Ataxia (a broad-based, unsteady gait) Nystagmus (involuntary eye movements) Intention tremor (seen when the patient is asked to perform the 'finger-nose test') Slurred speech Hypotonia
74
Differentials of cerebellar syndrome
VITAMIN C V- vascular eg stroke I- infective eg Lyme disease,inflammatory eg MS TA- trauma M- metabolic ef alcohol I- iatrogenic eg drugs like phenytoin, carbamazepine N- neoplastic C- congenital or hereditary eg Fredric's ataxia
75
Parkinson’s disease
there is a progressive reduction of dopamine in the basal ganglia of the brain, leading to disorders of movement. classic triad: Resting tremor Rigidity Bradykinesia
76
Parkinson disease on examination
Tremor Face (reduced expression) Cogwheel rigidity Bradykinesia power and reflexes should be normal Gait ( shuffling, stoopeed) Micrographia Check eye movements Cerebellar signs Postural BP
77
Parkinson disease clinical features
Unilateral Tremor ( pill rolling, worse on rest, improves on movement) cogwheel rigidity Bradykinesia Psychiatric features Sleep disturbance and insomnia Anosmia Cognitive impairment and memory problems autonomic invovlement ( eg constipation, postural hypotension, erectile dysfunction)
78
Progressive supra nuclear palsy
PD and vertical graze palsy inability to look up or down results in recurrent falls
79
multisystem atrophy PD
Parkinsonism with cerebellar signs eg ataxia and sig autonomic failure
80
Cortico-basal degeneration (CBD)
CBD is a Parkinson-plus syndrome, including the Parkinsonian triad of tremor, hypertonia, and bradykinesia. Characteristically, it involves spontaneous activity by an affected limb, or akinetic rigidity of that limb.
81
Parkinson disease ix
DAT scan /spect - the amount of active dopamine-using brain cells is quantified MRI to look for Parkinson + syndrome
82
Benign essential tremor
AD inheritance symmetrical improves with rest worse on intentional movement no other pd features Improves with alcohol
83
Ramsay hunt syndrome
occurs after latent Varicella zoster virus reactivation in the geniculate ganglion of the facial nerve.
84
Ramsay hunt syndrome clinical features
unilateral facial nerve (Cranial nerve VII) palsy (e.g. unable to raise eyebrow against resistance or bear teeth, loss of nasolabial fold), vestibulocochlear nerve (cranial nerve VIII) symptoms (e.g. tinnitus, unilateral hearing impairment, vertigo) lesions visible with crusting in or behind the ear, pain and vesicular rash in the external auditory meatus, palate or tongue. This is treated with acyclovir and prednisolone.
85
Cushings triad
Increased blood pressure, decreased heart rate, irregular breathing
86
Neurofibromatosis type 1 features
C – Café-au-lait spots (hyperpigmented and coffee-coloured. Visualised by UV light) R – Relative with NF1 A – Axillary or inguinal freckles BB – Bony dysplasia such as Bowing of a long bone or sphenoid wing dysplasia I – Iris hamartomas (Lisch nodules) yellow brown spots on the iris N – Neurofibromas G – Glioma of the optic nerve
87
Bilateral acoustic neuromas are associated with
neurofibromatosis type 2
88
Tuberous sclerosis features
depigmented 'ash-leaf' spots which fluoresce under UV light, these are oval patches of white/hypopigmented skin roughened leathery patches of skin( shagreen patches) angiofibromas subungual fibromata developmental problems Epilepsy
89
Trigeminal Neuralgia
patients over age of 50 severe shooting or stabbing pain in the distribution of one or more divisions of the trigeminal nerve. Precipitated by chewing, washing face, brushing, shaving ,touching the face or talking. tx with carbamazepine
90
Huntington triad features
Movement disorder, behavioural changes and decreased cognition
91
Wernickes encephalopathy triad
ataxia, confusion, and ocular abnormalities
92
Internuclear ophthalmoplegia
presents with ipsilateral impairment of the adducting eye and nystagmus in the abducting eye, MS is a cause

Medicine (72 decks)

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