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Medicine > Neurology > Flashcards

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
Q

Dorsal column lesion

A

Loss vibration and proprioception
Tabes dorsalis(form of neurosyphilis), SACD (Subacute combined degeneration)

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26
Q

Spinothalamic tract lesion

A

Loss of pain, sensation and temperature

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27
Q

Central cord lesion

A

Flaccid paralysis of the upper limbs

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28
Q

Infarction spinal cord

A

Dorsal column signs (loss of proprioception and fine discrimination

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29
Q

Cord compression

A

UMN signs -bladder urge, , Hyperreflexia
Malignancy
Haematoma
Fracture
pain Worse on lying down
Sensor deficits

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30
Q

Brown-sequard syndrome

A

Hemisection of the spinal cord
Ipsilateral paralysis
Ipsilateral loss of proprioception and fine discrimination
Contralateral loss of pain and temperature

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31
Q

Guillain-Barré Syndrome

A

causes acute, symmetrical, ascending weakness and can also cause sensory symptoms.
It is usually triggered by an infection

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32
Q

Guillain-Barré Syndrome features

A

Lower motor neurone signs in the lower limbs (hypotonia, flaccid paralysis, areflexia).
peripheral loss of sensation or neuropathic pain
Cranial nerve signs

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33
Q

Guillain-Barré Syndrome Ix

A

Nerve conduction studies (reduced signal through the nerves) (due to demyelination)
Lumbar puncture for CSF

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34
Q

Guillian barre lumbar puncture findings

A

raised protein with a normal white cell count and glucose

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35
Q

Guillain-Barré Syndrome Mx

A

IV immunoglobulins
Plasma exchange (alternative to IV IG)
Supportive care
VTE prophylaxis

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36
Q

Clinical presentation Bulbar palsy

A

damage to cranial nerves supplying speech and swallowing, LMN signs like tongue wasting, fasciculations

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37
Q

Which cranial nerves does bulbar palsy affect

A

9, 10 and 12
glossopharyngeal and vagus–> absent gag reflex
hypoglossal –> tongue fasciculation

38
Q

Pseudobulbar palsy

A

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
Q

Management of absence seizures

A

Sodium Valproate or Ethosuximide

40
Q

Myasthenia gravis

A

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
Q

Myasthenia gravis clinical features

A

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
Q

Myasthenia gravis Ix

A

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
Q

Management of myasthenia graves

A

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
Q

Features of common peroneal nerve lesion

A

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
Q

What is motor neurone disease

A

Disorder that affects both UMN and LMN without causing sensory involvement

46
Q

Tx motor neurone disease

A

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
Q

White cell count in bacterial meningitis

A

High neutrophil count

48
Q

White cell count in viral meningitis

A

High lymphocyte count

49
Q

Glucose in bacterial meningitis

A

Low

50
Q

Glucose in viral meningitis

A

high

51
Q

Protein in bacterial meningitis

A

High

52
Q

Protein in viral meningitis

A

mildly raised or normal

53
Q

Most common bacterial causes of meningitis in >3 y

A

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae

54
Q

Most common bacterial causes of meningitis in neonates

A

Streptococcus agalactiae (Group B streptococcus),
Escherichia coli, S pneumoniae
Listeria monocytogenes.

55
Q

Meningitis triad

A

photophobia, neck stiffness, headache, GCS normal (unless unresponsive)

56
Q

most common cause of infectious encephalitis

A

Herpes Simplex Virus (HSV)

Other causes include:
CMV, Adenovirus, Influenzavirus,tb, Listeria
Fungal eg cryptococcosis,

57
Q

Encephalitis triad

A

headache
altered GCS/confusion
fever

58
Q

Bilateral medial temporal lobe involvement on MRI is strongly supportive of

A

a diagnosis of encephalitis

LP with CSF analysis also needed for dx

59
Q

Tx encephalitis

A

IV aciclovir and IV ceftriaxone to cover for bacterial infections.

60
Q

Tx autoimmune encaphilitis

A

steroids and intravenous immunoglobulin
plasma exchange

61
Q

most common lower motor neuron facial palsy

A

Bell’s palsy.
no forehead sparing like what would occur in a UMN lesion (stroke)

62
Q

Cause of Sub-acute combined degeneration of the cord

A

complication of vitamin B12 deficiency caused by degeneration both the dorsal columns and corticospinal tracts

63
Q

SADC clinical presentation

A

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
Q

Drugs causing a peripheral neuropathy

A

amiodarone
isoniazid
vincristine
nitrofurantoin
metronidazole

65
Q

Causes of sensory peripheral neuropathies

A

ABCDE:
Alcohol
B12/Folate
Chronic Renal Failure
Diabetes Mellitus
Everything Else (!) - Vasculitis and Paraneoplastic

66
Q

Charcot Marie Tooth Syndrome

A

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
Q

Charcot marie tooth clinical features

A

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
Q

diabetes mellitus mononeuritis multiplex clinical features

A

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
Q

Superior oblique moves eye

A

down and in

70
Q

Inferior oblique

A

moves eye up and out

71
Q

Cauda equina symptoms

A

LMN pattern - areflexia, full bladder/incontinence
reduced lower limb sensation and increased weakness
severe back pain
impotence.
“saddle” anaesthesia

72
Q

Causes of caudal equine syndrome

A

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
Q

DANISH

A

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
Q

Differentials of cerebellar syndrome

A

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
Q

Parkinson’s disease

A

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
Q

Parkinson disease on examination

A

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
Q

Parkinson disease clinical features

A

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
Q

Progressive supra nuclear palsy

A

PD and vertical graze palsy
inability to look up or down results in recurrent falls

79
Q

multisystem atrophy PD

A

Parkinsonism with cerebellar signs eg ataxia and sig autonomic failure

80
Q

Cortico-basal degeneration (CBD)

A

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
Q

Parkinson disease ix

A

DAT scan /spect - the amount of active dopamine-using brain cells is quantified
MRI to look for Parkinson + syndrome

82
Q

Benign essential tremor

A

AD inheritance
symmetrical
improves with rest
worse on intentional movement
no other pd features
Improves with alcohol

83
Q

Ramsay hunt syndrome

A

occurs after latent Varicella zoster virus reactivation in the geniculate ganglion of the facial nerve.

84
Q

Ramsay hunt syndrome clinical features

A

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
Q

Cushings triad

A

Increased blood pressure, decreased heart rate, irregular breathing

86
Q

Neurofibromatosis type 1 features

A

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
Q

Bilateral acoustic neuromas are associated with

A

neurofibromatosis type 2

88
Q

Tuberous sclerosis features

A

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
Q

Trigeminal Neuralgia

A

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
Q

Huntington triad features

A

Movement disorder, behavioural changes and decreased cognition

91
Q

Wernickes encephalopathy triad

A

ataxia, confusion, and ocular abnormalities

92
Q

Internuclear ophthalmoplegia

A

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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