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ICM Matrix > Neurology > Flashcards

Neurology Flashcards

1
Q

What is shingles also known as?

A

Herpes Zoster Infection

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2
Q

What causes shingles?

A

reactivation of varicella zoster virus

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3
Q

Key risk factors for shingles

A

increasing age, immunosuppressive conditions, HIV

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4
Q

typical presentation of shingles

A

acute, unilateral, painful blistering rash

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5
Q

Which dermatomes are commonly affected in shingles

A

T1- L2

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6
Q

Features of shingles

A

prodromal period

  • 2-3day hx of burning pain over the dermatomes affected
  • may have fever, headache, lethargy

Rash

  • erythematous, macular rash which becomes vesicular
  • demarcated by dermatome and doesnt cross the midline
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7
Q

How is shingles diagnosed?

A

clinical diagnosis

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8
Q

What are the complications of shingles

A
  • post- herpetic neuralgia
  • herpes zoster ophthalmicus
  • herpes zoster oticus (Ramsay Hunt syndrome):
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9
Q

What is syncope?

A

transient loss of consciousness with spontaneous complete recovery

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10
Q

What are the main causes of syncope?

A
  • Reflex mediated (neurally mediated)
  • Cardiac (arrhythmias and structural causes)
  • Orthostatic (iatrogenic, dementia, volume depletion)
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11
Q

Which investigations should be carried out in syncope?

A
  • ECG (?prolonged QT)
  • lying standing BP / tilt table test
  • Glucose
  • Electrolytes
  • FBC
  • Underlying illness (CXR, CT, LP, ECHO etc)
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12
Q

Causes of cardiac syncope

A 
arrhythmias 
- bradycardia / tachycardia 
structural
- valvular
- MI
- HOCM
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13
Q

What is vasovagal syncope?

A

triggered by emotion, pain or stress. Often referred to as ‘fainting’

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14
Q

What is subarachnoid haemorrhage?

A

presence of blood in the subarachnoid space

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15
Q

What are the causes of SAH?

A

head injury (traumatic SAH) is the most common cause

spontaneous SAH (non-traumatic)

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16
Q

Causes of spontaneous SAH

A
  • Intracranial aneurysm( ruptured ‘berry’ aneurysms)

- Arterial dissection

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17
Q

Which conditions are associated with berry aneurysms?

A
  • Adult Polycystic Kidney Disease

- coarctation of the aorta

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18
Q

Classical presentation of SAH

A
  • Thunderclap headache
  • N&V
  • Meningism (photophobia, stiff neck)
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19
Q

How can a SAH be confirmed?

A

CT head
LP if CT Head if negative
Neuro referral

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20
Q

Which findings on an LP are indicative of SAH

A

xanthochromia (result of RBC breakdown) and normal or raised opening pressure

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21
Q

After SAH is confirmed, which investigations can be carried out to identify a causative pathology?

A

CT inter-cranial angiogram (vascular lesion e.g aneurysm)

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22
Q

What is Multiple sclerosis?

A

autoimmune disorder characterised by demyelination in the central nervous system

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23
Q

Who is at higher risk of MS

A

women ages 20-40 living at higher latitude

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24
Q

How can MS be diagnosed

A

refer to neuro and bloods to exclude other causes

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25
Q

What are the most common initial presentations of MS

A
  • optic neuritis
  • transverse myelitis (inflammation within spinal cord)
  • cerebellar sx ( dysmetria, ataxia, vertigo)

sx disseminated in time and space

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26
Q

Which investigations should be carried out for MS?

A

MRI

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27
Q

What is a venous sinus thrombosis?

A

occurs when a blood clot forms in the brain’s venous sinuses. This prevents blood from draining out of the brain. As a result, blood cells may break and leak blood into the brain tissues, forming a hemorrhage.

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28
Q

What are the symptoms of venous sinus thrombosis?

A
  • headaches
  • n&v
  • blurred vision
  • LOC
  • seizures
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29
Q

How is venous sinus thrombosis diagnosed?

A

MRI venography

CT venography

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30
Q

What is a Cavernous sinus thrombosis

A

the formation of a clot within the cavernous sinus

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31
Q

What is the most common cause of CST

A

infection

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32
Q

Common clinical features of CST

A

headache, unilateral periorbital oedema, proptosis (eye bulging), photophobia and cranial nerve palsies

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33
Q

Which nerve is most commonly affected in CST

A

abducens nerve (CN VI)

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34
Q

Complication of CST

A

Where the cause is infection, thrombosis of the cavernous sinus can rapidly progress to meningitis.

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35
Q

Investigations requested in suspected CST

A

CT Head/ MRI
FBC
Blood culture
?LP

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36
Q

Which seizures last a few seconds and are associated with a quick recovery

A

Absence

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37
Q

What may provoke an absence seizure

A

hyperventilation or stress

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38
Q

Who is most commonly affected by absence seizures?

A

3-10 years old and girls are affected twice as commonly as boys

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39
Q

Prognosis of absence seizures

A

good prognosis - most become seizure free in adolescence

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40
Q

Status epilepticus is defined as…

A

a single seizure lasting >5 minutes OR

>= 2 seizures within a 5-minute period without the person returning to normal between them

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41
Q

Why is the priority in Status epilepticus to terminate seizure activity

A

can lead to irreversible brain damage

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42
Q

What is a febrile convulsion?

A

seizures provoked by fever in otherwise normal children

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43
Q

clinical features of febrile convulsion

A

usually occur early in a viral infection
usually lasting less than 5 minutes
most commonly tonic-clonic

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44
Q

How can a generalise seizure be further classified

A

Motor- e.g tonic-clonic

Non-motor - e.g absence

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45
Q

Sx of epilepsy

A

bite their tongue
incontinence of urine
post-ictal phase

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46
Q

Which investigations are ordered following a patients first seizure?

A

EEG and MRI

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47
Q

What are the guidelines for driving post seizure?

A
  • Generally patients cannot drive for 6 months following a seizure.
  • For patients with established epilepsy they must be fit free for 12 months before being able to drive
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48
Q

What is the difference between a generalised and focal seizure?

A

Focal onset seizures start in one area and can spread across the brain and cause mild or severe symptoms, depending on how the electrical discharges spread. Generalized seizures can start as focal seizures that spread to both sides of the brain.

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49
Q

What happens in tonic-clonic seizure?

A 
Tonic 
- muscles stiffen
- LOC
- tongue biting
Clonic 
- rhythmical jerking
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50
Q

What is Bell’s palsy?

A

Acute, unilateral facial nerve (CN VII) paralysis

- rapid onset ( < 72 hours)

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51
Q

Features of Bell’s palsy

A
  • Lower motor neuron facial nerve : forehead affected
  • Post-auricular pain (preceding paralysis)
  • Altered taste
  • Dry eyes

Facial muscle weakness (unilateral):

  • drooping of the eyebrows
  • corner of the mouth
  • loss of the nasolabial fold
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52
Q

What is the bell’s phenomenon?

A

The eye can’t be closed- eyeball rotates upwards and outwards

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53
Q

What is the follow-up for bell’s palsy?

A

If paralysis shows no improvement after 3 week, refer to ENT urgently

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54
Q

What is the prognosis for bell’s palsy?

A

Full recovery within 3-4 months

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55
Q

What are the two main ascending tracts of the spinal cord and what information do they carry?

A

Dorsal - fine touch, proprioception, vibration sense

Spinothalamic - pain and temperature

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56
Q

What is the descending tract of the spinal cord called and what does it carry?

A

corticospinal tract carries motor information

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57
Q

Which signs indicate there is a problem with the spinal cord rather than with the other parts of the nervous system?

A

often bilateral and asymmetrical

mixed upper and lower motor neuron signs as the spinal cord is part of both the CNS and PNS

  • upper signs : increased tone, clonus, hyperreflexia
  • lower signs: muscle wasting, flaccid paralysis, reduced reflexes

sphincter involvement (e.g urinary retention/constipation)

autonomic dysfunction indicates lesion is above T6

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58
Q

How to tell where in the spinal cord the problem is

A

cervical if all 4 limbs affected
thoracic if only lower limbs affected

above C3 if resp difficulties and diaphragm affected

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59
Q

What is Amyotrophic lateral sclerosis

A

(motor neuron disease)
affects both upper (corticospinal tracts) and lower motor neurons
results in a combination of upper and lower motor neuron signs

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60
Q

What features are seen in neoplastic spinal cord decompression?

A

back pain, may be worse on coughing or lying down

  • lower limb weakness
  • sensory loss or numbness
  • neuro signs dependent on level of lesion
  • -above L1 usually UMN in legs and sensory
    • below L1 usually LMN in legs and perianal numbness
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61
Q

Which investigation should be requested following suspected neoplastic spinal cord decompression?

A

urgent whole MRI spine within 24hrs of presentation

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62
Q

What are the symptoms of diabetic peripheral neuropathy?

A

Sensory loss:

  • Tingling
  • Numbness - unable to feel light touch
  • Cannot feel pain
  • Unable to detect change in temperature
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63
Q

What are the presentations of diabetic foot disease?

A
  1. neuropathy: loss of sensation

2. ischaemia: absent foot pulses, reduced ankle-brachial pressure index (ABPI), intermittent claudication

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64
Q

What is involved in annual diabetic foot check?

A
  1. screening for ischaemia: done by palpating for both the dorsalis pedis pulse and posterial tibial artery pulse
  2. screening for neuropathy: a 10 g monofilament is used on various parts of the sole of the foot
65
Q

What is guillain-barre syndrome?

A

immune-mediated demyelination of the peripheral nervous system often triggered by an infection

66
Q

What infection triggers guillain-barre syndrome?

A

campylobacter jejuni

67
Q

What are the characteristic features of guillain-barre syndrome?

A

Progressive, symmetrical weakness of all limbs

  • usually ascending (leg first)
  • reflexes reduced or absent
  • mild sensory symptoms
68
Q

What are the other features for guillain-barre syndrome?

A
  1. Weakness
    - Maximum severity at 2 weeks after initial onset , stops progressing after 5 weeks
    - Facial weakness, dysphasia, dysarthria
    - May lead to resp failure
  2. Pain – neuropathic pain esp in legs, possible back pain
  3. Reflexes – may be reduced or absent
  4. Sensory symptoms – paraesthesia & sensory loss starting in the lower extremities
  5. Autonomic symptoms – reduced sweating, heat tolerance, urinary hesitancy
69
Q

How do you diagnose GBS?

A

Clinical assessment

70
Q

What investigations may be helpful in diagnosing GBS?

A
  1. Nerve conduction studies – most useful confirmatory test, if initially normal should be repeated after 2 weeks.
  2. Lumbar puncture – elevated level of CSF protein with normal white cell count, week 1 after symptom onset
71
Q

What does Chronic IDP stand for?

A

chronic inflammatory demyelinating polyneuropathy

72
Q

Symptoms of Chronic IDP

A
  1. Initially present with some limb weakness which will slowly progress to symmetrical weakness in muscles of the hands, feet, shoulder and hip.
  2. Symptoms may be progressive, episodic or monophasic (1-3 years).
  3. Symptoms should last > 8 weeks
  4. Loss of sensation, numbness, tingling, pins and needles
73
Q

Clinical features of Chronic IDP

A
  1. Muscle atrophy in hands, feet, shoulders and hips
  2. Absent or diminished deep tendon reflexes
  3. Impaired responses to sensory stimulation
  4. Ataxic gait
  5. Some cranial nerve involvement such as dysphagia or diplopia
74
Q

Investigations of Chronic IDP

A
  • NCS
  • Lumbar Puncture
  • Peripheral nerve biopsy
75
Q

Features of migraine

A
  1. a severe, unilateral, throbbing headache
    - -> attacks may last up to 72 hours
  2. associated with nausea, photophobia and phonophobia
  3. patients characteristically go to a darkened, quiet room during an attack
  4. ‘classic’ migraine attacks are precipitated by an aura.
  5. typical aura are visual, progressive, last 5-60 minutes and are characterised by transient hemianopic disturbance or a spreading scintillating scotoma
76
Q

What medication is contraindicated in migraine with aura?

77
Q

Symptoms of tension headache

A
  • often described as a ‘tight band’ around the head or a pressure sensation.
  • bilateral
  • tends to be of a lower intensity than migraine
  • may be related to stress
78
Q

Symptoms of cluster headache

A
  1. Unilateral periorbital pain
  2. Ipsilateral autonomic symptoms: eyelid oedema, facial sweating or flushing, nasal congestion, conjunctival injection, lacrimation
  3. Brief attacks of < 3 hours duration
  4. pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours
  5. clusters typically last 4-12 weeks
79
Q

What is essential tremor?

A

Autosomal dominant condition which usually affects both upper limbs

80
Q

Features of essential tremor

A
  • postural tremor: worse if arms outstretched

- improved by alcohol and rest

81
Q

What is parkinson’s disease?

A

Progressive neurodegenerative condition caused by degeneration of dopaminergic neurons in the substantia nigra

82
Q

What is the classic triad of features of parkinson’s disease?

A
  1. Bradykinesia
    - short, shuffling steps
    - difficulty initiating movement
  2. Tremor
    - worse when stessed or tired
    - ‘pill-rolling’
  3. Rigidity
    - lead pipe
83
Q

How is parkinson’s diagnosed?

A

usually clinical

84
Q

What investigation can distinguish between essential tremor and parkinson’s?

A
  • Single-photon emission computed tomography
85
Q

How do you differentiate between parkinson’s disease and drug-induced parkinsonism?

A

In drug-induced parkisonism:
- motor symptoms are generally rapid onset and bilateral

  • rigidity and rest tremor are uncommon
86
Q

What is huntington’s disease?

A
  • inherited neurodegenerative condition.

- progressive and incurable condition that typically results in death 20 years after the initial symptoms develop.

87
Q

Features of huntington’s disease

A

Typically develop after 35 years of age:

  • chorea
  • personality changes (e.g. irritability, apathy, depression) and intellectual impairment
  • dystonia
  • saccadic eye movements
88
Q

What can peripheral neuropathy conditions be divided into?

A
  1. Motor loss

2. Sensory loss

89
Q

What conditions cause motor loss in peripheral. neuropathy?

A
  1. Guillain-Barre syndrome
  2. lead poisoning
  3. chronic inflammatory demyelinating polyneuropathy (CIDP)
  4. diphtheria
90
Q

What conditions cause sensory loss in peripheral. neuropathy?

A
  1. diabetes
  2. uraemia
  3. leprosy
  4. alcoholism
  5. vitamin B12 deficiency
  6. amyloidosis
91
Q

What nerve damage causes a foot drop?

A

Peroneal nerve (L4-L5, S1-S2)

92
Q

What nerve damage causes a wrist drop?

A

Radial nerve

93
Q

What is carpel tunnel syndrome?

A

When carpel tunnel is swollen/inflammed - the median nerve is affected

94
Q

Symptoms of carpel tunnel syndrome

A
  • Aching, tingling, pins & needles
  • Symptoms can spread up the arm
  • Worse on movement
  • temporary relief by hanging had out of bed at night or shaking vigorously
95
Q

What examination tests do you carry out for carpel tunnel syndrome?

A

Phalens

  • hold wrist fully palmarflexed
  • tap on wrist reproduces symtpoms

Tinel’s sign
- tapping over dorsum of the wrist percipitates pain

96
Q

What does wasting of the thenar eminence indicate?

A

Median nerve affected

97
Q

What investigation can be carried out for carpel tunnel syndrome?

98
Q

What do you not prescribe for carpel tunnel syndrome?

99
Q

What is myasthenia gravis?

A

Autoimmune disorder from insufficient functioning ACh receptors

Affect women > men

100
Q

What is the key feature of myasthenia gravis?

A

muscle fatigability

  • worsens with activity
  • improves after rest
101
Q

What other features can you get with myasthenia gravis?

A
  • extraocular muscle weakness: diplopia
  • proximal muscle weakness: face, neck, limb girdle
  • ptosis
  • dysphagia
102
Q

What is the diagnostic test for myasthenia gravis?

A
  • Serological testing for ACh receptor antibodies

- Repetitive EMG

103
Q

What is cerebral palsy?

A

disorder of movement and posture due to a non-progressive lesion of the motor pathways in the developing brain

104
Q

What is the classification of cerebral palsy?

A
  1. Spastic
  2. dyskinetic
  3. ataxic
  4. mixed
105
Q

What non-motor problems can children with cerebral palsy develop?

A
  1. learning difficulties (60%)
  2. epilepsy (30%)
  3. squints (30%)
  4. hearing impairment (20%)
106
Q

What are the possible manifestations of cerebral palsy?

A
  1. abnormal tone early infancy
  2. delayed motor milestones
  3. abnormal gait
  4. feeding difficulties.
107
Q

What is stroke?

A

sudden interruption in the vascular supply of the brain

108
Q

What are the types of stoke?

A
  1. Ischaemic
    - subtype: TIA
    - ‘ blockage in blood vessel’
  2. Haemorrhagic
    - blood vessel burst leading to reduction in blood
109
Q

What are the symptoms of a stroke?

A
  1. Motor weakness
  2. speech problems (dysphasia)
  3. swallowing problems
  4. visual field defects
  5. balance problems
110
Q

What are some symptoms more common with haemorrhagic stroke than ischaemic?

A
  • decrease in consciousness
  • headache
  • N & V
  • Seizures
111
Q

What is the FAST campaign?

A
  1. Face - ‘Has their face fallen on one side? Can they smile?’
  2. Arms - ‘Can they raise both arms and keep them there?’
  3. Speech - ‘Is their speech slurred?’

4, Time - ‘Time to call 999 if you see any single one of these signs.’

112
Q

What are the 2 types of imaging used in stroke?

A

CT
MRI

1st line = non-contrast CT head

113
Q

What criteria needs to be met for immediate treatment of ischaemic stroke?

A

Criteria
1. patients present with 4.5 hours of onset of stroke symptoms

  1. the patient has not had a previous intracranial haemorrhage, uncontrolled hypertension, pregnant etc
114
Q

What is the surgical option for acute ischaemic stroke?

A

Thrombectomy

115
Q

Secondary prevention for stroke

A

1st line = Clopidogrel

2nd line = aspirin + modified-release (MR) dipyridamole

116
Q

What is TIA?

A

a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction. (<24 hours)

117
Q

Clinical features of TIA

A
  • unilateral weakness or sensory loss.
  • aphasia or dysarthria
  • ataxia, vertigo, or loss of balance

symptoms typically resolve within 1 hour

118
Q

What is the advice on driving for TIA?

A

Do not drive until seen by specialist

119
Q

What investigation should be carried out for TIA?

A
  1. MRI - to detect territory of ischaemia
  2. Urgent carotid doppler

CT should be done unless alternative diagnosis

120
Q

What is raised intracranial pressure?

A

Additional volume in the brain + ventricles

121
Q

Features of raised ICP

A
  1. headache
  2. vomiting
  3. reduced levels of consciousness
  4. papilloedema
  5. Cushing’s triad
    - widening pulse pressure
    - bradycardia
    - irregular breathing
122
Q

What investigations should be carried out for raised ICP?

A
  1. Neuroimaging = underlying causes

2. Invasive ICP monitoring

123
Q

What is temporal arteritis?

A

Large vessel vasculitis which overlaps with polymyalgia rheumatica (PMR).

124
Q

Features of temporal arteritis

A
  1. Jaw claudication
  2. temporal headache
  3. eventually leads to vision loss as optic nerve loses blood supply as large to medium vessels becomes narrowed.
  4. Can be systemically unwell.
  5. Hard, non-pulsating temporal artery (normal = pulsating, able to palpate and doesn’t feel hard)
125
Q

What is the gold standard investigation for temporal arteritis?

A

USS and biopsy

  • raised ESR > 50mm/hr
126
Q

What is vasculitis?

A

Inflammation of small vessels

- May be drug reaction

127
Q

Symptoms of vasculitis

A
  • Itching, burning purpuritic rash

- 1-3mm lesions, often on legs

128
Q

What is Alzheimers?

A

progressive degenerative disease of the brain

129
Q

When should antipsychotics be given to patients with Alzheimers?

A

when pt is at risk of harming themselves or others or has delusions/hallucinations causing them severe distress

130
Q

What is the most common causative pathogen in enchephalitis?

131
Q

Symptoms of enchephalitis

A 
confusion or disorientation.
seizures or fits.
changes in personality and behaviour.
difficulty speaking.
weakness or loss of movement in some parts of the body.
loss of consciousness.
132
Q

Which investigations should be requested in ?encephalitis

A

CSF
PCR for HSV
MRI
EEG

133
Q

What might you see in CSF of encephalitic patient

A

lymphocytosis, elevated protein

134
Q

Life threatening complication of meningitis

A

septicaemia resulting in permanent damage of nerves or brain

135
Q

Symptoms of meningitis

A

headache, neck stiffness, photophobia, confusion, fevers, non-blanching rash

136
Q

Gold standard investigation for meningitis

A

lumbar puncture

137
Q

Characteristic CSF findings in bacterial meningitis

A

cloudy, low glucose, high protein

138
Q

What should be given to patients with suspected meningococcal disease in a pre-hospital setting?

A

IM benzylpenicillin

139
Q

When should you suspect hiv ?

A
  • unusually severe/prolonged symptoms that are recurrent or unexplained
  • conditions related to immunosuppression (shingles/oral candidiasis)
  • lymphadenopathy
  • pyrexia
  • weight loss
140
Q

HIV risk factors

A
  • coming from high prevalence area
  • sex between men and men
  • injecting drug use
141
Q

When should asymptomatic patients with HIV be tested after possible exposure?

A

at 4 weeks

142
Q

How is HIV monitored

A

HIV viral load and CD4 lymphocyte cell count

143
Q

What are people with CD4 count <200 at a higher risk of?

A

HIV-related opportunistic infections and cancers

144
Q

The causative pathogen of tuberculosis

A

Mycobacterium tuberculosis

145
Q

Which vaccine offers protection against TB

146
Q

What are the 2 types of TB

A

PRIMARY
infection occurring in previously uninfected host , usually asymptomatic

SECONDARY
If the host becomes immunocompromised the initial infection may become reactivated.

147
Q

Gold standard investigation for active TB

A

Sputum culture

148
Q

What investigations may be requested in ?active TB

A

Sputum culture -GOLD STANDARD
CXR
NAAT

149
Q

What is a classical finding in CXRs in active TB

A

Upper lobe cavitation and hilar lymphadenopathy

150
Q

Give key side effects for TB drugs

A

Rifampicin : red/orange secretions

Isoniazid: peripheral neuropathy

Pyrazinamide: hyperuricaemia=gout

Ethambutol : optic neuritis

151
Q

Primary and secondary features of syphilis

A

Primary features

  • chancre
  • lymphadenopathy

Secondary features - occurs 6-10 weeks after primary infection

  • systemic symptoms: fevers, lymphadenopathy
  • rash on trunk, palms and soles
  • condylomata lata (painless, warty lesions on the genitalia )
152
Q

Investigations for ?syphilis

A

clinical diagnosis and GUM referral for serology and microscopic

153
Q

How is lyme disease spread

154
Q

key features of lyme disease

A 
erythema migrans (bulls eye rash)
systemic features (headaches, lethargy, fever)
155
Q

How is lyme disease diagnosed

A

clinical if erythema migrans is present

ELISA antibodies to Borrelia burgdorferi

156
Q

What is a prion disease and what is the most common

A

A prion is a type of protein that can trigger normal proteins in the brain to fold abnormally.

Creutzfeldt-Jakob disease

157
Q

features of prion disease

A

rapid onset dementia and myoclonus

158
Q

What is Whipples disease

A

Whipple disease is a rare bacterial infection that most often affects your joints and digestive system. Whipple disease interferes with normal digestion by impairing the breakdown of foods, and hampering your body’s ability to absorb nutrients, such as fats and carbohydrates.

ICM Matrix (15 decks)

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