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Ria's final year flashcards > Neurology > Flashcards

Neurology Flashcards

1
Q

Define Guillan Barre Syndrome

A

Acute inflammatory demyelinating polyneuropathy

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2
Q

Pathophysiology of Guillan Barre Syndrome

A

An inflammatory process where antibodies after a recent infection react with self-antigen on myelin or neurons

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3
Q

Mid-shaft humeral fracture

A

Associated with radial nerve injury
- Ask patient to extend wrist
- Check for sensory loss to small area between the dorsal aspect of the 1st and 2nd metacarpals

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4
Q

First line treatment in MG

A

Pyridostigmine

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5
Q

What can be given for rapid therapy in myasthenic crisis?

A

Plasma exchange or IVIG

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6
Q

How long do cluster headaches typically last?

A

4 to 12 weeks

(Each episode lasts 15 minutes to 2 hours)

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7
Q

List the cranial nerves

A
  1. Olfactory
  2. Optic nerve
  3. Oculomotor
  4. Trochlear
  5. Trigeminal - motor, sensory + reflex
  6. Abducens
  7. Facial nerve - motor + sensory
  8. Vestibulocochlear - hearing + balance
  9. Glossopharyngeal - motor + reflex
  10. Vagus - motor
  11. Accessory - motor
  12. Hypoglossal - motor
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8
Q

What do you look for on general inspection of the upper limbs?

A

Abnormal posture
Scars
Muscle wasting
Involuntary movements
Fasciculations
Tremor

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9
Q

In testing power for upper limbs - when you say “push up against me” in shoulder abduction, what nerve root are you testing?

A

C5

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10
Q

In testing power for upper limbs - when you say “push down against me” in shoulder adduction, what nerve root are you testing?

A

C6/7

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11
Q

In testing power for upper limbs - when patient arms are in the boxer position and you say “pull me in towards you” in elbow flexion, what nerve root are you testing?

A

C5/6

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12
Q

In testing power for upper limbs - when patient arms are in the boxer position and you say “push me out” in elbow extension, what nerve root are you testing?

A

C7

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13
Q

In testing power for upper limbs - when patient has wrist cocked up “push up against me” in wrist extension, what nerve root are you testing?

A

C6

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14
Q

In testing power for upper limbs - when patient has wrist cocked up “push down against me” in wrist flexion, what nerve root are you testing?

A

C6/7

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15
Q

In testing power for upper limbs - what is the nerve root tested in thumb abduction?

A

C8/T1

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16
Q

In testing power for upper limbs - what is the nerve root tested in finger abduction?

A

C8

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17
Q

In upper limb exam, what nerve roots are tested in supinator reflex?

A

C5/6

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18
Q

In upper limb exam, what nerve roots are tested in biceps reflex?

A

C5/6

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19
Q

In upper limb exam, what nerve roots are tested in triceps reflex?

A

C6/7

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20
Q

What are you assessing in finger-nose test?

A

Coordination
Observe as well for intention tremor and past pointing (cerebellar disease)

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21
Q

UMN vs LMN

A

UMN:
No wasting and fasciculations
Tone inc.
Reflexes inc.
Plantars upgoing
Clonus
Absent abdominal reflex

LMN:
Wasting and fasciculations
Tone dec.
Reflexes dec. or absent
Plantars downgoing

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22
Q

Which sensory pathway carries pain and temperature?

A

Spinothalamic tract

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23
Q

Which sensory pathway carries vibration and proprioception?

A

Dorsal column

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24
Q

A patient presents with a sudden onset of right homonymous hemianopia. Where is the lesion?

A

Left occipital lobe

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25
Q

What are the atherosclerotic causes of stroke?

A

Intracranial stenosis
Aortic arch atheroma
Small vessel disease
Carotid and vertebral stenosis

26
Q

What are cardioembolic causes of stroke?

A

AF
Cardiac thrombus
Valvular disease

27
Q

List the causes of ischaemic stroke

A

Atherosclerosis
Cardioembolic
Arterial dissection
Inflammatory vascular disorders (GCA, vasculitis)
Haematological disorders (e.g. antiphospholipid, SCD)
Genetic (CADASIL. MELAS)

28
Q

66 year old with acute vertigo. On examination, he has dysarthria, gaze-evoked nystagmus fast beating to the right and right dysdiadochokinesia and intention tremor. He has difficulty performing tandem gait. Where is the lesion?

A

Right cerebellum

Cerebellum lesions are IPSILATERAL

Hemisphere lesions are CONTRALATERAL

29
Q

Name the cerebellar lesions

A

DANISH

Dysdiadokinesis
Ataxia (unsteadiness)
Nystagmus
Intention tremor/dysmetria
Slurred/scanning speech
Hypotonia

30
Q

What are cross signs a clue of?

A

Posterior circulation infarct

31
Q

Causes of SAH

A

Aneurysms
Trauma
Infection/mycotic aneurysms - infective endocarditis
Abnormal clotting (e.g. on warfarin)
Arteriovenous malformation

32
Q

Eye opening response of GCS

A

4 - spontaneous
3 - to speech
2 - to pain
1 - no response

33
Q

Best verbal response of GCS

A

5 - orientated to time, place and person
4 - confused
3 - inappropriate words
2 - incomprehensible sounds
1 - no response

34
Q

Best motor response in GCS

A

6 - obeys commands
5 - moves to localised pain
4 - flexion withdrawal from pain
3 - abnormal flexion (decorticate)
2 - abnormal extension (decerebrate)
1 - no response

35
Q

Define status epilepticus

A

Continuous seizures, or serial (two or more) discrete seizures between which there is incomplete recovery of consciousness, of at least 5 minutes’ duration.

36
Q

Define seizures

A

Seizures paradoxical discharge of cerebral neurones which is apparent to an external observer (e.g. generalised seizure) or as an abnormal perceptual experience by the subject

37
Q

What does the EEG show in an abscence seizure?

A

Specific pattern of 3Hz

38
Q

What is the difference between partial and complex partial?

A

Partial = FOCAL
- duration: seconds
- symptom: Jacksonian
- EEG: focal spikes

Complex partial = FOCAL WITH LOSS OF AWARENESS
- duration: minutes
- symptom: stereotype
- EEG: spikes

39
Q

Weber’s syndrome

A

Affects the medial portion of the midbrain.
Can be caused by the occlusion of a branch of the PCA.
Causes contralateral hemiparesis and a 3rd nerve palsy.

40
Q

What is the Barthel index?

A

Scale that measures disability or dependence in activities of daily living in stroke patients

41
Q

Common causes of autonomic dysreflexia

A

Urinary retention and faecal impaction

42
Q

What is typically spared in motor neuron disease?

A

Eye movements

(also you don’t get any sensory disturbance)

43
Q

When to do thrombolysis and thrombectomy in acute ischaemic stroke?

A

Thrombectomy should be done within 6 hrs
Thrombolysis should be done within 4.5 hrs

So if it happens at 5hrs for example, you could give thrombectomy in isolation, but if <4.5hrs you should offer both.

44
Q

What are the four types of motor neurone disease?

A

Amytrophic lateral sclerosis
Bulbar palsy
Progressive muscular atrophy
Primary lateral sclerosis

44
Q

What are the four types of motor neurone disease?

A

Amytrophic lateral sclerosis
Bulbar palsy
Progressive muscular atrophy
Primary lateral sclerosis

45
Q

What is amytrophic lateral sclerosis?

A

Typical MND
70% of cases
Wasting and fasciculations and brisk reflexes and upgoing plantars - UMN and LMN
Dysarthria and dysphagia
Progress over months to 4 years

46
Q

What is bulbar palsy?

A

20% of MND cases
Dysarthria and/or dysphagia
Limb involvement later, maybe years

47
Q

What is progressive muscular atrophy?

A

Purely LMN

48
Q

What is primary lateral sclerosis?

A

Purely UMN

49
Q

What is used in the management of an acute relapse in MS?

A

High dose steroids (e.g. methylprednisolone)

50
Q

What visual field defect do temporal lobe infarcts cause?

A

Contralateral superior quadranopia

51
Q

What visual field defect do parietal lobe infarcts cause?

A

Contralateral inferior quadranopia

52
Q

Name a drug treatment to idiopathic intracranial hypertension

A

Acetazolamide

53
Q

How do you treat headaches caused by raised ICP secondary to brain mets?

A

Dexamethasone

54
Q

First line treatment for myoclonic seizures in females and males

A

Male = Sodium valproate
Female = Levetiracetem

55
Q

First line treatment for tonic or atonic seizures in females and males

A

Males = sodium valproate
Females = lamotrigine

56
Q

First line treatment for focal seizures

A

first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide

57
Q

What is Cushing’s reflex?

A

Cushing reflex is a physiological nervous system response to increased intracranial pressure that results in hypertension and bradycardia.

Cerebral perfusion pressure (CPP) = mean arterial pressure (MAP) - intracranial pressure.
Therefore if ICP is high, the only way the body can compensate to increase CPP is by increasing MAP. A sympathetic reflex therefore results in hypertension. This results in a counter parasympathetic reflex by stimulation of the baroreceptors resulting in bradycardia.

58
Q

Treatment of a brain abscess?

A

IV 3rd-generation cephalosporin (e.g. ceftriaxone) + metronidazole

59
Q

Treatment of MS

A

Depends on pattern of disease activity and patient
Relapses - exclude infection. oral or IV steroids can be considered to shorten course
Disease-modifying therapies - interferons, dimethyl fumarate, fingolimod, natalizumab, alemtuzmab, ocrelizumab
Haemopoietic stem cell transplant

60
Q

What criteria is used to help make the diagnosis of MS?

A

McDonald Criteria 2017

Ria's final year flashcards (12 decks)

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