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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
What are the atherosclerotic causes of stroke?
Intracranial stenosis Aortic arch atheroma Small vessel disease Carotid and vertebral stenosis
26
What are cardioembolic causes of stroke?
AF Cardiac thrombus Valvular disease
27
List the causes of ischaemic stroke
Atherosclerosis Cardioembolic Arterial dissection Inflammatory vascular disorders (GCA, vasculitis) Haematological disorders (e.g. antiphospholipid, SCD) Genetic (CADASIL. MELAS)
28
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?
Right cerebellum Cerebellum lesions are IPSILATERAL Hemisphere lesions are CONTRALATERAL
29
Name the cerebellar lesions
DANISH Dysdiadokinesis Ataxia (unsteadiness) Nystagmus Intention tremor/dysmetria Slurred/scanning speech Hypotonia
30
What are cross signs a clue of?
Posterior circulation infarct
31
Causes of SAH
Aneurysms Trauma Infection/mycotic aneurysms - infective endocarditis Abnormal clotting (e.g. on warfarin) Arteriovenous malformation
32
Eye opening response of GCS
4 - spontaneous 3 - to speech 2 - to pain 1 - no response
33
Best verbal response of GCS
5 - orientated to time, place and person 4 - confused 3 - inappropriate words 2 - incomprehensible sounds 1 - no response
34
Best motor response in GCS
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
Define status epilepticus
Continuous seizures, or serial (two or more) discrete seizures between which there is incomplete recovery of consciousness, of at least 5 minutes' duration.
36
Define seizures
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
What does the EEG show in an abscence seizure?
Specific pattern of 3Hz
38
What is the difference between partial and complex partial?
Partial = FOCAL - duration: seconds - symptom: Jacksonian - EEG: focal spikes Complex partial = FOCAL WITH LOSS OF AWARENESS - duration: minutes - symptom: stereotype - EEG: spikes
39
Weber's syndrome
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
What is the Barthel index?
Scale that measures disability or dependence in activities of daily living in stroke patients
41
Common causes of autonomic dysreflexia
Urinary retention and faecal impaction
42
What is typically spared in motor neuron disease?
Eye movements (also you don't get any sensory disturbance)
43
When to do thrombolysis and thrombectomy in acute ischaemic stroke?
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
What are the four types of motor neurone disease?
Amytrophic lateral sclerosis Bulbar palsy Progressive muscular atrophy Primary lateral sclerosis
44
What are the four types of motor neurone disease?
Amytrophic lateral sclerosis Bulbar palsy Progressive muscular atrophy Primary lateral sclerosis
45
What is amytrophic lateral sclerosis?
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
What is bulbar palsy?
20% of MND cases Dysarthria and/or dysphagia Limb involvement later, maybe years
47
What is progressive muscular atrophy?
Purely LMN
48
What is primary lateral sclerosis?
Purely UMN
49
What is used in the management of an acute relapse in MS?
High dose steroids (e.g. methylprednisolone)
50
What visual field defect do temporal lobe infarcts cause?
Contralateral superior quadranopia
51
What visual field defect do parietal lobe infarcts cause?
Contralateral inferior quadranopia
52
Name a drug treatment to idiopathic intracranial hypertension
Acetazolamide
53
How do you treat headaches caused by raised ICP secondary to brain mets?
Dexamethasone
54
First line treatment for myoclonic seizures in females and males
Male = Sodium valproate Female = Levetiracetem
55
First line treatment for tonic or atonic seizures in females and males
Males = sodium valproate Females = lamotrigine
56
First line treatment for focal seizures
first line: lamotrigine or levetiracetam second line: carbamazepine, oxcarbazepine or zonisamide
57
What is Cushing's reflex?
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
Treatment of a brain abscess?
IV 3rd-generation cephalosporin (e.g. ceftriaxone) + metronidazole
59
Treatment of MS
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
What criteria is used to help make the diagnosis of MS?
McDonald Criteria 2017

Ria's final year flashcards (12 decks)

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