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Year 4 - NSS > Neurology > Flashcards

Neurology Flashcards

1
Q

Space occupying lesions
- Symptoms

A

SOL - Symptoms

  1. Seizures
    - Aura
    - Smells/tastes in temporal lobe
  2. Focal neurology and gait disturbance
  3. Neuropsychiatric
    - Personality (frontal)
    - Mental state
    - Memory/cognition
  4. Endocrine
  5. ICP
    - Headaches
    - Vomiting
    - Papilloedema
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2
Q

Neuro SoL
- Imaging

A

Neuro SoL - Imaging

  1. CT +/- contrast
    - Contrast for vessels and tumours
  2. MRI
  3. Diffusion weighted MRI
  4. Multimodal MRI
    - MR spectoscopy (metabolism)
    - MR perfusion (vascularity)
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3
Q

Imaging
- Describing SoLs

A

Imaging
- Describing SoLs

  1. Patient
  2. Imaging technique
  3. Intra-extra axial (paranchyma or outside)
    - nb pituitary is extra-axial
  4. Shape/location
    eg. Irregular, circular, frontal-temporal
  5. Density/intensity
    - Hypo/hyper dense on CT
    - Hypo/hyper intense on MRI
  6. Border
    - Defined
    - Oedema
  7. Contrast
    - Homogenous/heterogenous
    - Rim enhancement eg. abscesses
  8. Mass effect
    - Effacement of sulci
    - Midline shift
    - Ventricle compression
    - Basal cisterns: obliterated/patent
  9. Hydrocephalus
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4
Q

Spinal cord compression
- Aetiologies

A

SCC
- Aetiologies

  1. Trauma
  2. Prolapsed IVD
  3. Atlantoaxial subluxation
    - RA
  4. Infection
    - Pott’s disease/discitis
    - IVDUs
  5. Bony metastasis
  6. Others
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5
Q

Tetraplegia vs paraplegia

A

Tetraplegia
1. Four limbs
2. Above T1

Paraplegia
1. Lower limbs
2. T1 or below

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6
Q

CES
- Symptoms
- Spinal level

A

CES

  1. Level of L4/L5 or L5/S1
  2. Symptoms
    - Weakness
    - Paraesthesia
    - Ataxia
    - LMN signs
    - Urinary retention
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7
Q

Spinal metastasis
- 5 primaries

A

Spinal metastasis Bs

  1. Prostate
  2. Breast
  3. Lung
  4. Kidney

5 . Thyroid

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8
Q

CES-I vs CES-R

A

CES-I
- Incomplete cauda equina
1. Urinary disturbance

CES-R
- Complete cauda equina

  1. Retention
  2. Overflow incontinence
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9
Q

CES Syndrome

  • MN signs?
  • Presentation
A

CES Syndrome

  1. MN signs
    - LOWER signs
  2. Presentation
  • 50% atypical presentation
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10
Q

CES

  1. Decompression Timeline
    - Recommendation
  2. Non-surgical treatments
A

CES

  • Decompression Timeline
    1. 48 hours
    2. BASS (british association of spinal surgeons)
  • Non-surgical treatments
  1. Radiotherapy
  2. Anti-inflammatories
  3. Antibiotics
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11
Q

Status Epilepticus
- A-E

A

Status Epilepticus
- A-E

  • Airway
    1. Tongue
    2. Bleeding
  • Breathing
    1. Challenging
    2. ABG
  • Circulation
    1. Access
  • Disability
    1. Glucose
  • Else
    1. Medications
    2. Trauma
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12
Q

Status Epilepticus
- Algorithm

A

Status Epilepticus
- Algorithm

  1. CBG check
    - Glucose
  2. A-E
  3. Lorazepam 4mg IV
    - Repeat after 10-15 minutes
    - IM Midazolam 10mg
    - PR Diazepam 10mg
  4. Phenytoin 20mg/kg
    - Max 50mg/min
    - Contact ITU
  5. ITU
    - Rapid sequence
    -Thiopental etc.
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13
Q

Status epilepticus
- Definition

A

Status epilepticus
- Definition

  1. > 5 mins continuous
  2. > 2mins
    - Without full recovery within 5 mins
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14
Q

Status epilepticus
- ABG findings

A

Status epilepticus
- ABG findings

  1. Lactic acidosis
  2. Hypoxia
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15
Q

Status epilepticus
- Blood Ix

A

Status epilepticus
- Blood Ix

  1. FBC
  2. U&E/LFT/Bone profile
  3. CRP/Cultures
  4. Glucose
  5. Clotting screen
  6. Toxicology
    - If on AEMs
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16
Q

Delirium
- vs dementia

A

Delirium
- vs dementia

1 Abrupt & fluctuating
2 Impaired intention & orientation

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17
Q

Delirium
- Mx of behaviour

A

Delirium
- Mx of behaviour

  1. Environment
    - Orientation
    - 1-1 nursing
  2. Quetiapine
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18
Q

Delirium
- WHIPMS causes

A

Delirium
- WHIPMS acronym causes

W - Wernicke’s
H - Hypoglycaemia
I - Infections/intracranial
M - Meningitis/encephalitis
P - Poisoning
S - Status epilepticus

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19
Q

Meningitis
- Common causes
1. Bacterial
2. Viral

A

Meningitis
- Common causes

  1. Bacterial
    - S pneumoniae
    - N menigitides
    - Hib
  2. Viral
    - Herpes simplex
    - Mumps virus
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20
Q

Meningitis
- Specific Signs

A

Meningitis
- Specific signs

  1. Jolt acceleration of headache 100%
  2. Kernig’s sign 9%
    - pain on hip flexion
  3. Brudzinski’s sign 1%
    - lift head
    - knees will bend
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21
Q

Meningitis
- Empirical ABx

A

Meningitis
- Empirical ABx

  1. Local guidelines
  2. Vancomycin
    + cef
    +cefo
    +mero
    +chloramphenicol
  3. Ampicillin
    - 50+yo
    - immunocomprimise
  4. Nonate
    - Cefo + ampicillin
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22
Q

Meningitis
- CNS abscess mx

A

Meningitis
- CNS abscess mx

  1. Metronidazole
  2. Surgical intervention
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23
Q

Meningitis
- Chemo-prophylaxis

A

Meningitis
- Chemo-prophylaxis

  1. Rifampicin
    - 2 doses
  2. Ciprofloxacin
    - 1 dose
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24
Q

Sub-arachnoid haemorrhage
- Presentation

A

Sub-arachnoid haemorrhage
- Presentation

  1. Thunderclap headache
  2. Meningism
  3. Decreased consciousness
  4. Focal neurology
    - Hemiparesis
    - CN III palsy
  5. Ophthalmopathy
    - Papilloedema
    - Retinal haemorrhage
  6. Seizures
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25
Q

Sub-arachnoid haemorrhage
- Head CT findings

A

Sub-arachnoid haemorrhage
- Head CT

  1. White areas
    - extravasation of blood
  2. Detect early hydrocephalus
  3. 10% may be negative
    - 6h from headache: 100%
    - 48hr from headache: only 89%
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26
Q

Sub-arachnoid haemorrhage
- LP/CSF

A

Sub-arachnoid haemorrhage
- LP/CSF

  1. Must wait 12 hours post-headache
  2. Xanthochromia
    - Spectophometry for bilirubin
    - 100% sensitive for 1 week
  3. Constituents
    - Blood stained
    - Elevated opening pressure
    - Lymphocytic reaction
    - Elevated protein
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27
Q

Sub-arachnoid haemorrhage
- MRI

A

Sub-arachnoid haemorrhage
- MRI

  1. T2-FLAIR sequence
  2. Echo-gradient sequences
    - Haemosiderin
    - Susceptibility artefact
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28
Q

Sub-arachnoid haemorrhage
- Angiography

  1. Non-invasive
  2. Invasive
A

Sub-arachnoid angiography

  • Non-invasive
    1. CTA
    2. MRA
  • Invasive
    1. DSA
  • Digital subtraction angiography
  • Endo-vascular coiling at same time
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29
Q

Sub-arachnoid haemorrhage
- Mx

A

Sub-arachnoid haemorrhage
- Mx

  1. Secure aneurysm
    - Endo-vascular coiling
    - Surgical clipping
  2. Prevent vasospasm (d4-d14)
    - Nimodipine
    - HTN therapy
  3. Treat
    - Hydrocephalus
    - Ventricular drain/shunt
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30
Q

Neurology history
- Formulation

A

Neurology history
- Formulation

  1. A/S/L
  2. Onset
    - Timing
    - Mode
  3. Symptoms
    - Nature
    - Distribution
    - Progression
  4. Severity
  5. Salient information
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31
Q

Neurology
- Anatomical DDx

A

Neurology
- Anatomical DDx

  1. Brain
  2. Brainstem
  3. Cerebellum
  4. Spinal cord
  5. Motor pathway
  6. Nerve roots
  7. Plexuses
  8. Peripheral nerves
  9. NMJ
  10. Muscle
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32
Q

Neuro ddx
- Brainstem Pathology presentations

A

Brainstem
- Pathologies

  1. Multiple CN palsies
  2. Cerebellar and CN Sx
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33
Q

Neuro DDx
- Cerebellar lesions

A

Neuro DDx
- Cerebellar lesions

  1. DANISH
  2. Broad based ataxia
    - Heel-shin
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34
Q

Parkinson’s
- Examination

A

Parkinson’s
- Examination

  1. Gait
    - Forward flexed
    - Assymetric reduced arm swing
    - Cog wheel rigidity
    - Turning on block
    - Reduced facial expression
  2. Tremor
    - At rest
    - Relaxed arm
    - Frequency 3-6
    - Nature: pill-rolling
    - Admonished by movement
  3. Rigidity
    - Lead pipe at elbow
    - Cog wheel at wrist
  4. Bradykinesia
    - Cannot maintain amplitude or rhythm of repeated movement
    - Micrographia
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35
Q

Neuropathies
- Symmetry in degeneration and autoimmune disease

A

Neuropathies
- Symmetry in degeneration and autoimmune disease

  1. Asymmetric early on
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36
Q

Neuro ddx
- Spinal features

A

Neuro ddx
- Spinal features

  1. Below a certain point
  2. Can involve spincters
  3. Motor and sensory
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37
Q

Neuro ddx
- Nerve root features

A

Neuro ddx
- Nerve root features

  1. Dermatomal distribution
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38
Q

Neuro ddx
- Plexus features

A

Neuro ddx
- Plexus features

  1. Unusual Distribution
  2. Sensory and motor
39
Q

Neuro ddx
- NMJ presentation

A

Neuro ddx
- NMJ presentation

  1. Muscular only
  2. Distribution
  3. Fatigability
    - eg gaze
40
Q

Myasthenia gravis
- Pathology

A

Myasthenia gravis
- Pathology

  1. Anti-ACh IgG
  2. Thymus abnormalities
    - Hyperplasia
    - Tumors
41
Q

Myasthenia gravis
- Presentation

A

Myasthenia gravis
- Presentation

  1. Fatigability
  2. Extraocular muscles
  3. Ptosis
  4. No sensory or reflex loss
42
Q

NMJ
- Drug triggers

A

NMJ
- Drug impacts

  1. Aminoglycosides
  2. Beta blockers, CCBs
    … See MG website
43
Q

Myasthenic crisis
- Features

A

Myasthenic crisis

  1. Slack facial muscles
  2. Head falling
  3. Jaw slack
    - drooling
    - absent gag reflex
  4. Nasal voice
  5. Limp body
44
Q

Cholinergic crisis
- Features

A

Cholinergic crisis
- Features

  1. Miosis
  2. SLUDGE
  3. Flaccid muscle paralysis
    - Like myasthenic
45
Q

Myasthenia gravis
- Ix

A

Myasthenia gravis
- Ix

  1. AChR antibodies
  2. Tension test
    - Edrophonium
  3. EMG
    - Muscle fatigue
  4. CT thorax
  5. Ice test
    - Ptosis
46
Q

Myasthenia gravis
- early management

A

Myasthenia gravis
- early management

  1. Supportive
    - respiratory
    - aspiration
    - DVT
  2. Spirometry
    - FVC
    - ITU if <1l and ABG
47
Q

Myasthenia gravis
- Therapeutic management

A

Myasthenia gravis
- Therapeutic management

  1. Acetylcholinesterase inhibitors
    - Pyridostigmine
    30 mins before meals
    - Neostigmine (ITU)
  2. CSTs
  3. Azathioprine
  4. IVIG
  5. Aspiration and DVT
48
Q

Guillain barre syndrome
- 4 Subtypes

A

Guillain barre syndrome
- 4 Subtypes

  1. AIDP
  2. AMAN
  3. AMSAN
  4. Miller Fisher Syndrome
49
Q

Guillain Barre Syndrome
- Post infectious features

A

Guillain Barre Syndrome
- Post infectious

  1. Acute, rapidly progressing
    - 1-3 weeks after URI or GI
  2. Flaccid paralysis
    - both arms and legs
    - often backache
  3. Bi modal peek
    - commonest in elderly
50
Q

GBS
- Autonomic involvement

A

GBS
- Autonomic involvement

  1. Cardiac arrhythmia
  2. Ileus
51
Q

GBS Respiratory Failure
- Monitoring

A

GBS Respiratory Failure
- Monitoring

  1. Spirometry QDS
  2. 1/4 need NIV
52
Q

GBS
- Therapeutic Management

A

GBS
- Therapeutic Management

  1. IVIG
  2. Plasmapheresis
  3. Ventilation
53
Q

MS
- S&S

A

MS
- S&S

  1. Optic neuritis
    - blurred vision
    - ocular pain
    - disc swelling/normal (pale)
    - RAPD (slower response to swinging)
  2. Nystagmus
  3. Intra nuclear opthalmoplegia
    - 3rd nerve
    - no adduction
  4. Spinal cord lesion
    - Lhermitte’s shock pain
    - Upper limb UMN
  5. Other
    - Trigeminal neuralgia
    - Epilepsy
    - psychosis
    - dementia
54
Q

MS
- Pathophysiology

A

MS
- Pathophysiology

  1. Body attacks myelin
  2. Multiple plaques
  3. Brain and spinal cord
    - disseminated in space
    - disseminated in time
55
Q

MS
- Prevalence

A

MS
- Prevalence

  1. 7000 new per year
  2. > 130,000 UK
  3. 3:1 F:M
56
Q

Ms
- Ix

A

Ms
- Ix

  1. MRI brain
    - multiple plaques
  2. CSF
    - Oligoclonal bands
  3. Visual delay
57
Q

MS
- Criteria

A

MS
- Criteria

  1. McDonald Criteria
    - two lesions in time and space
    - MRI evidence
58
Q

MS
- Clinical courses

A

MS
- Clinical courses

  1. Clinically isolated
  2. RRMS
    - Relapsing remitting (+24hrs each)
    - Most common
    - Worsening
  3. SPMS
    - secondary progressive
    - gradual and worsening
  4. PPMS (15%)
    - primary progressive
59
Q

MS Mx

  1. Acute
  2. Chronic
A

MS Mx

  1. Acute
    - Rule out infection
    - Short course of steroids for inflammation
  2. Chronic
    - DM treatment
    - MDT
60
Q

MS
- Disease Modifying Treatment

  1. Factors to consider
  2. Drugs: Eg.
A

MS
- Disease Modifying Treatment

  1. Course of MS
  2. Activity of disease

Eg.
Interferon beta
Alemtuzumab
Cladribine

61
Q

MS
- Uhthoffs Sign

A

MS
- Uhthoffs Sign

  1. Worse in heat
62
Q

Epilepsy
- definition

A

Epilepsy
- definition

  1. ?
63
Q

Epilepsy
- types

A

Epilepsy
- types

  1. Focal onset
  2. Generalised onset
  3. Unknown onset
64
Q

Seizure
- Quality of movement

A

Seizure
- Quality of movement

  1. Clonic
    - Fast out
    - Slow in
65
Q

Seizure
- Stabilisation phase mx

A

Seizure
- Stabilisation phase mx

  1. A-E
  2. Time it
    - monitor vitals
  3. Oxygen
  4. ECG
  5. CBG
    - Thiamine
    - D50W (dextrose in water)
  6. IV access
66
Q

Seizure initial phase
- 5-20min mx

A

Seizure initial phase
- 5-20min mx

  1. IM midazolam
    - 10/5mg
  2. IV Lorazapam
    - 4mg max
    - 0.1mg/kg/dose
  3. IV diazepam
    - 10mg max
    - 0.15-0.2mg/kg/dose
67
Q

Seizure
- Second phase therapy (20-40 mins)

A

Seizure
- Second phase therapy (20-40 mins)

  1. Fosphenitoin
  2. Valproate
  3. Levetiracetam
68
Q

Generalised weakness
- Common Differentials

A

Generalised weakness
- Common Differentials

  1. Stroke/TIA
  2. MS
  3. Post ictal
  4. Hypo
  5. Nerve palsy
  6. Narcolepsy/cataplexy
69
Q

Generalised weakness
- uncommon differentials

A

Generalised weakness
- uncommon differentials

  1. Haemorrhage/Haematoma
  2. Spine trauma
  3. Encephalitis/brain abscess
  4. MG/GBS
  5. Drug induced
  6. Electrolyte abnormality
70
Q

4 Motor neurone disease

A

4 Motor neurone disease

  1. ALS
  2. PMA
  3. PBP
    4.PLS
71
Q

PLS
- Features

A

Primary lateral sclerosis

  1. Prgressive tetraparesis
72
Q

MND
- Differentials

A

MND
- Differentials

  1. Cervical myelo-radiculopathy
  2. yringomyleia
  3. Syphilic pachymeningiti
  4. Motor neuropathy
73
Q

Motor neurone disease
- Investigations

A

Motor neurone disease
- Investigations

  1. MG
  2. NCS
74
Q

MND
- Management principles

A

MND Mx

  1. Communication
    - Ceiling of care
  2. MDT
    - Resp
    - Nutrition
    - Psych
  3. Riluzole
    - 6 Mo Life extension
75
Q

MND
- Supportive mx

A

MND
- Supportive mx

  1. PEG nutrition
  2. Ventilation
    - NIV
    - Intubation
    - Ceiling of care
76
Q

MND
- Complications

A

MND
- Complications

  1. Respiratory failure
    - Breathlessness on lying flat
  2. Aspiration pneumonia
77
Q

MND
- Presentation

A

MND Presentation

  1. Commonly 60s-70s
  2. UMN
    - Spasticitiy/Babinski
  3. LMN
    - Atrophy/Weakness
    - Fasciculations
  4. Bulbar
    - Jaw jerk
    - Swallowing
    - Pseudobulbar
78
Q

MND
- Presentation

A

MND Presentation

  1. Commonly 60s-70s
  2. UMN
    - Spasticitiy/Babinski
  3. LMN
    - Atrophy/Weakness
    - Fasciculations
  4. Bulbar
    - Jaw jerk
    - Swallowing
    - Pseudobulbar
79
Q

Migraines
- Associated symptoms

A

Migraines
- Associated symptoms

  1. Nausea/vomiting
  2. Auras
    - Visual (black/white/prism)
    - 1 hr before onset
80
Q

Cluster headache
- Associated symptoms

A

Cluster headache
- Associated symptoms

  1. Watery eye
  2. Runny nose
  3. Hyperhydrosis
81
Q

Tension headache
- Timing

A

Tension headache
- Timing

  1. Onset later in the day
  2. Up to 1 hour
82
Q

Cluster headaches
- Timing

A

Cluster headaches
- Timing

  1. Night-time
  2. 20mins - 1 hour
  3. Once or more per day
83
Q

Migraine
- Exacerbating and relieving

A

Migraine
- Exacerbating and relieving

  1. Relieved by dark room/nap
  2. Photo/phono-phobic
84
Q

Cluster headache
- Exacerbating relieving

A

Cluster headache
- Exacerbating relieving

  1. Too painful to sit still
85
Q

Tension headache
- Intensity

A

Tension headache
- Intensity

4-6

86
Q

Migraine headache
- Intensity

A

Migraine headache
- Intensity

6-8

87
Q

Cluster headache
- Intensity (1-10)

A

Cluster headache
- Severity

8-10

88
Q

Chronic migraines
- Timing

A

Chronic migraines
- Timing

15 days per month

89
Q

Headaches
- Family history

A

Headaches
- Family history

  1. Hemiplegic migraines
    - First-degree relative
90
Q

Tension headache
- Medical management

A

Tension headache
- Medical management

  1. Conservative
  2. TCA
    - Amitriptyline
91
Q

Migrane
- Medical management

A

Migrane
- Medical management

  1. Paracetamol
  2. Naproxen
  3. Metoclopromide
  4. Triptans
    - Sumatriptan
    - Limit to 2 days per week
92
Q

Migraines
- Medical prevention

A

Migraines
- Medical prevention

  1. Anti-HTN
    - Propanolol
    - Candesartan
  2. TCA
    - Amitriptyline
  3. Anti-histamine
    - Histofen
  4. AEDs
    - Lamotrigine
    - Valproate
93
Q

Cluster headache
- Medical management

A

Cluster headache
- Medical management

  1. Nasal/Sub-cut
    - Triptan
  2. High flow oxygen

Year 4 - NSS (5 decks)

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