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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
Sub-arachnoid haemorrhage - Head CT findings
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%
26
Sub-arachnoid haemorrhage - LP/CSF
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
27
Sub-arachnoid haemorrhage - MRI
Sub-arachnoid haemorrhage - MRI 1. T2-FLAIR sequence 2. Echo-gradient sequences - Haemosiderin - Susceptibility artefact
28
Sub-arachnoid haemorrhage - Angiography 1. Non-invasive 2. Invasive
Sub-arachnoid angiography - Non-invasive 1. CTA 2. MRA - Invasive 1. DSA - Digital subtraction angiography - Endo-vascular coiling at same time
29
Sub-arachnoid haemorrhage - Mx
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
30
Neurology history - Formulation
Neurology history - Formulation 1. A/S/L 2. Onset - Timing - Mode 3. Symptoms - Nature - Distribution - Progression 4. Severity 5. Salient information
31
Neurology - Anatomical DDx
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
32
Neuro ddx - Brainstem Pathology presentations
Brainstem - Pathologies 1. Multiple CN palsies 2. Cerebellar and CN Sx
33
Neuro DDx - Cerebellar lesions
Neuro DDx - Cerebellar lesions 1. DANISH 2. Broad based ataxia - Heel-shin
34
Parkinson's - Examination
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
35
Neuropathies - Symmetry in degeneration and autoimmune disease
Neuropathies - Symmetry in degeneration and autoimmune disease 1. Asymmetric early on
36
Neuro ddx - Spinal features
Neuro ddx - Spinal features 1. Below a certain point 2. Can involve spincters 3. Motor and sensory
37
Neuro ddx - Nerve root features
Neuro ddx - Nerve root features 1. Dermatomal distribution
38
Neuro ddx - Plexus features
Neuro ddx - Plexus features 1. Unusual Distribution 2. Sensory and motor
39
Neuro ddx - NMJ presentation
Neuro ddx - NMJ presentation 1. Muscular only 2. Distribution 3. Fatigability - eg gaze
40
Myasthenia gravis - Pathology
Myasthenia gravis - Pathology 1. Anti-ACh IgG 2. Thymus abnormalities - Hyperplasia - Tumors
41
Myasthenia gravis - Presentation
Myasthenia gravis - Presentation 1. Fatigability 2. Extraocular muscles 3. Ptosis 4. No sensory or reflex loss
42
NMJ - Drug triggers
NMJ - Drug impacts 1. Aminoglycosides 2. Beta blockers, CCBs ... See MG website
43
Myasthenic crisis - Features
Myasthenic crisis 1. Slack facial muscles 2. Head falling 3. Jaw slack - drooling - absent gag reflex 4. Nasal voice 5. Limp body
44
Cholinergic crisis - Features
Cholinergic crisis - Features 1. Miosis 2. SLUDGE 3. Flaccid muscle paralysis - Like myasthenic
45
Myasthenia gravis - Ix
Myasthenia gravis - Ix 1. AChR antibodies 2. Tension test - Edrophonium 3. EMG - Muscle fatigue 4. CT thorax 5. Ice test - Ptosis
46
Myasthenia gravis - early management
Myasthenia gravis - early management 1. Supportive - respiratory - aspiration - DVT 2. Spirometry - FVC - ITU if <1l and ABG
47
Myasthenia gravis - Therapeutic management
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
Guillain barre syndrome - 4 Subtypes
Guillain barre syndrome - 4 Subtypes 1. AIDP 2. AMAN 3. AMSAN 4. Miller Fisher Syndrome
49
Guillain Barre Syndrome - Post infectious features
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
GBS - Autonomic involvement
GBS - Autonomic involvement 1. Cardiac arrhythmia 2. Ileus
51
GBS Respiratory Failure - Monitoring
GBS Respiratory Failure - Monitoring 1. Spirometry QDS 2. 1/4 need NIV
52
GBS - Therapeutic Management
GBS - Therapeutic Management 1. IVIG 2. Plasmapheresis 3. Ventilation
53
MS - S&S
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
MS - Pathophysiology
MS - Pathophysiology 1. Body attacks myelin 2. Multiple plaques 3. Brain and spinal cord - disseminated in space - disseminated in time
55
MS - Prevalence
MS - Prevalence 1. 7000 new per year 2. >130,000 UK 3. 3:1 F:M
56
Ms - Ix
Ms - Ix 1. MRI brain - multiple plaques 2. CSF - Oligoclonal bands 3. Visual delay
57
MS - Criteria
MS - Criteria 1. McDonald Criteria - two lesions in time and space - MRI evidence
58
MS - Clinical courses
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
MS Mx 1. Acute 2. Chronic
MS Mx 1. Acute - Rule out infection - Short course of steroids for inflammation 2. Chronic - DM treatment - MDT
60
MS - Disease Modifying Treatment 1. Factors to consider 2. Drugs: Eg.
MS - Disease Modifying Treatment 1. Course of MS 2. Activity of disease Eg. Interferon beta Alemtuzumab Cladribine
61
MS - Uhthoffs Sign
MS - Uhthoffs Sign 1. Worse in heat
62
Epilepsy - definition
Epilepsy - definition 1. ?
63
Epilepsy - types
Epilepsy - types 1. Focal onset 2. Generalised onset 3. Unknown onset
64
Seizure - Quality of movement
Seizure - Quality of movement 1. Clonic - Fast out - Slow in
65
Seizure - Stabilisation phase mx
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
Seizure initial phase - 5-20min mx
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
Seizure - Second phase therapy (20-40 mins)
Seizure - Second phase therapy (20-40 mins) 1. Fosphenitoin 2. Valproate 3. Levetiracetam
68
Generalised weakness - Common Differentials
Generalised weakness - Common Differentials 1. Stroke/TIA 2. MS 3. Post ictal 4. Hypo 5. Nerve palsy 6. Narcolepsy/cataplexy
69
Generalised weakness - uncommon differentials
Generalised weakness - uncommon differentials 1. Haemorrhage/Haematoma 2. Spine trauma 3. Encephalitis/brain abscess 4. MG/GBS 5. Drug induced 6. Electrolyte abnormality
70
4 Motor neurone disease
4 Motor neurone disease 1. ALS 2. PMA 3. PBP 4.PLS
71
PLS - Features
Primary lateral sclerosis 1. Prgressive tetraparesis
72
MND - Differentials
MND - Differentials 1. Cervical myelo-radiculopathy 2. yringomyleia 3. Syphilic pachymeningiti 4. Motor neuropathy
73
Motor neurone disease - Investigations
Motor neurone disease - Investigations 1. MG 2. NCS
74
MND - Management principles
MND Mx 1. Communication - Ceiling of care 2. MDT - Resp - Nutrition - Psych 3. Riluzole - 6 Mo Life extension
75
MND - Supportive mx
MND - Supportive mx 1. PEG nutrition 2. Ventilation - NIV - Intubation - Ceiling of care
76
MND - Complications
MND - Complications 1. Respiratory failure - Breathlessness on lying flat 2. Aspiration pneumonia
77
MND - Presentation
MND Presentation 1. Commonly 60s-70s 2. UMN - Spasticitiy/Babinski 3. LMN - Atrophy/Weakness - Fasciculations 4. Bulbar - Jaw jerk - Swallowing - Pseudobulbar
78
MND - Presentation
MND Presentation 1. Commonly 60s-70s 2. UMN - Spasticitiy/Babinski 3. LMN - Atrophy/Weakness - Fasciculations 4. Bulbar - Jaw jerk - Swallowing - Pseudobulbar
79
Migraines - Associated symptoms
Migraines - Associated symptoms 1. Nausea/vomiting 2. Auras - Visual (black/white/prism) - 1 hr before onset
80
Cluster headache - Associated symptoms
Cluster headache - Associated symptoms 1. Watery eye 2. Runny nose 3. Hyperhydrosis
81
Tension headache - Timing
Tension headache - Timing 1. Onset later in the day 2. Up to 1 hour
82
Cluster headaches - Timing
Cluster headaches - Timing 1. Night-time 2. 20mins - 1 hour 3. Once or more per day
83
Migraine - Exacerbating and relieving
Migraine - Exacerbating and relieving 1. Relieved by dark room/nap 2. Photo/phono-phobic
84
Cluster headache - Exacerbating relieving
Cluster headache - Exacerbating relieving 1. Too painful to sit still
85
Tension headache - Intensity
Tension headache - Intensity 4-6
86
Migraine headache - Intensity
Migraine headache - Intensity 6-8
87
Cluster headache - Intensity (1-10)
Cluster headache - Severity 8-10
88
Chronic migraines - Timing
Chronic migraines - Timing 15 days per month
89
Headaches - Family history
Headaches - Family history 1. Hemiplegic migraines - First-degree relative
90
Tension headache - Medical management
Tension headache - Medical management 1. Conservative 2. TCA - Amitriptyline
91
Migrane - Medical management
Migrane - Medical management 1. Paracetamol 2. Naproxen 3. Metoclopromide 4. Triptans - Sumatriptan - Limit to 2 days per week
92
Migraines - Medical prevention
Migraines - Medical prevention 1. Anti-HTN - Propanolol - Candesartan 2. TCA - Amitriptyline 3. Anti-histamine - Histofen 4. AEDs - Lamotrigine - Valproate
93
Cluster headache - Medical management
Cluster headache - Medical management 1. Nasal/Sub-cut - Triptan 2. High flow oxygen

Year 4 - NSS (5 decks)

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