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Year 6 Cross Section > Neurology > Flashcards

Neurology Flashcards

1
Q

stroke definition

A

rapid onset neuro deficit of vascular origin

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2
Q

Glabellar tap

A

confirmatory test of Parkinson’s
if tap patients forehead, eyes blink

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3
Q

MSA symptoms

A

autonomic dysfunction
cerebellar dysfunction
rigidity > tremor

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4
Q

PSP symptoms

A

vertical gaze palsy
postural instability
speech disturbance

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5
Q

corticobasilar degeneration

A

unilateral parkinsonism
aphasia
alien limb phenomenon

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6
Q

Parkinsonism Vs Parkinson’s

A

Parkinsonism: symmetrical, rapid progression, poor response to levodopa
Parkinson’s: asymmetrical, progressive nature, good response to Levodopa

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7
Q

Parkinsonism symptoms

A

vascular (strokes)
idiopathic
AI encephalitis
Infective (Syphollis, HIV, CJD)
Congential e.g. Wilson’s
Drugs (antipsychotics)

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8
Q

MS definition

A

AI demyelinating disorder of CNS, multiple plaques in separate time and space

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9
Q

MG management

A
  1. long acting ACh-esterase inhibitors e.g. neostogmine
  2. immunosuppression: azothioprine
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10
Q

ALS

A

mixed UMN/LMN

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11
Q

PLS

A

UMN

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12
Q

PMA

A

LMN

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13
Q

PBP

A

bulbar

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14
Q

investigations in MND

A

MRI brain +/- spinal cord
EMG
LP

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15
Q

unilateral vs bilateral UMN lesion gait

A

UL = circumducting gait
BL = scissoring gait

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16
Q

spasticity vs rigidity

A

spasticity = pyramidal
rigidity = extra-pyramidal

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17
Q

pyramidal tracts

A

corticospinal tracts
corticobulbar tracts

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18
Q

causes of cerebellar syndrome

A
  • vascular: vertebrobasiliar stroke
  • infection: encephalitis/abscess
  • trauma: raised ICP
  • AI: MS/ paraneoplastic
  • Metabolic: ethanol/poisons
  • Neoplastic: posterior fossa tumour
  • congenital: spinocerebellar ataxia
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19
Q

fast phase nystagmus

A

cerebellar = towards lesion
vestibular = away from lesion

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20
Q

nystagmus maximal looking

A

cerebellar = towards lesion
vestibular = away from lesion

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21
Q

zones of cerebellum and function

A
  • spinocerebellum: movement and posture
  • neocerebellum: motor planning
  • vestibulocerebellum: balance and vision
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22
Q

spinocerebellum problem presentation

A

truncal ataxia

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23
Q

neocerebellum problem presentation

A

dysmetria
intention tremor

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24
Q

vestibulocerebellum problem presentation

A

diplopia
nystagmus

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25
Q

Wallenberg’s syndrome symptoms (My PANDAS)

A

Miosis (Horner’s)
nYstagmus
Ptosis (Horner’s)
Anhidrosis (Horner’s)
Nystagmus
Dysphagia (ipsliateral)
Ataxia
Sensory loss of limb (contralateral)

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26
Q

3 causes of Marcus Gunn pupil

A

MS
Glaucoma
Retinal disease

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27
Q

Weber’s syndrome

A

midbrain strokes
ipsilateral 3rd nerve palsy
contralateral hemiplegia

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28
Q

autonomic dysreflexia

A

usually spinal injuries above T6
lack if splanchnic outflow from T6-T12

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29
Q

causes of syringomyelia

A

affects spinothalamic tracts
- Chiari malformations
- Trauma
- Tumours
- Idiopathic

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30
Q

symptoms of syringomyelia

A

loss of sensation to pain and temp, especially in hands
progressive limb weakness and stiffness

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31
Q

management of synringomyelia

A

shunting

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32
Q

pre-ganlionic Horner’s sx

A

anhidrosis of face

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33
Q

central Horner’s sx

A

anhidrosis of face and trunk

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34
Q

post-ganglionic Horner’s sx

A

no anhidrosis

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35
Q

central causes of Horner’s

A

stroke
syringomyelia
sclerosis (multiple)
wallenburg’s lateral meduallary syndrome

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36
Q

Pre-ganglionic causes of Horner’s

A

Tumour (pancoast)
Thyroidectomy
Cervical Rubs

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37
Q

Post-ganglionic causes of Horner’s

A

carotid artery dissection
cavernous sinus thrombosis
cluster headache

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38
Q

symptoms of degenerative cervical myelopathy

A
  • pain in neck and limbs
  • loss of ANS function
  • loss of digital dexterity
  • loss of sensory function and numbness
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39
Q

testing cerebellar dysfunction in upper limbs

A

tone
pronator drift
rebound phenomenon
coordination

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40
Q

cause of painful 3rd nerve palsy

A

posterior communicating artery aneurysm

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41
Q

ptosis and large pupil

A

3rd nerve palsy

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42
Q

ptosis and normal pupil

A

MG

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43
Q

ptosis and small pupil

A

Horner’s

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44
Q

UMN motor pathway

A

motor cortex to anterior horn cell

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45
Q

LMN motor pathway

A

anterior horn cell to motor unit

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46
Q

if UMN signs, where could lesion be?

A

brain
brainstem (midbrain, pons, medulla)
spinal cord

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47
Q

if UMN/LMN signs, where could lesion be?

A

anterior horn cell

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48
Q

if sensory signs, where could lesion be?

A

DRG

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49
Q

if motor symptoms, where could lesion be?

A

NMG or muscle

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50
Q

what are the different sensory pathways?

A

proprioception
vibration sense
touch
pain and temp

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51
Q

posterior circulation stroke symptoms

A

diplopia
dysarthria
dizziness
dysphagia

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52
Q

lateral medullary syndrome symptoms

A

ipsilateral Horner’s
ipsilateral sensory alteration of pain and temp
ipsilateral cerebellar ataxia
contralateral alteration of pain and temp (spinothalamic tract)

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53
Q

important parts to remember about status epilepticus

A

check BM
if poor nutrition/alcohol abuse - give Pabrinex

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54
Q

absence seizure EEG

A

3Hz

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55
Q

atonic sx and EEG

A

Sx: loss of tone
EEG: spikes

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56
Q

myoclonic sx and EEG

A

sx: jerking
EEG: spikes

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57
Q

investigations in epilepsy

A

eye witness account
examination
bloods
ECG, EEG
MRI brain

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58
Q

important parts of epilepsy management

A

safety advice: showers rather than bath, stop driving, inform DVLA
start treatment after 2 clearly unprovoked seizures >24 hrs apart

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59
Q

ALS symptoms

A

wasting and fasciculations
brisk reflexes and upgoing plantars
dyarthria and dysphagia

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60
Q

Bulbar palsy symptoms

A

dysarthria and dysphagia
limb involvement later

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61
Q

progressive muscular atrophy

A

pure LMN

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62
Q

primary lateral sclerosis

A

pure UMN

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63
Q

mimics of MND

A

syringomyelia
benign fasciculation syndrome
multifocal motor neuropathy

64
Q

management of GBS

A

admit, early stages are unpredictable
spirometry
cardiac monitor
DVT prophylaxis
IVIg/plasma exchange

65
Q

causes of predominantly sensory neuropathy

A

diabetes
thiamine def
malignancy
leprosy
amyloid
uraemia

66
Q

causes of predominantly motor neuropathy

A

GBS
porphyria
diptheria
botulism
lead

67
Q

Parkinson’s disease features

A

gait
mask like face
bradykinesia
reduced arm swing
rigidity
asymmetric resting tremor
postural instability
tremor
autonomic dysfunction

68
Q

MS differentials

A

neurosarcoidosis
neuromyelitis optica spectrum disorders

69
Q

fundoscopy tips

A
  • use R hand to examine R eye
  • use L hand to examine L eye
70
Q

MRC grading

A

0: no contraction
1: flicker or trace of contraction
2: active movement, with gravity eliminated
3: active movement against gravity
4: active movement against gravity and resistance
5: normal power

71
Q

reflex nerve root

A
  • biceps (C5, C6)
  • supinator (C5, C6)
  • triceps (C7)
  • knee (L3-4)
  • ankle (L5-S1)
72
Q

dorsal columns function

A

fine touch
vibration
proprioception

73
Q

lateral spinothalamic tract function

A

pain
temperature

74
Q

lateral corticospinal tract function

75
Q

parietal lobe function

A

sensory cortex
body organisation

76
Q

temporal lobe function

77
Q

patterns of motor deficits: corticol lesions

A
  • hyperreflexia proximally in arm or leg
  • unexpected patterns (e.g. all movements in hand/foot)
78
Q

patterns of motor deficits: internal capsule/corticospinal lesions

A
  • contralateral hemiparesis
79
Q

patterns of motor deficits: lesion with decrease cognition/homonyous hemianopia

A

cerebral hemisphere

80
Q

patterns of motor deficits: cord lesions

A
  • quadriparesis/paraparesis
  • motor and reflex level = LMN signs at level, UMN signs below
81
Q

patterns of motor deficits: peripheral neuropathies

A

distal weakness

82
Q

peripheral neuropathy with one nerve involved and causes

A

mononeuropathy
(trauma/entrapment)

83
Q

peripheral neuropathy with several nerves involved and causes

A

mononeuritis multiplex
(vasculitis/DM)

84
Q

UMN lesions affect what cells

A

motor cells in pre-central gyrus to anterior horn cells

85
Q

UMN lesion signs

A

pyramidal weakness
no wasting
spasticity (inc tone +/- clonus)
hyperreflexia
upgoing plantar

86
Q

LMN lesions affect what cells

A

anterior horn cells to peripheral nerves

87
Q

LMN lesion signs

A

wasting
fasciculation
flaccid/ dec tone
hyporeflexia
down going plantars

88
Q

primary muscle lesions signs

A

symmetrical loss
reflexes lost later
no sensory loss
fatiguability in MG

89
Q

sensory deficits pattern: distal sensory loss cause

A

neuropathy

90
Q

sensory deficits pattern: sensory level cause

A

cord lesion
hemi-cord lesion = Brown-Sequard

91
Q

sensory deficits pattern: dissociated sensory loss and cause

A

e.g. cervical cord lesion (Syringomyelia)
selective loss of pain and temp
(conservation of proprioception and vibration)

92
Q

muscle weakness differentials if caused by problem with cerebrum/ brainstem

A
  • vascular (infarct/haemorrhage)
  • inflammation (MS)
  • SOL
  • infection (enceph, abscess)
93
Q

muscle weakness differentials if caused by problem with cord

A
  • vasc (ant spinal artery infarction)
  • inflammation (MS)
  • injury
94
Q

muscle weakness differentials if caused by problem with anterior horn

95
Q

muscle weakness differentials if caused by problem with roots/plexus

A
  • spondylosis
  • CES
96
Q

muscle weakness differentials if caused by problem with motor nerves

A
  • mononeuropathy e.g. compression
  • polyneuropathy e.g. GBC
97
Q

muscle weakness differentials if caused by problem with NMJ

A

GB
LEMS
Botulism

98
Q

muscle weakness differentials if caused by problem with muscle

A

toxins = steroids
myositis
inherited (DMD)

99
Q

hand wasting differentials if caused by problem with cord

A

MND
Polio
Syringomyelia

100
Q

hand wasting differentials if caused by problem with Roots

A

(C8,T1)
compression e.g. spondylosis

101
Q

hand wasting differentials if caused by problem with brachial plexus

A

compression (cervical ribs, Pancoast)
Klumpke’s

102
Q

hand wasting differentials if caused by problem with Neuropathy

A

mononeuritis = DM
compressive mononeuropathy = median/ulnar

103
Q

hand wasting differentials if caused by problem with muscle

A
  • disuse (RA)
  • compartment syndrome
  • distal myopathy
  • cachexia
104
Q

gait disturbance with basal ganglia problem and causes

A

festinating/shuffling
- PD
- Parkinsonism (MSA, PSP, Lewy body dementia)

105
Q

gait disturbances with UMN bilateral lesion and cause

A

spastic, scissoring
- cord (compression, trauma, syringomyelia)
- bihemispheric (CP, MS)

106
Q

gait disturbances with UMN unilateral lesion and cauuse

A

spastic circumducting
- hemisphere lesion: CVS, MS, SOL
- hemicord: MS, tumour

107
Q

gait disturbances with LMN bilateral lesion and cause

A

bilateral foot drop
- polyneuropathy: CMT, GBS
- cauda equina

108
Q

gait disturbances with LMN unilateral lesion and cause

A

foot drop - high stepping gait
- anterior horn: polio
- radicular: L5 root lesion
- sciatic/common peroneal nerve: trauma, DM

109
Q

TACS diagnostic requirements

A

all 3 of:
1. Hemiparesis (contralateral)
2. Homonymous hemaniopia (contralateral)
3. Higher corticol dysfunction (dysphagia, neglect)

110
Q

PACS vs TACS

A

PACS only needs 2/3

111
Q

cause of lacunar stroke

A

small infarcts around basal ganglia, internal capsule, thalamus, pons

112
Q

symptoms of lacunar stroke

A

absence of:
higher corticol dysfunction
homonymous hemianopia
brainstem signs

113
Q

stroke secondary prevention

A

clop 75mg started after 2 weeks
(initially 300mg aspirin)

114
Q

stroke extra management points

A

MDT
safe eating
neuro rehab
DVT prophylaxis
sores

115
Q

subdural appearance on CT head

A

crescentic haematoma over one hemisphere

116
Q

extradural appearance on CT head

A

lens shaped haematoma

117
Q

Kernig’s sign

A

straightening leg with hip at 90 degrees = pain

118
Q

Brudzinki’s sign

A

lifting head = lifting of legs

119
Q

when to give dexamethasone in meningitis?

120
Q

definition of epilepsy

A

recurrent tendency to spontaneous, intermittent abnormal electrical activity in brain

121
Q

causes of epilepsy

A

idiopathic
acquired:
- vascular (CVA, SOL)
- corticol scarring (trauma, infection)

122
Q

neuro obs

A

GCS
pupils
HR
BP
RR
SpO2
Temp

123
Q

important to remember with CN6 palsy

A

false localising sign

124
Q

what is neuroprotective ventilation?

A

hyperventilate

125
Q

what worsens the Parkinson’s tremor?

A

worsened by distraction

126
Q

what are the features of Parkinsons?

A
  • tremor (worse at rest)
  • rigidity (inc tone = lead pipe, rigidity + tremor = cog wheeling)
  • bradykinesia (slow initiation of movement, hypomemetic face)
  • reduced arm swing
127
Q

what Parkinson’s meds to start if young and fit?

A

start with Da agonists, MOA-B inhibitors, L-DOPA

128
Q

What Parkinson’s meds to start if biologically frail +/- co-morbidities?

A

L-DOPA, MOA-B inhibitors

129
Q

benefit of COMT inhibitors

A

lessen end of dose effect

130
Q

Lhermitte’s sign

A

neck flexion = electric shock in trunk/limbs

131
Q

treatment of MS

A

IFN-beta
Natalizuman

132
Q

cord compression signs

A

LMN signs at level
UMN signs below level
acute: tone and reflexes reduced

133
Q

what is spondylosis?

A

degeneration due to trauma or ageing

134
Q

symptoms of cervical spondylosis

A

neck stiffness
arm pain
motor/sensory upper limb disturbances according to compression level

135
Q

symptoms of lumbar spondylosis

A

low back pain
sciatica

136
Q

what are the most commonly compressed nerve roots

137
Q

L5 root compression symptoms

A

weak toe extension
foot drop
weak inversion
decreased sensation on inner dorsum

138
Q

S1 root compression symptoms

A

weak plantar flexion and eversion
loss of ankle jerk
calf pain

139
Q

systemic causes of facial nerve palsy

A

GBS
sarcoid
DM

140
Q

definition of mononeuritis multiplex

A

2+ peripheral nerves affected

141
Q

median nerve (C6-T1)
- location
- motor function
- sensory loss

A
  • wrist: carpal tunnel/trauma
  • motor function: LLOAF muscles, thenar wasting
  • sensory loss: radial 3.5 fingers
142
Q

ulnar nerve (C7-T1)
- location
- motor function
- sensory loss

A
  • elbow trauma (e.g. supracondylar fracture)
  • motor: claw hand, hypothenar wasting
  • sensory: ulnar 1.5 fingers
143
Q

radial nerve (C5-T1)
- location
- motor function
- sensory loss

A
  • damaged at wrist (low), humerus (high) and axilla (very high)
    Motor:
  • low = finger drop
  • high = wrist drop
  • v high = triceps paralysis, wrist drop
    sensory: snuff box
144
Q

phrenic nerve (C3-C5)
- location
- motor function

A
  • neoplastic (lung Ca, myeloma), mechanical (cervical spondylosis), infective (HIV, TB)
  • motor: orthopnoea and raised hemidiaphragm
145
Q

Lateral cutaneous nerve of thigh (L2-3)
- location
- sensory loss

A
  • entrapment under inguinal ligament
  • sensory: meralgia paraesthetica (anterolateral burning thigh pain)
146
Q

sciatic nerve (L4-S3)

A
  • pelvic tumours, pelvic fractures
  • motor: hamstrings, all muscles below knee
  • sensory: below knee laterally and foot
147
Q

common peroneal nerve (L4-S1)
- location
- motor function
- sensory loss

A
  • fibular head trauma/sitting cross legged
  • motor: foot drop, weak ankle dorsiflexion and eversion
  • sensory: below knee laterally
148
Q

Tibial nerve (L4-S3)
- motor function
- sensory loss

A
  • motor: can’t plantar flex, poor toe flexion
  • sensory: sole of foot
149
Q

GBS management

A

Airwary
Analgesia
Autonomic (may need catheter)
Antithrombotic (TEDS, LMWH)

150
Q

Charcot-Marie-Tooth symptoms

A

peroneal muscular atrophy
Hereditary motor and sensory neuropathy

151
Q

MND diagnostic criteria

A

El Escorial

152
Q

where is lesion in ALS

A

loss of motor neurones in cortex and anterior horn

153
Q

symptoms of myopathy

A
  • gradual onset
  • symmetrical proximal weakness
  • preserved tendon reflexes
154
Q

NF1 symptoms

A

CAFE NOIR
Cafe au lait spots
Axillary freckling
Fibromas (Neuro)
Eye (Lisch nodules)
Neoplasia (CNS, phaeo)
Orthopaedic (Kyphoscolisosi)
dec IQ and epilepsy
Renal (inc BP)

155
Q

causes of peripheral neuropathy

A

ABCDE
Alcohol
B12 deficiency
Cancer and Chronic Kidney Disease
Diabetes and Drugs (e.g. isoniazid, amiodarone)
Every vasculitis

Year 6 Cross Section (23 decks)

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