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Med Finals - Medicine > Neurology > Flashcards

Neurology Flashcards

1
Q

Define stroke

A

Cerebrovascular accident caused by ischaemia, infarction of intracranial haemorrhage

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2
Q

Define transient ischaemic attack

A

Symptoms of a stroke that resolve within 24 hours. Transient neurological dysfunction secondary to ischaemia without infarction

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3
Q

History of a stroke

A

Sudden onset neurological symptoms
Weakness of limbs, face
Dysphasia
Visual loss
Sensory loss

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4
Q

Risk factors for a stroke

A

Cardiovascular disease- angina, MI, PVD
Previous stroke or TIA
AF
Carotid artery disease
Hypertension
Diabetes
Smoking
Vasculitis
Thrombophilia
COCP

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5
Q

Management of stroke

A

CT head within 1 hour
Aspirin 300mg
Thrombolysis within 4.5 hours
Thrombectomy - 24 hours

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6
Q

Management of TIA

A

Aspirin 300mg
Secondary prevention

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7
Q

Risk factors for intracranial bleeds

A

Head injury
Hypertension
Aneurysms
Ischaemic stroke
Brain tumours
Anticoagulants

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8
Q

What is assessed in GCS

A

Eyes, verbal and motor response

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9
Q

GCS scores eyes

A

Eyes - AVPU
Spontaneous - 4
Speech - 3
Pain - 2
None - 1

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10
Q

GCS scores verbal

A

Orientated - 5
Confused conversation - 4
Inappropriate words - 3
Incomprehensible sounds - 2
None - 1

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11
Q

GCS scores motor

A

Obeys commands - 6
Localises to pain - 5
Normal flexion - 4
Abnormal flexion - 3
Extends - 2
None - 1

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12
Q

Define a sub dural haemorrhage

A

Haemorrhage occuring between the dura mater and arachnoid mater.

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13
Q

What shape is a subdural haemorrhage on a CT

A

Crescent shaped

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14
Q

Where does bleeding happen in subdural haemorrhage

A

Caused by rupture of the bridging veins in the outer most meningeal layer

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15
Q

Define extradural haemorrhage

A

Bleed occuring between the skull and the dura mater

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16
Q

What shape is an extra dural haemorrhage on CT

A

Bi-convex, lemon, lentiform

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17
Q

Where does bleeding happen in an extra dural haemorrhage

A

Most commonly the middle meningeal artery - in the temporo-parietal region

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18
Q

Classic presentation of extradural haemorrhage

A

Traumatic head injury followed by period of improved neurological symptoms which rapidly decline over hours.

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19
Q

Define intracerebral haemorrhage

A

Bleeding within brain tissue

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20
Q

Define subarachnoid haemorrhage

A

Bleeding between the arachnoid mater and the pia mater

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21
Q

Classical presentation of subarachnoid haemorrhage

A

Sudden onset occipital headache during strenuous activity - thunderclap headache
Neck stiffness
Photophobia
Vision changes
Neurological symptoms

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22
Q

Risk factors for subarachnoid haemorrhage

A

Hypertension
Smoking
Excessive alcohol
Cocaine
FH

Black, femal, 45-70
Sickle cell anaemia, connective tissues disorders (marfans, Ehlers-Danlos), neurofibromatosis, ADPKD

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23
Q

Investigations in subarachnoid haemorrhage

A

CT head!
Lumbar puncture if negative
Angiography - locate source of bleed

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24
Q

What is seen on lumbar puncture in subarachnoid

A

Red cells - traumatic lumbar puncture?
Xanthochromia - yellow colour caused by bilirubin

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25
Q

Management of subarachnoid haemorrhage

A

Surgery
Coiling
Clipping

Nimodipine - prevent vasospasm.
Lumbar puncture or shunt - hydrocephalus
Mange complications - seizures

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26
Q

Define multiple sclerosis

A

A chronic progressive condition that involves demyelination of the myelinated neurones in the central nervous system - caused by an inflammatory process involving the activation of immune cells against myelin
Demyelinating polyneuropathy disseminated in time and space.

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27
Q

Causes of MS

A

Multiple genes
SBV
Low vitamin D
Smoking
Obesity

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28
Q

Possible presentations of MS

A

Optic neuritis - most common, monocular vision loss.
Abnormal eye movements
Focal weakness - Bells, Horners, limb paralysis, incontinence
Focal sensory symptoms - trigeminal neuralgia, numbness, paraesthesia, lhermittes sign
Ataxia - sensory or cerebella.

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29
Q

Define sensory ataxia

A

Loss of proprioception causing ataxia
Results in a positive romberg’s test -

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30
Q

Define cerebellar ataxia

A

Results from the problems with the cerebellum causing issue with coordination

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31
Q

Define clinically isolated syndrome

A

Describes the first episode of neurological symptoms which cannot be classed as MS as is not disseminated in time and space

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32
Q

What are the main patterns seen in MS

A

Relapsing-remitting
Secondary progressive
Primary progressive

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33
Q

Define relapsing-remitting MS

A

Most common pattern
Episodes of disease a neurological symptoms followed by recover.
These occur in different areas and episodes

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34
Q

Define secondary progressive MS

A

Where there was relapsing-remitting disease at first but there is a progressive worsening of symptoms with incomplete remission. Symptoms become more and more permanent

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35
Q

Define primary progressive MS

A

There is worsening of disease and symptoms from the point of diagnosis without initial relapses and remissions

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36
Q

Investigations in MS

A

Largely clinical
MRI
Lumbar puncture

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37
Q

What is seen on lumbar puncture in MS

A

Oligoclonal bands

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38
Q

Define optic neuritis

A

Inflammation of the optic nerve

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39
Q

Features of optic neuritis

A

Unilateral reduced vision developing over hours to days
Central scotoma - blind spot
Pain on eye movement
Impaired colour vision
Relative afferent pupillary defect

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40
Q

Management of MS

A

Disease modification - induce long term remission

Treat relapses - methylprednisolone 500mg for 5 days

Symptomatic treatment
Exercise
Neuropathic pain management
Depression
Urge incontinence - oxybutynin
Spasticity - baclofen, physiotherapy

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41
Q

Define Parkinson’s disease

A

A condition where there is a progressive reduction of dopamine in the basal ganglia of the brain leading to disorder of movement

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42
Q

What is the classic triad of parkinsions diseas

A

Resting tremor
Bradykinesia
Rigidity

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43
Q

Classic presentation of parkinsons

A

Stooped posture
Facial masking
Forward tilt
Reduced arm swing
Shuffling gait
Unilateral tremmor - pill rolling
Rigidity - cogwheel
Bradykinesia - slower and smaller, shuffling, hand writing, dificulty turning, hypomimia
Depression
Sleep disturbance
Loss of sense of smell
Postural instability
Cognitive impairment and memory problems

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44
Q

Distinguish parkinson’s from benign essential tremor

A

Parkinson’s
Asymmetrical, 4-6 hz, resting, improves with intentional movement, other parkinson’s features, No change with alcohol

Benign essential
Symmetrical, 5-8 hz, intention, improves with rest, no parkinson’s feature, improves with alcohol

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45
Q

Define multiple system atrophy

A

Rare condition where the neurones of multiple systems degenerate. Affects the basal ganglia causing parkinson’s as well as other areas leading to autonomic and cerebellar dysfunction.

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46
Q

Define dementia with lewy bodies

A

Type of dementia associated with parkinsonism. Causing progressive cognitive decline as well as hallucinations, delusions, sleep disorders and fluctuating consciousness.

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47
Q

Examples of parkinson’s plus syndromes

A

Progressive supranuclear palsy
Corticobasal degeneration
Multiple system atrophy
Dementia with lewy bodies

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48
Q

Management of parkinson’s disease

A

Levodopa - co-benyldopa, co-careldopa (can cause dyskinesias, excessive motor activity)
COMT inhibitors - entacapone.
Dompamine agonists - bromocryptine, pergolide, cabergolin (Cause pulmonary fibrosis)
MOABs - selegiline, rasgiline

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49
Q

Define benign essential tremmor

A

Common condition associated with old age - characterised by a fine tremor affecting all the voluntary muscles

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50
Q

Features of benign essential tremor

A

Fine tremor
Symmetrical
More prominent or voluntary movement
Worse when tired, stressed or after caffeine
Improved with alcohol
Absent in sleep

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51
Q

Management of benign essential tremor

A

Propranolol
Primidone

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52
Q

Define epilepsy

A

The umbrella term for a condition where there is a tendency to have seizures.

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53
Q

Define seizure

A

Transient episodes of abnormal electrical activity

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54
Q

Investigations in epilepsy

A

EEG
MRI
ECG

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55
Q

Examples of types of seizure

A

Generalised tonic clonic
Focal seizures
Absence seizures
Atonic seizure
Myoclonic seizure
Infantile spasms

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56
Q

Define generalised tonic-clonic seizures

A

Loss of consciousness with tonic movements - muscles tensing - followed by clonic movement - muscles jerking.
Associated with tongue biting, incontinence, groaning, irregular breathing
Post seizure there is a prolonged post-ictal period of confusion, drowsiness, irritable, and depressed.

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57
Q

Management of generalised tonic-clonic seizures

A

1st - sodium valproate
2nd - lamotrigine or carbamazepine

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58
Q

Define focal seizures

A

Start in the temporal loves and affect hearing, speech, memory and emotions
Present with hallucinations, memory flashbacks, deja vu, doing strange things on autopilot

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59
Q

Management of focal seizures

A

Reverse of generalised tonic clonic
1st - carbamazepine or lamotrigine
2nd - sodium valproate or levetiracetam

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60
Q

Define absence seizures

A

Typically seen in children, patient becomes black, stares into space then abruptly returns to normal. They will be unaware of their surroundings and wont respond. Typically last 10-20 seconds.

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61
Q

Management of absence seizures

A

Sodium valproate
Ehosuximide

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62
Q

Define atonic seizures

A

Also known as drop attackes. Characterised by brief lapses in muscle tone for short periods of time, without loss of consciousness

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63
Q

Management of atonic seizures

A

1st - sodium valproate
2nd - lamotrigine

64
Q

Define myoclonic seizures

A

Sudden brief muscle contractions, normally remaining awake. Occur in vaious form of epilepsy but mainlt in children

65
Q

Management of myoclonic seizures

A

1st - sodium valproate
2nd - lamotrigine, levetiracetam or topiramate

66
Q

Define infantile spasms

A

Also known as west syndrome
Clusters of full body spasms in infants - very poor prognosis!

67
Q

Management of infantile spasms

A

Prednisolone
Vigabatrin

68
Q

Side effects of sodium valproate

A

Teratogenic
Liver damage and hepatitis
Hair loss
Tremor

69
Q

Side effects of carbamazepine

A

Agranulocytosis
Aplastic anaemia
Induces P450

70
Q

Side effects of phenytoin

A

Folate and vit D deficiency
Megaloplastic anaemia
Osteomalacia

71
Q

Side effects of ethosuximide

A

Night terrors
Rashes

72
Q

Side effects of lamotrigine

A

Stevens-Johnson syndrome - life threatening skin rashes
Leukopenia

73
Q

Define status epilepticus

A

Seizures lasting more than 5 minutes or more than 3 in one hour

74
Q

Management of status epilepticus

A

ABCDE
Community - buccal midazolam, rectal diazepam
IV lorazepam 4 mg repeated after 10 minutes
IV phenobarbital or phenytoin

75
Q

Define neuropathic pain

A

Pain caused by abnormal functioning of the sensory nerves delivering abnormal painful signals to the brain.

76
Q

Common causes of neuropathic pain

A

Post herpetic - shingles
Nerver damage in surgery
MS
Diabetic neuralgia - feet
Trigeminal neuralgia
Complex regional pain syndrome

77
Q

Features of neuropathic pain

A

Burning
Tingling
Pins and needles
Electric shocks
Loss of sensation to touch the affected area

78
Q

Management of neuropathic pain

A

Amitriptyline
Duloxetine
Gabapentin
Pregabalin

Tramadol
Capsaicin
Physiotherapy
Psychological
Trigeminal - carbamazepine

79
Q

Define facial nerve palsy

A

Isolated dysfunction of the facial nerve - typically presenting with unilateral facial weakness.

80
Q

Branches of the facial nerve

A

Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical

81
Q

Function of the facial nerve

A

Motor - facial expression, stapedius, posterior digastric, stylohyoid and platysm.
Sensory - taste to anterior 2/3 of tongue
Parasympathetic - submandibular, sublingual salivary glans and lacrimal gland.

82
Q

What is presentation of an upper motor nuerone facial nerve palsy

A

Forehead sparing unilateral facial weakness.

83
Q

What is the presentation of a lower motor neurone facial nerve palsy

A

Unilateral facial weakness with no forehead sparing.

84
Q

Causes of upper motor neurone facial nerve palsy

A

Cerebrovascular accidents
Tumours

Bilateral - motor neurone disease, pseudobulbar palsies

85
Q

Define Bell’s palsy

A

Idiopathic lower motor neurone facial nerve palsy

86
Q

Management of Bells palsy

A

Prednisolone

87
Q

Define Ramsay-Hunt syndrome

A

A lower motor neurone facial nerve palsy caused by varicella zoster virus
Normally present with a painful, tender vesicular rash in the ear canal pinna or arround ear.

88
Q

Management of Ramsay-Hunt syndrome

A

Prednisolone
Aciclovir

89
Q

Causes of lower motor neurone facial nerve palsy

A

Infection - otitis media, malignant otitis media, HIV, lyme’s disease
Systemic disease - diabetes, sarcoidosis, leukaemia, MS, GBS
Tumours - acoustic neuroma, parotid tumours, cholesteatomas
Trauma - direct nerver, damage in surgery, base of skull fracture.

90
Q

Define brain tumours

A

Abnormal growths within the brain.

91
Q

Classic presentation of brain tumours

A

Focal neurological symptoms
Raised intracranial pressure.

92
Q

Features of raised intracranial pressure

A

Headache - constant, nocturnal, worse on waking, coughing, straining, bending forwards.
Altered mental state
Visual field defect
Seizure
Third and sixth nerve palsies
Papilloedema

93
Q

Define papiloedema

A

Swelling of the optic disc caused by raised intracranial pressure.

94
Q

Fundoscopic changes in papilloedema

A

Blurring of the optic disc margin
Elevated optic disc - vessels curve across it
Loss of venous pulsation
Engorged retinal veins
Haemorrhages
Around optic disc
Paton’s lnes - creases in retina around optic disc.

95
Q

What is the triad of raised intracranial pressure

A

Cushing’s triad
Brady cardia
Irregular respiration
Widened pulse pressure

96
Q

Common types of brain tumours

A

Seconday metastases
Gliomas
Meningiomas
Pituitary tumours
Acoustic neuroma - vestibular schwannoma

97
Q

What cancer commonly metastasis to the brain

A

Lung
Breast
Renal cell carcinoma
Melanoma

98
Q

Define glioma

A

Tumour of the glial cells in the brain or spinal cord.
Astrocytoma - glioblastoma multiforme
Oligodendroglioma
Ependymoma

99
Q

Define meningioma

A

Tumour frowing from cells of the meninges in the brain and spinal cord.
Usually benign but often space occupying

100
Q

Management of brain tumours

A

Palliative
Chemo
Radio
Surgery

101
Q

Define huntington’s Chorea

A

Is a autosomal dominant genetic condition that causes a progressive deterioration in the nervous system. This is a trinucleotide repeat disorder that involves a mutation on the HTT gene on chromosome 4

102
Q

Define anticipation

A

A feature of trinucleotide repeat disordfers where successive generations have more repeat genes resulting in earlier age onset and increased severity

103
Q

Presentation of Hungtington’s chorea

A

Cognitive, psychiatric or mood problems
Chorea - involuntary, abnormal movement
Eye movement disorders
Speech difficulties
Swallowing difficulties

104
Q

Investigations in Huntington;s chorea

A

Genetic testing!

105
Q

Management of Huntington’s choresa

A

Cannot slow or stop the diseasae
SALT
Genetic counselling
Advanced directives
End of life care
Symptomatic relief
Movement - antipsychotics, Benzos, dopamine depleting agents

106
Q

Prognosis of Huntington’s Chorea

A

15-20 years after the onset of symptoms.

107
Q

Define myasthenia gravis

A

An autoimmune condition that causes muscle weakness that gets progressively worse with activity and improves with rest.
Antibodies against acetylcholine receptors prevent excitation at neuromuscular junctions stopping contraction.
These antibodies also activate the complement system leading to damage of post synaptic membrane

108
Q

Presentation of mysasthenia gravis

A

Weakness that gets worse with muscle use and improves with rest.
Typically better in the morning and worse at night. Most commonly affecting proximal muscles
Extraocular muscle weakness causing double vision
Eyelid weakness causing ptosis
Weakness in facial movements
Difficulty with swallowing
Fatigue when chewing
Slurred speech
Progressive weakness

109
Q

How to elicit fatiguability on examination

A

Repeated blinking - ptosis
Prolonged upward gaze - diplopia
Repeated abduction of arm - unilateral weakness

110
Q

What autoantibodies are present in myasthenia gravis

A

Acetylcholine receptor antibodies
Muscle specific kinase
LRP4 antibodies

111
Q

Management of myasthenia gravis

A

Reversible acetylcholinesterase inhibitors - pyridostigmine or neostigmine
Immunosuppression - pred, azathioprine
Thymectomy
Rituximab
Exulizumab

112
Q

Define myasthenic crisis

A

Life threatening worsening of symptoms often triggered by another illness. LEads to respiratory failure - requiring bipap or intubation

113
Q

Management of myasthenic crisis

A

IV Ig and plasma exchange

114
Q

Define Lambert-Eaton myasthenic syndrome

A

Progressive muscle weakness with increased use, typically occuring in patients with small-cell lung cancer
Results from auto immune attack on voltage-gated sodium channels.

115
Q

Presentation of Lambert-Eaton syndrome

A

Insidious onset of proximal muscle weakness.
Intraocular muscle weakness
Reduce tendon reflexes

116
Q

Management of Lambert-Eaton syndrome

A

Diagnose and mange underlying condition (malignancy)
Amifampridine
Immunosuppression
IV Ig
Plasmapheresis

117
Q

Define Charcot-Marie tooth disease

A

An inherited disease that affects the peripheral motor and sensory nerves. Various types of autosomal dominant genetics which cause dysfunction of the myelin or the axons

118
Q

Clinical features of Charcot-Marrie-Tooth disease

A

High foot arches
Distal muscle wasting - inverted champagne bottle legs
Weakness in the lower legs - loss of ankle dorsiflecion
Weakness in the hands
Reduced tendon reflexes
Reduced muscle tone
Peripheral sensory loss

119
Q

Causes of peripheral neuropathy

A

ABCDE
Alcohol
B12 deficiency
Cancer and CKD
Diaeteds and Drugs- amiodarone, isoniazid, cisplatin
Every vasculitis

120
Q

Management of Charcot-Marie-Tooth disease

A

Cannot prevent progression
Physio
OT
Podiatrists
Orthopaedic surgeons

121
Q

Define Guillian Barre syndrome

A

An acute paralytic polyneuropathy that affects the peripheral nervous system.
Causes acute symmetrical ascending weakness and can also cause sensory symptoms.
Often triggered by infection.

122
Q

Presentation of guillian barre

A

Symmetrical ascending weakness
Reduced reflexes
Peripheral loss of sensation or neuropathic pain
May progress to the cranial nerves causing facial weakness

123
Q

Criteria fro diagnosis of GBS

A

Brighton criteria
Supported by investigations
Nerve conduction studies
Lumbar puncture - raised protein no cells or glucose

124
Q

Management of GBS

A

IV Ig
Plasma exchange
Supportive care
VTE prophylaxis
Close monitoring of respiratory function

125
Q

Define neurofibromatosis

A

Genetic condition that causes benign nerve tumours to develop throughout the nervous system.
Type 1 is more common than type 2

126
Q

Classical features of neurofibromatosis type 1

A

CRABBING - at least 2 of 7
Cafe-au-lait spots 6 or more
Relative with NF1
Axillary or inguinal freckles
BB - Bony dysplasia such as Bowing of long bone or spenoid wing dysplasia
Iris hamartomas - yellow, brown spots on iris
Neurofibromas - 2 or more
Glioma

127
Q

Investigations in neurofibromatosis

A

Clinical criteria
Genetic testing
Xray - bone lesions
CT/MRI -

128
Q

Management of neurofibromatosis type 1

A

Manage and monitor symptoms and complications

129
Q

Complications of neurofibromatosis

A

Migraines
Epilepsy
Renal artery stenosis and HTN
Learning and behavioural poblems
Scoliosis
Vision loss
Malignant peripheral nerve sheath tumours
Gastrointestinal stromal tumour
Brain tumour
Spinal cord tumour
Increased risk of cancer
Leukaemia

130
Q

What is neurofibromatosis most associated with

A

Acoustic neuromas! - bilateral

131
Q

Define tuberous sclerosis

A

a genetic condition that causes features in multiple systems
Caharacteristic feature is the deveelopment of hamartoma - benign neoplastic growths of the tissue they originate in. They commonly affect the skin, brain, lungs, heart. kidneys and eys

132
Q

Signs of tubersou sclerosis in skin

A

Ash leaf spots
Shagreen patches - thckened dimpled pigmented patches
Angiofibromas - small coloured pigmented papules that occur over the nose and cheeks
Subungual fibromata - fibromas under the nail bed
Cafe-au-lait spots
Pliosis - isolated patch of white hair on the head, eyebrows, eyelashes or beard.

133
Q

Common features of tuberous sclerosis

A

Epilepsy
Learning disabilit and development delay
Rhabdomyomas in the heart
Gliomas
PCKD
Lympangioleiomyomatosis
Rentinal hamartomas

134
Q

Managment of tuberous sclerosis

A

Suppportive and monitoring of complications

135
Q

Red flags for headaches

A

Raised intracranial pressure or haemorrhage
Fever, photophobia or neck stiffness
Dizziness - stroke
Visual disturbance
Sudden onset occipital
Worse on coughing or straining
Postural, worse on standing lying or bending
Waking from sleep
vomiting
Trauma
Pregnancy

136
Q

Define tension headaches

A

Mild ache across the forehead in a band like pattern - muscle aches

137
Q

Causes of tension type headache

A

Stress
Depression
Alcohol
Skipping meals
Dehydration

138
Q

Management of tension type headaches

A

Reassurance
BAsic analgesia
Relaxation
Hydration!

139
Q

What can causes a secondary tension headache

A

Underlying condition - infection, obstructive sleep apnoea or pre-eclampsia
Alcohol
Head injury
Carbonmonoxide poisioning

140
Q

Define sinusitis

A

Headache associated with inflammation of the sinuses - facial pain behin nose forehead and eyes
Normally resolves - irrigation can help

141
Q

Define analgesic headache

A

A headache caused by medication overuse - non-specific tension type feature with excessive use of analgesia

142
Q

Define trigeminal neuralgia

A

Intense facial pain tha comes on suddenly in the distribution of the trigeminal nerma

143
Q

Management of trigeminal neuralgia

A

Carbamazepine

144
Q

Define migraines

A

A complex neurological condition that causes headaches and other associated symptoms

145
Q

Typical patterns of migraines

A

Migraine without aura
Migraine with aura
Silent migraine - no headache
Hemiplegic migraine

146
Q

Typical headache in migraine

A

Moderate to severe intensity
Pounding or throbbing in nature
Unilateral - mostly
Photophobia
Phonophobia
Maybe aura
Nausea and vommiting

147
Q

Define aura in migraine

A

Term usedto describe visual changes
Sparks
Blurring
Lines across vision
Loss of different visual fields

148
Q

Define hemiplegic migraine

A

Stroke mimic
Typical migraine symptoms
Sudden or gradual onset
Hemiplegia
Ataxia

149
Q

Potential triggers of migraine

A

Stress
Bight lights
Strong smells
Certain food - chocolate, cheese, caffeine
Dehydration
Menstruation
Abnormal sleep patterns
Trauma

150
Q

Typical stages of migraine

A

Prodromal
Aura
Headache
Resolution
Postdromal

151
Q

Acute management of migraine

A

Paracetamol
Triptans - sumatriptan
NSAIDs
Antiemetics

152
Q

Migraine prophylaxis

A

PRopanolol
Topiramate
Amitriptyline

Acupuncture

153
Q

Define cluster headaches

A

Severe unbearable unilateral headaches usually around the eye.
Occur in clusters - 3-4 a day for weeks than a long gap maybe a years

154
Q

Presentation of cluster headaches

A

Red swollen watering eye
Pupil constriction
Ptosis
Nasal discharge
Facial sweating

155
Q

Acute management of cluster headaches

A

Triptans
High flow oxygen!!

156
Q

Prophylaxis of cluster headaches

A

Verapamil
Lithium
Prednisolone

Med Finals - Medicine (10 decks)

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