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AMK > Neurology > Flashcards

Neurology Flashcards

1
Q

Crescent shaped haemorrhage - what is it, Px and cause?

A

Subdural haemorrhage
Caused by rupture of bridging veins
Presents with gradually increasing confusion

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2
Q

lemon shaped haemorrhage - what is it, Px and cause?

A

Extradural haemorrhage
Trauma to pterion, rupture of the middle meningeal artery
Px = trauma, lucid period, rapid decline

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3
Q

thunderclap headache after strenuous activity. what is it, cause and special Mx

A

subarachnoid haemorrhage.
aneurysm rupture
endovascular coiling

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4
Q

recognising stroke in ED tool

A

ROSIER

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5
Q

5 points for haemmorhagic stroke Mx

A
  1. non contrast CT head
  2. BP control to <140mmHG (IV labetalol)
  3. reverse anticoagulation
  4. refer to neurosurgery
  5. if aneurysm = endovascular coiling
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6
Q

reversing warfarin

A

vitamin K & prothrombin complex concentrate

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7
Q

reversing dabigatran

A

idaracizumab

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8
Q

factor Xa reversal

A

prothrombin complex concentrate

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9
Q

how to differentiate ischaemic and haemorrhagic stroke on CT

A

ischaemic = hypodense
haem = hyperdense

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10
Q

gold standard diagnosis for ischaemic stroke

A

Diffusion weighted MRI

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11
Q

management of ischaemic stroke

A

thrombolysis (alteplase) within 4.5hrs
if presents after 4.5hrs: mechanical thrombectomy

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12
Q

long term management of ischaemic stroke

A

aspirin and clopidogrel
atorvastatin to prevent recurrence

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13
Q

contraindications to thrombolysis

A

intracranial/GI bleed
major surgery in the last 2 weeks
INR >1.7

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14
Q

horners syndrome

A

ptosis, miosis, anhidrosis

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15
Q

Wallenberg syndrome (lateral medullary)
what vessel is occluded

A

ipsilateral: ataxia, nystagmus, face numbness, horners

contralateral: body numbness

PICA occlusion

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16
Q

Lateral pontine

A

similar to wallenberg

ipsilateral hearing loss

AICA occlusion

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17
Q

Locked in syndrome
which artery is occluded

A

tetraplegia, preserved consciousness and vertical gaze

basilar artery occlusion

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18
Q

pathophysiology of MS

A

inflammatory demyelination of CNS neurones causing destruction go oligodendrocytes

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19
Q

two main types of MS

A

relapse-remitting (occurs in phases with improvement)
Primary progressive (gradual deterioration)

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20
Q

presentation of MS

A

optic neuritis = painful eye movements, red desats, loss of central vision
Internuclear ophthalmoplegia (nystagmus during horizontal vision)
parasthesia
cerebellar ataxia

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21
Q

what does MRI show in MS?

A

paraventricular plaques

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22
Q

methylprednisolone is the management of …

A

acute attacks of MS

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23
Q

two drug classes used for RRMS

A

disease modifying = interferon-beta/fingolimod
symptoms reducing e.g. amantadine for fatigue

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24
Q

cause of guillain barre

A

infective gastroenteritis (campylobacter jejuni, CMV, epstein barr virus)

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25
Q

pathophis of guillain barre

A

demyelination of PNS

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26
Q

symmetrical ascending weakness of the limbs
reduced reflexes
parasthesia

A

Px of guillain barre

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27
Q

medical management for guillain barre

A

IV immunoglobulin
plasmapheresis

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28
Q

differentiating between guillain barre and miller fisher

A

Miller-fisher starts proximally, Guillain barre starts distally

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29
Q

muscle weakness condition linked to thymoma

A

myasthenia gravis

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30
Q

presentation of myasthenia gravis

A

eye drooping, double vision
weak facial muscles, jaw
trouble swallowing, slurred speech

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31
Q

what is pyridostigmine?

A

acetylcholinesterase inhibitor
Mx for myasthenia gravis

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32
Q

similar symptoms to myasthenia gravis but has small cell lung cancer

A

Lambert eaton syndrome

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33
Q

Mx of lambert eaton syndrome

A

amifampridine
allows more ACh into synapse

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34
Q

Px of ramsay hunt syndrome

A

unilateral facial nerve palsy
hearing loss
herpetic rash in ear canal

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35
Q

Mx of ramsay hunt syndrome

A

Aciclovir
Prednisolone

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36
Q

Mx of tonic clonic seizure

A

lamotrigine (if female of reproductive age)
sodium valproate

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37
Q

Mx of absence seizures

A

ethosuximide

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38
Q

Mx of focal seizures

A

lamotrigine

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39
Q

Mx flowchart for status epilepticus

A
  1. rectal diazepam / IV lorazepam if you have IV access
  2. sodium valoproate
  3. general anaesthesia
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40
Q

triad of huntingtons disease

A

autosomal dominant inheritance
choreoathetosis
dementia

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41
Q

MRI in huntingtons

A

atrophy of caudate nucleus and putamen

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42
Q

MRI in alzheimers

A

widespread cerebral atrophy

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43
Q

Px of charcot-marie-tooth syndrome

A

high foot arch
distal muscle wasting (reverse champagne bottle legs)
reduced muscle tone
peripheral neuropathy

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44
Q

features of Brown-Sequard syndrome

A

damage to a hemisection of the spinal cord
Results in:
ipsilateral: loss of proprioception, paralysis, hyperreflexia
contralateral: loss of pain and temperature sensation

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45
Q

loss of pain/temp sensation and motor function below the lesion
what is this???

A

anterior cord syndrome

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46
Q

loss of proprioception below the lesion
what is this?

A

posterior cord syndrome

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47
Q

bladder/bowel dysfunction
lower back+leg pain
lower limb motor deficit
loss of perianal sensation and tone

what is this and what is the main cause?

A

Cauda equina syndrome
Massive herniated disc

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48
Q

multiple system atrophy

A

parkinsonism + autonomic dysfunction e.g. postural hypotension; incontinence; impotence

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49
Q

corticobasal degeneration

A

Parkinsonism + spontaneous limb movements / akinesia

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50
Q

progressive supranuclear palsy

A

Parkinsonism + impaired vertical gaze

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51
Q

lewy body dementia

A

Parkinsonism + hallucinations

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52
Q

what is a positive Romberg’s sign and what does it show?

A

eyes closed, can’t stand still
shows that there is sensory ataxia due to a dysfunctional dorsal column - can’t detect proprioception

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53
Q

Cushings Triad

A

signs of raised ICP
1. bradycardia
2. hypertension
3. irregular breathing

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54
Q

wernicke’s encephalopathy triad, why does this happen

A
  1. confusion
  2. ataxia
  3. ophthalmoplegia

this happens due to thiamine deficiency in alcohol overuse

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55
Q

cluster headache: px and mx

A

unilateral eye pain, bloodshot eye, vomiting, rhinorrhoea
Mx =
High flow oxygen

sumatriptan

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56
Q

cluster headache: px and mx

A

unilateral eye pain, bloodshot eye, vomiting, rhinorrhoea
Mx = sumatriptan
Proph = verapamil

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57
Q

tension headache

A

band around the head, non-pulsatile
Mx = pain relief

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58
Q

migraine
Mx

A

Px: photophobia, nausea, aura
Mx = sumatriptan
Proph = propanolol

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59
Q

headache associated with obese women, stooping and in the mornings
What to rule out

A

idiopathic intracranial headache

Rule out venous sinus thrombosis

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60
Q

sharp stabbing pain on the side of head when eating/talking

A

Trigeminal Neuralgia

Mx = carbamazepine
vascular decompression

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61
Q

giant cell arteritis triad

A
  1. headache
  2. jaw claudication
  3. temporary loss of vision
62
Q

management of giant cell arteritis

A

prednisolone

63
Q

meningitis px

A

fever, neck stiffness, headache, photophobia, non-blanching rash

64
Q

bacterial meningitis CSF

A

low glucose, high protein, high WBC

65
Q

viral meningitis/encephalitis CSF

A

normal glucose, high protein

66
Q

Mx of meningitis

A

in GP = IM benzylpenicillin
in hospital = IV ceftriaxone/aciclovir

67
Q

Px of encephalitis (diff. it from meningitis)

A

fever, headache, bizarre behaviour, confusion, seizures

68
Q

Mx of encephalitis

A

IV acyclovir and ceftriaxone

69
Q

alcohol withdrawal stages

A
  1. tremor, anxiety, palpitations
  2. hallucinations
  3. delirium tremens: ataxia, seizures, confusion
70
Q

Mx of alcohol withdrawal

A

chlordiazepoxide + pabrinex (contains thiamine, prevents wernickes encephalopathy)

71
Q

Px of opioid toxicity

A

drowsiness, respiratory distress, constricted pupils

72
Q

Mx of opioid toxicity

A

naloxone

73
Q

tongue fasciculations, dribbling, trouble swallowing

A

bulbar palsy due to lower motor neurone lesion in CN 9, 10, 12

74
Q

UMN lesion vs LMN lesion
site, muscle tone, fasciculations, reflexes

A

UMN : cerebrum, brainstem etc. LMN: anterior horn cell, nerve roots
UMN: spasticity, LMN: hypotonia
LMN: fasciculations present
UMN: hyperreflexia

75
Q

acute onset confusion, fluctuation, inattention

A

delirium

76
Q

seizure like movements, pelvic thrusting, back arching

A

pseudoseizure

77
Q

focal seizure - temporal lobe

A

lip smacking, deja vu, hallucinations, olfactory sensations

78
Q

focal seizure - frontal lobe

A

motor: paralysis, eye movements to the side
twitching
Stiffening

79
Q

focal seizure - parietal lobe

A

tingling
Vertigo
Parasthesia

80
Q

focal seizure - occipital lobe

A

spots and lines in the visual field
Scotoma
Amaurosis

81
Q

managing acute raised ICP

A

hyperventilation, elevate the head of bed, mannitol, induce hypothermia

82
Q

normal pressure hydrocephalus Px and Mx

A

urinary incontinence, abnormal gait, dementia
Mx: ventriclo-peritoneal shunt

83
Q

suspected TIA Mx

A

aspirin 300mg loading dose, TIA clinic

84
Q

confirmed TIA Mx

A

clopidogrel
atorvastatin

85
Q

difference between stroke and bells palsy

A

bells palsy is a lower motor neurone lesion - forehead is affected

stroke - forehead sparing

86
Q

where is lumbar puncture done

A

L3/4 towards the subarachnoid space

87
Q

crushing to the axillary region causes damage to what nerve? effect?

A

radial nerve
loss of sensation to dorsal thumb and index finger

88
Q

dementia classification according to MMSE

A

<10 severe
10-20 moderate
21-26 mild

89
Q

suspected SAH but CT head is clear
next MX

A

lumbar puncture
check for xanthochromia

90
Q

thiamin is vitamin ….

A

b1

91
Q

lesion in parietal lobe causes what visual defect

A

homonymous inferior quadrantinopia

92
Q

lesion in temporal lobe causes what visual defect

A

homonymous superior quadrantinopia

93
Q

triad of parkinsons

A

rigidity
resting tremor
bradykinesia

94
Q

pathophysiology of vasovagal syncope

A

a trigger causes increased cardiac contractility.
vagal firing causes reduced cardiac contractility + reduced vascular tone.
reduced preload and venous return
mean arterial blood pressure drops to below the level of cerebral auto regulation
reduced cerebral perfusion
transient loss of consciousness

95
Q

CN VII UMN vs LMN palsy Px

A

UMN: forehead sparing, facial drooping, slurred speech
LMN = bells palsy. forehead is affected, drooping eyelids and face

96
Q

upper motor neurone features

A

weakness
spasticity
hyperreflexia

97
Q

lower motor neurone features

A

fasciculations
atrophy
hypotonia

98
Q

rapid cognitive decline and myoclonic jerks
suspect what, Ix

A

suspect sporadic creutzfeld jakob disease
Ix electroencephalogram

99
Q

Korsakoffs syndrome
cause
Px

A

B1 (thiamine) deficiency due to chronic alcoholism
anterograde amnesia
confusion
confabulations

100
Q

what is beriberi
epidemiology
cause
risk factors
two types

A

severe form of thiamine (B1) deficiency
rare in West, found in sub saharan africa
Rx: chronic alcoholism, diet consisting of white rice, chronic diarrhoea, long term diuretic use
Wet: cardiovascular system (fast heart rate, swelling)
dry: nervous system (numbness, muscle wasting, confusion)

101
Q

what Ix is done in MND

A

electromyography confirms denervation

102
Q

4 features of MND

A

degenerative disease
affects both UMN and LMN
no eye involvement
no sensory or sphincter disturbance

103
Q

most common type of MND and PX

A

amyotrophic lateral sclerosis
UMN and LMN signs
hyperreflexia, spasticity
fasciculations, atrophy

104
Q

Bulbar palsy cause and Px

A

disease of CN 9-12
quiet nasal speech, weak jaw, flaccid tongue

105
Q

pseudo bulbar palsy cause and Px

A

bilateral lesions above mid pons
spastic tongue, brisk jaw reflect

106
Q

progressive muscular atrophy presents with mainly …. signs

A

LMN

107
Q

primary lateral sclerosis presents with mainly …. signs

A

UMN

108
Q

what drug improves life expectancy in MND

A

riluzole

109
Q

what is used to manage muscle spasms in MND

A

baclofen

110
Q

what nerve is responsible for sensory component of the gag reflex

A

glossopharyngeal

111
Q

what nerve is responsible for the motor component of the gag reflex

A

vagus

112
Q

what proteins are present in alzheimers x 2

A

tau
amyloid precursor protein

113
Q

what proteins are present in frontotemporal dementia x 3

A

TARDP-43
Tau protein
Pick bodies (ballooned neuronal cells)

114
Q

what protein is present in lewy body dementia + parkinsons

A

alpha synuclein

115
Q

what is a coma

A

tate of impaired consciousness in which the patient is not rousable despite external stimuli

116
Q

what is a persistent vegetative state

A

state in which individuals have lost cognitive neurological function and awareness of the environment

but retain non-cognitive function and a preserved sleep– wake cycle.

117
Q

oculocephalic reflex

A

on rotating head to left/right, the eyes will m maintain their position by conjugating movement in the opposite direction

“dolls eye reflex”

118
Q

oculovestibular reflex

A

injecting cold water into the ear causes the eyes to look towards the irrigated side

119
Q

decerebrate posturing
what does it show

A

elbows extended
wrists and fingers flexed
knee extended
plantar flexion

shows upper brainstem lesion

120
Q

decorticate posturing

A

arms flexed at elbow and wrist
knee and ankle extendeed

shows diencephalon lesion (thalamus, hypothalamus, cerebellum)

121
Q

duchenne’s muscular dystrophy
cause
pathophis
PX

A

x linked recessive
absence of dystrophin
proximal muscle weakness that spreads
cardiomyopathy
“Gower’s” sign to. get up

122
Q

Becker’s muscular dystrophy
cause
pathophis
PX

A

x linked recessive
altered dystrophin
muscle cramps,
cardiomyopathy symptoms are worse

123
Q

occlusion of what vessel causes global aphasia

A

left middle cerebral artery

124
Q

wernickes encephalopathy

A

ophthalmoplegia, ataxia, and confusion

125
Q

entacapone moa and indication

A

COMT inhibitor
prevents elinimation of L-dopa
parkinsons

126
Q

selegiline moa and indication

A

MAOI
reduces metabolism of dopamine in the brain
parkinsons

127
Q

1st line management of parkinsons

A

L dopa + carbidopa

128
Q

numbness
hypo and hyperreflexia
weakness of limbs
ataxia

what is it and what is it assoc. with

A

subacute combined degeneration of the cord

assoc with b12 defieincy / pernicious anaemia

129
Q

5 types of gait

A

cerebellar
sensory ataxia
hemiparetic
spastic
parkinsonian

130
Q

Cerebellar ataxia gait
Px and causes

A

Walk unsteadily (as if they’re drunk), then compensate for this by adopting a wide stepping gait/broad based

Nystagmus

e.g. MS, alcoholic cerebellar degeneration

131
Q

sensory ataxia gait
px, cause

A

Wide-based, high stepping gait

Positive rombergs test

e.g. MS, vitamin b12, tabes dorsalis (tertiary syphilis)

132
Q

hemiparetic gait
px, cause

A

Flexion+internal rotation of the upper limb & extension of the lower limb

Foot is dragged in a semi-circle shape, sometimes scrapes the floor

e.g. focal brain lesions (stroke/tumour)

133
Q

diplegic / spastic gait
px, cause

A

Scissoring gait

Legs move slowly and stiffly

e.g. MS, MND, Subacute combined degeneration of the cord

134
Q

parkinsonian gait
px

A

Shuffling, stooped

Turning occurs as multiple stiff steps

135
Q

blown pupil is caused by what CN defect

A

ipsilateral oculomotor palsy

136
Q

Mx of amaurosis fugax

A

aspirin

137
Q

Bells palsy Px

A

unilateral facial droop
loss of lacrimation
hyperacusis

138
Q

Syringomyelia
who is affected
Px

A

a fluid-filled cavity that typically lies within the cervical or thoracic spinal cord

Young patients are usually affected.

loss of pain and temperature sensation, with preservation of light touch and vibration (due to the syrinx’s compression of the anterolateral pathway)

139
Q

what is chiari malformation

A

structural defect in the cerebellum. One of the cerebella tonsils will be displaced downwards through the foramen magnum (basically a herniation)

140
Q

symptoms of chiari malformation

A

headaches
associated with valsalva manoeuvre/straining

Lhermitte’s sign: electrical shock like pain that runs down back and into limbs

Paralysis in a clockwise fashion (RA, RL, LL, LA)

can develop into syringomyelia

141
Q

Dx of synringomyelia

A

MRI

142
Q

cluster headache prophylaxis

A

verapamil

143
Q

headache that is worse on standing up but relieved when lying down

caused by…

A

idiopathic intracranial hypotension

dural leak somewhere

144
Q

treatment of idiopathic intracranial hypotension

A

fluids, caffeine
blood patch: patients own blood is injected into the epidural space to prevent dural leak

145
Q

differential for cluster headache

differences

A

paroxysmal hemicrania

PH has more attacks, continuous pain, absolute response to indomethacin

146
Q

differentiating between amaurosis fugal and CRAO

A

CRAO is not transient
amaurosis fugal is transient, and like a curtain falling

147
Q

subacute combined degeneration of the cord causes what column abnormalities

A

dorsal column

148
Q

functional B12 deficiency is caused by

A

nitrous oxide recreational use

149
Q

miller fisher presentation

A

ataxia
areflexia
ophthalmoplegia !!!!!

150
Q

autonomic dysreflexia
what and happens when

A

autonomic dysfunction e.g. urianry retention, bradycardia, hypertension

within 1 year of spinal cord injury

151
Q

differentiating between wernickes encephalopathy and korsakoffs syndrome

A

korsakoffs has confabulation and antero/retrograde amnesia

152
Q

choosing between mannitol and dexamethasone

A

mannitol is better for raised icp caused by trauma

dex is better for neoplasms causing raised icp

AMK (29 decks)

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