Neurology Flashcards

Question

What is the ROSIER scale and what is the criteria?

Answer 1

- Recognition of Stroke in the Emergency Room - Loss of consciousness (-1) - Seizure activity (-1) - Asymmetric facial weakness (+1) - Asymmetric arm weakness (+1) - Asymmetric leg weakness (+1) - Speech disturbance (+1) - Visual disturbance field (+1)

Answer 2

- Non-contrast CT of the head - FIRST LINE / GOLD STANDARD - CT angiogram - MRI of the head - alternative to CT - Bloods - FBC - Serum glucose - U&Es - Cardiac enzymes - PTT

Answer 3

- Hypoglycaemia - Hyponatraemia - Hypercalcaemia - Uraemia - Hepatic encephalopathy - Brain tumours - Seizures - Complicated migraine

Answer 4

- Stabilisation and referral - FIRST LINE - Give supplemental oxygen - Send to stroke unit

Answer 5

- IV Alteplase for thrombolysis - Thrombectomy depending on the NIH stroke score - Anticoagulation

Answer 6

- Clopidogrel 75mg daily - FIRST LINE - Aspirin or subsequently dipyridamole alone as combination is contraindicated. - High dose statin - Atorvastatin - Manage hypertension, diabetes, smoking, other cardiovascular risk factors - Lifestyle advice

Answer 7

- DVT - Aspiration pneumonia - Neurological sequalae - Depression - Fatigue - Seizures

Answer 8

- Stabilisation and referral - FIRST LINE - Give supplemental oxygen - Send to stroke unit

Answer 9

- Immediate referral for neurosurgery management - Craniotomy - Stereotactic aspiration - Stop anticoagulant or antithrombotic medication immediately - Warfarin - Dabigatran - Factor Xa inhibitor

Answer 10

- Wernicke's encephalopathy is a neurological emergency resulting from thiamine deficiency with varied neurocognitive manifestations. - Wernicke–Korsakoff syndrome is the combined presence of Wernicke encephalopathy and alcoholic Korsakoff syndrome.

Answer 11

- Alcohol abuse - Malnutrition - Anorexia - Malabsorption due to stomach cancer and IBD - Prolonged vomiting e.g. due to chemotherapy, hyperemesis gravidarum

Answer 12

- Ophthalmoplegia: weakness or paralysis of the eye muscles, nystagmus; lateral rectus; conjugate gate palsies - Ataxia or unsteady gait - Changes in mental state e.g. confusion, apathy, and difficulty concentrating - May also present with hypotension, hypothermia and reduced consciousness.

Answer 13

- Mainly targets the limbic system, causing severe memory impairment: - Anterograde amnesia: inability to create new memories - Retrograde amnesia: inability to recall previous memories. - Confabulation: creating stories to fill in the gaps in their memory which they believe to be true. - Behavioural changes

Answer 14

- Diagnosis is typically based upon clinical presentation - Bloods - LFTs - Thiamine levels - Blood alcohol level - Red cell transketolase test - low - MRI/CT can confirm diagnosis

Answer 15

- Alcohol intoxication - Alcohol withdrawal - Encephalitis - Miller-Fisher syndrome

Answer 16

The inability to make new memories.

Answer 17

The inability to recall previous memories.

Answer 18

- IV thiamine alongside glucose - Followed by oral supplementation

Answer 19

- Untreated Wernicke's encephalopathy can lead to: - Hearing loss - Seizures - Spastic paraparesis - Coma - Death

Answer 20

Migraine is a chronic, genetically determined, episodic neurological disorder that usually presents in early-to-mid life.

Answer 21

- Family history - Female gender: migraines are three times more common in women - Obesity - Other important triggers include tiredness, lack of food, dehydration, menstruation, red wine and bright lights

Answer 22

- CHOCOLATE - CHocolate - Oral Contraceptives - alcOhoL - Anxiety - Travel - Exercise

Answer 23

- Headache - severe unilateral pulsating, throbbing pain aggravated by movement - Nausea and Vomiting - Photophobia - sensitivity to light - Phonophobia - sensitivity to sounds - With or without aura

Answer 24

- Aura - term used to describe visual changes associated with migraines

Answer 25

- Typical aura: develops over 5 minutes, lasts 5-60 minutes and is fully reversible - Visual symptoms e.g. distortion, lines, dots, zigzag lines, scotoma - Paresthesia - Speech disturbance

Answer 26

- Atypical aura: may last more than 60 minutes - Motor weakness (e.g. hemiplegic migraine - dysarthria, ataxia, ophthalmoplegia, hemiparesis) - Diplopia - Visual symptoms affecting one eye - Poor balance (e.g. vestibular migraine) - Decreased level of consciousness

Answer 27

- Migraine is a clinical diagnosis - Fulfils the International Classification of Headache Disorders (ICHD)-3 - Investigations are to rule out another pathology: - CT or MRI of the head - ESR - Lumbar puncture

Answer 28

- Stroke - Other primary headaches - Secondary headaches

Answer 29

- Analgesia - ibuprofen or aspirin or paracetamol - FIRST LINE - Oral triptan alone (e.g. oral sumatriptan) +/- paracetamol or an NSAID - Antiemetics e.g. metoclopramide or prochlorperazine - AVOID OPIATES

Answer 30

- FIRST LINE - Triptan e.g. Sumatripan - SECOND LINE - Ergot alkaloid - THIRD LINE - Corticosteroid - FOURTH LINE - Butalbital-containing compounds

Answer 31

- Headache diary - FIRST LINE - propranolol (beta blocker) - Topiramate (anti-epileptic) - contraindicated in pregnancy - Amitriptyline (tri-cyclin antidepressant) - Frovatriptan or Zolmitriptan - Mindfulness, acupuncture, riboflavin (vitamin B2)

Answer 32

- Depression - Migraine-triggered seizures - Migrainous infarction - Status migrainosus: a severe, debilitating migraine lasting for more than 72 hours that may warrant admission

Answer 33

- Criteria for the diagnosis of migraine. - P - Pulsatile headache - O - One-day duration - U - Unilateral - N - Nausea - D - Disabling

Answer 34

Tension-type headaches is a common primary headache disorder and can be either episodic or chronic.

Answer 35

- Stress - Bad posture - Sleep deprivation - Eye strain - Depression - Alcohol - Skipping meals - Dehydration

Answer 36

- Bilateral with a pressing/tight sensation of mild-moderate intensity - Frequency varies depending on type of headache: chronic or episodic - Other associated symptoms: - Nausea or vomiting - Photophobia - Phonophobia

Answer 37

- It is a clinical diagnosis based on criteria outlined by the International Headache Society - Other investigations to rule out other pathology - CT or MRI of the head - ESR

Answer 38

- Other primary headaches - Secondary headaches

Answer 39

- Analgesia e.g. paracetamol or NSAIDs - FIRST LINE - Limit the use of analgesia to no more than 6 days a month to reduce chance of medication-overuse headache - Lifestyle - evaluation of stress, depression, anxiety and sleep disorder.

Answer 40

- Antidepressants e.g. Amitriptyline - FIRST LINE - Muscle relaxants e.g. Tizanidine - SECOND LINE - Lifestyle - evaluation of stress, depression, anxiety and sleep disorder. - If no improvement then refer to neurology

Answer 41

- Cluster headaches are intensely painful, unilateral, periorbital headaches with associated autonomic dysfunction. - Headaches occur in clusters: - Clusters usually last 2 weeks to 3 months, separated by remission periods lasting at least 3 month - Patients experience 1 to 8 attacks per day - Clusters typically occur 1 to 2 times per year

Answer 42

- Male: 3 times more common in males - Family history - Autosomal dominant gene has a role - Smoking - Alcohol excess

Answer 43

- Diagnosis is predominantly based on clinical presentation - At least 5 headache attacks fulfilling the symptomatic criteria - Investigations to rule out other pathology: - CT or MRI of the brain - ESR

Answer 44

- Unilateral, periorbital or temporal headaches lasting 15 minutes to 3 hours - Ipsilateral autonomic symptoms: - Lacrimation (teary eye) - Conjunctival injection (red eye due to enlargement of conjunctival vessels) - Nasal congestion - Rhinorrhoea (nasal discharge) - Ptosis (eyelid drooping) - Miosis (excessive constriction of the pupil of the eye) - Facial sweating - Nausea and vomiting - Photophobia, with agitation and restlessness

Answer 45

- Other primary headaches - Secondary headache

Answer 46

- Triptans e.g. SubQ Sumatriptan (75% response rate within 15 minutes) - High-flow O2 (70% response rate within 15 minutes) - Drugs that should be avoided - paracetamol, NSAIDs, Opioids, Ergots, Oral Triptans

Answer 47

- Verapamil - FIRST LINE - Lithium - Prednisolone - short course for two or three weeks to break the cycle during clusters

Answer 48

- Mental illness: depression, anxiety, self-harm and suicide - Auto-enucleation: individuals attempting to remove the affected eye due to a belief that the pain will subside

Answer 49

Trigeminal neuralgia is a pain syndrome which describes severe unilateral pain in the distribution of one or more trigeminal branches.

Answer 50

- Advancing age: rare in people younger than 40 years of age - Female gender: more common in women - Demyelinating disease: trigeminal neuralgia is 20 times more common in patients with multiple sclerosis

Answer 51

- Facial pain: comes on spontaneously and last anywhere between a few seconds to hours. - Lacrimation - Facial swelling - Rhinorrhoea - Ptosis

Answer 52

- May suggest a serious underlying cause: - Age of onset before 40 years - Pain only in the ophthalmic division (eye socket, forehead, and nose), or bilaterally - Sensory changes - Deafness or other ear problems - History of skin or oral lesions that could spread perineurally - Optic neuritis - Family history of multiple sclerosis

Answer 53

- Trigeminal neuralgia is a clinical diagnosis - Investigations to rule out other pathology - MRI of the brain - Intra-oral X-ray (if pain from a dental origin is suspected)

Answer 54

- Anti-convulsant e.g. Carbamazepine - FIRST LINE - Baclofen - SECOND LINE - Refer to neurology - Microvascular decompression

Answer 55

Overuse of medication causing headaches.

Answer 56

- Similar to that of a tension headache.

Answer 57

- Headache occurring on 15 or more days per month in a person with a pre-existing headache disorder AND - Regular overuse for more than 3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache.

Answer 58

- Withdrawal of analgesia - Discussion with or referral to a neurologist if overuse of opiates or tranquilisers

Answer 59

Alzheimer's disease (AD) is a progressive neurodegenerative disorder that causes significant deterioration in mental performance.

Answer 60

- Age - old age is a major risk - Genetics / Family history - Cardiovascular disease: smoking and diabetes increase risk. Exercise decreases risk. - Depression - Low educational attainment - Low social engagement and support - Others: head trauma, learning difficulties

Answer 61

- Poor memory - Language problems: receptive and expressive dysphasia - Problems with executive functioning: planning and problem solving - Disorientation

Answer 62

- Poor memory - Language problems: receptive and expressive dysphasia - Problems with executive functioning: planning and problem solving - Disorientation

Answer 63

- Agitation and emotional lability - Depression and anxiety - Sleep cycle disturbance - Disinhibition: social or sexually inappropriate behaviour - Withdrawal/apathy - Motor disturbance: wandering is a typical feature of dementia - Psychosis

Answer 64

- Agitation and emotional lability - Depression and anxiety - Sleep cycle disturbance - Disinhibition: social or sexually inappropriate behaviour - Withdrawal/apathy - Motor disturbance: wandering is a typical feature of dementia - Psychosis

Answer 65

- Loss of independence: increasing reliance on others for assistance with personal and domestic activities - Early stages: problems with higher level function (e.g. managing finances, difficulties at work) - Later stages: problems with basic personal care (e.g. washing, eating, toileting) and motor function (e.g. walking, transferring)

Answer 66

- Loss of independence: increasing reliance on others for assistance with personal and domestic activities - Early stages: problems with higher level function (e.g. managing finances, difficulties at work) - Later stages: problems with basic personal care (e.g. washing, eating, toileting) and motor function (e.g. walking, transferring)

Answer 67

- Cognitive assessment: e.g. mini mental state examination (MMSE)/ Montreal cognitive assessment scale (MoCA) - FBC - Metabolic panel - Vitamin B12 - Urine drug screen - MRI or CT - will show medial temporal lobe atrophy

Answer 68

- Other dementias - Depression - Delirium

Answer 69

- Supportive therapy - FIRST LINE - Mild-to-moderate AD: acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine). - Moderate-to-severe AD: N-methyl-D-aspartic acid receptor antagonist (e.g. memantine). May be used in combination with acetylcholinesterase inhibitors.

Answer 70

Vascular dementia is a chronic progressive disease of the brain bringing about cognitive impairment. It is a common form of dementia caused by cerebrovascular disease.

Answer 71

- Ischemic stroke - Small vessel disease - Haemorrhage - Leukaraiosis

Answer 72

- Symptoms of dementia appear suddenly and brain function decline is step-wise (e.g. decreases with each stroke) - Symptoms of vascular dementia vary depending on which region of the brain is damaged

Answer 73

- Clinical diagnosis based upon comprehensive history and physical examination - Neuropsychological tests: e.g. mini mental state exam, used to confirm loss of brain function - FBC - ESR - Blood glucose - LFTs - B12 - TFTs - Medication review - CT or MRI of the brain - shows multiple cortical and subcortical infarcts and changes e.g. atrophy of the brain cortex, confirming ischaemia - ECG

Answer 74

- Supportive therapy - FIRST LINE - Antiplatelet therapy - FIRST LINE - Acetylcholinesterase inhibitors e.g. donepezil

Answer 75

- Frontotemporal dementia is a neurodegenerative disorder characterised by focal degeneration of the frontal & temporal lobes. - FTD is a heterogeneous condition with various subtypes e.g. Pick's disease

Answer 76

- Family history - MAPT gene (chromosome 17) - GRN gene (chromosome 17) - C9ORF72 gene (chromosome 9)

Answer 77

- Frontal lobe effects: personality and behaviour changes - Disinhibition (e.g. socially inappropriate behaviour) - Loss of empathy - Apathy (losing interest and/or motivation) - Hyperorality (e.g. dietary changes, attempt to consume non-edible products, eat beyond satiety) - Compulsive behaviour (e.g. cleaning, checking, hoarding)

Answer 78

- Temporal lobe effects: language problems - Effortful speech - Halting speech - Speech-sound errors - Speech apraxia (i.e. difficulty in articulation) - Word-finding difficulty - Surface dyslexia or dysgraphia: mispronouncing difficult words (e.g. yacht)

Answer 79

- MRI - GOLD STANDARD - frontal and temporal love atrophy - Diagnosis is based upon cognitive assessment - Brain biopsy - NOT RECOMENDED - only way to obtain definitive diagnosis, typically done after death (presence of Pick's bodies)

Answer 80

- Supportive therapy - FIRST LINE - SSRI's - may help with behavioural symptoms

Answer 81

- Lewy body dementia is a neurodegenerative disease. - It is a type of dementia characterised by fluctuating cognitive impairment, visual hallucinations and parkinsonism.

Answer 82

- Older age - Male sex - Family history

Answer 83

- Early symptoms are typically cognitive ones (Alzheimer's-like) - Difficulty focusing - Poor memory - Visual hallucinations - Disorganized speech - Depression

Answer 84

- Later symptoms are typically motor ones (Parkinson's-like) - Resting tremors - Stiff and slow movements - Reduced facial expressions

Answer 85

- Diagnosis of Lewy body dementia is based on the pattern of symptoms - Single-photon emission computer tomography (SPECT) - MRI or CT - Exclude other cause of symptoms: - FBC - U&Es - MSU - ESR - Serum B12 - Folate - Glucose - Thiamine - Ca2+ - TSH - Diagnosis can only be confirmed with a brain autopsy - shows Lewy Bodies in neurons. - Lewy bodies look like dark, eosinophilic inclusions in brainstem and neocortex.

Answer 86

- Alzheimer's - Parkinson's - Frontotemporal dementia - Vascular dementia

Answer 87

- Supportive care - FIRST LINE - Dopamine analogue e.g. Levodopa - Cholinesterase inhibitors e.g. Donepezil - Avoid using antipsychotics as there is increased risk of side effects

Answer 88

Parkinson’s Disease (PD) is a neurodegenerative disorder characterised by loss of dopaminergic neurones within the substantia nigra pars compacta (SNPC) of the basal ganglia (nigrostriatal pathway).

Answer 89

- Age: prevalence of 1% in those aged 60-70 and up to 1-3% in those ≥80 years old - Gender: males are 1.5 times more likely than females to develop PD - Family History

Answer 90

- Bradykinesia - Tremor - Rigidity - Micrographia - Hypomimia - Postural instability

Answer 91

- Anosmia (smell blindness) - Sleep disturbance: REM sleep is impaired - Psychiatric symptoms - Depression - Anxiety - Dementia: usually develops after motor symptoms, unlike in Lewy-body dementia - Constipation

Answer 92

- PD is a clinical diagnosis: it should be suspected in a patient who has bradykinesia and at least one of the following: - Tremor - Rigidity - Postural instability - MRI of the brain - exclude other diseases - SPECT - Dopaminergic agent trial

Answer 93

- Essential benign tremor - Metabolic abnormalities - Lewy Body dementia

Answer 94

- Motor symptoms are affecting quality of life - Levodopa + decarboxylase inhibitor - Co-benyldopa (levodopa and benserazide) - Co-careldopa (levodopa and carbidopa) - Motor symptoms are NOT affecting quality of life - Dopamine agonist (Pramipexole, ropinirole), Monoamine oxidase B inhibitor (Selegiline, rasagiline), Levodopa + decarboxylase inhibitor

Answer 95

- Motor fluctuations - Dyskinesia - Dystonia, Chorea, Athetosis - Psychiatric complications

Answer 96

- Parkinsonism consists of a constellation of symptoms including: - Bradykinesia - Tremor - Rigidity - Postural instability

Answer 97

Huntington’s chorea is an autosomal dominant genetic neurodegenerative condition that causes a progressive deterioration in the nervous system.

Answer 98

- Patients are usually asymptomatic until symptoms begin around aged 30 to 50. It presents with an insidious, progressive worsening of symptoms. - Typically begins with prodromal phase: cognitive, psychiatric or mood problems. - Chorea (involuntary, abnormal movements) - Eye movement disorders - Dysarthria: speech difficulties - Dysphagia: swallowing difficulties - Dementia

Answer 99

- Diagnosis is made in a specialist genetic centre using a genetic test for the faulty gene and identification of the number of CAG repeats. - This involves pre-test and post-test counselling regarding the implications of the results.

Answer 100

- Counselling - FIRST LINE - Speech and language therapy - Medical treatment is for symptomatic relief: - For disordered movements - Antipsychotics (e.g. olanzapine) - Benzodiazepines (e.g. diazepam) - Dopamine-depleting agents (e.g. tetrabenazine) - For depression - Antidepressants

Answer 101

- Huntington disease: CAG repeat - Myotonic dystrophy: CTG repeat - Friedreich ataxia: GAA repeat - Fragile X syndrome: CGG repeat

Answer 102

Multiple sclerosis (MS) is an autoimmune, cell-mediated demyelinating disease of the central nervous system.

Answer 103

- Age: most commonly diagnosed in 20-40 year olds - Female gender: MS is 3 times more common in females - Smoking - Obesity - Vitamin D deficiency - Northern latitudes - Family history: HLA-DR2 is implicated; 30% monozygotic twin concordance - Autoimmunity: patients often have a family history of other autoimmune disorders - EBV infection: the virus with the greatest link to MS

Answer 104

- Optic neuritis - Double vision - Internuclear ophthalmoplegia and conjugate lateral gaze disorder - Upper motor neuron signs with spastic paraparesis are common - Cerebellar signs: such as ataxia and tremor - Sensory loss: due to demyelination of spinothalamic or dorsal columns - Trigeminal neuralgia: stimulation to face causes pain

Answer 105

- Optic neuritis - Double vision - Internuclear ophthalmoplegia and conjugate lateral gaze disorder - Upper motor neuron signs with spastic paraparesis are common - Cerebellar signs: such as ataxia and tremor - Sensory loss: due to demyelination of spinothalamic or dorsal columns - Trigeminal neuralgia: stimulation to face causes pain

Answer 106

- Blurred vision and red desaturation - Numbness, tingling and other strange sensations: plaques in the sensory pathways - Weakness - Bowel and bladder dysfunction: plaques involve the autonomic nervous system - Lhermitte’s phenomenon: electric shock sensation on neck flexion, caused by stretching the demyelinated dorsal column. - Uhtoff’s phenomenon: worsening of symptoms following a rise in temperature, such as a hot bath

Answer 107

- MRI brain and spine - GOLD STANDARD - Shows multiple CNS lesions - Lumbar puncture - oligoclonal bands in CSF and increased IgG - Visual evoked potentials - FBC - normal - Metabolic panel - normal - TSH - normal - Vitamin B12 - normal

Answer 108

- The McDonald criteria is used to diagnose MS. - In brief, the criteria can be described as symptoms/signs which demonstrate dissemination in space (i.e. different parts of the CNS affected) and time. - The main diagnostic criteria: - Diagnosis is based on: - 2 or more relapses AND EITHER - Objective clinical evidence of 2 or more lesions OR - Objective clinical evidence of one lesion WITH a reasonable history of a previous relapse

Answer 109

- MDT care - Legally need to inform the DVLA - Supportive therapy - lifestyle changes, regular exercise and good sleep hygiene

Answer 110

- Corticosteroids - Oral or IV methylprednisolone - FIRST LINE

Answer 111

- Beta-interferon - Alemtuzumab (anti-CD52) and natalizumab (anti-alpha4beta1-integrin) - Glatiramer acetate - Fingolimod

Answer 112

- Genitourinary: urinary tract infections, urinary retention and incontinence - Constipation - Depression: offer mental health support if required - Visual impairment - Mobility impairment: offer physiotherapy, orthotics and other mobility aids - Erectile dysfunction

Answer 113

- Guillain-Barré syndrome is an acute paralytic polyneuropathy. - It is an autoimmune, rapidly progressive demyelinating condition of the peripheral nervous system, often triggered by infection

Answer 114

- Male: slightly more common in males than females (1.8:1) - Age: peak incidence between 15-35 years old and 50-75 years old - Infections: typically gastrointestinal or respiratory: - Bacterial: e.g. Campylobacter jejuni (30%) and mycoplasma pneumoniae - Viral: e.g. Zika virus, influenza, Epstein-Barr virus and cytomegalovirus - Malignancies: lymphoma may increase the risk of GBS - Vaccines: association with the influenza vaccination (uncommon)

Answer 115

- Reduced sensation in affected limbs - Symmetrical weakness in lower extremities first, progressing to the upper limbs - Ataxia with hypoflexia (or areflexia) in affected limbs - Autonomic dysfunction - Respiratory distress - Cranial nerve involvement and bulbar dysfunction

Answer 116

- Tingling and numbness in hands and feet: often precedes muscle weakness - Symmetrical, progressive, ascending weakness - Unsteady when walking - Back and leg pain: common at some point in disease course - Shortness of breath - Facial weakness and speech problems

Answer 117

- Predominantly a clinical diagnosis evidenced by progressive weakness and areflexia (or hyporeflexia) in the weaker limbs. The Brighton criteria is used for diagnosis. - Bloods to exclude other causes - FBC - U&Es - TFTs - LFTs - Anti-ganglioside antibodies - Spirometry - Cultures - Lumbar punctures - Nerve conduction studies

Answer 118

- Transverse myelitis - Myasthenia gravis - Lambert-eaton myasthenic syndrome - Botulism - Polymyositis - Vasculitic neuropathy

Answer 119

- IV immunoglobulins (IVIg) - FIRST LINE - Plasma exchange - FIRST LINE - Thromboprophylaxis - Physiotherapy - Intensive care support: for those who develop ventilatory failure (20%), intensive care and mechanical ventilation may be required

Answer 120

- Type 2 respiratory failure - Impaired mobility - Pulmonary complications - Autonomic dysfunction - Psychiatric impact

Answer 121

Charcot-Marie-Tooth disease is a group of inherited diseases that affects the peripheral motor and sensory nerves.

Answer 122

- Pes cavus: high foot arches - Hammer toes: the middle joint of a toe bends upwards - Distal muscle wasting causing inverted champagne bottle legs - Hand and arm muscle wasting causing claw hand - Thickened palpable nerves e.g. common peroneal

Answer 123

- Symptoms usually start to appear before the age of 10 years but the onset of symptoms can be delayed until 40 or later. - Weakness in the lower legs, particularly loss of ankle dorsiflexion - Foot drop - High-stepped gait - Weakness in the hands - Reduced tendon reflexes - Reduced muscle tone - Peripheral sensory loss - Tingling and burning sensations in the hands and feet - May be neuropathic pain

Answer 124

- Genetic testing - GOLD STANDARD - Nerve conduction studies - FIRST LINE - Bloods - FBC, LFTs, TFTs, B12 and Folate - Hip X-ray - normal or hip dysplasia

Answer 125

- Diabetic neuropathy - Chronic inflammatory demyelinating polyneuropathy - Acquired peripheral neuropathy - Hereditary spastic paraplegia - Spino-cerebellar degeneration

Answer 126

- Physiotherapists - FIRST LINE - Occupational therapist - Podiatrist - Orthopaedic surgery - correct disabling joint deformities

Answer 127

- A brain tumour is an abnormal growth occurring in any tissue contained within the cranium, including the brain, cranial nerves, meninges, skull, pituitary gland, and pineal gland. - There are many different types of brain tumours. They vary from benign tumours (e.g. meningiomas) to highly malignant (e.g. glioblastomas).

Answer 128

- A brain tumour is an abnormal growth occurring in any tissue contained within the cranium, including the brain, cranial nerves, meninges, skull, pituitary gland, and pineal gland. - There are many different types of brain tumours. They vary from benign tumours (e.g. meningiomas) to highly malignant (e.g. glioblastomas).

Answer 129

The scale goes from I to IV based on the morphologic and functional features of the tumour cells; a grade IV tumour being the most abnormal looking cells that also tend to be the most aggressive.

Answer 130

- Gliomas - Astrocytoma - Oligodendroglioma - Ependymoma - Meningiomas - Pituitary adenoma - Hemangioblastomas - Acoustic neuroma (AKA vestibular Schwannoma)

Answer 131

- Headache: worse on waking, coughing and bending - Vomiting - Altered mental state - Visual field defects - Seizures (particularly focal) - Unilateral ptosis - Third and sixth nerve palsies - Papilloedema (on fundoscopy)

Answer 132

- Headaches - Nausea - Vomiting - Seizures - Focal neurological symptoms - depends on location of tumour - Signs of ICP

Answer 133

- CT/ MRI - FIRST LINE - Blood tests e.g. FBC, U&Es, LFT’s, B12 - Tissue biopsy: to determine cancer grade and guide management - GOLD STANDARD

Answer 134

- Other causes of space-occupying lesion: - Aneurysm - Abscess - Cyst - Haemorrhage - Idiopathic intracranial hypertension

Answer 135

- Steroids e.g. IV Dexamethasone: to reduce oedema/ inflammation - Surgery (dependent on the grade and behaviour of the brain tumour) - Chemotherapy - Radiotherapy - Palliative care

Answer 136

- Hydrocephalus: as the tumour grows it can compress nearby cells and structures e.g. as meningiomas enlarge they can compress the ventricles and block CSF flow causing hydrocephalus - Midline shift and herniations through foramen magnum: due to rising pressures

Answer 137

- Lung - Small lung and non-small small cell - Breast - Melanoma - Renal cell - GI

Answer 138

- CT or MRI - GOLD STANDARD

Answer 139

- Steroids e.g. dexamethasone: reduce cerebral oedema - Stereotactic radiotherapy/ chemotherapy - Surgery if <75 years - Palliative care

Answer 140

- Cauda equina syndrome (CES) is a neurosurgical emergency which occurs when the bundle of nerves below the end of the spinal cord are compressed.

Answer 141

- Bilateral lower limb weakness and/or reduced sensation - Decreased or absent lower limb reflexes - Reduced perianal sensation (S2-S4) and anal tone on examination - Palpable bladder due to urinary retention

Answer 142

- Lower back pain and sciatica (97%) - ‘Saddle anaesthesia’: numbness in the peri-anal region, groin and inner thighs (93%) - Bladder and bowel dysfunction: urinary retention or incontinence (92%), or rarely faecal incontinence - Leg weakness and difficulty walking/ paralysis of the legs - Leg weakness if flaccid and hypo-reflexic/ areflexic (lower motor neuron signs) - Erectile dysfunction

Answer 143

- Examinations: PR exam, knee reflexes, ankle reflexes etc - Rectal exam - FIRST LINE - MRI spine - GOLD STANDARD - Bladder ultrasound - CT myelography - if contraindications of MRI

Answer 144

- Conus medullaris syndrome - Vertebral fracture - Peripheral neuropathy - Mechanical lower back pain

Answer 145

- EMERGENCY decompressive laminectomy - Antibiotics for abscess - Corticosteroids or radiotherapy

Answer 146

- Complications of delayed presentation or decompression - DVT - Post-operative complications

Answer 147

- CMS - Damage to the spinal cord at vertebral level T12-L2 - CES - Damage to the spinal cord at vertebral level L1-L5

Answer 148

- CMS - Often presents with upper motor neuron signs (e.g. hyperflexia and hypertonia) - CES - Usually presents with lower motor neuron signs (hyporeflexia and hypotonia)

Answer 149

- Meningitis describes inflammation of the leptomeninges (the arachnoid and pia mater) and usually occurs due to a bacterial, viral, or fungal infection. - Bacterial meningitis and meningococcal disease are notifiable diseases in England

Answer 150

N. meningitidis and S. pneumoniae are the commonest causes of bacterial meningitis in the UK, whilst enteroviruses such as coxsackievirus are the most common cause of viral meningitis.

Answer 151

- Neonatal: group B streptococcus, E. coli, Listeria monocytogenes - Children: N. meningitidis, S. pneumoniae, H. influenzae - Adults: S. pneumoniae, N. meningitidis - Immunocompromised: Listeria monocytogenes, M. tuberculosis

Answer 152

- Enteroviruses: coxsackievirus and echovirus - Herpes simplex virus (HSV): HSV-2 meningitis is more common than HSV-1 - Varicella-zoster virus (VZV)

Answer 153

- Cryptococcus neoformans - Candida

Answer 154

- Immunocompromised patients - Non-immunised patients - Crowded environment

Answer 155

- Kernig’s sign: when the hip is flexed and the knee is at 90°, extension of the knee results in pain - Brudzinski sign: severe neck stiffness causes the hips and knees to flex when the neck is flexed - Petechial or purpuric non-blanching rash: associated with meningococcal disease (N. meningitidis) - Pyrexia - Reduced GCS

Answer 156

- Meningism - Headache - Photophobia - Neck stiffness - Fever - Nausea and vomiting - Seizures - Symptoms can develop quickly or over several days, but typically occur within 3 to 7 days of exposure to the pathogen.

Answer 157

- Lumbar puncture - GOLD STANDARD - CSF gram stain - CSG culture - CSF PCR - FBC - CRP - Coagulation screen - Blood glucose - Blood culture - Whole-blood PCR

Answer 158

- Antibiotics - depends on local guidelines - Cephalosporins - IV Cefotaxime or IV Ceftriaxone - >50 or immunocompromised add IV Amoxicillin (to cover listeria) - Steroids - dexamethasone

Answer 159

- Supportive treatment - Self-liming in 4-40 days - Acyclovir in HSV or VZV caused meningitis

Answer 160

Cryptococcal meningitis - IV Amphoteracin B

Answer 161

- Ciprofloxacin: a single 500mg dose of oral ciprofloxacin - FIRST LINE - Rifampicin: SECOND LINE as it requires > 1 dose and interferes with other medications

Answer 162

- Abscess - Cerebral oedema - Hydrocephalus and brain herniation - Seizures - Sensorineural hearing loss - Memory loss - Cerebral palsy - Long-term cognitive and behaviour deficit - Waterhouse-Freidrichsen syndrome - Sepsis

Answer 163

Encephalitis describes inflammation of the brain parenchyma. It mostly affects frontal and temporal lobes.

Answer 164

- Immunocompromised - Blood/fluid exposure: HIV and West Nile virus - Mosquito bite: West Nile virus - Transfusion and transplantation: CMV, EBV, HIV - Close contact with cats: toxoplasmosis

Answer 165

- Pyrexia - Reduced GCS - Focal neurological deficit, such as: - Aphasia - Hemiparesis - Cerebellar signs - May also have signs of meningitis: meningio-encephalitis

Answer 166

- Fever - Headache - Fatigue - Confusion - Seizures - Behavioural changes: - Memory disturbance - Psychotic behaviour - Withdrawal or change in personality

Answer 167

- Bloods - FBC - CRP - U&Es - Blood culture - Contrast CT or MRI - Lumbar puncture and CSF investigations - HIV serology - EEG

Answer 168

- Meningitis - Encephalopathy - Status epilepticus - CNS vasculitis

Answer 169

- Antiviral medication: - Acyclovir - FIRST LINE - Ganciclovir and Foscarnet if CMV infection - Further management will depend on the underlying organism

Answer 170

- Seizures - Ischaemic stroke - Hydrocephalus: accumulation of cerebrospinal fluid (CSF) within the brain - Lasting fatigue and prolonged recovery - Aphasia - Change in personality or mood - Changes to memory and cognition - Learning disability - Headaches - Chronic pain - Movement disorders - Sensory disturbance - Hormonal imbalance

Answer 171

Herpes zoster (HZ) (shingles) is caused by reactivation of varicella-zoster virus (VZV) that was acquired during a primary varicella infection, and is characterised by dermatomal pain and papular rash.

Answer 172

- Macular-vesicular rash in dermatomal distribution - Usually in a single stripe of vesicles around either the left or the right side of the body or on one side of the face. - Crust formation and drying occurs over the next week with resolution in 2-3 weeks - Pain, itching, or tingling in the area where the rash is - Malaise, myalgia, headache and fever can be present - Disseminated infection may occur, if immunosuppressed

Answer 173

- Shingles are usually diagnosed based on clinical presentation of the skin lesions - Diagnosis confirmed with: viral PCR, culture, immunohistochemistry - Tzanck test: look for multinucleated giant cells in the fluid of the vesicles - Look for varicella zoster antibodies or viral DNA.

Answer 174

- Oral aciclovir/ valaciclovir - IV aciclovir if pregnant, immunosuppressed or severe/ disseminated infection - Topical antibiotic treatment for secondary bacterial infection - Oral/ topical analgesics

Answer 175

Motor neurone disease is an umbrella term that encompasses a variety of specific diagnoses. It is a cluster of degenerative disease characterised by axonal degeneration of neurones in the motor cortex, cranial nerve nuclei and anterior horn cells.

Answer 176

- Amyotrophic lateral sclerosis: UMN + LMN - Progressive muscular atrophy: LMN only - Primary lateral sclerosis: UMN only - Progressive bulbar palsy: LMN only

Answer 177

- Advancing age - Male gender: 1.2 to 1.8 times more likely to develop MND - Family history: familial in 5% of cases and the SOD1 mutation is implicated - Smoking: currently a ‘probable’ risk factor for MND - Exposure to heavy metals and certain pesticides

Answer 178

- Mixed UMN and LMN signs - Spastic paraparesis with brisk reflexes - Upgoing plantar responses - Fasciculations (twitches in the muscles) especially on the tongue - Dysarthria and dysphagia: particularly in progressive bulbar palsy - Muscle wasting: particularly of small hand muscles and tibialis anterior - Reduced tone

Answer 179

- Progressive weakness often first noticed in the upper limbs - Clumsiness - Fatigue - Falls - Speech and swallow issues: particularly in progressive bulbar palsy

Answer 180

- El Escorial criteria - GOLD STANDARD - MND is a clinical diagnosis - Investigations to rule out other pathology - Electromyography - Nerve conduction studies - MRI of the spine - Lumbar puncture - Pulmonary function tests

Answer 181

- Multiple sclerosis - Polyneuropathies - Myasthenia gravis - Diabetic amyotrophy - Guillain-Barre syndrome - Spinal cord tumours

Answer 182

- Riluzole and supportive care - FIRST LINE - Respiratory support - BiPAP - Supportive treatment: - Antispasmodics: such as baclofen - Analgesia - Feeding support: many patients require nutritional support, often with PEG tube - Speech and language therapy - Physiotherapy - Advanced directives to document the patients wishes as the disease progresses - End of life care planning

Answer 183

Myasthenia gravis is a chronic autoimmune disorder of the postsynaptic membrane at the neuromuscular junction of skeletal muscle.

Answer 184

- Female gender: twice as common in women - Family history - Autoimmunity: either a personal or family history of autoimmune disorders such as rheumatoid arthritis and SLE - Thymoma or thymic hyperplasia: 10-15% of patients have a thymoma, whilst up to 70% have thymic hyperplasia

Answer 185

- Proximal muscle weakness with fatigability: often affecting the face and neck - Ptosis (drooping eyelid) - Complex ophthalmoplegia - Head drop - rare sign - Myasthenic snarl - snarling expression when attempting to smile

Answer 186

- Lethargy - Muscle weakness: worsens throughout the day, can improve with rest - Diplopia: double vision due to effects on eye muscles - Slurred speech - Dysphagia: difficulty swallowing - Fatigue in jaw when chewing - Shortness of breath: may suggest a myasthenic crisis

Answer 187

- Based upon a clinical diagnosis - FIRST LINE - Antibodies: AchR antibodies are GOLD STANDARD - anti-MuSK and anti-LRP4 - GOLD STANDARD if AchR is negative - CT or MRI at the thymus - for thymoma - Thyroid function - Serial pulmonary function tests - Tensilon test - Crushed ice test

Answer 188

- Lambert-Eaton myasthenic syndrome - Botulism - Penicillamine-induced myasthenia gravis - Primary myopathies

Answer 189

- Acetylcholinesterase inhibitor e.g. Pyridostigmine - FIRST LINE - Prednisolone - SECOND LINE - Azathioprine - THIRD LINE - Other - methotrexate or rituximab - Thyroidectomy

Answer 190

- IV immunoglobulin or plasmapheresis - Intubation: if severe respiratory compromise - Corticosteroids may be used as an adjunct

Answer 191

- Myasthenic crisis: weakening of the respiratory muscles and is often provoked by infections or medications. Patients present with increasing shortness of breath, which can deteriorate into respiratory failure. - Respiratory failure - Aspiration pneumonia: dysphagia increases the risk of aspiration

Answer 192

- Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune disorder of the neuromuscular junction in the peripheral nervous system. - It may occur as a paraneoplastic disorder in association with cancer, usually a small cell carcinoma of the lung, or may occur without cancer, as part of a more general autoimmune state.

Answer 193

- Can be associated with other autoimmune diseases e.g. Hashimoto’s thyroiditis or diabetes mellitus type 1. - Small cell lung cancer malignancy - Smoking - Family history of autoimmune disease

Answer 194

- Symmetrical proximal muscle weakness, especially proximal leg muscle weakness - Diplopia: double vision due to effect on intraocular muscles - Ptosis: drooping of eyelids due to effect on levator muscles - Slurred speech: due to effect on oropharyngeal muscles - Dysphagia: due to effect on oropharyngeal muscles - Reduced tendon reflexes

Answer 195

- Test for autoantibodies against voltage-gated calcium channels - Electromyography - Chest X-ray / CT scan - for small cell lung cancer - Nerve conduction studies

Answer 196

- Botulism - Myasthenia gravis - Myopathy - Chronic inflammatory demyelinating neuropathy - Guillain-Barre syndrome

Answer 197

- Manage underlying malignancy - Pyridostigmine/ amifampridine - Immunosuppressants - IV immunoglobulins - Plasmapheresis

Answer 198

- Respiratory failure: when respiratory muscles are affected - Aspiration: due to impaired swallowing - Amifampridine related seizures - Osteoporosis: related to corticosteroid use

Answer 199

Carpal tunnel syndrome (CTS) is a collection of symptoms and signs caused by compression of the median nerve in the carpal tunnel.

Answer 200

- Female > Male: due to same size tendon but in smaller wrist. - Age: Usually in those over 30 years old.

Answer 201

- Pain: worse at night after a day's use of hands - Numbness - Paraesthesia: relieved by hanging hand over bed and shaking it (wake and shake) - Muscle weakness in the hands - Tinels, Phalens and Durkans sign: +ve - Light touch, 2-point discrimination and sweating can be impaired

Answer 202

Flex the wrists are far as possible and hold that position for a minute, this results in numbness in the areas of the hand innervated by the median nerve in people with carpal tunnel syndrome

Answer 203

Tap the transverse carpal ligament, this reproduces the symptoms of tingling or feelings of pins and needles in areas of the hand served by the median nerve

Answer 204

Manually compressing the carpal tunnel with the thumb for 30 second, to reproduce symptoms of carpal tunnel

Answer 205

- Tinels, Phalens and Durkans sign: +ve - clinical diagnosis - Electromyography - GOLD STANDARD - Ultrasound or MRI of the wrist

Answer 206

- Behavioural modification e.g. changing positioning of hand when typing etc - Physical therapy - Mild-Moderate/Pregnant - Wrist splint - FIRST LINE - Corticosteroid injection - SECOND LINE - Severe - Surgical decompression - FIRST LINE

Answer 207

- Sciatica is where the sciatic nerve, which runs from your lower back to your feet, is irritated or compressed. - Leading to pain from the lower back down to the lower leg. - Pain is associated with injury or compression of the sciatic nerve.

Answer 208

- Aching and sharp leg pain which radiates to the middle or lower buttock and outer thigh. - Unilateral (Bilateral is a red flag for cauda equina syndrome) - Numbness - Motor weakness - Loss of reflexes - Loss of ankle jerk reflex - S1 spinal nerve compression. - Loss of knee jerk reflex - L4 nerve compression.

Answer 209

- Lasegu's sign positive - CT or MRI of the spine - GOLD STANDARD

Answer 210

- Examiner raises straight leg which stretches nerve root over the herniated disk. - If pain worsens when leg is between 30-70 degrees then the diagnosis is conformed.

Answer 211

- Cauda Equina - Paralysis

Answer 212

- Sciatic pain usually resolves on it’s own over time but the pain can be relieved with pain medication - Analgesia (NOT opioids) - NASIDs - If symptoms worsen - Amitriptyline - Duloxetine - Specialist management - Epidural corticosteroid injections. - Local anaesthetic injections. - Radiofrequency denervation. - Spinal decompression. - Surgical treatment for tumours, cysts or injury to spinal cord.

Answer 213

Foot drop is a result of weakness of the foot dorsiflexors.

Answer 214

- Common peroneal nerve lesion is the most common cause. - L5 radiculopathy. - Sciatic nerve lesion. - Superficial or deep peroneal nerve lesion. - Other possible includes central nerve lesions (e.g. stroke) but other features are usually present.

Answer 215

- Leg crossing - Kneeling

Answer 216

- If the patient has isolated peroneal neuropathy there will be weakness of foot dorsiflexion and eversion → Reflexes will be normal. - Weakness of hip abduction is suggestive of a L5 radiculopathy.

Answer 217

- Steppage gait - drag their toes while walking - Unilateral symptoms - Tripping over - Numbness and weakness in the same side - In some cases skin on top of foot and toes feels numb

Answer 218

- Clinical diagnosis - FIRST LINE - Imaging - X-ray, CT or MRI - Nerve conduction study

Answer 219

- Brace and Splint. - Physiotherapy. - Specialised shoes → prevents foot drop when walking. - Nerve stimulation. - Surgery if indicated.

Answer 220

- Wrist drop is a medical condition in which the wrist and the fingers cannot extend at the metacarpophalangeal joints - The characteristic deformity of a radial nerve lesion

Answer 221

- Radial nerve injury - stab wounds to the chest. - Compression of the radial nerve. - Brachial plexus injury. - Fracture or dislocation of the humerus. - Neurological conditions such as multiple sclerosis, polio, or amyotrophic lateral sclerosis (ALS).

Answer 222

- Wrist splint - Surgical removal of bone or anatomical defects (if from compression)

Answer 223

- C7 root injury - Posterior interosseous neuropathy

Answer 224

- A radial nerve lesion

Answer 225

- Posterior interosseous nerve lesion

Answer 226

- C7 and C8 lesion

Answer 227

- Corticospinal lesion.

Answer 228

- Wrist splint - Surgical removal of bone or anatomical defects (if from compression)

Answer 229

- C7 root injury - Posterior interosseous neuropathy

Answer 230

- Deformity where the fingers are bent into a position that looks like a claw. - Results in hyperextension at the metacarpophalangeal joints and flexion of the interphalangeal joints. - Also known as ulnar claw and spinster’s claw.

Answer 231

- Brachial plexus lesion (C8-T1). - Other spinal cord lesions eg syringomyelia, polio. - Volkmann's contracture. - Rheumatoid arthritis (advanced, untreated disease). - Ulnar and median nerve lesion.

Answer 232

- Complete - results from both Ulnar and Median Nerve Palsy, involves all digits. - Partial (or incomplete) - involves only ulnar 2 digits and is referred to as an isolated Ulnar Nerve Palsy.

Answer 233

Surgery - Nerve repair or decompression if possible.

Answer 234

- Spinal cord compression (SCC) results from processes that compress or displace arterial, venous, and cerebrospinal fluid spaces, as well as the cord itself. - This is a medical emergency as it can lead to paralysis.

Answer 235

- Back pain: radicular pain (spinal/ root pain) may precede weakness and sensory loss - Progressive weakness of legs (typically symmetrical) with UMN signs e.g. contralateral spasticity and hyperreflexia - Sensory loss 1-2 cord segments below level of lesion - UMN signs below the level of lesion - LMN signs at level of lesion - Signs dependent on level of lesion e.g. - L5/S1 lesion = sciatica (sensory loss and pain in back of thigh/ leg/ lateral aspect of little toe) - L4/L5 lesion = L5 nerve root compression (sensory loss/pain in lateral thigh/lateral leg & medial side of big toe) - Bladder and anal sphincter involvement: a late sign; hesitancy, frequency and painless retention

Answer 236

- MRI of spine - GOLD STANDARD - Biopsy/surgical exploration - Screening blood tests: FBC, ESR, B12, U&Es, LFT, PSA - Chest X-ray - Check for TB

Answer 237

- Transverse myelitis - Multiple sclerosis - Carcinomatous meningitis - Cord vasculitis - Spinal artery thrombosis/ aneurysm - Trauma - Guillain-Barre syndrome

Answer 238

- Steroids e.g. IV dexamethasone - Laminectomy or microdiscectomy - Chemotherapy if indicated - Analgesia

Answer 239

- A classical syndrome of painless short-lived monocular blindness. - It is a term usually reserved for transient visual loss of ischaemic origin.

Answer 240

- Occurs due to the temporary reduction in the retinal, ophthalmic or ciliary blood flow leading to temporary retinal hypoxia. - The principle cause of amaurosis fugax is transient obstruction e.g. due to emboli, of the ophthalmic artery, which is a branch of the internal carotid artery. - However, other ischaemic causes to consider include giant cell arteritis (i.e. temporal arteritis) and central retinal artery occlusion.

Answer 241

- Syncope is the term used to describe the event of temporarily losing consciousness due to a disruption of blood flow to the brain, often leading to a fall. - Syncopal episodes are also known as vasovagal episodes, or simply fainting.

Answer 242

- Elderly - Pregnant women - Certain medications that - Block vasoconstriction e.g. calcium channel blockers, beta blockers, alpha blockers, and nitrates - Affect the volume status e.g. diuretics - That prolong the QT interval e.g. antipsychotics and antiemetics - Anxiety and panic disorders - Alcohol abuse - Drug abuse

Answer 243

- A pathological process affecting a peripheral nerve or nerves

Answer 244

- A process affecting a single nerve

Answer 245

- Usually describes a condition that affects several nerves, but in no discernible pattern, and no underlying unifying condition. i.e. the nerves have been individually damaged.

Answer 246

- Many nerves involved. Usually describes a symmetrical disease, and it usually begins distally. Can be sensory, motor or mixed. Classified into demyelinating, or axonal types. Loads of different types and different classifications. Often widespread loss of tendon reflexes is typical, with distal weakness and distal sensory loss

Answer 247

- Postural hypotension - Reduced sweating - Ejaculatory failure - Horner's syndrome

Answer 248

- Erectile dysfunction - Constipation - Nocturnal diarrhoea - Urine retention - Holmes-Adie pupil

Answer 249

The mnemonic DAVID can be used: - D – Diabetes - A – Alcoholism - V – Vitamin Deficiency – B12 - I – Infective / inherited – Guillian-Barre / Charcot-Marie-Tooth - D – Drugs – e.g. isoniazid

Answer 250

- A disorder that causes persistent feelings of low mood, low energy and reduced interest. - Persistent depressive disorder is characterised by at least 2 years of a depressed mood for most of the day, for more days than not, for at least 2 years.

Answer 251

- Older age - Recent child birth *(postpartum depression)* - Trauma - Co-existing conditions - Family history of depression - Medications *e.g. corticosteroids* - Female sex

Answer 252

- Low/Depressed mood - Anhedonia - *a lack of pleasure in activities* - Low energy - Anxiety and worry - Irritability - Avoiding social situations (e.g. school) - Hopelessness about the future - Poor sleep, particularly early morning waking - Poor appetite or over eating - Poor concentration - Reduced libido - Weight changes

Answer 253

- Clinical diagnosis - ICD-11 or DSM-5-TR diagnostic criteria depending on the subcategory - Bloods - FBC, Metabolic panel, TFTs, Patient health questionnaire

Answer 254

- Antidepressant if mild or severe - First Line - e.g. Citalopram, Fluoxetine - Consider if mild - Psychotherapy or other non-pharmacological treatment - Immediate symptom management with benzodiazepines +/- antipsychotic - Emergency cases - Supportive treatments

Answer 255

Von Hippel Lindau disease is a rare autosomal dominant disorder characterized by a mutation in a tumour suppressor gene which leads to the formation of cysts and benign tumours in various parts of the body like the eye, CNS, kidneys, adrenal glands and pancreas.

Answer 256

- The olfactory nerve - Reduced smell and taste

Answer 257

- The olfactory nerve - Trauma - Frontal lobe tumour - Meningitis

Answer 258

- The optic nerve - Visual field defects - Pupillary abnormalities - Optic neuritis - Optic atrophy

Answer 259

- The oculomotor nerve - Fixed dilated pupils which don't accommodate - Ptosis - Complete internal ophthalmoplegia - Unopposed lateral rectus causes outward deviation of the eye

Answer 260

- The oculomotor nerve - Diabetes mellitus - Giant cell arteritis - Syphilis - Posterior communicating artery aneurysm - Idiopathic - Raised ICP (if uncal herniation through the tentorium - this compresses the nerve)

Answer 261

- The trochlear nerve - Diplopia due to weakness of downward and inward eye movement (pure vertical diplopia) - Compensation by tilting the head away from the affected side

Answer 262

- The trochlear nerve - Trauma to the orbit - Diabetes - Infarction secondary to hypertension

Answer 263

- The trigeminal nerve - Reduced sensation or dysasthesia over the affected area - Weakness of jaw clenching and side-to-side movement. - If LMN lesion, the jaw deviates to the weak side when the mouth is opened - May be fasciculation of temporalis and masseter

Answer 264

- The trigeminal nerve - Sensory: - Trigeminal neuralgia - Herpes zoster - Nasopharyngeal carcinoma - Motor: - Bulbar palsy - Acoustic neuroma

Answer 265

- The abducent nerve - Inability to look laterally - Eye is deviated medially because of unopposed action of the medial rectus muscle

Answer 266

- The abducent nerve - MS - Pontine CVA

Answer 267

- Facial nerve - Facial weakness - LMN lesion: - Forehead is paralysed - the final common pathway to the muscles is destroyed - UMN lesion: - Upper facial muscles are partially spared because of alternative pathways in the brainstem

Answer 268

- Vestibulocochlear nerve - Unilateral sensorineural deafness - Tinnitus - Slow-growing lesions seldom present with vestibular symptoms as compensation has time to occur - Vertigo - Nystagmus

Answer 269

- Glossopharyngeal nerve - Unilateral lesions do not cause any deficit because of bilateral corticobulbar connections - Bilateral lesions result in pseudobulbar palsy - Loss of gag reflex

Answer 270

- Glossopharyngeal nerve - Trauma - Brainstem lesions - Cerebellopontine angle and neck tumours - Polio - Guillain-Barre syndrome (GBS)

Answer 271

- Vagus nerve - Palatal weakness: - Nasal speech - Nasal regurgitation of food - Palate moves asymmetrically when the patient says 'ahh' - Recurrent nerve palsy: - Hoarseness - Loss of volume - Bovine cough

Answer 272

- Vagus nerve - Trauma - Brainstem lesions - Tumours in the cerebellopontine angle, jugular foramen and neck - Polio - GBS

Answer 273

- Accessory nerve - Weakness and wasting of the muscles which turn the head to the contralateral side

Answer 274

- Accessory nerve - Trauma - Brainstem lesions - Tumours in the cerebellopontine angle, jugular foramen and neck - Polio - GBS

Answer 275

- Hypoglossal nerve - LMN lesion: - Wasting of the ipsilateral side of the tongue, with fasciculation - Attempted protrusion of tongue causes deviation towards the affected side

Answer 276

- Polio - Syringomyelia tuberculosis - Median branch thrombosis of the vertebral artery

Answer 277

Epilepsy is an umbrella term for a condition where there is a tendency to have seizures. Seizures are transient episodes of abnormal electrical activity in the brain.

Answer 278

- Cerebrovascular disease - Head trauma - Cerebral infections - Family history: epilepsy or neurological illness - Premature birth - Congenital malformations of the brain - Genetics conditions associated with epilepsy

Answer 279

- Criteria 1: ≥2 unprovoked (or reflex) seizures occurring more than 24 hours apart - Criteria 2: 1 unprovoked (or reflex) seizure with a probability of further seizures felt to be at a similar recurrence risk to patients with ≥2 unprovoked seizures over the next 10 years. - Criteria 3: A diagnosed epilepsy syndrome

Answer 280

- EEG - GOLD STANDARD - MRI or CT of the brain - ABG or VBG - ECG - Bloods - U&Es - Glucose - FBC - Blood cultures - Inflammatory markers

Answer 281

- FIRST LINE - Sodium valproate - SECOND LINE - Lamotrigine or Carbamazepine

Answer 282

- FIRST LINE - Carbamazepine or Lamotrigine - SECOND LINE - Sodium valproate or Levetiracetam

Answer 283

- FIRST LINE - Sodium valproate or Ethosuximide

Answer 284

- FIRSR LINE - Sodium valproate - SECOND LINE - Lamotrigine

Answer 285

- FIRST LINE - Sodium valproate - Other options - lamotrigine - Levetiracetam - Topiramate

Answer 286

- Prednisolone - Vigabatrin

Answer 287

- Epilepsy surgery: removal of cause of seizure e.g. specific part of the brain or tumour. - Nerve stimulation: certain nerves e.g. the vagus nerve are stimulated, which is thought to control seizures by influencing neurotransmitter release.

Answer 288

- Adults who present with an isolated seizure: - Should stop driving for 6 months, providing no cause is found on brain imaging and there is no epileptiform activity on EEG - If the above conditions are not met or the patient has known epilepsy: - Patients must be seizure-free for 12 months before they may qualify for a driving license - If seizure-free for 5 years, a 'til 70 licence is usually reinstated - Withdrawal of anti-epilepsy medication: - Patients must not drive if medication has been withdrawn and for 6 months after the last dose - If the patient drives a heavy goods vehicle (HGV): - They must be seizure-free for 5 years before they can start driving - ALL PATIENTS MUST INFORM THE DVLA

Answer 289

- When the affected area is limited to one hemisphere - or one half of the brain - or sometimes even a smaller area like a single lobe, it is known as a focal seizure. - A generalised seizure is where both hemispheres of the brain are affected. These can be subcategorised.

Answer 290

- Tonic seizure: the muscles become stiff and flexed, which can cause the patient to fall, usually backwards

Answer 291

- Atonic seizures: aka drop attacks. The muscles suddenly relax and become floppy, which can cause the patient to fall, usually forward. These don’t usually last more than 3 minutes. They typically begin in childhood. They may be indicative of Lennox-Gastaut syndrome.

Answer 292

- Clonic seizures: violent muscle contractions (convulsions).

Answer 293

- Tonic-clonic seizures: there is loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) episodes. Typically the tonic phase comes before the clonic phase. There may be associated tongue biting, incontinence, groaning and irregular breathing.

Answer 294

- Myoclonic seizures: short muscle twitches. The patient usually remains awake during the episode. They occur in various forms of epilepsy but typically happen in children as part of juvenile myoclonic epilepsy.

Answer 295

- Absence seizures: aka petit mal seizures, impaired awareness or responsiveness. Patient becomes blank and stares into space before returning to normal. Motor abnormalities are either absent or very minor e.g. eyelid flutters or repetitive lip smacking. Common in children. Most patients (> 90%) stop having absence seizures as they get older.

Answer 296

- Status epilepticus (SE) is a single, continuous seizure lasting more than five minutes or two or more seizures within a five-minute period without regaining consciousness in between. - It is a medical emergency.

Answer 297

- Psychogenic non-epileptic spells (PNES) - Convulsive syncope - Infantile spasms (West syndrome) - Febrile convulsions

Answer 298

Subarachnoid haemorrhage (SAH) is a type of intracranial haemorrhage characterised by blood within the subarachnoid space.

Answer 299

- Increasing age: most commonly presents in people > 50 years old - Hypertension - Smoking - Alcohol excess: there is a significantly increased risk with current alcohol abuse - Cocaine use - Family history - Polycystic kidney disease (PKD): 5 times more common in autosomal dominant PKD - Connective tissue disorders: such as Marfan syndrome or Ehlers-Danlos - Neurofibromatosis: tumours form on your nerve tissues

Answer 300

- Non-contrast CT - GOLD STANDARD - Lumbar puncture if CT is negative - CT angiogram - FBC - Serum glucose - Clotting screen

Answer 301

- CCB - Nimodipine - FIRST LINE - Surgery: - Endovascular coiling of the aneurysm - Surgical clipping via craniotomy - Shunt for hydrocephalus

Answer 302

- Re-bleeding (22 chance in the 1st month) - Vasospasm - Hydrocephalus - Seizures - Hyponatraemia

Answer 303

- Intracerebral haemorrhage describes bleeding within the cerebrum. - Two types: - Intraparenchymal haemorrhage: involves just the brain tissue - Intraventricular haemorrhage: blood extends into the ventricles of the brain which store cerebrospinal fluid

Answer 304

- Head injury - Hypertension - Aneurysms - Ischaemic stroke can progress to haemorrhage - Brain tumours - Anticoagulants such as warfarin

Answer 305

- 3rd nerve palsy - An aneurysm arising from the posterior communicating artery will press on the 3rd nerve, causing a palsy with a fixed dilated pupil - 6th nerve palsy - A non-specific sign which indicates raised intracranial pressure - Reduced GCS

Answer 306

- Headache - Severe, sudden onset - Occipital - ‘Thunderclap’ headache - Meningism: photophobia and neck stiffness - Vision changes - Nausea and vomiting - Speech changes - Seizures - Weakness - Confusion - Coma

Answer 307

- Headache - Weakness - Seizures - Vomiting - Reduced consciousness - Specific signs will depend on the area affected

Answer 308

- Non-contrast CT of the head - GOLD STANDARD - Angiography - Check FBC and clotting factors - U&Es

Answer 309

- Consider intubation, ventilation and ICU care if they have reduced consciousness - Correct any clotting abnormality - Correct severe hypertension but avoid hypotension - Drugs to relieve intracranial pressure e.g. Mannitol - Craniotomy - Stereotactic aspiration - STOP ANTICOAGULANT OR ANTITHROMBOTIC MEDICATIONS

Answer 310

- Bleeding below the dura mater in the brain.

Answer 311

- Head injury - Brain atrophy - Alcohol abuse - Hypertension - Aneurysms - Ischaemic stroke can progress to haemorrhage - Brain tumours - Anticoagulants such as warfarin

Answer 312

- Reduced GCS: loss of consciousness right after the injury or in the ensuing days to weeks as the haematoma increases in size. - Headaches - Vomiting - Seizures - Sometimes there can be focal neurological symptoms e.g. muscle weakness, unequal pupils, hemiparesis or sensory problems

Answer 313

- Non-contrast CT - GOLD STANDARD - acute subdural haematoma - chronic subdural haematoma - midline shift - Check FBC and clotting

Answer 314

- Stroke - Dementia - CNS masses e.g. tumours or abscesses - Subarachnoid haemorrhage - Epidural haemorrhage

Answer 315

- Surgery - clot evacuation, craniotomy or burr holes - IV mannitol to reduce ICP - Reverse clotting abnormalities

Answer 316

- Bleeding above the dura mater of the brain.

Answer 317

- Head injury - Hypertension - Aneurysms - Ischaemic stroke can progress to haemorrhage - Brain tumours - Anticoagulants such as warfarin

Answer 318

- Reduced GCS: loss of consciousness right after the injury or in the ensuing days to weeks as the haematoma increases in size. - Headaches - Vomiting - Seizures - Sometimes there can be focal neurological symptoms e.g. muscle weakness, unequal pupils, hemiparesis or sensory problems

Answer 319

- CT or MRI scan - Hyperdense mass - -lemon mass' shape - bi-convex - Check FBC and clotting - Skull X-ray - may show a fracture

Answer 320

- Epilepsy - Carotid dissection - Carbon monoxide poisoning - Subdural haematoma - Subarachnoid haemorrhage

Answer 321

- Urgent surgery - Craniotomy for clot evacuation and ligation of the vessel - IV mannitol to reduce ICP - Stabilise patient

Answer 322

- The Glasgow Coma Scale (GCS) is a universal assessment tool for assessing the level of consciousness. - It is scored based on eyes, verbal response and motor response. - The maximum score is 15/15, minimum is 3/15. When someone has a score of 8/15 or below then you need to consider securing their airway as there is a risk they are not able to maintaining it on their own.

Answer 323

- Spontaneous = 4 - Speech = 3 - Pain = 2 - None = 1

Answer 324

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

Answer 325

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

Neurology Flashcards

(349 cards)