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PACES Y6 > Neurology > Flashcards

Neurology Flashcards

1
Q

Presentation of poliomyelitis

A

Muscle atrophy
LMN signs
Can be unilateral or bilateral

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2
Q

Cause of poliomyelitis

A

Motor lesion in anterior horns
Results in LMN signs

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3
Q

Management of poliomyelitis

A

Supportive
Muscle relaxants for spasms
Surgery to correct deformities

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4
Q

Presentation and cause of Charcot-Marie-Tooth

A

Foot drop
High-arched feet (pes cavus)
Champagne bottle legs
Peripheral sensory loss
LMN signs

Cause by autosomal dominant mutation affecting myelin sheath

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5
Q

Investigations and management of Charcot-Marie-Tooth

A

Nerve conduction studies
Genetic testing

MDT
Neurologist and genetecists to diagnose
Physiotherapy
Occupational therapy for ADL
Orthopaedic surgeons to correct deformities

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6
Q

Parkinsons cause and presentation

A

Progressive reduction of dopamine in substantia nigra of basal ganglia

Stooped posture
Reduced arm swing
Shuffling gait (bradykinesia)
Facial masking (hypomimia)

Unilateral fine tremor, worse at rest
Cogwheel rigidity
Anosmia

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7
Q

Parkinsons investigations

A

Clinical
Trial with levodopa
Single photon emission computed tomography

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8
Q

Parkinsons management

A

Levodopa (not a dopamine agonist, as it needs to be converted in the brain into dopamine) with carbidopa (decarboxylase inhibitor)
Dopamine agonists can be given if motor symptoms not affecting QOL
MAO-B inhibitor

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9
Q

Causes of upper motor neuron unilateral cerebellar signs

A

Stroke
Tumour
Trauma
Multiple sclerosis

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10
Q

Patient has the following:
UMN: weakness, spasticity
Cerebellar: ataxia, tremor
Sensory: pins/needles, numbness

What other signs could you expect and what is the cause?

A

Optic neuritis
Internuclear opthalmoplegia
Uhthoff’s phenomenon
Lhermitte’s sign

Multiple sclerosis (UMN, sensory, and eyes)

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11
Q

Multiple sclerosis investigations

A

Anti-maltose binding protein
CSF and serum: oligoclonal bands
MRI with contrast: periventricular plaques, dawson fingers

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12
Q

Multiple sclerosis medical management (acute and long-term)

A

Acute: high-dose steroids

Long-term: IV natalizumab for relapse risk reduction

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13
Q

Causes of peripheral neuropathy (sensory/motor)

A

Alcohol
B12 deficiency
Cancer and CKD
Diabetes and drugs (amiodarone, isoniazid)
Every vasculitis

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14
Q

Causes of Horner’s syndrome

A

Central: stroke, tumour, multiple sclerosis
Pre-ganglionic: pancoast’s, thyroidectomy
Post-ganglionic (no anhidrosis): carotid artery dissection, cavernous sinus thrombosis, cluster headache

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15
Q

Management of Horner’s (acute and long term)

A

Acute: find and treat cause e.g. stroke, tumour, trauma

Long-term: MDT, artificial tears, botox for ptosis, emotional support

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16
Q

Presentation of motor neuron disease (different types)

A

Amyotrophic lateral sclerosis: UMN in legs, LMN in arms
Primary lateral sclerosis: UMN
Progressive muscular atrophy (best prognosis): LMN
Progressive bulbar palsy (worst prognosis): palsy of tongue, facial muscles affected (brainstem motor nuclei affected)

17
Q

Causes of upper motor neuron signs

A

Stroke
Tumour
Trauma
Multiple Sclerosis
Motor neuron disease
Parkinsons

18
Q

Causes of lower motor neuron signs

A

Guillain-Barre syndrome
Myasthenia gravis
Trauma (nerve injury)
Motor neuron disease
Polio
Muscular dystrophy

19
Q

Causes of mixed upper and lower motor neuron signs

A

ALS
Polio

(also the boundary is the anterior horn cells in the spinal cord)

20
Q

Types of multiple sclerosis

A

Relapsing-remitting
Secondary progressive
Primary progressive

21
Q

Definition of multiple sclerosis

A

Multiple lesions in the CNS separated by space (multiple locations) and time (new lesions occuring over time)

22
Q

Causes of sensorineural and conductive hearing loss

A

Sensorineural: age, loud noise, ototoxic medications
Conductive: earwax, otitis media, perforation of ear drum

23
Q

Causes of internuclear opthalmoplegia

A

Multiple sclerosis
Stroke
Tumour
Trauma
Infections e.g. encephalitis and meningitis

(Impaired adduction of eye ipsilateral to medial longitudinal fasciculus, nystagmus in other eye)

24
Q

Eye palsy signs

A

3rd: down and out, may be dilated (mydriasis), ptosis
4th: up and out, vertical diplopia
6th: adducted eye, horizontal diplopia

25
Q

What is RAPD and its causes?

A

Swinging light test
Both eyes dilate when light shone into affected eye (they will constrict if it is not swung)

Retinal detachment
Optic neuritis e.g. multiple sclerosis

26
Q

Examples of dopaminergic and antidopaminergic drugs

A

Dopaminergic
- levodopa
- dopamine agonists e.g. bromocriptine
- MAO-B inhibitors

Antidopaminergic
- Haloperidol (typical)
- Risperidone (atypical)
- Metaclopramide

27
Q

Power meanings 0-5/5

A

0: no contraction
1: contraction but no movement
2: move without gravity (different position)

3: move against gravity
4: little resistance
5: maximal resistance

28
Q

How is benign essential tremor different to parkinsons?

A

Symmetrical
Better at rest
Worse with intention
Improves with alcohol (parkinsons doesn’t change)

29
Q

Causes of intention tremor

A

Multiple sclerosis
Cerebellar disease
Essential tremor
Stroke

30
Q

What are Parkinson’s plus syndromes

A

Conditions which cause Parkinsonism as part of their features

Multiple system atrophy: multiple areas in brain affected (including basal ganglia), also causes autonomic dysfunction (consiptation, sweating), and cerebellar dysfunction (ataxia)

Dementia with Lewy Bodies

31
Q

How does drug-induced parkinsonism present differently?

A

Rapid onset
Bilateral
Rigidity and rest tremor uncommon

32
Q

Side effects of levodopa

A

Dry mouth
Palpitations
Psychosis

33
Q

What signs does cerebral palsy cause (i.e. UMN/LMN etc.)?

A

UMN signs: spastic
Cerebellar: ataxic

34
Q

Myasthenia gravis presentation, investigation, management

A

Extraocular muscle weakness: diplopia
Ptosis
Proximal muscle weakness

EMG
ACh-r antibodies
CT thorax

ACh-esterase inhibitors: pyridostigmine
Crisis: IVIG, plasmapheresis

35
Q

Causes of proximal muscle weakness

A

Inflammation: polymyositis, dermatomyositis
Neurological: multiple sclerosis, MND
Trauma
Vtiamin D or calcium deficiency

36
Q

What is Lambert-Eaton?

A

Similar to myasthenia gravis
Small cell lung cancer antibodies against VGCCs
No ophthalmoplegia and ptosis

37
Q

What are the 12 cranial nerves?

A
  1. Olfactory
  2. Optic
  3. Oculomotor
  4. Trochlear
  5. Trigeminal
  6. Abducens
  7. Facial
  8. Vestibulocochlear
  9. Glossopharyngeal
  10. Vagus
  11. Accessory
  12. Hypoglossal

PACES Y6 (6 decks)

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