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Phase 2a Annabel > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the 3 layers of the meninges?

A

Dura - outer
Arachnoid- keeps CSF in contact with brain
Pia- on brain surface, present between vessels and neurons

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2
Q

Where does the circle of Willis lie?

A

Subarachnoid - between arachnoid and pia

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3
Q

What myelinates axons in the brain?

A

Oligodendrocytes

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4
Q

What myelinates axons in the rest of the body?

A

Schwann cells

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5
Q

What are 3 functions of the frontal lobe?

A

Voluntary movement on opposite side of body
Dominant hemisphere controls speech and writing (right handed = left dominant)
Reasoning
Memory
Intellectual functioning

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6
Q

What is the primary function of the parietal lobe?

A

Receives and interprets sensations (pain, touch, size, shape and proprioception)

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7
Q

What is the primary function of the temporal lobe?

A

Understand spoken word (wernickes) and sounds

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8
Q

What are the 2 primary functions of the occipital lobe?

A

Understanding visual images
Understanding meaning of written words

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9
Q

Where is CSF produced?

A

Ependymal cells in choroid plexuses of lateral ventricles

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10
Q

Where is CSF absorbed?

A

Arachnoid granulations in superior sagittal sinus

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11
Q

Where do sympathetic nerves arise from?

A

Thoracic and lumbar regions of spinal cord

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12
Q

What receptors are present at Presynaptic sympathetic neurones?

A

Nicotinic

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13
Q

What receptors are present at postsynaptic sympathetic neurones?

A

Adriinergic receptors

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14
Q

What neurotransmitter is used at presynaptic sympathetic neurones?

A

Acetylcholine

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15
Q

What neurotransmitter is used at postsynaptic sympathetic neurones?

A

Noradrenaline

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16
Q

What neurotransmitter is used at presynaptic parasympathetic neurones?

A

Acetylcholine

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17
Q

What neurotransmitter is used at postsynaptic parasympathetic neurones?

A

Acetylcholine

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18
Q

What receptors are present at presynaptic sympathetic neurones?

A

Nicotinic

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19
Q

What receptors are present at postsynaptic parasympathetic neurones?

A

Muscarinic

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20
Q

What are 3 functions of the sympathetic system?

A

Inc HR
Increases force of contraction
Vasoconstriction
BronchoDILATION
Reduces gastric motility
Male ejaculation

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21
Q

What are 3 functions of the parasympathetic nervous system?

A

Decreases heart rate
Decrease force of contraction
Vasodilation
BronchoCONSTRICTION
Increases gastric motility
INCREASED gastric secretions
Male erection

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22
Q

Define dermatome

A

Area of skin supplied by a single spinal nerve

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23
Q

Define myotome

A

Volume of muscle supplied by a single spinal nerve

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24
Q

Define transient ischaemic attack (TIA)

A

Brief episode (5-15 mins) of neurological dysfunction due to ischaemia without infarction

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25
Q

What are the risk factors of TIA?

A

Age
Smoking
HTN
Past TIA
Heart disease
AF

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26
Q

What are 3 causes of TIA?

A

Atherthromboembolism from carotid (MC)
Small vessel occlusion
Valve disease
Hyperviscosity

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27
Q

What 2 regions of circulation can be affected by TIA?

A

90%= anterior circulation (carotid artery)
10% = posterior circulation (vestibulobasilar artery)

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28
Q

What are the symptoms of an anterior/carotid TIA?

A

Weak/ numb contralateral leg
Amaurosis fugax
Dysphasia
Hemiparesis (one sided weakness)

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29
Q

Define amourosis fugax

A

Sudden transient loss of vision in one eye
“Curtain comes down vertically into one field of vision”

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30
Q

What causes amaurosis fugax?

A

Temporary reduction in blood flow to the retinal,ciliary or ophthalmic artery causing temporary retinal hypoxia

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31
Q

What is amaurosis fugax a sign of?

A

Imminent stroke

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32
Q

What are the symptoms of a posterior TIA?

A

Diplopia (double vision)
Vertigo
Vomiting
Choking
Ataxia (no control of body movement)
Transient global amnesia
Can be unconscious

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33
Q

What is the differential diagnosis of TIA?

A

Stroke
- impossible to differentiate until after
- TIA usually resolves, stroke often doesn’t
- stroke infarct

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34
Q

How is TIA diagnosed?

A

Usually clinical
Diffusion weighted MRI (1st line)
Carotid artery doppler ultrasound to find issues
Bloods: polycythaemia, vasculitis ect

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35
Q

How is stroke risk predicted after TIA?

A

ABCD2

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36
Q

What ABCD2 score strongly predicts a stroke?

A

6<
Greater than 4 should be seen within 24 hrs

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37
Q

How is TIA treated acutely?

A

Immediate 300mg aspirin
AF = anticoag

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38
Q

How is TIA treated long term?

A

Aspirin + Clopidogrel (P2Y12 inhibitor) 75mg
Long term statin
Control CV factors

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39
Q

What is an example of a statin?

A

Simvastatin

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40
Q

What are the 2 types of stroke?

A

Haemorrhagic
Ischaemic

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41
Q

Define stroke

A

Rapid neurological disturbance lasting >24 hours caused by infarction

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42
Q

Who is most commonly affected by strokes?

A

BAME
Men
Increases with age

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43
Q

What type are most strokes?

A

Ischemic

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44
Q

Define ischaemic stroke

A

Arterial embolism occludes a vessel resulting in infarction

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45
Q

Define haemorrhagic stroke

A

Rupture of blood vessel leading to infarction

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46
Q

What are 3 risk factors of strokes?

A

Increased age
HTN
Smoking
Past TIA
DM
Heart disease

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47
Q

What are 3 causes of ischaemic stroke?

A

Thromboembolism
Cardioembolism
Hyperviscosity
Hypoperfusion (blood loss)

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48
Q

What are the symptoms of a stroke in the ACA region?

A

Leg weakness
Gait apraxia (loss of function in lower limbs)
Incontinence
Drowsiness

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49
Q

What are the symptoms of a stroke in the MCA region?

A

Contralateral arm and leg weakness+ sensory loss
Aphasia/ Dysphasia
Facial droop
Homonymous hemianopia

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50
Q

What is the MC stroke region presentation?

A

MCA

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51
Q

What are the symptoms of a stroke in the PCA territory?

A

Contralateral homonymous hemianopia (visual field loss in same halves of both eyes)
Cortical blindness
Visual agnosia
Prosopagnosia (cant see faces)
Unilateral headache

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52
Q

What are the symptoms of a stroke in the posterior (vestibulobasilar) region?

A

Very catastrophic
Facial paralysis
Quadriplegia
Altered consciousness

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53
Q

What are 2 differential diagnoses of stroke?

A

Hypoglycaemia
Intracranial lesion
Syncope

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54
Q

Define lacunar stroke

A

Infarct of small arteries supplying the midbrain (internal capsule, basal ganglia ect)

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55
Q

What are the symptoms of a lacunar stroke?

A

Pure sensory loss
Ataxic hemiparesis
Unilateral weakness

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56
Q

How is stroke diagnosed?

A
  1. Immediate non contrast CT (identifies haemorrhagic)
    GS: MRI
    ECG for AF or MI
    Bloods: thrombocytopenia ect
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57
Q

How is stroke classified?

A

Bamford classification

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58
Q

How is ischemic stroke treated?

A

Immediate 300mg aspirin
Thrombolysis with altepase (within 4.5 hours)
After:
Aspirin for 2 weeks
Clopidogrel

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59
Q

How is haemmoragic stroke treated?

A

Neurosurgery immediately
Stop anticoags
Mannitol (diuretic) to decrease pressure

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60
Q

What is a specific sign of stroke?

A

Pronator drift
- arm on affected side will pronate with palm down when patient asked to lift arms to ceiling

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61
Q

What are 4 types of haemmorhage?

A

Intracerebral
Subarachnoid
Extradural
Subdural

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62
Q

Define subarachnoid haemorrhage (SAH)

A

Spontaneous bleeding into subarachnoid space (between arachnoid and pia)

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63
Q

What is the MC cause of SAH rupture?

A

Berry aneurysm
Also
Trauma
AV malformation
Idiopathic

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64
Q

What age is commonly affected by SAH?

A

35-65

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65
Q

Define berry aneurysm

A

Rupture at the junction of circle of Willis

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66
Q

What is the MC site of a berry aneurysm?

A

Anterior communicating/ ACA junction

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67
Q

What are the risk factors of SAH?

A

HTN
FHx
Polycystic kidneys
Connective tissue disorders
Coarctation of aorta

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68
Q

What is the mortality rate of SAH?

A

50% <
The rest usually left with significant disability

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69
Q

What are the symptoms of SAH?

A

Sudden onset of severe occipital headache ‘thunderclap”
May have sentinel headache (early sign before)
Meningitis signs
Decreased consciousness
Fixed dilated pupils

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70
Q

What are 2 differential diagnoses of SAH?

A

Migraine
Meningitis
Intracerebral bleeds

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71
Q

How is SAH diagnosed?

A

Head NC-CT (GS)- star shaped
Lumbar puncture if CT doesn’t confirm
- xanthochromia confirms

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72
Q

What does a star shape in the middle of the brain on CT indicate?

A

SAH

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73
Q

How is SAH treated?

A

Refer to neurosurgeon - endovascular coiling
Nimodipine (CCB)

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74
Q

What are 2 complications of SAH?

A

Re bleeding
Hydrocephalus
Cerebral ischaemia

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75
Q

Define Subdural haemorrhage (SDH)

A

Accumulation of blood between the arachnoid and dura mater following the rupture of a bridging vein between cortex and venous sinus

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76
Q

What are the risk factors of SDH?

A

Small brain: babies, alcoholics, dementia
Trauma- can be long ago or very minor
Anticoag

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77
Q

What are 3 causes of SDH?

A

Deceleration trauma
Shaken babies/abuse
Brain atrophy

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78
Q

Outline the pathophysiology of SDH

A

Bleeding from bridging veins into SD space -> clot -> later clot autolyses (draws water and expands) -> increase in ICP -> shifting of midline structures -> hernia and death

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79
Q

What are the symptoms of SDH?

A

Long interval between injury and symptoms and gradual onset
Decreased/ fluctuating consciousness
Drowsiness
Behaviour change
Signs of increased ICP: Cushing triad

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80
Q

How is SDH diagnosed?

A

NC-CT head - crescent shaped/banana
Acute = hyperdense, chronic = hypodense
Midline shift

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81
Q

What is banana shape on CT indicative of?

A

SDH
suBdural = Banana

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82
Q

What is Cushings triad? (signs of ICP)

A

Bradycardia
Irregular breathing
hypertension

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83
Q

How is SDH treated?

A

Surgery: burr hole and craniotomy
IV mannitol to decrease ICP

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84
Q

Define extradural haemorrhage (EDH)

A

Collection of blood between the dura mater and bone usually due to head injury

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85
Q

What is the MC cause of EDH?

A

Rupture of middle meningeal artery after fracture of the temporal bone

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86
Q

What are the risk factors of EDH?

A

Young adult - decrease risk when age increases
Trauma

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87
Q

Why is EDH uncommon in older people?

A

Dura more adhered to skull

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88
Q

What are the symptoms of EDH?

A

Head injury -> initial loss of consciousness and drowsiness -> lucid interval -> rapid deterioration
“I feel fine”
Late onset = severe headache, nausea, vomiting, decreased GCS, death (resp arrest) ect

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89
Q

What are the differential diagnoses of EDH?

A

Epilepsy
CO poisoning
Meningitis

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90
Q

How is EDH diagnosed?

A

NC-CT head: shows lemon shape
Confined to cranial sutures
May show skull fracture
Midline shift

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91
Q

What is a lemon shape on CT head indicative of?

A

EDH

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92
Q

How is EDH treated?

A

Urgent surgery to evacuate clot and ligate vessel
ABCDE
IV mannitol

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93
Q

What causes Intracerebral haemorrhage?

A

Spontaneous due to ischemic infarction or aneurysm rupture

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94
Q

What are the signs of Intracerebral haemorrhage on CT?

A

Acute/fresh bleed is hyperdense on CT (bright white)

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95
Q

Define meningitis

A

Inflammation of the meninges

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96
Q

What is the MC cause of meningitis in pregnancy?

A

Listeria monocytogenes

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97
Q

What are 2 causes of meningitis in neonates?

A

Group B haemolytic strep (colonises vagina)
- S.agalactiae
E. Coli

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98
Q

What are 3 causes of meningitis in children?

A

N. Meningitidis
Strep. Pneumoniae
Haemophilius influenzae

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99
Q

What are 3 causes of meningitis in elderly people/immunocompromised?

A

Cytomegalovirus
Cryptococcus neoformans
TB
HIV
HSV

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100
Q

What is fungal cause of meningitis?

A

Cryptococcus neoformans

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101
Q

What type of bacteria is n. Meningitidis?

A

Gram negative diplodoccus

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102
Q

What is the MC cause of meningitis?

A

Viral (Enteroviruses) eg

HSV2
Varicella
Measles

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103
Q

What is the sign of N. Meningitidis?

A

Non blanching purpuric rash

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104
Q

What is the appearance of S. pneumoniae?

A

Gram positive diplococcus in chains

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105
Q

What vaccine is available against N.Meningitidis?

A

Men B+C
Men ACWY

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106
Q

What vaccine is available against s. Pneumoniae?

A

PCV

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107
Q

What are the risk factors of meningitis?

A

Intrathecal drug administration (spinal canal)
Age extremes
Pregnancy
Crowding
Endocarditis

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108
Q

What are the general symptoms of meningitis?

A

Headache
Neck stiffness
Fever

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109
Q

What are the symptoms of bacterial meningitis?

A

Sudden onset
Triad of normal symptoms
Papillodema
Non blanching purpuric rash
Altered mental state
Positive signs
Nerve palsies (III)

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110
Q

What are the 2 signs of meningitis?

A

Kernig’s sign
Brudzinski’s sign

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111
Q

What is Kernig’s sign?

A

Can’t extend knee without pain when hip is flexed

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112
Q

What is Brudzinski’s sign?

A

Knees and hips automatically flex when neck is flexed

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113
Q

What are the symptoms of viral meningitis?

A

Benign and self limiting
Headache can last for a few months

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114
Q

How is meningitis diagnosed?

A

Blood tests before LP
LP and CSF analysis

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115
Q

What is present in bacterial meningitis CSF?

A

Cloudy yellow colour
Neutrophilia and polymorphs
Low glucose
Increased opening pressure

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116
Q

What are the CSF findings in viral meningitis?

A

Clear CSF
Lymphocytes
Normal glucose
Normal opening pressure

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117
Q

What are the CSF findings of TB meningitis?

A

Ziehl Neelson stain
Low glucose
High opening pressure

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118
Q

How is bacterial meningitis treated in the community?

A

Immediate IV or IM benzylpenicillin

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119
Q

How is bacterial meningitis treated in hospital?

A

IV cefotaxime or ceftriaxone
+ amoxicillin for neonates and elderly
+ vancomycin for travellers

Also dexamethasone to reduce cerebral oedema

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120
Q

What is given to those in contact with people with meningitis?

A

Ciprofloxacin (all ages and pregnant)
Or
Rifampicin (NOT FOR PREGNANCY)

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121
Q

How is viral meningitis treated?

A

Usually fine
Acyclovir for HSV

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122
Q

What are 2 differential diagnoses of meningitis?

A

Subarachnoid haemorrhage
Migraine

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123
Q

What are 3 complications of meningitis?

A

Hearing loss
DIC (septicaemia)
Waterhouse freidrechsen syndrome (adrenal haemorrhage -> adrenal insufficiency)

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124
Q

Define encephalitis

A

Infection and inflammation of the brain parenchyma

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125
Q

What is the MC cause of encephalitis/

A

HSV-1

Also: varicella, HIV, EBV, toxioplasmosis (cats)

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126
Q

What are the risk factors of encephalitis?

A

Extremes of age
Immunocompromised

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127
Q

What are the symptoms of encephalitis?

A

Triad: fever, headache, altered mental state

Features of viral infection
Seizures
Whole brain affected = problems of consciousness

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128
Q

How is encephalitis diagnosed?

A

MRI
CSF shows elevated lymphocytes
EEG shows sharp and slow waves

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129
Q

What lobe is MC affected by encephalitis?

A

Temporal

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130
Q

How is encephalitis treated?

A

IV aciclovir
Mostly supportive
If seizures give primidone

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131
Q

What are the causes of seizures?

A

VITAMIN DE

Vascular
Infection
Trauma
Autoimmune
Metabolic
Idiopathic (EPILEPSY)
Neoplasms
Dementia and drugs
Eclampsia

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132
Q

Define epilepsy

A

Recurrent tendency to have seizures (>2 >24 hours apart) with no apparent cause

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133
Q

Define seizure

A

Spontaneous, uncontrolled, intermittent abnormal electrical activity in the brain

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134
Q

What are the qualities of ictus/ epileptic seizures?

A

Eyes open
Synchronous movements
Can occur in sleep

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135
Q

What are the risk factors of epilepsy?

A

> 20 or 60<
FHx
Premature birth
Alzheimer’s

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136
Q

Outline the pathophysiology of epilepsy

A

Normal balance between GABA (-) and glutamate (+) shifts towards glutamate
- Glutamate is more excitatory

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137
Q

Define prodrome

A

Nonspecific behavioural symptoms that can occur in the hours/days before a seizure

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138
Q

Define aura

A

More specific sensory disturbances (bad feeling, strange smells ect) that can occur before a seizure

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139
Q

What are the 2 classifications of seizure?

A

Generalised
Partial/focal

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140
Q

Are most seizures generalised or focal?

A

Focal

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141
Q

Define generalised seizure

A

Simultaneous onset of electrical discharge throughout the whole cortex, and ALWAYS is associated with loss of consciousness/awareness

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142
Q

How long do epileptic seizures usually last?

A

30-120 seconds

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143
Q

Define focal seizure

A

Electrical discharge is limited to one area of the brain, but can later become generalised

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144
Q

Outline the process of an epileptic seizure

A

Prodrome -> aura -> ictal event/seizure -> post ictal period

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145
Q

Define post ictal period

A

The period after a seizure

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146
Q

What are the symptoms in a post ictal period?

A

Headache
Confusion
Todd’s paralysis (temporary paralysis and muscle weakness)
Dysphasia
Amnesia

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147
Q

What symptom of a post ictal period is specific to epilepsy?

A

Sore tongue

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148
Q

What are 5 types of generalised seizure?

A

Tonic-clonic/grand-mal
Absence
Myoclonic
Tonic
Atonic/akinetic

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149
Q

What are 5 features of tonic-clonic seizures?

A

Often no aura
Loss of consciousness
Tonic phase: rigid and stiff limbs (fall)
Clonic phase: muscles jerking
Period of drowsiness, confusion, coma after

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150
Q

What are 4 features of absence seizures?

A

Usually occurs in children
Cease of activity, stares and pales for a few seconds
Amnesia of attack
3-Hz spike on ECG

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151
Q

What is the feature of myoclonic seizures?

A

Sudden isolated jerk of limb, face or trunk
- May suddenly fall

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152
Q

What is the feature of tonic seizures?

A

Sudden intense stiffening usually with grunt/cry
- NOT followed by jerking

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153
Q

What is the feature of atonic seizures?

A

Sudden loss of muscle tone (floppy) and cessation of movement causing a fall

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154
Q

What are 3 types of focal seizures?

A

Simple partial seizure
Complex partial seizure
Partial seizure with secondary generalisation

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155
Q

Define simple focal seizure

A

No LOC or memory and awareness is unimpaired, no post-ictal symptoms

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156
Q

Define complex focal seizure

A

Affecting awareness at some point, and patient is unaware and there is a post ictal period

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157
Q

Define focal seizure with secondary generalisation

A

Focal seizures spread widely, causing a secondary generalised seizure
2/3 of patients have this

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158
Q

Where do most complex focal seizures arise from?

A

Temporal lobe

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159
Q

What are the features of a simple focal seizure?

A

Isolated limb jerking
Head turning away from side of seizure
Todds paralysis

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160
Q

What are the features of a complex focal seizure?

A

Hallucinations
Lip smacking
Automatism

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161
Q

What are most secondary generalised seizures?

A

Tonic-clonic

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162
Q

What are the features of temporal lobe seizures?

A

Aura- deja but, hallucinations, fear ect
Anxiety o out of body experiences
Dysphasia
Post-ictal period

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163
Q

What are the symptoms of a frontal lobe seizure?

A

Motor features such as posturing or peddling
Jacksonian march- marches up or down homunculus starting in face or thumb
Post-ictal Todd’s palsy (of limbs involved in seizure)

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164
Q

What are the symptoms of a parietal lobe seizure?

A

Sensory disturbances- tingling or numbness

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165
Q

What are the symptoms of occipital lobe seizures?

A

Visual phenomenons - spots, flashes ect

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166
Q

What are features that differentiate epilepsy from syncope?

A

Tongue biting
Head turning
Muscle pain
LOC
Cyanosis
Post-ictal symptoms

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167
Q

How is epilepsy diagnosed?

A

Must have at least 2 seizures 24+ hours apart

ECG- not diagnostic
MRI with hippocampus imaging
CT head to check for lesion
FBC to check for metabolic causes

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168
Q

Define status epilepticus

A

Complication of epilepsy

Seizure >5 mins OR more than one seizure within 5 mins

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169
Q

What are the symptoms of status epilepticus?

A

Convulsive: jerking, grunting, drooling
Non-convulsive: no jerking, confusion, unable to speak

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170
Q

How is status epilepticus treated?

A

IV or rectal benzodiazepines

  • lorazepam or buccal midazolam
    Second line = phenytoin
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171
Q

How are tonic-clonic seizures treated?

A

Men + non-childbearing women: sodium valporate
Childbearing women: lamotrigine/levetiracetam

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172
Q

How are tonic/atonic seizures treated?

A

Men: sodium valoprate
Women: lamotrigine

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173
Q

How are myoclonic seizures treated?

A

Men: sodium valoprate
Women: levetiracetam

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174
Q

How are absence seizures treated?

A

Ethosuximide

2nd is the usual

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175
Q

How are focal seizures treated?

A

Lamotrigine or levetiracetam

  1. Carbamazepine, oxcarbaepine, zonisamide
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176
Q

What are 2 side effects of sodium valoprate?

A

Teratogenic
Hair loss and growing back curly
Weight gain
Oedema

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177
Q

What is a side effect of carbamazepine?

A

Agranulocytosis
Aplastic cytosis

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178
Q

What are the side effects of ethosuximide?

A

Night terror and rash

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179
Q

What are 2 side effects of lamotrigine?

A

Steve Johnson syndome
Leukopeni

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180
Q

How does sodium valoprate work?

A

Increases GABA

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181
Q

How does carbamazepine work?

A

Increases refractory period of sodium channels

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182
Q

How does lamotrigine work?

A

Na channel blocker

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183
Q

What are some surgical treatments for epilepsy if drugs are ineffective?

A

Surgical resection for hippocampal sclerosis or tumour
Vagal nerve stimulation

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184
Q

What are the causes of status epilepticus?

A

Abruptly stopping treatment
Alcohol abuse
Poor therapy compliance

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185
Q

When can epilepsy patients drive?

A

After they have been free from daytime seizures for a year

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186
Q

Define spina cord compression/myelopathy

A

Compression of the spinal cord resulting in upper neurone signs and symptoms specific to the site of compression

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187
Q

What are 2 causes of spinal cord compression?

A

Vertebral body neoplasms
Secondary malignancy from lungs, breast, prostate ect

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188
Q

What are 2 consequences of spinal cord compression?

A

Disc herniation- centre moves out of the outer part
Disc prolapse- nucleus pulposus moves and can create a bulge in the disc

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189
Q

What are the symptoms of spinal cord compression?

A

Progressive leg weakness with UMN signs
Sensory loss below the level of the lesion
Can have sphincter involvement

190
Q

How is spinal cord compression diagnosed?

A

MRI- GS and done AS SOON AS POSSIBLE
CXR to see malignancy

191
Q

How is spinal cord compression treated?

A

Malignancy = IV dexamethasone
Neurosurgery
- microdisectomy (remove herniated tissue)
- laminectomy (remove lamina/spongy tissue)

192
Q

Define sciatica

A

S1 nerve root compression

193
Q

Define cauda equina syndrome

A

Compression below conus medullaris/ cauda equina - distal to termination of spinal cord at L1/L2

194
Q

What is the MC cause of cauda equina?

A

Lumbar disc herniation (occurs in around 2%)

Spondylolistesis, tumours, abscesses, trauma

195
Q

What are the symptoms of cauda equina?

A

Leg weakness and LMN signs
Saddle anaesthesia- loss of sensation when wiping/perineum
Bladder and bowel dysfunction
Variable areflexic flaccid leg weakness

196
Q

How is cauda equina diagnosed?

A

MRI to localise lesion

197
Q

How is cauda equina treated?

A

Refer to neurosurgeon asap for surgical decompression
Can give surgical spine sensation, spinal fusion/ fixation

198
Q

What are 3 causes of cranial nerve lesions?

A

Tumour
MS
Trauma
Aneurysm
Infection

199
Q

What are the symptoms of CN 3/ Oculomotor palsy?

A

Ptosis- dropping eyelids
Fixed dilated pupil
Eye down and out
Double vision

200
Q

What are 3 causes of CN 3 palsy?

A

Raised ICP
Diabetes
HTN
Giant cell arteritis

201
Q

What are the symptoms of CN 4/ trochlear nerve palsy?

A

Head tilt to unaffected side to correct lack of superior oblique
Diplopia when looking down

202
Q

What causes CN 4 palsy?

A

Trauma to orbit only

203
Q

What are the signs of CN 6 palsy?

A

Eyes will be adducted as it innervates lateral rectus

204
Q

What are the symptoms of CN 5/ trigeminal palsy?

A

Jaw deviates to side of lesion
Loss of corneal reflex

205
Q

What are the symptoms of CN VII/ facial nerve palsy?

A

NOT FOREHEAD SPARING (that would be UMN)
Facial droop and weakness
Ocular dryness
Decreased taste
Incomplete eye closure
Ear pain
Difficulty chewing

206
Q

What are the causes of CN VII palsy?

A

Bell’s palsy- may be due to inflammation and oedema of facial nerve due to viral infection or autoimmune
Middle ear infection
Inflammation of the parotid gland

207
Q

Define trigeminal neuralgia

A

Episodes of acute severe facial nerve pain of the trigeminal nerve

208
Q

How is Bell’s palsy treated?

A

Supportive
Can give Prednisolone
Eye care: lubricants, sunglasses ect

209
Q

What are the causes of trigeminal neuralgia?

A

Vascular compression (MC)
Compression by other lesions
MS
Idiopathic

210
Q

What are the symptoms of trigeminal neuralgia?

A

Short lived episodes of electric shock pain in the distribution of the trigeminal nerve
Can be triggered by cold air or eating

211
Q

How is trigeminal neuralgia diagnosed?

A

CT/MRI to find lesion
Clinical diagnosis: short bursts of pain (>3 with unilateral facial pain)

212
Q

What type of drug is carbamazepine?

A

Anticonvulsant

213
Q

How is trigeminal neuralgia treated?

A

Carbamazepine
2. Gabapentin/lamotrigine

Surgery = micro vascular decompression

214
Q

What are the symptoms of CN VIII/ vesibulocochlear palsy?

A

Hearing impairment
Vertigo and lack of balance

215
Q

What are the causes of CN 8 palsy?

A

Close to bone so- bone fracture
Ear infections
Tumours in internal acoustic meatus

216
Q

What are the symptoms of CN 9/10 lesion?

A

Impaired gag reflex
Swallowing issues
Vocal issues

217
Q

What is the cause of CN 9/10 lesions?

A

Jugular foramen lesion

218
Q

What are the symptoms of CN 11 lesion?

A

Can’t shrug shoulders
Can’t turn head against resistance

219
Q

What are the symptoms of CN 12 palsy?

A

Tongue deviates towards the side of the lesion

220
Q

Define myasthenia gravis (MG)

A

Autoimmune condition against nicotinic acetylcholine receptors in the NMJ that gets better with rest and worse with activity

221
Q

What age does MG present in women?

222
Q

What age does MG usually present in males?

223
Q

What is MG in women associated with?

A

Autoimmune disease
- pernicious anaemia (B12)
- SLE
- RA
- Thymic hyperplasia

224
Q

What is MG associated with in men?

A

Thymic tumour / thymic hyperplasia

225
Q

What can cause transient MG?

A

D-Penicillamine treatment for Wilson’s disease

226
Q

Outline the pathophysiology of MG

A

Anti-AChR antibodies made -> block NMJ -> prevent ACh activation -> activate complement system -> damages NMJ

In exercise more receptors used -> more blocked -> increased muscle weakness

227
Q

What are the symptoms of MG?

A

Muscle weakness worse in exercise and better at rest
Eye issues: ptosis, piplopia, myasthenic snarl when smiling
Jaw and speech fatiguability
Chewing and swallowing difficulties (bulbar)
Tendon reflexes can fatigue

228
Q

What are 2 differential diagnoses of MG?

A

Lambert-Eaton myasthetic syndrome
MS
Hyperthyroidism
GBS

229
Q

How is MG diagnosed?

A

Anti AChR + Anti MuSK (muscle specific tyrosine kinase)
Clinical diagnosis
EMG (electromyography) and NCS (nerve conduction studies)
CT of thymus
Tensilon test

230
Q

What is a Tensilon test?

A

Used to diagnose MG

IV edrophonium (anti-cholinesterase) given and muscle power will increase

231
Q

What are the side effects of a Tensilon test?

A

Cardiac arrhythmia

232
Q

How is MG treated?

A

Anti-cholinesterase pyridostigmine so ACh stays in NMJ
Immunosupression- Prednisolone
Thymectomy

233
Q

What is an example of an anti-cholinesterase?

A

neostigmine
pyridostigmine

234
Q

What are the side effects of anti-cholinesterases?

A

DUMBELLS

Diarrhoea
Urination
Miosis
Bradycardia
Emesis
Lacrimation
Lethargy
Salivation

235
Q

What is a complication of MG?

A

Myasthenic crisis

236
Q

What are the features of myasthenic crisis?

A

Weakness of respiratory muscles in a relapse

237
Q

How is myasthenic crisis treated?

A

Plasma exchange
IV IG

238
Q

What is monitored in MG?

A

FVC for myasthenic crisis

239
Q

What 2 drugs can worsen MG?

A

Beta blockers
Antibiotics

240
Q

What is Lamber-Eaton syndrome associated with?

A

Small cell lung cancer

241
Q

Define Lamber-Eaton syndrome

A

Autoantibodies against presynaptic voltage gated calcium channels preventing the release of ACh

242
Q

What are the symptoms of Lamber-Eaton syndrome?

A

Very similar to MG but

Gets better with exercise and not associated with thymus
Symptoms start in extremities+ head and neck

243
Q

How is Lambert-Eaton syndrome treated?

A

Treat malignancy
Amifadiprine - potassium channel blocker
Acetylcholineesterase inhibitor- pyridostigmine
Consider IVIG and plasma exchange

244
Q

What are 2 causes of sciatica?

A

Spinal: IV Disc hernia
Non-spinal: piriformis syndrome

245
Q

What are the symptoms of sciatica?

A

Pain from buttock down lateral leg -> pinky toe
Weak plantar flex ion
Absent ankle jerk

246
Q

How is sciatica diagnosed?

A

Can’t straighten straight leg without pain
MRI

247
Q

Define syncope

A

Temporary loss of consciousness due to disrupted blood flow to the brain, often causing a fall

248
Q

What are the other terms for syncope?

A

Vasovagal episodes
Fainting

249
Q

Outline the pathophysiology of syncope

A

Strong stimulus in vagus nerve -> parasympathetic NS activated -> counteracts sympathetic NS -> brain blood vessel vasodilates -> cerebral circulation BP drops -> hypoperfusion of brain

250
Q

What are the symptoms of syncope?

A

Prodromal- before the attack: hot/clammy, light headed, dizzy, blurred vision
Sudde loss of consciousness and fall to ground
Unconscious until blood flow returns
May be twitching, shaking or convulsion

251
Q

What are 3 primary causes of syncope?

A

Missed meals
Dehydration
Extended standing in warm environment
In response to a stimuli eg. Blood

252
Q

What are 3 secondary causes of syncope?

A

Hypoglycaemia
Anaemia
Infection
Anaphylaxis
Arrhythmia
Cardiomyopathy

253
Q

How is syncope investigated?

A

Full history and exam
ECG- arrhythmia or long QT
Bloods- anaemia, electrolytes, blood glucose

254
Q

How is syncope treated?

A

Basically avoid causes
When experiencing Prodromal symptoms, sit or lie down

255
Q

What are 4 limb neuropathies/mononeuropathies?

A

Carpal tunnel syndrome
Wrist drop
Claw hand
Foot drop

256
Q

Define carpal tunnel syndrome

A

Pressure and compression on the median nerve as it passes through the carpal tunnel in the wrist

257
Q

What are the risk factors of carpal tunnel syndrome?

A

Female
Hypothyroidism
DM
Pregnancy
Obesity
RI
Acromegaly

258
Q

What are the symptoms of carpal tunnel syndrome?

A

Gradual onset of symptoms
Aching pain in hand
Tingling in thumb, index, middle, and 1/2 the ring finger and palm
Relieved by dangling hand over edge
May have sensory loss and thenar degradation

259
Q

How is carpal tunnel syndrome diagnosed?

A

Phalen’s test
Tinel’s test
Electromyography (EMG)

260
Q

What is Phalen’s test?

A

Patient can only maximally flex wrist for 1 minute without pain (back of palms against each other)

261
Q

What is Tinel’s test?

A

Tapping on nerve at wrist causes tingling

262
Q

How is carpal tunnel syndrome treated?

A

Wrist splint at night
Local steroid injection
Surgical decompression

263
Q

What muscles are supplied by the median nerve?

A

LOAF

2 lumbricals
Opponents pollicis
Abductor pollicis brevis
Flexor pollicis brevis

264
Q

What causes wrist drop?

A

Radial nerve palsy

265
Q

How is wrist drop treated?

A

Splint
Analgesia

266
Q

What causes claw hand?

A

Ulnar nerve palsy

267
Q

What causes foot drop?

A

Peroneal nerve compression

268
Q

What are 2 causes of foot drop?

A

Knee injury compression
Muscle or nerve disorders
Brain and spinal cord disorders
Bone lesions

269
Q

What are the symptoms of foot drop?

A

Foot dragging when lifting
Steeppage gait- one thigh raised higher than other
Numbness of top of foot and toes
Bi/unilateral

270
Q

How is foot drop diagnosed?

A

Clinical
Nerve conduction studies
X-ray, USS, CT, MRI

271
Q

How is foot drop treated?

A

Braces or split
Physical therapy
Nerve stimulation
Surgery

272
Q

Who is affected by giant cell arteritis?

A

~50 year old Caucasian women

273
Q

What are the symptoms of giant cell arteritis?

A

Unilateral tender scalp
Intermittent jaw claudication
Worse case = amaurosis fugax

274
Q

How is giant cell arteritis diagnosed?

A

Temporal artery biopsy
- Big part as skip lesions
Shows granulomatous non cesating inflammation of intima and media with skip lesions
Normocytic normochromic anaemia

275
Q

How is giant cell arteritis treated?

A

Corticosteroids - Prednisolone
Amaurosis fugax = IV methylprednisolone

276
Q

Define multiple sclerosis

A

Chronic autoimmune T cell mediated demyelination of the CNS

277
Q

What cells are affected by MS?

A

Oligodendroyctes

278
Q

Who is commonly affected by MS?

A

Females> males
20-40 years
White people

279
Q

What are the risk factors of MS?

A

Female
FHx
EBV
Low vitamin D
Genetics

280
Q

What gene increases the risk of MS?

281
Q

Outline the pathophysiology of MS

A

Molecular mimicry

Initial infection -> cell recognition -> after infection myelin recognised as antigen -> cytokine release and antibody formation

282
Q

What are the 3 types of MS?

A

Relapsing + remitting
Primary progressive
Secondary progressive

283
Q

What is the MC type of MS?

A

Relapsing + remitting

284
Q

Describe relapsing + remitting MS

A

Symptoms occur in attacks, then periods of good health/remission, then relapse again

285
Q

Describe primary progressive MS

A

Gradually worsening disability without relapse or remission

286
Q

Describe secondary progressive MS

A

Follows on from relapsing and remitting
Symptoms then gradually worsen

287
Q

How many patients with relapsing and remitting MS will develop secondary progressive MS?

A

75% within 35 years after onset

288
Q

What is Charcot’s neurological triad (MS)?

A

Scanning or staccato speech
Intention tremor
Nystagmus

289
Q

What are the optic symptoms of MS?

A

Unilateral optic neuritis -> loss of colour discrimination and eye can change colour
Inter nuclear opthalmoplegia (cant adduct right eye when looking to left)
Vision worse when hot

290
Q

What are the sensory symptoms of MS?

A

Uhtoff’s phenomenon (transient neurological dysfunction when temperature increased)
Lhermitte’s sign (electric shocks going down the cervical spine radiating down the limbs)

291
Q

What are the motor symptoms of MS?

A

Spasticity
Ataxia
UMN signs

292
Q

How is MS diagnosed?

A

MRI: lesions in the periventricular regions and discrete white matter abnormalities
CSF: oligoclonal bands of IgG and increased lymphocytes
Evoked potential test

292
Q

What criteria is used to diagnose MS?

A

McDonald’s criteria

293
Q

What is McDonald’s criteria for MS?

A

2 or more attacks at separate times and affecting different parts of the CNS

294
Q

How is MS treated acutely?

A

3 days IV methylprednisolone

295
Q

What is the prophylaxis for MS?

A

Beta interferons
Biologicals

296
Q

How is tremor in MS treated?

A

Clonazepam

297
Q

How is fatigue in MS treated?

298
Q

How is spacisity in MS treated?

299
Q

How is Incontenence in MS treated?

A

Anticholinergics
- Eg. Oxybutin

300
Q

Define Guillain Barre syndrome

A

Acute, inflammatory, autoimmune demyelinating polyneuropathy characterised by ascending weakness

301
Q

What is the MC acute polyneuropathy?

302
Q

What are the causes of GBS?

A

GI or upper respiratory tract infection

Campylobacter jejuni
CMV
Mycoplasma
Zoster
HIV
EBV

303
Q

Outline the pathophysiology of GBS

A

Molecular mimicry

Infection and response -> antigens similar to Schwann cells so -> autoimmune destruction of Schwann cells -> demyelination -> acute polyneuropathy

304
Q

What are the symptoms of GBS?

A

1-3 weeks post infection symmetrical ascending muscle weakness + paralysis
Loss of reflexes
Some have respiratory failure
Often reduced sensation

305
Q

What are 2 differential diagnoses of GBS?

A

Sarcoidosis
MG
Stroke
B12 deficiency
Lyme disease

306
Q

How is GBS diagnosed?

A

Nerve conduction tests + EMG
Lumbar puncture: raised protein and normal WCC
Anti GM1

307
Q

How is GBS treated?

A

IV immunoglobulin
Plasma exchange

308
Q

What should be monitored in GBS?

A

FVC to check for respiratory failure

309
Q

What is the leading cause of death in GBS?

310
Q

Define Parkinson’s

A

Degenerative movement disorder caused by dopamine neuron degeneration in the substantia niagra

311
Q

What is the Parkinson’s triad?

A

Rigidity
Bradykinesia
Resting tremor

312
Q

What are the risk factors of Parkinson’s?

A

Male
Increased age
FHx
Non-smoker!

313
Q

What are the causes of Parkinson’s?

A

Idiopathic
Drug induced
Environmental factors
Parkinson genes

314
Q

What are the features of a parkinsonian tremor?

A

Asymmetrical
Pill rolling of thumb
Exacerbated by rest

315
Q

What are the features of parkinsonian rigidity?

A

Cogwheel rigidity
Increased tone in limbs and trunk
Can cause pain and problems when turning in bed

316
Q

What are the features of gait in Parkinson’s?

A

Reduced asymmetrical arm swing
Narrow gait
Stooped posture and small steps
Shuffling and may drag feet

317
Q

What are the symptoms of Parkinson’s?

A

Parkinsonian triad
Onset is ALWAYS ASYMMETRICAL
Changes in gait
Smaller handwriting
Expressionless face
Loss of sense of smell

318
Q

Outline the pathophysiology of Parkinson’s

A

Dopamine depletion from substantia niagra due to Lewy body deposition -> decreased activity of direct pathway -> increased activity of indirect pathway -> thalamic inhibition

319
Q

How is Parkinson’s diagnosed?

A

Clinically mainly
Can confirm by response to levodopa

320
Q

How is Parkinson’s treated?

A

GS: levodopa + decarboxylase inhibitors
Dopamine agonist
MAO-B inhibitors
COMT inhibitors

321
Q

How does levodopa work?

A

Precursor to dopamine so can cross BBB so it can be converted to dopamine in brain and used

322
Q

How do decarboxylase inhibitors work?

A

Prevent peripheral conversion of L-dopa to dopamine so reduces peripheral side effects and maximise dose that crosses BBB

323
Q

What are 2 decarboxylase inhibitors?

A

Co-careldopa
Co- beneldopa

324
Q

What are the side effects of levodopa?

A

Postural HTN
Psychosis
Arrhythmia

325
Q

What is a dopamine agonist used to treat Parkinson’s?

A

pramipexole
ropinirole

326
Q

How do MAO-B inhibitors work?

A

Inhibit MAO-B enzymes that break down dopamine, causing a reduction in dopamine breakdown

327
Q

What are 2 MAO-B inhibitors?

A

Selegiline
Rasagiline

328
Q

What are the side effects of dopamine agonists?

A

Compulsive behaviour
Drowsiness
Hallucinating

329
Q

How do COMT inhibitors work?

A

Inhibits COMT which breaks down dopamine

330
Q

What are 2 COMT inhibitors?

A

Entacapone
Tolcapone

331
Q

What is Parkinson’s plus?

A

Parkinsonism + early autonomic clinical features

332
Q

What are 2 Parkinson plus syndromes?

A

Multiple system atrophy- postural HTN, incontenence
Lewy body dementia
Corticobasal degeneration- spontaneous rigidity
Progressive supranuclear palsy- vertical gaze palsy

333
Q

What are the complications of Parkinson’s?

A

Depression
Wearing off medication

334
Q

Define Huntingtons disease

A

Autosomal dominant neurodegenerative movement disorder characterised by lack of GABA

335
Q

Define chorea

A

Continuous flow of jerky, semi purposeful movements flitting from one part of the body to another

CEASES IN SLEEP

336
Q

What gene is mutated in Huntington’s?

A

CAG trinucleotide repeat disorder on chromosome 4 in HTT gene

337
Q

What can happen with trinucleotide repeat disorders?

A

Anticipation

Successive generations have more repeats causing earlier onset and increased severity

338
Q

What degenerates in Huntington’s?

A

Degeneration of caudate nucleus and putamen
- Lack of input nuclei
- Increased size of frontal lateral horns

339
Q

How many gene repeats of CAG will guarantee Huntington’s?

340
Q

What occurs in the brain in Huntington’s?

A

Cholinergic and GABAnergic neuron degeneration in basal ganglia

341
Q

How many repeats of CAG is normal?

342
Q

Outline the pathophysiology of Huntington’s chorea

A

Progressive cerebral atrophy -> loss of GABA-nergic and cholinergic neurons-> excessive thalamic stimulation -> chorea and excessive movements

343
Q

What are some non-Huntington’s causes of chorea?

A

Sydenham’s chorea (rheumatic fever)
Wilsons
SLE

344
Q

What are the symptoms of Huntington’s?

A

Prodromal phase of mild psychotic and behavioural symptoms
Chorea
Dysarthria (unclear speech)
Behaviour changes: agression, addiction, apathy, self neglect
Depression
Death within 15 years

345
Q

How is Huntingtons diagnosed?

A

Mainly clinical
Genetic testing shows >35 repeats
MRI shows caudate nucleus atrophy and increased size of frontal horns

346
Q

What is the young onset variant of Huntington’s?

A

Westphal variant

347
Q

How is Huntington’s treated?

A

Counselling- genetic, helping them prepare
Dopamine depleting agent for chorea

348
Q

What is a dopamine depleting agent and how does it work?

A

Tetrabenazine- irreversibly blocks VMAT

349
Q

Define dementia

A

Neurodegenerative condition characterised by a decrease in cognition (memory, judgement and language)

350
Q

What is the MC cause of dementia?

A

Alzheimer’s

351
Q

What dementia is MC in women?

A

Alzheimer’s

352
Q

What dementia is MC in men?

A

Vascular and mixed

353
Q

What are the risk factors of Alzheimer’s?

A

Increased age
Fhx
Downs syndome
Caucasian

354
Q

Outline the pathophysiology of Alzheimer’s

A

Beta amyloid plaques and tau protein tangles accumulate -> neuronal death, brain atrophy, decreased ACh

355
Q

What are the symptoms of Alzheimer’s?

A

4As

Amnesia (recent memories lost first)
Aphasia( speech muddled)
Agosia (recognition problems)
Apraxia (cant carry out tasks despite normal motor function)

356
Q

What gene mutation increases the risk of Alzheimer’s?

A

Apoprotein E allele E4

357
Q

How is Alzheimer’s treated?

A

Acetylcholinesterase inhibitors (donepezil/rivastigmine)
- stops breakdown of ACh
Memantine

358
Q

What is an example of a Acetylcholinesterase inhibitor?

A

Donepezil
Rivastigmine

359
Q

What causes frontotemporal dementia?

A

Pick inclusion bodies (silver aggregated Tau proteins) can be seen post mortem

360
Q

What are the features of frontptemporal dementia?

A

Younger onset (45-64)
Personality changes and social conduct problems (frontal)
Speech and language affected (temporal)

361
Q

What causes Lewy body dementia?

A

Alpha-synuclein aggregates form Lewy body deposition in neurons in the substantia niagra and cortex

362
Q

What is Lewy body dementia associated with?

A

Parkinson’s

363
Q

What are the symptoms of Lewy body dementia?

A

Visual hallucinations
Problems with REM sleep
Cognitive fluctuations
Prominent executive dysfunction
Parkinsonism

364
Q

What is Parkinsonian dementia?

A

Parkinson’s THEN Lewy body dementia

365
Q

How is Lewy body dementia treated?

A

Acetylcholinesterase inhibitors
Mematine

366
Q

How does vascular dementia progress?

367
Q

Define vascular dementia

A

Cognitive impairment caused by cerebovascular disease

368
Q

What are the risk factors of vascular dementia?

A

Stroke or TIA
Hypertension
DM
Smoking
Obesity
CHD

369
Q

What are the symptoms of vascular dementia?

A

Stepwise deterioration
Attention defects
Misplacing items
Forgetting past/current events

370
Q

How is dementia diagnosed?

A

MMSE (mini mental state examination)
Brain MRI shows cortical atrophy

370
Q

How is dementia prevented?

A

Stop smoking, good diet, exercise, low alcohol
Engage in >6 leisurely activities
Mental activity

371
Q

What MMSE is normal?

372
Q

What MMSE indicates severe imparement?

373
Q

What are the 2 categories of headache?

A

Primary- no underlying cause
Secondary- underlying cause of the headache

374
Q

What are 3 causes of secondary headache?

A

GCA
Meningitis
Medication overuse
Trauma
SAH
Infection

375
Q

What are 4 primary headaches?

A

Migraine
Cluster
Tension
Trigeminal neuralgia

376
Q

Define migraine

A

Recurrent throbbing headache often preceded by an aura and associated with N+V and vision changes

377
Q

Who is migraine MC in?

378
Q

What are the triggers of a migraine?

A

CHOCOLATE

Chocolate
Hangovers
Orgasms
Cheese
Oral contraceptives
Lie ins
Alcohol
Tumult/loud noise
Exercise

379
Q

What are the symptoms of a migraine?

A

Severe throbbing headache
Nausea, photophobia, phonophobia
May be preceded by aura
Can last 4-72 hours

380
Q

How is migraine diagnosed?

A

Usually clinical:

Aura
N+V OR photophobia and 2 of
Unilateral headache, worsened by daily activity, pulsating, moderate to severe pain, motion sensitivity
Exclude clinical causes (CT/MRI)

381
Q

How are migraines acutely treated?

A

NSAIDs + sumatriptan
Give anti emetic

382
Q

What is an example of an anti emetic?

A

Prochlorperazine

383
Q

How are migraines prevented?

A

Propanolol
Anti convulsant: topiramate

384
Q

When is topiramate CI?

A

Pregnancy
Reduces effects of oral contraceptives

385
Q

What are the MC chronic daily recurrent headache?

A

Tension headache

386
Q

What is the MC primary headache?

A

Tension headache

387
Q

What are the causes/triggers of tension headaches?

A

Stress
Sleep deprivation
Bad posture
Hunger
Eye strain
Noise

388
Q

What are the symptoms of tension headache?

A

Bilateral
“Band like” sensation around head
Non pulsatile
May have scalp muscle tenderness
Pressure behind eyes

389
Q

How are tension headaches treated?

A

Lifestyle changes
Stress relief: massage or acupuncture
Aspirin+ NSAIDs or paracetamol

390
Q

What is the headache that is MC in males?

A

Cluster headache

391
Q

What are the risk factors of cluster headaches?

A

Smoker
Male
Autosomal dominant gene

392
Q

What are the symptomss of cluster headache?

A

Abrupt onset and ALWAYS UNILATERAL ON THE SAME SIDE
Excruciating pain around ONE eye, temple, or forehead
Can have ptosis and bloodshot eye
Stuffy nose
Crescendo pattern

393
Q

How are cluster headaches treated acutely?

A

100% oxygen for 15 mins
SC sumatriptan

394
Q

How are cluster headaches prevented?

A

Verapamil (CCB)

395
Q

What are red flags in a headache?

A

Fever
Neoplasm history
Pregnancy
Sudden onset
Older onset
LOC
Papillodema
Worse by sitting/ standing

396
Q

Define motor neurone disease

A

Degenerative disease caused by loss of neurones from the motor cortex, anterior horn cells, and cranial nerve nuclei

397
Q

What are the risk factors of MND?

A

FHx
Smoking
Exposure to pesticides and heavy metal

398
Q

What are upper motor neurone signs?

A

More muscle tone/Spascisity
More/Brisk reflexes
Positive babinski sign
Toes point UP
Upper limb extensor <flexors
Lower limb flexor < extensor

399
Q

What are lower motor neurone signs?

A

Less muscle tone/ flaccid
Fasciculations (twitching)
Muscle wasting
Less reflexes
Visible spontaneous contraction of motor units
Toes point down
Negative babinski

400
Q

What is Babinski sign?

A

toes go UP when foot stroked

401
Q

What gene is linked to MND?

402
Q

What should mixed UMN and LMN signs indicate?

403
Q

How is MND distinguished from MG?

A

MND never affects eye movements

404
Q

How is MND distinguished from MS?

A

MND Never affects senses or sphincters

405
Q

What are the symptoms of MND?

A

Stumbling spastic gait
Foot drop
Weak grip
Shoulder abduction hard
Absence of sensory symptoms

406
Q

When does MND usually present?

A

> 40 years old but usually middle age

407
Q

How is MND diagnosed?

A

Mainly clinical
- definitive of LMN and UMN signs present in 3 regions
Nerve conduction studies
EMG

408
Q

What are the 4 types of MND?

A

Amyotrophic lateral sclerosis (ALS)
Progressive muscular atrophy (PMA)
Progressive bulbar palsy (PBP)
Primary lateral sclerosis (PLS)

409
Q

What is the MC MND?

410
Q

What occurs in ALS?

A

Loss of motor neurones in motor cortex

411
Q

What are the symptoms of ALS?

A

UMN+LMN signs
Painless progressive spastic paraplegics
Split hand sign- thumb adrift

412
Q

What are the symptoms of PMA?

A

LMN ONLY

Weakness, muscle wasting starting in one limb and spreading
Starts distally

413
Q

What is affected in PBP?

A

Lower cranial nerves (9+)

414
Q

What are the symptoms of PBP?

A

LMN ONLY

Tongue palsy
Trouble swallowing
Choking
Trouble chewing

415
Q

What causes PLS?

A

Loss of Betz cells in motor neurones

416
Q

What are the symptoms of PLS?

A

UMN ONLY

Spastic leg weakness
Progressive tetraparesis

417
Q

How is MND treated?

A

Riluzole
Analgesia
Palliative

418
Q

How does riluzole work?

A

Antiglutamatergic

Na+ channel blocker inhibits glutamate release

419
Q

Where are LMN located?

A

Anterior horns of spinal cord and in cranial nerve nuclei in brain stem

420
Q

Define peripheral neuropathy

A

Damages to peripheral nerves causing motor and sensory changes

421
Q

What are the causes of peripheral neuropathy?

A

ABCDE

Alcohol
B12 deficiency
Cancer and CKD
DM and drugs
Every vasculitis

422
Q

What are 2 mechanisms of peripheral neuropathy?

A

Axonal loss
Demyelination
Compression
Wallerian degeneration (nerve cut and dies distally)

423
Q

How does axonal loss in peripheral neuropathy present?

A

Sensory changes: numbness, burning, pins and needles
THEN
Motor symptoms

424
Q

How does demyelination present in peripheral neuropathy?

A

Motor changes then sensory

425
Q

How is peripheral neuropathy diagnosed?

A

Nerve conduction studies

426
Q

Define mononeuritis multiplex

A

Peripheral neuropathy affecting several individual nerves

427
Q

What are the causes of mononeuritis multiplex?

A

WARDS PLC

Werner’s
AIDS/ amyloidosis
RA
DMT2
Sarcoidosis
Polyarteritis nodosa
Leprosy
Carcinoma

428
Q

What causes Brown-Sequard syndome?

A

Hemisection of spinal cord

429
Q

What are the symptoms of Brown-Sequard syndome?

A

In relation to lesion

Ipsilateral hemiplegia
Ipsilateral loss of proprioception, motor and vibration
Contralateral loss of pain and temperature

430
Q

Describe why the symptoms of Brown-sequard syndrome occur

A

Ipsilateral loss of motor ect= corticospinal cord decussates at medulla
Contralateral loss= spinothalamic cord descussates in spinal tract

431
Q

Define Charcot-Marie Tooth syndrome

A

Inherited disease affecting motor + sensory nerve caused by a dysfunction in myelin OR axons

432
Q

What are the 2 types of Charcot-Marie Tooth syndrome?

A

Type 1: demyelinating (MC)
Type 2: axonal

433
Q

What gene is mutated in CMT?

A

Autodom mutation of PMP22 gene on chromosome 17

434
Q

What are the symptoms of CMT?

A

Firstly affects feet, then progresses to hands

Clumsiness
Weak ankles/ strained ankles
HIGH FOOT ARCH AND HAMMER TOES (pes cavus)
Foot drop
STORK LEGS

435
Q

How is CMT diagnosed?

A

Nerve conduction tests (reduced in type 1)
Genetic testing
Nerve biopsy

436
Q

How is CMT treated?

A

Physio
Exercise
Supportive

437
Q

What is Wernickes encephalopathy?

A

Reversible acute emergency of severe thiamine deficiency

438
Q

What is the MC cause of Wernickes encephalopathy?

A

Excess alcohol

439
Q

What are the symptoms of Wernickes encephalopathy?

A

Triad:

Ataxia
Confusion
Opthalmoplegia

440
Q

How is Wernickes encephalopathy diagnosed?

A

Clinical
Macrocytic anaemia
Deranged LFT

441
Q

How is Wernickes encephalopathy treated?

A

Parenteral pabrinex
Oral thiamine for prophylaxis

442
Q

What is the complication of Wernickes encephalopathy?

A

Korsakoff syndrome

Irreversible damage and increased memory loss

443
Q

Define Duchenne muscular dystrophy

A

X linked recessive mutated dystrophin gene

444
Q

What occurs in Duchenne muscular dystrophy?

A

Muscle replaced with adipose

445
Q

What are the symptoms of Duchenne muscular dystrophy?

A

Gower’s sign (cant get up from lying down)
Skeletal deformities
Wheelchair bound
Respiratory arrest by 20s :(

446
Q

How is Duchenne muscular dystrophy diagnosed?

A
  1. Creatine kinase
    Genetic testing
447
Q

Define tremor

A

Voluntary rhythmic oscillatory movement

448
Q

What are the features of an essential tremor?

A

Alcohol suppresses
Progressive
Quite fast

449
Q

What are the features of a dystonic tremor?

A

Task specific
Variable axis
Little finger hyperextended

450
Q

What are the features of a functional tremor?

A

Disttractabilty (improves when attention shifts)
Variability
Slow, effortful
Archimedes spiral

451
Q

Define dystonia

A

Agonist and antagonist muscle activated simultaneously causing twisting movements

452
Q

What are the features of dystonia

A

Better walking backwards
Spontaneous remission
Stress exacerbated

453
Q

Define chorea

A

Abnormal, abrupt, unpredictable involuntary movement

454
Q

Define myoclonus

A

Sudden, brief, involuntary jerk of movements

455
Q

Define tic

A

Brief movement or vocalisations that resemble voluntary actions

456
Q

How is Bell’s palsy differentiated from a stroke?

A

Bell’s palsy affects forehead

457
Q

Are primary or secondary brain tumours more common?

458
Q

What is the MC origin of a brain tumour?

A

Non small cell lung

459
Q

What is the MC primary brain tumour?

A

Astrocytoma

460
Q

What are 3 primary brain cancers?

A

Astrocytoma
Oligodendrocytoma
Meningioma

461
Q

How is Astrocytoma graded?

462
Q

What are the 4 categories of Astrocytoma?

A

I: pilocytic
II: diffuse astrocytoma
III: anaplastic astrocytoma
IV: glioblastoma multiforme (WORST)

463
Q

What are the symptoms of a primary brain tumour?

A

Increased ICP: headache, drowsiness, vomiting, PAPILLODEMA
Neuro defecit
Seizure (focal)
Lethargy/tiredness

464
Q

How are brain tumours diagnosed?

A

CT with contrast /MRI

465
Q

Should a lumbar puncture be done in brain tumours?

A

No

Can provoke coning (herniation through foramen magnum -> brain stem compression -> potential death)

466
Q

How are brain tumours treated?

A

Surgery
Chemo

467
Q

What haemmorage involves veins?

468
Q

What is the Mc cause of bacterial meningitis?

A

Streptococcus pneumoniae

469
Q

What haemmorage does not cross sutures?

Phase 2a Annabel (12 decks)

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