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Its the final countdown > Neurology > Flashcards

Neurology Flashcards

1
Q

Patient with sensory loss in little finger and lateral half of ring finger.
weakness bending fingers, but can raise thumb vertically with good resistance
reflees preserved

which nerve was injured?

A

Ulnar nerve
supplies
* sensation to little finger and medial half of ring finger
* most flexor muscles in the hand ( not the thumb)

( sensory nerve distributionL RUM

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2
Q

neuropathic pain management
1st line
rescue therapy in exacerbations
topical management
non-medical option

A

1ST Line: amitriptyline, duloxetine, gabapentin, pregabalin
* neupathic pain analgesis are montherapy - if one doesnt work, swith to another ( no compounding)

rescue therapy - tramadol

localised - topoical capsaicin ( e.g. post-herpetic neuralgia)

non0medical - pain clinic

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3
Q

defective downward gaze and vertical diplopia is caused by danmage to what nerve

A

ipsilateral CN IV ( trochlear)

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4
Q

Pt with double vision, worse going down stairs. On inspection, the left eye is deviated laterally. What CN is the cause

A

L trochlear
Palsy – defective downward gaze & vertical diplopia

LR6SO4 , rest of mvmts are occulomotor

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5
Q

abducens nerve oalsy

A

ipsilateral medially deviated eye

LR6SO4

lateral rectus function lost –> cannot pul laterally –> mediallyu deviated eye

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5
Q

appearance of CNIII palsy

A

isposilateral down and out

LR6SO4, everything else uis occuulomotor

so LR6 functions ( out) and SO4 functions (down)

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5
Q

define
- TIA
- crescendo TIA

A

TIA - transient neurological dysfunction secondary to ischaemia without infarction
crescendo TIA - >=2TIAs in a week ( high stroke risk)

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5
Q

stroke management
- where to admit
- what dDx to exclude
- Ix
- Rx

A
  • stroke centre
    exclude hypoglycaemioa
  • CT brain 9 exclude intracerebral haemorrhage)
    Aspririn 300mg stat (post CT), 14 days
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6
Q

most common type of stroke

A

ischaemic ( 85%)

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6
Q

A patient with generalised headache, fluctuating GCS and history of alcohol abuse. What type of stroke are they likely to have had and how would this appear on a CT

A

subdural haemorrhage ( bridging veins )

star shaped - SAH
crescent shape - bridging veins subdural
lemon shape - epidural (EGGsrradural - extradural)

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7
Q

Medical thrombectomy in ischaemia is performed using
(med)
(mechanism o action)
(window of opportunity)

A

alteplase
tissue plasminogen activator (rapid clot breakdown)
within 4.5 hrs of storke onset

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8
Q

3 featyures of TIA managment

A

300mg Aspirin daily
2ndary CVD prevention (statins)
24hr referral to stroke specialist

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9
Q

ischaemic stroke doses and durations
Aspirin
clopidogrel ( alternative)
Atorvastatin

A

Aspirin 300mg 14 days
clopidogrel 75mg OD / Dipyridamole 200mg BD)
Atorvastatin 80mg

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10
Q

sections of the “eye” section of GCS

A

spontaneous opening = 4
speech = 3
Pain = 2
None=1

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10
Q

what are the 3 sections of the GCS and the points for each

A

eyes = 4
voice response = 5
Motor response = 6

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10
Q

sections of the “verbal” section of GCS

A

oriented = 5
confused conversation - 4
innappropiate words =3
incomprehensible = 2
none = 1

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11
Q

sections of the “motor response “ section of GCS

A

obeys commands = 6
localises pain - 5
normal flexion - 4
abnormal flexion - 3
extension - 2
none- 1

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12
Q

two groups of people in which subdurals are more common

A

elderly
alcoholics

brain atrophy - increased likelihood of bridging veins tearing

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13
Q

30 yo man collapses when playing rugby. He is taken to the stroke unit with unilateral weakness and headache. The CT shows a lemon shaped bleed, which does not cross the sutures, what artery is most likely to have been ruptured

A

middle meningeal

this is an extradural haemorrhage (EGGstradural)
- associated w/ temporal bone fracture
-CT - biconvex shape, limpited by the cranial sutures
-Typical pt: young pt, traumatic head injury & ongoing headache. Has a period of improved neurological Sx followed by rapid decline over hrs ( bleed begins to compress)

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14
Q

where dose subarachnoid bleeds occur

A

bleed into subarachnoid space - where cerebrospinal fluid is located

most commonly ruptured brain aneurysm

typical presentation
- sudden onset OCCIPITAL headache
- during strenuous activity ( sex/weight lifting

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15
Q

2 key risks associated with SAH

A

cocaine
sickle cell anaemia

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16
Q

5 features of “thunderclap headache” in SAH

A
  1. occipital headache
  2. Neck stiffness
  3. Photophobia
  4. Vision changes
    ???meningitis???
  5. Neuro Sx (speech, weakness, seizure, LOC)
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17
Q

A pt is brought to the stroke specialist unit with a suspected SAH (sudden extreme occipital pain, meningism and weakness). The 1st line Ix is conducted but is negative. what other test should be used, give the 2 findings suggesgting SAH

A

1st lien - CT

2nd - CSF
- RCC raised
- Xanthochromia (yellow due to bilirubin)

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18
Q

SAH Mx

A

MDT supportive Mx
reduced conciousness - intubate & ventilate

surgical intervention (coiling/clipping) - Tx aneurysm

Nimodipine - CCP, prevents vasospasm ( which causes ischaemia)

hydrocephalus - LP/shunt

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19
Q

are parkinsons symptoms typically symmetrical or assymetrical

A

assymetricalp

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20
Q

parkinsons triad

A
  • resting tremor “pillrolling tremor - 4-6Hz,slow)
  • rigidity
  • bradykinesia
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21
Q

5 signs of parksinons ( not in the triad

A

facial masking
stooped posture
forward tilt
reduced arm swing
shuffling gait

( triad - bradykinesia, resting tremor, rigidity)

others: depression, sleep disturbance, anosmia ( smell), cognitive impairmenr/ memory problesm

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22
Q

Parkinsons vs bening essential tremor

asymmetrical
5-8hz
improves at rest
improves with intentional movement
improves with alcohol
no other parkinsons features

A

asymmetrical - Par
5-8hz - BET (Par=4-5)
improves at rest BET
improves with intentional movement Par
improves with alcohol (BET (Par - no change)
no other parkinson’s features (BET)

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23
Q

name 4 parkinsons plus syndromes

A

multiple system atrophy
dementia with lewy bodies
progressive supranuclear palsy
corticobasal degeneration

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24
Q

desrribe Sx of multiple system atrophy

A

mulitple areas of brain degenerate

parkinsonism - basal ganlglia affected

autonomic dysfunction ( postural hypotension, constipation, abnormal sweatign, sexual dysfunction )

Ataxia - cerebellar dysfunction

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25
Q

1st line parkinson tx
- if motor Sx affecting QOL
- if motor Sx NOT affecting QOL

A

motor Sx - Levodopa
dopamine replacement, often given w/ peripheral decarboxylase inhibitor ( stop L-dopa breakdown) :
Co-benyldopa (benserazide), Co-careldopa (carbidopa)

no-motor Sx - dopamine agonist/ L-dopa/ MAO-B inhibitor - selegiline/rasageline)

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26
Q

L-dopa’s effect decreases over time, so is reserved for when other medications are not helping.

excess dosing of L-dopa leads to

A

dyskinesas

Dystonia(excess muscle contraction –> abnormal postures / exaggerated Mvmt)
Chorea (involuntary jerking …huntingtons choriea)
athetosis ( involuntary twistign/writhing movments in hands/feet)

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27
Q

presentation of anterior cerebral artery stroke

A

contralateral hemiparesis & sensory loss

worse in lower extremity

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28
Q

stoke in middle cerebral artery

A

contralateral hemiparesis & sensory loss
upper>lower extremity

contralateral homonymous hemianopia

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29
Q

Posterior cerebral artery

A

contralateral homonymous hemianopia with macular sparing (central vision remains)

visual agnosia impairment in recognition of visually presented objects.

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30
Q

An 88-year-old woman is having difficulty recognising objects around the house.

On examination, when asked to point to a pen, she selects a newspaper and she cannot give the correct name for any of the items in the room.

She can recognise familiar faces, there is no weakness, aphasia or unsteadiness.

She has homonymous hemianopia with preservation of the central visual fields.

What cerebral vessel is most likely to have been occluded to cause these symptoms?

A

Posterior cerebelar artery - homonymous hemianopia w/ macular sparing & visual agnosia).

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31
Q

Webers syndrome ( branches of PCA supplying midbrain)

A

ipsilateral CNIII palsy
contalateral weekness of upper & lower extremities

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32
Q

Posterior inferiror cerebella artery ( Wllenberg/lateral medullary syndrom)

A

ipsilateral facial pain & temperature loss
contralateral: limb/torso pain & temp loss
Ataxia , nystagmus

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33
Q

Anteriori inferior cerebellar arteriy ( lateral pontine syndrome)

A

ipsilateral facial pain & temperature loss
ipsilateral facial paralysis and deafness
contralateral: limb/torso pain & temp loss
Ataxia , nystagmus

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34
Q

retinal/ ophthalmic arteriy

A

amaurosis fugax

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34
Q

basilar artery

A

locked-in syndrome

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35
Q

lacunar stroke

A

hemiparesis, hemisensory loss, hemiparesis with limb ataxia

ass. w/ HTN

common sites: basal ganglia, thalamus, internal capsule

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36
Q

describe visual field and sight of lesion: total blindness to one eye

A

cause: ipsilateral lesion of optic nerve (pre-chiasm: optic nerves –> chiasm –> tract –> lateral geniculate body –> optic radiations)

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37
Q

describe visual field and sight of lesion: bipolar hemianopia

A

tunnel vision ( bilateral lateral loss of vision)

cause midline chiasm lesion ( so outer parts of the chiasm preserved, so partial eyesight)

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38
Q

Nasal hemianopia

A

lesion of ipsilateral perichiasmal area

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39
Q

describe visual field and sight of lesion: homonymous hemianopia

A

bilateral vision loss on same half of visual field ( e.g. both eyes lose left vision in left homonymous hemianopaia)

cause: lesion/ pression in contralateral optic tract
OR
lesion in contralateral occipital lobe ( all optic radiations damaged)

optic nerve –> optic chiasm –> optic tract –> lateral geniculate body –> optic radiations

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40
Q

describe visual field and sight of lesion: homonymous inferior quadrantinopia

A

bottom quadrant visual field loss bilaterally of same side ) e.g. both left homonymous inferior quadrantanopia)

contalateral, lower optic radiations lesion

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41
Q

describe visual field and sight of lesion: homonymous superior quadrantanopia

A

same quadrant vison loss bilaterally

cause: lesion of contralateral upper optic radiations

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42
Q

at what vertebral level does the spinal cord terminate

A

L2/3

. The nerve roots exit either side of the spinal column at their vertebral level (L3, L4, L5, S1, S2, S3, S4, S5 and Co).

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43
Q

what 3 functions does the cauda equina supply

A

sensation: lower limbs, perineum, bladder, rectum

motor: lower limbs, anal sphincter, urethral sphincter

Parasympathetic: bladder, rectum

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44
Q

what is the most common cause of caude equina syndrome

A

herniated disc

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45
Q

give 5 causes of cauda equina syndrome

A
  • Herniated disc (the most common cause)
  • Tumours, particularly metastasis
  • Spondylolisthesis (anterior displacement of a vertebra out of line with the one below)
  • Abscess (infection)
  • Trauma
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46
Q

give 3 red flag Sx of cauda equina

A
  • Bilateral sciatica
  • Bilateral or severe motor weakness in the legs
  • Reduced anal tone on PR examination

( * Saddle anaesthesia (loss of sensation in the perineum – around the genitals and anus)
* Loss of sensation in the bladder and rectum (not knowing when they are full)
* Urinary retention or incontinence
* Faecal incontinence
)

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47
Q

what are the features of incomplete CES ( cauda equina syndrome)

A

pts complain about urinary Sx - altered urinary sensation, loss of desire to void, hesitancy, urgency

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48
Q

what are the features complete cauda equina syndrome

A

definitive urinary retention with associated overflow incontinence

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49
Q

what is the Mx in CES

A

NEURO EMERGENCY

  • Immediate Adx
  • Emergency MRI
  • Neurosurgical input to consider lumbar decompression surgery
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50
Q

where does metastatic spinal cord compression occur

A

L1/2 ( occlusion of end of spinal cord, not cauda equina)

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51
Q

CES & MSCC ( metastatic cord compression) have similar symptoms,

A
  • back pain*
    worse on
  • straining: cough/ sneezing/bowel movement.
  • lying down

Claudication ( muscle pain/cramp on walking or exercising)

Cauda equina - LMN signs (reduced tone and reduced reflexes). As nerves LMN; have already exited the spinal cord.

SCC: compression higher up –> UMN signs (increased tone, brisk reflexes and upping plantar responses) will be seen.

52
Q

Tx for MSCC

A

high-dose oral dex ( immediately, even before imaging)
* Analgesia
* Surgery, Radiotherapy, Chemotherapy

53
Q

what Ix is appropriate in MSCC

A

Whole spine MRI <24hrs

54
Q
A
55
Q

Neisseria meningitidis is a cause of bacterial meningitis, what type of bacteria is N.meningitis

A

G-ve Diplococci

56
Q

what is the 1st line test used to screen for HIV in ASx or Sx pts

A

HIV antibody and HIV antigen

HIV antibody - HIV1/2 differentiation assay, ab devlop 4-6wks later in most (the rest by 3 months)

57
Q

what viruses most commonly causeviral meningitis

A

enteroviruses (e.g. coxsackie)
Herpes simplex virus (HSV)
Varicella zoster virus (VZV)

58
Q

what are the two special tests in examining form meningitis

A

Kernigs test (straigtening the Knee w/hip flex –> spinal pain/ ressitance to mvmt)

Brudzinkis test (Bending neck (flex chin to chest) –> involuntary flexing of hips and knees)

59
Q

characteristics of CSF in bacterial meningitis

appearance
Glucose
Protein
WCC

A

appearance - cloudy
Glucose - low ,1/2 plasma
Protein high >1g/l
WCC 10-5,ooo polymorphs/mm3

60
Q

characteristics of CSF in viral meningitis

appearance
Glucose
Protein
WCC

A

appearance - clear/ cloudy
Glucose 60-80% plasma glucose (slightly reduced)
Protein - normal/raised
WCC - 15-1000 lymphocytes/mm3

61
Q

characteristics of CSF in tuberculus meningitis

appearance
Glucose
Protein
WCC

A

appearance - slightly cloudy, fibrin web
Glucose low <1/2plasma ( TB - bactaeria, so glucose same as with bacteria)
Protein high >1g/l)
WCC 30-300 lymphocytes/mm3

62
Q

characteristics of CSF in fungal meningitis

appearance
Glucose
Protein
WCC

A

appearance: cloudy
Glucose low
Protein high
WCC 20-200 lymphocytes

fungal = cryptococcal meningitis

63
Q

what medication should be added to tx in suspected viral meningitis

A

aciclovir

64
Q

what medication should be added to in meningitis tx iif penicillin resisstant pneumococcal infection is suspected

A

vncomycin

penecillin resistant - e.g. Hx foreign travel/ prolonged Abx exposure

65
Q

what is used in bacterial menignitis mx to prevent neurological/ hearing complications

A

steroids - e.g. dex

66
Q

what MSK condition is temporal arteritis associated with?

A

polymyalgia rheumatica

67
Q

what irreversible condition is associated with GCA

A

vision loss

68
Q

what visual Sx are found in GCA

A

blurred/double vision
loss of vision

  • Scalp tenderness (e.g., noticed when brushing the hair)
  • Jaw claudication
  • Blurred or double vision
  • Loss of vision if untreated
    temporal artery: tender, thickened, w/ reduced/absent pulsation
69
Q

GCA can be diagnosed clinically. but also w/ inflammatory markers, biopsy or Duplex US. what finding in a temporal artery biopsy indicates temporal arteritis?

A

multinucleated giant cells

70
Q

GCA can be diagnosed clinically. but also w/ inflammatory markers, biopsy or Duplex US. what finding in a Duplex US indicates temporal arteritis?

A

hypoechoic “halo” sign

stenosis of temporal artery

71
Q

Mx of GCA involves immediate steroids ( before confirming dx ) .

what is the med & dose in

GCA w/o visual Sx/jaw claudication

GCA w/ visual Sx/ jaw claudication

A

w/o visual/jaw Sx: 40-60 prednisolone daily

w/ visual/jaw Sx: 500mg-1000mg methylpred daily

72
Q

what non-steroidal meds are used in GCA Mx

A

Aspirin 75 mg daily - reduces vision loss/strokes

PPI - gastroprotecion due to steroids

Bisphosphonates & AdCal due to steroids

73
Q

a pt w/ suspected GCA is started on 60mg prednisolone and biopsy is conducted. however this returns normal, what is the most appropriate next step

A

carry on prednisolone, retake biopsy in 7-14 days

there may be skip lesions, hence the biopsy will be normal instead of showing multinucleated giant cells

74
Q

what is the most likely cause of encephalitis

A

HSV-1 ( 95%)

temporal & inferior frontal lobes)

75
Q

what Ix are appropriate in ?encephalitis

A

CSF (lymphocytes, raised protein, –> PCR for HSV, VZV, enteroviruses)
neuroimaging - medial temporal & inferior frontal changes ( e.g. petechial haemorrhage) , normal in 1/3 of pts
EEG 0 lateralised periodic discharges at 2Hz

76
Q

Mx encephalitis

A

IV aciclovir

77
Q

biconvex (or lentiform) mass on CT scan indicates what type of haemorrhage

A

extradural

( biconvEXtradural) - limited by suture lines

subdural- bridging veins

78
Q

injury of what artery results in extradural haemorrhage

A

middle meningeal

79
Q

in which type of haemorrhage in bleeding limited by suture lines

A

extradural

80
Q

occlusion of what artery causes Amaurosis fugax

A

retinal/ophthalmic artery

internal carotid artery > ophthalmic artery > central retinal artery

81
Q

A 72-yo man presents to the ED with new-onset left-sided weakness. He is orientated. On examination, the patient has reduced L arm and leg power, and a left facial droop.
Ophthalmic examination identifies left homonymous hemianopia. what type of stroke is this?

A

Partial anterior circulation infarct

PACs

2/3
- unilateral hemiparesis +/-hemisensory loss in face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction ( e.g. dysphasia)

82
Q

features of pseudo seizures ( psychogenic non-epileptic seizure)

A
  • pelvic thrusting
  • family member with epilepsy
  • females
  • crying after seizure
  • don’t occur when alone
  • gradual onset
83
Q

what blood test can differentiate true seizures from psuedoseizures

A

prolactin - raised in true seizures

84
Q

what age group of women and of men are affected by myasthenia gravis

A

women <40

men >60

e.g. A 35-yo woman presents to her GP with increasing fatigue, SOB and feeling increasingly tired with increasing weakness in her neck and limbs.

85
Q

A 35-yo woman presents to her GP with increasing fatigue, SOB and feeling increasingly tired with increasing weakness in her neck and limbs.
PMHx: pernicious anaemia
DHx: oral cyanocobalamin ( for anaemia)

Examination: ptosis of her right eye.

most appropriate Ix?

A

Acetylecholine receptor antibody test

86
Q

tumours in which gland are strongly linked to myasthenia gravis

A

thymus

20-40% of pts with thymoma develop myasthenia gravis

87
Q

name 2 antibodies associated with myasthenia gravis

A

MuSK - muscle specific kinase
LRP4 - low-density lipoprotein receptor related protein 4

Myasthenia gravis
-receptor antibodies block recepts, preventing movement
- receptors cause complement system –> damage at post synaptic memebrane

88
Q

features of myasthenia gravis

A

summarised: muscle weakness ( proximal muscle / small muscles of head and neck) , worsens with mvmt, improves with rest

diplopia - extraocular muscle weakness
ptosis - eyelid weakness causes drooping
weakness in facial mvmts
weak swallow
jaw fatigue when chewing
slurred speach
progressive weakness w/ repetitive mvmts

89
Q

what examinations can be used to elicit muscle fatiguability in myasthenia gravis

A

repeated blinking –> ptosis
prolonged upward gazine –> diplopia
abduction of 1 arm 20 times –> unilateral weakness

?thymectomy scar

90
Q

tests for Dx myasthenia gravis
- antibodies
- imaging
- test where there is doubt about Dx

A

ab: ACh-R (85%), MuSK (10%) LRP4 (<5%)
imaging: CT /MRI for thymoma
edrophonium test: IV edrophonium chloride ( neostigmine) blocks ACh-esterase enzymes, increases ACh, so temporarily relieving weakness

91
Q

Tx options in Myasthenia gravis

A

Pyridostigmine/ neostigmine ( reversible ACh-esterase inhibitors)
Prednisolone/ azathioprine - immunosuppressants, prevent antibody production
thymectomy ( Sx relief even w/o thymoma)

MAb: rituximab

92
Q

what is a common trigger of myasthenic crisis

A

another illness - eg resp. tract infection

causes resp failure ( due to muscle weakness)

93
Q

Mx in myastbhenic crises

A

muscle weakness - BiPAP/ full intubation & ventilation

medical ( immunomodulatory therapies : IV immunoglobulins, plasma exchange)

94
Q

which medication is used for headache prophylaxis in cluster headaches

sumatriptan, verapamil or propanolol

A

verapamil

95
Q

acute tx in cluster headache

A

sumatriptan and high flow O2

( verapamil is prevention)

96
Q

what medication is used as migraine prophylaxis

A

propanolol

97
Q

what eye sign on fundoscopy indicates raised ICP in pt with headach

A

Papilloedema

98
Q

triggers for tension headaches ( x5)

A

stress
depression
alcohol
skipping meals
dehydration

(mild headache, band like pattern, gradual appearance and resolution, no visual changes )

99
Q

Tx in tension headach e

A

conservative: reassure, relaxation techniques, hot towels
basic analgesia

100
Q

Mx of sinusitis

A

resolves in 2-3wks
mostly viral

medical
nasal irrigation
steroid nasal spray -prolonged Sx

may need abx

101
Q

Mx in hormonal headache

A

hormonal headache : tension-like headache due to oestrogen, occur2-3days pre menstruation, perimenopause, early pregnancy ( late pregnancy = ? preeclampsia)

Mx OCP

102
Q

1st ine mx in trigeminal neuralgia

A

carbamazepine

surgery - decompress/ damage nerve

103
Q

features of cluster headache

A

severe, unilateral headache, (around the eye)
clusters: 3-4/day for weeks/months, the 1-2yrs w/o
duration 15 mins- 3hrs
red, swollen, watery eye, miosis, ptosis, nasal discharge, ipsilateral hyperhidrosis

104
Q

Medications (x3) for cluster headache prophylaxis

A

verapamil

lithium
prednisolone ( short course)

105
Q

what are the 4 types of migraines

A
  • Migraine without aura
  • Migraine with aura
  • Silent migraine (migraine with aura but without a headache)
  • Hemiplegic migraine
106
Q

typical features of a migraine

A

unilateral
pounding/throbbing
headache
photophobia
phonophobia

107
Q

acute management of migraines

A

paracetamol
triptans ( sumatriptan 50mg as migraine starts - serotonin receptor agonist (5HT receptors))
NSAIDs (ibuprofen/naproxen)

antiemetics in vomiting - metoclopramide

108
Q

medication for migraine prophylaxis

A

propanolol
topiramate ( teratogenic)
amitriptyline

109
Q

presentation of CNIV palsy

A

Presentation – eye upwards ( as SO depresses eye)
There will also be a compensatory head tilt
Struggling to go down the stairs * cant see the floor with cranial nerve 4*

110
Q

in addition to thymomas, myasthenia gravis is associated to which conditions?

A

autoimmune disorders: pernicious anaemia, autoimmune thyroid disorders, rheumatoid, SLE

thymic hyperplasia in 50-70%

111
Q

what antibodies are associated with LEMS

A

Voltage-gated calcium channel (VGCC) antibodies

LEMS - opposite of Myasthenia as the weakness imprioves with movement

it is ass. w/ malignancies - esp SCLC

112
Q

what is the antiplatelet regimen in an ischaemic stroke

A

Aspirin 300mg daily 2weeks
clopidogrel 75mg daily long-term
also offer statin if pt is not already on one

113
Q

in medication overuse headaches, the analgesics should be stopped
what is the advice in
simple analgesia
triptans
opioids

A

simple analgesia - stop immediately
triptans - stop immediately
opioids -wean down

114
Q

what risk is increased by giving pts with history of migraine with aura COCP

A

ischaemic stroke risk is greatly increased

115
Q

automatism (smacking lips) and staring o into the space without being aware of what is happening is found in what epileptic seizure

A

focal impaired awareness seizure

differs from absence seizures which are in children, w/o automatisms

116
Q

what seizure is characterised by a sudden loss of muscle tone, limp limbs and loss of consciousness?

A

generalised atonic seizure

117
Q

which seizure is characterised by jerking movements, brief duration ( <1 minute), typically without loss of awareness?

A

myoclonic

118
Q

a 74-year-old presents to his general practitioner after experiencing a number of episodes of light headedness, occuring when he stands up from a sitting or lying down.
PMHx - includes Parkinson’s disease for DHx - levodopa

Exam: BP 130/80mmHg (lying), HR 60/min, RR 14/min and afebrile.
After 3 minutes standing - BP: 100/70mmHg (standing), respiratory rate 14/min, and heart rate 62/min with no compensatory tachycardia. On auscultation of the chest, heart sounds are dual with no murmur, and the lungs are clear.

Which is the most likely cause of hispostural hypotension?

A

Parkinson’s disease - causes hypotension due to autonomic failure

119
Q

A woman presents with altered sensation in her left eye following an RTA. .

Exam: patient’s pupils are equal and reactive to light.
No visual field defects
Visual acuity is 6/6 with contact lenses. Gentle application of cotton wool to the right globe elicits blinking and tearing, while the application to the left globe elicits no response.

In what nerve is the cranial lesion?

A

CN V1 - ophthalmic branch of trigeminal
causes loss of corneal reflex

CNV - facial sensation and mastication
Lesions may cause:
trigeminal neuralgia
loss of corneal reflex (afferent)
loss of facial sensation
paralysis of mastication muscles
deviation of jaw to weak side

120
Q

A patient presenting with mixed UMN & LMN Sx & fasciculations with few/no sensory signs suggests what condition?

A

motor neurone disease

121
Q

A patient presenting with mixed UMN & LMN Sx & fasciculations with few/no sensory signs. and asymmetric limb weakness suggests what condition?

A

Amyotropic lateral sclerosis
subset of MND
LMN Sx in arms & UMN Sx in legs

122
Q

what are the 3 main types of MND

A

amyotrophic lateral sclerosis (ALS) - most common

progressives bulbar palsy - 2nd most common; muscles of talking & swallowing

progressive muscular atrophy , primary lateral sclerosis

123
Q

what areas of the body are generally unaffected in MND

A

external ocular muscles
cerebellum
abdo reflexes & sphincter ( until later)

124
Q

describe MND

A

progressive, fatal condition where upper and lower motor neurones stop functioning - no sensory involvement

125
Q

Mx in MND

A

non e

Riluzole - slows progression by some months in ALS

NIV - non-invasive ventilation when resp muscles affected

126
Q

apart from the hands, benign essential tremor is present in …

A

head tremor, jaw tremor and vocal tremor

( affects voluntary muscles)

127
Q

features of essential tremor

A
  • Fine tremor
  • Symmetrical
  • More prominent on voluntary movement
  • Worse when tired, stressed or after caffeine
  • Improved by alcohol
  • Absent during sleep
128
Q

what is the hereditary pattern of benign essential tremor?

A

autosomal dominant

129
Q

Mx in benign essential tremor

A

none

purely symptomatic
- propranolol ( selective B-blocker)
- Primidone ( barbituate anti-epileptic medication)

130
Q

how would damage to the ulnar nerve present?

A

hypothenar muscle wasting
loss of thumb adduction
wasting of 1st web space
ulnar claw hand ( hyperextension @ metacarpophalangeal joint, flexion at interphalangeal joint)

131
Q

how would radial nerve palsy present

A

wrist drop
loss of sensation in 1st dorsal web space

132
Q

how would musculocutaneous nerve plsy present

A

reduced flexion at elbows & loss of supination

133
Q

how would a median nerve compression present

A

carpal tunnel syndrome

nerve innervates thenar muscles & sensory innervation to lateral 3 & half digits

134
Q

how would an axillary nerve palys present

A

wastage of deltoid muscles
loss of sensation from the badge area

135
Q

a pt presents with a Hx of AF presents with left-sided ptosis, miosis and ataxia. There is a loss of pain sensations in the right limbs and trunk and the left side of the face.

BM and Sats are normal, a non-contrast CT head is ordered.

Where is the site of the pathology causing this presentation?

A

left posterior inferior cerebellar artery

this is Wallenberg’s (lateral medullary syndrome)

which presents as:
- ipsilateral horner’s
- ipsilateral facial numbness
- contralateral body numbness

136
Q
A

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