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TAS > Neurology > Flashcards

Neurology Flashcards

1
Q

What is a tonic-clonic seizure

A

Generalised tonic contractions followed by clonic contractions
Begins with tonic contractions of all four limbs

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2
Q

Ketogenic diet

A

high fat
low fat
controlled high proteins

Used for epilepsy that is resistent to usual AED

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3
Q

Generlised tonic clonic management

A

1st line - Sodium valproate
2nd line - Lamotrigine

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4
Q

Sodium valproate side effects

A

Nausea
Vomiting
Abdominal pain
Liver function abnormalities

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5
Q

Oxcarbazine side effects

A

Sedation
Rash

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6
Q

Lamotrigine side effect

A

Rash

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7
Q

Carbmazepine side effect

A

Ataxia
Sedation
Leukopenia
Thrombocytopenia
Rash

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8
Q

Typical Absence and atypical absence treatment

A

1st line - Ethosuximide
2nd line - sodium valproate

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9
Q

Ethosuximide side effect

A

GI disturbance
Rash

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10
Q

Myoclonic seizures treatment

A

1st line - sodium valproate
Adjunctive - keppra or topiramate

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11
Q

Carbamazepine affect on myoclonic seizure?

A

Worsens it

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12
Q

Tonic or atonic seizure treatment

A

1st line - sodium valproate
2nd line - lamotrigine
Adjunctive - rufinamide or topiramate

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13
Q

Topiramate side effect

A

Sedation
weight loss
Paraesthesia

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14
Q

What is required for seizures

A

-Population of pathologically excitable neurones
- Increase in excitatory glutamatinergic activity through recurrent connections to spread discharge
- Reduction in normal activity of inhibitory gama-aminobutyric acid-ergic projections

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15
Q

Functions of CSF

A
  • Protect brain from impact
  • Remove waste and toxins
  • Help regulates intracerebral blood pressure
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16
Q

Where is CSF produced?

A

Produce in choroid plexus by ependymal cells

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17
Q

Route of CSF

A

Choroid plexus in lateral ventricles
Foreman of munro
Third ventricle
Aqueduct of sylvius
Fourth ventricle
Spinal cord and cerebral hemispheres

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18
Q

What reabsorbs CSF

A

Arachnoid villi

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19
Q

What is Communicating hydrocephalus

A

No obstruction between ventricles and subarachnoid space

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20
Q

Causes of communicating hydrocephalus

A

Increase excretion of CSF - choroid plexus tumour
Failure to reabsorb it - blockage of arachnid granulations by debris after meningitis or haemorrhage

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21
Q

What is non-communicating hydrocephalus

A

Physical obstruction between ventricles and subarachnoid space

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22
Q

Causes of non-communicating hydrocephalus

A

Congenital malformation - aqueduct estenosis, Arnold -Chiari malformation
Acquired obstruction - brain tumour

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23
Q

CSF results in bacterial meningitis

A

wBC 100 -10,000
Lymphocytes <100
Protein >1
Glucose <0.4

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24
Q

CSF in viral meningitis

A

WBC <100
Lympocytes 0 10 - 1000
Protein 0.4 - 1
Glucose - normal

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25
Q

TB meningitis

A

WBC <100
Lympocytes 50 - 1000
protein - 1-5
glucose <0.3

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26
Q

What nerve is affected In Bell’s palsy

A

7th cranial nerve

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27
Q

7th cranial nerve branches

A

temporal branch
zygomatic branch
buccal branch
marginal mandibular branch
cervical branch

Sensory branch - anterior 2/3 of tongue

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28
Q

What pharyngeal pouch is 7th cranial nerve dervived from?

A

2nd

29
Q

layers of brain

A

Cerebral cortex
Pia mater
Subarachnoid space (filled with CSF)
Arachnoid mater
Dua mater
Skull
Scalp

30
Q

Where is Subdural space

A

Dua mater and the arachnoid mater meninges

31
Q

Subdural haemorrhage

A

Causes by traumatic head injury

32
Q

Subarachnoid haemorrahage

A

Thunder clap headache

33
Q

Extradural haemorrhage

A

Between skull and dural mater
Lucid period

34
Q

What are EEG findings of focal seizure with partial awareness?

A

Centrotemporal spikes

35
Q

What happens in a partial (focal) seizure?

A

Small area of brain has unusual electrical acitivity and does not affect awareness

36
Q

Congenital malformations of brain that lead to partial / focal seizures

A

Sturge-Weber syndrome
tuberous sclerosis
focal cortical dysplasia

37
Q

Focal Brian lesions that cause partial / focal seizures

A

Congenital malformations
Brain tumours
Benign idiopathic epilepsy syndromes

38
Q

Clinical symptoms of seizures in occipital lobe

A

Simple visual hallucinations

39
Q

Clinical symptoms of seizures in parietal lobe

A

Focal sensations

40
Q

Clinical symptoms of seizures in frontal lobe

A

Generalised difficult to characterise sensation

41
Q

Clinical symptoms of seizures in temporal lobe

A

complex visual hallucinations

42
Q

Benign childhood epilepsy with centrotemporal spikes

A

Type of focal seziures
Occur at night
Start with buccal and throat tingling followed by tonic / clonic contractions down one side of face and drooling and inability to speak
Consciousness and comprehension preserved

43
Q

Partial / focal seizure treatment

A

Oxcarbamazepine
Leveitiracetam

44
Q

West syndrome features on EEG

A

Hypsarrhythmia

45
Q

Absence seizures features on EEG

A

3 hertz spike and slow wave discharges

46
Q

Lennox-gastaut features on EEG

A

1 to 2 hertz interictal slow spike waves

47
Q

Lennox-gastuat

A

Mutliple seizure types
Developemental delay

48
Q

Juvenile myoclonic seizures features on EEG

A

4 to 5 hertz poly spike and slow wave discharge

49
Q

Cause of Rett syndrome

A

sporadic mutation in MECP 2
X linked dominant inheritance

50
Q

Clinical presentation of Rett syndrome

A

Aerophagia - abdominal extension and difficulty respiratory
Apraxia
Aphasia
Drooling
Abnormal breathing pattern
Spinal deformity
Hand sterotypes
Epilepsy

51
Q

What nerve is damaged to cause foot drop? (Weakness in dorsiflexion and eversion)

A

Common perineal nerve

52
Q

Inability to plantar flex ankle and toe and invert foot - which nerve is affected?

A

Tibial nerve

53
Q

How is Friedreich’s Ataxia inherited?

A

Autosomal recessive
Most patients have repeat GAA expansion of flaxtaxin gene(defect in FXN gene)

54
Q

What does Friedrich Ataxias include?

A

Spinocerebellar tracts
Dorsal spinal column
Pyramidal tracts
cerebellum
medulla

55
Q

Presentation of Friedreich’s ataxia

A

Progressive ataxia
Absence of deep tendon reflex - no achilles reflex
Spasticity
Peripheral neuropathy
Dysarthria
MSK - pes cavus, hammer toe
Heart - cardiac hypertrophy, myocardial fibrosis, heart failure
Diabetes
Hearing loss
Optic atrophy

56
Q

Investigations for Friedreich’s ataxia

A

Nerve conduction studies - absent sensory action potentials
Genetic analysis
ECG - ventricular hypertrophy with t wave inversion
MRi of brain and spinal cord

57
Q

Treatment of friedreich’s ataxia

A

symptomatic and supportive
PT’s
SALT
Annual review of systems

58
Q

Types of cells that line choroid plexus

A

simple columnar cells (Ependymal cells)

59
Q

What is syringemyelia?

A

Cysts/ syrinx form on spinal cord

As they widen, they compress anterior horn cells and causes fasiculations
Ass. Arnold-chaira malformations and spina bifida

60
Q

How to differientiate between neonatal hypotonia having central or peripheral cause?

A

weakness

61
Q

Presentation of Central cause of neonatal hypotonia

A

Irritiable
Microcephaly
Encephalopathy
normal strength
Normal deep tendon reflexes

62
Q

CNS caused of neonatal hypotonia

A

Genetics - Trisomy 21, Prader-Willi syndrome, Zellweger syndrome
Cerebral malformations
Hypoxic ischeamia encephalopathy

63
Q

PNS causes of neonatal hypotonia

A

Anterior cell horn - spinal muscular atrophy
NMJ - congenital myasthenia gravis
Muscles- congenital myotonic dystrophy

64
Q

Congenital myotonic dystrophy

A

Developmental delay
Polyhydramnios and premature
Baby is week - may need ventilatory support
Decrease in facial expressions
Decrease in reflexes and strength

65
Q

SMA

A

Normal facial expressions
Generalised weakness

66
Q

Which branch of cranial 5th never has motor and sensory

A

mandibular

67
Q

Where does inflammation of facial nerve cause bells palsy the most

A

Through the temporal bone

68
Q
A

TAS (18 decks)

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