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Phase 3a - GP > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the dermatomes in your arms?

A

C4 - shoulder
C5 - lateral upper arm
C6 - thumb
C7 - three middle fingers
C8 - pinkie
T1 - medial upper and lower arm
T2 - axilla

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2
Q

What are the dermatomes in your legs anteriorly?

A

L1 - pelvic area
L2 - lateral upper thigh (upper corner)
L3 - medial upper thigh to the knees
L4 - medial lower leg
L5 - lateral lower leg to big toe and 3 middle toes
S1 - pinkie toe to heel

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3
Q

What is stocking glove neuropathy?

A

Symptoms of peripheral neuropathy that cause numbness, weakness, or sensory changes in the hands and feet.

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4
Q

What is chronic fatigue syndrome?

A

aka myalgic encephalomyelitis is sudden or gradual onset of persistent disabling fatigue, post-exertional malaise (PEM), unrefreshing sleep, cognitive and autonomic dysfunction, and pain, with symptoms lasting at least 6 months.

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5
Q

RF for chronic fatigue syndrome

A

F
Epstein-Barr infection in adolescents
coronavirus disease 2019 (COVID-19)
positive family history of ME/CFS
adolescence and 30-50 years

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6
Q

Sx of ME/CFS?

A

post-exertional malaise/fatigue (PEM; exertional exhaustion)
persistent disabling fatigue
cognitive dysfunction
sore throat
headache
sleep alteration
pain in muscles

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7
Q

Ix for ME/CFS?

A

DePaul symptom questionnaire
FBC with WBC - to exclude infection
ESR/CRP

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8
Q

Tx for ME/CFS?

A

Multidisciplinary support + rehabilitation + management of pain and sx

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9
Q

What is Bell’s palsy?

A

An acute unilateral peripheral facial nerve palsy in patients - physical examination and history are otherwise unremarkable. Consists of deficits affecting all facial zones equally that fully evolve within 72 hours.

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10
Q

Tx of Bell’s palsy?

A

High-dose corticosteroids

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11
Q

What is Parkinson’s disease?

A

A condition where there is a progressive reduction in dopamine in the basal ganglia, leading to disorders of movement.

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12
Q

Sx of Parkinson’s?

A

** Bradykinesia - slower + smaller movement - micro-graphia, shuffling gait, difficulty initiating movement
** Tremor - resting, pill-rolling tremor, worse when px distracted
** Rigidity - increased tone, cogwheel rigidity

Other sx:
Depression
Postural instability - inc. falls
Cognitive impairment
Anosmia

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13
Q

Difference between Parkinson’s resting tremor and benign essential tremor?

A

Parkinson’s - asymmetrical, worse at rest, improves with intentional movement, no change with alcohol

Benign - symmetrical, improves at rest, worse with intentional movement, improves with alcohol

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14
Q

What kind of dementia is associated with Parkinson’s disease?

A

Dementia with Lewy bodies

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15
Q

Tx of Parkinson’s?

A

NOT CURABLE!

1st line - Levodopa + combined with decarboxylase inhibitors - c0-beneldopa
2nd line - COMT inhibitors or Dopamine agonists

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16
Q

What is the SE of Levodopa + decarboxylase inhibitor?

A

Dyskinesia - abnormal movements associated with excessive motor activity
Restlessness

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17
Q

What is cauda equina?

A

Collection of nerve roots at the bottom of the spine (below level L1-L5) are compressed.

18
Q

What do the nerves of the cauda equina supply?

Mention sensory, motor and parasympathetic innervation

A

Sensation to the lower limbs, perineum, bladder and rectum

Motor innervation to the lower limbs and the anal and urethral sphincters

Parasympathetic innervation of the bladder and rectum

19
Q

What are the possible causes of compression in cauda equina? (3)

A

MC Herniated disc
Tumours
Spondylolisthesis (anterior displacement of a vertebra out of line with the one below)
Abscess (infection)
Trauma

20
Q

Sx of cauda equina?

A

** 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)
Sexual dysfunction
Urinary retention/incontinence
Faecal incontinence
Bilateral sciatica
Bilateral motor weakness in the legs
Reduced anal tone on PR examination

21
Q

Ix for cauda equina?

A

GS - MRI lumbar spine
PR exam

22
Q

Tx of cauda equina?

A

Emergency Tx!!
Immediate hospital admission
Emergency MRI scan confirm cauda equina syndrome
Lumbar decompression surgery

23
Q

Define radiculopathy

A

Compression of the nerve roots as they exit the spinal cord and spinal column, leading to motor and sensory symptoms.

24
Q

What is metastatic spinal cord compression (MSCC)?

A

When a metastatic lesion compresses the spinal cord (before the end of the spinal cord and the start of the cauda equina) - different to cauda equina.

25
Q

How does cauda equina present differently to MSCC?

A

Cauda equina presents with lower motor neuron signs (reduced tone and reduced reflexes)

MSCC presents with upper motor neuron signs (increased tone, brisk reflexes and upping plantar responses) - compression occurs higher up

26
Q

What are the 4 main types of migraines?

A

Migraine without aura
Migraine with aura
Silent migraine (migraine with aura but without a headache)
Hemiplegic migraine

27
Q

What are the 5 stages of migraine?

A
  1. Premonitory or prodromal stage (can begin several days before the headache)
  2. Aura (lasting up to 60 minutes)
  3. Headache stage (lasts 4 to 72 hours)
  4. Resolution stage (the headache may fade away or be relieved abruptly by vomiting or sleeping)
  5. Postdromal or recovery phase
28
Q

Typical features of a migraine?

A

Usually unilateral but can be bilateral
Moderate-severe intensity
Pounding or throbbing in nature
Photophobia (discomfort with lights)
Phonophobia (discomfort with loud noises)
Osmophobia (discomfort with strong smells)
Aura (visual changes)
Nausea and vomiting

29
Q

How does aura present?

A

Sparks in the vision
Blurred vision
Lines across the vision
Loss of visual fields (e.g., scotoma)

30
Q

What’s a hemiplegic migraine?

A

Main Sx - hemiplegia (unilateral limb weakness)
+ ataxia + impaired consciousness

Can mimic stroke or TIA

31
Q

Migraine triggers?

A

Stress
Bright lights
Strong smells
Certain foods (e.g., chocolate, cheese and caffeine)
Dehydration
Menstruation
Disrupted sleep
Trauma

32
Q

Tx of migraine - acute + prophylaxis management?

A

Acute:
NSAIDs
Paracetamol
Triptans (e.g. sumatriptan)

Prophylaxis:
Propranolol (a non-selective beta blocker)
Amitriptyline (a tricyclic antidepressant)
Topiramate (teratogenic and very effective contraception is needed)

33
Q

How do tension headaches present?

A

Mild ache or pressure in a band-like pattern around the head.
No visual changes

34
Q

RF for tension headaches?

A

Stress
Depression
Alcohol
Skipping meals
Dehydration

35
Q

Tx of tension headache?

A

Simple analgesia (e.g., ibuprofen or paracetamol)

If chronic: Amitriptyline

36
Q

What are the 3 branches of the trigeminal nerve?

A

Ophthalmic (V1)
Maxillary (V2)
Mandibular (V3)

37
Q

What is trigeminal neuralgia?

A

Severe unilateral pain in the distribution of one or more trigeminal branches.

38
Q

Patients with what cdtn commonly experience trigeminal neuralgia?

A

multiple sclerosis

39
Q

Describe features of trigeminal neuralgia

A

Sudden onset
Lasts seconds to hours
Electricity-like, shooting, stabbing or burning pain
Can be triggered by touch, talking, eating, shaving or cold etc

40
Q

Tx of trigeminal neuralgia?

A

1st line - Carbamazepine

41
Q

Causes of syncope

A

Dehydration
Missed meals
Extended standing in a warm environment, such as a school assembly
A vasovagal response to a stimuli, such as sudden surprise, pain or the sight of blood

Secondary causes:
Hypoglycaemia
Anaemia
Infection
Anaphylaxis

Phase 3a - GP (15 decks)

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