Neurology Flashcards
How do you diagnose carpal tunnel syndrome and what does it show?
Nerve conduction studies show prolonged action potential
How do you manage mild to moderate cases of carpal tunnel syndrome?
Wrist splints at night
Corticosteroid injections
What do you do at the bedside before sending a patient with signs suggestive of cauda equina to have a whole spine MRI?
Full neurological examination
How do you manage severe or refractory cases of carpal tunnel syndrome?
Surgical decompression- flexor retinaculum division
What gene is mutated in Huntington’s disease?
IT15 (HTT gene)
A patient with a history of diabetes and hypertension is more likely to get which type of stroke?
Ischaemic stroke
A patient has a headache that feels like they were hit on the back of their head, signs of meningism and no fever. What do they have?
Subarachnoid haemorrhage
What is the mode of inheritance for neurofibromas?
autosomal dominant inheritance
If one dose of rectal diazepam has been given in status ellipitucs and they are still seizing with IV access, what do you administer next?
IV lorazepam
What does facial weakness with hyperacusis and absent vesicles around ear suggest?
Bell’s palsy
What are the precursor proteins found in Alzheimer’s disease?
Beta and gamma secretase
Which foramen does the middle meningeal artery run through?
Foramen spinosum
List three conditions where a CT Head is needed within 8 hours
- some loss of consciousness since injury
2 >65 years old - bleeding disorders
When is a CT head indicated within 1 hour?
If there is both a loss of consciousness at any point AND:
2 >65 years old
3. bleeding disorders
4. dangerous mechanism of injury
A patient with a stroke has AF. What is the treatment and when is it given?
Abixapan 2 weeks after to prevent haemorrhagic transformation.
What is the sign when knee extension is painful in meningitis?
Kernig sign
What is the sign when neck flexion causes knee/hip flexion in meningitis?
Brudzinski sign
Which artery is affected in stroke patients with prosopagnosia and homonymous hemianopia only?
Posterior cerebral artery
Name five factors that gives a better MS prognosis
Female
<25
First presentation of optic neuritis
>1 year between episodes
Less lesions on MRI
What is one of the first things to do with a stroke patient in the hospital to prevent complications?
Make them NBM to prevent aspiration pneumonia
If the onset of a stroke is unknown what is contraindicated?
Thrombolysis
What dermatome covers the medial lower leg?
L4
What causes paraplegia and what is it?
Spinal cord compression
5/5 upper limbs
0/5 lower limbs
What is the sensory level at the umbilicus?
T10
A lesion where in the brain causes a left mouth droop?
Left brain stem
due to cranial nerves
Where is the lesion causing intranuclear opthalmoplegia in MS?
medial longitudinal fasciculus
this causes eyes not to align
Would MS or spinal cord compression cause absent ankle jerks?
NO
MS never affects LMN
Spinal cord can compress LMN roots
What does Romberg test test?
proprioception
What antibiotics are used to treat a cerebral abscess?
IV metronidazole and cefuroxime
What is the most useful step after a patient present with epillepsy or syncope?
Gain collateral history of what happened before and after the episode
A patient with meningitis has a seizure, what are you going to do next?
Add IV acyclovir for enecephalitis
What is the difference in visual defect between an MCA stroke and a PCA stroke?
MCA stroke- homonymous hemianiopia
PCA stroke- visual agnosia
What nerve lesion causes a winged scapula?
Long thoracic nerve
What nerve is damaged in a hip dislocation and what signs are seen?
Sciatic nerve
Loss of flexion and extension of foot and hamstrings
Loss of sensation below the knee except medial leg
What nerve injury causes a shuffling gait and claw foot
Tibial nerve injury
blow to the back of the knee
A pregnant/ obese woman presents with burning sensation in their thigh. Why?
Lateral femoral cutaneous nerve trapped in inguinal ligament
What GCS Verbal score is given to confused and muddled speech?
4
What GCS Verbal score is given to inappropriate words without conversational exchanged speech?
3
How can alcohol intoxication affect speech
Dysarthria (cerebellar speech)
Due to cerebellar dysfunction
What dermatome covers the dorsum of the foot?
L5
What dermatome covers the cheek?
trigeminal nerve
What is the next step after a patient with Parkinsons is refractory with levodopa?
Decrease levodopa dose and add a dopamine agonist e.g ropinerole
What type of gait is seen in parkinsons?
Extrapyrimidal gait
What type of gait is seen in stroke or cerebral paslsy?
Spastic gait
What type of ataxia and gait is seen in Vitamin B12 deficiency?
Sensory ataxia ->stomping gait
Loss of proprioception
What type of gait is seen in proximal muscle weakness?
Waddling gait
What type of gait is seen in post hip surgery to avoid pain?
Antalgic gait
What type of gait is seen in Guillain barre syndrome, MS or peroneal nerve injury?
High stepping gait
What type of gait is seen in normal pressure hydrocephalus?
Gait apraxia
Is there confusion in lacunar stroke?
No
Cauda equina is the compression of sensory fibres leaving which spinal levels? And how does this affect reflexes?
S3-S5
LMN affected so reduced reflexes
What type of strokes are carotid dopplers not useful in?
Posterior circulation stroke
What kind of meningitis in a patient with a history of alcoholism and recent chest infection? What is the mortality?
Pneumococcal meningitis
20% mortality
Which meningitis bacterial vs viral presents more suddenly and severe?
Bacterial
What is the most sensitive test for subarachnoid haemorrhage within 48 hrs?
Non contrast CT head
How would you administer Parkinsons medication if they are NBM?
Insert NG tube to administer medication
Rotigotine patch
If they have dementia: rivastigmine patch
What is the most common form of GBS? What is a complication of this?
Inflammatory demyelinating polyneuropathy (which can affect sensory nerves too unlike MG) which can lead to type 2 respiratory failure
Does frontotemporal dementia cause motor issues?
No
Consider Huntington’s disease
Which headaches occur roughly the same time everyday?
Cluster headaches
What is a contraindication to a lumbar puncture apart from raised ICP?
rapidly evolving non blanching rash
What risk does clozapine cause and what investigation is needed?
Agranulocytosis - do an FBC
What type of memory is most impaired in dementia?
Short term memory
What is the best treatment for a neuropathic bladder in an MS patient
self-catheterisation
medication is unlikely to helpI
In neuroleptic malignant syndrome what blood marker is diagnostic?
CK levels
Where is the lesion if there is intrinsic hand muscle wasting and sensory loss of forearm?
T1
