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Phase 3a > Neurology > Flashcards

Neurology Flashcards

1
Q

Define MS

A
  1. Chronic autoimmune disease
  2. Involves CNS
  3. Degeneration of myelin in brain and spinal cord
  4. Leads to eventual demyelination and axonal loss
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2
Q

Sx of MS

A
  1. Patchy paraesthesia
  2. Optic neuritis - loss of central vision
  3. Internuclear opthalmoplegia
  4. Subacute cerebellar ataxia
  5. Spastic paraparesis
    • Lhermitte’s sign (bend neck down they get Sx)
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3
Q

State the 3 classifications of MS

A
  1. Relapsing - remitting (80%)
  2. Primary progressive (<10%)
  3. Progressive-relapsing (10%)
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4
Q

Dx of MS

A
  1. +ve clinical Hx/exam
  2. MRI
  3. CSF
    • Oligoclonal bands in CSF
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5
Q

Name the criteria used to diagnose MS

A

McDonald criteria

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6
Q

Tx of MS

A
  1. Acute
    • 1g IV methylpred
  2. Chronic
    • Disease modifying therapies (DMTs)
      • beta-interferon
      • Dimethyl fumarate
    • Symptomatic therapies
      • Physio
      • Modafinil for fatigue
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7
Q

Summarise Wilson’s disease

A
  1. Autosomal recessive impaired Cu metabolism
    -> Leads to accumulation of Cu in liver + brain
  2. Akinetic rigid syndrome, tremor, ataxia
  3. Ix - Serum caeruloplasmin (low = +ve)
  4. Tx - Chelators (Trientine)
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8
Q

Summarise Wernicke’s encephalopathy

A
  1. Thiamine deficiency (B1)
  2. Sx: Triad of Sx
    • Ataxia
    • Confusion
    • Ocular abnormalities (nystagmus)
  3. Ix
    • Neuro exam
    • MRI head
    • Bloods (low thiamine)
  4. Tx
    • High dose IV thiamine
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9
Q

Summarise visual field loss

A
  1. Monocular vision loss (vision loss one eye)
    • Optic nerve
  2. Bitemporal hemianopia
    • Optic chiasm
  3. Homonymous heminopia
    • Optic radiation
  4. Quadrantanopias
    • Optic radiation
  5. Macular sparing in occipital lobe lesions (central vision spared)
    • Occipital lobe
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10
Q

Summarise vertigo

A
  1. Perception of false sensation of movement or spinning
  2. Ax:
    • Peripheral cause: BPPV, labyrinthitis
    • Central cause: Migraine, MS
  3. Tx:
    • Brandt-daroff exercises (BPPV)
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11
Q

Define Vascular dementia (VaD)

A
  1. Umbrella term
  2. Collection of cognitive impairment syndromes
  3. Cerebrovascular disease (ischaemic or haemorrhagic)
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12
Q

Sx of VaD

A
  1. Progressive stepwise deterioration in cognition
  2. Visual disturbance
  3. Seizures
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13
Q

Ddx of VaD

A
  1. Alzheimer’s
    • Memory impairment
    • Slow and continuous
  2. Lewy body dementia
    • Flux in cognition
    • Visual hallucination
    • Parkinsonism
  3. Frontotemporal dementia
    • Personality + behaviour changes
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14
Q

Ix of VaD

A
  1. Cognition screening
  2. Med review to exclude meds induced
  3. B12 deficiency, hypothyroidism
  4. MRI head (extensive white matter change)
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15
Q

Tx of VaD

A
  1. Address cardio rf
  2. Sx Tx
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16
Q

Trigeminal neuralgia

A
  1. Chronic pain
  2. Severe, sudden and brief bouts
  3. Shooting/stabbing pain
  4. Distribution of one or more divisions of trigem
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17
Q

Ax of trigeminal neuralgia

A
  1. Malignancy
  2. MS
  3. Sarcoidosis
  4. Lyme disease
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18
Q

Tx of trigeminal neuralgia

A
  1. Carbamazepine
  2. Phenytoin
  3. Gabapentin
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19
Q

Define TIA

A
  1. Sudden onset
  2. Focal neuro deficit
  3. Vascular aetiology
  4. Resolving Sx within 1h
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20
Q

Sx of TIA

A

Sudden onset of focal neuro deficits
- Dysphasia (speech)
- Arm or leg weakness
- Sensory changes
- Ataxia, vertigo
- Visual disturbance

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21
Q

Ix of TIA

A
  1. MRI
  2. Carotid USS
  3. ECHO
  4. 24h tape
  5. Bloods (glucose, lipid, clotting)
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22
Q

Tx of TIA

A
  1. Lifestyle mods
  2. Control vasc. rf
  3. Aspirin + clopidogrel
  4. Stenting
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23
Q

Summarise Status epilepticus

A
  1. Seizure >5 minutes OR multiple seizures over 5 minutes without returning to full level of consciousness
  2. Tx
    • Premonitory stage (0-10mins)
      • Diazepam 10-20mg
    • Early status (0-30mins)
      • Buccal/rectal Diazepam (community)
      • 0.1mg/kg Lorazepam (IV)
    • Established status (0-60mins)
      • Phenytoin
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24
Q

State caveat to hypo management (glucose) in alcohol abuse pt

A

IV pabrinex PRIOR to glucose
- Avoid precipitation of Wernicke’s encephalopathy (B1 deficiency)

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25
Q

Define SDH

A
  1. Accumulation of blood
  2. Between dura mater and arachnoid mater
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26
Q

Ax of SDH

A
  1. Trauma
  2. Bleeding disorder
  3. Anticoag therapy
  4. Chronic alcohol
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27
Q

Sx of SDH

A
  1. Headache
  2. N+V
  3. Confusion
  4. Diminished eye, verbal or motor response
  5. Focal neuro signs
  6. Sub-acute presentation (3d ->3w)
  7. Chronic presentation (>3w)
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28
Q

Ix of SDH

A
  1. Hyperacute phase (<1h)
    • Isodense clot + cerebellar oedema
  2. Acute phase (<3d)
    • Crescent shaped hyperdense collection
  3. Sub-acute phase (3d -> 3w)
    • Need contrast enhanced CT/MRI
  4. Chronic phase (>3w)
    • Hypodense haemotoma
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29
Q

Tx of SDH

A
  1. Acute - craniotomy
  2. Chronic - burr holes
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30
Q

Define SAH

A
  1. Bleed in subarachnoid space
  2. Beneath arachnoid mater
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31
Q

Rf for SAH

A
  1. Hypertension
  2. Adult polycystic kidney disease
  3. Xs EtOH
  4. Smoking
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32
Q

Sx of SAH

A
  1. Sudden onset severe headache
  2. Hx of physical exertion or coitus prior to onset
  3. Loss of consciousness
  4. Previous sentinel headache (similar but not severe)
  5. Meningism (stiff neck)
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33
Q

Ix of SAH

A
  1. CT head
  2. CSF if CT not definitive (CSF for xanthochromia)
  3. CT angiogram next line
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34
Q

Tx of SAH

A
  1. Medical
    • Nimodipine (prevent vasospasm)
  2. Radio + surgical
    • Coiling or stenting
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35
Q

Define EDH

A
  1. Bleed between dura mater and inner surface of skull
  2. Almost always trauma induced
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36
Q

Sx of EDH

A
  1. Brief loss of consciousness post initial trauma, regain then subsequent deterioration
  2. Headache
  3. N+V
  4. Seizures
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36
Q

Ix for EDH

A
  1. ECG - exclude heart block
  2. BM - exclude hypo
  3. CT head
  4. Bloods
    • Anaemia from blood loss
    • U&Es and LFTs if GA needed
    • Coag screen
    • Group + save
37
Q

Summarise Sub-acute combined degeneration of the cord (SCDC)

A
  1. Neuro disorder from B12 deficiency
  2. Degen of dorsal columns
  3. Symmetrical distal sensory Sx, mixed UMN and LMN signs
  4. MRI + nerve conduction studies
  5. B12 replacement therapy
37
Q

Tx of EDH

A
  1. Conservative + A->E
  2. Anticonvulsants
  3. Burr hole craniotomy
38
Q

Summarise Spinal cord compression (SCC)

A
  1. Medical emergency
  2. Sx include:
    • Weakness + sensory disturbance below level of compression
    • Deep back pain
    • Bladder and bowel involvement
    • UMN signs
  3. Ax include:
    • Trauma
    • Malignancy
    • Disc prolapse
  4. Ix - MRI spine
  5. Tx - high dose steroids + neurosurgery
39
Q

UMN lesion signs

A
  1. Disuse atrophy
  2. Increased tone
  3. Hyperreflexia
  4. Babinski sign (upgoing plantars)
40
Q

LMN lesion signs

A
  1. Marked atrophy
  2. Reduced tone
  3. Fasiculations (involuntary twitches)
  4. Downgoing plantars
41
Q

Sx of spastic hemiparesis

A
  1. Unilateral spastic hypertonia
  2. Hyper-reflexia
  3. Ankle clonus
  4. Upgoing plantar
  5. Pyramidal weakness
42
Q

Describe spastic hemiparesis

A
  1. Arm in flexion (upper limb flexor stronger than extensor)
  2. Lower limb in extension (vice versa)
43
Q

Ax of spastic hemiparesis

A
  1. Lesion in contralateral cerebral hemisphere
  2. MS
44
Q

Sx of sensory peripheral neuropathy

A
  1. Weakness, numbness, pain
  2. Glove + stockings presentation
45
Q

Ax of sensory peripheral neuropathy

A
  1. Alcohol toxicity
  2. B12 deficiency
  3. Chronic renal failure
  4. DM
  5. Vasculitis
46
Q

Summarise Parkinsonism

A
  1. Bradykinesia + at least one of:
    • Rigidity
    • Tremor
    • Postural instability
  2. Non motor features
    • Autonomic dysfunction (constipation)
    • Olfactory loss
    • Psych features
47
Q

Summarise Parkinson’s

A
  1. Neurodegen disorder adults >65
  2. Asymmetric tremor, bradykinesia, rigidity
  3. Lewy body formation + neuronal death in dopaminergic cells of substantia nigra
  4. Clinical Dx
  5. Tx - Levodopa
48
Q

Summarise optic neuritis

A
  1. Inflammation of optic nerve
  2. Adult women
  3. Sx include:
    • Visual loss
    • Periocular pain
    • Loss of colour vision
  4. Ax include:
    • Demyelinating lesions (MS)
    • Autoimmune
  5. Ix include:
    • Visual assessment
    • MRI
  6. Tx include:
    • Methylpred
49
Q

Summarise normal pressure hydrocephalus (NPH)

A
  1. Triad of Sx:
    • Dementia
    • Magnetic gait (feet stuck to floor)
    • Incontinence
  2. Ix include:
    • CT/MRI (dilated lateral ventricles)
  3. Tx include:
    • Therapeutic LP
50
Q

Summarise the Glasgow Coma Scale

A
  1. Eye response
    • 4/4 = open spontaneously
    • 3/4 = open to voice
    • 2/4 = open to pain
    • 1/4 = do not open
  2. Verbal response
    • 5/5 = oriented
    • 4/5 = confused
    • 3/5 = inappropriate words
    • 2/5 = incomprehensible sounds
    • 1/5 = no sounds
  3. Motor response
    • 6/6 = obey command
    • 5/6 = localises to pain
    • 4/6 = withdraws to pain
    • 3/6 = abnormal flexion to pain
    • 2/6 = extension to pain
    • 1/6 = no movement

THRESHOLD FOR INTUBATION: GCS 8

51
Q

Summarise myasthenia gravis

A
  1. Autoimmune disease
  2. Antibodies against nicotinic ACh receptors on muscle fibres -> muscle weakness
  3. Sx include:
    • Fatigable muscle
    • Weakness
    • Bilateral ptosis
  4. Ix include:
    • Bloods: serum ACh receptor antibody
    • CT chest
  5. Tx include:
    • Immunosuppressive therapy
    • AChesterase inhibitors
52
Q

Summarise MND

A
  1. Protein misfolding
  2. UMN + LMN signs
  3. Resp complications usual cause of death
53
Q

Summarise migraine

A
  1. Recurrent, unilateral throbbing headache
  2. Preceded by aura
  3. 4-72h, photophobia, phonophobia, N+V
  4. Tx: Propranolol, amitriptyline (prophylaxis)
54
Q

Define meningitis

A

Inflammation of meninges (dura mater, arachnoid mater and pia mater)

55
Q

Ax of meningitis

A
  1. bacterial
    • Strep. pneumoniae
    • N. meningitidis
    • H. influenzae
  2. Viral
    • Enteroviruses
  3. Fungal
    • Cryptococcus neoformans
  4. Parasitic
    • Amoeba
    • Toxoplasma
56
Q

Sx of meningitis

A
  1. Headache
  2. Fever
  3. Neck stiffness
  4. Photophobia
  5. N+V
  6. NON BLANCHING PETECHIAL RASH
57
Q

Signs of meningitis

A
  1. Kernig’s
    • Lie flat
    • Hip + knee 90 degree flex
    • Extend patient knee
    • Resistance = +ve
  2. Brudzinski’s
    • Lay flat, passive flex neck towards chest
    • Flexion of hip and knee by pt = +ve
58
Q

Ix of meningitis

A
  1. LB for CSF
  2. Bloods
    • FBC
    • U+Es
    • Clotting
    • Glucose
    • Cultures
    • ABG
  3. Bact. throat swab
  4. PCR (viral)
  5. HIV
59
Q

Summarise CSF interpretation for meningitis

A
  1. Bacterial meningitis
    • Clear/turbid
    • Neutrophils
    • Culture +ve
    • Protein ^
    • Glucose = reduced
  2. Viral
    • Clear/turbid
    • Lymphocytes
    • Culture -ve
    • Protein ^
    • Glucose = normal
  3. Tuberculous
    • Clear
    • Turbid
    • +/- fibrin web
    • Lymphocytes + neutrophils
    • -ve stain; acid-fast bacilli +ve
    • Protein ^
    • Glucose = reduced
60
Q

Tx of meningitis

A
  1. Bacterial
    • IV ceftriaxone (suspected)
    • Dexamethasone (strongly suspected)
  2. Viral
    • Aciclovir
61
Q

Summarise Lyme disease

A
  1. Ixodes tickes
  2. Stage 1 (localised disease, several weeks) Sx include:
    • Tick bite
    • Flu Sx
    • Regional lymphadenopathy
  3. Stage 2 (early disseminated disease, weeks - months after bite)
    • Continued flue like Sx
    • Neuroborreliosis (facial nerve)
    • Early painful arthiritis
  4. Stage 3 (late disseminated disease, months to years post bite)
    • Arthritis
    • Late neuro disorders
  5. Tx includes:
    • Doxy
62
Q

Summarise Lambert-Eaton Myasthenic Syndrome (LEMS)

A
  1. Autoimmune disorder
  2. Affects neuromuscular transmission
  3. Antibodies against pre-synaptic voltage gated Ca2+ channels
  4. ASSOCIATED WITH SCLC
  5. Sx: autonomic features + weakness
63
Q

Summarise TACI

A

Total Anterior Circulation Infarct (TACI)
- Anterior AND middle cerebral arteries on affected side
- Contralateral hemiplegia (complete paralysis or hemiparesis (partial paralysis)
- AND contralateral homonymous heminopia
- AND higher cerebral dysfunction (aphasia)

64
Q

Summarise PACI

A

Partial Anterior Circulation Infarct
- Anterior OR middle cerebral artery
- 2 of the TACI presentation
- OR higher cerebral dysfunction alone

65
Q

Summarise LACI

A

Lacunar Circulation Infarct with 1 out of:
- Pure motor stroke
- Pure sensory stroke
- Sensorimotor stroke
- Ataxic hemiparesis
- Dysarthia

66
Q

Summarise POCI

A

Posterior Circulation Infarct
- Vertebrobasilar arteries (supplying cerebellum, brain stem, occipital lobe)
- Cerebellar dysfunction
- OR conjugate eye movement disorder
- OR bilateral motor/sensory deficit

67
Q

Tx of ischaemic stroke

A
  1. CT head to rule out haemorrhagic stroke
  2. CT angio for large vessel occlusion
  3. Thrombolysis with ALTEPLASE if within 4.5h of Sx onset + no contraindication of:
    • trauma
    • recent surgery
    • SBP > 185
    • Oral anticoag
  4. Mechanical thrombectomy
68
Q

Summarise spinal claudication

A
  1. Degenerative disease of lumbar spine with narrowing of spinal canal
  2. Sx include:
    • Insidious onset back pain
    • Leg pain + weakness + numbness
    • Activity related
    • Relieved from stooped posture/bend over
  3. Dx - MRI
  4. Tx - Physio, pain Mx, decompression surgery
69
Q

Summarise Huntingdon’s disease

A
  1. Autosomal dominant neurodegen
  2. Choreoathetosis + dementia
  3. Dx - Genetic testing
  4. Tx - MDT Sx relief (Tetrabenazine for chorea) + pt support
70
Q

Summarise Horner’s syndrome

A
  1. Collection of signs and Sx from impairment to sympathetic nerve supply to eye
  2. Sx include:
    • Ptosis
    • Miosis (constriction of pupil)
    • Anhidrosis (lack of sweating) on affected side
  3. Ix include:
    • CT head for tumours or vasc. abnormalities
    • Bloods: DM or autoimmune causes
  4. Tx: Manage/ treat underlying cause
71
Q

Summarise GBS

A
  1. Acute inflammatory demyelinating polyneuropathy
  2. Rapid, progressive, ascending symmetrical weakness, often preceded by infection
  3. Dx: Clinical + LP and nerve conduction studies
  4. Tx: Supportive + IVIG (IV immunoglobulins)
72
Q

Summarise typical absence seizures

A
  1. Petit mal
  2. Brief episodes 3-20s
  3. Staring with impairment of awareness and responsiveness
  4. Usually begins 4-14 yrs, resolve by 18
  5. Provoked by hyperventilation
  6. EEG: 3 Hz spike-wave discharge
  7. Back to normal straight after
73
Q

Summarise atypical absence seizures

A
  1. 5-30s
  2. Not provoked by hyperventilation
  3. Reduction in responsiveness incomplete
  4. Usually children with global cogn. impairment therefore hard to distinguish
  5. Persist into adulthood
74
Q

Summarise tonic-clonic seizures

A
  1. Grand mal/ convulsive
  2. Loss of consciousness
  3. Initial tonic phase:
    • Stiffening with a cry evoked by air forced through contracted vocal cords
    • Legs extended + arms extended/flexed
  4. Subsequent clonic phase:
    • Jerking of extremities
    • Gradual increase in amplitude + decrease in frequency
  5. 30-120s
  6. Drooling or foaming
  7. Tongue, cheek or lip biting
  8. Incontinence
  9. Postictal lethargy
  10. Postictal lethargy + confusion
75
Q

Which nerve is involved in facial nerve palsy?

A

CN7 (facial nerve)

76
Q

Summarise Creutzfeldt-Jakob disease

A
  1. Rapidly progressive
  2. Universally fatal
  3. Neurodegen disorder
  4. Sx include:
    • Rapidly progressive dementia
    • Psych disturbance
    • Myoclonus
  5. Tx: Palliative
77
Q

Summarise seizure and DVLA rules

A
  1. One off seizure = reapply in 6m
  2. > 1 = reapply in 12m
  3. Seizure following change in antileptic meds = last seizure 6m ago
78
Q

Summarise focal seizures

A
  1. Complex
    • With impaired consciousness
    • Temporal lobe
    • Post-ictal Sx common (confusion)
  2. Simple
    • Without impaired consciousness
    • Post-ictal Sx absent
79
Q

Management of seizures

A
  1. Focal seizures: Lamotrigine
  2. Absence seizures: Ethosuximide
  3. Carbamazepine may WORSEN myoclonic seizures
80
Q

Summarise diabetic peripheral neuropathy (DPN)

A
  1. Distal symmetrical sensory neuropathy
  2. Small fibre predominant neuropathy (loss of pain/temp change sensation)
  3. Charcot arthropathy
81
Q

Cause of diplopia

A
  1. CN3 = occulomotor
  2. CN4 = trochlear
  3. CN6 = abducens
82
Q

Tx for cluster headaches

A
  1. Sumatriptan
  2. Steroids
  3. Greater occipital nerve blocks
  4. Li (prophylaxis)
83
Q

Sx of cerebellar syndromes

A
  1. Dysdiadochokinesia - hand roti
  2. Ataxia - unsteady gait
  3. Nystagmus - involuntary eye movements
  4. Intention tremor (finger-nose test: tremor as they approach target)
  5. Slurred speech
84
Q

Which nerves bulbar palsy?

A

CN 9, 10, 12

85
Q

Summarise Brown-sequard syndrome (BSS)

A
  1. Damage to one side of spinal cord
  2. Sx include:
    • Ipsilateral hemiplegia
    • Loss of proprioception + vibration
    • Loss of pain and temperature sensation
  3. Most common cause = trauma, disk herniation
86
Q

Summarise Bell’s palsy

A
  1. LMN facial weakness
  2. Altered taste + dry eyes/mouth
  3. Tx: corticosteroids
87
Q

Summarise Alzheimer’s

A
  1. Progressive neurodegen disorder
  2. Cogn. decline, memory impairment
  3. Amyloid plaques
  4. Tau tangles
  5. Neuronal loss + brain atrophy
  6. Neurotransmitter imbalance
  7. Inflammatory response
88
Q
A

Phase 3a (5 decks)

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