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1. Fellowship Written - SAQ > Neurology > Flashcards

Neurology Flashcards

1
Q

Why would you perform a lateral canthotomy
What are 3 signs it is needed in unconscious patient
conscious patient?

A

Ocular compartment syndrome

Unconscious
RAPD
Raised intra ocular pressure
Dilated puptil suggesting retrobulbar haematoma

Conscious
Decreased acuity, pain, opthalmoplgeia

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2
Q

what are the poor prognosticating factors on SAH CT

A
  1. loss of white gray matter differentiaiton
  2. obstructive hydrocephalus
  3. tonsiller herniation
  4. loss of sulci
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3
Q

GBS v spinal cord lesion

A
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4
Q

what is the relevance of FVC and its interpreation in monitoring GBS?

A
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5
Q

what are the differentials for acute bilateral leg weakness?

A
  • GBS
  • lambert Eaton
  • spinal cord compression/cauda equina
  • hypokalaemia paralysis
  • myasthenia gravis
  • traumatic spinal cord injury
  • spinal cord infarct
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6
Q

what are the classical features of GBS

A
  • symmetrical ascending weakness
  • areflexia
  • minimal sensory loss
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7
Q

what investigations are useful in ?GBS

A
  • LP - raised protein and WCC
  • anti ganglioside antibodies
  • nerve conduction studes suggesting peripheral demyelination
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8
Q

what are the life threatening complications of GBS

A
  1. Resp - hypoventilation and respiratory arrest
  2. autonomic - BP and HR
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9
Q

what are the clinical features of facial nerve palsy?

A
  • weakness of upper and lower facial musculature
  • decreased taste anterior 2/3 ipsalateral tongue
  • ipsalateral hyperacuisis
  • ipsalateal reduced tear production
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10
Q

what are the peripheral causes of an isolated facial nerve palsy??

A

meningioma/cholesteatoma
temporal bone fracture
parotid neoplasm
mastoid surgery
facial laceration
lyme
sarcoid
amyloid
GBS
diabetes
botulism
HIV
syphillis

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11
Q

what is the treatment for idiopathic bells palsy

What is the prognosis and what factord are associated with poorer income?

A

Treatment:

    • eye care to prevent corneal exposure eg patch, lubricant
  • pred 60mg 5/7 then taper
  • ?need for antivirals

Prognosis
86% complete recovery 2 months
partial recovery
less chance of recovery in:
* pregnancy
* older age
* diabetes
* taste affected

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12
Q

what are the typical examination findings of third nerve palsy

A
  • eye looks down and out (loss or adduction, elevation)
  • ptosis
  • binocular horizontal, vertical or oblique diplopia
  • pupil dilatation
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13
Q
A
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14
Q

in a third nerve palsy how does ipsalateral pupil dilation help distinguish aetiology?

A

Pupil constriction is mediated by parasympathetic fibres that accompany CN III they travel peripherally & are more susceptible to compression resulting in pupil dilation.
symptom not there in vascular cause

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15
Q

What are the causes of aniscoria?

A
  • 3rd nerve palsy
  • physiologica
  • trauma
  • horners
  • acute close angle glaucoma
  • drugs eg tropicamide
  • Adies pupil
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16
Q
A
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17
Q

positive and negatives on scan

Diagnosis

A

positives
* hyperdensity in midbrain consistent with acute bleed
* dilatation of lateral horns consistent wth hydrocephalus

negatives
* no tonsiler herniation
* no midline shifft
* no intraventriclar blood
* no sign of trauma

Diagnosis
acute intracranial haemorrhage

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18
Q

what are the PRN end of life meds?

A
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19
Q

What are the components of OTTAWA SAH rule?

A
  • age over 40
  • neck stiffness
  • witness LOC
  • onset during extertion
  • thunderclap
  • limited neck flexion on examination

if any is a yes it cant be ruled out

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20
Q

what are the investigsations and pros and cons for ?sah 6 hours post presentation

What is the best scan within 6 hours?

A

**LP **

Pros - high sensitivy and specificty
cons - risks of infection, tine consuming, operator dependent

CTA

Pros - can diagnose aneurysms, pain free
Cons - 1-2% aneurysmic and may be asymptomatic

within 6 hours - CT

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21
Q

what are the ways to minimise post LP headache?

A
  • atraumatic needle
  • small needle calibre
  • early mobilisation
  • replace style before removal of needle
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22
Q

what can cause a headache and visual symptoms?

A

SAH
migraine
GCA
acute angle close glaucoma
CVA
SOL

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23
Q

what features of hx suggest migraine

A

prior migraines
FH
parasthesia
scotoma
nausea
photophobia

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24
Q

what is the first line medical treatment for migraine?

A
  • paracetamol 1g PO
  • ibuprofen 400mg PO
  • Aspirin 900mg PO
  • Sumitriptan 50mg PO
  • Stemetil 15mg slow IV
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25
Q

what drugs can be used in migraine prophylaxis

A

propranolol
amitryptiline
verapamil
sodium valproate

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26
Q

what clinical features of GBS would suggest intubation is needed

A

bulbar weakness
severe reduction in FVC
tachynpnoea
hypoxia

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27
Q

what are the spinal tracts for movement and what do they control?

A

corticospinal - skeletal muscle
corticobulbar - cranial nerves

28
Q

what part of the nervous system is responsible for involuntary movement

A

extra pyrimadal
basal ganglia

29
Q

what is hemiballismus

A

involuntary movement

30
Q
A
31
Q
A

Rinne
512 tuning fork on mastoid and infront of ear. Which is louder?
if louder on mastoid then conductive hearing is better

Wever
512hz tuning form in middle and say where louder
moves to conductive hearing loss or away from sensorineural

32
Q

what are some atraumatic causes of senosorineural hearing loss?

A

idopathic
aspiring - gentamicin
vasculitis
sarcoid

33
Q

what are the contraindications to LP

A

patient refusal
raised ICP
localised skin infection around site
focal neurological signs
coagulopathy
patient agitation

34
Q

SAH symptoms

A

headache
vomiting
collapse
photophobia
neck stiffness
transient LOC
focal neuro signs

35
Q
A
36
Q

what are the break down products that make blood appear yellow

A

bilirubin
oxyhaemoglobin

37
Q

What criteria would suggest a CT is needed before LP for ?SAH

A

signs if RICP
immunosuppression
focal deficit
new seizure
within 6 hours of ?sah headache
reduced GCS

38
Q

three non tox causes

A

heat stroke
meningitis
hyperthyroid

39
Q

name some tox causes and key examination findings

A
  • serotonin toxicity - rigidity, hyperreflexia, mydriasis
  • sympathomimetic - mydriases, tachycardia, hypertension
  • anti-cholinergic - full bladder, tdry skin, flushed, delirium
40
Q

4 drugs and doses for stopping seizure

A
  1. midazolam IV 5mg aliquots
  2. leviteracetam 1-2mg IV
  3. phenytoin 15mg/kg IV
  4. sodium valproate 1000mg
41
Q

differentials for prolonged seizure

A
  • head injury and ICH
  • eclampsia
  • primary epilepsy
  • meningitis
  • hypoglycaemia
42
Q

5 serious complications of status

A
  1. hypoxic brain injury
  2. ICH
  3. pulmonary oedema
  4. rhabdo and AKI
  5. fractures eg spine
43
Q

8 causes for first seizure

A

hypoglucaemia
primary epilepsy
meningitis
trauma and ICH
toxins - sympathomimetic
drug withdrawal
SOL
CVA

44
Q

main side effects of IV phenytoin and management

A
  • sodium channel blockade and widended qrs and VT - sodium bicarm 2mmol/kg IV every 2 mins
45
Q

name some stroke mimics and how you may identify them

A
  1. hypoglycaemia - low bsl/known diabetic
  2. SOL - known CA
  3. seizure/todds paralysis - known epilepsy, witnssed seizure
  4. hemiplegic migraine - migraine sufferer, headache
  5. functional - psych hx
  6. MS - known hx
  7. Bells - LMN facial signs
46
Q

what is the inclusion criteria for CVA thrombolysis

A

Clinical stroke +
* over 18
* clear onset within 4.5 hours
* No evidence of ICH on CT
* Consent
* focal deficit

47
Q

exclusion criteria for CVA thrombolysis

A
  • ICH
  • no consent
  • major surgery in last 14 days
  • SBP over 185
  • GI/GU bleed within 21 days
  • platelets under 100
  • on warfarin and INR over 1.5
  • resolving neurology
48
Q
A
49
Q

indications for IR clot retrieval

A
50
Q

what scoring system is used post TIA

A

ABCD2

51
Q

finding

A

hyperdense MCA sign

52
Q

What are the main causes of dizziness?

A

Peripheral - BPPV, vestibular neuritis, meinieres

Central - CVA, SOL, MS

other
hypoglycaemia
pre syncope
sepsis

53
Q

list three history and three exam findings to help differentiate between central and peripheral causes of vertigo

A

Peripheral
* History - consitutinal sx, worse on movement, viral prodrome, tinnitus, hearing loss, sudden onset
* Exam - dix hallpike +ve, abnormal ENT exam, up/down/rotary nystagmus

Central
* History - other neuro sx, CVS risk fx, gradual onset
* Exam - focal neuro deficity, other CN signs, horizontal nystagmus, any cerebella sign

54
Q

what investigations and why when looking at central v peripheral vertigo

A
55
Q
A
56
Q

What are the components of a HINTS exam and its clinical significance?

A

**1. nystagmus **- horizontal suggests peripheral. Vertical suggests central
2. head impulse test - correcrive saccade suggests periphral, none is central
3. Test of skew - abnormal skew test with ocular tilt suggests central

57
Q

what features of nystagmus suggest central cause?

A

vertical or rotational
change in direction
non fatiguable
spontaneous

58
Q

what are some differentials for hyperensive encephalopathy

A

ICH
menigoencephalitis
toxoplasmosis
SOL
migraine
hypoglycaemia

59
Q

define:
hypertensive emergency
hypertensive urgency

A

hypertensive emergency - over180 or 120 with end organ damage
hypertensive urgency - over 180 or 120 with no end organ damage

60
Q
A
61
Q

what is the target for treating hypertensive emergency/urgency

A

reduce MAP by 15-25% in 2 hours

62
Q

what in a history suggests delirium as a cause for confusion?

Psychosis?

A

delirium
* abnormal vitals
* no psych hx
* recent illness
* inattention
* neuro signs
* exam findings eg crackles

Psychosis
* known diagnosis
* not taking meds
* gradual onset

63
Q

what can cause apnoea post termination of seizure

A

over medication
hypercapnoea
hypoglycaemia
post ictal
coning eg SOL
subclinical seizure
SDH/EDH
menigitis

64
Q
A
65
Q
A

1. Fellowship Written - SAQ (27 decks)

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