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Phase 3a > Neurology > Flashcards

Neurology Flashcards

1
Q

What investigations are used for the peripheral nervous system?

A
  • Nerve conduction studies (PNS)
  • Electromyography (EMG)
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2
Q

What investigations can be used for CNS?

A
  • EEG - Seizure classifying
  • CT head
  • MRI
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3
Q

What would a spine neurological problem present with?

A
  • Back pain
  • Radiating down both legs
  • Bilateral
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4
Q

What would a brain neurological problem present with?

A
  • Headache
  • Vision disturbance
  • Unilateral
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5
Q

What is a GCS score out of?

A

15

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6
Q

What is in a GCS?

A

MoVE 654 - take the best reading from both sides
MOTOR - none (1) - abnormal extension - abnormal flexion - flexion to withdraw from pain - localises - obey command (6)
VERBAL - none - incomp - inappropriate - confused - oriented
EYES - none - pain - speech - spontaneous

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7
Q

What do the scores from a GCS mean?

A

15 - perfect
<8 - intubate
3 - comatose

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8
Q

What are the main spinal tracts?

A

Corticospinal - descending
Spinothalamic - ascending
Dorsal column-medial lemniscus (DCML)- ascending

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9
Q

Is the corticospinal tract ascending or descending?

A

Descending

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10
Q

Is the spinothalamic tract ascending or descending?

A

Ascending

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11
Q

Is the dorsal column-medial lemniscus tract ascending or descending?

A

Ascending

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12
Q

What does the dorsal column-medial lemniscus tract transmit?

A
  • Light touch
  • Proprioception
  • 2 point discrimination
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13
Q

What does the spinothalamic tract transmit?

A
  • Pain
  • Temperature
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14
Q

What does the corticospinal tract transmit?

A

Motor

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15
Q

Where does C5+6 innervate?

A
  • Biceps
  • Lateral forearm
  • Thumb + index finger
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16
Q

What reflex is testing C5+6?

A

Biceps reflex

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17
Q

Where does C7 innervate?

A
  • Triceps
  • Middle finger
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18
Q

What reflex tests for C7?

A

Triceps reflex

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19
Q

Where does C8+T1 innervate?

A
  • Medial forearm
  • Medial two fingers
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20
Q

Where does L5 innervate?

A
  • Big toe
  • Dorsum
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21
Q

Where does S1 innervate?

A
  • Heel and sole
  • Ankle
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22
Q

What reflex tests for S1?

A

Ankle

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23
Q

What would be seen in L5 rediculopathy?

A
  • Positive ankle jerk
  • Positive foot drop
  • Poor inversion
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24
Q

What would be seen in a common peroneal palsy?

A
  • Absent ankle reflex
  • Positive foot drop
  • Poor eversion
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25
Q

What reflex tests for L3+4?

A

Knee

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26
Q

What is a TIA?

A

<24 hrs transient focal neurology with tissue ischaemia

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27
Q

What is a TIA a marker of?

A

IHD

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28
Q

What is the gold standard test for a TIA?

A

An MRI

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29
Q

What is a stroke?

A

> 24hr focal neurological deficit with tissue infarct

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30
Q

Can you drive after having a TIA?

A

Not for 1 month

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31
Q

What are the two types of stroke?

A

Ischaemic (85%) or haemorrhagic (15%)

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32
Q

What are the causes of an ischaemic stroke?

A
  • Carotid thromboembolus
  • Atherogenesis
  • AF
  • Atrial septal defect - paradoxical embolus
  • Infective endocarditis
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33
Q

What are the types of a haemorrhagic stroke?

A
  • Epidural haematoma
  • Subdural haematoma
  • Subarachnoid haemorrhage
  • Intracerebral haemorrhage
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34
Q

What are the causes of a haemorrhagic stroke?

A
  • Trauma
  • Alcoholism
  • Anticoagulants
  • Berry aneurysm
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35
Q

What are the main risk factors for stroke?

A
  • T2DM
  • Obsese
  • HTN
  • Hypercholesterolaemia
  • Males
  • Increased age
  • Smoking
  • AF
  • Anticoagulants
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36
Q

What are the symptoms of a total anterior circulation stroke?

A
  • Higher cortical dysfunction - speech and co-ordination problems
  • Homonymous hemianopia - vision loss
  • Unilateral hemiplegia + hemi sensory loss
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37
Q

What is a partial anterior circulation stroke?

A

Either the middle or anterior cerebral artery affected

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38
Q

What is a total anterior circulation stroke?

A

Both the middle and the anterior cerebral artery are affected

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39
Q

What are the symptoms of a partial anterior circulation stroke?

A

2/3 of:
- Higher cortical dysfunction - speech and co-ordination problems
- Homonymous hemianopia - vision loss
- Unilateral hemiplegia + hemi sensory loss

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40
Q

What are the symptoms of a posterior circulation stroke?

A

1 of:
- Isolated vision loss
- Cerebellar symptoms
- Contralateral CN palsy

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41
Q

What are the symptoms of a lacunar stroke?

A
  • Pure motor
  • Pure sensory
  • Ataxic hemiparesis
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42
Q

Where is a stroke in the anterior cerebellar artery going to affect the most?

A
  • LOWER LIMB!! - leg weakness
  • Urinary-faecal incontinence +/- personality changes
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43
Q

Where is a stroke in the middle cerebellar artery going to affect the most?

A
  • UPPER LIMB!!!
  • Ipsilateral gaze deviation
  • face droop + forehead spared
  • Brocas/wernickes
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44
Q

What is a painful cranial nerve 3 palsy a sign of?

A

Vertebral artery dissection

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45
Q

What is seen in weber’s syndrome (midbrain stroke)?

A

Ipsilateral CN3 palsy + contralateral hemiplegia (fixed dilated pupil pointing down and out)

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46
Q

What is seen in wallenburg’s syndrome (stroke of posterior inferior cerebellar artery)?

A
  • Ipsilateral spinothalamic face loss + Contralateral spinothalamic rest of the body loss (pain + temp loss)
  • dysphagia
  • Ipsilateral horners
  • Ipsilateral cerebellar loss
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47
Q

What will a basilar artery stroke cause?

A

Locked in syndrome

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48
Q

What will a retinal artery stroke cause?

A

Amorosis fugax

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49
Q

How is a stroke diagnosed?

A

1st - Non-contrast CT
GS - diffusion weighted MRI
- Bloods
- Consider doppler USS (carotid)

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50
Q

How are ischaemic strokes treated if less than 4.5 hours from onset?

A
  • IV alteplase (thrombolysis)
  • Consider thrombectomy if clot in large artery and within 6 hours
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51
Q

How are ischaemic strokes treated if more than 4.5 hours since onset?

A

300mg aspirin STAT

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52
Q

What is the long term prevention of a ischaemic stroke?

A
  • High dose statin (800mg simvastatin)
  • Lifelong clopidogrel
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53
Q

What is a sub-arachnoid haemorrhage?

A

Ruptured circle of Willis

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54
Q

What are the causes of sub-arachnoid haemorrhage?

A
  • Trauma - mc
  • Berry aneurism
  • Mycotic aneurism
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55
Q

What are the symptoms of sub-arachnoid haemorrhage?

A
  • 10/10 instant thunderclap headache
  • Increased intercranial pressure symptoms (CN3+6 palsy + cushing’s triad)
  • Meningism
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56
Q

What is cushing’s triad?

A
  • Irregular breathing
  • Widened pulse pressure
  • Bradycardia
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57
Q

How is a sub-arachnoid haemorrhage diagnosed?

A

1st - Non-contrast CT head - star shaped haematoma
GS - CT angiogram + LP >12hr later
- Bloods - U+E’s - hyponatremia!

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58
Q

What are the red flags for headache?

A
  • Worse in morning/at night
  • 3+ eps of n+v
  • worse on coughing + straining
  • worse on changing position (leaning forward)
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59
Q

How is a sub-arachnoid haemorrhage treated?

A
  • Decrease ICP - Raise bed head 30 degrees, hyperventilation, IV mannitol, dexamethasone, Burr hole surgery
  • Nimodipine to decrease artery vasospasm
  • Endovascular coiling surgery
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60
Q

What are the possible complications of sub-arachnoid haemorrhage?

A
  • Vasospasm
  • Rebleeding
  • SIADH
  • Hyponatraemic salt losing
  • Hydrocephalus
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61
Q

What is a subdural haematoma?

A

Ruptured bridging veins
<3 days acute, >21 days chronic

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62
Q

What are the causes of a subdural haematoma?

A

Acute - traumatic injury
Chronic - shaken baby, low impact trauma, alcoholism

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63
Q

What are the symptoms of a subdural haematoma?

A
  • Severe headache if acute
  • N+V
  • Dysarthria (slurred speech)
  • Vision changes
  • Increased ICP symptoms
  • Decreased GCS
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64
Q

How is a subdural haematoma diagnosed?

A

Non-contrast CT head - crescent haematoma

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65
Q

How is a subdural haematoma treated?

A
  • Decrease ICP - Raise bed head 30 degrees, hyperventilation, IV mannitol, dexamethasone, Burr hole surgery
  • Craniotomy + clot evacuation
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66
Q

Who is at risk of a subdural haematoma?

A
  • Alcoholics
  • Elderly
  • Babies
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67
Q

What is an epidural haematoma?

A

Ruptured middle meningeal artery

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68
Q

What causes an epidural haematoma?

A

Low impact trauma

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69
Q

Who is at risk of an epidural haematoma?

A

20-30 yrs

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70
Q

What are the symptoms of an epidural haematoma?

A
  • Initial LOC
  • Lucid interval for hours
  • Rapid symptom deterioration - decreased GCS, N+V, Increased ICP
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71
Q

What are signs of head trauma?

A
  • Battle sign
  • Raccoon eyes
  • Hemotympanum
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72
Q

How is an epidural haematoma diagnosed?

A

NCCT head - suture lines confined

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73
Q

How is an epidural haematoma treated?

A
  • Decrease ICP
  • Craniotomy + clot evacuation
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74
Q

What are the possible complications of a subdural or epidural haematoma?

A
  • Cerebral oedema
  • Coning
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75
Q

Who experiences syncope?

A
  • Older pts
  • CV morbidity
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76
Q

When do patients suffer with syncope?

A
  • Exercise
  • Postural
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77
Q

What symptoms do patients experience pre syncope?

A
  • Pale
  • clammy
  • autonomic
  • chest pain
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78
Q

What symptoms do patients have in the ictal phase of syncope?

A
  • Floppy
  • Loss of colour
  • Eyes closed
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79
Q

What symptoms do patients experience in the post-ictal phase of syncope?

A

Immediate recovery + no amnesia

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80
Q

Who can suffer from general tonic-clonic epilepsy?

A

All ages

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81
Q

What can cause a generalised tonic-clonic seizure?

A
  • Alcohol
  • Decreased sleep
  • Meds
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82
Q

What can occur in the pre-ictal phase of a tonic-clonic seizure?

A
  • Aura
  • Deja-vu
  • Automatisms
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83
Q

What can happen in the ictal phase of a tonic-clonic seizure?

A
  • Rigid fall to the floor and symmetrical limb jerk
  • Eyes open
  • Tongue biting
  • <5 min
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84
Q

What can happen in the post ictal phase of a general tonic-clonic seizure?

A
  • Post-ictal drowsiness for 30 mins
  • Confusion
  • Todd paralysis
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85
Q

Who can suffer with non-epileptic attack disorder?

A
  • Younger pts
  • Psych history
  • Stress
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86
Q

What can cause a non-epileptic attack?

A

Increased stress and panic

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87
Q

What can happen pre-ictal phase of a non-epileptic attack?

A
  • Panicked + unaware
  • Abrupt
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88
Q

What can happen in the ictal phase of a non-epileptic attack?

A
  • Violent asymmetrical limb jerking
  • Waxing+ wanings
  • Eyes and mouth variable (no tongue biting)
  • Pelvic thrusting
  • > 5 min
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89
Q

What happens in the post-ictal phase of a non-epileptic attack?

A
  • Rapid increased emotional response
  • No amnesia
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90
Q

What is epilepsy?

A

A recurrent idiopathic tendency to have seizures

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91
Q

What can cause epilepsy?

A
  • Vascular - dementia, strokes
  • Infection - meningitis, encephalitis
  • Trauma
  • Autoimmune - rheumatoid arthritis, SLE, TB
  • Mineral - hypoglycaemia, hyponatremia
  • Idiopathic
  • Neoplasms
  • Drugs
  • Everything else + eclampsia
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92
Q

What are the risk factors for epilepsy?

A
  • Congenital problems (tuberous sclerosis, cerebral palsy)
  • Acquired (meningoencephalitis, febrile convulsions)
  • Dementia
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93
Q

What can decrease seizure threshold?

A
  • Hypoglycaemia
  • Alcohol
  • Stress
  • Meds
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94
Q

What medications can decrease seizure thresholds?

A
  • Tricyclic antidepressants
  • Lithium
  • Ciprofloxacin
  • Clozapine
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95
Q

What is the difference between a focally aware and a focally unaware seizure?

A

Focal aware - doesn’t involve brainstem
Focal unaware - involves brainstem

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96
Q

What is the most common kind of focal epilepsy?

A

Temporal

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97
Q

What are the symptoms of a temporal seizure?

A
  • Visual aura
  • Automatisms
  • Todd paralysis
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98
Q

What are the symptoms of a frontal seizure?

A
  • Motor symptoms
  • Bizarre behaviour
  • Jacksonian march
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99
Q

What are the symptoms of a parietal seizure?

A
  • Vague numbness
  • Tingling
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100
Q

What are the symptoms of an occipital seizure?

A
  • Visual hallucinations
  • Blindness
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101
Q

What are the types of generalised seizures?

A
  • Tonic clonic
  • Absence
  • Tonic/atonic
  • Myoclonic
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102
Q

How is epilepsy diagnosed?

A
  • Bloods, ECG, LSBP
  • CT head
  • EEG
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103
Q

What is raised in a true epileptic seizure?

A

Prolactin and lactate

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104
Q

What are the rules for informing the DVLA after having a seizure?

A

Evidence on EEG - no driving for 2 months
No evidence on EEG - no driving for 6 months

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105
Q

What is the treatment for general tonic-clonic seizures?

A
  • Sodium valproate (m)
  • Lamotrigine (f)
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106
Q

What is the treatment for focal seizures?

A

Lamotrigine or levetiracetam

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107
Q

What is the treatment for absence seizures?

A

Ethosuximide

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108
Q

What is the treatment for myoclonic seizures?

A

Levetiracetam (f) or sodium valproate (m)

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109
Q

What are possible complications of epileptic seizures?

A

Status epilepticus

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110
Q

How is status epilepticus treated?

A
  1. IV lorazepam
  2. IV lorazepam
  3. IV phenytoin/sodium valproate/ carbamazepine
  4. IV phenobarbital under special guidance + ITU
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111
Q

What is the best investigation for seizures?

A

EEG

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112
Q

What is status epilepticus?

A

Back-to-back seizures or >5min seizure

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113
Q

Which anti-epileptic medications are teratogenic?

A
  • Valproate - spina bifida, cleft palate
  • Phenytoin - hydantoin syndrome
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114
Q

What are causes of non-epileptic seizures?

A

C - cardiogenic - MF, arrhythmias, heart block
R - reflex - postural hypo, vasovagal syncope
A - artery insufficiency
S - systemic
H - hypoglycaemia

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115
Q

What is parkinsons?

A

Loss of dopaminergic neurons from the substantia nigra affecting the nigrostriatal pathway

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116
Q

What is the most common neurodegenerative disease?

A
  1. Alzheimer’s
  2. Parkinson’s
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117
Q

What are the risk factors for parkinson’s?

A
  • Idiopathic
  • FH
  • Males
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118
Q

What is the pathology of parkinson’s?

A

Reduction in the nigrostriatal pathway causing less GABA-ergic inhibition therefore gross cortex inhibition + harder to initiate movement

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119
Q

What can cause an exacerbation of parkinson’s?

A
  • Antipsychotics (e.g. haloperidol)
  • Metoclopramide
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120
Q

What are the symptoms of parkinson’s?

A

Need 1 of these:
- Bradykinesia
- Rigidity
- Resting tremor
- Postural instability
Plus:
- Anosmia
- Hypomimia (mask like face)
- Micrographia
- Postural hypotension
- REM sleep

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121
Q

What is given to a patient who is delirious with parkinson’s instead of haloperidol?

A

Diazepam and benzodiazepines

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122
Q

How is parkinson’s diagnosed?

A
  • Clinical (bradykinesia + 1 other symptoms)
  • MRI - often normal
  • DaT - 2 dots instead of 2 commas
  • Post excisional biopsy - loss of dopaminergic neurones
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123
Q

How is parkinson’s treated?

A
  • MDT approach
    1. Co-careldopa (L-dopa + decarboxylase inhibitor)
    2. Adjuvants - entacapone, ropinirole
    3. Deep brain stimulation last line
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124
Q

Why does Levodopa need to be prescribed with a decarboxylase inhibitor in parkinson’s?

A

To improve its efficacy over time

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125
Q

What is the difference between a parkinson tremor and a benign essential tremor?

A

A parkinson’s tremor is a unilateral resting tremor whereas an essential tremor is a bilateral symmetrical intentional tremor

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126
Q

How does alcohol affect a parkinson’s tremor and a benign essential tremor?

A
  • Alcohol worsens a parkinson tremor
  • Alcohol improves a benign essential tremor
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127
Q

How is a benign essential tremor treated?

A

Propranolol

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128
Q

How is a parkinson’s tremor treated?

A

L-DOPA

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129
Q

What is Huntington’s disease?

A

CTG expansions on HTT gene on chromosome 4 causing high levels of glutamate and low levels of GABA

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130
Q

What is the inheritance pattern of Huntington’s?

A

Autosomal dominant

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131
Q

When do Huntington’s symptoms typically start to appear?

A

30-50 years, usually males

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132
Q

How is Huntington’s staged?

A

> 35 CTG expansion repeats - diagnose
35-55 mod
55 severe

133
Q

What are the symptoms of Huntington’s?

A
  • Subcortical dementia
  • Psychosis
  • Depression
  • Chorea
134
Q

How is Huntington’s diagnosed?

A
  • Family history
  • MRI - striatum atrophy
135
Q

How is Huntington’s treated?

A
  • MDT support, genetic counselling
  • Depression -SSRI
  • Psychosis - antipsychotic
  • Chorea - tetrabenazine
136
Q

What are the main causes of death in Huntington’s?

A
  1. Resp arrest
  2. Suicide
137
Q

What is the most common cause of a recurrent headache?

A

Migraine

138
Q

What are triggers of a migraine?

A

C - Chocolate
H - Hangovers
O - Orgasms
C - Cheese
O - Oral contraceptives
L - Lie ins
A - Alcohol
T - Loud noises
E - Exercise

139
Q

What are the stages of a migraine?

A

Prodrome (vague behaviour symptoms)
Aura (Visual flashes and floaters)
Migraine event (4-72hrs)

140
Q

How long can a migraine last?

A

4-72 hours

141
Q

What are the symptoms of migraine?

A

Needs at least 5 attacks of:
- Typically unilateral
- Pulsatile
- Mod-severe headache
- Exacerbated with motion
- With 1 of photophobia, phonobia, N+V

142
Q

What are the treatments for migraines?

A

Acute - PO Sumatriptan or aspirin
Prophylaxis - Propranolol, amitriptyline

143
Q

What is the most debilitating primary headache?

A

Cluster headache

144
Q

How long do cluster headaches last?

A

15 mins - 3 hours, in clusters of 4-12 weeks

145
Q

What are the symptoms of cluster headaches?

A
  • Periorbital and retroorbital pain with trigeminal autonomic symptoms
    >5 attacks with no underlying cause
  • Conjunctal injection
  • Miosis
  • Ptosis
  • Rhinorrhoea + lacrimation
146
Q

What is the treatment for cluster headaches?

A

Acute - SC sumatriptan + 100% high flow oxygen
Prophylaxis - verapamil

147
Q

What are tension headaches associated with?

A

Stress

148
Q

What is the most common primary headache?

A

Tension headache

149
Q

What are the symptoms of a tension headache?

A
  • Band like mild pain around temples +/- trapezius radiation
  • No eye symptoms
  • No aura or motion sickness
150
Q

How long can a tension headache last?

A

30 min - days

151
Q

What is the treatment for tension headache?

A

Simple analgesia (paracetamol/NSAIDs)

152
Q

What is the most common type of secondary headache?

A

Med overuse headache

153
Q

What can cause a medication overuse headache?

A

> 15d/month ibuprofen, paracetamol, triptans
10d/month codeine, tramadol
For more than 3 months

154
Q

How is a med overuse headache treated?

A

Stop analgesia (simple - immediately, opioid - wean)

155
Q

What trigeminal neuralgia?

A

Electric shock waves in trigeminal distribution exacerbated by talking, touching, shaving

156
Q

What can exacerbate trigeminal neuralgia?

A

Talking, Touching, Shaving

157
Q

How long does trigeminal neuralgia last?

A

15s - 2 mins

158
Q

How many attacks of trigeminal neuralgia are needed for diagnosis?

A

2

159
Q

What is trigeminal neuralgia related to?

A

MS!!!!!

160
Q

What is the treatment for trigeminal neuralgia?

A

Carbamazepine

161
Q

What is giant cell arteritis?

A

Large cell vasculitis at temporal artery

162
Q

What are the risk factors for giant cell arteritis?

A
  • 50+
  • F
  • Caucasian
163
Q

What are the symptoms of giant cell arteritis?

A
  • Intermittent jaw claudication
  • temporal tenderness
  • amaurosis fugax
164
Q

How is giant cell arteritis diagnosed?

A
  • Raised ESR
    GS: Temporal artery biopsy (granulomatosis, skip lesions)
165
Q

What is the treatment for giant cell artertitis?

A

Methylprednisolone

166
Q

What is anterior horn disease?

A

A number of medical diseases affecting the anterior horn of the spinal cord, resulting in motor symptoms

167
Q

What can cause anterior horn disease?

A
  • Anterior spinal artery infarct
  • Polio
  • Spinal muscular atrophy
  • MND
168
Q

How is polio spread?

A

Faeco oral spread

169
Q

What are the symptoms of polio?

A
  • 90% asymptomatic
  • 1% acute flaccid paralysis + muscle atrophy
170
Q

What is the possible complication of polio?

A

Bulbar palsy + retrograde travel

171
Q

How is polio diagnosed?

A

CSF PCR

172
Q

How is polio treated?

A

Prevent via IPV vaccination

173
Q

What is the most common type of anterior horn disease?

A

Motor neurone disease

174
Q

Who does MND typically affect?

A

60 y Males

175
Q

What are the risk factors for MND?

A
  • Idiopathic (mc)
  • Familial (SOD1, TDP43, C9 or f72)
  • Related to frontotemporal dementia
176
Q

What are the four subtypes of MND?

A
  • Amyotrophic lateral sclerosis - MC - UMN+LMN
  • Pseudobulbar palsy - CN9-12
  • Primary lateral sclerosis - only UMN
  • Progressive muscle atrophy - only LMN
177
Q

What are the symptoms of MND?

A
  • Mixed UMN + LMN
  • No sensory
  • No eye
  • No sphincter
178
Q

What are UMN signs?

A
  • Hyperreflexia
  • Hypertonic - rigid, spastic
  • Babinski +ve
  • Arm flexors and leg extensors stronger
179
Q

What are LMN signs?

A
  • Hyporeflexic
  • Hypotonic
  • Fasciculations (esp tongue)
  • Widespread weakness
180
Q

How is MND diagnosed?

A
  • El escorial criteria (3 spinal regions involved)
  • EMG
181
Q

What is the treatment for MND?

A
  • MDT
  • Manage symptoms
  • Riluzole
182
Q

What is multiple sclerosis?

A

Type 4 hypersensitivity reaction vs major basic protein of oligodendrocytes

183
Q

Who is at risk of being affected by MS?

A
  • Female
  • 20-40 yrs
  • FH
  • Other autoimmunity
184
Q

What is MS associated with?

A

Trigeminal neuralgia

185
Q

Where does MS affect?

A
  • Optic nerves
  • Brainstem
  • Corpus callosum
186
Q

What are the types of MS?

A
  • Primary progression
  • Secondary progression
  • Relapsing remitting (mc)
187
Q

What criteria is used to make an MS diagnosis?

A

McDonald’s criteria

188
Q

What are the symptoms of MS?

A

> 2 attacks disseminated in time+place,
- UMN only!
- Pyramidal UMN
- Intention tremor, ataxia, dysarthia
- Overactive bladder + impotence
- Heat exacerbates pain
- Neck flexion = electric shock pain
- Eyes - optic neuritis, diplopia etc

189
Q

How is a diagnosis of MS made?

A
  • McDonald’s criteria + MRI with contrast
  • LP = oligoclonal IgG bands
  • NCS = decreased myelination
190
Q

What is the treatment for MS?

A

Acute = PO methylprednisolone 500mg or IV methylprednisolone
Long term = DMARDS - glatiramer, Beta interferon

191
Q

What is a key differential for optic neuritis/MS?

A

Neuromyelitis optica

192
Q

Do the DVLA need to be informed of an MS diagnosis?

A

Must be notified but safe to drive

193
Q

How are symptoms of MS treated?

A

Spasticity - baclofen
Neuropathic pain - Gabapentin
Bladder - Oxybutynin
Fatigue - Modafinil

194
Q

What are possible complications of MS?

A
  • Gait issues (85%)
  • MH issues
195
Q

What is meningitis?

A

Meningeal infection

196
Q

Who is at risk of meningitis?

A
  • Non vaccinated
  • Neonates
  • Immunocompromised
197
Q

What are the types of meningitis

A

Viral (mc) - HSV2, mumps, measles, VZV
Bacterial (more severe) - S.pneumonia, N.meng, GBS, Listeria

198
Q

What is the most likely cause of meningitis in a <3m old?

A
  • Group B strep
  • Listeria
199
Q

What is the most likely cause of meningitis in a 3m-6yr old?

A
  • S.pneumonia
  • N.meningitidis
  • Haemophilus influenza B
200
Q

What is the most likely cause of meningitis in 6-60 yr old?

A
  • S.pneumonia
  • N.meningitidis
201
Q

What is the most likely cause of meningitis in a 60+ yr old?

A
  • S.pneumonia
  • N.meningitidis
  • Listeria
202
Q

How is group b step seen?

A

+ve coccus in chains

203
Q

How is strep pneumoniae seen?

A

+ve coccus in chains

204
Q

How is Neisseria meningitidis seen?

A

-ve diplococcus

205
Q

How is haemophilus influenza b seen?

A

-ve coccobacillus

206
Q

How is listeria seen?

A

+ve bacillus

207
Q

What are the symptoms of meningitis?

A
  • headache
  • neck stiffness
  • photophobia
  • Non blanching rash
  • fever
  • fatigue
  • Kernig
  • Brudzinski
208
Q

What are the symptoms of meningitis in a neonate?

A
  • Resp distress
  • Poor feeding
  • Dehydration
  • Reduced GCS
  • Fever
  • Non blanching rash
209
Q

How is meningitis diagnosed?

A
  • Bloods
  • CT head
  • GS: lumbar puncture analysis
210
Q

When is a lumbar puncture contraindicated in meningitis diagnosis?

A

If non-blanching rash is present - this is diagnostic of Neisseria meningitidis and meningococcal meningitis

211
Q

What will be seen on LP if bacterial meningitis?

A

Turbid, neutrophils, <50% glucose , raised protein

212
Q

What will be seen on LP if viral meningitis?

A

Clear, lymphocytes, >60% glucose , Raised/= protein

213
Q

What will be seen on LP if fungal/TB meningitis?

A

Fibrinous, lymphocytes, <50% glucose, raised/= protein

214
Q

What is the treatment for meningitis?

A

GP = IM benpren 1.2g and refer secondary care
Secondary care =
<3m cefotaxime
>3m ceftriaxone + dexamethasone

215
Q

What is prophylaxis for meningitis?

A

Ciprofloxacin to close contacts STAT dose

216
Q

Does Public Health England need to be notified for meningitis?

A

Yes

217
Q

What are the possible complications of meningitis?

A
  • Sensorineural deafness
  • Waterhouse Friedrichsen syndrome
218
Q

What is the main pathogen involved in encephalitis?

A

HSV 1

219
Q

What are the symptoms of encephalitis?

A
  • Seizures
  • Focal neurological (mc temporal)
  • Fever
  • Confused
  • Changes in GCS
220
Q

What can cause encephalitis?

A
  • HSV1
  • TB
  • Lyme disease
  • Measles
  • CMV
  • Toxo plasmosis
221
Q

How is encephalitis diagnosed?

A

CT head - temporal petechial haemorrhage
LP - Viral CSF picture
EEG - periodic 2Hz firing

222
Q

How is encephalitis treated?

A

IV acyclovir

223
Q

What is a brain abscess?

A

Pus collection intracranially

224
Q

Who is normally affected by a brain abscess?

A
  • 30-40yr men
  • Immunocompromised
  • T2DM
225
Q

What is the most common organism that causes brain abscess?

A

Staph intermedius

226
Q

What are the risk factors for a brain abscess?

A
  • Septic emboli
  • Trauma
  • Mastoiditis
  • Congenital heart disease in children
227
Q

What are the triad of symptoms for a brain abscess?

A
  • Fever
  • Headache with red flags
  • Focal neurology
    +/- raised ICP
228
Q

How is a brain abscess diagnosed?

A

Contrast enhanced CT head - ring enhancing lesion

229
Q

How is a brain abscess treated?

A
  • Reduce ICP
  • IV flucloxacillin
230
Q

How is a patient who is braindead identified?

A
  • Apnoea >5mins
  • Brainstem signs - no corneal, caloric, cough reflexes, fixed dilated pupil
  • GCS 3 (comatose)
231
Q

Who does MG affect?

A

Male - 60 yr old with thymoma
Female - 40 yr old with autoimmune disease

232
Q

What meds should be avoided in myasthenia gravis?

A
  • Beta blockers
  • Aminoglycosides (gentamicin)
  • Lithium
  • CCB
  • Magnesium sulphate
233
Q

What are the symptoms for MG?

A
  • Fatiguability as day goes on
  • diplopia + ptosis
  • jaw fatigue
  • talking difficulty
  • bulbar palsy
234
Q

How is MG diagnosed?

A

Serology - Anti Acetylcholine receptor antibodies
Electromyogram - Fatiguability

235
Q

How is MG treated?

A

Neostigmine + pyridostigmine

236
Q

What are the possible complications of MG?

A

Myasthenic crisis - MG + T2 resp failure

237
Q

What are the symptoms for Lambert-Eaton myasthenic syndrome?

A
  • Weakness in legs
  • Autonomic symptoms (incontinence)
  • Improves throughout day
238
Q

How is Lambert-Eaton myasthenic syndrome diagnosed?

A
  • CXR - Small cell carcinoma
  • Serology
  • Electromyogram - incremental increases in activity
239
Q

How is Lambert-Eaton myasthenic syndrome treated?

A

Diaminopyridine
Immunosuppression

240
Q

What is Guillain barre?

A

Ascending symmetrical polyneuropathy, schwann demyelination

241
Q

What is demyelinated in Guillain Barres?

A

Schwann cells

242
Q

What does Guillain Barres usually come after?

A

Post campylobacter gastroenteritis (or URTI)

243
Q

What are the symptoms for Guillain Barres?

A
  • Reduced tendon reflexes
  • Symmetrical leg weakness
244
Q

How is Guillain Barres diagnosed?

A
  • LP - Raised protein + normal WCC
  • Serology - Anti GM1
  • Nerve conduction studies - decreased conduction speed
245
Q

How is Guillain Barres treated?

A

IV Ig + plasmapheresis

246
Q

Where can brain tumour mets come from?

A

Breast, bone, lung, liver

247
Q

What is the most common type of brain tumour?

A

Astrocytoma - 4= glioblastoma multiforme

248
Q

What are the symptoms of a brain tumour?

A
  • Red flag headache
  • Raised ICP Sx
  • N+V
  • Focal neuro
  • Seizures/epilepsy
249
Q

How are brain tumours diagnosed?

A

1st - NCCT head
GS - MRI head

250
Q

How are brain tumours treated?

A
  • Reduce ICP
  • IV dexamethasone
  • Consider Surgery in primary tumours
  • Consider chemo/radio in secondary tumours
251
Q

What can cause neuropathy?

A
  • Axon damage
  • Wallerian degeneration
  • Radiculopathy
  • Demyelination
252
Q

What are the types of neuropathy?

A

Mononeuropathy - one nerve
Mononeuritis multiplex - multiple single nerves
Polyneuropathy - symmetrical nerve pathology, glove + stockings

253
Q

What nerve does carpal tunnel affect?

A

Median (C6-T1)

254
Q

What can cause carpal tunnel?

A
  • Repetitive overuse
  • Hypothyroid
  • Acromegaly
  • Rheumatoid arthritis
  • Pregnancy
255
Q

What are the symptoms for carpal tunnel syndrome?

A
  • Tingling in palm distribution
  • Wake and shake
  • Thenar muscle wasting
256
Q

How is carpal tunnel diagnosed?

A

Tinel + phalen +ve

257
Q

What is the treatment for carpal tunnel?

A

Splints + cold compress

258
Q

What does ulnar compression cause?

A

Claw hand (C8-T1)

259
Q

What can cause ulnar nerve compression?

A

Medial epicondyle fracture of humerus

260
Q

What does radial compression cause?

A

Wrist drop (C5-T1)

261
Q

What can cause radial nerve compression?

A

Midshaft humerus fracture

262
Q

What does LS radiculopathy present with?

A

Foot drop + weak inversion with present ankle jerk reflex

263
Q

What does common peroneal palsy present with?

A

Foot drop + weak eversion with absent ankle jerk

264
Q

What does a CN 3 palsy cause?

A

Down + out
Dilated

265
Q

What does a CN 4 palsy cause?

A

Diplopia

266
Q

What does a CN 6 palsy cause?

A

Impaired abduction

267
Q

What does a CN 7 palsy cause?

A

Bells Palsy

268
Q

What does a CN 5 palsy?

A
  • Weak mastication
  • Decreased tongue sensation
269
Q

What does a CN8 palsy present with?

A
  • Hearing loss
  • Vertigo + balance problems
270
Q

What does a CN9 + 10 palsy present with?

A

Bulbar symptoms
- Swallowing
- Coughing
- Uvula - contralateral to CNx lesion

271
Q

What does CN11 palsy present with?

A

Weak head turn + shrug

272
Q

What does a CN12 palsy present with?

A

Ipsilateral tongue deviation

273
Q

How is Bells palsy treated?

A

72hr Prednisolone + eye care

274
Q

What does spinal cord myelopathy present with?

A
  • No saddle symptoms
  • Usually cervical
  • UMN below lesion
275
Q

What does cauda equina present with?

A
  • Saddle symptoms (+incontinence, anaesthesia)
  • Usually LMN
276
Q

What does anterior cord compression cause?

A

Motor symptoms

277
Q

What does posterior cord compression cause?

A

Dorsal column medial lemniscus pathway symptoms

278
Q

What are the causes of spinal cord compression?

A
  • Trauma
  • Malignancy
  • Osteophytes
  • Slipped discs
  • Spinal stenosis
  • Myeloma
  • RA
279
Q

What are the symptoms of cord compression?

A
  • Back pain
  • Hoffman sign
  • Deltopectoral reflex
  • Crossed adductors
  • Treacle hands
  • Babinski +ve clonus
280
Q

How is cord compression diagnosed?

A

Urgent MRI whole cord

281
Q

How is cord compression

A

Urgent dexamethasone IV + surgical decompression

282
Q

What is duchenne muscle dystrophy?

A

Xp21 frameshift mutation deletion in dystrophin gene

283
Q

What is becker muscular dystrophy?

A

Xp21 missense mutation

284
Q

How is myotonic dystrophy inherited?

A

Autosomal dominant

285
Q

What are the symptoms for muscular dystrophy?

A
  • Calf pseudohypertrophy
  • Gower +ve
  • Symmetrical weakness
    Beckers = later, less severe
    Duchenne = Earlier, more severe
286
Q

How is muscular dystrophy diagnosed?

A

Bloods - Raised CK
GS = muscle biopsy stained

287
Q

How is muscular dystrophy treated?

A
  • Supportive MDT
  • Regular ECHO scan
  • Corticosteroid to slow progression
288
Q

What is hydrocephalus?

A

Accumulation of CSF in cranium

289
Q

What are the two types of hydrocephalus?

A
  • Communicating - no obstruction
  • Non-communicating - obstruction in CSF flow(mc)
290
Q

What are the risk factors for hydrocephalus?

A
  • Spina bifida
  • Dandy walker
291
Q

What are the symptoms of hydrocephalus?

A
  • Impaired upturn gaze
  • Gross cortical enlargement
  • Raised ICP symptoms
  • Effect on motor + speech milestones
292
Q

How is hydrocephalus diagnosed?

A
  • CT head = ventriculomegaly, obstruction
  • LP = Increased opening pressure
293
Q

What is the treatment for hydrocephalus?

A
  • VP shunt
  • Endoscopic ventriculostomy
294
Q

What are the symptoms of normal pressure hydrocephalus?

A

Wet (incontinent)
Wacky (arms)
Wobbly (ataxic gait)

295
Q

How is normal pressure hydrocephalus diagnosed?

A

LP = normal pressure
CT = ventriculomegaly + sulcal effacement

296
Q

How is normal pressure hydrocephalus treated?

A

VP shunting

297
Q

What is idiopathic intracranial hypertension?

A

Raised ICP in an overweight female

298
Q

What are the risk factors for IIH?

A
  • Female 20-50
  • Raised BMI
  • Vitamin A
  • Tetracyclines
  • COCP
  • Pregnant
299
Q

What are the symptoms of IIH?

A
  • Migraine mimic
  • Bilateral papilledema
  • Vision changes
300
Q

How is IIH diagnosed?

A
  • CT head
  • MRI head (torturous optic nerve)
  • LP - >250 opening pressure
301
Q

How is IIH treated?

A
  • Weight loss
  • Acetazolemide
302
Q

Where is the most common site for a dural venous sinus thrombosis?

A

Superior sagittal sinus

303
Q

What are risk factors for dural venous sinus thrombosis?

A
  • Factor V leiden
  • SLE
  • COCP
  • Pregnancy
  • Disseminated intravascular coagulation
304
Q

What are the symptoms of dural venous sinus thrombosis?

A
  • Headache - acute, sudden onset, N+V
  • Focal neuro (motor)
  • Seizures
  • Raised ICP
  • Papilledema
  • Reduced GCS
  • Vision changes
305
Q

How is dural venous sinus thrombosis diagnosed?

A

GS = MR Venogram
- CT + contrast - empty delta sign

306
Q

How is dural venous sinus thrombosis diagnosed?

A

LMWH

307
Q

What is meniere’s?

A

Excessive endolymph in labyrinth inner ear

308
Q

What are the symptoms of meniere’s?

A
  • 40-50y male with aural fullness
  • Drop attacks
  • Vertigo
  • Tinnitus
  • Unidirectional nystagmus
  • Romberg +ve
309
Q

How is Meniere’s treated?

A

Antihistamines + betahistine

310
Q

What is acoustic neuroma?

A

90% cerebellopontine tumour

311
Q

Which cranial nerves are affected in acoustic neuroma?

A

CN5+8

312
Q

What are the symptoms of acoustic neuroma?

A
  • Tinnitus
  • Hearing loss
  • Vertigo
  • Absent corneal reflex
313
Q

How is acoustic neuroma treated?

A

Urgent ENT referral +/- surgery

314
Q

What is benign paroxysmal positional vertigo?

A

Around 20s episodes of vertigo triggered by postural changes

315
Q

How is benign paroxysmal positional vertigo treated?

A

Epley manoeuvre + vestibular rehab

316
Q

What is vestibular neuritis caused by?

A

Post viral infection

317
Q

What are the symptoms of vestibular neuritis?

A
  • N+V
  • Tinnitus
  • No sensorineural hearing loss
318
Q

How is vestibular neuronitis treated?

A

Supportive treatment + antihistamine

319
Q

What is viral labyrinthitis caused by?

A

Post viral infection

320
Q

What are the symptoms for viral labyrinthitis?

A
  • N+V
  • Tinnitus
  • Sensorineural hearing loss
321
Q

How is viral labyrinthitis treated?

A

Supportive treatment + antihistamine

322
Q

What is optic neuritis?

A

Demyelinated optic nerve

323
Q

What are the symptoms for optic neuritis?

A
  • Central scotoma
  • Pale optic disc
  • Relative afferent pupillary defect
  • T2 white matter hyperintensity
  • Dichromatopsia
324
Q

What is central retinal artery occlusion?

A

Eye stroke

325
Q

What are the symptoms for central retinal artery occlusion?

A
  • Amorosis fugax
  • Relative afferent pupillary defect
  • Cherry red macular spot
326
Q

What is acute angle glaucoma?

A

Blockage in aqueous humour - raised intraoccipital pressure + optic nerve damage

327
Q

What are the symptoms of acute angle glaucoma?

A
  • Painful red eye
  • Halos around lights
  • Hazy cornea
  • N+V
328
Q

How is acute angle glaucoma treated?

A

Pilocarpine + acetazolomide

329
Q

What are flash and floaters a sign of?

A

Retinal detachment

Phase 3a (6 decks)

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