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3A med mine > Neurology > Flashcards

Neurology Flashcards

1
Q

Aside from levodopa, what medication groups might be used to treat Parkinson’s disease?

A

Monoamine oxidase B inhibitors(MAO-B inhibitors)
COMT inhibitors
Dopamine agonists
Amantadine
Anticholinergics

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2
Q

Aside from medications, what treatments are available for Parkinson’s disease?

A

Deep brain stimulation
Physio, SALT, OT

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3
Q

At what vertebral level is an LP taken?

A

L3/L4

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4
Q

Describe CSF analysis indicative of a bacterial infection

A

Opening pressure: High
Appearance: cloudy/yellow
Glucose: serum: low(<50%)
Protein: High: >1g/L
WWC: high-neutrophilia

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5
Q

Describe CSF analysis indicative of a fungal/TB infection

A

Opening pressure: High
Appearance: cloudy/fibrous
Glucose: serum: low(<50%)
Protein: High: >1g/L
WWC: high-lymphocytosis

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6
Q

Describe CSF analysis indicative of viral infection

A

Opening pressure: normal
Appearance: clear/cloudy
Glucose: serum:high: >60%
Protein: normal
WWC: high-lymphocytosis

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7
Q

Define a TIA

A

Sudden onset focal neurological deficit with a vascular aetiology typically lasting <1hr but always <24 hours
Completely resolves

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8
Q

Descirbe the clinical features of Brown-Sequard syndrome

A

Ipsilateral weakness below lesion
Ipsilateral loss of proprioception and virbation sensation
Contralateral loss of pain and temperature sensation

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9
Q

Descirbe the symptoms of a Wallenberg’s stroke

A

Ipsilateral Horner’s syndrome
Ipsilateral loss of pain and temperature sensation in face
Contralateral loss of pain and temperature sensation in trunks and limbs
Ipsilateral cerebellar signs
Ipsilateral bulbar muscle weakness
Diplopia

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10
Q

Describe a focal saware seizure

A

Patients retain consciousness experiencing only focal symtpoms
Usually no ictal symptoms

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11
Q

Describe a focal seizure with impaired awareness

A

Patients lose consciousness, usually post an aure or at seizure onset
Commonly originate from the temporal lobe

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12
Q

Describe a myoclonic seizure

A

Sudden jerks of a limb, trunk or face

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13
Q

Describe a secondary generalised seizure

A

Focal seizure that evolves into a bilateral tonic-clonic seizure

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14
Q

Describe a tonic clonic seizure

A

Loss of consciousness
Stiffening(tonic) and jerking(clonic) of limbs
Post-ictal confusion common

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15
Q

Describe an absence seizure

A

Brief pauses for <10 seconds

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16
Q

Describe an atonic seizure

A

Sudden loss of muscle otne causing the patient to fall with consciousness retained

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17
Q

Describe some potential signs/symptoms of brain metastases

A

Headache: worse on waking, lying down or with coughing/straining
Raised ICP
Neuro deficits
Cushing’s reflex
Systemic: weight loss, night sweats, fevers etc

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18
Q

Describe the acute management of a cluster headache

A

100% oxygen-usually effective in <10 minutes
SC triptan

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19
Q

Describe the acute management of a migraine

A

Avoid triggers
Oral triptan +NSAID OR oral triptan+ paracetemol(may use nasal tripatn especially in younger people
Non-oral metoclopramide or prochlorperazine and add non-oral NSAID/triptan

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20
Q

Describe the acute management of an ischamic stroke

A

Rule out haemorrhagic: NCCT head
Aspirin 300mg orall/rectally
<4.5 hours post onset: thrombolysis with IV alteplase
CT/MRI angiography
Mechanical thrombectomy

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21
Q

Describe the acute management of an MS flare?

A

High dose IV methylprednisolone for 5 days
Reduce duration or relapse not severity
Rule out infection

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22
Q

Describe the aetiology of a brain abscess

A

Usually contiguous spread of infection from sinusitis, otitis media or dental infection
Haematogenous spread from distant sources; endocardities etc
Direct inoculation: trauma/neurosurgery

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23
Q

Describe the aetiology of a TIA

A

MC: Embolism: often from atherosclerotic plaques in the heart
Lacunar
Haemodynamic compromise(stenosis of major artery)

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24
Q

Describe the aetiology of acoustic neuroma

A

Develop from Schwann cells of vestibulocochlear nerve
Majority are sporadic cases
Can be associated with NF2

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25
Q

Describe the aetiology of Bell’s palsy

A

Unknown
Linked to HSV1
ebv
vzv

26
Q

Describe the aetiology of Charcot neuropathy

A

DM(mc)-> microvascular disease, autonomic and peropheral neuropathy-> cumulative damage to joints
Also:
Chronic alcohol abuse
Syringomyelia
Syphilis

27
Q

Describe the aetiology of chronic fatigue syndrome

A

Unknown
Triggers like EBV
Psychological stress

28
Q

Describe the aetiology of diabetic peripheral neuropathy

A

Chronic hyperglycaemia-> accumulation of advanced glycation end products, oxidative stress and inflammatory pathways

29
Q

Describe the aetiology of Duchenne muscular dystrophy

A

X linked recessive-> mutation in dystrophin genes

30
Q

Describe the aetiology of encephalitis

A

HSV1 responsible for 95% of cases in adults
Also: HSV2, CMV, EBV, VZV, HIV
Autoimmune encephalitis: NMDA receptor antibody associated encephalitis

31
Q

Describe the aetiology of epilepsy

A

Idiopathic generalised epilepsy
:Childhood absence
Juvenile absence
Juvenile myoclonic
generalised tonic clonic
Structural:
Stroke
Trauma
Malformations
Genetic
Infectious
Metabolic
Immune
Unknown

32
Q

Describe the aetiology of essential tremorr

A

Not fully understood
50% of cases have an autosomal dominant trait

33
Q

Describe the aetiology of Guillain Barre syndrome

A

1-3 weeks post infection-mc Campylobacter
Others: mycoplasma and EBV
40% idiopathic
Others: CMV, HIC, hepatitis A, vaccinations

34
Q

Describe the aetiology of herpes zoster ophthalmicus

A

Varicella zoster virus which remains dormant in the trigeminal ganglion following chickenpox, reactivates andn spreads along the opthlamic division of the trigeminal nerve

35
Q

Describe the aetiology of Huntington’s disease

A

Autosonomal dominant mutation involving excessive repetition of CAG nucelotide in huntingtin gene
Gradual degeneration of caudate nucleus and putamen

36
Q

Describe the aetiology of ischaemic strokes

A

Thrombotic: thrombus wihtin artery supplying blood to brain(atherosclerosis)
Embolic: embolus from elsewhere in the body

37
Q

Describe the aetiology of meniere’s disease

A

Dilatoin of endolymphatic spaces of membranous labyrinth resulting in an increased fluid pressure within the inner ear

38
Q

Describe the aetiology of MS

A

Combination of genetic and environmental factors including potential viral pathogens
CD4 mediated destruction og oligodendrogial cells and humoral response to myelin binding protein

39
Q

Describe the aetiology of neurofibromatosis type 1

A

Mutation on chromosome 17 which codes for neurofibromin(tumour suppressor protein)

40
Q

Describe the aetiology of neurofibromatosis type 2

A

Mutation on chromosome 22->merlin-> tumour suppressor protein important in schwann cells resultling in schwannomas

41
Q

Describe the aetiology of SAH

A

MC: head injury
LC: spontaenous
Berry aneurysm: 85% of cases
AVM’s
Pituitary apoplexy
Myocitic(infective) aneurysms

42
Q

Describe the aetiology of sub-acute combined degeneration of the spinal cord

A

Anything that can cause B12 deficiency:
Pernicious anaemia
Malabsorption syndromes
Dietary deficiencies
Recreational nitrous oxide inhalation

43
Q

Describe the aetiology of trigeminal neuralgia

A

Primary-idiopathic or secondary
Secondary causes include:
Malignancy-nerve compression
AVM
MS
Sarcoidosis
Lyme disease

44
Q

Describe the causes of mononeuropathies

A

Fixed: Nerve compression against hard surface, entrapment of nerves in narrow anatomical spaces
Transient: Repetitive actions that cause trauma to neuron

45
Q

Describe the clinical features of a cluster headache

A

Severe intense stabbing sharp pain aorund one eye
Conjunctival lacrimation, redness, lid swelling
Mitosis/ptosis
Attacks last 15 minutes-2 hours
Generally attacks in clusters for 4-12 weeks then remission for months/years

46
Q

Describe the clinical features of a tension headache

A

Episodic primary headache
‘tight band’ or pressure sensation, usually bilateral
Lower intensity than migraine
No aura, n+v
Related to stress
May co-exist with migraine

47
Q

Describe the clinical features of idiopathic intracranial hypertension

A

Non-pulsatile bilateral headaches, worse in the morning or after bending forwards
Morning vomiting
Visual disturbances: transient visual darkening/loss-> optic nerve ischaemia
Bilateral papilloedema on fundoscopy
6th nerve palsy: horizontal diplopia
Pulsatile tinnituss
Photopsia

48
Q

Describe the clinical features of narcolepsy

A

Typical onset in teenage years
Hypersomnolence
Cataplexy(sudden loss of muscle tone often triggered by emotion)
Sleep paralysis
Vivid hallucinations on going to sleep/waking up

49
Q

Describe the clinical features of normal pressure hydrocephalus

A

‘Wet, wacky and wobbly’
Incontinence
Dementia
Magnetic gait-often appear as though ‘stuck’ can’t lift feet off floor

50
Q

Describe the direct movement pathway in the substantia nigra

A

Excitatory
Increases thalamus activity-> increase movement

51
Q

Describe the drivinfg rules for a patient with a TIA

A

Cannot drive until seen by a specialist
If dr happy and no lasting effects: cand rive again after 1 month
If lorry/bus: 1 year

52
Q

Describe the epidemiology of a cluster headache

A

Middle aged men
Smokers
Related to nocturnal sleep
Can be triggered by alcohol

53
Q

Describe the epidemiology of a subdural haemorrhage

A

Elderly: >65 years
Infants-shaken baby

54
Q

Describe the epidemiology of a TIA

A

Peak >70 years
M>F

55
Q

Describe the epidemiology of bell’s palsy

A

Peak incidence: 15-45 years
Higher prevalence in pregnant women

56
Q

Describe the epidemiology of central venous sinus thrombosis

A

F>M
20-35yrs

57
Q

Describe the epidemiology of charcot arthropathy

A

MC in pts with long standing DM
Middle aged and elderly population

58
Q

Describe the epidemiology of chronic fatigue syndrome

A

Peak: 30-40 years
F:M:2:1

59
Q

Describe the epidemiology of diabetic peripheral neuropathy

A

Common complication of both types of diabetes
Occurs in 50% of long term diabetic patients
Risk increases with duration of diabetes and poor glycaemic control

60
Q

Describe the epidemiology of Duchenne muscular dystrophy

A

Males predominnalty affected with females are carreirs(X linked)

3A med mine (12 decks)

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