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Helena's finals > neurology 2 > Flashcards

neurology 2 Flashcards

1
Q

work up post stroke

A 
long term ECG + 24 hour tape - AF
HTN
lipids
HbA1c
carotid dopplers 
cardiac echo for thrombus
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2
Q

most common cause of peripheral neuropathy

A

diabetes

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3
Q

peripheral neuropathy causes

A 
Alcohol
B12/folate
CKD
Diabetes
Everything else eg. drugs (chemo, isoniazid)
syphillis
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4
Q

down and out eye

A

3rd nerve (oculomotor) palsy

pupil dilated (parasympathetic fibres) - surgical cause eg. tumours, aneurysms

pupil not dilated - medical cause eg. diabetes, vascular disease

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5
Q

6th nerve palsy cause

A

raised ICP - 6th nerve has longest intracranial path (false localising sign)

Multiple sclerosis

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6
Q

forhead sparing 7th nerve palsy

A

stroke, multiple sclerosis ie. upper motor neurone

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7
Q

NOT forhead sparing 7th nerve palsy

A 
bell's palsy
ramsy hunt
Guillain barre syndrome
Lyme disease
local malignancy eg. parotid
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8
Q

shen do you start parkinsons treatment

A

when symptoms are affecting quality of life

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9
Q

acute multiple sclerosis first line

A

methylprednisolone

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10
Q

Cerebellum signs

A 
Dysdiadokinesia
Ataxia (broad based)
Nystagmus 
Intention tremor
Slurred speech 
Hypotonia

Dysarthia

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11
Q

Causes of cerebellar syndrome

A 
MS
Stroke
Tumour 
Drugs (phenytoin)
Alcohol
Paraneoplastic syndrome — treat underlying cancer
Hypothyroidism
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12
Q

Causes of motor neurone disease

A

Sporadic disease of anterior horn cells of the motor pathway

Genetic forms - SOD1 mutation (A Dom)

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13
Q

Mx MOtor neurone disease

A

Riluzole - increases life expectancy for 3 years

Supportive MDT 
- SALT
Communication aids 
Dietician - gastrostomy due to loss of swallowing 
Psychology

Ventilation —- life threatening resp failure

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14
Q

Proximal myopathy
Causes
Signs

A

shoulder girdle/ hip and thigh muscle weakness

Causes
Inherited:
- duchennes, beckers (pseudo calf hypertrophy)
- muscular dystrophy type 1&2

Acquired:
Infection - hiv, influenza
Inflammation - RA, dermato/polymositis, sarcoidosis
Endocrine - addisons, Cushing Diseas
Autoimmune - thyroid disease, SLE
Drugs - alcohol, steroids

Signs
- walking aids
- muscle mass is normal, symmetrical proximal muscle wasting is late sign
- underlying cause
- muscle tenderness!!!!!! – disorder of blood vessels
- difficult standing without arms
Normal sensation, reflexes

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15
Q 
dermato vs poymysositis
definition
causes
investigations
treatment
A

inflammatory myositis - dermatomyositis involves the skin

polymyositis is a diagnosis of exclusion of other causes of inherited and acquired myopathies

causes of polymyositis: autoimmune, connective, drugs (statins), infections (HIV), idiopathic
causes of dermatomyositis: cancer (ovary, GI, breast)

signs
inspection: normal/ symmetrical proximal muscle wasting, skin (heliotrope rash, gottren’s papules)
palpation: muscle tenderness
facial weakness +/- dysphagia
power: proximal muscle weakness (unable to stand from a squatting position, difficulty lifting things, difficulty walking up stairs
normal reflexes or reduced if severe muscle atrophy
normal sensation

Ix. Drug history, elevated CK, EMG , muscle biopsy is diagnostic

Mx. steroids, steroid sparing agents (azathioprine, methotrexate)

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16
Q

causes of drug induced parkinsonism

A

dopamine antagonists such as antixpsychotics

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17
Q

essential/dystonic tremor vs parkinsons tremor

A

essential tremor:

  • improves with alcohol
  • symmetrical tremor

parkinsons tremor

  • asymmetrical
  • pill rolling
  • worse at rest
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18
Q

what sleep issue may preceed parkinsons disease

A

rapid eye movement sleep disorder: poor sleep, acting out dreams

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19
Q

what roportion of patients with parkinsons disease have depression

A

one third

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20
Q

examination findings for parkinsons

A

inspection:

  • walking aids
  • mask like face
  • stooped posture
  • shuffling gait, small steps, loss of arm swing on one side, difficulty turning, unsteadiness, difficulty initiating gait

tone - assymmetrical cogwheeling, tremor, rigidity

power function - repetitive hand movements like walking the thumb along the fingers

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21
Q

subacute combined degeneration of the cord

examination findings

A

UMN (myelopathy) + distal LMNs (length dependent neuropathy)

inspection

  • walking aids
  • normal/ proximal muscle mass wasting
  • anaemia

tone normal

power normal

reflexes: brisk, extensor plantar responses
sensation: vibration and proprioception loss, paraesthesia, loss of sensation disttally
coordination: limb incoordination
gait: ataxic, romberg’s sign positive

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22
Q

special test in subacute combined degeneration of the spinal cord

A

romberg test - cant stay balanced with eyes closed

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23
Q

Lhermitte’s phenomenon

A

intrinsic lesion of cervical cord

passive flexion of the neck gives electric shock sensation down the back

multiple sclerosis and subacute combined degenereation of the spinal cord

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24
Q

signs of B12 deficiency

A 
megaloblastic anaemia
neuropathy
myelopathy
optic atrophy
pyschiatric/ cognitive impairment 
glossitis
autonomic neuropathy
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25
Q

Charcot marie tooth disease

  • cause
  • diagnostic investigations
  • features of disease
A

autosomal dominant chr 17 - sensorimotor neuropathies
patients present before age 20 - progressive
peripheral nerves DESTRUCTION

Ix. genetic desting

classic type 1A disease

  • distal > upper limb muscle wasting
  • inverted champagne bottle appearance – preserves thigh muscles
  • foot deformities: toe clawing, hammer toes, charcot joints, pes cavus (high arch)
  • wasting of small muscles in hand – ulnar nerve damage
  • tremor
  • scoliosis

tone normal/ reduced
distal weakness
absent reflexes
sensation lost distally in all modalities

high stepping gait due to bilateral foot drop (popliteal nerve)

26
Q

Carotid endartectomh

A

75% stenosis symptomatic

27
Q

Heels and toes walking

Which nerves regions

A

Heels L4/5

Toes S1/2

28
Q

Triceps reflex root

A

C7/8

29
Q

Biceps reflex root

A

C5/6

30
Q

Brachioradialis root

A

C6

31
Q

Knee reflex root

A

L3/4

32
Q

Ankle reflex root

A

S1/2

33
Q

Tuning fork nerves

A

128Hz

34
Q

causes of small pupil

A

miosis
anisocoria (different sizes) - degree of anisocoria is worse in the dark
- physiological: no more than 1mm difference in diameter between the eyes and equal in light
- pilocarpine (pharmacological)
- Horners (ptosis, miosis, anhidrosis)
- Argyll Robertson pupil - tertiary syphilis, sudden constriction on accomdation, both pupils miosis but to different degress. do not react to light
- opiate use (bilateral)
- multiple sclerosis

topical cocaine solution

  • if equal dilation = physiological
  • if anisocoria = horner’s
35
Q

horner’s where is the lesion

A

hydroxy amphetamine 1% solution
pupils dilate equally = central lesion
anisocoria remains = post ganglionic lesion

36
Q

mx syphilis

A

penicilin G IV –> IM for a total of 3 weeks

HIV serology

37
Q

congenital syphilis

A

Hutchinson triad

  1. interstitial keratitis - inflammation of the cornea
  2. hutchinson’s incisors - widly spaced teeth
  3. Cranial 8 deafness
38
Q

internuclear opthalmoplegia findings

A

cause: interruption of the medial longitudinal fasciculus that connects the nuclei of cranial nerves 3 and 6 to coordinate them

unilateral - ipislateral failure to adduct on contralateral gaze + nystagmus in other eye
* horizontal diplopia

bilateral - exotropic eyes (eyes look out away from nose), vertical nystagmus
– Multiple sclerosis

39
Q

bulbar palsy

  • definition
  • where is the lesion
  • causes
  • signs
A

lower motor neuron syndrome involving the lower cranial nerves 11, 12

lesions can be anywhere from the nuclei in the medulla to the lower motor neuron

causes: stroke (nerve bodies in the brainstem), motor neurone disease, medullary infarction, brainstem tumours, guillain barre, lyme disease, congenital

signs:
- NG tube for feeding
- saliva at side of mouth
- tongue fascivulations (but can move rapidly from side to side)
- say ahhh (failure of soft palate to elevate)
- dysphagia
- lip, tongue, palatal weakness
- note and quality of speech – nasal
- absent gag reflex/ jaw jerk

40
Q

pseudobulbar palsy

A

BILATERAL UPPER motor neurone syndrome involving 11, 12

lesions from the cortex to the nuclei in the medulla

causes: motor neuron disease, bilateral hemispheric infarction, high brainstem tumour, multiple sclerosis, trauma

signs:
- signs:
- NG tube for feeding
- saliva at side of mouth
- spastic tongues (do not fasciculate) + slow/spastic when moved from side to side
- say ahhh (failure of soft palate to elevate)
- dysphagia
- lip, tongue, palatal weakness
- note and quality of speech – high pitched, dysarthria
- absent gag reflex
- brisk jaw jerkjaw jerk

41
Q

MND and bulbar palsy

A

typicall mixed bulbar/pseudobulbar palsy

- fasciculating tongue with brisk jaw jerk

42
Q

where does the spinal cord end

A

L1/2 at the conus

43
Q

cauda equina syndrome symptoms

A

pain in lower back
variable paralysis/ sensory disturbance of lower limbs
saddle anaesthesia
bladder/bowel/sexual disturbance

LMN signs

44
Q

cauess of cauda equina syndrome

A

***lumbar disc prolapse
traumatic

infective abscess 
ankylosing spondylitis 
vascular (epidural haematoma) 
neoplastic 
iatrogenic (spinal anesthesia)
45
Q

mx cauda equina

A

urgent decompression by neuro surgeons

46
Q

pilocarpine uses

A

reduce pressure inside the eye and treat dry mouth

angle closure glaucoma until surgery can be performed, ocular hypertension, primary open angle glaucoma, and to bring about constriction of the pupil following its dilation.

47
Q

signs and symptoms of myasthenia gravis

A

bilateral ptosis
diplopia at extremes of gaze
fatiguable ptosis (ask patient to look up)
facial weakness
dysphagia
painless fatiguable muscle weakness - check power, raise arms up and down then re-check power

normal reflexes, sensation

48
Q

tenilon test

A

myasthenia gravis

IV edrophonium temporarily improves weakness but not done in elderly due to cardiac side effects

49
Q

cervical myelopathy

A

progressive compression of the spinal cord at the cervical lesion - denegerative, neoplastic, infective, trauma

LMN at the level of the lesion
UMN signs below

walking aid
increased tone, clonus 
pyramidal weakness
brisk reflexes
loss of sensation (vibration, proprioception)

spastic stiff legs and foot drop

50
Q

hoffman sign

A

finger flick the middle nail
index finger and thumb flex in response

multiple sclerosis, cervical myopathy

51
Q

pyramidal weakness

A

UMN weakness
upper limb flexors stronger than extensors
lower limb extensors stronger than flexors

52
Q

foot drop nerve involved

A

peroneal nerve injury

53
Q

spinal cord stroke

A

rare
usually anterior spinal arteries –> loss of pain and temperature, preservation of proprioception and vibration (dorsal medial lemniscus supplied by posterior spinal arteries)

54
Q

transverse myelitis

A

inflammation of the spinal cord

can be isolated or occur with MS

can occur following bacterial/ viral infections (especially where there is a rash)

ascending weakness, sensory disturbances are common

55
Q

carotid stenosis

A

> 70% stenosis of at least one carotid endartectomy – mx. endartectomy or stenting

> 50% surgical if symptomatic

<70% stenosis - antiplatelets, statins, lifestyle changes

56
Q

optic neuritis

A

pain in one eye on movement
blurred vision
worsened with heat - hot shower/ exercise *Urthoff’s sign)
pale optic disc

57
Q

Multiple sclerosis vs Guilain barre as CSF analysis

A

MS – oligoclonal bands only in the CSF (not in serum)
GBS – systemic so the oligoclonal bands are in the CSF & serum

think where does the inflammation start

58
Q

Sub arachnoid haemorrhage imaging

A

CT scan – may not show anything initially, takes 6hrs

CSF — xanthochromia 4-12 hours after

59
Q

normal CSF opening pressure

A

10-18 cm H20

60
Q

what does blood, oedema and ischaemia look like on CT

A

blood = white
oedema (ischaemia/infarct) = grey
normally infarcts dont show anthing on CT

61
Q

work up for first seizure in adult life

A

space-ocupying lesions - malignancy, neurocysticercosis
cerebral bleeds
metabolic disturbancs

immunocompromised (HIV): cryptococcus neoformns, TB, toxoplasmosis

Helena's finals (22 decks)

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