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Progress test study > Neurology 2.0 > Flashcards

Neurology 2.0 Flashcards

1
Q

Nystagmus is associated with a lesion of what cranial nerve and why?

A

CN VIII Things like vertigo or an vestibular defect can cause nystagmus

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2
Q
  • pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours
  • Typically last 4-12 weeks
  • intense sharp, stabbing pain around one eye (recurrent attacks ‘always’ affect same side)
  • patient is restless and agitated during an attack

What is this and what else is a telling symptoms

A

Cluster Headaches

  • accompanied by redness, lacrimation, lid swelling
  • nasal stuffiness
  • miosis and ptosis in a minority
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3
Q

Treatment for a cluster Headache Attack.

Prophylaxis?

A

Acutely

  • 100% Oxygen
  • Triptan

Prophylactically

  • Verapamil
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4
Q

What things are risk factors for cluster headaches

A

Being male, smoking, another family member, alcohol can exacerbate

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5
Q

Chronic paroxysmal hemicrania?

A

Multiple (5+) short (5-10min) headaches that are centered around the eye (VI)

*CH are usually longer >15min and more common in men

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6
Q

What is the first line treatment for Chronic paroxysmal hemicrania

A

Indomethacin

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7
Q

What are you ‘red flags’ for headaches?

A
  • sudden onset
  • severe and debilitatin pain
  • fever
  • vomiting
  • disturbed consciousnes
  • max in the morning
  • worse with bending/cough/sneezing
  • neuro symptoms and signs
  • “new” in elderly
  • you obese female
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8
Q

Probable cause of an acute headache?

A

Respiratory tract infection

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9
Q

Probable cause of chronic headaches?

A

Tension-type

Combination

Migraine

Transformed migraine

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10
Q

Describe a tension-type headache

A
  • Symmetrical tightness
  • episodic or chronic
  • Last for hours and recurr each day
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11
Q

What is the mnemonic to remember cerebellar disease symptoms and what are they?

A

D ysdiodochokinesia: This is this inability to perform rapid alternating movements
A taxia
Nystagmus

Intention tremor
Slurred staccato speech
Hypotonia

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12
Q

How to remember glascow coma score?

A

654 MoVE

Motor (6 points) Verbal (5 points) Eye opening (4 points).

Motor response

  1. Obeys commands
  2. Localises to pain
  3. Withdraws from pain
  4. Abnormal flexion to pain (decorticate posture)
  5. Extending to pain
  6. None

Verbal response

  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None

Eye opening

  1. Spontaneous
  2. To speech
  3. To pain
  4. None
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13
Q

ABCD2

A

used to assess a patient’s stroke risk after a transient ischaemic attack.

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14
Q

CHA2DS2VASC

A
  • CHF hx +1
  • Hypertension +1
  • Age >75 +2
  • Diabetic +1
  • Stroke/TIA +2
  • Vascular disease Hx +1
  • Age 64-75 +1

scoring tool used to assess the risk of stroke in patients with atrial fibrillation

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15
Q

Features of a subdural haemorrage?

What vessels are impacted?

A
  • fluctuating consciousness
  • raised ICP
  • headache
  • commonly seen in trauma eg; oldperson/alcohol and falling over
  • damage too the bridging vessels between cortex and venous sinuses
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16
Q

What is an Acoustic neuroma

what will you see with big ones?

A

more correctly called vestibular schwannomas

noncancerous growth that develops on the eighth cranial nerve.

cranial nerve VIII: hearing loss, vertigo, tinnitus
If a large tumour other CN may be involved:
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy

17
Q

When you are investigating a potentially acoustic neuroma/vestibular schwanomma, what imaging do you want to be doing?

A

MRI of cereballar-pontine angle

OR intracranial

18
Q

Three main subtypes of Ischaemic Stoke, what should you be thinking about with each

A
  • Embolic Strokes: AF
    • ECG → telemetry → Holter moniter
  • Thrombotic Stroke: Carotid stenosis
    • US
  • Hypoperfusion Stroke: Low CO
    • Shock?
19
Q

What stroke is NOT associated with Carotid stenosis

A

POCS- Posterior Circulation Stroke Syndrome

As it impacts the posterior aspect of the circle of willis

20
Q

What ELSE would you see wil POCS apart from 2 of the classical stroke signs?

A
  • Cerebellar signs:
  • Vestibular signs: vertigo
  • Brainstem signs: Change in HR, BP, RR
21
Q

What type of ischaemic stroke is associated with HTN?

A

Lacunar stroke

22
Q

If someone has a homonymous quadrantopia, where will the lesion be?

A

PITS

Parietal: inferior

Temporal: Superior

Always contralateral to the site!

23
Q

What do you prescribe for suspected Bell’s Palsy?

A

Prednisolone and lubricating Eye drops

patients may not be able to close their eyes and may also need eye tapes!

24
Q

A 61-year-old man presents with a two-week history of a sharp, stabbing pain over his right cheekbone. He describes the pain as ‘very severe’ and ‘coming in spasms’. It typical lasts for around one minute before subsiding. The pain can be triggered by shaving and eating. Examination of his eyes, cranial nerves and mouth is unremarkable. What is the most likely diagnosis?

A

Trigeminal neuralgia

Unilateral pain commonly evoked by light touch, including washing, shaving, smoking, talking, and brushing the teeth (trigger factors), and frequently occurs spontaneously

25
Q

What is Guillian Barre?

What are the main initial symptoms?

A

An immune-mediated demyelination of the PNS, often triggered by an infection.

  • Progressive weakness “tingling/numbness → flaccid paralysis” of all four limbs: ascending, hands +feet first.
  • Mild sensory involvement
  • Back pain
  • areflexia
  • Resp depression
  • diplopia
  • autonomic involvement; eg urinary incontinence
26
Q

What bacteria commonly triggers guillian barre?

A

Campylobacter

so look out for previous gastro symptoms in the Hx!!

27
Q

How quickly does Gullian Barre progress?

A

hours to weeks.

Symptoms usually peak ~2-4weeks

28
Q

How is it that a campylobacter, CMV or EBV can cause Gullian Barre?

A

They all have capsules that contain antigens have similar structures to the axons of myelocytes

and when the body creates an antibody response both the virus and muscle cells are attackes

“molecular mimicry”

29
Q

How do you diagnose Gullian Barre?

A

Bilateral weakness

Areflexia (absent reflexes)

LP shows high protein + low WBC in CSF

EMG may show decrease muscle velocity

30
Q

How do you treat Guillain Barre

A

Plasmapheresis

Immunoglobulins

??resp support??

Corticosteriods are AVOIDED

31
Q

What is the triad you will see with normal pressure hydrocephalus?

A
  1. Urinary incontinence
  2. Dementia + bradyphrenia (slow thought)
  3. Gait abnormality

These symtpoms will develop over a few months

32
Q

What will you see on imaging with Normal Pressure Hydrocephalus?

A
  • Hydrocephalus + an enlarged 4th ventricle
33
Q

Normal pressure hydrocephalus is a common cause of _____ in the elderly, and is due to what?

A

Common cause of dementia in the elderly

Due to inadequant CSF absorption by arachnoid villi

34
Q

What are the commonly known side effects of electroconvulsive therapy

A
  • Nausea
  • Short term memory impairment
  • Headaches
  • Cardiac arrhythmias
35
Q

What do you use blood test wise to distinguish between a true seizure and a pseudo seizure

A

Measure prolactin (increased after real seizures)

36
Q

What are the 2 important causes of status epilepticus to rule out first?

A

Hypoxia and hypoglycaemia

37
Q
A

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