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Pathology > neurology > Flashcards

neurology Flashcards

1
Q

what does a large pupil suggest?

A

III nerve palsy because there is parasympathetic deficit

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2
Q

what is Horner’s syndrome?

A

lack of sympathetic supply may be due to tumour or brainstem stroke.
myosis
ptosis
anhidrosis

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3
Q

where is the most common place for the carotid artery to become diseased?

A

carotid sinus

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4
Q

what type of stroke is the most common?

A

embolic

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5
Q

what will damage to Wernicke’s area result in?

A

receptive dysphasia

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6
Q

what is the least common type of intracranial haemorrhage?

A

extra dural

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7
Q

what mimics stroke?

A

subdural

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8
Q

how does subdural haemorrhage lead to symptoms?

A

the clot autolyses and this causes osmosis, rise in intracranial pressure then midline shift

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9
Q

how does subarachnoid haemorrhage kill?

A

vasospasm reduces the blood going to the brain

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10
Q

what can detect the time between muscle fibres contracting in NMJ problems like myasthenia gravis?

A

electromyography

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11
Q

in what diseases does the electron encephalography occipital rhythm slow?

A

dementia

epilepsy

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12
Q

what can visual evoked potentials be used for the diagnosis of?

A

MS

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13
Q

what antibiotic should be given for meningitis?

A

cefotaxime

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14
Q

what is petechial rash a sign of?

A

meningococcal septicaemia, NOT meningitis

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15
Q

what does botulism present with

A

descending paralysis and cranial neuropathy

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16
Q

what does stroke of the lenticulostriate arteries lead to?

A

ischaemia of the internal capsule and so deficit of anywhere on the contralateral side supplied by corticospinal tract

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17
Q

what are the features of a posterior cerebral artery stroke?

A

visual field loss and brainstem symptoms

may have macular sparing

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18
Q

risk factors for subdural haemorrhage

A

alcoholic
elderly
warfarin

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19
Q

what symptoms suggest haemorrhagic stroke rather than ischaemic?

A

vomiting
headache
drowsiness

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20
Q

why does intra-axial haemorrhage occur?

A

hypertension
lobar-Charcot Bouchard aneurysms
treat with catheter angiography

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21
Q

what viral infection is associated with MS?

A

EBV

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22
Q

what areas does MS mainly affect?

A

around the ventricles
white matter of spinal cord
some cortex

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23
Q

what happens in active areas of destruction in MS?

A

lymphocyte cuffing

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24
Q

what can MS and cervical cord compression cause?

A

Lhermitte’s phenomenon-electric shock when bend neck

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25
Q

in MS what is present in the CSF only?

A

inflammatory markers

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26
Q

what is the difference between tonic and clonic

A

in the clonic phase, muscles can relax so movments are larger but more spread apart

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27
Q

what is the archer pose?

A

ipsilateral flexion
contralateral extension
happens in frontal lobe seizures

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28
Q

what area will first be affected in syncope?

A

visual because it is a highly metabolic area

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29
Q

what is the commonest type of epileptic seizure

A

structural/focal

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30
Q

what is the treatment for generalised tonic clonic epilepsy?

A

sodium valproate

lamotrigine

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31
Q

what is the AED used for generalised myoclonic seizures?

A

sodium valproate

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32
Q

what is the treatment for focal epilepsy?

A

carbamazepine
sodium valproate
lamotrigrine

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33
Q

what is the most common complication of traumatic brain injury

A

raised intracranial pressure following brain swelling

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34
Q

which cranial nerves are associated with the brainstem?

A

all but I and II

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35
Q

what nerves are affected in jugular foramen syndrome?

A

9-12

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36
Q

causes of obstructive hydrocephalus?

A

tumour
blood
stroke of cerebellum obstruct foramen of Magendie or Luschka and cause expansion of 3rd ventricle

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37
Q

symptoms of raised ICP

A

headache, especially worse on waking
vomiting
decreased consciousness

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38
Q

what does the brainstem connect?

A

the thalamus and the spinal cord

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39
Q

which artery supplies the brainstem

A

basilar

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40
Q

why might coughing and straining lead to pain?

A

radicular pain, thoracic radiculopathy

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41
Q

causes of spinal cord compression

A 
tumour
disc prolapse
TB
granuloma
vertebral body destruction and lipping
epidural abscess
epidural haemorrhage
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42
Q

differentials of spinal cord compression

A

frontal lobe infarct
MS
Guillian Barre
B12 deficiency

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43
Q

symptoms of radiculopathy (LMN)

A

stabbing/dull arm pain
dull reflexes
weakness
Lhermitte’s phenomenon

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44
Q

where does radicular pain radiate

A

below the lesion

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45
Q

causes of radiculopathy

A

trauma
herpes zoster
tumour

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46
Q

what will a lesion of L5 lead to?

A

loss of dorsiflexion so foot drop-deep peroneal nerve>tibialis anterior

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47
Q

what will a lesion of S1 lead to

A

loss of plantar flexion

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48
Q

why is mannitol used if a patient has fixed dilated pupil?

A

the parasympathetic fibres on the outside of III have been compressed, this indicates raised ICP, mannitol increases diuresis.

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49
Q

what will increased cranial pressure lead to?

A

decreased cranial perfusion pressure

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50
Q

which muscle is likely to be first affected by LMN problems?

A

first dorsal interosseus

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51
Q

which muscles are likely to be affected first in peripheral neuropathy?

A

distal, glove and stocking-this is opposite to myopathies

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52
Q

what is the pyramidal pattern of weakness?

A

due to upper motor neurone lesion/stroke, it’s where flexion is strong in the arm and extension is strong in the leg

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53
Q

what change in muscle tone is associated with weakness

A

spasticity-clasp knife reflex

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54
Q

symptoms of brain tumours

A

raised ICP (headache, decreased GCS)
progressive neurological deficit
epilepsy (new onset focal seizures)
lethargy

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55
Q

what are the most common primary brain tumours

A

astrocytomas-4th stage is glioblastoma multiforme

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56
Q

which muscle fibres supply stretch receptors?

A

gamma motor neurones

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57
Q

what can lead to cerebellar dysfunction

A

genetic defects

aquired-toxic (AED, alcohol),immune mediated, neurodegenerative

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58
Q

symptoms of cerebellar dysfunction

A

ataxia
nystagmus
intention tremor
slurring speech-scanning dysarthria

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59
Q

features of chronic pain

A

can be distracted by activity-worse at night
history of associated condition
electric shocks or shooting or dull and poorly localised
associated with depression

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60
Q

how is neuropathic pain treated

A

gabapentin, physio, exercise

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61
Q

symptoms of Duchenne’s

A

calf pseudohypertrophy
weakness
Gower’s sign-hands to climb up legs

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62
Q

what does dystrophin do?

A

attaches actin to dystrophin associated protein complex, this stabalises the sarcolemma

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63
Q

what is bulbar palsy?

A

LMN problem of 9-12, symptoms are increased jaw jerk, difficulty swallowing, nasal voice, slurring speech

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64
Q

why might thymomectomy be conducted?

A

myasthenia gravis

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65
Q

symptoms of anterior cerebral artery stroke

A

contralateral leg weakness and parasthesia
akinetic mutism
incontinence
drowsiness

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66
Q

symptoms of middle cerebral artery stroke

A 
arm and leg paresis and parasthesia
facial droop
aphasia
hemianopia
cognitive change
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67
Q

symptoms of posterior cerebral artery stroke

A

contralateral homonymous hemianopia
visual agnosia
headache

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68
Q

posterior circulation stroke

A 
dysarthria
N&V
altered consciousness
visual disturbance
pseudo or bulbar palsy
hemi or tetraparesis
possibly brainstem symptoms
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69
Q

treatment for ischaemic stroke

A

alteplase given in 4.5 hours, not if they have cancer, clotting disorder, liver disease, acute pancreatitis, recent major surgery, haemorrhage

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70
Q

what can burr holes be used for

A

subdural haematoma

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71
Q

what does dexamethasone do?

A

decreases ICP

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72
Q

what do oligoclonal bands show?

A

MS

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73
Q

what kind of blindness will a parietal lobe lesion lead to?

A

inferior homonymous quandrantanopias

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74
Q

what are lobar strokes caused by?

A

cerebral amyloid angiopathy

75
Q

what would you give an ischaemic stroke patient if it is over 4.5 hours since their stroke?

A

clopidogrel and aspirin

76
Q

what diseases is subarachnoid haemorrhage associated with?

A

PKD
coarction of the aorta
Ehlers-Danlos syndrome

77
Q

if a patient has a lucid interval following trauma, what is the most likely diagnosis?

A

extradural haemorrhage

78
Q

if a patient has fluctuating symptoms of headache, vomiting and seizures, what is the most likely diagnosis?

A

subdural haemorrhage

79
Q

what kind of haemorrhage should you not do lumbar puncture?

A

extradural or subdural

80
Q

which branch of the trigemminal nerve is most affected in trigemminal neuralgia?

A

mandibular

81
Q

how does carbamazepine work?

A

inhibits Na channels

82
Q

how does Lamotrigine work

A

inhibits glutamate release

83
Q

what are the roots of the sciatic nerve?

A

L4-S3

84
Q

what is sciatica?

A

compression of the nerve roots of the sciatic nerve-it is a radiculopathy leads to unilateral leg pain

85
Q

what is the treatment for radiculopathy or myelopathy?

A

conservative-with NSAIDs, unless the patient shows neurological symptoms

86
Q

what bacteria is most likely to cause Guillian Barre?

A

campylobacter jejuni

87
Q

3 main symptoms of brain tumour

A

headache
new onset seizures
progressive neurological defiict

88
Q

what is the most common cause of meningitis?

A

strep pneumoniae (+ve cocci)

89
Q

define dementia

A

decline from previous normal cognitive function, enough to impair ADL

90
Q

what is neutropenic sepsis?

A

febrile neutropenia, treated with vancomycin

91
Q

what do the lenticulostriate arteries branch from?

A

the middle cerebral artery

92
Q

where are berry aneurysms commonly found?

A

PICA or anterior cerebral bifurcations

93
Q

what area of the brain does Alzheimer’s affect?

A

medial temporal and parietal

94
Q

which study shows dementia is prevented by healthy behaviours?

A

Caerphilly

95
Q

frontal symptoms

A

contralateral hemiparesis
personality change
Broca’s-expressive, non fluent dysphasia
can’t plan

96
Q

temporal symptoms

A

dysphagia
contralateral homonymous hemianopia
amnesia

97
Q

parietal symptoms

A

contralateral hemisensory loss
decreased 2 point discrimination
dysphagia

98
Q

occipital symptoms

A

polyopia

contralateral visual field defects

99
Q

common sites of embolic stroke

A

MCA

PICA

100
Q

what suggests a stroke may be ischaemic

A

previous TIA
ischaemic heart disease
DVT

101
Q

secondary causes of headache

A

subarachnoid haemorrhage
meningitis-all over head
giant cell arteritis, scalp tenderness and jaw claudication
trauma, at site of injury
raised ICP worse on straining, lying down, idiopathic
medication overuse from mixed analgesics, triptans

102
Q

what degenerative neurone diseases have sphincter and sensory distrurbance

A

MS

polyneuropathies like GB, DM

103
Q

most common motor neurone disease presentation

A

amyotrophic lateral sclerosis

104
Q

causes of bulbar palsy

A 
progressive bulbar palsy (MND)
brainstem tumour
Guillian Barre
polio
myasthenia gravis
105
Q

what is affected in myasthenia gravis?

A

post synaptic nicotinic receptors are destroyed by IgG immunity

106
Q

side effects of cholinergic stimulation

A 
salivation
diarrhoea
lacrimation
sweating
vomiting
miosis
107
Q

what is Horner’s syndrome characterised by?

A

miosis
ptosis
anhydrosis

108
Q

what is Bell’s palsy?

A

swelling of VII causing unilateral weakness of facial muscles and cannot taste from anterior 2/3 of tongue

109
Q

what will happen if the ulnar nerve is damaged?

A

some weakening of wrist flexors
interossei
medial 2 lumbricals
hypothenar wasting>claw hand

110
Q

what will radial nerve damage lead to?

A

wrist and finger drop when arm is protonated and extended

anatomical snuffbox sensory loss

111
Q

sciatic nerve damage symptoms?

A

foot drop

lateral leg sensory loss

112
Q

common peroneal nerve damage?

A

foot drop

weak dorsiflexion and everson

113
Q

how will accessory nerve palsy present?

A

cannot turn head or shrug shoulders

114
Q

causes of Horner’s

A 
cerebral infarction
brainstem demyelination
cord tumour
apical lung tumour
brachial plexus trauma
115
Q

what disorder of tone occurs in pyramidal disorders?

A

spasticity

116
Q

what makes up the basal ganglia?

A

globus pallidus
striatum
subthalamic nucleus
substantia nigra

117
Q

causes of peripheral polyneuropathies

A 
Diabetes
Alcohol
Vitamin deficiency-B12
Infective (Guillian Barre, leprosy, sy[hilis)
Drugs (isoniazid)
Charcot-Marie-Tooth (sensorimotor)
118
Q

how would you treat uraemia neuropathy?

A

dialysis

119
Q

what is ameurosis fugax?

A

temporary obstruction of the retinal artery

120
Q

neck stiffness signs

A

Kernig’s painful to extend knee when hip is flexed

Brudinski’s bend neck and hip and knees flex

121
Q

most common causes of SAH

A

berry aneurysm
AV malformation
idiopathic

122
Q

what is idiopathic?

A

unknown cause

123
Q

what is iatrogenic

A

where a treatment causes another disease

124
Q

prophylaxis for migraines

A

beta blockers

125
Q

treatment for migraines

A

oral sumatriptan, as for cluster

126
Q

causes of giant cell arteritis

A

SLE
RA
HIV

127
Q

treatment of giant cell arteritis

A

IV methylprednisiolone

128
Q

trigemminal neuralgia treatment

A

carbamazapine-an AED

129
Q

causes of trigemminal neuralgia

A

tumour
AV malformation
MS

130
Q

treatment for Gullian Barre?

A

self limiting, symptomatic do not give steroids

131
Q

what causes thenar atrophy

A

wasting of abductor pollicis braves from median nerve

132
Q

what kind of intracranial haemorrhage might a seizure be indicative of?

A

subdural

133
Q

viral causes of meningitis

A

EBV
herpes simplex
mumps

134
Q

what does HHV8 cause

A

Karposi’s

135
Q

most common cause of meningitis?

A

Streptococcus pneumoniae

136
Q

signs of encephalitis

A

meningeal signs and seizures

137
Q

what do herpes zoster and herpes simplex cause?

A

zoster-shingles

simplex-encephalitis

138
Q

what histological changes may lead to dementia?

A

tau tangles

amyloid deposits

139
Q

what study supports healthy behaviours for the prevention of dementia?

A

Caerphilly study

140
Q

pharmacologic treatment for Alzheimer’s disease

A

acetyl-cholinesterase inhibitors

141
Q

3 types of dementia?

A

fronto temporal
Alzheimer’s
semantic

142
Q

how is dementia assessed?

A

6 part cognitive impairment test

143
Q

what is used for an MS relapse?

A

methylprednisolone

144
Q

what marker will be raised in giant cell arteritis

A

ESR

145
Q

absence seizures

A

sodium valproate

146
Q

generalised

A

sodium valproate

147
Q

focal seizures treatment

A

carbemazapine

148
Q

what drug is used to prevent migraine?

A

beta blocker-propanol

149
Q

what drug is used when a migraine comes on

A

sumatriptan

150
Q

what is the 4th cardinal symptom of Parkinson’s?

A

postural instability

151
Q

receptors affected in myasthenia gravis?

A

acetylcholine (nicotinic)

muscle specific tyrosine kinase

152
Q

total anterior circulation stroke-3 symptoms

A

unilateral weakness and or sensory deficit
homonymous hemianopia
higher cerebral dysfunction

153
Q

lacunar stroke symptoms

A

unilateral weakness of face/arm/face
pure sensory loss
ataxic hemiparesis

154
Q

why do headaches happen before SAH

A

leaking of the aneurysm

155
Q

tension headache features

A

bilateral

non pulsatile

156
Q

how long do cluster headaches last?

A

15-160mins

157
Q

features of cluster headache

A

watery and bloodshot eye with lid swelling
facial flushing
ptosis

158
Q

prevention of cluster

A

cluster of heartbeats-arrhythmia so verapamil

159
Q

trigemminal neuralgia triggers

A 
shaving
eating
dental prostheses
implants
vibration
160
Q

treatment of trigemminal

A

carbemazepine

161
Q

treatment of myasthenia gravis?

A

oral acetyl cholinesterase inhibitors, pyrostigmine and thymus removal

162
Q

what increases life expectency in MND

A

riluzole

163
Q

epileptic driving?

A

free of daytime seizures for over a year

164
Q

extra pathology in Parkinson’s?

A

Lewy bodies with SN degeneration

165
Q

used with levodopa

A

decarboxylase inhibitors

166
Q

cauda equine signs and symptoms

A 
bilateral or unilateral pain in legs
variable leg weakness
saddle anasthesia
poor anal tone
erectile dysfunction
bladder or bowel dysfunction
167
Q

cluster and migraine treatment difference

A

cluster-sumatriptan and verampamil (a Ccb!)

migraine-propranolol

168
Q

what inflammatory marker will be raised in giant cell arteritis?

A

ESR-not CRP, like SLE

169
Q

what should be started immediately if you suspect giant cell arteritis?

A

prednisolone

170
Q

differentials of seizure

A

epilepsy
brain tumour
encephalitis
Huntington’s

171
Q

what meningitis infections are common in neonates

A

E coli and group B strep

172
Q

what neuro condition do you not use steroids for?

A

Guillian Barre syndrome, use IfG because it will impair healing

173
Q

carbemazapine

A

used for focal pathologies lfke focal seizures, trigeminal neuralgia

174
Q

what happens in a simple partial seizure

A

one lobe is affected and there is no loss of consciousness

175
Q

what must happen for a diagnosis of epilepsy?

A

2 unprovoked seizures over 24hours apart

176
Q

status epilepticus?

A

seizure lasting ovr 30 minutes

177
Q

how long does dementia develop after motor symptoms in Parkinson’s disease?

A

1 year

178
Q

what is levodopa used with

A

carbidopa

179
Q

dopamine agonist

A

pramiprexole-compulsive behaviour

180
Q

MAOB inhibitor

A

rasagiline-AF

181
Q

myasthenia gravis drug

A

neostigmine

182
Q

what agent is used to stop vasospasm

A

nimodipine, need to be nimble to dip under the arachnoid mater

183
Q

neuro symptoms

A

changed behaviour

headache

Pathology (21 decks)

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