neurology Flashcards
1
Q
what does a large pupil suggest?
A
III nerve palsy because there is parasympathetic deficit
2
Q
what is Horner’s syndrome?
A
lack of sympathetic supply may be due to tumour or brainstem stroke.
myosis
ptosis
anhidrosis
3
Q
where is the most common place for the carotid artery to become diseased?
A
carotid sinus
4
Q
what type of stroke is the most common?
A
embolic
5
Q
what will damage to Wernicke’s area result in?
A
receptive dysphasia
6
Q
what is the least common type of intracranial haemorrhage?
A
extra dural
7
Q
what mimics stroke?
A
subdural
8
Q
how does subdural haemorrhage lead to symptoms?
A
the clot autolyses and this causes osmosis, rise in intracranial pressure then midline shift
9
Q
how does subarachnoid haemorrhage kill?
A
vasospasm reduces the blood going to the brain
10
Q
what can detect the time between muscle fibres contracting in NMJ problems like myasthenia gravis?
A
electromyography
11
Q
in what diseases does the electron encephalography occipital rhythm slow?
A
dementia
epilepsy
12
Q
what can visual evoked potentials be used for the diagnosis of?
A
MS
13
Q
what antibiotic should be given for meningitis?
A
cefotaxime
14
Q
what is petechial rash a sign of?
A
meningococcal septicaemia, NOT meningitis
15
Q
what does botulism present with
A
descending paralysis and cranial neuropathy
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
17
Q
what are the features of a posterior cerebral artery stroke?
A
visual field loss and brainstem symptoms
may have macular sparing
18
Q
risk factors for subdural haemorrhage
A
alcoholic
elderly
warfarin
19
Q
what symptoms suggest haemorrhagic stroke rather than ischaemic?
A
vomiting
headache
drowsiness
20
Q
why does intra-axial haemorrhage occur?
A
hypertension
lobar-Charcot Bouchard aneurysms
treat with catheter angiography
21
Q
what viral infection is associated with MS?
A
EBV
22
Q
what areas does MS mainly affect?
A
around the ventricles
white matter of spinal cord
some cortex
23
Q
what happens in active areas of destruction in MS?
A
lymphocyte cuffing
24
Q
what can MS and cervical cord compression cause?
A
Lhermitte’s phenomenon-electric shock when bend neck
25
in MS what is present in the CSF only?
inflammatory markers
26
what is the difference between tonic and clonic
in the clonic phase, muscles can relax so movments are larger but more spread apart
27
what is the archer pose?
ipsilateral flexion
contralateral extension
happens in frontal lobe seizures
28
what area will first be affected in syncope?
visual because it is a highly metabolic area
29
what is the commonest type of epileptic seizure
structural/focal
30
what is the treatment for generalised tonic clonic epilepsy?
sodium valproate
| lamotrigine
31
what is the AED used for generalised myoclonic seizures?
sodium valproate
32
what is the treatment for focal epilepsy?
carbamazepine
sodium valproate
lamotrigrine
33
what is the most common complication of traumatic brain injury
raised intracranial pressure following brain swelling
34
which cranial nerves are associated with the brainstem?
all but I and II
35
what nerves are affected in jugular foramen syndrome?
9-12
36
causes of obstructive hydrocephalus?
tumour
blood
stroke of cerebellum obstruct foramen of Magendie or Luschka and cause expansion of 3rd ventricle
37
symptoms of raised ICP
headache, especially worse on waking
vomiting
decreased consciousness
38
what does the brainstem connect?
the thalamus and the spinal cord
39
which artery supplies the brainstem
basilar
40
why might coughing and straining lead to pain?
radicular pain, thoracic radiculopathy
41
causes of spinal cord compression
```
tumour
disc prolapse
TB
granuloma
vertebral body destruction and lipping
epidural abscess
epidural haemorrhage
```
42
differentials of spinal cord compression
frontal lobe infarct
MS
Guillian Barre
B12 deficiency
43
symptoms of radiculopathy (LMN)
stabbing/dull arm pain
dull reflexes
weakness
Lhermitte's phenomenon
44
where does radicular pain radiate
below the lesion
45
causes of radiculopathy
trauma
herpes zoster
tumour
46
what will a lesion of L5 lead to?
loss of dorsiflexion so foot drop-deep peroneal nerve>tibialis anterior
47
what will a lesion of S1 lead to
loss of plantar flexion
48
why is mannitol used if a patient has fixed dilated pupil?
the parasympathetic fibres on the outside of III have been compressed, this indicates raised ICP, mannitol increases diuresis.
49
what will increased cranial pressure lead to?
decreased cranial perfusion pressure
50
which muscle is likely to be first affected by LMN problems?
first dorsal interosseus
51
which muscles are likely to be affected first in peripheral neuropathy?
distal, glove and stocking-this is opposite to myopathies
52
what is the pyramidal pattern of weakness?
due to upper motor neurone lesion/stroke, it's where flexion is strong in the arm and extension is strong in the leg
53
what change in muscle tone is associated with weakness
spasticity-clasp knife reflex
54
symptoms of brain tumours
raised ICP (headache, decreased GCS)
progressive neurological deficit
epilepsy (new onset focal seizures)
lethargy
55
what are the most common primary brain tumours
astrocytomas-4th stage is glioblastoma multiforme
56
which muscle fibres supply stretch receptors?
gamma motor neurones
57
what can lead to cerebellar dysfunction
genetic defects
| aquired-toxic (AED, alcohol),immune mediated, neurodegenerative
58
symptoms of cerebellar dysfunction
ataxia
nystagmus
intention tremor
slurring speech-scanning dysarthria
59
features of chronic pain
can be distracted by activity-worse at night
history of associated condition
electric shocks or shooting or dull and poorly localised
associated with depression
60
how is neuropathic pain treated
gabapentin, physio, exercise
61
symptoms of Duchenne's
calf pseudohypertrophy
weakness
Gower's sign-hands to climb up legs
62
what does dystrophin do?
attaches actin to dystrophin associated protein complex, this stabalises the sarcolemma
63
what is bulbar palsy?
LMN problem of 9-12, symptoms are increased jaw jerk, difficulty swallowing, nasal voice, slurring speech
64
why might thymomectomy be conducted?
myasthenia gravis
65
symptoms of anterior cerebral artery stroke
contralateral leg weakness and parasthesia
akinetic mutism
incontinence
drowsiness
66
symptoms of middle cerebral artery stroke
```
arm and leg paresis and parasthesia
facial droop
aphasia
hemianopia
cognitive change
```
67
symptoms of posterior cerebral artery stroke
contralateral homonymous hemianopia
visual agnosia
headache
68
posterior circulation stroke
```
dysarthria
N&V
altered consciousness
visual disturbance
pseudo or bulbar palsy
hemi or tetraparesis
possibly brainstem symptoms
```
69
treatment for ischaemic stroke
alteplase given in 4.5 hours, not if they have cancer, clotting disorder, liver disease, acute pancreatitis, recent major surgery, haemorrhage
70
what can burr holes be used for
subdural haematoma
71
what does dexamethasone do?
decreases ICP
72
what do oligoclonal bands show?
MS
73
what kind of blindness will a parietal lobe lesion lead to?
inferior homonymous quandrantanopias
74
what are lobar strokes caused by?
cerebral amyloid angiopathy
75
what would you give an ischaemic stroke patient if it is over 4.5 hours since their stroke?
clopidogrel and aspirin
76
what diseases is subarachnoid haemorrhage associated with?
PKD
coarction of the aorta
Ehlers-Danlos syndrome
77
if a patient has a lucid interval following trauma, what is the most likely diagnosis?
extradural haemorrhage
78
if a patient has fluctuating symptoms of headache, vomiting and seizures, what is the most likely diagnosis?
subdural haemorrhage
79
what kind of haemorrhage should you not do lumbar puncture?
extradural or subdural
80
which branch of the trigemminal nerve is most affected in trigemminal neuralgia?
mandibular
81
how does carbamazepine work?
inhibits Na channels
82
how does Lamotrigine work
inhibits glutamate release
83
what are the roots of the sciatic nerve?
L4-S3
84
what is sciatica?
compression of the nerve roots of the sciatic nerve-it is a radiculopathy leads to unilateral leg pain
85
what is the treatment for radiculopathy or myelopathy?
conservative-with NSAIDs, unless the patient shows neurological symptoms
86
what bacteria is most likely to cause Guillian Barre?
campylobacter jejuni
87
3 main symptoms of brain tumour
headache
new onset seizures
progressive neurological defiict
88
what is the most common cause of meningitis?
strep pneumoniae (+ve cocci)
89
define dementia
decline from previous normal cognitive function, enough to impair ADL
90
what is neutropenic sepsis?
febrile neutropenia, treated with vancomycin
91
what do the lenticulostriate arteries branch from?
the middle cerebral artery
92
where are berry aneurysms commonly found?
PICA or anterior cerebral bifurcations
93
what area of the brain does Alzheimer's affect?
medial temporal and parietal
94
which study shows dementia is prevented by healthy behaviours?
Caerphilly
95
frontal symptoms
contralateral hemiparesis
personality change
Broca's-expressive, non fluent dysphasia
can't plan
96
temporal symptoms
dysphagia
contralateral homonymous hemianopia
amnesia
97
parietal symptoms
contralateral hemisensory loss
decreased 2 point discrimination
dysphagia
98
occipital symptoms
polyopia
| contralateral visual field defects
99
common sites of embolic stroke
MCA
| PICA
100
what suggests a stroke may be ischaemic
previous TIA
ischaemic heart disease
DVT
101
secondary causes of headache
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
what degenerative neurone diseases have sphincter and sensory distrurbance
MS
| polyneuropathies like GB, DM
103
most common motor neurone disease presentation
amyotrophic lateral sclerosis
104
causes of bulbar palsy
```
progressive bulbar palsy (MND)
brainstem tumour
Guillian Barre
polio
myasthenia gravis
```
105
what is affected in myasthenia gravis?
post synaptic nicotinic receptors are destroyed by IgG immunity
106
side effects of cholinergic stimulation
```
salivation
diarrhoea
lacrimation
sweating
vomiting
miosis
```
107
what is Horner's syndrome characterised by?
miosis
ptosis
anhydrosis
108
what is Bell's palsy?
swelling of VII causing unilateral weakness of facial muscles and cannot taste from anterior 2/3 of tongue
109
what will happen if the ulnar nerve is damaged?
some weakening of wrist flexors
interossei
medial 2 lumbricals
hypothenar wasting>claw hand
110
what will radial nerve damage lead to?
wrist and finger drop when arm is protonated and extended
| anatomical snuffbox sensory loss
111
sciatic nerve damage symptoms?
foot drop
| lateral leg sensory loss
112
common peroneal nerve damage?
foot drop
| weak dorsiflexion and everson
113
how will accessory nerve palsy present?
cannot turn head or shrug shoulders
114
causes of Horner's
```
cerebral infarction
brainstem demyelination
cord tumour
apical lung tumour
brachial plexus trauma
```
115
what disorder of tone occurs in pyramidal disorders?
spasticity
116
what makes up the basal ganglia?
globus pallidus
striatum
subthalamic nucleus
substantia nigra
117
causes of peripheral polyneuropathies
```
Diabetes
Alcohol
Vitamin deficiency-B12
Infective (Guillian Barre, leprosy, sy[hilis)
Drugs (isoniazid)
Charcot-Marie-Tooth (sensorimotor)
```
118
how would you treat uraemia neuropathy?
dialysis
119
what is ameurosis fugax?
temporary obstruction of the retinal artery
120
neck stiffness signs
Kernig's painful to extend knee when hip is flexed
| Brudinski's bend neck and hip and knees flex
121
most common causes of SAH
berry aneurysm
AV malformation
idiopathic
122
what is idiopathic?
unknown cause
123
what is iatrogenic
where a treatment causes another disease
124
prophylaxis for migraines
beta blockers
125
treatment for migraines
oral sumatriptan, as for cluster
126
causes of giant cell arteritis
SLE
RA
HIV
127
treatment of giant cell arteritis
IV methylprednisiolone
128
trigemminal neuralgia treatment
carbamazapine-an AED
129
causes of trigemminal neuralgia
tumour
AV malformation
MS
130
treatment for Gullian Barre?
self limiting, symptomatic do not give steroids
131
what causes thenar atrophy
wasting of abductor pollicis braves from median nerve
132
what kind of intracranial haemorrhage might a seizure be indicative of?
subdural
133
viral causes of meningitis
EBV
herpes simplex
mumps
134
what does HHV8 cause
Karposi's
135
most common cause of meningitis?
Streptococcus pneumoniae
136
signs of encephalitis
meningeal signs and seizures
137
what do herpes zoster and herpes simplex cause?
zoster-shingles
| simplex-encephalitis
138
what histological changes may lead to dementia?
tau tangles
| amyloid deposits
139
what study supports healthy behaviours for the prevention of dementia?
Caerphilly study
140
pharmacologic treatment for Alzheimer's disease
acetyl-cholinesterase inhibitors
141
3 types of dementia?
fronto temporal
Alzheimer's
semantic
142
how is dementia assessed?
6 part cognitive impairment test
143
what is used for an MS relapse?
methylprednisolone
144
what marker will be raised in giant cell arteritis
ESR
145
absence seizures
sodium valproate
146
generalised
sodium valproate
147
focal seizures treatment
carbemazapine
148
what drug is used to prevent migraine?
beta blocker-propanol
149
what drug is used when a migraine comes on
sumatriptan
150
what is the 4th cardinal symptom of Parkinson's?
postural instability
151
receptors affected in myasthenia gravis?
acetylcholine (nicotinic)
| muscle specific tyrosine kinase
152
total anterior circulation stroke-3 symptoms
unilateral weakness and or sensory deficit
homonymous hemianopia
higher cerebral dysfunction
153
lacunar stroke symptoms
unilateral weakness of face/arm/face
pure sensory loss
ataxic hemiparesis
154
why do headaches happen before SAH
leaking of the aneurysm
155
tension headache features
bilateral
| non pulsatile
156
how long do cluster headaches last?
15-160mins
157
features of cluster headache
watery and bloodshot eye with lid swelling
facial flushing
ptosis
158
prevention of cluster
cluster of heartbeats-arrhythmia so verapamil
159
trigemminal neuralgia triggers
```
shaving
eating
dental prostheses
implants
vibration
```
160
treatment of trigemminal
carbemazepine
161
treatment of myasthenia gravis?
oral acetyl cholinesterase inhibitors, pyrostigmine and thymus removal
162
what increases life expectency in MND
riluzole
163
epileptic driving?
free of daytime seizures for over a year
164
extra pathology in Parkinson's?
Lewy bodies with SN degeneration
165
used with levodopa
decarboxylase inhibitors
166
cauda equine signs and symptoms
```
bilateral or unilateral pain in legs
variable leg weakness
saddle anasthesia
poor anal tone
erectile dysfunction
bladder or bowel dysfunction
```
167
cluster and migraine treatment difference
cluster-sumatriptan and verampamil (a Ccb!)
| migraine-propranolol
168
what inflammatory marker will be raised in giant cell arteritis?
ESR-not CRP, like SLE
169
what should be started immediately if you suspect giant cell arteritis?
prednisolone
170
differentials of seizure
epilepsy
brain tumour
encephalitis
Huntington's
171
what meningitis infections are common in neonates
E coli and group B strep
172
what neuro condition do you not use steroids for?
Guillian Barre syndrome, use IfG because it will impair healing
173
carbemazapine
used for focal pathologies lfke focal seizures, trigeminal neuralgia
174
what happens in a simple partial seizure
one lobe is affected and there is no loss of consciousness
175
what must happen for a diagnosis of epilepsy?
2 unprovoked seizures over 24hours apart
176
status epilepticus?
seizure lasting ovr 30 minutes
177
how long does dementia develop after motor symptoms in Parkinson's disease?
1 year
178
what is levodopa used with
carbidopa
179
dopamine agonist
pramiprexole-compulsive behaviour
180
MAOB inhibitor
rasagiline-AF
181
myasthenia gravis drug
neostigmine
182
what agent is used to stop vasospasm
nimodipine, need to be nimble to dip under the arachnoid mater
183
neuro symptoms
changed behaviour
| headache
