Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CP3 Medicine > Neurology > Flashcards

Neurology Flashcards

1
Q

List the advantage of MRI head over CT head

List the CIs of MRI

A

No ionising radiation in MRI

Any metal containing implants / bullets + shrapnel
Claustrophobic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the CSF findings seen in MS? (3)

A

Lymphocytes upto 50
Protein - moderately raised (<1g)
Oligoclonal IgG bands on electrophoresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

List the Irreversible (6) + Reversible (9) RFs for ischaemic stroke

A

Age/Gender
PMH/FH
Hypercoagulable state / AF

Poor diet / exercise 
Smoking / alcohol
HTN / Hyperchol
DM / Obese
COC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List some rarer RFs for ischaemic stroke (6)

A

Endocarditis / Vasculitis
Migraine / Polycythaemia
Antiphospholipid syndrome / Amyloidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List some RFs for haemorrhagic stroke (5)

A 
FH
Vascular abns (aneurysm / AVM / HHT)
Uncontrolled HTN
Coagulopathies / anticoags
Heavy recent alcohol intake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 3 diff types of cerebral ischaemia

A

Regional (affects cortical areas)
Lacunar (subcortical - from microinfarcts/small vessel disease)
Global ischaemia (post-arrest: can reverse/transient sx but risk reperfusion injury // severe can cause cortical laminar necrosis = vegetative)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 3 zones in cerebral ischaemia called?

A

Infarct core - defo will die
Oligaemic periphery - survives from collaterals
Ischaemic penumbra - uncertain outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List the main clinical features of an ischaemic stroke (4)

A 
Contralateral mm weakness / hemiplegia
Facial weakness
Higher dysfunction
Visual disturbance
Rare - epileptic fit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List some examples of higher dysfunction (6)

A 
Agnosia
Asterognosis
Receptive aphasia
Expressive aphasia
Apraxia
Inattention (neglect)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the practical management of ?Stroke coming onto the ward

A

Quick focussed Hx / NIHSS score
Assess for CIs (fam/GP/Notis)
IV access + baselines (FBC, clotting, Glucose, UEs)
Weight (estimate)
Catheterise (if required)
Consultant review + urgent CT / thrombolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Post-thrombolysis, what features would indicate complications/haemorrhage?

What aspects of management should be delayed during thrombolysis infusion?

A

Acute HTN
Severe headache
Nausea/vomiting
-> discontinue infusion + urgent CT

During 1st 24hrs/ during infusion:
Avoid catherisation
Avoid NG
Avoid aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the secondary prevention measures post-stroke? (5)

A 
Antihypertensive therapy
Statin
Antiplatelet therapy
Identify/tackle RFs
Manage co-morbidities e.g. AF/DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the laws regarding driving after a stroke?

A

Cannot drive for 4wks post stroke

After 4wks if clinical improvement satisfactory, may return to driving w/o having to inform DVLA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List some post-stroke complications (8)

A

Post-stroke pain
Incontinence
Pressure sores
Depression

DVT/PE
Aspiration/hydrostatic pneumonia

Malignant MCA syndrome
Seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is malignant MCA syndrome and its features / Tx

A

Neuro deterioration due to cerebral oedema following middle cerebral aa stroke

Variable but:
Increased agitation
Reducing GCS
Haemodynamic / thermal instability
Signs of raised ICP

Decompressive hemicraniectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some high-risk features of a further stroke post-TIA?

A

Recurrent TIAs in short period
TIA on anticoag / AF
ABCDD score of ≥4

Age >60
BP at presentation (>140/90)
Clinical features - unilateral weakness (2) / speech disturbance w/o weakness (1)
Duration of Sx - 60mins+ (2) / <60mins (1)
Diabetes - pre-existing (1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How are high-risk and low-risk TIAs managed?

A 
High-risk:
Statin (e.g. simva 40mg)
300mg aspirin (unless CI)
Arrange 24hr urgent clinic
Advise don't drive until seen specialist

Low risk:
Same but less urgent clinic referral (1wk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What further Ix / prophylactic interventions can be done after TIAs (1+2)

A

Carotid USS in specialist clinic

Carotid endarterectomy if stenosed >50%
OR
Percutaneous luminal angioplasty ± stenting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

List the RFs for venous sinus thrombosis (7)

A 
Pro-thrombotic state (85%):
Pregnancy / puerperium
Oral contraceptive
Malignancy
Genetic thrombophilia

Head injury
Recent LP
Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the clinical features for cortical (5) / dural (5) / sagittal lateral (5) venous sinus thrombosis

A 
Cortical:
Thunderclap headache
Fever
Focal signs
Seizures
Encephalopathy
Dural:      (ophthal signs + fever)
Proptosis/chemosis
Ocular pain 
Ophthalmoplegia
Papilloedema
Fever
Sagittal lateral:     (raised ICP signs)
Headache
Vomiting
Fever
Papilloedema
Seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the diff types of intra-cerebral haemorrhage?

A

Deep intra-cerebral: subcortical
from micro aneurysms (Charcot-Bouchard) and degen of small penetrating aa’s

Lobar intra-cerebral: in cerebral cortex
Normotensive / >60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe the immediate management for intra-cerebral haemorrhage

A

Reverse anticoag
Lower BP to <140/90 within 1hr (IV betolol)
Neurosurgical intervention possibly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the presenting features of a SAH? (5 + 3)

A 
Thunderclap headache (after transient HTN)
Vomiting
Photophobia
Drowsiness / coma
Focal signs

Neck stiffness
+ve Kernig’s
Papilloedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the predisposing abnormalities causing SAH? (3)

A

Berry (saccular) aneurysm (70%)
AVM (10%)
No lesion found (20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the RFs for berry aneurysm development?

What is the most common site of berry aneurysm?

A 
Polycystic kidney disease
FH
HTN
Smoking
Ehlers-Danlos / Marfans

Commonest site is anterior communicating aa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are some complications of SAH (4)

A

Death (30% immediate)
Rebleed
Hydrocephalus (from CSF pathway fibrosis)
Cerebral vasospasm (poss -> ischaemic damage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What investigations are done in SAH? (4)

A

Bloods: FBC, clotting, UEs, LFTs, ESR
CT*
LP if CT normal
CT angio - for all pts fit for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How is SAH managed? (7)

A 
4wks bed rest
HTN control
Nimodipine - prevents vasospasm
IV fluids - prevents further vasospasm
Analgesia
Stool-softeners (prevent straining)
Neurosurgical referral/discussion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What pt groups are subdural haemorrhages seen in?

A

Acute: major trauma pts

Subacute/Chronic:
Elderly
Coagulopathy
Alcoholics (clotting)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How do subacute/chronic subdurals present? (4)

A 
S/O raised ICP 3wks post-insult:
Headache
Drowsy/confusion
Focal neuro signs
Stupor/coma (late: coning)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How do acute / chronic subdurals look on CT?

A 
Acute:
Crescenteric 
White (increased density)
Midline shift
Ventricular compression

Subacute: isodensity

Chronic:
Lentiform shape (convex lens)
Darker (radiolucent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How are subdurals managed?

A

Serial CT imaging
Neurosurgery
Chronics may self-resolve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How does an extradural (epidural) haemorrhage present?

A

Young pt minor injury (sports/assault)
Blow to side → middle meningeal aa tear
Brief unconsciousness → lucid recovery period

Over mins-hrs:
Progressive hemiparesis / stupor
Ipsilateral dilated pupil → then bilateral
Resp arrest (untreated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is seen on CT in extradural haemorrhage?

How is it managed?

A

Lentiform shape
Midline shift
Ventricular compression

Urgent neurosurgery – burr hole (release pressure)
If v. minor – conservative/monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the 3 cardinal features of Parkinsonism

A

Resting tremor
Bradykinesia
Rigidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

List some detailed features of the tremor in Parkinsonism

A

4-7Hz pill rolling
Increases in: rest / anxiety / clenching opposite
Decreases in: movement / finger-nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

List some other detailed features of Parkinsonism

A

+ve Glabellar tap reflex
↓ Spontaneous blinking

‘Lead pipe’ rigidity
‘Cog wheeling’ effect

Hypersalivation
Hypomimia

Micrographia
‘Walking’ thumb along fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

List the Parkinson plus syndromes + how they are different

A 
Progressive supranuclear palsy:
Early dementia / Early speech probs
Postural instability
Vertical gaze palsy
VS PD - symmetrical / no tremor

Multisystem atrophy:
Autonomic / Cerebellar / Pyramidal

Cortico-basal degen:
Akinetic rigid 1 limb
Cortical sensory loss e.g. astereognosis

Vascular: BG strokes
Pyramidal / Legs worse

LBD:
Early dementia / Visual hallucinations
Symmetrical motor signs later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

List features of Parkinsons DISEASE (other than Parkinsonism) (14)

A 
Characteristic stoop
Fixed flexed joints (all except PIP/DIP)
Dysphagia
Constipation
Urological
Sweating
Shuffling (festinant) gait
Slurring/monotonous (eventually anarthria)
No arm swing
Unsteady turning
Depression (1/3rd)
Dementia/cognition problems (later)
Insomnia (later)
REM behavioural sleep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the SEs of levodopa?(4+3)

A

N+V (→ domperidone alleviates)
Confusion
Visual hallucinations (→ atypicals alleviate)
Chorea

Later SEs (2-5yrs):
Motor fluctuations (akinesia switching on/off)
Dyskinesia
Dystonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

List other Parkinsons drugs/Tx used (5) (give examples of drug names)

A

D-r agonists: bromocriptine / cabergoline / ropinirole
MOA-B inhibs: selegeline / rasagiline
COMT inhibs: entacapone
Anticholinergics: procyclidine
Surgery: thalotomy / deep brain stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

List the diff patterns of MND (4)

A

Amylotrophic lateral sclerosis**
Progressive muscular atrophy
Primary lateral sclerosis (rare)
Bulbar presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Which areas are affected in MS? (+ what effects does it have)

A 
Optic nn → optic neuritis
CST → hemi/mono/para-paresis
DST → paraesthesia/proprioceptive loss
Cerebellar peduncles → cerebellar signs inc. vertigo
Brainstem → bladder/bowel/sexual
Cognition → (late) IQ/language
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

List the classifications of MS (3)

A

Primary progressive (10-20%)
Relapsing/remitting (80-90%) (to 2o progressive)
Fulminant (<10%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

List the diagnostic tools for MS (5)

A

Clinical Dx (2+ characteristic episodes)
Bloods before neuro referral:
FBC/UE/LFT/TFT / B12 / Ca / Gluc / ESR / HIV

MRI confirms Dx
CSF: raised WCC/protein / oligoclonal IgG
VER (visual evoked responses) – prev optic nn lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

List the DDx for MS:
Relapsing-remitting (3)
Primary progressive (3)

A

Relapsing-remitting:
TIA
SLE w. neuro involvement
CNS sarcoidosis

Primary progressive:
MND
CNS mass
Spinal/cerebellar degen e.g. Alz/Hunt/Park

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Outline the general management of MS (6)

A 
MDT
Annual R/V
Lifestyle (exercise/smoking)
Pt education (prompt recog sx / tx)
Manage comps
Modifying therapy (dimethyl fumarate / teriflunomide / natalizumab for severe)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

List the complications of MS (9)

A 
Mental health
Fatigue
Mobility issues
Pressure sores
Constipation
Bladder dysfunc
Sexual dysfunc
Ataxia
Spasticity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are good/poor prognostic factors in MS?

A

Good: sensory onset
Poor: older at presentation / early cerebellar / cognition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How does ALS present?

A

Progressive spastic tetra-paresis
± Bulbar/pseudo-bulbar
Fronto-temporal dementia

LMN signs: hands → arms + down
UMN signs: legs → up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How does progressive muscular atrophy present?

A

Painless wasting in small hand mm’s + spreads

Just spinal LMNs

52
Q

How does primary lateral sclerosis present?

A

Progressive tetraparesis

Just cortical UMNs

53
Q

List the diagnostic tools for MND (4)

A

Clinical (mixed UMN/LMN)
Bloods: exclude DDx
MRI: exclude myelopathy/radiculopathy
Dx – EMG: denervation

54
Q

Outline the general management of MND (5)

A 
MDT
Nutritional support / gastrostomy
Resp support (NIPPV)
Manage comps (as per MS)
Modifying therapy: Riluzole
55
Q

List possible causes for Dementia (surgical sieve)

A

V: Multi-infarct / Cerebral infarcts / Binswangers / Lupus
I: HIV / syphillis / CJD / Cryptococcus
T: major head / repetitives
Toxins: Alc / Drugs / heavy metals inc. Wilsons
M: B1/B12/Fol defc / Uraemia / Liver failure / Hypothyroid
Mechanical: Hydroceph (inc. NPH) / Haematomas
N: primary/secondarys
D: Alz (62%) / LBD (4%) / FTD (2%) / PD+ (2%) / Hunt’s

56
Q

List + describe the diff types of vascular dementia (4)

A

Post-stroke (25% stroke pts within 1yr)
Multi-infarct (cortical): stepwise decline
Subcortical: h/o HTN
Mixed cortical/subcortical

57
Q

List the features of LBD (3+5)

A

Core:
Fluctuating cognition
Visual hallucinations
Parkinsonism

Supporting:
Syncope
Autonomic e.g. post hypo
Falls
Neuroleptic sensitivity
REM sleep behaviour
58
Q

List the early features of FTD (7)

A 
Emotional blunting / loss inhibition
Personal hygiene
Hyperorality
Word finding difficulties / less speech
Echolalia / aphasia
Loss insight
Primitive reflexes e.g. grasp
59
Q

What are the features of CJD? (3)

How is it Dx?

A

Middle aged dementia
UMN signs limbs
Visual disturbances

Dx; EEG

60
Q

What are the features of Huntington’s? (2)

A

Middle aged dementia

Progressive chorea

61
Q

List the DDx of peripheral neuropathy

A

V: vasculitic
I: HIV/syphillis / CIDP / GBS
Toxins: Alc / Lead / Chronic liver disease
A: RA / CTDs / Myxoedema
M: DM / B12+Folate / Thiamine defc / Uraemia
I: amio / statins / pheny / hydralazine / abx
N: paraprot (myeloma) paraneoplastic
C: Charcot-Marie Tooth / Friedrich’s ataxia

62
Q

List the causes of peripheral neuropathy with predominately motor loss (6)

A 
Guillain-Barre syndrome
Porphyria
Lead poisoning
Charcot-Marie-Tooth
Chronic inflamm demyelinating polyneuropathy (CIDP)
Diphtheria
63
Q

List the causes of peripheral neuropathy with predominately sensory loss (6)

A 
DM
Alcohol
B12 defc
Uraemia
Amyloidosis
Leprosy
64
Q

Describe the difference b/wn demye + axonal neuropathy

List some other nerve damage patterns + what happens

A

Demyelination: only schwanns / immune-med / regrow
↓ Conduction velocity

Axonal: neuronal bodies degen from axon / can’t regrow
↓ Amplitude

Wallerian: post-section / microinfarction
Compression: focal demye
Infiltration: malignancy / granulomatous

65
Q

What are the features of GBS? (4)

A

1-3wks post trivial infection (campylo/CMV)
Ascending paralysis
Loss tendon reflexes
Proximal mm involvement (20%) - Resp/CN

NB sensory loss uncommon

66
Q

List some complications of GBS

A 
LRTI
Pressure sores
VTE
BP instability / arrhythmia (autonomic involvement)
Residual weakness post-recovery (10-20%)
Mortality (10% in acute phase)
67
Q

How is GBS managed?

A 
HDU nursing
Monitor FVC ± Ventilation
SC heparin / TEDS
Prevent complications
High-dose IVIG within 2wks (NB steroids useless)
68
Q

Describe the presentation/progression of shingles

A

Pain/paraesthesia (days)
Erythema / vesicles / burning / itching / dermatomal
2-3d later become pustular

69
Q

List poss complications of shingles

A

Post-herpetic neuralgia (10%)
Corneal scarring / uveitis / panophthalmitis
Facial palsy / sensorineural loss / CN5,9,10 neuropathy

70
Q

How is shingles managed?

A

5-7d oral aciclovir

Paracetamol / amitriptyline

71
Q

How is post-herpetic neuralgia managed?

A

Amitriptyline
Topical capsaicin

(Gradual recovery over 2yrs)

72
Q

What are the possible features of MG (4)

A 
Weakness/fatiguability of:
Extra-ocular
Proximal mm (limb/face/neck) 
→ Ptosis
→ Dysphagia
→ Speech difficulties / chewing (facial exp mm)
→ Proximal mm weakness (arms >legs)
73
Q

List some conditions assoc w. MG (5)

A 
Pernicious
Autoimm thyroid
SLE
Rheumatoid
Thyroid hyperplasia / thymoma
74
Q

What Ix can be done if suspecting MG? (4)

A

Anti-ACh-R IgG autoAbs
EMG
TFTs / CT thorax (exclude thymoma)

75
Q

Describe the management of MG (3+3)

A

Long-term:
Initial immunosupp – oral pred
Long-acting anticholinesterases e.g. neo/pyridostigmine
Thymectomy

Relapses:
Corticosteroid/Azathioprine
FVC monitoring ± ventilation
Severe: Plasmaphoresis/IVIG

76
Q

Describe the pathology behind:

  1. Duchenne’s
  2. Becker’s
  3. Myotonic dystrophy
A
  1. Duchenne’s: X-linked recessive dystrophin gene mutation
  2. Becker’s: partially func dystrophin
  3. MD: autosom dom Cl- channelopathy
77
Q

What is the difference b/wn:
Muscular dystrophies
Myopathues
Neurogenic disease

A

Muscular dystrophy: genetic progressive deterioration

Myopathies: predominant effect on mm

Neurogenic: peripheral nn / LMNs → SkM atrophy

78
Q

What Ix can be done for a suspected myopathy? (3)

A

CK (serum mm enzyme):
Raised in – dystrophy / inflamm mm disorder
Normal in – MG

EMG – classic traces in:
Myopathy / denervation / myotonic discharge / MG

Mm biopsy: ddx b/wn denervation + mm disease

79
Q

List the management options for spasticity related motor problems (Con/Med/Surg) (3/4/4)

A

Conservative:
Physio
Gait retraining
Remove exac stim e.g. constipation

Medical:
Baclofen / Dantrolene / BZDs / Botox

Surg:
Tendon lengthening
Fixed deformity release
Electrostim
Orthopaedic referral for contractures
80
Q

What is the pathological difference b/wn bulbar palsy + pseudo-bulbar palsy?

What neuro disease may present with a mix?

A

Bulbar: LMN weakness from medullary CNs (9/10/12)

Pseudobulbar: bilateral UMN weakness from medullary CNs (9/10/12)

MND: mixed bulbar/pseudo

81
Q

What are the features of a bulbar palsy? (6)

A 
LMN tongue (wasted/fascic/flaccid)
Speech: quiet/nasal
Poor soft palate elevation (ahh)
Jaw jerk absent
Gag absent
Dysphagia
82
Q

What are the features of a pseudo bulbar palsy? (6)

A 
UMN tongue (stiff/spastic/not wasted)
Speech: donald duck/high-pitched/slurred (dysarthria)
Normal soft palate elevation (ahh)
Jaw jerk exaggerated
Gag present
Dysphagia
83
Q

What are the main causes for bulbar/pseudobulbar palsy? (2)

What are some rarer causes? (4+2)

A

V: Stroke
D: MND

BULBAR:
GBS
Botulism
Brainstem tumours
Congenital

PSEUDO:
Trauma
MS

84
Q

What features may be present in a cerebral lesion in:

  1. Frontal (5)
  2. Temp-Par L (dom) (3)
  3. Temp-Par R (2)
  4. Occipital (1)
A

Frontal:
Intellect / personality / Urinary / hemiparesis / Broca’s

L T-P (dom): Contralat neglect / Wernicke’s / Agraphia
R T-P: Contralat neglect / Agnosia

Occipital: Visual field/spatial defects

85
Q

What are features of a cerebellar lesion? (6)

+ of a midline cerebellar lesion? (4)

A 
Disdiadokinesia / Dysmetria
Ataxia
Nystagmus
Intention tremor
Slurred staccato speech
Hypotonia

Broad gait
Romberg’s (unsteady when close eyes)
sUpport needed (sit/standing)
Vertigo/vom (sitting forward + arms across chest)

86
Q

List some causes of unilateral (3) + bilateral (4) cerebellar dysfunc

A

Unilateral:
Stroke
MS
Tumour (acoustic neuroma, meningioma)

Bilateral:
Alcohol
Anti-epileptics
Severe hypothyroid
Paraneoplastic degen (breast, small cell lung)
87
Q

What is the func of the BG?

What are the BG structures? (7)

A

Modulates cortical motor activity

Corpus striatum: caudate / globus pallidum / putamen
Subthalamic nucleus
Substantia nigra
Parts of thalamus

88
Q

What are the features of BG dysfunction? (7)

A 
Bradykinesia (→ akinesia)
Mm rigidity
Tremor
Dystonia (spasms)
Athetosis (writhing)
Chorea
Hemiballismus (violent invol prox arm mm)
89
Q

Where does the lesion lie in:
Central scotoma
Monocular loss of vision
Bitemporal hemi/quadrantanopia (superficial + inferior)
Homomymous hemianopia
Homonymous quadrantanopia (superficial + inferior)

A

Central scotoma → macular
Monocular → ipsilateral optic nn

Bitemp hemi/quad:
Superfic = pituitary tumour (below chiasm)
Inf = craniopharyngioma, meningioma, carotid aneurysm

Homonymous hemi = contralateral optic tract
Homonymous quad:
Superfic = Temporal contralat optic tract
Inf = Parietal

90
Q

What is the difference b/wn Broca’s + Wernicke’s aphasia? How does each manifest

What are some other types of aphasia? (2)

A

Broca’s = motor speech; expressive
Non-fluent / good comprehension / poor repetition

Wernicke’s = understanding speech; receptive
Fluent / poor comprehension / poor repetition

Global = both
Nominal = word finding difficulty
91
Q

List the different causes of DYSARTHRIA + their different manifestations in speech (5)

A 
Bulbar = high-pitched, nasal
Pseudobulbar = donald duck 'gravelly' (UMN)

MG = speech fatigues / dies away

Extrapyramidal = soft / indistinct / monotonous
Cerebellar = slow / staccato / slurred
92
Q

What are the features of Horner’s?

A

MioSIS (unilateral constriction)
PtoSIS (partial) - just Mullers mm
AnhidroSIS

93
Q

List the 1st / 2nd / 3rd order causes of Horner’s?

How are they differentiated clinically?

A

1st order: BRAINSTEM stroke / syphilis / MS / tumour

2nd order:
INTRATHORACIC pancoast / cervical rib / TB
NECK lymphadenopathy / trauma / thyroid surg

3rd order: ICA aneurysm / transient migraine / idiopathic

94
Q

List the DDx for pathology of a LMN lesion (4)

A

Ventral horn: MND / Post-polio
Peripheral nn: neuropathy
NMJ: MG
Muscular

95
Q

List the DDx for a UMN lesion (6)

A 
V: stroke / AVM / haemorrhage
I: post-meningitis
T: traumatic brain injury
A: MS / MND
I: drugs
N: SOL
D: Parkinson's
96
Q

How would a unilateral cord lesion (hemisection) present? (3)
What is the Eponymous name for it?
List some possible causes (3)

A

Ipsilateral weakness (CST)
Ipsilateral loss vibration/proprio (DC)
Contralateral loss pain/temp/light (STT)

Brown-Sequard

RTA
Penetrating injury
Facet dislocation

97
Q

How would a dorsal column lesion present? (3)

What is the Eponymous name for it?

A

Clumsiness
Electric-shock like sensations / tingling / numbness
Sensory ataxia (loss 2-point discrimination)

98
Q

List the indications for LP (5)

A 
Dx: Meningitis/Encephalitis
Dx: Neurosyph / MS / Behcet's
Dx: SAH (if CT normal)
Intrathecal drugs
Measure CSF pressure ± drain
99
Q

List the contraindications for LP (5)

A 
Local infection
Clotting problems
?Raised ICP (if unconscious → CT first)
Haemodynamically unstable
Congenital e.g. NTD
100
Q

List the complications of LP (5)

A

Infection
Cerebellar tonsillar coning

Spinal nn damage
Dry tap (not worked)
Spinal tap (post-LP headache: 30%)
101
Q

List the differentials for causes of secondary headaches

A 
V: Raised ICP / IIH / HTN
I: meningitis / sinusitis / SAH
T: post-traumatic
A: giant cell arteritis
M: metabolic disturbances
I: nitrates / vasoactives
N: SOL
102
Q

Describe the classic presentation of tension headaches

How are they treated?

A 
Middle-aged woman
Depression
Band-like (occiput/vertex)
Non-pulsatile
Episodic
OTC analgesia (NB caution overuse)
If >2/wk: low-dose amitriptyline
103
Q

Describe the classic presentation of cluster headaches

A

Male
After drinking
Wakes from sleep
Mins-hrs
Severe unilateral pain around eye / poss BG pain
Aura (20%)
Autonomics: ptosis / watering / red eye / vom

104
Q

How are cluster headaches managed?

What is the main DDx to exclude

A

Start of attack – SC/Nasal Triptans
During attack – 12L O2 non-rebreather
Prophylaxis – alc avoidance / verapamil (off-licence)

Main DDx: acute angle closure glaucoma

105
Q

List some common triggers for migraines (6)

A

Stress / emotional states
Alcohol
Physical exercise

Menstruation
OCP
Specific food groups

106
Q

Outline the management for migraines

A

Headache diary
Avoid triggers

Acute:
NSAIDs / para / anti-emetics
(Severe) Sumatriptan / nasal triptan if vom

Prophylaxis:
Menses related: mefanamic acid / triptans 2d prior
1st – topiramate / propanolol (for child bearing)
2nd - amitriptyline / carba

107
Q

List some possible features of IIH

How is it treated? (2)

A 
Young obese woman OCP
Headache
Pulsatile tinnitus
Diplopia / CN6 palsy
Visual disturbances
Bilateral papilloedema
Trial corticosteroids 
VP shunt (to prevent optic atrophy)
108
Q

How does trigeminal neuralgia typically present?
What is it caused by?
How is it treated?

A

Sudden severe pain across facial distrib
Sensory trigger

Ageing / Compression / MS

TCAs / Carba

109
Q

What are the 2 diff types of hydrocephalus

Who are the at risk groups for hydrocephalus (3)

A

Non-communicating (obstructive)
Communication (non-resorptive)

Congenital malformations
Post-insult (trauma/SAH)
Meningitis

110
Q

What are the features of hydrocephalus

A 
Headache
Vomiting
Papilloedema
UMN pyramidal signs
Cognitive disturbance
Ataxia
111
Q

How is hydrocephalus managed?

A

Acetozolamide ± furosemide
VA/VP shunt
Endoscopic 3rd ventriculostomy
Brain tumour removal

112
Q

What are the 3 features of NPH?

How is it treated?

A

Dementia
Ataxic gait
Urinary incontinence

LP trials (of improvement) + VP shunt

113
Q

What are the 3 main types of primary brain tumours?

+ their natural progression

A

Malignant glioma – rapid growth (6m)
Meningioma – slow growth benign
Astrocytoma – slow growth benign

114
Q

List the commonest locations of origin for brain mets (6)

A

Thyroid
Melanoma
Kidney

Breast
Bronchus
Bum (colon)

115
Q

List 4 paraneoplastic syndromes

A

Myasthenia Gravis
Lambert-Eaton Myasthenic syndrome
Paraneoplastic sensory neuropathy
Paraneoplastic cerebellar degeneration

116
Q

What types of cancer assoc w. paraneoplastic cerebellar degeneration? (4)

A

Small cell lung
Hodgkins
Breast
Ovarian

117
Q

List some viral causative organisms of meningitis (4)

A

Enteroviruses:
Coxsackie A/B
Echoviruses

HIV
HSV

118
Q

What features indicate complications in meningitis (4)

What acute neuro complications could these indicate? (3)
What are some other (systemic) acute complications

A

Progressive drowsiness / LOC
Lateralising signs
CN lesions
Seizures

Hydrocephalus
Severe cerebral oedema
Venous sinus thrombosis

Sepsis
DIC
Adrenal haemorrhage (Waterhouse-Friderichsen)

119
Q

How does TB meningitis present in contrast to normal?

How is it treated?

A

More gradual + wt loss

Same as resp (RIPE 12m) + Dexa

120
Q

List necessary Ix for ?Meningitis (6)

A 
Bloods: FBC / UEs / LFTs / Clotting / Glucose / Lactate
LP
CT
Blood cultures
Serum PCR
Throat swabs
121
Q

List possible long-term complications of bacterial meningitis (5)

A

Brain abscess
Hydrocephalus
Hypotonia
CN palsy (e.g. sensorineural deafness)

122
Q

List some causes of brain abscess (5)

A 
Paranasal sinus infection
Otitis media
BActerial endocarditis
Neurosurg
Trauma
123
Q

What are the meningitis empirical Abx in:

  1. Non-blanching rash
  2. Immunosupp (inc. DM) / >60
  3. Non-immunosupp / <60
A
  1. Ben-pen / PA-cefotaxime (IM + IV)
  2. Ceftriax / Amoxi / dexa (IV) (PA-chloramphenicol)
  3. Ceftriax / Dexa (IV)
124
Q

List the diff types of syncope (7)

A

Situational: post-prandial / micturition / defacation
Vasovagal: transient parasymp (heat/noxious)
Neurogenic: TIA/Stroke /subclav steal syndrome
Cardiogenic: structural / arrhythmia
Orthostatic: post hypo
Psychogenic
Endocrine: hypogly / anaemic

125
Q

List the Ix for recurrent syncope

A 
FBC / UE / Gluc
ECG
LSBP
CT head / EEG
ECHO
126
Q

What is subacute combined degeneration of cord (SCDC) due to?
What are the features (4 ± 2)

A

Due to B12 defc
Can be precipitated by folate

Peripheral sensory neuropathy (vibration/proprio)
UMN signs in legs, classic ∆: 
• +ve Babinski
• Brisk knee reflex
• Absent ankle reflex

Plus poss also:
Normal tone/power
Ataxic gait

CP3 Medicine (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions