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Phase 2a Summaries > Neurology > Flashcards

Neurology Flashcards

1
Q

Name 3 signs of an ACA stroke?

A
  • Leg weakness and sensory disturbance
  • Gait apraxia
    Akinetic mutism (decrease in spontaneous speech)
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2
Q

Name 3 signs of an MCA stroke?

A
  • Contralateral arm and leg weakness
  • Contralateral sensory loss
  • Hemianopia
  • Midline shift on CT
  • Facial droop
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3
Q

Name 3 signs of an PCA stroke?

A
  • Contralateral homonymous hemianopia
  • Visual agonisa
  • Prosopagnosia (inability to recognise faces)
  • Unilateral headache
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4
Q

Name 3 signs of an posterior circulation stroke?

A
  • Locked in syndrome
  • Altered consciousness
  • Vertigo, nausea and vomitting
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5
Q

What is the first line investigation in a stroke before any treatment?

A

CT to distinguish whether it is haemorrhagic is ischaemic

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6
Q

When can you offer prophylaxis for stroke?

A

Less than 4.5 hours post onset of symptoms

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7
Q

What treatment is used for prophylaxis of stroke?

A
  1. Tissue plasminogen acttivator - IV alteplase

2. Anti-platelet - clopidogrel

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8
Q

What are 4 of the contraindications of prophylaxis?

A
  • Recent surgery (3 months)
  • Active malignancy
  • patient on anti-coagulation
  • severe liver disease
  • acute pancreatitis
  • clotting disorders
  • evidence of brain aneurism
  • recent arterial puncture
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9
Q

Name 3 clinical presentations of Subarachnoid haemorrhage?

A 
Thunderclap headache 
Neck stiffness 
Kernigs and Brudunski's sign 
Papilloedema 
Vomitting, colapse
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10
Q

What is Kernigs Sign?

A

Unable to extend leg at knee when the thigh is flexed

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11
Q

What is Brudzinki’s sign?

A

When patient neck is flexed, patient will flex knees and hips

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12
Q

Name a treatment method for Subarachnoid haemorrhage?

A

CCB - IV Nimodipine

Surgery

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13
Q

What is the epidemiology of subdural haemorrhage?

A

Alcoholics, dementia, shaken baby syndrome

brains are more atrophic

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14
Q

What is the pathology of subdural haemorrhage?

A

Bleeding from bridging veins -> forms haematoma-> haematoma autolyses - increase osmotic /oncotic pressure

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15
Q

What is the clinical presentation of subdural haemorrhage?

A

Headache, personality change, unsteadiness, signs of increase ICP, focal neurology

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16
Q

What is seen on a CT of a patient with a) subdural haemorrhage b) extradural haemorrhage?

A

a) Crescent shaped +/- midline shift

b) Convex shaped

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17
Q

What investigation is contraindicated in extradural haemorrhage and why?

A

Lumbar puncture - can cause herniation and coning through foramen magnum

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18
Q

Name a cause of extradural haemorrhage?

A

Fractured temporal or parietal bone -> lacerate middle meningeal artery

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19
Q

How long does

a) Epileptic seizure
b) Non-epilpetic seizure
c) Syncope - typically last?

A

a) 30-120 seconds
b) 1-20 mins
c) 5-30 seconds

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20
Q

What are the three different types of partial/focal seizures?

A

a) Partial seizure (simple) without impairment of consciousness
b) Partial seizure (complex) with impairment of consciousness
c) secondary generalised seizure

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21
Q

What are the 5 different types of generalised seizure?

A
  1. Tonic-clonic
  2. Absence
  3. Myoclonic
  4. Tonic
  5. Atonic
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22
Q

What is first line treatment for generalised seizure?

A

Valproate

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23
Q

What is first line treatment for partial/focal seizure?

A

Carmazepine

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24
Q

What is the clinical presentation of a tonic-clonic seizure?

A

Tonic - rigidity and limbs stiffen

Clonic- rythmic muscular contraction and relaxation

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25
Q

Name 4 of the differences of the clinical presentations of epilepsy and syncope?

A

Syncope there is tongue biting and head turning
Syncope rarely arises from sleep - epilepsy often does
Cyanosis in syncope
Muscle pain in syncope

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26
Q

Name 4 of the clinical presentations of non-epileptic seizures?

A

Eyes are typically closed
Itcal crying and speaking
History of psychiatric illness
Dramatic motor phenomena or prolonged atonia

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27
Q

How does carmazepine work?

A

Inhibits neuronal Na+ channels so reduces neuronal excitability

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28
Q

Name 2 pathological findings of parkinson’s disease?

A
  1. Presence of lewy bodies (composed of alpha synuclein)

2. Loss of dopaminergic receptors in substantia nigra

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29
Q

What are the three characteristic symptoms of parkinson’s?

A
  1. Rigidity
  2. Bradykinesia - slow to initiate movement
  3. Resting tremor - “pill rolling”
    (Depression, sleep disorders, anosmia)
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30
Q

How do you diagnose parkinson’s?

A

Clinical examination, by confirming response to Levodopa

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31
Q

What is the 1st, 2nd and 3rd line drug treatment for parkinson’s?

A
  1. L-Dopa given alongside a dopamine decarboxylase inhibitor eg cocaroldopa (to cross BBB)
  2. Dopamine agonist eg roprinirole
  3. Mono-oxidase inhibitors eg oral selegilline
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32
Q

When would you give dopamine agonists and mono-oxidase inhibitors in parkinson’s?

A

To delay starting L-dopa in the early stages

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33
Q

What is the mechanism of action of L-dopa?

A

l-dopa can be taken up by dopaminergic receptors and converted into dopamine

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34
Q

What are the side effects of L-dopa?

A

Nausea, vomitting, arrhythmia, psychosis and visual hallucinations, dyskinesia

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35
Q

Why is a decarboxylase inhibitor given alongside L-dopa?

A

The decarboxylase inhibitor (cocaroldopa) prevents peripheral conversion of L-dopa to dopamine and therefore reduces peripheral side effects, and maximising dose crossing BBB

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36
Q

Name 4 long term complications of L-dopa use?

A
  1. Reduced efficacy over time
  2. On- dyskinesia
  3. Off-dykinesia
  4. Freezing - unpredictable loss of mobility
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37
Q

What is the mechanism of action of mono-oxidase inhibitors?

A

Inhibit enzyme which breaks down dopamine so domaine remains for longer

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38
Q

What are the symptoms of tremor in Parkinsons?

A

Worst at rest, often asymmetrical - pill-rolling of thumb and fingers

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39
Q

What are the symptoms of bradykinesia in Parkinsons?

A

Slow to initiate movement, decrease blink rate, monotonous hypo phonic speech, low amplitude movements

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40
Q

What are the symptoms of rigidity in Parkinsons?

A

Increase tone, limbs resist passive extension, cogwheel rigidity felt during rapid pronation/supination

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41
Q

Name 3 findings in the parkinsonism gait?

A

Reduced asymmetrical arm swing, stooped posture, small steps, shuffling, dragging foot

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42
Q

How would you distinguish motor neurone disease from multiple sclerosis?

A

No sensory loss or spinchter disturbance in motor neurone disease

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43
Q

How would you distinguish motor neurone disease from myasthenia gravis?

A

No affect on eyes movement in MND

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44
Q

What are the 3 main signs of UMN lesions?

A
  1. Spascitiy (increased muscle tone - hypertonia)
  2. Brisk reflexes (tendon and jaw reflexes)
  3. Plantars upturned on stimulation (positive babinki’s sign)
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45
Q

What are the 3 characteristic patterns of limb muscle weakness in UMN?

A
  1. Upper limb extensors weaker than flexors
  2. Lower limb flexors are weaker than extensors
  3. Finer more skilled movement impaired
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46
Q

What are the 4 main signs of LMN lesions?

A
  1. Muscle tone reduced (hypotonia)
  2. Muscle wasting
  3. Fasiculations - spontaneous contraction of motor units
  4. Reflexes depressed or absent
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47
Q

What are the 5 types of multiple sclerosis?

A

a) Relapsing remitting
b) Primary progressive
c) Secondary progressive
d) Progressive relapsing

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48
Q

What is Uhtoff’s phenomenon?

A

Symptoms worse in heat as new myelin is heat insufficient in MS

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49
Q

What is Lhermites phenomom?

A

Electric like sensation on flexion of the neck in MS

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50
Q

Name 4 symptoms of MS?

A 
Unilateral optic neuritis 
Bladder incontinence 
Spascitiy and weakness (legs) 
Sexual dysfunction 
Intention tremor
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51
Q

What would you see on LP - CSF fluid of patient with MS?

A

Oligioclonal IgG bands

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52
Q

What is the GOLD standard diagnosis for MS?

A

MRI- periventricular lesions and white matter abnormalities (plaques)

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53
Q

Name 3 treatment options for MS?

A

Acute - IV methylprednisolone

Precention - beta interferon, azathriorprine

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54
Q

Name some infective causes of GBS?

A

Campylobacter jejuni, EBV, HIV, CMV

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55
Q

What is the pathophysiology of GBS?

A

Infection -> autoantibody mediated nerve cell damage formation -> damage to schwann cells -> demyelination -> decreased peripheral nerve conduction

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56
Q

Name 4 clinical presentations of GBS?

A

Parasthesia in the hands and feet
Absent deep tendon reflexes
Symptoms are symmetrical
Proximal muscles are more affected - no wasting

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57
Q

How do you diagnose GBS?

A

CSF shows elevated protein and low WBC
Clinical examination
Look at stool sample for infective cause

58
Q

What type of peripheral neuropathy is GBS?

A

Acute symmetrical polyneuropathy - present as axonal or demyelinating

59
Q

What are the causes of peripheral neuropathy?

A

Diabetes, Alcohol, Vitamin deficiency, Infection, drugs

60
Q

What are the 3 presentations of peripheral neuropathy?

A
  1. Symmetrical
  2. Asymmetrical sensory - patchy distribution
  3. Asymmetrical sensorimotor (mononeuritis multiplex)
61
Q

What is the best way to diagnose peripheral neuropathy?

A

Nerve conduction studies, reduced conduction velocities and or conduction block in sensory or motor nerve

62
Q

Give an example of a mononeuropathy?

A

Carpal tunnel syndrome

63
Q

In carpal tunnel syndrome where would you experience parasthsia?

A

Thumb, index and middle finger (median nerve distribution)

64
Q

What is the pathology of the IDH mutation?

A

causes excessive 2-hydoxyglutarate, genetic instability in glial cells, inapproropiate mitosis, cancer

65
Q

Which 2 genetic mutations do all olgiodendrogliomas posses?

A

IDH-1 mutation

1p19q

66
Q

Name 4 things you would see in a patient with motor neurone disease?

A

Stumbling spastic gait, proximal myopathy, weak grip, shoulder abduction, aspiration pneumonia

67
Q

What is the characteristic rash in meningitis?

A

Non-blanching petechial/purpuric rash

68
Q

What is the triad of clinical presentation in meningitis?

A

Headache, neck stiffness and fever

69
Q

If a) cytomegalovirus b) Bacterial was the cause of meningitis,what would the CSF results show?

A

a) Normal protein and normal glucose, clear fluid

b) Turbid appearance, raised protein and low glucose

70
Q

What would be the CSF results in a subarachnoid haemorrhage?

A

Blood stained (xanthochromoa), normal glucose and high protein

71
Q

Which form of meningitis presents without a rash?

A

Viral meningitis - no specific treatment - less severe disease

72
Q

What are the signs of meningococcal sepsis?

A

Shock

Prolonged capillary refill time, cold hands and feet, decreased BP and evolving rash

73
Q

Which antibiotic do you give in prophylaxis of contacts in meningitis?

A

Ciprfloxacin

74
Q

What is the first line management in meningococcal sepsis?

A

Take blood cultures, IV antibiotics - don’t need to LP as know likely cause

75
Q

Give 4 differential diagnosis for encephalitis?

A

Encephalopathy, hypoglycaemia, hepatic encephalopathy, diabetic ketoacidosis, SLE, Wernickes

76
Q

Name 4 signs and symptoms of encephalitis?

A

Decreased GCS, fever, headache, focal neurological signs, seizures, history of travel, photophobia

77
Q

Name a) 3 viral and b) 3 non-viral causes of encephalitis?

A

a) Herpes simplex, coxsackie, EBV

b) Bacterial, malaria, TB, Lyme disease

78
Q

How would you confirm the diagnosis of encephalitis?

A

CSF - send for Viral PCR (common herpes simplex)

79
Q

Name 4 investigations you would do in a patient with encephalitis?

A
  1. Bloods
  2. Contrast enhanced CT
  3. LP
  4. EEG- periodic sharp and slow wave complexes
80
Q

What are the two treatment methods in encephalitis?

A

IV acyclovir and IV dextrose

81
Q

When would you add amoxicillin in meningitis treatment?

A

> 50, immunocompromised or pregnant to cover listeria or alcohol excess

82
Q

What would you add to Cefotaxmine if meningitis has been caused by strep pneumoniae?

A

Dexamethasone to decrease cerebral oedema

83
Q

Name 3 red flag signs for a patient with a suspected brain tumour?

A
  1. New headache with history of cancer
  2. Cluster headache
  3. Seizure
  4. Papiloedema
  5. Altered conciousness
84
Q

What complication does a lateral tectorial herniation in the brain cause?

A

3rd Nerve palsy and Contralateral hemiparesis

Forces uncut of temporal lobe out of the tentorium cerebelli

85
Q

Name the 4 most common locations of metastases to the brain causing secondary brain tumours? (lucy,ben,marry, really magnificent)

A
  1. NSC Lung (25%) and SC Lung (39%)
  2. Breast
  3. Melanoma
  4. Renal cell
  5. Melanoma
86
Q

Which drug is used to decrease cerebral oedema?

A

Dexamethasone

87
Q

Name a pharmacological treatment method for glioblastoma?

A

Temolozomide

88
Q

Which two genetic mutations are found in oligiodendrogliomas?

A

1p19q

IDH

89
Q

How does IDH mutation cause genetic instability in glial cells?

A

Mutation of isocitrate dehydrogenase, results in excessive build up on 2-hydroglutarate

90
Q

Name the 3 presentations of brain tumour?

A
  1. Symptoms of raised ICP (headache, papilloedema)
  2. Progressive neurologica deficit
  3. Epilepsy
91
Q

When is Babinki’s reflex positive?

A

Upper Motor Neurone lesions

92
Q

Name 3 causes of spinal cord compression?

A
  1. Vertebral body neoplasm
  2. Disc Herniation
  3. Disc Prolapse
93
Q

What is the clinical presentation of spinal cord compression?

A

Progressive weakness or legs with UMN symptoms
Bladder incompetence
Tone and reflexes reduced

94
Q

In spinal cord compression where is the sensory loss felt?

A

1-2 cord segments below the level of compression

95
Q

What is the GOLD standard diagnosis for spinal cord compression?

A

MRI

96
Q

Name 3 differences between huntigndons and parkinson’s?

A

PD - Increase muscle tone, Decrease in HD
PD - reduced movement, HD, overshooting movement
PD not enough dopamine, HD- too much dopamine

97
Q

What is the genetic mutation in Huntigdon’s?

A

Mutation on chromosome 4 resulting in repeated expression of CAG sequence
Autosomal dominant

98
Q

What is the definition of ataxia?

A

Wild movements which are clumsy, ill directional and poorly controlled

99
Q

What is the definition of apraxia?

A

Disorders of consciously organised patterns or movement or impaired ability to recall acquired motor skill

100
Q

What is Babinki’s Sign?

A

Plantars are upturned on stimulation suggests MND

101
Q

Name 3 tests to assess memory in dementia?

A
  1. 6 CIT
  2. Montreal cognitive assessment (MOCA) - sensitive
  3. Mini-mental state examination (MMSE) <25 suggestive
102
Q

Name 3 specialised diagnostic tests in dementia?

A
  1. Structural MRI - can show brain atrophy
  2. Amyloid imaging - look for neurofibrillary tangles (tau)
  3. Brain function PET
103
Q

Name 3 differences between dementia and depression?

A
  1. Depression onset and decline rapid, AD vague insidious onset
  2. Depression is subjective complaints of memory loss, AD = confusion
  3. Depression patient is distressed and unhappy with variability in cognitive performance, AD mood may be labile and cognitive performance is consistant
104
Q

Name the signs of cerebellar disease?

A 
Dysiadokinesia 
Ataxia 
Nystagmus 
Intention tremor 
Slurred speech 
Hypotonia
105
Q

Name 3 causes of cerebellar disease?

A

Toxic eg alcohol or phenytoin, Post-infectious cerebellitis, multi-system atrophy

106
Q

Give an example of an asymmetrical sensorimotor polyneuropathy?

A

Vasculitis

107
Q

What is the first line treatment for a migraine?

A

Sumatriptin (5HT agonist)
Selective serotonin receptor agonists,
(remove triggers and NSAIDS)

108
Q

What are the triggers for a migraine?

A

CHOCOLATE

Chocolate, hangovers, orgasms, caffeiene, oral contraceptive, lie-ins, alcohol, travel, exercise

109
Q

How long does a migraine typically last?

A

4-72 hours

110
Q

Give 4 characteristics of a migraine?

A

Unilateral, pulsing, aggregate by exercise, moderate/sever,photophobia/ photophobia

111
Q

Name 4 risk factors for a tension headache?

A

Stress, sleep deprivation, hunger, anxiety, noise

112
Q

How long does a tension headache typically last?

A

30 minutes to 7 days

113
Q

How long does trigeminal neuralgia typically last?

A

Fraction of a second to 2 mins

114
Q

What is the main risk factor for trigeminal neuralgia?

A

Hypertension

115
Q

What is the first line treatment for cluster headache?

A

Acute treatment = 100% oxygen

Calcium channel blocker - vermapril (prevention)

116
Q

How long does a cluster headache typically last?

A

15-180 mins

117
Q

Whats first line and second line treatment for temporal arteritis?

A 
1st = high dose oral corticosteroid 
2nd = IV TIS methylprednisoline
118
Q

Give three high risk factors of early stroke?

A

Atrial fibrillation, more than one TIA in a week, TIA whilst on anti-coagulant

119
Q

What is the clinical presentation of Huntingdon’s?

A

Chorea (involuntary, rapid, jerky movements)
Psychiatric/behavioural (irritability, aggression, impulsivity)
Dementia and fits

120
Q

When is ICP made worse?

A

Worse on walking, lying down, bending forward

121
Q

What are the clinical features of dementia with Lewy bodies?

A

Visual hallucinations, fluctuating cognition, parkinsonism

122
Q

Give 3 causes of haemorrhagic stroke?

A

Hypertension. migraine, coagulation diorder, drugs (cocaine), tumours

123
Q

What is the treatment for motor neurone disease?

A

Riluzole (increases survival 2-4 months)

124
Q

How do you treat GBS?

A

IV Ig plasmapheresis

Supportive (resp)

125
Q

Give 4 situations where you would delay lumbar puncture?

A
  1. Severe sepsis or rapidly evolving rash
  2. Severe respiratory or cardiac compromise
  3. Significant bleeding risk
  4. Signs of raised intracranial pressure
126
Q

Which 3 autonomic features are seen in cluster headaches?

A

Unilateral lacrimation, nasal congestion, conjunctival injection
Transit ipsilateral Horner’s syndrome

127
Q

What are the triggers for epilepsy?

A

Sleep deprivation, alcohol and drugs, intercurrent illness, missed doses of treated patients

128
Q

Which neurological drug lowers the effectivity of the contraceptive pill?

A

Carbamazepine

129
Q

Other than atherscleroris or emboli give 2 other causes of TIA?

A
  • Vasculitis, sickle cell anaemia

- Polycythaemia

130
Q

What ABCD2 score requires urgent referral in the risk of developing a stroke?

A

> 6

131
Q

If you suspected atherosclerosis as the cause of TIA, what specific investigation would you carry out and what treatment would you consider?

A 
Carotid Doppler and carotid endarterectomy 
Consider warfarin (vitamin K antagonist)
132
Q

Which 2 medications would you consider using in extradural haemorrhage to reduce the symptoms?

A

Dexamethasone – reduces cerebral oedema, stabilises blood-brain barrier, glucocorticoid
Nimodipine – calcium channel blocker, reduces vasospasm

133
Q

Name 3 non-neurological symptoms of parkinsons?

A

Dementia, hallucinations, dribbling, constipation

134
Q

What is the treatment for acute cluster headache and prophylaxis?

A 
Acute = sumatriptan 
Prolphylaxis = CCB - veramapril
135
Q

Give 3 features a patient with aura may experience preceding their migraine?

A

Zig-zag lines, tingling and weakness down one side, visual distrurbance

136
Q

Other than imaging, what physical examination would you do in Cauda Equine?

A

PR examination - checking anal and sphincter tone

137
Q

What is the classical presentation of myasthenia gravis?

A

Slow/increasing muscular fatigue

Signs = diplopia, ptosis, on costing voice fades, normal tendon reflex

138
Q

How would you treat this condition?

A

Anticholinesterade eg pyridostigmine

139
Q

Which antibodies may be present in myasthenia graves?

A

Anti-AChR and Anti-MUSK

140
Q

Give 3 mechanisms by which you can develop peripheral neuropathy?

A

Demylination- schwann cell damage

Axonal degeneration, infarction, infiltration of inflammatory cells

141
Q

What are Tilen’s and Phalen’s Sign?

A

Tinel’s – lightly tap over a nerve to induce irritation in it, eg over the wrist
Phalen’s – ask patient to hold wrists in full flexion (reverse prayer position) for 30-60 seconds, press on the wrist if need be, should get a tingling sensation/pain
Diagnostic for carpal tunnel syndrome

142
Q

Give 3 diseases carpal tunnel is associated with?

A

Diabetes mellitus, hypothryoidism, acromegaly and amyloidosis

Phase 2a Summaries (12 decks)

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