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Meddygaeth B > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the components of a neurological systems review?

A

Fits/faints/funny turns? Headaches? Memory problems? Altered vision? Hearing difficulties? Speech and swallowing difficulties? Weakness? Numbness/ tingling? Balance coordination issues? Incontinence/erectile dysfunction?

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2
Q

Define Amyotrophic Lateral Sclerosis

A

Type of Motor Neuron Disease, typically has LMN signs in arms and UMN signs in legs. Can have genetic component, chromosome 21

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3
Q

What are headache red flags?

A

High severity headache, fever, new onset neurological deficit, cognitive dysfunction, change in personality, recent head trauma (3months), made worse by cough, sneeze, exercise or change in posture, halos around lights or worse in dark, jaw claudication answers scalp tenderness.

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4
Q

What is the MRC grading scale for power assessment?

A

0) no power
1) twitching but no movement
2) movement, but cannot overcome gravity
3) can overcome gravity
4) movement against gravity and resistance
5) normal muscle strength

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5
Q

What structures are composed of upper motor neurons?

A

Motor cortex
Spinal cord
White matter tracts

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6
Q

What structures make up lower motor neurons?

A

Motor nerves
Nerve root
Neuromuscular junction
Anterior horn cell

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7
Q

What are the signs of UMN disease?

A

Increased reflexes

Increased tone

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8
Q

What are the signs of LMN disease?

A

Decreased reflexes, normal/decreased tone, fasciculations

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9
Q

What is brown-sequard syndrome?

A

A hemi section of the spinal cord. Causes UMN signs ipsilateral to the side of injury. Additionally there will be decreased sensation of vibration and proprioception ipsilaterally. HOWEVER as the spinothelamic tracts decussate upon entering spinal cord pain and temperature sensation will be diminished on the contralateral leg

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10
Q

Where would a lesion causing homonymous hemianopia be?

A

Occipital cortex or optic radiation

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11
Q

Where would a lesion be causing bitemporal hemianopia?

A

Optic chiasm

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12
Q

Where would a lesion causing monocular blindness be?

A

Optic nerve

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13
Q

What are CT scans used for?

A

Identifies acute collections of blood, use in trauma, sub arch harmorrhage, stroke and polycystic kidney disease + headache

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14
Q

What do you use MRI for?

A

Intrinsic brain/spine pathology. Use in MS, suspected caused equina

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15
Q

Derangements of what electrolytes can result in limb weakness?

A

Potassium, calcium, phosphate and magnesium

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16
Q

What is the method for diagnosing Guillain Barre Syndrome (GBS)?

A

Clinically, LMN signs, glove and stocking distribution, progressive starting dismally moving proximal. LP -cytoalbuminologic dissociation - normal cell count but elevated protein level

17
Q

What does sub acute neuropathy in HIV look like on LP?

A

Increased lymphocytes and increased protein

18
Q

What is Bell’s palsy?

A

One sided lower motor neurons facial weakness.

Likely idiopathic, no imaging necessary

19
Q

What is the treatment for Bell’s palsy?

A

Corticosteroids given in early course of disease
Tape eye closed at night to avoid corneal damage
Recover within 4-6months, recurrence is uncommon

20
Q

What are the causes of footdrop?

A

Lumbar nerve root lesion (radiculopathy) -back pain, no ankle reflex e.g. prolapsed disk
Common perineal nerve palsy- painless, ankle reflex present, normally caused by unaccustomed activity of prolonged kneeling

21
Q

What investigations do you need to do following someone presenting after generalized tonic-clinic seizure?

A

ABCDE
BMs, ECG, neurological examination, investigate for metabolic disturbances e.g. hyponatraemia and hypocalcaemia
Eventually structural brain imaging, CT used acutely especially if decreased consciousness

22
Q

What advice should be given to a patient suffering from epilepsy?

A

Avoid situations where they would be in danger if they suddenly lost consciousness
Working at height, cycling in traffic, swimming, baths, horse riding
Driving

23
Q

What is treatment for epilepsy in females of childbearing age?

A

Lamotrigine

Makes the pill work less well and the pill makes it work less well

24
Q

After seizures what does DVLA say?

A

Stop driving immediately, inform DVLA, NO DRIVING FOR 1 year.

25
Q

What is a strong indication of tonic clonic seizure?

A

History of bilateral tongue biting

26
Q

What is a sign of optic neuropathy?

A

Relative afferent pupillary defect, detected by ‘swinging light test’.
In optic neuritis the affected eye paradoxically dilates as information from damaged optic nerve is weaker than info from functional contralateral nerve

27
Q

What is the treatment for acute attack of MS?

A

High dose IV methyl prednisolone 1g daily for 3 days.

28
Q

What are the risks of high dose steroids?

A

G.I. Irritation, agitation, restlessness and insomnia. Rarely steroid psychosis. Hyperglycaemia can occur acutely (v. rare). Avascular necrosis of the hip

29
Q

What is L’Hermitte’s phenomenon?

A

Sudden electric shock type sensations radiating up and down spinal column provoked by flexion or extension of the neck and accompanied by paraesthesia in the arms, legs and abdomen with a feeling of tight band around chest

30
Q

What is the criteria for MS DMARDs ?

A

Patients experiencing two or more significant relapses over a two year period

31
Q

Weird sensory issues, always test for what?

A

B12! Treatable if diagnosed early, potentially irreversible if missed

32
Q

What tests should be done before giving immunosuppressive steroids?

A

FBC, renal function, random glucose and urine dipstick

33
Q

What are the commonest symptoms of an MS relapse?

A

Urinary frequency, urgency and retention and functional (sensory less likely) symptoms

34
Q

What inflammatory conditions can mimic MS?

A

Sjögren’s syndrome (ask about systemic symptoms)
Devic’s syndrome AKA neuro myelitis optica (check NMO and aquaporin 4 antibodies)
Anticardiolipin antibody syndrome, neurosarcoidosis

Meddygaeth B (9 decks)

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