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My Phase 3a cards > Neurology > Flashcards

Neurology Flashcards

1
Q

What is a hemi-Parkinsonian gait?

A

Parkinsonian gait with reduced arm swing on 1 side

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2
Q

What gait is most commonly seen in stroke? Describe it.

A

Hemiplegic gait: 1 leg is stiffly extended and swung to avoid toe catching

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3
Q

In what condition would you expect a high-stepping gait?

A

Peripheral neuropathy - tabes dorsalis

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4
Q

How might you test for impaired proprioception?

A

Romberg’s test

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5
Q

Describe Romberg’s test and what a positive result looks like

A

Stand with feet together and eyes closed. Swaying or falling indicates a positive Romberg’s.

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6
Q

What are the 2 most common causes of “black outs”?

A

Seizures and Syncope

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7
Q

Describe the typical history of syncope

A 
Prodrome: feeling light headed before
<30 seconds unconscious
Quick recovery
Urine incontinence
No tongue biting
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8
Q

What are the brains excitatory and inhibitory neurotransmitters?

A

Glutamate and GABA

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9
Q

How do you treat status epilepticus?

A

Benzodiazipines

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10
Q

How do benzodiazepines work to treat status epilepticus?

A

Enhance GABA

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11
Q

How long until a seizure becomes status epilepticus?

A

> 5 minutes

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12
Q

First line treatment of focal epilepsy?

A

CARBAMAZEPINE

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13
Q

First line treatment of generalised epilepsy?

A

VALPROATE

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14
Q

Which 2 areas of the brain are responsible for consciousness?

A

Cortes and Reticular Activating System of the brain stem

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15
Q

What is an infratentorial lesion? What may cause it?

A

Lesion below the tentorium cerebelli - tumour

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16
Q

How may a supratentorial lesion cause coma/brain death?

A

Increased pressure causes herniation

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17
Q

Give examples of supratentorial lesions which may cause herniation

A

subarachnoid haemorrhage, subdural haematoma, extradural haematoma

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18
Q

What are the most common causes of coma?

A

Drug overdose and head trauma

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19
Q

Supportive management of coma?

A

ABC, DVT prophylaxis, NG tube, Catheter

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20
Q

What may cause coma with neck stiffness?

A

Subarachnoid Haemorrhage and Meningitis

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21
Q

What do focal neurological signs suggest in a comatose patient? What would you use to treat the problem?

A

Herniation

Drugs to reduce intracranial pressure: Mannitol and dexamethasone

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22
Q

What are the most common causes of coma without neck stiffness, focal signs or fever?

A

Drug overdose and hypoglycaemia

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23
Q

What are the 3 diagnostic criteria for brain death?

A
  1. Irreversible cause
  2. Unresponsive patient with no function
  3. Brain stem death
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24
Q

Describe the Doll’s Head Eye Maneuver.

A

Open eyes and move head: if the eyes watch the ceiling the brain stem is intact, POSITIVE result
If the eyes are fixed in the head, brain stem is not intact - NEGATIVE result

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25
Q

What is Amaurosis Fugax?

A

Sudden visual loss caused by an occlusion of the retinal artery

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26
Q

What causes painful visual loss?

A

Optic Neuritis

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27
Q

How might Multiple Sclerosis first present?

A

With optic neuritis- painful visual loss, loss of colour vision

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28
Q

What pattern of visual loss is present in giant cell arteritis?

A

“Altitudinal” field defect- patient feels as if they are looking over a wall

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29
Q

What symptoms would be present in a lesion of the optic nerve? (4)

A
  • loss of colour vision
  • loss of visual acuity
  • loss of pupillary reflexes
    cenrtal scotoma
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30
Q

What visual defect would you get in a parietal lobe lesion?

A

Avoidance of half of the visual field on the contralateral side e.g. drawing half a clock with all the numbers on the right hand side

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31
Q

What is agnosia?

A

Not being able to recognise things by sight

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32
Q

Describe the pattern of weakness in an Upper Motor Neurone Lesion.

A

Strong flexors in the arm and weak extensors, the opposite pattern in the legs

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33
Q

What would cause proximal weakness and opthalmoplegia?

A

Myasthenia Gravis

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34
Q

What is the most common cause of peripheral neuropathy?

A

Diabetes

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35
Q

What is the treatment for Guilian Barre?

A

IV Immunoglobulins

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36
Q

What is the treatment for Myasthenia Gravis?

A

Acetylcholine esterase inhibitors e.g. donezepil

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37
Q

A patient presents with ataxia, headache and confusion - her symptoms are progressive… What could be causing these symptoms?

A

Raised intracranial Pressure

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38
Q

What drug is used to reduce cerebral oedema?

A

Mannitol

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39
Q

What eye signs might you see in raised ICP?

A 
Tramps palsy (CN III)
6th nerve palsy
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40
Q

If someone has CSF leakage through the nose and a headache which is worse on standing what is wrong?

A

Reduced intracranial pressure

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41
Q

What are the symptoms of foramen magnum herniation?

A

neck pain
erratic breathing
tetraparesis

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42
Q

What is the most common cause of stroke?

A

Ischaemia (80% of strokes are ischaemic, 20% are haemorrhagic)

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43
Q

What is the treatment for ischaemic stroke?

A

Thrombolysis

44
Q

When should you treat an ischaemic stroke with thrombolysis?

A

Within 4.5 hours

45
Q

What drug is used for thrombolysis?

A

Alteplase, tissue plasminogen activator

46
Q

Name 2 acute and 2 long term treatments of migraine?

A

Acute - NSAIDs, triptans

Chronic - beta blockers, amitriptyline

47
Q

What is the management of a cluster headache?

A

Oxygen

Sumatriptan

48
Q

What should you do if you suspect trigeminal neuralgia?

A

MRI head

49
Q

Treatment of trigeminal neuralgia?

A

Carbamazepine, microvascular decompression

50
Q

What would the blooods of someone with giant cell arteritis look like?

A

raised CRP, Platelets and Alk Phos

51
Q

What is the management for giant cell arteritis?

A

60mg Prednisolone

52
Q

What should you prescribe alongside steroids and why?

A

Bisphosphonates and PPI to protect stomach lining and bone density

53
Q

15% of strokes are….

A

haemorrhagic

54
Q

85% of strokes are…

A

ischaemic

55
Q

How long do TIA symptoms last?

A

<24 hours

56
Q

What is the risk stratifying score for TIA?

A 
ABCD2: 
Age >60 = 1
Blood pressure > 140/90 = 1
Clinical Features: weakness = 2, speech disturbance = 1
Duration >60 mins = 2, <60 mins = 1
Diabetes = 1
57
Q

If your ABCD2 score is high risk what needs to happen? And if medium/low risk?

A

Specialist assessment within 24 hours, all TIAs assessed within 7 days

58
Q

What is the medical treatment for TIA?

A

75mg clopidogrel

59
Q

Surgical treatment for TIA?

A

Carotid endarterectomy if >70% occulsion

60
Q

Which arteries are occluded in Total Anterior CIrculation Infarcts? (TACIs)

A

Anterior and middle cerebral artery

61
Q

What is the presentation of a TACI involving the middle and anterior cerebral artery?

A

unilateral hemiparesis and hemisensory loss
homonymous hemianopia
dysphasia
dysarthria

62
Q

Waht artery is occluded in posterior circulation infarcts?

A

Vestibulobasilar arteries

63
Q

What is the presentation of an occulsion in the posterior circulation (vetibulobasilar arteries)

A

cerebellar syndromes
LOC
homonymous hemianopia

64
Q

What is a lacunar infarct?

A

Infarct of the perforating arteries supplying the internal capsule and basal ganglia

65
Q

How do lacunar infarcts present?

A

ataxic hemiparesis

66
Q

Name the stroke: ipsilateral III nerve palsy, contralateral weakness of arm and leg?

A

Weber’s syndrome: branches of the posterir cerebral artery that supply the midbrain

67
Q

Name the stroke: locked in syndrome

A

Basilar artery

68
Q

Name the stroke: contralateral paralysis and weakness, usually the leg

A

Anterior cerebral artery

69
Q

Name the stroke: contralateral paralysis and weakness, usually the arm + aphasia

A

Middle cerebral artery

70
Q

Name the stroke: contralateral homonymous hemianopia with macular sparing

A

posterior cerebral artery

71
Q

Acute management of ischaemic stroke?

A

300mg aspirin

thrombolysis with alteplase IF within 4.5 hours of stroke

72
Q

After a head injury someone has a lucid interval… what type of brain bleed do they have?

A

Extra dural haemorrhage

73
Q

What is the treamtent for an extra dural haemorrhage?

A

Burr hole

74
Q

Who gets sub-dural haemorrhages and why?

A

Elderly people and other people who fall e.g epileptics and alcoholics

75
Q

Someone who has fallen over presents with Fluctuating consciousness, insidious intellectual slowing, personality change, sleepiness, headache, unsteadiness - what’s the bleed?

A

Subdural haemorrhage

76
Q

What do berry aneurysms and arterio-venous malformations increase your risk of?

A

Sub-arachnoid haemorrhage

77
Q

Name 3 conditions associated with subarachnoid haemorrhage.

A

Ehlers Danlos, COarction of Aorta, PKD

78
Q

What gives a thunderclap headache?

A

Subarachnoid haemorrhage

79
Q

What is the treatment for subarachnoid haemorrhage?

A

calcium channel blocker e.g. nimodipine OR surgical clipping

80
Q

A seizure with brief, rapid muscle jerks is?

A

Myoclonic

81
Q

What is anoher word for an “atonic” seizure?

A

Drop-attack

82
Q

What is the treatment for generalised seizures?

A

Sodium valproate

83
Q

What is the treatment for partial/focal seizures?

A

Carbamazepine

84
Q

What drug is contraindicated in absence seizures? What is the drug treatment?

A

Carbamazepine makes it worse, sodium valproate is used

85
Q

Pathophysiology of MS?

A

T - Cell mediated immune response causing demyelinated plaques in the CNS

86
Q

What is optic neuritis and what condition is it seen in classically?

A

Unilateral eye pain on movement and loss of central vision, multiple sclerosis

87
Q

What would you give to shorten an acute relapse of MS?

A

Methylprednisolone

88
Q

Which drug reduces relapses in MS?

A

Beta-interferon

89
Q

What is the histological finding of Parkinson’s disease?

A

Lewy bodies

90
Q

Name a dopamine receptor agonist. What does it treat?

A

Bromocriptine, Parkinson’s

91
Q

Where is the Huntingtin gene?

A

Chromosome 4

92
Q

What is diseased in Huntingdon’s?

A

cholinergic and GABA neurons in striatum of basal ganglia

93
Q

Personality change and lack of co-ordination are the first features to develop in….?

A

Huntingdon’s

94
Q

What drug can be used to treat chorea symptoms?

A

Tetrabenazine, dopamine antagonist

95
Q

What muscles are always spared in motor neuron disease?

A

Eye muscles!

96
Q

Which infections classically precede Guillian-Barre?

A

campylobacter, EBV

97
Q

What is the treatment for Guillian-Barre?

A

IV Immunoglobulin

98
Q

What do the antibodies attack in Myasthenia Gravis?

A

Post synaptic acetylcholine receptors

99
Q

What is the treatment for Myasthenia Gravis?

A

Acetycholine esterase inhibitors e.g. pyridostigmine

100
Q

Name an acetylchlineesterase inhibitor used in alzheimer’s treatment?

A

Rivastigmine

101
Q

What would indicate a haemorrhagic stroke?

A

meningism, severe headache, coma, drowsiness, reduced GCS, vomiting, focal deficit.

102
Q

What do you get if a berry aneurysm ruptures?

A

Subarachnoid haemorrhage

103
Q

What do you get if you rupture the bridging vein?

A

Subdural haemorrhage

104
Q

What are the risk factors for subdural haemorrhage?

A

Age, alcohol and anti coagulatns

105
Q

What do you get if you hit your head and tear your middle meningeal artery?

A

Extra dural haemorrhage

106
Q

When would you see a latent phase?

A

Extra dural haemorrhage

107
Q

What is Brudzinski’s sign?

A

Positive for meningitis: flexion of the neck causes knee flexion

My Phase 3a cards (11 decks)

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