Brainscape's Knowledge GenomeTM

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


See full index

Final Med > neurology > Flashcards

neurology Flashcards

1
Q

define epilepsy

A

Epilepsy is defined as a tendency to have recurrent unprovoked seizures. A single seizure is not enough to diagnose epilepsy. A seizure is defined as a transient excessive electricity in the brain that has motor, sensory, or cognitive manifestations discernible to the patient or observer.

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

What are the types of generalized seizures you can get?

A 
tonic clonic
absence
atonic 
tonic 
clonic
myoclonic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

tonic clonic seizure

A

tonic ( rigid as muscles contract) and then convulse making rhythmical muscular contractions (clonic).

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

absence

A

petit mal normally occurs in children

patient loses consciousness and appears vacant and unresponsive to observers forup to 30 sec

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

atonic

A

brief loss of muscle tone patient falls to the ground

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

tonic

A

sustained muscle contraction

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

clonic

A

rhythmic muscular contractions

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

myoclonic

A

an extremely brief muscular contraction less than .1 of a second seen as a jerky movement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is a partial seizure?

A

divided into simple (conscious) or complex ( impaired consciousness) . It can be then subdivided based upon the brain area affected temporal frontal parietal or occipital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

partial seizure temporal lobe

A

deja vu, jamais vu, olfactory/ auditory aura, epigastic discomfort.

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

partial seizure- frontal lobe

A

motor

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

partial seizure - parietal

A

sensory (crawling up arm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

occipital partial seizure

A

visual

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

SE of anticonvulsants common to all

A

(Na valproate, phenytoin, carbamazepine, lamotrigine) ALL are teratogenic

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

Na valproate SE (repro)

A

associated with neural tube defects

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

pheytoin SE (repro)

A

cleft palate and congential heart disease, interfere with the OCP so should double dose or use barrier methods.

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

Na valproate

A

weight gain hair loss and curling, nausea, vomiting, drug induced hepatitis, rash, drowsiness, tremor

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

lamotrigine

A

rash (steven johnson syndrome, headaches, dizziness, insomnia, vivid dreams.

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

carbamazepine SE

A

rash, nausea, atazia, diplopia, agranilocytosis, hyponatremia

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

phenytoin SE

A

acne, rash, atazia, ophalmoparesis, sedation, gingival hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the law concerning driving with an episode of loss of conciousness

A
  1. simple faint with prodromal syndromes and a proking factor no restrictions
  2. due to transient loss of blood supply to the brain with a low risk of reoccurrence than can return in 4 weeks time.
  3. if syncope with high risk of reoccurrance can drive four weeks after event if cause ID and treated. If not identified than cannot drive for 6 months.
  4. if unexplained loss of conciouness than cannot drive for 6 months
  5. If seizure activity than cannot drive for one year.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

limb weakness seconds to minutes

A

trauma (displaced vertebral fractures) or vascular insult (tia, stroke)

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

hours to days limb weakness ddx

A 
progressive demyelination (guillian barre and MS)
or slowly expanding subdural heamatoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

chronic weeks to months limb weakness

A

slow growing tumour or a motor neuron disease

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

Why is time of onset of stroke SO important in the history taking?

A

because the window of time in which to confirm the dx and administer thrombolysis is only 4.5 hours from onset.

26
Q

If there is a headache with the onset of limb weakness what would you be thinking of?

A

subarachnoid haemorrhage. unilateral headache may be hemiplegic migraine. gradual onset headache- slow growing tumour

27
Q

Why should you ask about seizures with the limb weakness?

A

seizures are associated with hypoglycaemia and also epilepsy (TODD’s paresis)

28
Q

What are the risk factors fro stroke that you should illicit in the history?

A

TIA, or past stroke, AF, atherosclerotic disease or RF

migraine with aura, and systemic lupus erythmatosus

29
Q

How do you differentiate between an upper and lower motor neuron lesion?

A 
upper motor neuron 
increased tone 
increased reflexes 
up going planters with babinski reflex and splaying of the toes
clonus 
LMN 
decreased tone
decreased reflexes 
fasiculations 
wasting.
30
Q

where is the lesion in receptive dysphasia

A

wernicke area in the temporal lobe of the dominant hemisphere

31
Q

where int he lesion in expressive dysphasia

A

broca’s area in the the frontal lobe of the dominant hemisphere

32
Q

When the patient is not responding to stimuli on side of his body where is the lesion?

A

parietal cortex

33
Q

complete blindness in one eye suggests

A

lesion is in the optic nerve

34
Q

homonymous hemianopia

A

loss of the same half of the vision field in both eyes suggests a lesion between the optic chiasm and visual cortex (beware visual neglect can mimic this)

35
Q

eye deviation

A

If the eye deviates away from the weak side this suggests a cortical lesion
if the eyes deviate towards the weak side it suggests a brain stem lesion.

36
Q

spinothalamic tract

A

pain and temp

37
Q

dorsal column

A

light touch, proproception, vibration

38
Q

In a LMN when the sensory sign present indicate

A

peripheral nerve lesion

39
Q

in a LMN lesion with the sensory signs absent

A

nerve root lesion

40
Q

What supplies the medial part of the cerebral cortex.

A

The motor cortex for the lower limbs is by the anterior cerebral artery

41
Q

What supplies the lateral portion of the motor cortex

A

hands, upper limb and face this is supplied by the middle cerebral artery.

42
Q

Why can a infarct by the MCA cause contralateral hemineglect?

A

it supplies the posterior parietal cortex.

43
Q

What are the first line investigations in a stroke?

A

bedside: blood glucose to rule out hypoglycaemia
ECG looking for AF
bloods: FBC polycythemia, thrombocytosis, or thrombocytopenia
clotting screen: if patient is on warfarin and to exclude a coagulopathy
imaging: CT brain non contrast to rule out haemorrhage

44
Q

If the patient has a confirmed ischeamic stroke but presents out side the thrombolysis window what can you do?

A

Anti platelet drug: aspirin
stroke unit: MDT and speech therapy OT, physiotherapist
VTE prophylaxis increased risk of thrombotic events PE or DVT
low molecular weight heparin if haemorrhaging stroke has been excluded.

45
Q

What are the second line investigations that are done on the stroke unit?

A

carotid doppler US: carotid artery atheromas that could be the source of emboli causing the stroke.
ECHO: cardiac source of emboli or a patent foramen ovale

46
Q

What are stroke patient in the ward more at risk of?

A

since they are immobile they need to be checked for pressure sores which can quickly become sources of infection. Regular moving of the patient is important.
aspiration pneumonia stroke patients have difficulty swallowing- speech and lang carry out a swallow assessment and they may need NG tube
VTE prophylaxis and recurrent ischeamic stroke

47
Q

What is a disability screen for a stroke patient?

A 
GCS
swallow
speech and lang
visual fields 
gait
48
Q

What is risk factor reduction in a patient with hx of stroke and also a carotid bruit?

A

carotid endarterectomy

also quite smoking

49
Q

drug prophylaxis in stroke patients?

A
  1. antiplatelet: clopidogrel daily
  2. daily statin: even if the cholesterol levels are normal
  3. daily angiotensin converting enzyme ACE inh and or thiazide diuretic aiming for a blood pressure less than 130/85
    or less than 120/80 if diabetic
50
Q

What is the stroke framework?

A 
Time course
deficit
location
disease
aetiology
51
Q

What is the score used to assess risk in a TIA

A

ABCD2 score
Age: 1 pt for greater than 65
blood pressure: 1 pt for grater than 140/90
clinical features: 1 pt for speech disturbance without weakness 2 pt for unilateral weakness
duration of symptoms: 1 pt for 10-59 min
2 pt for greater than 60
diabetes 1 pt
points greater than 4 need to be seen in 24 hrs at clinic

52
Q

what if you don’t find the cause of the TIA and discharge the patient?

A

Then the patient is 25% likely to develop a TIA, stroke or fatal CVA. within 90 days

53
Q

In the TIA clinic what investigations are they going to do?

A
  1. history looking for any modifiable risk factors: smoking hypertension, hyperlipidemia, D.M
  2. examination: carotid, pulse
  3. bedside ECG AF
  4. bloods: glucose, FBC, clotting profile
  5. imaging: MRI brain
54
Q

When to use antiplatelets?

A

useful in clots that form due to endothelial activation of platelets (atheroscerotic plaques) prevent MI and primary ischeamic stroke

55
Q

When to use anticoagulants?

A

clots that form during blood stasis (deep vein thrombosis or AF)
are rich in fibrin and erythrocytes. Need to be used by drugs that inhibit fibrin mesh formation.

56
Q

What two scoring systems can you use to determine the benefit of coagulation therapies or antiplatelet therapies?

A

CHA2DS2 VASC score and the HASBLED score

57
Q

What are the eye signs noted in patients with MS

A

*this can be on the other side but we will stick with one example for simplicity
get the patient to go from extreme right graze to extreme left gaze
the right eye is slow to adduct relative to the left and there is abnormal nystagmus of the left eye.

58
Q

What are the imaging and investigations you can do in a patient with MS

A

Lumbar puncture for oligoclonal bands, it is characteristic to find elevated levels of multiple IgG antbodies
IgG antibiotics are derived from B cell clones
dark bands on clonal gel
MRI brain and spinal cord looking for plaques (sclerotic- demyelonated)
delayed response to visually provoked potentials

59
Q

What are the contraindications for thrombolysis

A 
onset not confirmed with 4.5 hours
acute heamorrhage on CT scan
seizure at the onset of stroke
subarachnoid heamorrhage 
stoke/ head injury in the past 3 months 
major surgery/ trauma within 2 weeks
previous ICH
intracranial neoplasm 
arteriovenous malformation or aneurysm 
GI heamorhage 
LP in the past week
platelets less than 100
INR less than 1.7 
glucose less than 2.7 or greater than 22
pos. preg
TIA
systolic BP greater than 185 or diastolic greater than 110
suspected pericarditis
60
Q

Brown sequard syndrome explain anatomically

A

each half the spinal cord contains

  1. UMN innervating the ipsilateral side of the body
  2. dorsal column neurons (vibration, prop, and fine touch) innervating the ipslateral side of the body
  3. spinothalamic neurons (pain, temp, and light touch) innervating the contralateral side of the body.

Final Med (35 decks)

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