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Phase 3 > Neurology > Flashcards

Neurology Flashcards

1
Q

Which muscles are affected in radial palsy?

A

Extensor Carpi Radialis Longus

Externsor Digit communis

Brachioradialis

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2
Q

Which muscles are affected in ulnar palsy?

A

Abductor Digit Minimi

Adductor Pollicis

Flexror Carpi Ulnaris

1st Dorsal Interreous

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3
Q

What muscles are affected in median nerve palsy?

A

Lumbricals - I and II

Opponens pollicis

Abductor pollicis

Flexor Pollicis Brevis

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4
Q

What muscles are affected in anterior interossei branch of the median nerve?

A

Pronator quadratus

Flexor Pollicis longus

Flexor digitorum Profundus

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5
Q

List come causes of mononeuritis multiplex:

A

Diabetes

Vasculitis

INfective

Sarcoidosis

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6
Q

What is the pathology of Guillain Barre Syndrome? and what are some symptoms?

How is it treated?

A

Break-down in self tolerance due to post infection

  • campylobacter
  • EBV

Symptoms:
Progressive ascending motor weakness

flaccid paralysis

Loss of reflexes

delayed impulses on EMG

Treatment:

  • immunoglobulins
  • ventilation
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7
Q

What is Mysthenia Gravis? what is it related too - and list some symptoms?

A

Autoimmune condition where antibodies target acetylocholine receptor at post synpatic junction

associated with:

  • thymic hyperplasia
  • thyoma

Symptoms:

  • fluctuating weakness
  • ptosis
  • diplopia
  • dysphasia
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8
Q

How is Myasthenia Gravis treated?

A

Pyridostigamine

Steroids

Immunoglobulins

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9
Q

What are the types of stroke?

A

Thrombotic stroke
- atheroscleerotic plaque

embolic stroke

Lucunar stroke

Hemorrhagic

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10
Q

In order to have a Total Anterior circulatory stroke, what symptoms must one have?

What arteries are involved?

A

anterior and middle cerebral:

Contra- lateral hemiparesis

Contra - lateral homonymous heminopia

HIgher cererbral dysfunction

  • dysphasia
  • visual spatial disorder
  • contralateral hemisensory

**all 3 of these things must be present

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11
Q

In order to have a partial anterior circulatory stroke, what symptoms must be present?

What arteries are involved?

A

Middle cerebral:

Contra- lateral hemiparesis

Contra - lateral homonymous heminopia

HIgher cererbral dysfunction

  • dysphasia
  • visual spatial disorder
  • contralateral hemisensory

At least 2/3 out of these
or
Higher dysfunction
- dysphagia etc.

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12
Q

In order to have a Lucunar Syndrome stroke, What symptoms must be present?

What arteries are involved?

A

Small perforating arteries?

  • pure sensory
  • pure motor
  • sensori motor stroke
  • Ataxia hemiparesis
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13
Q

In order to have Posterior Circulating Syndrome stoke what symptoms must be present?

What arteries are involved?

A

Posterior cerebral artery
perforating cerebral artereis
cerebellar arteries

  • cranial nerve palsies
  • eye movement disorder
  • pupil disorders
  • cerebellar dysfunction
  • vertigo
  • nystagmus
  • ataxia
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14
Q

What is the tissue around the area of ischemia, which can potentially be saved called?

A

Penumbra tissue

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15
Q

On arrival at hospital for a stroke, what things much be checked/ done immediately?

A
  • take full history
  • ABCD assessment
  • Medical history
  • checking for bleeding disorders

*blood glucose

  • ECG
  • AF
  • IV access
  • NIL by mouth
  • Imagingin
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16
Q

What is the immediate treatment for an ischemic stroke?

A

*admission to stroke unit

  • Alteplase
  • <4.5 hours

*Aspirin

(thromboectomy if available)

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17
Q

What is secondary treatment of an ischemic stroke?

A
  • 24 hour CT scan
  • Aspirin 300mg for 14 days or till discharge

then:
Clopidogrel
or
Dipyridamole + Aspirin

+

Simvastatin

+

Anti- hypertensives

  • *retraining
  • physio
  • speech therapy
  • smoking
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18
Q

What type of hypersensitivity is MS?

A

Type IV

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19
Q

List some causes thought to be responsible for MS

A

HLA DR2

Environmental

Infections

  • EBV
  • HHV-6

Lack of Vit D

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20
Q

List the types of MS:

A

Relapsing Remitting
- 70% like this

Secondary Progressive

Primary Progressive

Progressive relapsing

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21
Q

List some common features of MS:

A

Optic Neuritis

Parasthesia

Weakness

Clumsiness

Hearing dysfunction

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22
Q

What is it called when symptoms of MS are made worse when the patient is hot?

A

UHthoff’s Phenomenon

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23
Q

What investigations are done in suspicion of MS?

A

MRI T2 weight
- Gadolinium contrast

Lumbar puncture
- Oligoclonal IgG Bands

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24
Q

Outwith imaging, what other investigations should be done for MS?

A

FBC

ESR

B12

ANCA
ANA
- exclude inflammatory conditions

Visual Evoked serology
- subclinical neuritis

Chest x-ray
- sarcoidosis

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25
Q

To diagnose MS, what criteria must there be?

A

> 2 attacks of demyelination dissemination within space and time.

26
Q

What is a pseudo-replase in MS?

A

Reemergence of of a previous symptom in the presence of an infection or increased heat.

27
Q

What is first line treatment for MS? with brief explanations of how they work?

A

Steroids for flare ups.
- methylprednisolone

Interferon Beta
- infectable

Glatiramer
- immune modulator

Dimethyl Fumarate
- reduces lymphocyte count

Teriflunomide
- supresses immune system

28
Q

What is second line treatment?

A

Fingolimond

Natalizumab

29
Q

What is the 3rd line treatment for MS?

A

Alemtuzumab

30
Q

How do you stain for cryptococcus meningitis?

A

Indian Stain

31
Q

What are some common syndromes that may develop into MS?

A

Optic neuritis
- 50% develop into MS within 15 years

Transverse myelitis
- inflammation of spinal cord
often present as incontinence in young people

Clinically isolated syndromes

Radiological isolated syndromes
- presents as MS on radiographic findings - usually incientenal

32
Q

What is a seizure?

A

Episode of neuronal hyperactivity within the brain, either localised or generalised.

33
Q

What is it called when there is a seizure, leading to jerking movements over one side of the body, and the patient remains conscious?

A

Simple focal Seizure

34
Q

Following a complex focal seizure what a person may be confused and have a set of syndromes following after about 2 minutes, what are these?

A

Speech arrest

Automatism

  • lip smacking
  • dystonic limb posturing
35
Q

What is it called when a person has both hemispheres involved during a seizure which results in loss of consciousness?

A

Generalised Seizures

36
Q

What are the subtypes of a generalised seizure?

A

Typical absence seizure
- often associated with masses in the brain

Generalised tonic clonic seizures / bi -lateral convulsive

  • tonic - stiffening
  • clonic - rapid relaxing and tensing

Myoclonic
- sudden jerks

Tonic seizures
- whole body contrats

Atonic seizure

37
Q

What is it called when a seizure lasts for >5 mins/ >30mins (depending on definition) or does not return to normal between 2 seperate seizures?

A

Status Epilepticus

an medical emergency where there is cardiovascular risk along with metabolic changes that can occur in the brain

recognised mortality due to these changes

38
Q

Name some things that can occur following a seizure:

A

Confusion and fatigue

Postictal confusion

Todd’s paralysis
- temporary suppression

39
Q

What investigations are done following a seizure?

A

Clinical history
- eye witness really important, since patient loses consciousness

MRI
- establish if any structural problem

EEG

  • hour long test
  • with photo-stimulation

Bloods
- Ca2+ levels

Glucose level
- hypoglycemia can mask

ECG
- QT interval

40
Q

when someone arrives in A&E following a seizure, what are the differentials and what can help you establish the cause?

A

Syncope

witnesses
how quickly they come round
how the felt prior to onset

41
Q

What is the definition of Epilepsy?

A

At least two unprovoked episodes of a seizure
tendency towards seizures.
*must be unprovoked

42
Q

Whats the life time risk of a seizure?

A

5-10%

43
Q

What is a focal seizure?

A

Area discharge from a irritated part of brain, from an other wise normal brain

44
Q

What is a bilateral convulsive seizure?

A

Generalised tonic clonic

45
Q

What immediate treatment of someone having a seizure?

A

Recovery position

ABCD

if no ABCs abnormalities then no need for hospitalisation

46
Q

What are some features of a focal epilepsy?

A

History of trauma

Aura

Post attack confusion

Automatisms

nocturnal events

47
Q

What are some features of Generalised seizure?

A

Photosensitivity

age of onset - young

lack of aura

Myoclonus - especially in morning

seizures in the morning
family history

EEG abnormalities

48
Q

What things do you get the patient to do during an EEG?

A

lie at rest

hyperventilate

Relax and make drowsy

Photic stimulation

49
Q

What is the treatment for focal epilepsy?

A

Lamotrigrine

Carbamazepine

Levetiractem

50
Q

What is the treatment for generalised?

A

Valproate

Levetriactem

Lamotrigrine

51
Q

What are the symptoms of optic neuritis?

A

Fogging of vision

Painful eye movement

Central vision loss

Colour desaturation

Dense central scotoma

52
Q

What are the clinical findings of optic neuritis?

A

RAPD

optic disc pallor

red colour destruction

53
Q

What are some common symptoms of Intracerebral TB?

A

Progresses over weeks

Palsy of cranials:

  • 3
  • 4
  • 6
  • 9
54
Q

What brain disease does JC virus cause?

A

Multifocal Leuco - encephephalopathy

55
Q

How is cryptococcal meningitis treated?

A

Amphotericin B

Fluconazole

ICP shunt

56
Q

What is a complication with cryptococcal meningitis patients who have HIV?

A

Paradoxical worsening with anti- retroviral medication

57
Q

What nerve palsy is usually first seen in high intra-cranial pressure?

A

6th nerve

58
Q

Which nerve palsy will present with a head tilting away?

A

Trocheal, 4th nerve.

59
Q

List some symptoms outwith motor, which occur in parkinson’s:

A

Dementia
Depression
anxiety

REM sleep behaviour disorder
restless legs

Constipation
urinary urgency

60
Q

What investigations are done into parkinson’s?

A

Bloods

  • thyroid
  • copper levels

MRI
- for vascular changes

Functional imaging
- DAT - SPECT
allows the dopaminergic neurons to be seen

61
Q

What drug is given to stop status epilepticus?

A

Lorazepam?

62
Q

What are the stages of parkinson’s?

A

Step 1-2:
Medulla/ Pons and Olfactory nucleus

pre-symptomatic stage. Loss of sense of smell

Step 3-4:
Midbrain/ substantia nigra
symptoms of movement

Step 5-6:
Neocortex involvement
- Parkinson’s associated dementia

Phase 3 (50 decks)

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