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Y3- TO LEARN > Neurology > Flashcards

Neurology Flashcards

1
Q

What is hemiballismus and what lesion causes it?

A

Uncontrolled flailing of limbs

Subthalamic lesion

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2
Q

Features of migraine?

A 
Throbbing
Unilateral
Inner side of eye
Worse on movement
Light and noise sensitivity
\+/- aura (20-60mins)
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3
Q

Triggers of migraine + aura?

A 
Sleep
Diet
Hormones
Stress
Physical exertion
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4
Q

How do migraines occur?

A

Stress= change to brain= serotonin release

Blood vessels constrict + chemicals irritate nerves–> pain

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5
Q

Acute treatment of migraine?

A

Aspirin or Naproxen or Ibuprofen +/- anti-emetic

Triptans (e.g. rizatriptan, sumatriptan)- 5hT agonist

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6
Q

Prophylactic treatment of migraine?

A

3+ attacks/month:

Propranolol
Topiramate (carbonic anhydrase inhibitor)
Amitriptyline

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7
Q

Features of tension-type headache?

A

Bilateral, tight band sensation

Pressing/tingling

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8
Q

Treatment of tension-type headache?

A

Relaxation
Simple analgesia
Ice packs

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9
Q

Features of cluster headaches?

A 
Mostly young people
Around sleep
Unilateral
Worse headache ever
Retro-orbital pain
Tearing
Cluster of months then disappear
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10
Q

Treatment of cluster headaches?

A

High flow O2
sub/cute Sumatriptan
Steroids

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11
Q

Prophylaxis for cluster headaches?

A

Verapamil

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12
Q

What is paroxysmal hemicrania?

A

Elderly

Unilateral severe pain + unilateral autonomic symptoms (e.g. headache, nasal congestion etc.)

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13
Q

Treatment of paroxysmal hemicrania?

A

ABSOLUTE response to Indomethicin

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14
Q

Common presentation of idiopathic intracranial hypertension?

A

Overweight/obese
Headaches
Worse in morning/ lying down
Morning N+V

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15
Q

What can idiopathic intracranial hypertension lead to?

A

Papilloedema + blindness/visual defects

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16
Q

Investigation of idiopathic intracranial hypertension?

A

MRI brain- normal
Lumbar puncture
Fundoscopy + VFs

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17
Q

Treatment of idiopathic intracranial hypertension?

A

Weight loss
Diuretics
Acetazolamide

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18
Q

Features of trigeminal neuralgia?

A

Unilateral STABBING pain
Triggered by touch
Usually V2/3

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19
Q

Treatment of trigeminal neuralgia?

A

Carbamazepine, Gabapentin, Phenytoin
Nerve ablation
Decompression

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20
Q

Presentation of brain tumours?

A

Progressive neurological deficit (correlate to location)
Weakness
Headache- wakes from sleep, valsalva, N+V
Seizures

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21
Q

A tumour in the parietal lobe may present with what neurological deficit?

A

Dyspraxia

Neglect (ignore one side)

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22
Q

A tumour in the frontal lobe may present with what neurological deficit?

A

Perserveration (stuck on one word)

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23
Q

Investigations of brain tumours?

A 
CT
MRI
LP
PET
Lesion biopsy
Angiogram
Fundoscopy
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24
Q

What is the commonest tumour in the brain?

A

METASTASES

breast, bronchus, kidney, thyroid, colon, melanoma

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25
Q

Most common primary tumour in brain?

A

Glioblastoma multiforme (grade 4 astrocytic tumour)

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26
Q

Glioblastoma multiforme can spread via…?

A

White matter tracking

CSF pathways

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27
Q

Management of glioblastoma multiforme?

A

Surgery (non-curative)
Chemo
Radiotherapy post-op

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28
Q

Where do oligodendroglial tumours occur, and how do they present?

A

Front lobes

Seizures

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29
Q

Pathology of oligodendroglial tumours (to distinguish for astrocytic)

A

Calcification
Cysts
Haemorrhage in tumour

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30
Q

Treatment of oligodendroglial tumours?

A

Chemotherapy- procarbazine

Surgery

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31
Q

Where do meningiomas arise form and what kind of tumour is it?

A

Arachnoid meningeal cells (outside brain)

BENIGN

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32
Q

Symptoms of meningiomas?

A

Mostly asymptomatic

Some headache, CN neuropathies

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33
Q

What are meningiomas associated with?

A

Breast cancer

Neurofibromatosis type 2

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34
Q

Treatment of meningiomas?

A

Surgery

Radiotherapy

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35
Q

Important role of the hippocampus?

A

Memory formation

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36
Q

Important role of the amygdala?

A

Regulating fear responses

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37
Q

What is the frontal lobe responsible for?

A

Planning, executive function and personality

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38
Q

What is the parietal lobe responsible for?

A

Sensation + language

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39
Q

What is the temporal lobe responsible for?

A

Speech and language

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40
Q

Brain lesions in the frontal lobe will produce what symptoms?

A 
Disinhibition, flippant
Short attention span
Personality, mood + insight changes
Urinary incontinence
Paraparesis
Magnetic gait
Expressive dysphagia
Seizures
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41
Q

Brain lesions in the temporal lobe will produce what symptoms?

A 
Memory problems (esp episodic)
Temporal epilepsy- deja vu, strange smells
Headache
Speech/language difficulties
Auditory dysfunction
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42
Q

Brain lesions in the parietal lobe will produce what symptoms?

A 
Loss of temp, proprioception etc.
Agnosia (can't identify objects eyes closed) 
Apraxia (gestures + complex motor)
Inattention
Visual field defects
Sensory dysfunction
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43
Q

Symptoms of spontaneous intracranial hypotension?

A 
Orthostatic headache + dizziness
Neck/arm pain
Diplopia
Muffled hearing
Galactorrhoea
Impaired SPHINCTER control
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44
Q

Side effects of sodium valproate?

A 
Weight gain
Hair loss
Fatigue
Teratogenic
REDUCE EFFICACY of oral contraceptive + emergency pill
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45
Q

Features of non-REM sleep?

A

Start of night
Decreased HR, BP, tidal volume
For protein synthesis, cell division and growth

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46
Q

Features of REM sleep?

A 
End of night
Atonic muscles (relaxed)
Dreaming
Fast activity on EEG
Early brain development, consolidates memory and maintains immune system
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47
Q

What is a circadian rhythm?

A

Endogenous factor regulates sleep-wake cycle- roughly 25 hours

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48
Q

What can interfere with normal circadian rhythm?

A

Light (esp blue light)

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49
Q

Symptoms of sleep deprivation?

A 
Irritability
Lethargic
Visual illusions
Suspicion
Microsleeps (2-30 secs)
Concentration lapses
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50
Q

How much sleep does someone need?

A

7-7.5 hours acceptable
4 hours NOT enough

15 min nap= 90 mins overnight

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51
Q

When do non-REM parasomnias occur, and why?

A

Between stages of sleep and waking

Activation of motor, cognitive or autonomic systems

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52
Q

Examples of non-REM parasomnias?

A 
Confusional arousals
Sleep walking
Sleep terrors/paralysis
Bruxism (teeth grinding)
Restless legs
Complex- shouting, weird movements, vivid dreams etc
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53
Q

Presentation of narcolepsy? (5)

A

Daytime sleepiness- esp eating/talking
Cataplexy- loss of muscle tone due to emotion
Hypnagogic hallucinations- at sleep onset
Sleep paralysis
REM sleep Behaviour Disorder (RBD)

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54
Q

Investigations of narcolepsy? (COMMON EXAM QUESTION)

A

Overnight polysomnography
Sleep latency tests
LP- low CSF hypocretin = narcolepsy

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55
Q

What do peripheral neuropathies affect?

A

Nerves outside brain + spinal cord

LMN + sensory + CN + autonomics

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56
Q

Classic presentation of a peripheral neuropathy?

A

Gloves + stocking distribution (affects hands + feet first then moves up the limb)

Altered sensation and diminished reflexes

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57
Q

What is a mononeuropathy?

A

involvement of a single nerve- focal nerve dysfunction

usually due to trauma or entrapment

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58
Q

What is mononeuritis multiplex?

A

2 separate nerves affected in different locations- rare

59
Q

What is a radiculopathy?

A

Affecting nerve roots- dermatomes/myotomes

60
Q

What is a plexopathy?

A

Affects a whole plexus- rare

High levels of pain/paralysis

61
Q

How does 90% of peripheral nerve damage occur + name other causes?

A

Axonal loss- diabetes, metabolic conditions, drugs, alcohol

Demyelination- Guillan Barre, CIDP etc.

62
Q

Presentation of hereditary neuropathy?

A

Pure motor, sensory, small fibre + autonomic variants

Can have muscle wasting + arthropathy

63
Q

If there is a lesion at the cervical spinal cord, what areas are involved?

A

Arms

UMN signs if central

64
Q

If there is a lesion at the lumbar spinal cord, what areas are involved?

A

Legs

no UMN signs

65
Q

Presentation of lumbar disc prolapse?

A

Unilateral leg pain

LMN symptoms + diminished reflexes

66
Q

Management of lumbar disc prolapse?

A

Conservative

Rarely needs surgery

67
Q

Investigation of disc prolapse?

68
Q

Presentation of spinal claudication?

A 
Intermittent pain, worse on movement, eases at rest
RELIEVES BY BENDING FORWARD
Ache in back of legs
Altered sensation 
Heaviness
69
Q

What is cervical myelopathy?

A

Disc prolapse in the cervical spine

70
Q

Symptoms of cervical myelopathy?

A 
Numb, clumsy hands
Finger tip paraesthesia
Hard fine motor tasks
Dropping things
Hoffman's sign- thumb flexion when DIP flexed
71
Q

Classification of TACS (total anterior circulation syndrome)?

A

(3Hs!)
All of:
- Hemi-loss (unilateral) weakness (face, arm + leg) +/- sensory
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)

72
Q

Classification of PACS (partial anterior circulation syndrome)?

A

Two of:

  • Hemi-loss (unilateral) weakness (face, arm + leg) +/- sensory
  • Homonymous hemianopia
  • Higher cerebral dysfunction (dysphasia, visuospatial disorder)
73
Q

Classification of POCS (posterior circulation syndrome)?

A

CN palsies
Bilateral motor/sensory deficit
Cerebellar dysfunction (eg ataxia, nystagmus, vertigo)
Isolated homonymous hemianopia or cortical blindness

74
Q

Features of executive dysfunction?

A 
Severe inattention
Can't sustain goal-directed behaviours
Apathy
Personality change
Lack of empathy
Lack of inhibition (distracted, hyperactive, impulsive, hypersexual, over eating etc.)
75
Q

A stroke in the middle cerebral artery would cause weakness to where?

A

Contralateral face + arm

76
Q

A stroke in the anterior cerebral artery would cause weakness to where?

A

Contralateral leg

77
Q

How can the brain respond to injury?

A

Rapid necrosis
or
Slow atrophy

78
Q

Acute neuronal injury leads to which pathological sign?

A

Red neuron (intense eosinophilia/red cytoplasm)

79
Q

What is gliosis?

A

Indicates CNS injury:

  • Astrocyte hyperplasia+hypertrophy
  • Enlarged nucleus
  • Expanded cytoplasm
80
Q

What does gliotic tissue look like?

A

Firm and translucent

81
Q

4 causes of brain oedema?

A
  1. Dying cells accumulate water
  2. Na in causes gradient
  3. Breakdown of BBB
  4. Haemorrhagic conversion
82
Q

Most common site of thromboembolic disease in brain?

83
Q

Signs of hypertensive encephalopathy?

A

Global cerebral oedema
Tenotorial/tonsillar herniation
Petechiae

84
Q

Where do 70% of paediatric brain tumours occur?

A

Below tentorium cerebelli

85
Q

Who might get multiple brain abscesses?

A

IV drug users

86
Q

Symptoms of brain abscess?

A

Fever
Headache
Focal deficit
Increased ICP symptoms

87
Q

Investigation of brain abscess?

A

CRP
CT/MRI
Culture of aspirate

88
Q

What can high velocity penetrating trauma lead to?

A

Cavitation (small bubble formations)

89
Q

How does diffuse axonal injury occur?

A

Widespread due to shearing/tearing of axons

90
Q

Which toxins can cause demyelination?

A

Carbon monoxide
Cyanide
Solvents

91
Q

Causes of acute cord compression?

A

Trauma (mostly C spine)
Infection (epidural abscess)
Prolapse
Haemorrhage

92
Q

Causes of chronic cord compression?

A

Degenerative disease e.g. spondylosis
Tumours
Rheumatoid arthritis

93
Q

Presentation of central cord compression?

A

Distal upper limb weakness

94
Q

Cause of central cord compression?

A

Hyperflexion/extension of already stenotic neck

Cord pinched + block blood supply to centre

95
Q

Treatment of tremors?

A

Beta blockers
Anti-convulsants
Anti-epileptics

96
Q

Features of polymyositis?

A

Symmetrical progressive proximal weakness
Increased CK
Tx- steroids

97
Q

What is dermatomyositis?

A

Similar to polymyositis + skin lesions (heliotrope rash)

98
Q

Symptoms of myotonic dystrophy?

A 
Myotonia
Limb weakness
Facial weakness
Cataracts
Ptosis
Frontal balding
Cardiac defects
99
Q

Causes of acute cognitive impairment?

A 
Viral encephalitis
Head injury
Stroke
Transient global amnesia
Transient epileptic amnesia
Alcohol
100
Q

Features of transient global amnesia?

A

Antegrade over retrograde amnesia
Always <24hrs
Knows self

101
Q

Causes of transient global amnesia?

A

Cause unknown-
Emotion?
Change in temperature?

102
Q

Features of transient epileptic amnesia?

A

Forgetful/repetitive questioning (antegrade)
20-30 mins
Temporal lobe seizures

103
Q

What is functional cognitive impairment?

A

Subjective impairment- everyday forgetfulness, fluctuation etc.

104
Q

Most common type of Prion disease?

A

Creutzfeldt-Jakob Disease (CJD)

105
Q

What is prion disease?

A

Neurodegenerative proteinopathy (prion protein)

106
Q

What pathology does Creutzfeldt-Jakob Disease lead to?

A

Spongiform changes

Astrocytosis

107
Q

Symptoms of Creutzfeldt-Jakob Disease (CJD)?

A

Rapid dementia
Myoclonus
Ataxia

108
Q

Diagnosis of Creutzfeldt-Jakob Disease (CJD)?

109
Q

Pathology of Alzheimer’s disease?

A

Amyloid plaques + neurofibrillary tangles + Tau protein

Disrupt cholinergic pathways

110
Q

Risk factors for Alzheimer’s disease?

A 
Age
Female
FH
Down's Syndrome
Head injuries
111
Q

Which part of the brain is affected first in Alzheimer’s disease?

A

Nucleus basalis of Meyner

112
Q

Genetics associated with Alzheimer’s disease?

A

APP or PSEN gene

ApoE2

113
Q

CT signs of Alzheimer’s disease?

A

Temporal, frontal + parietal
Widespread cortical atrophy
Narrow gyri + wide sulci
Dilation of ventricles to compensate

114
Q

Symptoms of Alzheimer’s disease?

A

Worsening memory- initial forgetfulness, then progressive

May affect mood, behaviour, and aphasia too- LATE STAGES

115
Q

Investigations of Alzheimer’s disease?

A

MMSE
MRI (atrophy of lobes)
SPECT (reduced metabolism)
CSF

116
Q

Treatment of Alzheimer’s disease?

A 
Acetylcholinesterase inhibitors (donepezil, galantamine or rivastigmine)
Memantine in severe (NMDA blocker)
Trazodone for insomnia
117
Q

What is Pick’s disease?

A

Frontotemporal dementia

118
Q

Which protein is involved in frontotemporal dementia?

A

Tau protein

119
Q

Age of onset of frontotemporal dementia?

A

Majority <65 (50-60)

120
Q

Symptoms of frontotemporal dementia?

A 
Frontal dysfunction (disinhibition, apathy, loss of empathy, compulsive behaviour, hyperorality)
Change in character, social skills, memory, language and intellect
Early LOSS OF INSIGHT
121
Q

Pathology of frontotemporal dementia?

A

Extreme cerebral atrophy (frontal then temporal)
Gliosis
Pick’s cells (swollen neurons)

122
Q

Investigation of frontotemporal dementia?

A

MRI (atrophy)
SPECT (reduced metabolism)
CSF

(not MMSE)

123
Q

Management of frontotemporal dementia?

A

Trazadone/ anti-psychotics

124
Q

Causes of vascular dementia?

A

Cerebrovascular disease (strokes)

125
Q

Symptoms of vascular dementia?

A

> 65 years
Slowness, executive dysfunction, inattention,
Focal deficits (from strokes)
STEP-WISE DECLINE

126
Q

Investigation of vascular dementia?

A

SPECT

MRI shows infarcts

127
Q

Management of vascular dementia?

A

Vascular risk factors

+/- cholinesterase inhibitors

128
Q

What is Parkinson’s Disease dementia?

A

Dementia starting more than 1 year AFTER the onset of parkinsonism

129
Q

What is Lewy-Body dementia?

A

Dementia or cognitive symptoms occurring BEFORE or at the same time as parkinsonism

130
Q

Which protein is involved in Lewy-Body dementia?

A

Alpha-synuclein

131
Q

Symptoms of Lewy-Body dementia?

A 
Progressive cognitive impairment
Recurrent visual hallucinations.
Features of parkinsonism--> FALLS
Fluctuating awareness
REM sleep disorders
132
Q

Cause of Lewy-Body dementia?

A

Degeneration of substantia nigra + Lewy bodies

133
Q

Investigation of Lewy-Body dementia?

A

DaT scan (dopamine transport imaging)

134
Q

Management of Lewy-Body dementia?

A

Levodopa (low dose)

Cholinesterase inhibitors

135
Q

Side effects of opioids?

A 
Apnoea
Orthostatic hypotension
N+V
Constipation
Confusion
Euphoria/ hallucinations
Dizziness
136
Q

What is progressive multifocal leukoencephalopathy?

A

Secondary demyelinating disorder caused by viral disease

137
Q

Where will a lesion cause contralateral homonymous hemianopia?

A

Occipital lobe

138
Q

Where will a lesion cause contralateral sensory deficits?

A

Parietal lobe

139
Q

Where will a lesion cause contralateral superior quadrantopia?

A

Temporal lobe

PITS

140
Q

Where will a lesion cause contralateral inferior quadrantopia?

A

Parietal lobe

PITS

141
Q

Where will a lesion cause urinary incontinence?

A

Frontal lobe

142
Q

Where will a lesion cause contralateral weakness of the face/arm/leg?

A

Frontal lobe

143
Q

What should be used instead of haloperidol as an anti-psychotic in Parkinson’s disease?

A

Quetiapine

144
Q

What should be used instead of meoclopramide for GI issues in Parkinson’s disease?

A

Domperidone

Y3- TO LEARN (13 decks)

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