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My Final Year 4 Revision > Neurology > Flashcards

Neurology Flashcards

1
Q

Why is Guillain Barre syndrome not very good a exams?

A

It looses its nerves

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2
Q

How do you get to the pacinian corpuscle from the brain?

A

Take the spinal cord and dendrite

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3
Q

What Q are in ROS?

(think from head to toe)

A

Headache

Fits, faints and funny turns

Memory problems

Altered vision or hearing

Weakness and numbness

Incontinence and erectile dysfunction

Balance and cordination (Gait)

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4
Q

DD for headache

A

Raised ICP

Migraine

Acute glaucoma

Subarachnoid haemorrhage

Trigeminal neuralgia

Cluster headache

Temporal artritis

Tension headache

Sinusitis

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5
Q

What red flags are there for headaches?

A

First and worst

Fever

Cognitive or neurological deficit

Personality change

Trauma within 3/12

Made worst by coughing, sneezing, exercise or posture

Halo around light or worst in dark

>65y and jaw claudication

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6
Q

DD Transient loss of conscioussness?

A

Abscence siezure

Generalised tonic clonic

Psychogenic non-epileptic siezure

Early morning myoclonus

Cardiogenic

Vasovagal

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7
Q

What features of a sieure would indicate a psychogenic cause?

A

Eyes closed

Arching of back

Shaking side to side

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8
Q

What would indicate a cardiogenic syncopy with TLC?

A

Palipatations

FH of sudden death

Triggered by exercise or turning neck

No post ictal

sweating and pallor

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9
Q

Head ache with stapping pain when brishing or chewing.

MLD (most likely diagnosis) ?

A

Trigeminal neuralgia

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10
Q

Headache with facial tenderness and rhinorrhoea

MLD (most likely diagnosis) ?

A

Sinusitis

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11
Q

What MRC grade is movement greater than gravity?

A

Grade 3+

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12
Q

What MRC grade is twitching with no movement?

A

MRC Grade 3

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13
Q

What are the LMN signs?

A

Decreased reflexes

Decreased tone

Fasiculations

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14
Q

What are the UMN signs?

A

Increased reflexes

Increased tone

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15
Q

What sensory tract are there in the spine?

A

Spinothalamic

Dorsal Columns

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16
Q

What sensory tracts carry temperature, pain and crude touch?

A

Spinothalalmic

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17
Q

What sensory tracts carries fine touch and proprioception?

A

Dorsal columns

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18
Q

At what level does the spinalthalamic tracts decussate?

A

Level of the rootlet, straight away

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19
Q

At what level does the dorsal coumumns decussate?

A

Medial lemniscal (medulla)

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20
Q

What part of the dorsal columns carries sensation to the lower limbs?

A

Gracille fasciculus - Ground for feet

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21
Q

What is Brown-Sequard syndrome?

A

Hemi-section of the cord is cut leading to…

Ipsilateral UMN signs and fine touch and propioception (dorsal clumumns)

Contralateral loss of paina and temperature (spinothalamic)

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22
Q

What motor tracts are there in the spinal cord?

A

Pyramidal

Extra-pyramidal

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23
Q

Where do pyramidal tract decussate?

A

At the level of the medulla

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24
Q

Where is the lesion with a Bitemporal hemianopia?

A

Optic chiasm

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25
Q

Where is the lesion with a Homonymous hemianopia?

A

Occipital cortex or optic radiation

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26
Q

Where is the probable lesino for monocular blindness on the optic tract?

A

Optic nerve

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27
Q

What is the DD for peripheral neuropathy?

VITMIN CDEF

A

Alchol

Vit B12

hypothyroid

CKD

Vasculitis

Malignancy -Lymphoma, MM

CMT disease

GB syndrome

Amyloidosis

Autoimmune

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28
Q

What investigation can be done for peripheral neuropathy?

A

CT head

MRI

CXR

X ray head

EEG

EMG

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29
Q

What questions are inculded in neuro review of systems?

(think head to toe)

A

Headaches

“Fits, faints and funny turns”

Memory problems

Altered vision or hearing

Numbness and Weakness

Incontinence and erectile dysfunction

Balance and co-ordination difficulties (gait)

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30
Q

What is the typical presentation of gruillian barre syndrome?

A

Areflexia with progressive weakness

Usually progressive over 4w. Can have cranial nerve and autonomic involvement.

Accompanied by features on LP and EMG

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31
Q

Guillain-Barre syndrome is described as a Poly-radiculo-neuropathy, what does this mean?

A

Involvemnt of the nerve roots and peripheral nerves

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32
Q

What Ix can be done for a presentation of Guillain barre syndrome?

A

Bedside - Spirometry

Bloods - FBC, UE, LFT, Bone, Ca, Mg, CRP, ESR

Imaging - CXR
Special tests - LP, EMG, ?MRI

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33
Q

What differentials are for Guilian Barre syndrome which may need to be considered?

A

Acute cervicle myelopathy

Infectinos - botulism, diptheria, lyme disease

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34
Q

What is the management of Guillain Barre syndrome?

A

IVIG or plasma exchange

VTE prophylaxis

Breathing - Exclude PE, spirometry, ABG for pCO2 ?ICU

Serology - campylobacter

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35
Q

Wgat night be found on LP with GB syndrome?

A

albuminocytological dissociation - raised protein

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36
Q

What may EMG show with GB syndrome?

A

Recuced velocity and amplitude of sensory and motor neurone. Incused delayed F waves.

In keeping with an aquired demylinating neuropathy

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37
Q

What is nerve conductino studies (EMG) a good investigation for?

A

Peripheral neruopathy

Localising pathology in PNS

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38
Q

What is an F wave when concerned with EMG?

A

Antidromic responce - Impulse created is relfected of the spine leading to a later and lesser muscle depolarisation after the compound motor actino potential (CMAP)

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39
Q

What is CMAP and SNAP in EMG?

A

CMAP - compound motor action potential

SNAP - sensory actino potential

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40
Q

What should be should be considered in a history history if fever, malaise and weightloss and therefore what maybe seen on LP

A

May be TB menigitis:

Lymphocytosis

High opening pressures

Very high protien

Very low glucose

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41
Q

Generalised weakness and areflexia with increased protein on LP?

A

Guilain barre syndrome

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42
Q

Chronic headaches worst when bending and associated visual changes. High opening pressure otherwise normal LP. MLD?

A

idiopathic intercranial hypertension

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43
Q

There is sensory and motor loss in the thumb, 2nd and 3rd digits as well as thenar eminesce. What nerve distibution is and MLD?

A

Median nerve

Carpal tunnel syndrome

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44
Q

Patient presents with eye changes: ptosis, diplopia bilaterallly and has proximal fratigue. MLD?

A

Myethenia gravis

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45
Q

What can oligoclonal bands on LP indicate?

A

Inflammatory disorder of the CNS which may include transverse myelitis or MS

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46
Q

What is xanthochromia and what does it indicate on LP?

A

Metabolites (oxyhaemoglobin and biirubin) from heamolysed RBC in CSF. This is surgestive of a bleed like subarachnoid haemorrhage.

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47
Q

A patient has progressive weekness on the right side of the face over 48 hours with difficulty closing the right eye lid. MLD?

A

Bells palsy

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48
Q

What is the treatment for bells palsy?

A

Steroids within 72hours +/- acyclovir

Tape eye shut

Resolves normally however may recurr

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49
Q

What differentials are ther for facial weakness?

A

UMN - tumour, stroke

LMN - truama, bells palsy, otitis media, MS or GB syndrome, Ramsey hunt syndrome

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50
Q

A 65 year old has severe pain on the left side of the face which developes into facial weakness and “ringing in the ears”. On inspection there are vesicles surrounding the external meatus. MLD?

A

Ramsey hunt syndrome - shingles of the geniculate nucleus of the facial nerve. This is a reactivation of Varicella Zoster

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51
Q

How could a Bells palsy be differentiated from a stroke?

A

Strokes are acute onset and forehead sparing with peripheral neurological signs. The Bells palsy take hours to days to onset and is a LMN and therefore not forehead sparing.

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52
Q

What is rigidity?

A

Velocity independent - common in parkinsons

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53
Q

What is spasticity?

A

Velocity dependent - chronic UMN lesion

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54
Q

Where is the lesion localised?

1) Inferior homonymous quadrantanopias
2) superior homonymous quadrantanopias

A

1) Parietal lobe
2) Temporal lobe

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55
Q
A
56
Q

Function of frontal lobe

A

Motor control Insight Emotions And output of speech (dominant side)

57
Q

Functions of temporal lobe

A

MemoryEmotionsComprehension of speech (dominant side -usually left hemisphere)

58
Q

Functions of parietal lobe

A

Sensations Special awareness

59
Q

Functions of occipital lobe

A

Eyesight

60
Q

What is the basal ganglia ?

A

Deep interconnected nuclei Including putamen, caudate, globus palladium and substantia NigraInvolved in integration of sensation and motor input

61
Q

Function of cerebellum

A

Coordination Balance and posture Controls same side of body (ipsilateral)

62
Q

contents of brain stem

A

Contains reticular formation and 10 cranial nerve nuclei Contains white matter tracts

63
Q

What are the levels of the nervous system (proximal to peripheral )

A

Cerebral cortex Basal ganglia CerebellumBrain stemSpinal cord Nerve rootNerve plexus Nerve Neuromuscular junction

64
Q

Shoulder abduction

A

Axillary nerveC5

65
Q

Elbow flexion

A

Brachiordialis = radial nerve, C5Biceps = musculocuteneous, C5,C6

66
Q

Elbow extension

A

Triceps = radial nerve C6,7,8

67
Q

Wrist extension

A

Entensor Capri ulnaris and radialis Radial nerve C7

68
Q

Finger extension

A

Extensor digitorumPosterior interosseuous nervec7,C8

69
Q

Thumb abduction

A

Abductor pollocks breves T1 Median nerve

70
Q

Extensor abduction

A

Ulnar nerve T1

71
Q

Hip flexion

A

L1, L2Lumbosacral plexus

72
Q

Hip extension

A

Inferior gluteal nerve L5 S1

73
Q

Knee extension

A

Femoral nerve L3 L4

74
Q

Knee flexion

A

Sciatic nerve L5 S1

75
Q

Dorsi flexion

A

Deep peroneal nerve L5

76
Q

Plantar flexion

A

Posterior tibial nerve S1

77
Q

Foot inversion

A

Posterior tibial nerve S1

78
Q

Foot eversion

A

Superficial peroneal nerve L5S1

79
Q

Toe extension

A

Deep peroneal nerve L5

80
Q

Biceps reflex

A

C5

81
Q

Supinator reflex

A

C6

82
Q

Triceps reflex

A

C7

83
Q

Knee reflex

A

L3/4

84
Q

Ankle reflex

A

S1

85
Q

Tests to do if query myasthenia gravis

A

Short acting anticholinesterase agent in MG would transiently improve symptoms. Do chest imaging to rule out thymoma Do CT brain Blood as,pale for anti acetylcholinesterase antibodies

86
Q

Problems with MG

A

Progressive fatiguable weaknessThey also have problems with mastication, talking, drinking, swallowing. Aspiration pneumonia and resp failure can result as unable to clear secretions

87
Q

Neuro systems review

A

Headaches Altered visionFits, faints, funny turnsHearing difficulties Memory problemsSpeech and swallowing difficulties WeaknessNumbness or tinglingIncontince or retentionErectile dysfunctionBalance or coordination difficulties How is it affecting ADLsFH

88
Q

Progressive weakness without sensory loss. Arm twitching. Legs giving way. Change in speech. Father died when in 30s.

A

Amyotrophic lateral sclerosis- UMN AND LMN lesions. Some genetic component but sporadic mutations more common

89
Q

Severe painful unilateral headaches. No warning. Eye watering, nasal stuffiness. No symptoms between headaches. Usually at night.

A

Cluster headache

90
Q

Tight band like headache precipitated by stress

A

Tension headache

91
Q

Brief stabbing pain when chewing or brushing teeth

A

Trigeminal neuralgia

92
Q

Photophobia, neck stiffness, fever, headache

A

Meningitis

93
Q

Sudden onset excruciating headache. Reaches climax within minutes

A

Subarachnoid haemorrhage

94
Q

Unilateral landing headshcem multiple triggers, lasts for hours, aversion to bright lights, can be preceded by aura

A

Migraine

95
Q

20 minute unilateral debilitating headache p. Retro orbital pain with red eye and watering

A

Cluster headache

96
Q

Headache triggered by changes in position or exertion. Changes in vision or headache with leaning forward, coughing, sneezing

A

Raised Icp- SOL- tumour, abscess. Hydrocephalus

97
Q

Pain around eyes with blurred vision and halos around lights

A

Acute angle closure glaucoma

98
Q

Scalp tenderness, unilateral. Jaw claudication .

A

Temporal arteritis

99
Q

Red flags for headaches

A

Sudden onset High severityFeverNew onset neurological deficit New onset cognitive dysfunction Change in personalityImpaired GCSrecent head traumaHeadache triggered by cough, sneeze, exercise or change in postureHeadache with halls around lights Headache with jaw claudication

100
Q

LOC triggered you vigorous exercise in a young person

A

Hypertrophic cardiomyopathy or cardiogenic syncope

101
Q

Triggered by pain, fear, prolonged standing. Preceded by pallor, nausea, sweating, no confusion afterwards

A

Vaso vagal

102
Q

Triggered when standing up

A

Postural hypotension

103
Q

Collapse on shaving or turning head

A

Carotid sinus sensitivity

104
Q

Crying out, falling to floor, period of stiffness followed by rhythmic jerking that gradually decreases in amplitude and frequency, period of confusion after

A

Generalised tonic clinic seizure

105
Q

LOC, pale and sweaty beforehand, jerking of limbs, eye rolled back short duration, no confusion

A

Vaso vagal

106
Q

Violent shaking, head moving side to side , arching back, episodes of stillness before starting again, forced eye closure

A

Psychogenic non epileptic struck

107
Q

Facial weakness on right side, motor weakness on left

A

Right side brainstem lesion

108
Q

Left weakness and sensory changes

A

Right hemisphere lesion

109
Q

Lower motor neurone weakness in all four limbs and loss of sensation

A

Peripheral neuropathy

110
Q

UMN signs in all four limbs and loss of sensation

A

Spinal cord lesion

111
Q

Loss of vision and pain in eye. Incontinence. Leg weakness

A

Think MS Do MRI brain and spine

112
Q

Elderly patient, head trauma, worsening lethargy, confusion

A

Subdural haematoma Do CT

113
Q

Progressive weakness, cannot walk unaided, started off at numbness and tingling in hands and feet. Now SOB. Had food poisoning three weeks ago Absent reflexes , glove and sticking sensory loss

A

GBSDifferential of transverse myelitis Do LP and MRI

114
Q

Treatment of GBS

A

Iv immunoglobulin Or plasma exchange DVT prophylaxis, lots of obs

115
Q

LP with high protein but normal white cells

A

GBS

116
Q

Key features of GBS

A

Peak disability in four weeks Antecedent trigger AreflexiaCSF- high protein, normal cell count Generally spontaneous recovery occurs

117
Q

Differentials of GBS

A

Acute myelopathiesBotulismDiphtheria Lyme disease Vasculitis neuropathy

118
Q

Oligoclonal bands in CSF and not in blood

A

Think MS

119
Q

Four limb symptoms and urinary disturbance

A

Cervical spine

120
Q

Right sided facial weakness. Whole face, no sparing. Sensation normal

A

Right LMN lesion. Bell’s palsy

121
Q

Treatment of Bell’s palsy

A

Steroids aciclovir Tape eye closed at night Can initially worsen before getting better

122
Q

Painful vesicles affecting external ear, palate. Facial weakness. Ear and face pain

A

Ramsay hunt syndrome Treat with aciclovir within 3 days of onset and steroids

123
Q

Young female with foot slapping when walking after a weekend kneeling

A

Common peroneal nerve palsy. Get nerve conduction studiesAsk about back pain as the palsy could be due to prolapsed disc.

124
Q

Wrist drop

A

Radial nerve palsy. Often due to compression on mid shaft of humerus. Get neurophysiology assessment. Give splint to help with function

125
Q

Young man, blurring in right eye, discomfort and pain in movement of eye. Reduction in vision in right eye. Left eye normal

A

Optic nerve problem. Eg optic neuritis

126
Q

Blood tests following RAPD

A

Serum b12 as deficiency can mimic optic neuropathy Look for evidence of multi system inflammationNo pun specific inflammatory markers eg CRP, ESRSpecific immunological markers- ANA, ANCA, serum ACE, Infectious triggers eg HIV, syphillis, hep B and CRarer antibodies eg DevicsMRI scan would show high signal in optic nerve

127
Q

Causes of an unsteady gait

A

Cerebellum problems leading to cerebellar ataxiaDorsal column problem leading to sensory ataxiaPeripheral nerve problems leading to sensory ataxia Vestibular problems

128
Q

Features of cerebellar disease

A

Vertigo and nauseaVoice changes- staccatoPoor coordination in arms and legsOne side of body affected- ipsilateral lesion

129
Q

Vestibular problems

A

Nausea Vertigo Room spinning Can lead to hearing loss and tinnitus

130
Q

Unsteady gait and sensory loss. Pins and needles. Balance worse in dark. Fall over when eyes closed

A

Sensory ataxia

131
Q

Unsteady gait and bladder disturbance

A

Spinal cord lesion

132
Q

How to treat MS relapse

A

High dose steroids, give PPI alongside thisTry to treat symptoms of the relapse

133
Q

Medications used in MS

A

Steroids to treat relapseDisease modifying agents eg beta interferonsBaclofen- reduce muscle spasticity. Can be very sedative throughGabapentin- reduce neuropathic pain Sertraline- depression often common with chronic diseaseOxybutinin- if urge incontinence a problem but can lead to bladder retention

134
Q

How to treat neuropathic pain

A

PregablinGabapentinTricyclic antidepressant eg amitriptyllineCarbamazepine (useful in trigeminal neuralgia)

135
Q

Side effects of beta interferons

A

Injection site reaction or rash Flu like symptoms for a few daysReduced immune system

136
Q

Conditions that can mimic MS

A

Devics syndrome- neuromyelitis optics, affects spinal cord and optic nerve. Test for NMO antibodiesAnticsediolipin antibody syndromeNeurosarcoidosisSjogrens

137
Q

Side effects of steroids

A

Acne Blurred vision Cataracts Glaucoma Easy bruising Difficulty sleeping High blood pressure Increased appetite and weight gain Increased Body hair Ulcers Diabetes Osteoporosis Impaired wound healing

My Final Year 4 Revision (16 decks)

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