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HUD > Neurology > Flashcards

Neurology Flashcards

1
Q

What is the aim of a neurological examination?

A

To determine is a lesion is present and to find the anatomical site of that lesion

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2
Q

What is the acronym for what aspects of the general neurological system you should be testing?

A

Two People Can’t Resist Sex

Tone, Power, Co-ordination, Reflexes, Sensation

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3
Q

What can differences in tone tell you about the location of a lesion?

A

Increased tone - UMN

Decreased tone - LMN

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4
Q

What is cog-wheeling?

A

Cog-wheel rigidity - tremor superimposed upon rigidity

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5
Q

What is important when testing for power?

A

Comparing both sides with similar forces

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6
Q

What is the scale for the MRC criteria of power?

A 
0 = complete paralysis
1 = flicker of contraction
2 = movement against gravity
3 = movement against gravity
4 = moderate power against resistance
5 = normal power
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7
Q

How is co-ordination tested?

A

Finger-nose command - patients own nose to your finger as fast as possible - arms length away from patient

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8
Q

What is dysdiadochokinesia?

A

Inability to repeat rapid alternating movements

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9
Q

How are reflexes tested?

A

Tendon Tap

  • Hyper-reflexia - UMN
  • Hypo-reflexia - LMN
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10
Q

How is sensation tested?

A

Light touch - cotton wools bilateral
Vibration - tuning fork
Pain - pin-prick
Temperature - metal (cold) and rubber (warm)

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11
Q

What is the Glasgow Coma Scale?

A

Rates coma severity

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12
Q

What are the factors determining the Glasgow Coma Scale?

A

Ability of the patient to open their eyes, perform movement and speech

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13
Q

If a patient has a low Glasgow coma scale what does this indicate?

A

Lower the score the more severe the loss of function

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14
Q

How many categories is the Glasgow Coma Scale split up into?

A

3
Motor response
Verbal responses
Eye opening

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15
Q

What does AMTS stand for?

A

Abbreviated Mental Test Score

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16
Q

What is the function of AMTS?

A

Rapid assessment of possible dementia in elderly patients

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17
Q

Name 3 of the initial questions in the AMTS.

A

What is your age?
What is the time?
Where do you live?

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18
Q

What is a more conclusive test than the AMTS?

A

Folstein test

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19
Q

What is a stroke?

A

Focal neurological deficit lasting longer than 24 hours due to a vascular lesion

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20
Q

What is the difference between a stroke and TIA?

A

The recovery time - TIA is a focal deficit but recovers in less than 24 hours

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21
Q

What are the three classifications of stroke based on symptoms and recovery times?

A

Minor Stroke - full evolution and recovery in < 1 week - minimal/no deficit

Stroke in evolution - symptoms that worsen in the first 48 hours

Completed stroke - stage of worst neurological deficit - typically 6-8 hours into event

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22
Q

What are the two main types of strokes with regard to pathogenesis?

A

Wet stroke - Haemorrhage into brain

Dry stroke - ischaemic vaso-occlusive brain death

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23
Q

Name a type of pathology can lead to stroke-like signs and symptoms?

A

Space-occupying lesions/tumour

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24
Q

Name three risk factors of stroke.

A

Diabetes
Cigarettes
Obesity

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25
Q

What is the usual cause of a dry stroke?

A

Embolism/thrombosis affecting the vessels proximal to the brain

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26
Q

What is the usual cause of a wet stroke?

A

Ruptured intra-cranial micro-aneurysm

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27
Q

What is the 2 main forms of treatment for a dry stroke?

A

Aspirin

tPA - tissue plasminogen activator - cleaves fibrin

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28
Q

Is carotid artery occlusion fatal?

A

It can be, but if only one carotid artery is occluded, the other artery can maintain blood supply to the brain as long as the circle of willis is patent

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29
Q

What is the primary cause of a subarachnoid haemorrhage?

A

Berry aneurysm in the circle of willis

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30
Q

Name 3 symptoms of a subarachnoid haemorrhage

A

Sudden loss of consciousness
Fast pain - headache/stiff neck
Kernig’s sign - patient in supine position, leg raised and bent at the knee - pain in the back is a positive Kernig’s sign indicating meningeal involvement

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31
Q

Describe the features of a subdural haematoma.
(Venous or Arterial)
(Fast or slow onset)
(Key symptom)

A

Venous
Slow onset
Loss of consciousness over hours/days

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32
Q

What is the typical aetiology of an extra dural haemorrhage?

A

Bleed in the Middle Meningeal Artery - normally due to trauma to the head

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33
Q

What is MS?

A

Multiple Sclerosis - an auto-immune disease characterised by demyelination in the CNS

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34
Q

Name 3 common effects of MS on the eyes?

A

Blurred Vision
Stabbing eye pain
Fading of the colour red

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35
Q

Name 3 common effects of MS

A 
Ataxia
Incontinence
Dementia
Blindess
Spastic tetraparesis
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36
Q

Name 3 methods of management of MS

A

ACTH/Methyl Prednisolone 1g IV for 3-5 days
Physiotherapy
Vitamin B12 injections
Beta-Interferon

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37
Q

What is the definition of allodynia?

A

Pain from a normally painless stimulus

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38
Q

What is the definition of hyperalgesia?

A

Increased response to a painful stimulus

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39
Q

What is the definition of Dysaesthesia?

A

An abnormal/unpleasant sensation to touch

40
Q

What is the definition of Paraesthesia?

A

An abnormal/unpleasant sensation with no input

41
Q

What is the definition of Hypoalgesia?

A

Diminished response to painful stimulus

42
Q

What is the definition of neuralgia?

A

Intermittent pain along the course of a nerve

43
Q

What is the definition of neuropathy?

A

Pathological nerve damage resulting in weakness/numbness/pain

44
Q

Name 6 characteristics that should be assessed when investigating facial pain.

A 
Onset
Quality (aching/stabbing/burning etc.)
Location
Duration
Radiation
Severity
45
Q

What is a primary neuralgia

A

Corresponds exactly to the anatomical distribution of a cranial nerve - normally idiopathic

46
Q

What are the classic features (4) of a primary neuralgia?

A

Unilateral
Sudden and severe pain
Short lasting episodes
No sensory/motor impairment

47
Q

What is the most common facial neuralgia?

A

Trigeminal Neuralgia

48
Q

Name 3 methods of management for facial pain?

A

LA injections - temporary
Botox injections alongside nerve
Carbamazepine - Anti-convulsant

49
Q

Name another form of facial neuralgia other than trigeminal neuralgia?

A

Glossopharyngeal Neuralgia

50
Q

What areas (4) are commonly painful in glossopharyngeal neuralgia?

A

Ear, base of the tongue, angle of mandible, tonsillar fossa

51
Q

What are the common triggers of pain in glossopharyngeal neuralgia? (5)

A

Chewing, swallowing, talking, yawning and coughing

52
Q

How is a secondary neuralgia defined?

A

Pain due to compression, irritation, tumour or disease.

53
Q

Name an intra-cranial secondary neuralgia.

A

Schwannoma (acoustic neuroma)

54
Q

What is the typical presentation of a schwannoma?

A

Unilateral deafness/tinnitus

55
Q

What are the 2 nerves normally affected in a schwannoma and what symptoms does their implication cause?

A

V - loss of corneal reflex

VII - palsy - later presentation

56
Q

Name a secondary neuralgia located in the cranial base.

A

Pagets Bone Disease

57
Q

What is the presentation of Pagets Bone Disease radiographically?

A

Hazy ‘cotton wool’ appearance of skull primarily base and occipitally

58
Q

What is Giant Cell Arteritis?

A

A condition characterised by granulomatous inflammation of mid-sized arteries

59
Q

Name 3 general treatments for facial pain.

A

Sodium channel blockers e.g. carbamapezine
Lidocaine injections
Gamma-knife/radiothermal ablation

60
Q

Name all 12 cranial nerves in order.

A 
Olfactory
Optic
Occulomotor
Trochlear
Trigeminal
Abducens
Facial
Vestibulocochlear
Glossopharyngeal
Vagus
Accessory
Hypoglossal
61
Q

What is the purpose of the olfactory nerve and where does it radiate from and terminate?

A

Sensory nerve - sense of smell

Radiates from the cribriform plate where the olfactory bulb passes through and the olfactory nerves terminate at the top of the nasal cavity

62
Q

What is the loss of sense of smell called?

A

Anosmia

63
Q

How is the olfactory nerve function tested?

A

Probing about sense of smell - can they smell their perfume, has it changed

Testing smell - coffee - seeing if they can distinguish between smells

64
Q

What 3 features are tested in optic nerve functional tests?

A

Visual Acuity - ability to focus
Visual Fields - breadth of vision
Pupillary reflexes - reflex to stimulus (light)

65
Q

What occurs in the optic chiasm?

A

Decussation of the nasal fields (medial fields) of each retina

66
Q

What happens if there is damage to the optic chiasm?

A

Bi-temporal hemianopia (tunnel vision)

67
Q

How can a pituitary tumour affect vision?

A

Pushes on optic chiasm - bitemporal hemianopia - tunnel vision

68
Q

How is the optic nerve tested?

A

Focus tested through moving finger towards patients nose and testing to see whether eyes cross over

Covering eye wiggling and moving finger from a starting position (arms length) to the middle of the patient - testing visual fields

Shine light in one pupil - testing for direct and consensual reflexes

69
Q

What reflexes (2) are you observing when testing pupillary reflex?

A

Direct reflex - response to light in the eye you shine light in

Consensual Reflex - response to light in other eye

70
Q

How do you determine the presence of an optic nerve lesion and which side is affected?

A

Where direct reflex is lost this is the side with the lesion:

When light is shone in eye - no direct reflex

When light is shone is other eye - consensual reflex maintained

71
Q

What is the difference in effects between an optic lesion and occulomotor lesion?

A

Optic nerve lesion:
Where direct reflex is lost this is the side with the lesion:

When light is shone in eye - no direct reflex

When light is shone is other eye - consensual reflex maintained

Occulomotor lesion:
Present in eye where there is no direct or consensual reflex but where the opposite eye demonstrates both direct and consensual reflexes

72
Q

What nerves supply extra occular muscles?

A

III, IV and VI

73
Q

What are the 7 extra occular muscles?

A 
Levator Palpebrae superioris
Superior oblique
Inferior oblique
Superior rectus
Medial rectus
Lateral rectus
Inferior rectus
74
Q

Which cranial nerves supply the extra-occular muscles and which nerve supplies which individual muscle?

A

III - Sup, Med, Inf. rectus, sphincter pupillae, inferior oblique and Levator Palpebrae superioris

IV - Superior oblique

VI - Lateral rectus

75
Q

What is the effect of a palsy of cranial nerve IV?

A

Diplopia - looking down and in

76
Q

What is the effect of a palsy of cranial nerve VI?

A

Diplopia - looking laterally

77
Q

What are the branches of the trigeminal nerve?

A

V1, 2, 3

78
Q

What type of nerve is the trigeminal nerve (motor or sensory)?

A

Motor and sensory

79
Q

What is the pseudo-chemical equation used to memorise the innervation of the extra-occular muscles?

A

LR6(SO4)3

80
Q

How is the trigeminal nerve tested?

A

Sensory - Light touch bilateral across 3 areas with cotton wisp and corneal reflex

Motor - Jaw jerk

81
Q

What are the potential causes of a trigeminal nerve palsy (UMN and LMN)?

A

UMN - Ischaemia, tumour, MS

LMN - acoustic neuroma, cavernous sinus lesion

82
Q

What type of nerve is the facial nerve (motor or sensory)?

A

Sensory and motor

83
Q

What is the sensory component of the facial nerve?

A

Taste to the anterior 2/3rds via chorda tympani

84
Q

What is the function of the motor component of the facial nerve?

A

Muscles of facial expresion, and secretomotor function to lacrimal submandibular and sublingual salivary glands

85
Q

How do you test the facial nerve?

A

Primarily testing of motor function as smell (olfactory) provides most of taste senses.

Forced opening of closed eyes
Squeezing of puffed cheeks
Opening of pursed lips

86
Q

What are the primary functions of the vestibulocochlear nerve?

A

Hearing and balance

87
Q

How do you test vestibulocochlear nerve function?

A

Whispering into each ear

Checking balance or presence of nystagmus or vertigo

88
Q

What is the function of cranial nerve IX?

A

Sensory to tonsillar fossa and pharynx

Taste to the posterior 1/3rd of the tongue and parasympathetic innervation of the parotid glands

89
Q

How do you test cranial nerve IX functionality?

A

Gag reflex by touching tonsillar fossa

90
Q

What is the function of cranial nerve X

A

Vagus - motor function to pharynx, larynx and soft palate

91
Q

How do you test cranial nerve X functionality?

A

Ask patient to say ahh - visualise uvula and soft apalte and initiate gag reflex

92
Q

How do you detect the presence of a deficit in function of cranial nerve X?

A

Soft palate will lie lower on side of lesion

Uvula will point away from side of lesion

93
Q

How do you test cranial nerve XI functionality?

A

Shrug test against resistance and turning head against resistance.

94
Q

What is the function of cranial nerve XII?

A

Motor function to the tongue (anterior 2/3rds)

95
Q

What is the sign of a deficit in function of cranial nerve XII?

A

Tongue deviation to a side (which ever side the deviation lies is where the lesion is)

HUD (4 decks)

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