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Phase 2a - conditions > Neurology > Flashcards

Neurology Flashcards

1
Q

What is a transient ischaemic attack?

A

A sudden onset, focal neurological deficit lasting under 24 hours.

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2
Q

What is the pathophysiology of a TIA?

A

Ischaemia to an area of the brain but without subsequent infarction.

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3
Q

What are the possible signs of a TIA?

A

Weak limb
Aphasia
Facial droop
Amaurosis fugax

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4
Q

What is amaurosis fugax?

A

Progressive vision loss, like a curtain coming down.

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5
Q

What artery is affected in amaurosis fugax?

A

Retinal artery

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6
Q

What are the causes of a TIA?

A

Thromboembolism
Cardiac dysrhythmia
Hyperviscosity - ie. sickle cell
Vasculitis

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7
Q

What investigations should be carried out in a TIA?

A

ABCD2 risk score - determines the urgency of treatment required.
Carotid doppler
CT angiography

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8
Q

What are the differential diagnoses for a TIA?

A

Hypoglycaemia
Migraine aura
Focal epilepsy

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9
Q

What risk factors should be controlled following a TIA?

A

Blood pressure
Cholesterol
Weight - exercise
Quit smoking

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10
Q

What drugs should be given in cases of a TIA?

A

Aspirin
Clopidogrel
Warfarin

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11
Q

What is the pathophysiology of a stroke?

A

An area of brain becomes infarcted and a permanent neurological deficit follows.

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12
Q

What are the two main types of strokes?

A

Ischaemic

Haemorrhagic

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13
Q

What are the risk factors for a stroke?

A 
High blood pressure 
Smoking 
Diabetes 
Obesity 
Hyperlipidaemia 
Past TIA 
Sedentary lifestyle
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14
Q

What aspect of a stroke determines the symptoms experienced?

A

The location of the blood vessel occlusion or haemorrhage.

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15
Q

What are the likely symptoms experienced in an anterior cerebral artery stroke?

A

Hemiparesis
Sensory disturbances
Drowsiness

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16
Q

What are the likely symptoms experienced in a middle cerebral artery stroke?

A 
Motor weakness 
Sensory disturbance 
Eye deviations 
Facial droop 
Receptive or affective aphasia.
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17
Q

What is receptive aphasia and where has been affected in a stroke that causes this?

A

Can’t understand speech.

Wernicke’s area in the temporal lobe has been infarcted.

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18
Q

What is affective aphasia and where has been affected in a stroke that causes this?

A

Can’t make speech.

Broca’s are in the frontal lobe has been infarcted.

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19
Q

What are the likely symptoms experienced in a posterior cerebral artery stroke?

A

Contralateral hemianopia

Other visual disturbances.

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20
Q

What are the likely symptoms experienced in a posterior circulation stroke?

A

Large motor deficits
Vertigo, nausea, vomiting
Altered consciousness

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21
Q

What is the largest deficit stroke?

A

Middle cerebral artery.

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22
Q

What investigations are used to investigate a stroke?

A

CT head
ECG
Carotid doppler

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23
Q

Which treatment can only be given within 4.5 hours of a stroke?

A

Thrombolytic

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24
Q

What is the contraindications for thombolytic therapy?

A

Recent surgery
Malignancy
Aneurysm

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25
What must be completely excluded before antiplatelet drugs are stared?
Haemorrhagic stroke
26
What other therapies are given post stroke to aid recovery and prevent further events?
Aspirin Clopidogrel Statins
27
What are the four types of haemorrhage?
Intracranial Subarachnoid Subdural Extradural
28
Where does the bleed come from in a subarachnoid haemorrhage?
Circle of Willis | most aften a berry aneurysm
29
What are the symptoms of a subarachnoid haemorrhage?
Sudden onset, severe headache - 'thunderclap' Vomiting Collapse Seizures
30
What are the signs if a subarachnoid haemorrhage?
Neck stiffness, low consciousness due to raised ICP | Positive Kering's sign
31
What is Kering's sign?
When both hip and knee are flexed, the extension of the knee is painful. (shows inflammation of meninges)
32
What investigations confirm a subarachnoid haemorrhage?
CT (detects 90%) | Lumbar puncture
33
What does a lumbar puncture show in a subarachnoid haemorrhage?
CSF is bloody, then turns xanthochromic (yellow) after 12 hours.
34
What are the differential diagnoses of a subarachnoid haemorrhage?
Migraine | Acute meningitis
35
What is the management of a subarachnoid haemorrhage?
Neurosurgery - very poor prognosis
36
What is a subdural haemorrhage?
Bleeding between the dura and arachnoid layer of the meninges.
37
What is the site of bleeding for a subdural haemorrhage?
Bridging veins (connect the cortex and venous sinuses)
38
What are the causes of a subdural haemorrhage?
Trauma (can be from a long time ago) | Metastases
39
What is the risk factor for subdural haemorrhage?
Brain atrophy - increases the distance the bridging brains travel, making them more susceptible to rupture.
40
What are the symptoms of subdural haemorrhage?
Fluctuating level of consciousness Cognitive decline Headache Drowsiness
41
What investigation can diagnose a subdural haemorrhage and what does it show?
CT | Crescent shaped collection of blood over one hemisphere.
42
What are the differential diagnoses for subdural haemorrhage?
Stroke | Dementia
43
What is the management of a subdural haemorrhage?
Neurosurgery - good prognosis
44
What is an extradural haemorrhage?
Bleeding between dura and bone.
45
What is the cause of an extradural haemorrhage?
Skull fracture - often across the path of the middle meningeal artery.
46
What are the symptoms of an extradural haemorrhage?
A head injury with a following lucid period Then decreasing consciousness Headache, vomiting and fits
47
What investigation can diagnose an extradural haemorrhage and what does it look like?
CT | Convex bleed on the edge of the skull.
48
What is the management for an extradural haemorrhage?
Neurosurgery
49
What are the two different type of epilepsy?
Generalised | Focal/partial
50
What is the pathophysiological cause of epileptic seizures?
Hyper-synchronous neuronal discharges
51
What types of seizures are generalised?
Absence Tonic-clonic Myoclonic
52
What is a tonic-clonic seizure?
Period of rigidity followed by rhythmic muscle jerking
53
What is often a trigger for focal seizures?
Structural abnormality
54
What are the non-motor symptoms of focal seizures?
Feeling of deja-vu Unusual tastes or smells Aura - awareness within the seizure Sensation disturbances
55
What are the motor symptoms of focal seizures?
Lip smacking Chewing Fiddling
56
What type of questions should be asked when someone reports a seizure?
How long did it last? Was there a feeling before the seizure began? How did you recover from the seizure? Did anything occur to trigger the seizure?
57
What investigations can be carried for seizures?
Electroencephalography | MRI - to look for focal lesions
58
What does an EEG show in a generalised seizure?
Stimulation simultaneously in all parts of the brain
59
What does an EEG show in a focal seizure?
Stimulation in only a specific area of the brain that does not spread far.
60
Is an EEG diagnostic for epilepsy?
No
61
What is the mainstay of treatment for epilepsy?
Anti-epileptic drugs
62
What is the first line medication for generalised epilepsy?
Sodium valporate or Iamotrigine
63
What is the first line medication for focal epilepsy?
Carbamazepine
64
What is the first line medication for a patient in an epileptic emergency?
Lorazepam
65
What is the cause of syncope?
Insufficient oxygen/blood to the brain.
66
What are the features of syncope?
Precipitants - sudden standing, pain, fear Prodrome - dizziness, light headed, sweats, nausea Blackout - still, limp, eyes shut, minor jerking Recovery - very rapid
67
What is a non-epileptic seizure?
Seizures that are associated with psychological distress.
68
What are the features of a non-epileptic seizure?
``` Non-synchronous movements Dramatic motor Crying and speaking Long duration Injury is rare. ```
69
What is the pathology of Parkinson's disease?
Deposition of Lewy bodies in the cytoplasm Degeneration of dopaminergic neurons in the substantia nigra lack of dopamine causes failure of basal ganglia function
70
What are the hallmark symptoms of Parkinson's?
Bradykinesia (slow movements) Tremor Rigidity
71
How may bradykinesia present itself?
Problems doing up buttons | Small handwriting
72
What are the changes in gait in Parkinson's?
Shuffling Reduced arm swing Slow to 'get going'
73
What are the non-movement features of Parkinson's disease?
Depression Dementia Other psychiatric problems
74
What scan can be used to see dopamine in the brain and what does it show in Parkinson's?
DaTSCAN | Shows reduced dopamine in the brain.
75
What is the main mechanism of most Parkinson's drugs?
Compensate for loss of dopamine.
76
What are the different pharmacological options available in Parkinson's disease?
L-Dopa Dopamine agonists ie. ropinirole Catecholamine-O-methylytansferasse inhibitors Monoamine oxidase B inhibitors
77
What is L-Dopa?
The precursor for dopamine, it can cross the BBB and is then metabolised to dopamine.
78
What is the action of COMT and MAO-B inhibitors?
Inhibit the breakdown of dopamine.
79
What are the complications of long term therapy use in Parkinson's disease?
Drugs stop working Symptoms when drugs are first taken ie. hyperkinetic Drugs wear-off quicker between doses.
80
What is the genetic basis of Huntington's disease?
Expansion of the CAG trinucleotide on chromosome 4. >36 repeats is diagnostic.
81
What is the inheritance of Huntington's disease?
Autosomal dominant
82
What is the physiological effect of Huntington's disease?
Atrophy and neuronal loss of striatum and cortex. Loss off GABA-nergic neurons.
83
What are the motor symptoms of Huntington's disease?
Chorea (excessive, irregular movements) | Incoordination
84
What are non-motor symptoms of Huntington's?
Depression | Dementia
85
Is there a cause for Huntington's?
No
86
What are the causes of secondary headaches?
Subarachnoid haemorrhage Meningitis Low-CSF volume Raised ICP
87
What are the types of primary headache?
Migraine Cluster headache Tension-type headache Trigeminal neuralgia
88
Why is it important to image any headache with red flag symptoms?
To exclude secondary causes.
89
What is the presentation of a migraine?
Unilateral Throbbing/pulsatile Aggravated by activity Moderate-severe
90
What can a migraine be associated with?
``` Nausea Vomiting Photophobia Phonophobia Aura ```
91
What is an migraine associated with aura?
A visual disturbance - flashing/blurring | All positive symptoms.
92
What are the triggers associated with migraines?
``` Chocolate Hangovers Cheese Oral contraceptive Sleep changes Alcohol ```
93
What are the differential diagnoses for a migraine?
Cluster headache | TIAs
94
What is the treatment of an active migraine?
``` NSAIDs oral triptan (ie. sumatriptan) can be taken when the migraine is first felt. ```
95
What are the prophylactic treatments for a migraine?
1 - propranolol or topiramate 2 - acupuncture 3 - botox
96
What are the symptoms of a tension-type headache?
``` Bilateral Tight/pressing Lasts from minutes to days Mild-moderate pain No more than one of photo/phonophobia. ```
97
What is the management of a tension-type headache?
Reassurance Stress relief Avoid triggers Analgesia
98
What are the symptoms of s cluster headache?
Unilateral orbital/supraorbital/temporal pain Severe or very severe Period of months with lots of attacks then long pain free periods.
99
What is the management of an acute cluster headache attack?
Sumatriptan
100
What is prophylactic management of cluster headaches?
Verapamil Corticosteroids Lithium
101
What are the features of a medication overuse headache?
Headache on >15 days of the month Regular pain relief for >3 months Headache has worsened over this period.
102
What is the cause of trigeminal neuralgia?
Compression of the trigeminal nerve by - intracranial vessels, tumour, MS, skull.
103
What is the presentation of trigeminal neuralgia?
Unilateral pain in the trigeminal nerve distribution (face) Electrifying/lightning/stabbing Precipitated by stimuli to that area of the face.
104
What is the pharmacological management of trigeminal neuralgia?
1 - carbamazepine | 2 - phenytoin, gabapentin
105
What is the surgical management of trigeminal neuralgia?
Microvascular decompression | Stereotactic radiotherapy.
106
Where does the spinal cord finish?
L1/L2
107
What does the spinal cord turn into at L1?
Cauda equina
108
Where would a lumbar puncture be carried out?
L4
109
What is tetraplegia?
Paralysis of all 4 limbs
110
What is paraplegia?
Paralysis of both legs
111
What is hemiplegia?
Paralysis of one half of the body
112
What are the causes of spinal cord compression?
Osteophytes Disc prolapse Malignancy Infection
113
What is the presentation of spinal cord compression?
Leg weakness Sensory loss or disturbance below the compression UMN signs below the compression - increased tone, reflexes.
114
What investigation can confirm spinal cord compression?
MRI spine
115
What is the treatment for spinal cord compression?
Surgical decompression
116
Where would a lesion be to cause cauda equina syndrome?
At or below L1
117
What are the symptoms of cauda equina syndrome?
Lower back pain Pain that radiates down the leg Numbness of the anus Loss of bowel or bladder control
118
What is the investigation and treatment for cauda equina syndrome?
MRI spine | Surgical decompression
119
What is multiple sclerosis?
Chronic autoimmune T-cell mediated demyelination of the CNS.
120
What is the epidemiology of multiple sclerosis?
More common in women More common further away from the equator Usually diagnosed at 20-40 years old
121
What determines the presentation of MS?
The locations of the lesions
122
What are the possible presentations of MS?
``` Diplopia (double vision) Optic neuritis Numbness/tingling of limbs Weakness Ataxia ```
123
What is required for a diagnosis of MS?
Two + lesions of the CNS disseminated in time and space. | Exclusion of other causes.
124
Describe relapsing/remitting MS.
Unpredictable attacks which sometimes leave permanent deficits.
125
Describe primary progressive MS.
Steady increase in disability without attacks
126
Describe secondary progressive MS.
Initially relapsing and remitting, followed by progressive increase in disability.
127
Describe progressive-relapsing MS.
Steady increase in disability with superimposed attacks.
128
What investigations can show the CNS lesions in MS?
MRI with contrast
129
What is the general management for a person with MS?
Reduce stress Occupational therapy Physiotherapy Counselling
130
What treatment can be offered during a flare up of MS?
Steroids - IV methylprednisolone
131
What drug can be offered for MS long term and what is its role?
Beta-interfon | Decrease the number of attacks of MS.
132
What is myasthenia gravis?
Autoimmune disorder of neuromuscular junction transmission.
133
What are the most common autoimmune antibodies present in myasthenia gravis?
anti-Ach receptor antibodies in (80%) | anti-MuSK antibodies
134
What is the presentation of myasthenia gravis?
Muscle weakness - ocular, bulber, proximal limb | The weakness is fatiguable (gets worse on repeated movements)
135
What are some possible signs of myasthenia gravis?
``` Ptosis Diplopia Complex ophthalmoplegia Dysarthria (speech problems) Head drop Limb weakness ```
136
What are two signs that suggest myasthenia gravis?
Ice pack test - ice pack on eye improves ptosis | Cogan's lid twitch - lid twitches on repetitive movements
137
What investigations can be carried out in myasthenia gravis?
Serology - serum anti-AchR antibodies or anti-MuSK antibodies. EEG CT thorax
138
What does and EEG show in myasthenia gravis?
Fatiguability
139
What is the CT thorax for in myasthenia gravis?
Check for a thymoma
140
What is the most common presentation of myasthenia gravis?
Ocular problems
141
What percentage of myasthenia gravis presents with a thymoma?
20%
142
What is the treatment for myasthenia gravis?
Pyridostigmine - acetylchoniesterase inhibitor Steroids Immunosuppression Thymectomy is thymoma present
143
What is the physiology of myasthenia gravis?
anti-ACh receptor antibodies prevent the binding of Ach on the post synaptic membrane so the impulse is not spread across the neuromuscular junction.
144
What can be offered in a myasthenia gravis crisis?
IV immunoglobulin | Plasmapheresis
145
What is lambert eaton myasthenic syndrome?
Anti-bodies to the voltage gated calcium channels.
146
What is the physiology of lambert eaton myasthenic syndrome?
When an impulse arrives at the the presynaptic junction, not as many calcium channels open so less calcium floods in, so not as many neurotransmitter vesicles are transported out.
147
What is the early presentation of lambert eaton myasthenic syndrome?
Gait changes
148
Why does lambert eaton myasthenic syndrome improveme with movement?
Each impulse stimulates more calcium channels so eventually there is enough calcium to trigger an effective response.
149
What is used to treat lambert eaton myasthenic syndrome ?
3,4 diaminopyridine | Immunosuppression
150
What is motor neuron disease?
Degenerative loss of neurons.
151
What is the presentation of upper motor neuron lesions?
``` Weakness Increased tone Increased reflexes Extensor plantar response (babinski reflex) No fasciculations or atrophy. ```
152
What is the presentation of lower motor neuron lesions?
``` Weakness Decreased tome Decreased reflexes Flexor/absent plantar response Fascilations Atrophy ```
153
What is the most common form of motor neuron disease?
Amyotrophic lateral sclerosis - AML
154
What are the general features of motor neuron disease?
``` Reduced dexterity Stiffness Wasting of intrinsic hand muscles Stumbling gait Foot drop Slurred speech ```
155
MND is a mostly clinical diagnosis. What are possible investigations that could be carried out to confirm diagnosis?
Bloods - raised creatinine due to muscle breakdown Nerve conduction studies Lumbar puncture - exclude inflam. MRI - rule out lesions
156
What is the management of MND?
No cute so all symptomatic treatment. Spasticity - baclofen Pain - analgesia
157
What do A-alpha sensory fibres carry?
Proprioception
158
What do A-beta sensory fibres carry?
light touch, pressure, vibration
159
What do A-delta fibres carry?
Cold and pain
160
What do C-fibres carry?
Warm and pain
161
Which fibres are large and myelinated?
A-alpha | A-beta
162
Which fibres are small and unmyelinated?
A-delta | C-fibres
163
What is a mononeuropathy?
Problem with one nerve
164
What are examples of common mononeuropaties?
Carpel tunnel syndrome | Sciatica
165
What is carpel tunnel syndrome?
Compression of the median nerve, causing pain and parasthesia in the median nerve distribution, causes wasting of thenar eminence.
166
How do you treat carpel tunnel syndrome?
Conservative - pain relief snd splint Hydrocortisone injection Surgical decompression
167
What is sciatica?
Compression of the L1 nerve root - sciatic nerve. Causing sensory loss and shooting pain down the legs.
168
What is a polyneuropathy?
Problem with many nerves
169
What is the pathophysiology of polyneuropathy?
Axonal degeneration | Demyelination
170
What are the causes of polyneuropathies?
``` Diabetes Vitamin deficiency Infection (ie. Guillain barre) Drugs Genetics ```
171
What is the most common polyneuropathy presentations?
Symmetrical sensorimotor. | Deficiency in a glove and stocking distribuction (ie. diabetic neuropathy)
172
What are the possible sensory symptoms of a polyneuropathy?
Numbness | Pins and needles
173
What are the possible motor symptoms of a polyneuropathy?
Weak Clumsy Wasting
174
What is Guillan-Barre syndrome?
Acute inflammatory demyelinating polyneuropathy
175
What is the cause of Guillan-Barre syndrome?
Infection ie. by campylobacter jejuni, CMV, EBV.
176
What are the symptoms of Guillain-Barre syndrome?
Progressive, ascending muscle weakness Motor and sensory losses Loss of reflexes.
177
What is the management of Guillain-Barre syndrome?
Depends on its severity. Severe - may need ventilation Immunoglobulin can reduce the duration of paralysis.
178
Which spinal nerve tracts carry motor information?
Corticospinal tracts
179
What is the path of the corticospinal tracts?
85% decussate in the medulla and travel down the spinal cord ipsilaterally to the area supplied.
180
What information do the dorsal column medial lemnisci tracts carry?
Vibration, touch, proprioception.
181
What is the path of the DCML tracts?
Travel up the spinal cord ipsilaterally to the area supplied and decussate in the medulla.
182
What information do the spinothalamic tracts carry?
Pain and temperature
183
What is Brown-Sequard syndrome?
A hemi-section of spinal cord resulting in specific set of symptoms.
184
What are the symptoms experience in Brown-Sequard syndrome?
Ipsilateral motor loss Ipsilateral vibration, touch and proprioception loss Contralateral pain and temperature loss
185
What CN I and what is an effect of a lesion here?
CN I - olfactory | Anosmia
186
What CN II and what is an effect of a lesion here?
Optic | Depends where the lesion is in the optic tract.
187
What CN III and what is an effect of a lesion here?
Occulomotor | Third nerve palsy - affected eye looks down and out.
188
What CN IV and what is an effect of a lesion here?
Trochlear | Weakness to the superior oblique muscle, double vision when looking down.
189
What CN V and what is an effect of a lesion here?
Trigeminal nerve | Unlateral facial sensory loss, muscles of mastication stop working.
190
What CN VI and what is an effect of a lesion here?
Abducens | Lateral rectus stop working, eye cannot be full abducted - causes horizontal diplopia.
191
What CN VII and what is an effect of a lesion here?
Facial Bell's palsy - mouth sagging, speech problems, failure of eye closure. Often caused by swelling of nerve within petrous bone canal due to infection.
192
What CN VIII and what is an effect of a lesion here?
Vestibulococlear | Hearing and balance deficits
193
What CN IX and what is an effect of a lesion here?
Glossopharyngeal | Diminished pharynx sensation
194
What CN X and what is an effect of a lesion here?
Vagus | Swallow and gag problems, uvula deviates away from lesion.
195
What CN XI and what is an effect of a lesion here?
Accessory | Weakness of sternocleidomastoid and trapezius muscle, head turning and shoulder shrugging.
196
What CN XII and what is an effect of a lesion here?
Hypoglossal | Tongue weakness, wasting and fasciculation.
197
What is the presentation of a brain tumour?
Progressive focal neurological deficit Raised ICP - headache, vomiting Seizures General cancer symptoms - malaise, weight loss.
198
What are the two main groups of brain tumours?
Primary or secondary.
199
What is a sign of raised ICP?
Papilloedema
200
What investigations can be carried out for a suspected brain tumour?
CT/MRI | Consider biopsy
201
What are the differential diagnoses for a brain tumour?
Stroke Abcess Cyst
202
What is the most common primary brain tumour?
Gliomas
203
What are three types of glioma?
Astrocytoma Oligodendroglioma Ependymal
204
What classification grades gliomas?
WHO classification
205
What does a grade I glioma mean?
Benign
206
What does a grade II glioma mean?
Diffuse - but can progress to be more aggressive
207
What does a grade III glioma mean?
Anaplastic
208
What does a grade IV glioma mean?
Glioblastoma
209
How are gliomas classified?
Histology | Molecular genetics
210
What specific mutation can indicate a oligodendroglioma?
1p19q deletion
211
For which grade of tumour can curative therapy be aimed?
Grade I
212
What are the common sites for brain mets to origionate?
Lung Breast Sometimes - kidney, GI tract, melanoma.
213
What is the most common causative organism of meningitis?
Strep pneumoniae
214
What cause of meningitis has a notoriously poor prognosis?
Neisseria meningitides
215
What is the presentation of meningitis?
Headache Neck stiffness Fever Photophobia
216
What signs can be elicited in meningitis?
Kering's - when both knee and hip are flexed knee extension is painful. Brudkinski's sign - flexion of neck causes leg flexion.
217
What is a sign of meningococcal septicaemia?
Non-blanching petechial rash
218
What are differential diagnoses for meningitis?
Malaria Subarachnoid haemorrhage Migraine
219
What would do if someone in the surgery is suspected to have meningitis?
Give IM benzylpenicillin | Call 999 or send to hospital
220
What are the investigations that should be carried out in meningitis?
Lumbar puncture Head CT Bloods - culture, FBC
221
What is the contraindication of a lumbar puncture?
Septicaemic - could cause a spread of infection to CSF that was not already there.
222
What is seen in the CSF of a meningitis caused by bacteria?
``` Cloudy Neutrophils Gram film visible High protein Low glucose ```
223
What is seen in the CSF of a meningitis caused by virus?
``` Clear Lymphocytes Not visible on gram film High protein Normal glucose Visible by PCR ```
224
What is seen in the CSF of a meningitis caused by TB?
``` Fibrin web appearance Lymphocytes High protein Low glucose Visible by PCR ```
225
What is seen in the CSF of a meningitis caused by crytococcal (fungal) cause?
``` Fibrin web appearance Lymphocytes Visible by India ink stain High protein Low glucose ```
226
What antibiotic is given for meningitis in hospital at the first instant?
IV cefotaxime | + amoxicillin if listeria suspected
227
What must always be done in a case of meningitis?
A notification of Public Health England.
228
What can PHE do when notified about a case of menigitis?
Trace contacts - men C vaccine | If N menigitides can give rifampicin as prophylaxis.
229
What is encephalitis?
Inflammation of the brain paranchyma
230
What are the common causes of encephalitis?
Viral - HSV, VZV
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What is the presentation of encephalitis?
``` Fever Headache Behavioural change Coma Seizures ```
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What investigations should be carried out in encephalitis?
MRI head | LP and CSF analysis
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What is the most common CSF finding in encephalitis?
Viral so lymphocytes, PCR visible.
234
What can be given in a viral cause of encephalitis?
IV acyclovir
235
What infection causes shingles?
Herpes voster
236
The reactivation of what infection causes shingles?
Varicella zoster (chicken pox)
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What is the presentation of herpes zoster?
Rash | Pain
238
What can be given to treat herpes zoster?
Acyclovir
239
What causative organism of tetanus?
Clostridium tetani
240
What is the effect of a tetanus infection?
Extreme spasm and pain | Can be localised or whole body.
241
What is the management of tetanus?
Vaccination for prevention
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What are the four types of dementia?
Alzheimer's Vascular Lewy body Fronto-temporal
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What is the pathogenesis of Alzheimer's disease?
Accumulation of B-amyloid plaques in the brain | Structural changes to tau protein
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What does an MRI show in Alzheimer's disease?
Gross atrophy
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What is the pathogenesis of vascular dementia?
Multiple infarcts, stroke, small vessel disease causing a vascular deficit to the brain.
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What is the pathogenesis of lewy body dementia?
Deposition of lewy bodies in the brain.
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What is the pathogenesis of fronto-temporal dementia?
Fronto-temporal lobe atrophy
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What is the general effect of dementia?
Gradual onset, progressive decline in cognitive function, memory, problem solving, language and activities of daily living.
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What are specific symptoms of lewy body dementia?
Can be fluctuating | Can have visual hallucinations early on
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What are specific symptoms of fronto-temporal dementia?
Behaviour and personality changes predominate.
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What can dementia be distinguished from depression?
Depression onsets more rapidly, patient is aware of their memory loss, patient is distress and has variable cognitive function.
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What is the recommended management for dementia?
Healthy lifestyle Develop routines Social support and care Treat any associated co-morbidities

Phase 2a - conditions (11 decks)

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