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Phase 2A Med Concise > Neurology > Flashcards

Neurology Flashcards

1
Q

Transient ischaemic attack (TIA) - Pathophysiology

A

Focal, sudden onset, neurological deficit lasting <24hrs, with complete clinical recovery
Ischaemia, without infarction

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2
Q

Transient ischaemic attack - Causes

A

Thromboembolism (from carotids)

Cardioembolism

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3
Q

Transient ischaemic attack - Symptoms

A

Weakness in left arm
Slurred speech
Left sided facial droop

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4
Q

Transient ischaemic attack - Risk factors

A

Smoking
Alcohol
Obesity - exercise/diet

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5
Q

Transient ischaemic attack - Investigations

A 
ABCD2 - Stroke risk score
Carotid doppler (stenosis)
CT angiography (stenosis)
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6
Q

Transient ischaemic attack - Treatment

A

Aspirin
Clopidogrel
Simvastatin
B-blocker (Atenolol)

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7
Q

Stroke - Pathophysiology

A

Rapid onset of neurological deficit caused by focal, cerebral, spinal or retinal infarction
If untreated within 24hrs leads to death

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8
Q

Stroke - Signs and symptoms

A

ACA (Anterior cerebral artery) - Frontal lobe - Drowsiness, logical thinking, personality
MCA (Middle cerebral artery) - Motor weakness, hemiplegia (paralysis of one side of body), sensory disturbances, aphasia (affected speech)
PCA (Posterior cerebral artery) - Contralateral hemianopia (blindness over half field of vision)

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9
Q

Stroke - Investigation

A

CT scan - check whether ischaemic or haemorrhagic

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10
Q

Stroke - Treatment

A

Ischaemic stroke - Aspirin/clopidogrel, IV altepase (thrombolysis)
Haemorrhagic - B-blocker (control BP), beriplex (if warfarin related), surgery
Rehab - Physio, OT
Lifestyle

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11
Q

Haemorrhage - Types

A

Extradural - Middle meningeal artery
Subdural - Bridging veins
Subarachnoid - Circle of Willis

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12
Q

Subarachnoid haemorrhage - Pathophysiology

A

Circle of Willis (subarachnoid)

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13
Q

Subarachnoid haemorrhage - Cause

A

Berry aneurysm causes spontaneous bleed in subarachnoid space

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14
Q

Subarachnoid haemorrhage - Symptoms

A

Sudden sharp pain in back of head
Neck stiffness
Systemically fine
Lower consciousness (raised ICP (intracranial pressure) due to artery rupture)

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15
Q

Subarachnoid haemorrhage - Investigations

A

CT

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16
Q

Subarachnoid haemorrhage - Treatment

A

Neurosurgery

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17
Q

Subdural haemorrhage - Pathophysiology

A

Rupture of bridging veins

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18
Q

Subdural haemorrhage - Cause

A

Head injury

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19
Q

Subdural haemorrhage - Symptoms

A

Fluctuating consciousness and headache due to raised ICP

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20
Q

Subdural haemorrhage - Investigations

A

CT - Crescent shaped collection of blood

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21
Q

Subdural haemorrhage - Treatment

A 
Neurosurgery - Irrigation
IV mannitol (reduce ICP)
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22
Q

Extradural haemorrhage - Pathophysiology/Cause

A

1) Head injury
2) Fracture in temporal/parietal bone
3) Rupture of middle meningeal artery
4) Rapid collection of blood in extradural space

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23
Q

Extradural haemorrhage - Symptoms

A

Decreased consciousness due to raised ICP

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24
Q

Extradural haemorrhage - Investgations

A

CT - Biconvex, hypodense haematoma

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25
Q

Extradural haemorrhage - Treatment

A 
Neurosurgery - Irrigation 
IV mannitol (Reduce ICP)
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26
Q

Epilepsy - Pathophysiology

A

2 or more unprovoked seizures with 24hrs apart
Seizure - Recurrent tendency of spontaneous, abnormal electrical activity in part of the brain due to excessive hypersynchronous neuronal discharges

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27
Q

Epilepsy - 2 Types

A

Generalised - Whole cortex

Partial/focal - Lobe

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28
Q

Generalised epilepsy - Symptoms

A

1) Rigidity/sitffening
2) Rhythmic muscle jerking
3) Drowsiness, confusion and coma

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29
Q

Partial/focal epilepsy - Symptoms

A 
Frontal lobe (motor) - Jacksonian march (seizure 'marches' up/down motor homonculus), limb paralysis
Parietal lobe (sensory) - Numbness, tingling
Temporal lobe (memory, emotion) - Hallucinations, out of body experience - fiddling
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30
Q

Differences between epilepsy and syncope

A

Seizure - Sudden onset, any position, falls backwards

Syncope - Sitting or standing, falls forwards

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31
Q

Epilepsy - Investgations

A

EEG (Electroencephalogram)

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32
Q

Epilepsy - Treatment

A

Emergency - IV lorazepam
Generalised - Sodium valporate
Partial/focal - Carbamezapine

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33
Q

Dementia - 4 Types (AVLF)

A

Alzheimer’s
Vascular
Lewy body
Fronto-temporal

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34
Q

Alzheimer’s - Onset

A

Gradual

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35
Q

Alzheimer’s - Signs and symptoms (4As)

A

Aphasia (speech)
Agnosia (sensation, recognition)
Apraxia (motor)
Amnesia (memory)

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36
Q

Alzheimer’s - Pathology

A

Degeneration of cerebral cortex with cortical atrophy

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37
Q

Vascular - Onset

A

Gradual or abrupt

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38
Q

Vascular - Signs and symptoms

A

Deterioration

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39
Q

Vascular - Pathology

A

Brain damage from cerebrovascular disease

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40
Q

Lewy body - Onset

A

Gradual

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41
Q

Lewy body - Signs and symptoms

A

Fluctuating cognition

Visuospatial impairment

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42
Q

Lewy body - Pathology

A

Deposition of abnormal proteins associated with parkinson’s disease

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43
Q

Fronto-temporal - Onset

A

Rapid progression

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44
Q

Fronto-temporal - Signs and symptoms

A

Behavioural and personality changes

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45
Q

Fronto-temporal - Pathology

A

Atrophy of fronto-temporal lobes

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46
Q

Dementia - Pathophysiology

A

A syndrome that causes memory loss, difficulties thinking, problem-solving, language

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47
Q

Dementia - Investigation

A

Clinical diagnosis

Mini-mental state exam (MMSE) - <17/30 = Serious cognitive impairment

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48
Q

Dementia - Treatment

A

Lifestyle
Social support
Rivastigmine (acetylcholinesterase inhibitor)
Control CV risk factors

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49
Q

Differences between dementia and delirium

A

Delirium - Acute, fluctuating, altered consciousness, caused by stroke or infection
Dementia - Gradual, progressive, normal consciousness, caused by disorder

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50
Q

Headaches - 2 Types

A

Primary - Migraine, cluster, tension-type, trigeminal neuralgia
Secondary - GCA, meningitis, drug overuse

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51
Q

Migraine - Symptoms

A

Unilateral more commonly (can be bilateral)
Pulsating/throbbing
Lasts 4-72hrs
Moderate to severe pain

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52
Q

Migraine - Causes (CHOCOLATE)

A 
Chocolate
Hangovers
Orgasms
Cheese
Oral contraceptive pill
Lie-ins
Alcohol
Tummult (loud noises)
Exercise
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53
Q

Migraine - Pathophysiology

A

1) Changes in brainstem blood flow
2) Unstable trigeminal nerve nucleus/nuclei in basal thalamus
3) Release of vasoactive neuropeptides (substance P)
4) Neurogenic inflammation, vasodilation

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54
Q

Migraine - Types

A

Migraine with aura

Migraine without aura

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55
Q

Migraine - Without aura - Symptoms

A 
>5 Attacks
Lasting between 4-72 hours
Unilateral, pulsating, moderate/severe pain
N&amp;V
Photophobia, phonophobia
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56
Q

Migraine - With aura - Symptoms

A 
>2 Attacks
Each aura symptom lasts up to an hour
Visual abnormalities (zigzags, spots)
Unilateral sensory (tingling, numbness)
Aphasia 
Motor weakness
Followed by headache
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57
Q

Migraine - Treatment

A

Avoid triggers

Sumatriptan (Triptan)

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58
Q

Prophylaxis definition

A

Preventative treatment

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59
Q

Tension headache - Symptoms

A 
Lasts 30mins-7days
Bilateral band around forehead
Tight/pressing
Lasts mins-days
Mild/moderate pain
Photophobia, phonophobia (only one, not both!)
No N&amp;V
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60
Q

Tension headache - Pathophysiology

A

Neurovascular irritation which refers to scalp muscles and soft tissues

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61
Q

Tension headache - Causes (MC SCOLD)

A 
Missed meals
Conflict 
Stress
Clenched jaw
Overexertion
Lack of sleep
Depression
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62
Q

Tension headache - Treatment

A

Amitriptyline (antidep)

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63
Q

Cluster headache - Symptoms

A 
Unilateral
Orbital, supraorbital or temporal pain 
Lasts 15mins-3hrs
Severe pain 
Night/morning hours
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64
Q

Cluster headache - Treatment

A

Sumatriptan

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65
Q

Trigeminal neuralgia - Symptoms

A

Unilateral facial pain confined to divisions of the trigeminal nerve
Electrifying/stabbing/lightning pain (very severe)
Lasts few seconds-few mins
No neurological deficit

66
Q

Trigeminal neuralgia - Cause

A

Compression of trigeminal nerve by intracranial vessels or a tumour, or other abnormal prominence

67
Q

Trigeminal neuralgia - Treatments

A 
Neuropathic analgesic (Gabapentin)
Surgical
68
Q

Giant cell arteritis - Symptoms

A 
Headache
Jaw claudication 
Fever
Weight loss
Depression
69
Q

Giant cell arteritis - Signs

A

Palpable, tender and reduced pulsation of temporal arteries

70
Q

Giant cell arteritis - Investigations

A

Temporal artery biopsy

Bloods - Raised ESR/CRP

71
Q

Giant cell arteritis - Treatment

A

Prednisolone
Aspirin
PPI (Omeprazole)

72
Q

Secondary headaches

A

Raised ICP

73
Q

Parkinsonism - Pathophysiology

A

Syndrome consisting of bradykinesia, resting tremor, rigidity

74
Q

Parkinsonism - Cause

A

Infections (encephalitis)
Drug induced
Vascular parkinsonism

75
Q

Parkinson’s disease - Cause

A

No known cause

76
Q

Parkinson’s disease - Pathophysiology

A

Neurodegenerative loss of dopamine secreting cells from the substantia nigra
Lack of dopamine causes alteration in neural circuits within basal ganglia that regulates movement

77
Q

Parkinson’s disease - Symptoms

A

Bradykinesia (problems with daily activities)
Tremor (unilateral)
Rigidity (stooped posture)
Gait (shuffling, reduced arm swing, slow to start)
Postural instability (impaired balance, more so when turning)
Depression
Dementia
Hallucinations

78
Q

Parkinson’s disease - Investigations

A

CT/MRI head - Atrophy of substantia nigra

79
Q

Parkinson’s disease - Treatment

A

No cure!
Co-careldopa (carbidopa/levodopa) - dopamine precursors
Ropinirole (Dopamine receptor agonist)
Amantadine (anticholinergic) - tremor

80
Q

Huntington’s disease - Pathophysiology

A

Autosomal dominant

1) >36 triplet repeats in huntington gene
2) Faulty huntington protein builds up in striatum causing cell death and loss of GABA-nergic neurons
3) Less GABA causes less regulation of dopamine to striatum causing increased dopamine levels and so increased movement

81
Q

Huntington’s disease - Symptoms

A

Purposeless, dance-like movements)
Dementia
Rigidity

82
Q

Huntington’s disease - Investigations

A 
Genetic testing (<36 triplet repeats in huntington gene)
MRI - Atrophy of striatum (caudate/putamen)
83
Q

Huntington’s disease - Treatment

A

No cure!
Risperidone (Dopamine receptor antagonist) - chorea/aggressive behaviour
Sertraline (SSRI) - depression

84
Q

Multiple sclerosis - Pathophysiology

A

Chronic autoimmune T-cell mediated demyelination of the CNS

85
Q

Multiple sclerosis - Risk factors

A

Young (20-40)
F>M
Further from equator (VitD link)

86
Q

Multiple sclerosis - Signs and symptoms

A

Motor weakness
Slurred talking
Numbness
Tremor

87
Q

Multiple sclerosis - Investigations

A

MRI (Demyelination plaques)

Lumbar puncture/CSF - CNS inflammation

88
Q

Multiple sclerosis - Treatment

A 
No cure!
IV methylprednisolone (steroid) - acute attacks
Beta interferon (chronic)
B-blocker (tremor)
Baclofen (spacicity) 
Gabapentin (neuropathic pain)
89
Q

Motor neuron disease - Pathophysiology

A

Destruction of motor neurons in:
Motor cortex (UMN signs)
Anterior horn cells (LMN signs)
Cranial nerve nuclei (Mixed UMN/LMN signs)

90
Q

Motor neuron disease - Lesions (symptoms)

A

UMN lesion - Weakness, increased reflexes, increased tone

LMN lesion - Weakness, atrophy, decreased reflexes, decreased tone

91
Q

Motor neuron disease - Symptoms

A 
Stiffness
Muscle wasting in hands
Tripping/stumbling gait
Foot drop
Slurred speech
Overall muscle atrophy and spasticity
92
Q

Motor neuron disease - Investigations

A

Bloods - Raised CK (creatinine kinase) due to muscle destruction
Electromyography - Denervation of muscles
Nerve conduction studies - R/O Motor neuropathies
Lumbar puncture - R/O inflammatory causes
MRI - R/O lesions

93
Q

Differences between motor neuron disease and multiple sclerosis

A

MND - No sensory loss

MS - Sensory loss

94
Q

Motor neuron disease - Treatment

A 
No cure
Riluzole (Anti-glutaminergic sodium channel blocker)
MDT approach
PEG tube (dysphagia)
Baclofen (spasticity)
Analgesic ladder (joint pain)
95
Q

Brain tumours - Pathophysiology

A

Progressive focal neurological deficit

96
Q

Brain tumours - Symptoms

A

Raised ICP - Headaches, vomiting
Epilepsy - focal or generalised seizures
Weight loss
Malaise

97
Q

Brain tumour - Types (GMAS)

A

Glioma
Meningioma
Acoustic neuroma
Secondary

98
Q

Spinal cord compression - Pathophysiology

A

Myelopathy

Compression of spinal cord resulting in upper neuron signs and symptoms dependent on where compression is

99
Q

Spinal cord compression - Causes

A

Osteophytes (bony projection when cartilage wears)
Disc prolapse
Tumour

100
Q

Spinal cord compression - Symptoms

A

UMN signs (everything increased)

101
Q

Spinal cord compression - Investigations

A

MRI urgently

102
Q

Spinal cord compression - Treatment

A

Surgical decompression

103
Q

Brown-sequard syndrome - Sign

A

Spinal nerve lesions

Level of lesion - Ipsilateral spinothalamic dysfunction (local sign)

104
Q

Radiculopathy - Pathophysiology

A

Compression of nerve root (LMN)

105
Q

Mononeuropathy - Pathophysiology

106
Q

Polyneuropathy - Pathophysiology

A

Multiple/systemic

107
Q

Peripheral neuropathy - Causes

A 
Compression
Infarction
Demyelination 
Infection 
Drugs
108
Q

Carpal tunnel syndrome - Risk factors

A 
Pregnancy 
Obesity 
Hypothyroidism 
Rheumatoid arthritis
Gout
Acromegaly
109
Q

Carpal tunnel syndrome - Symptoms

A 
Hand pain
Hand parathesia
Worse at night 
Loss of sensation in palms (radial)
Wasting of abductor pollicis brevis
110
Q

Carpal tunnel syndrome - Investigations

A

Phalens and tinents

111
Q

Carpal tunnel syndrome - Treatment

A

Pain relief
Hydrocortisone injection
Surgical decompression

112
Q

Sciatica - Pathophysiology

A

Nerve lesion of S1 nerve root (compression)

113
Q

Sciatica - Symptoms

A

Sensory loss

Pain in back of thigh/leg/lateral aspect of little toe (sciatic nerve distribution)

114
Q

Sciatica - Causes

A

Disc prolapse

Osteoarthritis

115
Q

Sciatica - Investigation

A

MRI urgently

116
Q

Cauda equina nerve lesion - Pathophysiology

A

Lesion at or below L1 (Bundle of spinal nerves - horses tail)

117
Q

Cauda equina nerve lesion - Causes

A

Tumours
Disc herniation
Trauma

118
Q

Cauda equina nerve lesion - Symptoms/signs

A 
Lumbosacral pain
Bladder problems
Bowel problems
Urinary retention
Erectile dysfunction
119
Q

Cauda equina nerve lesion - Investigation

120
Q

Cauda equina nerve lesion - Treatment

A

Surgical decompression

Dexamethasone

121
Q

3rd cranial nerve palsy - Pathophysiology

A

Tramps palsy - Down and out

122
Q

7th cranial nerve palsy - Pathophysiology

A

Bell’s palsy - Muscles of facial expression droop (Forehead and lip)
In a stroke just lip droops with forehead sparing, but bell’s palsy includes forehead too

123
Q

7th cranial nerve palsy - Treatment

A

Steroid (infection)

124
Q

1st cranial nerve lesion - Pathophysiology

A

Anosmia (olfactory)

125
Q

5th cranial nerve lesion - Pathophysiology

A

Facial sensation and muscles of mastication (trigeminal)

126
Q

8th cranial nerve lesion - Pathophysiology

A

Hearing and balance (vestibulococlear)

127
Q

9th/10th cranial nerves lesions - Pathophysiology

A

Swallow, gag, cough (glossopharyngeal, vagus)

128
Q

11th cranial nerve lesion - Pathophysiology

A

Sternocleidomastoid and trapezius - Shrug shoulder and shake head (accessory)

129
Q

12th cranial nerve lesion - Pathophysiology

A

Tongue deviates towards side of lesion (hypoglossal)

130
Q

Raised ICP - Symptoms

A 
Headache
Vomiting 
Pupillary changes
Seizures
Worse in morning
131
Q

Raised ICP - Investigation

A

CT head

Ophthalmology review

132
Q

Raised ICP - Investigation

A

Mannitol
Surgical (shunt/decompression)
Dexamethasone (tremor)

133
Q

Myasthenia gravis - Pathophysiology

A

Autoimmune IgG autoantibodies attach to receptors at NMJ

134
Q

Myasthenia gravis - Symptoms

A 
Muscle weakness and fatigability
Ptosis (upper eyelid drooping)
Talking and chewing problems
Swallowing
Any muscle can be affected variably
135
Q

Myasthenia gravis - Investigations

A

Anti-MuSK antibodies
Electromyography
CT/MRI - thyoma (thymus hyperplasia)

136
Q

Myasthenia gravis - Treatment

A

Pyridostigmine (acetylcholinesterase inhibitor)
Prednisolone (immunosuppression)
Methotrexate/cyclosporine
Thymectomy

137
Q

Duchenne muscular dystrophy - Pathophysiology

A

X-linked recessive
Only males (young)
Muscle degeneration and eventually premature death

138
Q

Duchenne muscular dystrophy - Symptoms

A

Awkward manner of running
Frequent falls
Easily fatigued

139
Q

Meningitis - Pathophysiology

A

Inflammation of the meninges

140
Q

Meningitis - Symptoms

A 
Neck stiffness
Headache
Photophobia
Fever
Non-blanching rash (meningococcal septicaemia)
141
Q

Meningitis - Causes

A

Viral - Herpes simplex, mumps

Bacterial - Strep pneumoniae, neisseria meningitis, listeria monocytogene

142
Q

Meningitis - Investigation

A

CSF analysis - protein, colour, glucose
CT head
Bloods - FBC, culture

143
Q

Meningitis - Treatment

A

GP - IM benzylpenicillin
Hospital - IV cefotaxime
Contacts - Rifampicin, men C vaccine

144
Q

Encephalitis - Pathophysiology

A

Infection of brain parenchyma

Unlike meningitis, cerebral function is altered

145
Q

Encephalitis - Causes

A

Viral

Bacterial

146
Q

Encephalitis - Symptoms

A 
Fever
Headache
Behavioural change
Seizures
Coma
147
Q

Encephalitis - Investigations

A

Lumbar puncture - Raised lymphocytes
Bloods - culture (Viral PCR)
CT head

148
Q

Encephalitis - Treatment

A

Immediate high dose IV acyclovir

149
Q

Herpes zoster - Pathophysiology

A

Initial infection - Chicken pox
Reactivation - Shingles
Varicella lies dormant in dorsal root ganglion

150
Q

Herpes zoster - Risk factors (reactivation)

A

Elderly

Immunocompromised

151
Q

Herpes zoster - Symptoms

A

Dermatomal distribution of rash and pain

152
Q

Herpes zoster - Treatment

A

Oral acyclovir

153
Q

Gullian-barre syndrome - Pathophysiology

A

Inflammation
Demyelinating
Polyneuropathy in PNS

154
Q

Gullian-barre syndrome - Causes

A

Campylobacter jejuni

155
Q

Gullian-barre syndrome - Symptoms

A

Progressive distal to proximal muscle weakness
Motor and sensory
Loss of reflexes
Resp depression

156
Q

Gullian-barre syndrome - Investigations

A

Lumbar puncture - Increased protein in CSF
Nerve conduction studies
Vital capacity (resp depression suspicion)

157
Q

Gullian-barre syndrome - Treatment

A

IV Ig
Ventilation
No steroids!

158
Q

CJD (Creutzfeldt-jakob disease) - Pathophysiology

A

Neurodegenerative disease

Apoptosis of neurons leads to cysts and plaques forming in brain giving it a sponge-like appearance

159
Q

CJD - Symptoms

A 
Ataxia 
Poor memory
Behavioural changes
Muscle weakness
Dementia
160
Q

Stroke risk score

Phase 2A Med Concise (18 decks)

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