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Forgotten EOY4 > Neurology > Flashcards

Neurology Flashcards

to remember the facts forgotten

1
Q

What is the most common CNS disease in the young?

A

MS

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2
Q

MS define

A

Type IV hypersensitivity reaction

Inflammatory demyelination of neurones in the brain and CNS - eventually neurodegeneration and brain atrophy

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3
Q

typical ms ptt

A

young white female in 20s

lives away from equator

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4
Q

Types of MS

A

Relapsing remitting
secondary progressive (starts of relapsing remitting then moves on to one continuous attack on myelin)
primary progressive - continuous
progressive-relapsing - continuous with superimposed even worse bouts

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5
Q

Pathophysiology of MS

A

peripheral activation of immune cells
activated immune cells manage to cross BBB
cytokine release and further inflammation disrupts BBB
more damage can happen
regulatory T cells relieve inflammation - remits
oligondendrocytes recover, until next relapse.

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6
Q

genetics and environmental factors implicated in MS

A

MHC genes
specifically HLA-DRB1 which is involved in T-helper cell differentiation

There is also a role of environment:

e.g. infections (herpes 6, EBV), Vit D and smoking

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7
Q

differentials for ms

A 
Lyme disease
lupus
migraine
encephalitis
stroke
tumour
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8
Q

Symptoms of MS not incl Charcot’s Triad

A 
Eyes - Optic Neuritis, diplopia,  
Ears and balance - Vertigo, Ataxia
Bladder/Bowel dysfunction
Altered sensation and Pain
Spasticity
Sexual dysfunction
Cognitive impairment
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9
Q

Charcot’s Neurologic Triad

A

plaques in

Brain stem - dysarthria
eye nerves - nystagmus, optic neuritis, lov
motor pathways - intention tremor

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10
Q

Diagnosing MS

A

Many criteria exist - Posser, Barkoff, Mcdonald etc.

>2 episodes of symptoms
dif points in time
dif areas of NS
absence of other treatable causes
\+/- results of neuro tests (clinical diagnosis)
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11
Q

Rx of MS during acute attack

A 
For acute relapse
DMT
methylpred
IV immunoglobs
plasma exchange
physical therapy
psychosocial support
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12
Q

Rx of ms to prevent relapse

A

drugs
1st line - beta interferon (SE infections)
DECREASE RELAPSE BY 30%
also, doxorubicin analogue: Glatiramer acetate

2nd line - Natalizumab - prevents BBB crossover
Alemtuzamab - inhibits T-cells

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13
Q

symptom management of someone with ms

A 
pain control
bladder and bowel
antispasmodics
fatigue
splint contractures
counselling
baclofen for the spasticity
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14
Q

ix for ms

A

mri - plaques

lp- antibodies in csf

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15
Q

What is the presentation of optic neuritis

A

Subacute loss of vision
painful eye movements
red desaturation
dyschromatopsia - reduced colour vision

give methylprednisolone, then pred can delay onset of ms

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16
Q

status epil

A 
Prolonged seizure -   more than 30 mins.
Recurrent attacks w/o regaining    
         consciousness.
Medical emergency.
Poor prognosis w/o proper treatment
Requires resuscitation, i.v. drugs, sometimes 
           I.C.U
17
Q

what se does carbamazepine share with small cell lung cancer?

A

SiADH

18
Q

na valp se

A

vomiting, alopecia, liver toxicity, pancreatitis/pancytopenia, retain fat (weight gain), oedema (edema), appetite increase, tremor, and enzyme inhibitor (cytochrome P450)

19
Q

which aed can cause rash

A

lamotrigine

+/- SJS!

20
Q

which aed - gingival hyperplasia

A 
phenytoin
coarsening facial features
lips get bigger
ging hyperplasia (n.b nifedipine, amlodipine can also cause this)
hirsutism
21
Q

Mastoid surgery after cholesteatoma risk

A 
Facial nerve palsy
altered taste sensation
csf leak
tinnitus
vertigo
hearing loss
22
Q

why is it important to further do ix if adult with otitis media e effusion?

A

because ome = eustachian tube dysfunction
common in children BUT
adults - post nasal space tumours

remember eustachian tube connects to nasopharynx

23
Q 
hx 
prog hearing loss
tinnitus
improved hearing in noisy surroundings
fhx

ex
schwartze’s sign - pink tm

ix
typanogram normal type a
audiogram 
conductive hearing loss
carhart notch at 2khz
A

otosclerosis

mature bone becomes woven bone
stapes fixed on to oval window \

conservative rx : hearing aid

surgery: stapedectomy

24
Q

once sound reaches stapes, how do we hear

A 
stapes articulates with oval window
moves perilymph and these vibrations transmitted through endolymph to the tectorial membrane
moves hair cells
depolarisation 
transmiited via cochlear nerve
25
Q

what tuning fork freq for rene/webers

A

256Hz

512Hz

26
Q

threshold on pure tone audiogram for normal

A

anything above 20dB

27
Q

why mri hearing loss unilater sensorineural

A

vestibular schwanoma

28
Q

dif b/w presbyopia and presbycusis

A

byopia- lens of the eye not able to accomodate as well

cusis - bilateral sensorineural hearing loss old age

29
Q

tympanogram

types a, b, c what mean

A

a=normal - 0dB

b=flat - effusion or perforation

c=eustachian tube dysfunction - peak has -ive pressure

30
Q

trigeminal neuralgia management

A

Management
carbamazepine is first-line
failure to respond to treatment or atypical features (e.g. < 50 years old) should prompt referral to neurology

31
Q

ct early ischaemic stroke findings

A

reduced grey/white matter distinction bc oedema

increased density of occluded vessel due to clotted blood

32
Q

psoriasis rx

A

general lisetyle, smoking-sunlight-soap subs-lose wught

topicals
steroids, vit d analogues, coal tar, dithranol, retinoids

phototherapy

systemic therapy
mtx
acitretin
ciclosporin

biologic - check tb status hiv
ethanercept - anti tnfa

33
Q

mtx se

A

liver lung fibrosis
mouth ulcers
gi upset

34
Q

Erythroderma

A

90% skin covred skin failure

admit
supportive care
emollients and wet wraps
treat complications
prophylaxis for infection
topical steroids
systemic treatment - mtx, ascitretin, cyclosporin
35
Q

How to decide whether or not to start anticoagulation in a PT?

A

Weight up risks and benefits using CHA2DS2VAsc and HASBL(A)D scores

C - CHF
H - htn
A >75 gets two points 
D - diabetes
S- stroke gets two points
Vascular problems e.g. mi
A - age over 65
S - sex is female

H - Htn
A - age >65
S - stroke

B - bleeding tendency
L - Labile INR
A - abnormal liver or renal
D - drugs such as aspirin/nsaids/alcohol

Forgotten EOY4 (5 decks)

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