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Year 3 ICSM DC > Neurology > Flashcards

Neurology Flashcards

1
Q

Define Bell’s palsy

A

Idiopathic LMN CNVII palsy

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2
Q

What is the most common cause of Bell’s palsy?

A

Viral infection

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3
Q

Describe the onset of Bell’s palsy

A

Prodromal pre-auricular pain
Unilateral facial weakness (never >2 days)
Hyperacusis

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4
Q

What is the cause of hyperacusis in Bell’s palsy?

A

Stapedius paralysis

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5
Q

Does Bell’s palsy affect the ipsilateral or contralateral side to the lesion?

A

Ipsilateral

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6
Q

How can Bell’s palsy be differentiated from UMN palsies?

A

Does not spare upper facial muscles

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7
Q

What is Bell’s phenomenon?

A

When trying to close eyes, eyes roll up but eyelid doesn’t close

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8
Q

What signs would be seen on sensation testing in Bell’s palsy?

A

None - it should be normal

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9
Q

Recall the steps of management for Bell’s palsy

A
  1. Protect cornea with patch

2. Give high dose prednisolone within 72 hours

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10
Q

What is the caution with giving prednisolone in Bell’s palsy?

A

If they have Ramsay Hunt syndrome (complication of shingles) it shouldn’t be given

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11
Q

What is a cluster headache?

A
  • Unilateral
  • Excruciating pain
  • Numerous times per day, typically at night
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12
Q

What is the most common trigger for cluster headaches?

A

Alcohol

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13
Q

What other symptoms are associated with cluster headache?

A
  • Ipsilateral lacrimation
  • Rhinorrhoea
  • Eyelid/ facial swelling
  • Partial Horner’s
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14
Q

Recall the 4 main types of dementia

A

Alzheimer’s
Vascular
Lewy-body
Frontotemporal

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15
Q

Describe the pathophysiology of alzheimer’s

A

Degeneration of cortex leading to cortical atrophy and reduced ACh transmission

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16
Q

Describe the pathophysiology of vascular dementia

A

Brain damage due to several cerebrovascular disease events

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17
Q

Describe the pathophysiology of Lewy Body dementia

A

Deposition of Lewy Body proteins in BRAINSTEM and NEOCORTEX

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18
Q

Differentiate the onset of each of the 4 main types of dementia

A

Alzheimer’s: insidious
Vascular: step-wise decline
Lewy-body: fluctuating levels of consciousness
Frontotemporal: changes in behaviour

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19
Q

What is encephalitis?

A

Inflammation of brain parenchyma

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20
Q

What is the most common pathogen implicated in encephalitis?

A

HSV

Always viral

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21
Q

Describe the symptoms of encephalitis

A

Like a subacute version of meningitis in terms of symptoms

May produce seizures

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22
Q

What is Cushing’s response and what is it used to identify

A

Triad of HTN, bradycardia and irregular breathing - used to identify raised ICP (eg due to encephalitis)

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23
Q

Differentiate simple and complex seizures

A

Simple does not affect consciousness, complex does

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24
Q

Recall the 5 types of generalised seizure

A 
Tonic-clonic
Myoclonic
Absence
Atonic
Tonic
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25
Q

Seizures in which lobe causes motor convulsions?

A

Frontal

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26
Q

Seizures in which lobe causes aura and hallucinations?

A

Temporal

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27
Q

What is an absence seizure also known as?

A

Petit mal

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28
Q

Define absence seizure

A

Loss of consciousness with maintained posture

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29
Q

Which form of seizure is difficult to differentiate from dementia?

A

Non-convulsive status epilepticus

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30
Q

Which blood marker is increased following a seizure?

A

Prolactin

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31
Q

What investigation is used to classify epileptic seizures?

A

EEG

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32
Q

Recall the 3 steps of management for status epilepticus

A
  1. Glucose if hypoglycaemic
  2. IV/PR diazepam
  3. Treat cause
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33
Q

After how many seizures should epileptic medication be started?

A

2

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34
Q

Recall 2 medications that can be used to treat focal seizures

A

Carbamazepine

Lamotrigene

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35
Q

Which medication is used to treat most generalised seizures?

A

Valporate

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36
Q

Define guillain-barre syndrome

A

Acute demyelinating polyneuropathy

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37
Q

Describe the symptoms of guillain barre syndrome

A

Ascending symmetrical limb weakness, paraesthesia and arreflexia

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38
Q

What would be seen on lumbar puncture in guillain-barre syndrome?

A

High protein

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39
Q

Recall the triad of symptoms in Horner’s syndrome

A

Miosis
Anhydrosis
Ptosis

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40
Q

What is Horner’s syndrome caused by?

A

Disruption of SNS supplying face

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41
Q

What is the most likely neoplastic cause of Horner’s syndrome?

A

Apical lung tumour

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42
Q

What is the inheritance pattern of Huntingdon’s disease?

A

Autosomal dominant

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43
Q

What are the 2 main symptoms of Huntingdon’s disease?

A

Chorea and dementia

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44
Q

What eye sign is produced by Huntingdon’s disease?

A

Slow, voluntary saccades

45
Q

What region would be atrophied on a CT scan in Huntingdon’s disease?

A

Striatum

46
Q

What are the 2 types of hydrocephalus?

A

Obstructive (impaired outflow) and non-obstructive (impaired resorption)

47
Q

What sort of hydrocephalus does meningitis cause?

A

Non-obstructive

48
Q

What are the symptoms of obstructive hydrocephalus?

A

Acute drop in conscious level

Diplopia

49
Q

Which cranial nerve is most likely to be affected by hydrocephalus?

A

CNVI

50
Q

Which meninges become inflamed in meningitis?

A

Pia and arachnoid

51
Q

What are the 2 most common bacterial pathogens implicated in meningitis?

A

Neisseria meningitidis

Streptococcus pneumoniae

52
Q

What is kernig’s sign and what is it used to diagnose?

A

Pain on lifting the leg - meningism

53
Q

What should always be done before a lumbar puncture in suspected meningitis?

A

CT to exclude mass lesion

54
Q

What is the first line choice of antibiotic treatment in suspected meningitis?

A

Cephalosporin

55
Q

What are the common names of migraine with and without aura?

A

With aura: classical

Without aura: common

56
Q

Recall the aetiology of migraine

A

Intracranial vasoconstriction –> localised ischaemia –> meningeal and extracranial vasodilation

57
Q

Recall the medical management of migraine both in the acute setting and for prophylaxis

A

Acute: NSAIDs, anti-emetics, triptans
Prophylaxis: beta-blockers, topiramate, amitryptiline

58
Q

Recall the 4 types of motor neuron disease

A
  1. Amylotrophic lateral sclerosis (UMN and LMN)
  2. Progressive muscular atrophy variant (only LMN)
  3. Progressive bulbar palsy variant
  4. Primary lateral sclerosis (only UMN)
59
Q

Recall 3 LMN and 3 UMN signs of motor neuron disease

A
  1. Hyporreflexia, fasciculations, muscle wasting

2. Spastic weakness, extensor plantars, hyperreflexia

60
Q

Which immunoglobins may be detectable by serology in motor neuron disease?

A

Anti-GM1 ganglioside

61
Q

What would nerve conduction studies show in motor neuron disease?

A

They would be normal

62
Q

What is multiple sclerosis?

A

Inflammatory demyelinating disease of CNS

63
Q

Recall the 4 types of MS - which of these is most common?

A
  1. Relapsing-remitting (most common)
  2. Clinically isolated (not strictly MS as is single attack)
  3. Primary progressive (steadily increasing disability)
  4. Morburg variant (severe fulminant, quickly causes death)
64
Q

What is the most common symptom of MS?

A

Optic neuritis

Unilateral decrease in visual acuity and painful eye movement

65
Q

What is uhthoff’s sign and what is it a sign of?

A

Worsening of symptoms as body gets overheated

Sign of MS

66
Q

What is required to diagnose MS?

A

Location of 2 or more lesions with corresponding symptoms

67
Q

What is the antibody implicated in myasthenia gravis?

A

Anti-nACh receptor

68
Q

Recall 2 tests you can do in an examination to detect myasthenia gravis

A
  1. Ask them to look up: eyelids will fatigue

2. Ask them to keep talking (eg count from 1 to 100) and they will fatigue in their speech

69
Q

What is the characteristic facial appearance of someone with myasthenia gravis?

A

Myasthenia snarl

70
Q

Which cranial nerves are considered “bulbar”?

A

9-12

71
Q

Recall one bulbar and one ocular sign of myasthaenia

A

Bulbar: Dysarthria reading aloud
Ocular: ptosis

72
Q

What improves a ptosis in myasthenia gravis?

A

Putting ice on eyes

73
Q

Which endocrine condition is associated with myasthenia gravis?

A

Hyperthyriodism

74
Q

What test is specifically used to diagnose myasthenia gravis and how does it work?

A

Tensilon test (uses drug tensilon which is an anti-cholinesterase)
Give tensilon
ACh levels increase
Positive result = rapid and transient improvement in symptoms

75
Q

What is neurofibromatosis?

A

Condition that leads to development of numerous neurocutaneous tumours

76
Q

Differentiate the type of neurocutaneous tumour produced by type 1 and type 2 neurofibromatosis

A

Type 1: peripheral and spinal neurofibromas, optic nerve gliomas and phaeochromocytomas
Type 2: schwannomas + meningiomas

77
Q

Which type of neurofibromatosis causes cafe au lait spots?

A

Type 1

78
Q

Differentiate the symptoms of type 1 and 2 neurofibromatosis

A

Both –> headache
Type 1: skin lesions and learning difficulties
Type 2: hearing changes and facial pain

79
Q

Recall the aetiology of parkinson’s disease

A

Neurodegeneration of dopaminergic neurons of substantia nigra

80
Q

Recall 6 signs of parkinson’s disease

A
  1. Asymmetrical pill-rolling tremor
  2. Cogwheel rigidity
  3. Shuffling gait
  4. Postural instability
  5. Hypomimic face
  6. Depression
81
Q

Describe the distribution of LMN and UMN signs in spinal cord compression

A

LMN at level of lesion

UMN below lesion

82
Q

What % of strokes are infarcts?

A

80%

83
Q

What is a lacunar infarct?

A

Thrombus blocking small artery

84
Q

How can hypotension cause a stroke?

A

If BP is below what is required to maintain flow, perfusion of watershed zones will be insuffucient –> infarct

85
Q

Where must a stroke affect in order to cause a loss of consciousness?

A

Thalamus

86
Q

A stroke affecting which artery causes a “classical” stroke?

A

Middle cerebral

87
Q

What is the main symptom of strokes affecting the posterior cerebral artery?

A

Hemianopia

88
Q

A stroke affecting which artery would result in Horner’s syndrome?

A

Posterior cerebellar artery

89
Q

Recall the management of stroke

A

<4.5 hours from onset: thrombolysis (alteplase)

>4.5 hours: aspirin and clopidogrel

90
Q

When can warfarin be started following a stroke?

A

When INR >2

91
Q

Why does connective tissue disease predispose to vascular events in the brain?

A

Associated with saccular aneurysms which can rupture to form a subarachnoid haemorrhage

92
Q

What is another name for a saccular aneurysm?

A

Berry aneurysm

93
Q

Where do berry aneurysms usually appear?

A

Circle of Willis

94
Q

Describe the headache produced by subarachnoid haemorrhage

A

Sudden onset worst headache ever

95
Q

What is the most common cause of subarachnoid haemorrhage?

A

Berry aneurysm rupture

96
Q

Recall 2 consequences of subarachnoid haemorrhage that causes signs

A 
Meningism (photophobia, neck stiffness)
Raised ICP (papilloedema, CNIII/IV palsy)
97
Q

What would be seen on lumbar puncture in subarachnoid haemorrhage?

A

Xanthochromia

98
Q

Where do subarachnoid haemorrhages form?

A

Between arachnoid and dura mater

99
Q

Recall the classification of subarachnoid haemorrhage

A

Acute: <3 days
Subacute: 3 days - 3 weeks
Chronic: >3 weeks

100
Q

Recall 2 acute signs of subdural haemorrhage

A

Decreased GCS

Ipsilateral fixed dilated pupil

101
Q

What is the surgical management of subarachnoid haemorrhage?

A

Burr hole

102
Q

What is the usual aetiology of TIA

A

Embolic

103
Q

Differentiate the clinical features of TIA depending on which of the 2 most commonly affected arteries is affected

A

Carotid: motor, unilateral, Broca’s dysphasia
Vertebrobasilar: homonymous hemianopia, hemiparesis, hemisensory defects

104
Q

What is the first step in the management of suspected TIA?

A

Immediate 300mg aspirin

105
Q

What score is used to assess stroke risk following a TIA?

A

ABCD2

106
Q

Describe the pain caused by trigeminal neuralgia

A

Sudden, sharp, uniltaeral

Has a trigger

107
Q

Which deficiencies cause Wernicke’s encephalopathy?

A

Vit B12

Thiamine

108
Q

What is the triad of symptoms in Wernicke’s encephalopathy?

A

Ataxia
Ophthalmoplegia
Confusion

Year 3 ICSM DC (17 decks)

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