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Phase 4 > Neurology > Flashcards

Neurology Flashcards

1
Q

Gullain Barre Syndrome:

What are some common causes of it?

How does it present?

What investigations should you do?

What is the treatment?

A

Causes:

Campylobacter Jejunum

Mycoplasma Pneumonia

EBV

Hep E - Genotype 3

**molecular mimicary

Presentation:

Symmetrical Weakness, proximal muslces affected.
- 20% devleop resipratory distress

Sensory changes

  • Pain
  • Distal Parasthesia

Weakness:

  • Loss of reflexes
  • Diploia
  • Dysphasia

Autonomic dysfuncton

  • postural hypotension
  • Constipation

Investigations:

Nerve conduction studies

Peak Flow - to assess respiratory function - every 4 hrly.

Lumbar puncture:

  • raised Protein
  • Normal White cells

*if detioration admitt to ITU

Treatment:

IV immunoglobulins

Plasma Exchange

Respiratory Support

Pain management

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2
Q

Bell’s Palsy:

A

Lower Motor Neuron lesion of the fascial nerve.

Unkown eitology but thought to be associated with:

  • latent HSV

*more common in pregnancy x3
*more common in DM x5

Clinical Features:

  • abrupt onset - over night
  • complete unilateral weakness
  • ipsilateral pain around ear
  • reduced taste (ageusia)
  • hypersensitivity of sounds (stapedius palsy)

Differentials:

  • Ramsay Hunt syndrome (VZV reactivation)
  • Mengitits
  • Braimstem lesions
  • Cerebellopontine angle tumours - accoustic
  • lymm disease (Borrelia)

Investigations:

To rule out other causes:

  • VZV antibodies
  • Borrelia antibodies
  • ESR
  • Glucose

*CT/MRI (tumours)

Mangagement:

within 72 hours - predisilone 60mg.

+72 hours - steroids but the evidence is not clear

**protection of th eye:

  • dark glasses
  • artificial tears
  • use of tape on the eyes
  • surgical eye closure if severe

Prognosis:

incomplete paralysis make full recover
- in a few weeks

complete paralysis - 80%

Myesthenia Crisis:

*Plasmaphresis

*Immunoglobulins

*ventilatory support

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3
Q

Myasthenia Gravis:

What can make this worse?

What is it associated with?

What investigations should be done?

How is it treated?

A

Autoimmune disease
-antibodies against nictonic receptor

Augmentors:

*climte change

* pregnancy

*hypokalamia

*gentamicin

*opiods

*Beta Blockers

Differentials:

Lambert- Eaton Syndrome

Polymyositis

Takayasu’s arteritis

botulism

Associations:

  • SLE
  • RA

Investigations:

  • Anti- AChR antibodies
  • Muscle Specific Tyrosine Kinase / MUSK antibodies
  • Low density lipolipoprotein receptor related protein
  • EMG studies
  • CT for thyoma (as associated)
  • Tensilon test (dangerous)

Treatment:

  • Anti-cholinesterase (pyridostigamine)
  • Immunosupression - steroids
  • Thyectomy
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4
Q

Lambort Eaton Syndrome?

Compare and contrast with MG:

A

Neuromuscular disease that prevents the release of neurotransmitters on the pre-synptic membrane

  • due to antibodies against the Ca2+ channel.

*associated with cancers
- small cell lung cancer

Clinical Features:

gait changes - this is well before changes to the muscles of the eye

Autonomic dysfunction

  • dry eyes
  • constipation

**weakness improves with exercise
this is contrasted with MG, which gets worse.

Treatment:

* cure underlying condition

* pyridostigamine

*Diaminopyridine
- this blocks K+ allowing Ca2+ to stay open for longer

*Immunoglobulins

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5
Q

Define Delierium:

A

A distrubanc of consciousness with reduced ability to focus, substain or shift attention.

It develops acutely (over hours to days) and tends to fluctate in its severity over that time

Evidence of a physiological cause induced by illness, trauma, medication or pyschological distress

Types:

* hypoactive

*hyperative

*mixed

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6
Q

What are some differentials to delierum?

And what are some common risk factors?

A

Dementia

Anxiety

Non- convulsive Status epilepticus

Primary mental illness - schizophrenia

Risk Factors:

>65 years old

Dementia

Hip fracture

Acute illness

Pyschological agitation (pain)

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7
Q

What is the management for Delerious patients?

A

Assessment:

*History
- any clues to underlying causes

*Examination

*Cognitive Assessment

  • AMT
  • MMSE

*Investigations

Investigations:

FBC

U&Es

Blood Glucose

ABG

Bone profile
- Ca2+

CRP

Spetic Screen

  • urine dipstick
  • CXR
  • Blood cultures
  • CT/ EEG
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8
Q

What is the management for delierum?

A

_**Resolve the causative factor_

_**Review medications_

_**Avoid constipation_

Reorientate the patient as best as possible

  • clocks
  • Calenders

Calm the patient with reassurance

Encourage physical movement

Maintain fluids

Sedation:

used only when patient is a risk to themselves and others:

1st line: Haloperidol

*avoid in parkinson’s

2nd line: Lorazepam

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9
Q

What is the Imaging investgiations can be done into Parkinson’s?

A

DAT SPECT scan

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10
Q

What is the treatment for cluster headaches?

A

100% oxgen. The to 80% as pain decreases
+
Triptans

Prophylaxis:

  • verapmil
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11
Q

During a GCS assessment, the supraorbital is squeezed and the patient moves their arm to below their clavical, what does this count as?

A

M4 - normal flexition

it does not count as localisation as it is not above clavical

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12
Q

What are the treatment options for generalised seizures?

A

1st line:

  • Sodium valporate

2nd line:

  • Lamotrigrine
    or
  • Carbamazepine
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13
Q

What are the treatment options for focal seizures?

A

1st line:

  • Carbamezepine
  • Lamotrigrine
  • *2nd Line:**
  • Sodium valporate
  • Levetiracetum
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14
Q

What type of seizure is most associatted with Automatisms?

A

Complex focal seizure of temporal lobe

Automatisms include:

  • lip smacking
  • Dystonic limb movement
  • undressing
  • walking in circles
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15
Q

What are some typical features of a generalised seizure?

A

Photosensitivity - some people sensitivity to certain light frequency.

Usually with genetic in nature

Tend not to have the build up

Usually in early hours of the days

No Aura

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16
Q

If an EMG shows diminished respone to continual stimulation what is a likely diagnosis?

A

Mysthenia Gravis

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17
Q

How are migraines treated acutely?

A

1st line:

  • Triptans
  • NSAIDs - high dose aspirin

2nd line:

  • Metaclopramide
  • Non- oral NSAIDs
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18
Q

What is the propholyatic treatment for migraines?

A

Avoid triggers:
- caffiene
- Cholocate
- Hangovers
etc

1st:
- propranolol
or
- Topiramate

2nd:
- accupuncture - 10 courses

3rd:

  • botulism injections
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19
Q

What is the diagnostic criteria for migraines?

A

Without aura:

>2 of the following:

  • unilateral
  • Pulsating
  • Mod pain
  • Aggrevated by activity

>5 attacks

Lasting 4-72 hours

N&V or Photophobia

With Aura:

>2 attacks

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20
Q

What are the antibodies investigated for in mysthenia gravis?

A

Acetlycholine Receptor

Muscle Specific Kinase - MuSK

Low Density Lipolipoproteins receptor related 4 - LRP4

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21
Q

How is Msythenia Gravis offocially diagnosed?

A

Autoantibodies

Edrophonium test

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22
Q

What type of ventilation is used in mysthenia gravis crisis?

A

BiPAP

or

Intubation

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23
Q

What are the most common causes of Guillian Barre syndrome?

A

Campylobacter

EBV

CMV

Hep E type 3

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24
Q

What is the criteria used for diagnosis of Guillian Barre syndrome?

and what additional tests can be done to support the diagnosis?

A

Brighton Criteria

  • EMG studies - reduced signals
  • LP rasied proteins
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25
Q

What is the management for Guillian Barre syndrome?

A

IV immunoglobulins

Plasma Exchange

Supportive care

VTE prophylaxis

+/-

Intubuation / ITU admission

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26
Q

What is the prognosis of Guillian Barre syndrome?

A

80% recover

15% have permenant neurological deficit

5% die

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27
Q

What is the investigation of choice into Cervical Spondylosis? and what is the treatment?

A

*MRI of Spine

  • *Radiculopathy:**
  • NSAIDs
  • Physiotherpay
  • Spinal Decompression

Myelopathy:

  • Laminectomy
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28
Q

What is the genetic risk factor for developing MS?

A

HLA DR2

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29
Q

What are the types of MS?

A

Relasping Remitting

Secondary Progressive

Primary Progressive

Progressive Relasping

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30
Q

What are some syndromes that may progress into MS?

A

Optic Neuritis

Transvermylitis

Clinically Isolated Syndromes

Acute Disseminated Encephalomyelitis

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31
Q

What is the name of the electric shocks felt across the body related to MS?

A

Lhermitte’s Sign

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32
Q

What other things can cause optic neuritis?

A

DM

SLE

Sarcoidosis

Syphilus

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33
Q

What are some core investigatiosn into MS?

A

MRI T2 - galadonium

LP - Oligolonal bands

Visual Evoked Potentials
- slowed

Vitamin D levels

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34
Q

What are some differentials to MS?

A

B12 deficiency

Motor Neuron

Myelopathy due to Cervical Neuropathy

Sarcoidosis

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35
Q

How are relaspes treated in MS?

A

Methylprednisolone

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36
Q

What is the mangement for MS?

A

MDT

  • neurologist
  • MS nurse
  • physiotherapist
  • Occupational therapist

Drugs:

drugs consist of disease modifying agents and new biologics.

1st line:

  • Interferon Beta
  • Dimethyl fumerate

2nd Line:

  • Natalizumab

3rd Line:
- Alemtuzumab

  • *Flares:**
  • Methylprednisolone
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37
Q

What are the causes of coma?

A

Metabolic:

  • drugs, poisoning
  • Hypoglycaemia
  • Hypoxia
  • septicaemia
  • hepatic encephalopathy (Conn Score)

Neurological:

  • Trauma
  • infection
  • Vascular
  • Epilepsy
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38
Q

What type of CT should be done into a suspected stroke?

A

Non - contrast CT

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39
Q

What is the most commonly survived brainstem stroke and what are the symptoms and which artery is typically involved?

A

Lateral Medullary Syndrome

Facial loss of pain and contralateral loss of pain on body

+

Nystagmus + Ataxia

Right Posterior Inferior Cerebrallar Artery

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40
Q

How long following a diagnosis of epilepsy can a person return to driving?

A

1 year for normal drivers

*6 months for non - epileptic seizure

10 years for public drivers

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41
Q

If a person experiences a seizure with Jacksonian movements, where is the likely source of the seizure?

A

Frontal lobe

  • focal seizure
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42
Q

Which drugs can exacerbate Myasthenia gravis?

A

Beta Blockers

Penicilliamine (Wilson’s disease drug)

Antibiotics

  • Gentamcin
  • Macrolides
  • quinolones
  • Tetracyclines

Phentyonin

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43
Q

What is the immediate management and long term management of cluster headaches?

A

Subcutaneous Triptans + 100% high flow O2

Prevention:

  • verapamil
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44
Q

Why must levodopa not be stopped acutely?

A

Can cause neuroleptic malignant syndrome

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45
Q

Which hormone may be elevated following a true seizure?

A

Prolactin

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46
Q

Which clinical test can be done to assess for cervical myelopathy?

A

Hoffman’s Test

Lhermitte’s sign

  • flexion of neck causes tingling down spine
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47
Q

What is the most likely diagnosis following Parkinson’s and how does it present?

A

Progressive Supranuclear Palsy

  • affects occular nerves and thus these should always be investigated following parkinsons.
  • Impaired upward gaze
  • Falls

*always suspect if a person diagnosed with Parkison’s falls over shortly afterwards

48
Q

How is Status epilepticus managed?

A

ABCDE
- Take bloods for electrolyte, glucose causes

1st line:

  • Lorazepam (or diazepam or midazolam buccal)
    x repeat 3-5 mins

*if evidence of hyoglycaemia
- 100ml Glucose 20%

*if evidence of Alcohol Give thiamine

  • *2nd Line - within 30mins:**
  • Phenytoin

3rd Line - >30 mins
GA

Monitor EEG

49
Q

What are the clinical signs of parkinson’s disease?

A

Pill Rolling Tremor

Bradykinesia

Cog-wheeling

Low Blink Rate

Drooling

Postural Instability

Masked Face

Shuffling

Gait Stooped Posture

Conjugate Gaze Disorders (either jerky pursuit or falling short of intended target)

Hypophonia (↓volume of speech)

Hypokinetic Dysarthria (mumbling)

50
Q

What may a patients family member tell you if they suspect parkinsons?

A

Change in writing
- micrographie

Change in walking

Difficultly turning

unsteady

Nightmares

51
Q

What are some differentials to Parkinsons? and what are some risk factors?

A

Lewy Body dementia

Brain tumours

Vascular Parkinson’s

Parkinson’s plus syndromes

Head Injury

52
Q

What drugs are associatted with developing Parkinson’s disease?

A

Metaclopramide

Anti-psychotics

53
Q
A
54
Q

What are some of the complications following a stroke and their treatments?

A

Chest infections

-Keep NIL by mouth

-Semi erect

-NG tube

Seizures

- Maintain cerebral oxygenation

- Avoid metabolic disturbances

Venous thrombosis

- Hydration

- Stocking

- Enoxaparin

Pressure sores

- Frequent turning

- Avoid urination on skin

Constipation

- Diet

- Movement

Depression and anxiety

- CBT

- Antidepressants

55
Q

What other important investigations should be done the following day after a stroke?

A

Second head CT to assess for a rebleed.

56
Q

List some modifiable risk factors for a stroke

A

Hypertension

Smoking

Diabetes

AF

Vavular disease

Lipids

Alcohol use

Cotting abnormalities

57
Q

What are the clinical features of cervivical spondlylosis?

A

Cervical radiculopathy

Cervical Myelopathy

Neck pain

58
Q

What is the treatment for cervical myleopathy?

A

Anterior disectomy

Laminectomy

59
Q

What are the secondary drugs given for stroke following the 14 days of aspirin:

A

Clopidogrel

or

Aspirin + Dipyridamole

These are for life.

60
Q

In the setting of a stroke due to AF, when should anti-coagulation take place?

A

14 days, following the aspirin

61
Q

What is the defintive best management for a patient who has had a stroke?

A

Thrombolysis + thromboectomy

*thromboectomy is usually done within 6 hours

62
Q

What is the absolute contraindications to thrombolysis?

A

Previous Intracranial haemorrhage

Seizure at onset of stroke

Intracranial neoplasm

SAH

Stroke in last 3 months

LP in last 7 days

G.I haemorrhage in last 3 weeks

Active bleeding

Pregnancy

Variceal ulcers

Uncontrolled hypertension

BP >200/120mmHg

63
Q

What are the symptoms of myasthenia Gravis?

A

Ptosis

Diplopia

Dysphagia

Slurred speach

Jaw fatigue

Weakness of proximal muscles
- neck muscles

64
Q

How can you examin someone with MG?
- what things can you do to elicit symptoms?

A

Repeated blinking

Upward gazing
- diplopia

Repeated abduction of one arm
- will cause unilateral weakness

65
Q

What are the indications for an endartectomy following a stroke or TIA?

A

Ischemic stroke within the distruption of the internal carotid

>70% stenosis

66
Q

What scoring system can be used to stratify which patients are at highr isk of having a stroke following a TIA, and should be referred?

A

ABCD2

>4 is severe and patients should be admitted and assessed by specialist within 24 hours

67
Q

What does an ischemic stroke appear like on CT?

A

Low desnity area - black on the scan with surrounding white area owing to oedema

68
Q

What question do you want to ask when someone has collasped/ fainted?

A

What were the doing before the epidosde?
- standing, watching TV

Palpatations?

Loss of consciouness?

How long did the episode last?

Any shaking?

Injuries?
- tongue biting

Loss of continecne?

Confusion afterwards?
- how did they person come about

69
Q

Following a seizure, how long are you band from driving, and how does this change if there is EEG of epilepsy?

A

Seizure: 6 months

Epilepsy: 1 year

70
Q

List several causes to a seizure:

A

Genetic

Alcohol withdrawal

Stroke

Withdrawal of Benzo’s

Tumour

Fever

Head injury

Hypoglycaemia and other metabolic abnormalites

Infection

71
Q

What is the most useful investgiation to confirm epilepsy and what can be done to increase chance of detecting epileptic activity?

A

EEG

  • EEG during sleep
  • Hyperventilating patient
  • Photic light stimulation
72
Q

What test should be order into someone with seizures for the first time?

A

Bloods:

  • FBC
  • Coagulation
  • U&Es
  • LFTs
  • Glucose

+/- Toxicology

+/- Anticonvulsant levels

73
Q

What advice/ intervetions should be offerred to woman who are pregnant and have epilepsy?

A

To maintain and control seizure activity, as the risk of falling is dangerous to baby.

Switch from sodium valporate to a less tetraogenic agent.

Offer:
- folic acid supplements

  • Alpha fetal protein screening
  • 20 week scan for abnormalities
74
Q

If amourosis fagux takes place, which artery has been occluded?

A

Retinal artery

75
Q

What are some cardiac causes of a stroke?

A

AF

Patent Foramen ovale

Infective endocarditis

Prosthetic valves - metalic

Acute M.I with left venticular wall motion

76
Q

What kind of drug is given alongside LDOPA?

A

DOPA decarboxylase inhibitor

*remember the DOPA part

77
Q

If patient has a ABCD2 score of >4, what should happen?

A

Admitted

Seen at TIA clinic with 24 hours and assessment and treatment within 2 weeks.

Investigatiosn include:

  • Doppler of carotids
  • ECG
  • CT angiography of brain
78
Q

What are the cardiovascular causes to a stroke?

A

AF

Patent foramen ovale

Prosthetic valves - metalic

Infective Endocartitis

MI. with large ventricular wall dilation causing thrombous

79
Q

What are the risk factors for Stroke?

A

Hypertension

smoking

DM

Alcohol

Previous TIA

AF

Family history

Sleep apnea

80
Q

What are the differentials to a stroke?

A

Migraine

Seizure

Alcohol withdrawal - Wernicke’s

TIA

Tumour

Hypoglycaemia

81
Q

In Status epilepticus what immediate investigations should be ordered?

A

Blood glucose
ABG
U&Es
Ca2+ levels

Consider:

  • Anti-convulsant levels
  • Toxicology
  • LP
  • Blood cultures
82
Q

Where is the lesion in RAPD?

A

Anterior to the optic chiasm

83
Q

What immediate things do you want to give to a patient in status?

A

Anticonvulsants
- Lorazepam

IV glucose

84
Q

What are UMN signs?

A

Spasticity
Brisk Reflexes
Clonus
Hoffman’s sign
Up going plantars
No muscle wasting

85
Q

What is the surgical intervention into Slipepd disc? and what are some of the complications?

A

Disectomy

  • CSF leak
  • Bleeding
  • Infection
86
Q

What investigations are done into CSF when mengitis is suspected?

A

WCC
White cell differentiation
Glucose to plasma
Protein
Cultures
Visual inspection

87
Q

What assessment is used for muscle strength and what are the scores?

A

MRC score
0 - no muscle contraction

1 - muscle contraction but no limb movement

2 - Active movement but not against gravity

3 - active movement against gravity

4 - active movement against some resistance

5 - normal power

88
Q

If a patient has a GCS of <8 what is one of the immediate things that should be done prior to any imaging?

A

Anaethetist and Intubation

  • airway is unsecure at GCS 8
89
Q

How will an old bleed on the brain present? and what is likely bleed?

A

HYPOdense

  • Black

*usually a subdural bleed

90
Q

If a person has ataxic gait without limb ataxia where is the lesion likely to be?

A

Cerebella Vermis

91
Q

What is the wide based gait with loss of heel to toe action called?

A

Ataxic gait

92
Q

What is the typical type of aura seen in migraines?

A

Jagged cresecent scotoma

93
Q

What are some common myotomes?

A

Lower Limb:

S1-S2 button my shoe - ankle flexion
L3-L4 kick the door - knee extension

Upper Limb:

C5- Arm flexion

C6: wrist extension
C7: Finger extension

C8: Finger flexion

T1: finger abduction

94
Q

What is a defining feature of neurofibromatosis type 1?

A

Freckles in the axillla

95
Q

What are the symptoms of cervical spondylosis?

A
  • *Radicuopathy:**
  • Neck pain
  • Headaches
  • Paraesthesia
  • Dermatomal Pain

**loss of dexterity and fine movement control in the hands
- Reduced reflexes**

Myelopathy:

  • loss of dexterity
  • Painful dermatomal
  • Spascicity in lower limbs
  • Gait changes
  • Autonomic dysfunction
    **positive hoffman’s sign
96
Q

What occular dysfunction won’t be seen with a 3rd nerve palsy?

A

Miosis

  • this is excessive constriction of pupil. This will not be present
97
Q

List some causes of peripheral neuropathy?

A
  • *Predominant motor loss:**
  • Guillian Barre syndrome
  • Charcot Marie tooth disease
  • *Predominant sensory Loss:**
  • Diabetes
  • Uraemia
  • B12
  • Alcohol
98
Q

What is the pneumonic that can help with the visual field defect seen with temporal or parietal lobe lesions?

A

PITS

Parietal - Inferior quad loss

Temporal - Superior quad loss

**both will be homologous heminopia

99
Q

What is first line for trigeminal neuralgia?

A

Carbamezapine

100
Q

Define syncope:

A

Global cerebral hypoperfusion resulting in loss of conciouness

101
Q

What are some common causes of carpel tunnel syndrome?

A

Hypothyroidism

Pregnancy

Rheumatoid disease

Polymyalgia rheumatica

Amyloidosis

102
Q

What are some differentials to Guillian Barre Syndrome?

A

MG

Botulism

Spinal cord compression

103
Q

What investigations should be done into peripheral neuropathy?

A

Bloods:

  • FBC
  • ESR
  • U&Es
  • TFTs
  • Glucose
  • B12
  • Protein Electrophresis
  • *Orifices:**
  • electrophresis (Bence Jones)
  • *X-rays:**
  • CXR
  • *Special Test:**
  • EMG
  • Lumbar puncture
104
Q

What are the risk factors for cluster headaches?

A

Male

Smoking

Alcohol can trigger

105
Q

What are the differentials for SAH?

A

Migraine

Mengitis

Cerebral Venous Sinus Thrombosis

Cavernous Sinus Thrombosis

106
Q

What are the clinical findings in SAH?

A

Kernigs sign
- Pain and resistance when knee is extended when hip is flexed

Meningisim

Terson’s sign

Diffuse T wave inversion

Lowered GCS / Coma

Photophobia

Irritated

107
Q

What is the grading system used for the radiological findings of SAH?

A

Fisher’s grading

108
Q

As soon as a bleed is confirmed via CT, what investigation next investigation should be done into SAH?

A

CT angiogram
- to confrim the cause (berry aneurysm/ AVM)

  • to allow for thearaputic intervention
109
Q

What is the management of SAH?

A

Surgerical:

Neurosurgery Coil to plug the Aneurysm

Clipping

Medical:

Bed rest
- avoid straining

Fluid resuscitation

Nimodipine
- avoid intracerebral vasospasm

VTE

Controlled blood pressure

Analgesia

+/- Ventricular stent
- off load hydrocephalus

110
Q

What are the different types of MND?

A

ALS

  • UMN
  • LMN

Progressive bulblar Pasly
- Cranials IX- XII

Progressive muscle atrophy
- LMN

Primary Lateral Sclerosis
- UMN

111
Q

What is the diagnostic criteria for MND?

A

Revised El Escorial Diagnostic criteria

  • UMN signs + LMN in >3 regions

**less than this is probable

112
Q

What investigations do you want to do into peripheral neuropathy?

A

Bloods:

  • FBC
  • Glucose
  • U&Es
  • B12
  • Electrophresis
  • ANCA
  • ANA

Orfices:

  • Urine electrophresis
  • Glucose

Special Tests:

  • EMG
  • *Consider looking for specifcs:**
  • Lead
  • Antiganglioside antibodies
113
Q

What are some of the causes of Carpel tunnel syndrome?

A

Myoxoedma
- Hypothyroidism

Acromegaly

Pregnancy

Sarcoidosis

Excessive dialysis

RA

Polymyalgia Rheumatica

114
Q

What two examination tests can be done into carpel tunnel syndrome?

A

Phalen’s test

Tinnel’s test

115
Q

Which muscles are implicated in Carpel tunnel syndrome?

A

Lumbricals

Oppensens policis

Abductor Pollicis Brevis

Flexor Pollicis Brevis

LOAF

Phase 4 (49 decks)

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