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Phase 3a > Neurology > Flashcards

Neurology Flashcards

1
Q

Define seizure

A

Clinical manifestation of abnormal, excessive and uncontrolled discharge of cerebral neurons

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2
Q

What is epilepsy?

A

Tendancy to experience recurrent unprovoked seizures

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3
Q

Cause of epilepsy?

A 
Idiopathic (70-80%)
Cerebral palsy
Neurodegenerative disorders
Neurocutaneous syndromes
Cerebral tumour
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4
Q

Metabolic causes of epilepsy

A

Hypoglycaemia
Hypocalcaemia
Hyperammonaemia

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5
Q

Autonomic features of seizures

A

Pallor
Vomiting
Sweating

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6
Q

Features of a seizure that indicate it is epileptic in nature

A 
Eyes open, rolled up
Head and eyes deviate to the same side
Absent pupillary response
Tongue biting
Incontinence
Cyanosis
Postictal confusion
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7
Q

Features of a seizure that indicates non-epileptic seizure

A 
Eyes close, opening is resisted
Present pupillary response
Equal flexor and extensor movements
Pelvic thrusting
Side to side head movements
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8
Q

5 childhood epilepsy syndromes

A 
Generalised epilepsy
Focal epilepsy
West syndrome
Childhood absence epilepsy
Juvenile myoclonic epilepsy
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9
Q

What is the first line treatment for a childhood generalised epilepsy syndrome?

A

Sodium Valproate

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10
Q

2nd line treatment for childhood generalised epilepsy syndrome?

A

Lamotrigine

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11
Q

What is seen on EEG in West Syndrome?

A

Hypsarrhythmia

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12
Q

What is the most common cause of west syndrome?

A

Tuberous Scleosis

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13
Q

What is the first line treatment of focal epilepsy syndrome?

A

Carbamazepine

+Valproate
+Lamotrigie

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14
Q

What does seizures in West Syndrome look like?

A

Violent flexion of head, trunk and limbs followed by extension of arms
Lasts 1-2 seconds but can occur 20-30 times
Often occurs on waking

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15
Q

What is the treatment of West Syndrome?

A

Vigabatrin and Corticosteroids

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16
Q

What is childhood absence epilepsy treated with 1st line?

A

Sodium valproate or ethosuximide

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17
Q

How can you induce an absence seizure?

A

Hyperventilation

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18
Q

What is seen on EEG for absence seizures?

A

3 second spike and wave

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19
Q

Which childhood epilepsy syndrome presents with morning clumsiness eg spilling drinks/food?

A

Juvenile myoclonic epilepsy

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20
Q

How is Juvenile myoclonic epilepsy treated?

A

Valproate or lamotrigine

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21
Q

How is status epileptics managed?

A
  1. ABCDE
  2. Check blood glucose (if <3mmol/L give IV glucose)
  3. At 5 mins - IV lorazepam/Rectal diazepam/IM midazolam
  4. At 15 mins IV lorazepam
  5. At 25 mins IV phenytoin (or IV phenobarbitol if on regular phenytoin)
  6. PR paraldehyde after start of phenytoin infusion
  7. Rapid sequence induction with IV sodium thiopental
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22
Q

What are the 4 dopamine pathways and what are they responsible for?

A

Mesolimbic - Reward
Mesocortical - Executive functions
Nigrostriatal - Motor
Tuberoinfundibular - Prolactin

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23
Q

What is the pathology of pakinson’s disease?

A

Accumulation of alpha synuclein protein (lewy bodies) in the pars compacta of the substantial nigra

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24
Q

Which spinal tract provides motor supply to the muscles in the limbs and digits?

A

Lateral corticospinal tract

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25
Q

What is the vestibulospinal tract responsible for?

A

Balance and posture

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26
Q

What does the rubrospinal tract do?

A

Fine motor control of hand

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27
Q

Which spinal tract is responsible for pain and temperature?

A

Lateral spinothalamic tract

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28
Q

Which spinal tract is responsible for fine touch and vibration?

A

Dorsal column medial lemniscus pathway?

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29
Q

At what vertebral level does the spinal cord terminate?

A

L1-2

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30
Q

What nerve supplies the thenar muscles of the hand?

A

Median

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31
Q

Which nerve supplies the muscles of the hypothenar eminence?

A

Ulnar

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32
Q

Which nerve roots form the median nerve?

A

C6-T1

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33
Q

What muscles does the median nerve supply?

A

Flexor muscles in anterior aspect of forearm, thenar muscles and lateral 2 lumbricals

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34
Q

What nerve roots form the ulnar nerve?

A

C8-T1

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35
Q

What nerve roots form the radial nerve?

A

C5-C8

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36
Q

What areas have sensory innervation from the median nerve?

A

Lateral aspect of palm, lateral 3 and and half fingers on palmer surface and their respective finger tips on palmar and dorsal side

37
Q

What is a stroke?

A

Rapid onset of focal neurological symptoms associated with infarction (80%) or haemorrhage (20%)

38
Q

How does total anterior circulation stroke present?

A

Includes all 3 of the following:

  • Unilateral weakness of arm, face and leg
  • Homonymous hemianopia
  • Higher cerebral dysfunction eg dysphagia/visuospatial disorder
39
Q

Which occlusion of which blood vessels cause a total anterior circulation stroke?

A

Anterior and middle cerebral arteries

40
Q

What is the clinical presentation of a partial anterior circulation stroke?

A

Includes 2 of the following:

  • Unilateral weakness of arm, face or leg
  • Homonymous hemianopia
  • Higher cerebral dysfunction eg dysphagia/visuospatial disorder
41
Q

Occlusion of which blood vessel causes a partial anterior circulation stroke?

A

Anterior cerebral artery

42
Q

Symptoms of posterior circulation syndrome

A

Includes 2 of the following:

  • Cranial nerve palsy and contralateral motor/sensory deficit
  • Bilateral motor/sensory deficit
  • Eye movement disorder
  • Cerebellar dysfunction
  • Isolated homonymous hemianopia
43
Q

What type of stroke syndrome is most common?

A

Lacunar syndrome

44
Q

What is the presentation of a lacunar stroke?

A

Includes 1 of the following:

  • Pure motor stroke
  • Pure sensory stroke
  • Sensori-motor stroke
  • Ataxic hemiparesis
45
Q

1st line investigation for suspected stroke

A

CT

46
Q

1st line management of ischaemic stroke

A

Thrombolysis with tissue plasminogen factor eg alteplase

47
Q

What risk is associated with thrombolysis?

A

Haemorrhage

48
Q

Contraindications of thrombolysis

A 
Recent trauma
Recent surgery
Recent internal bleed
HTN >200/100
Pregnancy
Recent stroke
Liver disease
Warfarin
49
Q

Within what time frame does Thrombolysis need to happen?

A

Within 4.5 hours of onset of symptoms

50
Q

Within what time frame does a thromboectomy need to happen?

A

Within 6 hours

51
Q

What medical therapy is given following stroke?

A

Aspirin 300mg for 14 days followed by 75mg daily

Warfarin if AF

52
Q

What risk score calculates the risk of TIA after stroke?

A

ABCD2

53
Q

What are the risk factors for TIA following stroke?

A 
Age >60 (1)
Blood Pressure >140/90 (1)
Clinical features
- Unilateral weakness (2)
- Speech disturbance (1)
Duration of symptoms
- >60 mins (2)
- 10-60 mins (1)
- <10 mins (0)
Diabetes (1)
54
Q

What risk score calculates the risk of stroke in patients with AF?

A

CHA2DS2-VASC

55
Q

What are the risk factors for stroke in patients with AF?

A 
Congestive heart failure (1)
Hypertension >140/90 (1)
Age >75 (2)
Diabetes (1)
Stroke (previous stroke/TIA) (2)
Vascular disease (1)
Age 65-75 (1)
Sex category (being female) (1)
56
Q

Features of migraines

A 
Sensory aura (15-30 mins)
Unilateral throbbing headache
N+V
Photophobia
Allodynia
57
Q

Triggers of migraines

A 
Chocolate
Heat
Oral contraceptives
Caffeine
O
Lack of sleep
Alchohol
Travel
Exercise

+cheese, anxiety,

58
Q

What is the management of migraine in an acute attack?

A

Oral triptan eg sumatriptan and NSAID/paracetamol

59
Q

What are the medical options for migraine prevention?

A

Topiramate or propranolol

60
Q

Risk factors for cluster headache

A

Male
<55yrs
Smoking
Alcohol consumption

61
Q

Features of a cluster headache

A

Unilateral, around eye
Lasts 30-90 mins, several occur in a week
Red eye, lacrimation, swelling, ptosis,
Rhinorrhoea, facial swelling, vomiting

62
Q

Management of cluster headache

A

100% high flow oxygen through non-rebreathe mask for 15 mins

Subcut triptan

63
Q

What medication is used for the prevention of cluster headaches?

A

Verapamil

64
Q

Features of a subarachnoid haemorrhage

A 
Thunderclap headache in back of head - sudden onset
Kernig's sign
LOC
CN signs
N+V
Photophobia
Double vision
Stiff neck
Hemiplegia 
Sentinel headache
65
Q

What is Kernig’s sign?

A

Flexion of thigh at hip to 90 degrees followed by extension of leg at knee.
In meningitis, this movement is greatly limited by spasm of hamstrings - which in turn causes pain - due to inflammatory exudates around the roots of the lumbar theca.

66
Q

What is Brudzinski’s sign?

A

Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.

67
Q

Investigations in SAH

A

CT - star shaped lesion

LP (contraindicated if increased ICP) - 3 samples show visible blood, xanthochromia after a few hours.

68
Q

Management of SAH

A

ABCDE

Surgical clipping/endovascular coiling

69
Q

What is meningism?

A

Stiff neck, headache and photophobia

70
Q

What immediate management is given for patients in the community with suspected meningitis?

A

IM Benzylpenicillin

71
Q

What is the antibiotic treatment for meningitis?

A

IV ceftriaxone for 7 days

72
Q

How does a patients with encephalitis present?

A

Infectious prodrome: fever, malaise, headache, drowsiness
Photophobia, stiff neck, +ve kernig’s sign, brudzilski’s sign
CN palsy, ataxia, confusion, hemiparesis, seizures, confusion, dysphagia, personality/behavioural change

73
Q

What will CSF show in encephalitis?

A

Increased WCC (Lymphocytes)
Normal/Decreased glucose
Increased protein

74
Q

What investigations should be done for suspected encephalitis?

A

Viral serology
Blood PCR for HSV, CMV, VZV, EBV
CT - cerebral oedema
MRI - shows characteristic bilateral temporal lobe involvement in HSV-1 infection

75
Q

How do you manage encephalitis?

A

IV acyclovir

76
Q

Features of GCA headache

A 
Associated with PMR
Generalised headache
Jaw claudication
Scalp tenderness
Fever, fatigue, visual loss (PANIC)
Superficial temporal artery is tender, firm and pulseless
77
Q

What is seen on bloods in GCA?

A

Massively increased ESR and CRP
Increased Platelets
Increased ALP
Decreased Hb (normochromic, normocytic anaemia)

78
Q

What is seen on temporal artery biopsy in GCA?

A

Granulomatous inflammation and mononuclear infiltration

79
Q

What is the immediate management of GCA?

A

High dose corticosteroids

80
Q

What are the main neurotransmitters involved in epilepsy?

A

Glutamate (increased)

GABA (decreased)

81
Q

What cell produces myeline in the central and peripheral nervous system?

A

Central - Oligodendrocytes

Peripheral - Schwaan cells

82
Q

How long can someone not drive for after a TIA/stroke?

A

4 weeks

83
Q

Wrist drop is due to damage of which nerve?

What causes it?

A

Radial

Nursemaid’s elbow due to radial head subluxation, can occur in children due to outward pull on extended pronated arm

84
Q

What is the triad of Wernick’s encephalopathy?

A

Opthalmoplegia, confusion, ataxia

85
Q

What test is gold standard for measuring respiratory muscle strength?

A

FVC monitoring

86
Q

Which nerve is damaged in foot drop?

A

Common peroneal nerve

87
Q

What sign on examination is severe electric shock type pain down back on passive flexion of neck?

A

Lhermitte’s sign

88
Q

Early symptoms of Huntington’s?

A 
Chorea - leads to agitation
Decreased auditory and visual reactions times
Extraoccular movements
Increased reflexes
Postural instability

Phase 3a (5 decks)

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