Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Long Case > Neurology > Flashcards

Neurology Flashcards

1
Q

Difference between simple partial and complex partial seizure

A

Simple: awareness unimpaired
Complex: awareness impaired and post ictal confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Tonic clonic vs myoclonic seizures

A

Tonic clonic: limbs stiffen and jerk

Myoclonic: limbs just jerk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of seziures

A 
2/3rd idiopathic
Space occupying lesion/stroke
Trauma/haemorrhage/increased ICP
Fever
Infection
Drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Things to ask in seizure history

A 
Length of time/tongue biting/incontinence
Prodrome
Post ictal changes
Triggers
Previous seizures or first one?
Family history
Drug use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Differential diagnosis for transient loss of consciousness

A

Vasovagal syncope
Orthostatic
Cardiac abnormality/arrhythmia
Hypoglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Investigations for seizures

A 
FBC, glucose, Ca, electrolytes, Creatinine, LFTs
Urine toxocology screen
CXR
Consider LP
CT head
EEG/MRI in certain patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Non pharmacological management of seizures

A 
Avoid triggers
Avoid driving for 1 year seizure free
Avoid swimming, heights, heavy machinery
Refer to first seizure clinic
Epilepsy nurse specialist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pharmacological management of seizures

A

Usually commenced by neurologist after 2nd seziure
Generalised: sodium valproate, lamotrigine
Partial: carbamazepine, levertiracetam
Pregnant or breastfeeding: Lamotrigine
Neurosurgical resection if clear epileptogenic focus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Distinguishing features of motor neurone disease

A

No sensory loss
Upper and lower motor neurons affected
Eye movements never affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name the 4 types of motor neurone disease

A

Amyotrophic lateral sclerosis: most common, upper and lower motor neuron signs, bladder spared
Progressive bulbar palsy: only affects cranial nerves 9-12
can be bulbar or corticobulbar
Progressive muscular atrophy: only LMN signs
Primary lateral sclerosis: Predominately UMN signs and no cognitive decline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Differentials for motor neuron disease

A 
Peripheral neuropathy
Myopathies
Post polio syndrome
Myasthenia gravis
Brain or spinal cord lesion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Investigations for motor neuron disease

A

MRI

Nerve conduction studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of MND

A 
Poor prognosis-multi disciplinary approach
Antiglutamatergic drugs (riluzole)
Amitriptylline for drooling
Consider NG/PEG
Baclofen/diazepam for spasticity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pathogenesis of MS

A

Plaques of demylination caused by a T cell mediated immune response
Primarily clinical diagnosis but can use MRI and oligonal bands on LP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Presentation of MS

A

Solo Neurological deficit which comes then goes, eg. weakness in a leg, optic neuritis, ataxia, parasthesia
Family history of MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are you looking for on examination for MS

A 
Spastic paraparesis
Sensory loss
Nystagmus
Impaired co-ordination
Ataxic gait
Failure of rhomburg test
Ophthalmoplegia
Decreased visual acuity
Lhermitte's sign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Investigations for MS

A

MRI
Evoked response testing of nerves
CSF (oligoclonal IgG bands on electrophoresis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of MS

A

Symptomatic management
Interferons decrease relapse frequency
Steroids in acute relapses
Methotrexate and aziothioprine can be trialled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pathogenesis of Myasthenia gravis

A

Autoimmune disease against acetylcholine receptors on post synaptic membranes which inhibits muscle contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Presentation to ask about with myasthenia gravis

A

Drooping eyelids
Difficulty chewing/swallowing
Proximal muscle weakness
Ask about other autoimmune diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Things to check on examination for myasthenia gravis

A 
Ptosis
peek sign
Sustained upward gaze
Thymectomy scar
Weakness of neck flexion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Investigations for myasthenia gravis

A

Acetylcholine esterase antibodies
Electromyogram
Thymoma investigation (cxr or thoracic CT)
Respiratory function tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Management of myasthenia gravis

A

Pyrodostigmine (causes increased drooling and crying)
Sudden worsening respiratory symptoms can be life threatening
Relapses treated with prednisone-often needed long term so give osteoporosis prophylaxis
If steroids fail give immunosuppresion with methotrexate or azathioprine
Thymectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Key signs of parkinson’s

A

Tremor
Rigidity
Akinesia/bradykinesia
Postural instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Pathogenesis of parkinson’s

A

Depletion of dopaminergic cells in pars compacta in substantia nigra

26
Q

Name some prodromal premotor symptoms of parkinson’s

A 
Anosmia
Depression
Insomnia
Autonomic effects
Dribbling
27
Q

Extra tests for parkinson’s on examination

A 
Glabellar tap
Occular movements
Lying and standing BP
Undo buttons
write name
28
Q

What are the parkinson’s plus syndromes

A

Progressive supranuclear palsy: early postural instability and vertical gaze palsy
Multisystem atrophy: Cerebellar signs
Lewy body dementia: hallucinations
Cortico-basal degeneration: akinetic rigidity affecting one limb

29
Q

Which drugs can induce parkinsonism

A

Haloperidol and lithium

Wilson’s disease

30
Q

Investigations for parkinsonism

A

MRI to exclude brain lesion

Levodopa challenge

31
Q

Management of parkinsonism

A

Multidiscip
Levodopa (can cause pychosis)
Dopamine agonists (ropinerole)
Anticholinergics help with tremor (but cause confusion, dry mouth and urinary retention)
Deep brain stimulation
Surgical ablation of overactive basal ganglia

32
Q

What causes a TIA?

A

Atherothromboembolism
Cardioembolism
Hyperviscosity

33
Q

Investigations for TIA

A 
FBC, ESR, U+E's, glucose, lipids
CXR
Carotid ultrasound
CT
?Echo
ECG
34
Q

How do we calculate stroke risk score after TIA?

A 
ABCD2
Age >60
Blood pressure >140/90
Clinical features (unilateral weakness/speech disturbance)
Duration of symptoms >1 hour
Diabetes
35
Q

Management of TIA

A

Avoid driving for a month
Diet and exercise
Control CV risk factors
Aspirin 300mg daily and clopidogrel 75mg daily
Consider carotid endarterectomy if >70% stenosed

36
Q

How do the causes differ for the two types of stroke?

A

Ischaemic: artherosclerosis and thromboemboli
Haemorrhagic: hypertension, berry aneurysm, av malformation

37
Q

Exam findings in a stroke caused by internal carotid artery

A

Hemiparesis on opposite side of the body and homonymous hemianopia
Dysphasia

38
Q

Exam findings in a stroke caused by anterior cerebral artery

A

Hemiparesis in legs
sensory loss in legs
change in personality/mood/behaviour

39
Q

Exam findings in a stroke caused by middle cerebral artery

A

Weakness on opposite side of the lower face and arms, can have aphasia

40
Q

Exam findings in a stroke caused by posterior cerebral artery

A

Homonymous hemianopia
problems with spatial skills and recognition
problems with memory and mood

41
Q

Exam findings in a stroke caused by midbrain

A

cranial nerve 3 and 4 deficits on SAME SIDE plus weakness and sensory loss on opposite side

42
Q

Exam findings in a stroke caused by medulla

A

cranial nerve 5 and 6 deficits on SAME SIDE plus weakness and sensory loss on opposite side

43
Q

Exam findings in a stroke caused by cerebellum

A 
DASHING
Dysdiadochokinesia
Ataxia
Slurred speech
Hypotonia
Intention tremor
Nystagmus
Gait abnormality
44
Q

Investigations for stroke

A 
FBC, electrolytes, creatinine, glucose, lipids, coag screen
Blood cultures if febrile
ECG ?AF
CT
Carotid USS
Echo if young and ?cause
45
Q

Management of acute ischemic stroke on discharge

A 
Protect airway- exclude haemorrhagic stroke
Give IV alteplase if within 4.5 hours
Clopidogrel 75mg
Consider heparin
DVT prophylaxis
Driving restriction
Statins
Consider carotid endartectomy
46
Q

Management of acute haemorrhagic stroke

A

Stop antithrombotics
Reverse anticoagulation
Neurosurgical referral

47
Q

What are some key causes of polyneuropathy

A 
Diabetes
Renal failure
Low B12 and B1
Isoniazid/phenytoin
Guillan barre syndrome
HIV/Syphilis
48
Q

key things to ask in polyneuropathy history

A 
Time course
Preceding events
Travel
Drugs
Sexual infections
Family history
49
Q

How to differentiate between sensory, motor and autonomic neuropathy

A

Sensory: numbness, burning, tingling, glove and stocking
Motor: progressive, weakness, wasting, reduced reflexes
Autonomic: ED, decreased sweating, urinary retention, homes adie pupil (dilated and unresponsive to light)

50
Q

Investigations for polyneuropathy

A 
FBC, ESR, glucose, TSH, b12/folate, ANA, ANCA
CXR
Consider LP
Urinalysis
Nerve conduction studies
51
Q

management of polyneuropathy

A

Treat underlying cause
foot care
Amitryptilline/gabapentin for neuropathic pain

52
Q

Guillan barre syndrome pathogenesis

A

Acute inflammatory demyelinating polyneuropathy, often caused by campylobacter or EBV
Symptoms progress for 4 weeks then resolve

53
Q

Presentation of Guillan barre symptoms

A 
Progressive muscle weakness over days
Areflexia
Pain
Speech
Facial droop
Autonomic dysfunction
54
Q

Investigations for guillan barre

A 
Nerve conduction studies
LP
Bloods (check campylobacter serology)
Spirometry
MRI spinal cord
55
Q

Diagnostic criteria for guillan barre

A

Progressive muscle weakness in limbs
Areflexia
Progressive sensory change over 2-4 weeks

56
Q

Treatment for guillan barre

A 
IV IG
Plasma exchange
Ventilate if severe respiratory involvement
DVT prophylaxis
Monitor vitals 
Follow every 4-6 weeks for 6 months
57
Q

Prognosis/complications for guillan barre

A

85% good recovery but 20% mortality if ventilated

Can have respiratory failure, Ileus and bladder issues

58
Q

What are the three most common muscular dystrophies?

A

Duchenne’s muscular dystrophy
Fascioscapulo humeral muscular dystophy
Becker’s muscular dystrophy

59
Q

What is the most common myotonic disorder?

A 
Dystrophia myotonica
Distal onset weakness
facial weakness/wasting
Diabetes
Male frontal baldness
Most patients die in middle age
60
Q

Work up of code stroke

A 
?symptoms worst at onset
?sudden onset
How long since last seen well
?anticoagulants ?malignancy ?pregnancy ?prior stroke ?haemorrhage
Take BP and determine NIHSS
CT head CT angiography CT perfusion

Long Case (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions