Brainscape's Knowledge GenomeTM

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


See full index

Phase 2a > Neurology > Flashcards

Neurology Flashcards

1
Q

Two types of stroke? Percentage of each?

Main way to differentiate between each?

A

Ischaemic - 80%
Haemorrhagic - 20%

Head CT

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

Two mechanisms of ischaemic stroke?
Where does each occur?
1: comes from? other example?
2: mechanism? which vessels?

Will have a core and a ____?

A
  • Embolism (away from brain) - clot form the heart (A-fib), cholesterol
  • Thrombotic (within brain vessel) - atherosclerosis, generally in larger vessels (IC, BA, MCA)

Penumbra - preserved by collateral circulation, may survive

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

Two mechanisms of haemorrhagic?
1: often occurs at?

Increased ______ pressures increases risk of ___?

Tissue ischaemic is because of two reasons?

A
  • Berry (saccular) aneurysms: often at ACA, PCA, MCA at junctions
  • Arteriovenous malformations (rare defect)

Increased intracranial pressures increases risk of brain herniation

Tissue ischaemia - lack of flow & leaked blood irriates other vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q 
Lacunar strokes:
mechanism?
aneurysms?
which vessels?
vessels feed what?
A

chronic HTN causes hyaline arteriolosclerosis (protein thickening)

Charcot-Bouchard

Lenticulostriate - occur on branch of MCA

Feed internal capsule and basal ganglia

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

When would a watershed strokes occur?

A

SHOCK - or other general decreased blood flow

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

What are the risk factors for forming Berry aneurysms? (3)

A

Chronic HTN, PKD, connective tissue disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q 
How would different arteries affected by stroke present clinically?
MCA (3)
ACA (1)
PCA (1)
Basilar (1)

What is the 4 letter pneumonic?

A

MCA - face, upper body, Broca’s (speech)
ACA - lower body
PCA - vision: homonymous hemianopia
Basilar artery - locked-in syndrome (bilateral loss of corticospinal tracts)

Face, Arms, Speech, Time (FAST)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Risk factors for ischaemic stroke:
Major heart problem?
2 basic others?

A

Atrial fibrillation

Metabolic syndrome - diabetes, obesity, HTN, low HDL cholesterol, high triglyceride
Smoking

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

Acute treatment for ischaemic stroke (2) vs haemorrhagic stroke (3)
Surgery? (2 x 2)

A

ISCHAEMIC - Aspirin (stops further clots), Thrombolytics (eg, tPA)

Surgery: MERCI or suction

HAEMORRHAGIC - Anti-hypertensives, Elevate head, Anti-convulsant

Surgery: clips, coil embolisation

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

What defines a TIA over a stroke?
______ long term problems
______ risk of ______

A

TIA - resolves in 24 hours

Minimal long term problems

Large increase risk of stroke occuring

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

Prevention of further strokes:
Lifestyle - 3 points
Medications - 3 points
Surgery - 1 point

A

Lifestyle - blood pressure (exercise, salt, alcohol), smoking, medical conditions
Medications - blood pressure, statins, anti-platelet or anti-coagulants
Surgery - carotid endarterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q 
EPIDURAL HAEMATOMA:
Occurs where?
Normal mechanism?
4 symptoms?
Clinical point to differentiate from subdural?
Diagnosis - scan? shows what?
Management - 3 key points?
A

Occurs in epidural space - between skull and periosteal dural mater

Damage to middle meningeal arteries - temporal bone fracture

Headache, N/V, High BP, Focal neural symptoms

Lucid interval present - good period followed by deterioration

CT scan - lens shape haematoma not crossing suture lines

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

SUBDURAL HAEMATOMA:
Occurs where?

Mechanism - what vessel? situation? 2 risky populations? baby?

Symptoms? (4- classic)

Diagnosis - scan, shows what?

Management: if there is a ______, then evacuate the haematoma

A

Occurs in sub-dural space - between dural and arachnoid maters

Bridging vessels
Trauama, Falls, MVC
Elderley (brain atrophy), Alcoholics (vein damage)
Shaken baby syndrome

CT-head: Concave (crescent) that can cross suture lines
Hyperdense (acute) Hypodense (chronic)

Midline shift >5mm, then evacuate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q 
SUBARACHNOID HAEMATOMA:
Occurs where?
Mechanism?
Symptoms - classic? meningitis like (2)?
Diagnosis - scan? if positive, then what?
Management - two strategies?
A

Occurs in subarachnoid space - in between arachnoid mater and pia mater

Berry (saccular) aneurysm ruptures in circle of Willis

“thunderclap” headache - severe, sudden
Neck stiffness, photophobia

CT-Head, positive, 4-vessel angiography

Supportive - bed rest, lower BP
Surgery - coil embolisation (preferred) or clips (out of date)

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

INTRACEREBRAL HAEMATOMA:
Occurs in where? (4)
3 example arteries supplying these areas?
3 causes of these arteries being damaged?
Sudden neurological defecits like hemiparesis? hemiplegia?
Management - increased _____ needs to be controlled. If there is _____ evacuation needed

A

Occurs in various places - thalamus, basal ganglia, cerebellum, PONS

Lenticulostriate, thalamo-geniculate, pontine branches

Hypertension, AV malformations, Amyloidosis

Hemiparesis - half side weakness
Hemiplegia - half side paralysis

Increased INTRACRANIAL PRESSURE needs to be controlled
If MASS EFFECT is present, evacuate

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

What is amaurosis fugax? What condition does it often occur in?

A

Emboli in retinal artery
Cannot see - “curtain descending over my vision”

Association with TIAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does the ABCD2 score predict? What does each letter represent?

A

Risk of stroke after a TIA has occured

Age
Blood pressure
Clincial features of the TIA
Duration & Diabetes

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

What specifically is inflamed in meningitis?

Two types of spread, that can cause the infection

A

LEPTOMENINGES - pia mater and arachnoid mater

DIRECT - skin, nose, fracture, spina bifida
HAEMATOGENOUS - blood

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

Bactaeria in meningitis:
Newborns (4)
Children & young adults (2)
Elderly and immunocomprimised (2)

A

• Newborns -
Group B streptococci,
E. Coli,
Listeria monocytogenes, Haemophilus influenzae

  • Children & young adults - Neisseria meningitidis, Streptococcus pneumoniae
  • Older adults & elderly - Streptococcus pneumoniae, Listeria monocytogenes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

3 viral causes of meningitis?

3 other categories of causes (non-bacterial)
What is different in these presentations?

A

Enterovirus (coxsackie)
HSV
HIV

FUNGAL - Cryptococcus genuses, Coccidioides genuses (chronic)
TUBERCULAR - Mycobacterium tuberculosis (chronic)
PARASITIC - Plasmodium falciparum (chronic)

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

Classic triad of MENINGITIS symptoms?
Other symptoms?

What are the two signs that will be positive in meningitis?

A

Classic triad - headaches, photophobia, neck stiffness
Fever often present

Two tests:
Kernig’s sign - knee at 90, straightened at knee, causes back pain
Brudzinski’s sign - neck flexed, causes knees to be flexed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q 
CSF in bacterial meningitis:
Colour?
WBC?
Protein?
Pressure?
Glucose?

Noted differences in VIRAL and FUNGAL/TB

A 
Signs of infection:
CSF - cloudy (should be gin clear)
WBC - increased (bacterial = neutrophils, lymphocytes = viral)
Protein - increased
Pressure - increased
Glucose - decreased

Viral - normal proteins, normal gram-staine, normal pressure, clear (not cloudy), massive WBC increases

Fungal/TB - fibrin web

23
Q 
Neisseria meningitis:
Microscopy vs S. pneumoniae
Causes a skin \_\_\_\_, looks like?
Notifiable to?
Why is it common in university students?
A

GRAM -VE, DIPLOCOCCI
Streptococcus pneumoniae is POSITIVE

Capillary damage and/or DIC
- non-blanching, purpuric, petechiae rash

Family carriers - move to a new house

Tell Public Health England

24
Q 
Treatment of meningitis:
In community?
Two classic broad spectrum?
Other antibiotic used in cover?
What is used other than antibiotics?
A

IN COMMUNITY - IM Benzylpenicillin, send to hospital

Commonly 3rd generation
cephalosporins:
Ceftriaxone, Cefotaxime

Amoxicillin covers Listeria

Steroids used - reduces brain swelling (inflammation)

25
Q

Important differential of meningitis?

How is viral meningitis treated?

A

Subarachnoid haemorrhage

Supportive w/ acyclovir

26
Q 
Encephalitis is inflammation of \_\_\_\_?
Normal cause (2)? + a rarer cause?
A 
of the BRAIN PARENCHYMA
Often viral (HSV, sometimes Varicella Zoster), sometimes bacterial
27
Q

Symptoms of encephalitis:
Early symptoms (4)
Late symptoms: (3)
Can still have _____ signs and symptoms, but ______ is often altered

A

Early symptoms - fever, headache, lethargy, behaviour changes

Late symptoms - focal signs, seizures, coma

Can still have MENINGITIS signs and symptoms, but CEREBRAL FUNCTION is often altered

28
Q

Normal treatment for encephalitis? (2)

What would the lumbar puncture show in this condition?

A

Supportive
Often IV acyclovir (anti-viral)

Would show raised lymphocytes

29
Q 
What organism cause tetanus?
Found where?
Mechanism of the disease?
What to do if there is a risk injury?
Two classic presentation points?
A

Clostridium tetani
Found in soil

Bacteria produce toxins - travel along axons and interfere with neurotransmitter release

Vaccintion if there is a risk injury

Risus sardonicus (satanic smile)
Complete muscle spasm
Could be localised?

30
Q

Rabies is what type of infection?
Cause by?
“Travels ____”

Has a varaible ______

Treatment: 2 options?
If it becomes _____

A

Viral infection

Inoculation throguh skin with saliva of rabid animal

Travels retrogradely along nerve

Pre or Post-exposure prophylaxis
If symptomatic - it’s fatal

31
Q

Name the 3 primary headaches?
Name 4 secondary headaches?
What is the name of the painful cranial neuropathy?

A

Primary -
migraine,
cluster,
tension type

Secondary -
meningitis,
subarachnoid haemorrhage, GCA,
chronic medication overuse (aspirin, paracetamol, NSAIDs, triptans, etc)

Painful cranial neuropathy - trigeminal neuralgia

32
Q 
MIGRAINE:
What side?
Severity?
Character of pain?
Onset?
How long?
4 associated symptoms?
Worsens with?
A

Often unilateral, Moderate/severe,
Throbbing,
Gradual onset
Duration: 4-72 hours

N/V, Photophobia, Phonophobia

Worsens with activity

33
Q 
Migraine treatment:
Normal (3 - 2 drugs and 1)
Severe (1 - drug)
Preventative? (2 - drugs)
Reduce \_\_\_\_\_? Examples of this?
A

NSAIDs/Aspirin, Antiemetic, Hydration

Severe - oral triptan (eg, Sumatriptan) is given. Has come contraindications - vascular diseases

Preventive - topiramate (anti-convulsant) or propranolol (beta-blocker)

Reduce triggers:
Chocolate, Hangovers, Orgasms, Cheese, OCP, Lie-ins, Alcohol, Tumult (loud noises), Exercise

34
Q 
TENSION TYPE:
What side?
Severity?
Character of pain?
How long?
Associated symptoms?
A

Bilateral
Mild to moderate
Waxes and wanes
Pressure or tightness band
Massive variable time - 30 minutes to 7 days
Little associated - sometimes photophobia or phonophobia

Triggers - missed meals, stress, overexertion, lack of sleep, depression

35
Q

Can you name some triggers of TENSION TYPE headache? (5)
What is the go to medication?
_____ relief?

A

Triggers: missed meals, stress, overexertion, lack of sleep, depression

Paracetamol or NSAIDs
Stress relief

36
Q 
CLUSTER:
What side? Where?
Severity?
Character of pain?
Onset?
How long?
Point about activity?
Associated points (3) - trigeminal autonomic features
A 
Unilateral - around eye
Severe
Deep continous pain
Begins quickly
Short (15-180 minutes)
Often causes restlessness and agitation

Horner’s syndrome (ptosis + miosis)
Lacrimation
Nasal charge

37
Q

What is the main medicatino for CLUSTER headache?

2 preventative drugs?

A

Treatment: SC SUMATRIPTAN

Preventive - topiramate or propranolol

38
Q 
RAISED ICP:
Headache is worse when (1)
Headache is worse when (1)
Headache is worse when (3)
Association with _/_
What is papilloedema?
A

Worse on waking
Worse on coughing, sneezing, straining
Postural - worse lying down

Nausea/Vomiting

Papilloedema (may be absent if acute): swollen optic disks

39
Q

Type of pain in trigeminal neuralgia? Lasting how long?

What is the main medication of trigeminal neuralgia? Next step?

A

Electrifying/Lightning/Stabbing pain - lasting a few seconds

Medication - CARBAMAZEPINE (anti-convulsant)
Phenytoin, Gabapentin (neuropathic pain analgesia)

Surgery is a final option

40
Q

Can have what before a migraine? What percentage of migraines?
3 points about it

A

Episodic migraines
Aura: 20% without, 80% with

Visual symptoms - flashing lights, zigzags
Sensory disturbances - tingling in hands and feet
Language aura and motor aura

41
Q

What would you see in a biopsy of someone with GCA?
Which vessels does GCA affect?
Why is it difficult to biopsy?

A

Giant cells in the elastic lamina

Branches of the carotid - eg, TEMPORAL, opthalmic, facial, occipital…

Segmental - need a long piece, and may not be present

42
Q 
How would someone with GCA present:
3 general symptoms
Temporal specific?
Opthalmic specific?
Facial specific?
Occipital specific?

3 signs related to the temporal arteries?

A

Malaise, fever, anaemia

Temporal - headache (often localised)
Opthalmic - visual disturbances (amaurosis fugax)
Facial - jaw claudication
Occipital - scalp tenderness

PALPABLE, TENDER and REDUCED PULSATION of temporal arteries

43
Q

3 points on epidemiology of GCA?

What is major lab result that would be seen in GCA?

A

Women > Men, Almost always >50, Common in Scandinavia

Increased ESR!! (also CRP)

44
Q

What is the go to treatment of GCA? Why does this need to be done quickly?

A

Corticosteroids
Eg - prednisolone

Because of the complication:
BLINDNESS (important to treat quick - don’t wait for biopsy)

45
Q

What is the definition of an epileptic seizure?
Too much ____?
Too little ____ ?

A

neurons synchronously active (paroxysmal discharge of cerebral neurons)

Too much excitation - lots of glutamate
Too little inhibition - too little GABA

46
Q 
What is the other name for a partial seizure?
What does it effect?
What are the two subtypes?
Basic characteristics of each subtype?
What is a Jacksonian March?
A

Focal seizure

Effects ONE hemisphere or ONE area

Simple - remain conscious (small area, strange sensations and jerking)

Complex - impaired consciousness (imapired awareness, may not remember)

A simple partial seizure spreads from the distal part of the limb toward the ipsilateral face

47
Q 
What can a generalised seizure progress from?
Definitions of the following?
TONIC
ATONIC
CLONIC
TONIC-CLONIC
MYOCLONIC
ABSENCE
Which of these is most common?
A

Can progress from a PARTIAL SEIZURE

  • TONIC - flexed, fall backwards
  • ATONIC - relaxed, fall forwards
  • CLONIC - convulsions
  • TONIC-CLONIC - sudden tense muscle, followed by convulsions
  • MYOCLONIC - short muscle twitches
  • ABSENCE - lose and regain consciousness, “space out”, commonly presents in childhood

Tonic-Clonic is most common

48
Q

If seizures last greater than 5 minutes what are these called?
What is the usually type of seizure?
What is the emergency treatment used? How does this work?

A

If seizures last greater than 5 minutes - STATUS EPILEPTICUS

Usually TONIC-CLONIC

Medical emergency - treated with BENZODIAZEPINES (enhances GABA)

49
Q

What are the three diagnostic tests that can be done in epilepsy?
What are the two symptoms that could occur after seizures?

A

MRI & CT - brain scan for abnormalities
EEG - detect electrical signals

Postical confusion
Todd’s Paralysis (paresis in arms or legs for around 15 hours after seizure)

50
Q 
Management of epilepsy:
Focal/partial medication?
Generalised medication?
Nerve \_\_\_\_\_?
Epilepsy \_\_\_\_\_?
Diet \_\_\_\_?
Avoid \_\_\_\_? eg \_\_\_\_
A
  • Focal - CARBAMAZEPINE
  • Generalised - SODIUM VALPORATE (teratogenic)

Nerve Stimulation

Epilepsy surgery

Ketone diet

Avoid triggers - eg flashing lights

51
Q 
Differential of seizures:
EPILEPTIC -
Time
\_\_\_\_ symptoms
3 more
A 
30-120 seconds
Positive symptoms - tingling and movement
Tongue biting
Head turning
Muscle pain
52
Q

Differential of seizures:
NON-EPILEPTIC -
Time
4 more

A 
1-20 minutes in duration (longer than epileptic)
Eyes closed
Crying or speaking
Pelvic thrusting
History of psychiatric illness
53
Q

Differential of seizures:
Syncope
Time
4 more

A 
5-30 seconds
Sweating
Nausea
Pallor
Dehydration

Phase 2a (9 decks)

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