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Danny's Phase 3A Medicine > Neurology > Flashcards

Neurology Flashcards

1
Q

Describe the typical onset of the various types of Dementia

A

Alzheimers: Gradual, progressive onset

Vascular: Abrupt (after stroke) or gradual

Lewy body: Insidious onset, progressive with fluctuations

frontotemporal: Insidious onset typically in 50s/60s then rapid progression

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2
Q

Describe the difference of symptoms between the various types of Dementia

A

Alzheimer’s: memory,language, visuospatial skills, later behavioural signs

Vascular: Focal neuro signs, signs of vascular disease

Lewy body: Visual hallucinations, Parkinsonism signs (tremors, falls, shuffle gait)

Frontotemporal: Disinhibition, poor judgement, decreased motivation, socially inappropriate

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3
Q

What can be seen on CT/MRI in Alzheimers?

A

1) Beta-amyloid plaques
2) Neurofibrillary tangles
3) Atrophy

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4
Q

What may be seen on imaging of Frontotemporal?

A
  • Frontal/temporal atrophy

- Picks cells

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5
Q

What may be seen on imaging of Vascular Dementia?

A

1) changes in blood vessels and vascular infarcts

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6
Q

What may be seen on imaging of Lewy body dementia?

A

Lewy bodies in cortex of midbrain

Generalised atrophy

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7
Q

Treatment of Alzheimers?

A

Donepazil (cholinesterase inhibitors)

Memantine

Treat depression, aggression/agitation

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8
Q

Treatment of Lewy body dementia?

A

Cholinesterase inhibitors

Memantine

Levodopa

Physiotherapy

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9
Q

Where do you test sensation in the following dermatomes on the arm?

C5-T2

A

C5 - Over deltoid

C6 - index finger

C7 - middle finger

C8 - little finger

T1 - inside arm

T2 - apex of axilla

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10
Q

Where do you test sensation in the following dermatomes on the leg?

L2-S2

A

L2 - anterior medial thigh

L3 - over knee

L4 - medial tibia

L5 - dorsum of foot running to big toe

S1 - lateral heel

S2 - popliteal fossa

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11
Q

Where do you test movement in the following myotomes on the arm?

C5-T1

A

C5 - shoulder abduction

C6 - elbow flexion

C7 - elbow extension

C8 - finger flexion

T1 - finger abduction

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12
Q

Where do you test movement in the following myotomes on the leg?

L2-S2

A

L2- Hip flexion

L3- Knee extension

L4- Ankle dorsiflexion

L5- Extension of big toe

S1- Ankle plantar flexion

S2- Knee flexion

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13
Q

What muscles do the radial nerve innervate?

A

Triceps and finger extensors

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14
Q

What muscles do the median nerve innervate?

A

LOAF

Lateral 2 lumbricals

Oppenens brevis

Abductor pollicis brevis

Flexor pollicis brevis

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15
Q

What muscles do the ulnar nerve innervate?

A

Intrinsic muscles of the hand, lumbricals, hypothenar and interossei

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16
Q

What nerve is responsible for:

Finger flexion?

Finger extension?

Finger abduction?

A

Median

Radial

Ulnar

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17
Q

What is the most common winged scapula nerve lesion?

A

Long thoracic nerve (serratus anterior)

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18
Q

What nerve is responsible for the following movements?

knee extension

knee flexion

ankle dorsiflexion

Big toe extension

ankle plantar flexion

A

knee extension - femoral L3

knee flexion - sciatic/tibial L5, S1/2

ankle dorsiflexion - peroneal L4

Big toe extension - peroneal L5

ankle plantar flexion - tibial S1

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19
Q

Name some foot drop differentials?

A

Muscle: myopathy

Nerve: peroneal nerve, sciatic nerve

Root: L4/5

Anterior horn: MND

Brain: parasaggital mengingioma

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20
Q

Which lobe is Brocas area in and what is its function?

A

region in the frontal lobe of the dominant hemisphere, usually the left, of the brain with functions linked to speech production

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21
Q

Which lobe is Wernicke’s area in and what is its function?

A

located in the temporal lobe on the left side of the brain and is responsible for the comprehension of speech

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22
Q

Difference in signs between Epidural and Subdural Haematoma?

A

Epidural = rapidly expanding with arterial blood (middle meningeal)
LUCID INTERVAL - patient feels better for a small while due to the way it ‘holds’ the blood

extra-dural haematoma is lentiform like a lemon

Subdural = slowly expanding with venous blood (bridging veins), fluctuating consciousness

subdural haematoma is sickle shaped like a banana

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23
Q

How do subdural and epidural haematomas look on CT?

A

Epidural - lemon (biconvex)

Subdural - banana (biconcave)

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24
Q

What are Kernigs and Brudzinkis sign?

A
  • Kernig’s (inability to straighten knee when hip flexed 90 degrees)
  • Brudzinski’s- neck stiffness - flex neck and knee+hip flex too
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25
Q

How is MS diagnosed?

A

presence of multiple CNS lesions, which cause symptoms that:

  • Last longer than 24 hours
  • Are disseminated in space (clinically or on MRI)
  • Are disseminated in time (>1 month apart)
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26
Q

What may be the first manifestation of MS?

A

Optic Neuritis - inflammation of optic nerve - reduced visual acuity

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27
Q

What is Lhermitte’s phenomenon?

A

Neck flexion brings on a sudden sensation of an electric shock running down your spine

Sign of MS

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28
Q

What is Uhthoffs phenomenon?

A

Temporary worsening of symptoms caused by an increase in temperature

(e.g. - MS patient in hot bath)

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29
Q

Typical MS symptoms?

A 
Visual loss (Optic neuritis)
Pyramidal weakness, spastic paraparesis
Sensory disturbance
Cerebellar symptoms (nystagmus / vertigo / tremor /ataxia / dysarthria)
Bladder involvement / sexual dysfunction
Lhermitte’s & Uhthoff’s phenomenon
Fatigue
Cognitive impairment
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30
Q

Typical Giant Cell Arteritis features?

A 
Jaw claudication
Scalp/ temporal tenderness
Double vision
Severe and frequent Headaches
Fatigue
Weight Loss
Anaemia
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31
Q

How is GCA diagnosed?

A

Temporal artery biopsy

High ESR
Temporal tenderness
New onset localised headache

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32
Q

Types of MS?

A

1) Clinically isolated syndrome (CIS)
2) Relapsing- remitting
3) Primary progressive
4) Secondary progressive

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33
Q

What is Clinically Isolated Syndrome?

A

First episode of MS characteristics that must last 24 hours.

first attack of demyelination

A diagnosis of MS can be made afterwards if the MRI shows lesions similar to those of MS

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34
Q

What is Secondary Progressive MS?

A

SPMS follows relapsing remitting. Relapsing remitting will transition into progressive worsening of neurological functioning

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35
Q

What is Primary Progressive MS?

A

Worsening of neurological functioning from the onset of symptoms, without early relapses or remissions

15% of diagnosis

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36
Q

What is Relapsing-Remitting MS?

A

clearly defined attacks of new or increasing neurologic symptoms.
These attacks – also called relapses or exacerbations – are followed by periods of partial or complete recovery (remissions).

During remissions, there may be no symptoms, and no apparent progression of the disease.

37
Q

What is the Glasgow Coma Scale?

A

The Glasgow Coma Scale (GCS) is the most common scoring system used to describe the level of consciousness in a person following a traumatic brain injury

38
Q

How is the GCS scored?

A

1) Eye opening (E) 4
2) Verbal response (V) 5
3) Motor response (M) 6

the score may be expressed as ‘GCS 12 = E2 V4 M6’

39
Q

Describe the GCS scoring

A

Motor response

  1. Obeys commands
  2. Localises to pain
  3. Withdraws from pain
  4. Abnormal flexion to pain (decorticate posture)
  5. Extending to pain
  6. None

Verbal response

  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None

Eye opening

  1. Spontaneous
  2. To speech
  3. To pain
  4. None
40
Q

Symptoms of Myasthenia Gravis?

A

1) Droopy eyelids (ptosis)
2) Droopy mouth
3) Double vision (diplopia)
4) Dysphagia
5) Dysarthria (facial muscles)
6) Muscle weakness
7) shortness of breath

41
Q

What are the autoantibodies in myasthenia gravis?

A

acetylcholine receptor antibodies (AChR)

muscle-specific tyrosine kinase (MuSK) antibodies

42
Q

Myasthenia Gravis diagnosis?

A

Anti- acetylcholine (AchR) receptor

anti- muscle specific Kinase (MuSK) antibodies

Large thymus/ clusters of immune cells in thymus - Thymomas (tumours)

43
Q

Symptoms of Optic Neuritis?

A

1) Reduced visual acuity over days
2) Pain on moving eye
3) Exacerbated by heat/exercise
4) Afferent pupillary defect
5) Dyschromatopsia (especially red)

44
Q

Treatment of MS?

Acute
Chronic?

A

Acute Episode- Steroids

Chronic -
1) Interferon beta (prevents immune activation)

2) glatiramer acetate (similar to myelin)
3) Natalizumab prevents t-lymphocytes crossing blood-brain barrier

45
Q

Signs of Huntingtons?

A
  • Chorea
  • Dystonia
  • Lack of co-ordination
  • Cognitive decline
46
Q

How does Huntingtons occur?

A

autosomal dominant

1) Chromosome 4 produces Huntingtin protein
2) Mutation to the Huntington gene on chromosome 4 results in CAG nucleotide repeats
3) This leads to an abnormal Huntingtin protein & neurodegenerative disorder

47
Q

Symptoms of Progressive Supranuclear Palsy?

A
  • Falls and balance problems
  • lack of interest, behaviour change, thought and memory problems
  • muscle stiffness
  • Dysarthria / Dysphagia
  • difficult eye and eyelid movements, focusing/ looking up/down
48
Q

Cause of PSP?

A

PSP occurs when brain cells in certain parts of the brain are damaged as a result of a build-up of a protein called tau.

49
Q

What is the most common cause of head tremor? (titubation)

A

Essential tremor

50
Q

What may relieve an essential tremor?

what Medication can be given?

A

Alcohol / rest

Propanolol

51
Q

How is Hoffmans sign elicited?

A

Flick the middle finger nail.

Flexion of ipsilateral thumb or index = positive sign

52
Q

Best treatment for ALS?

A

Riluzole

53
Q

Common causes of Chorea?

A 
Huntingtons 
Wilsons 
ataxic telengiectasia 
SLE
Hypoglycaemia 
Pregnancy
54
Q

Which type of MND has the worst prognosis?

A

Progressive bulbar palsy - difficulty swallowing / speech / respiratory insufficiency

55
Q

What condition is due to a CAG repeat?

A

Huntingtons

56
Q

What condition is due to a CCG repeat?

A

Fragile X syndrome

57
Q

What should be offered between 6-24 hours for a patient with an acute ischaemic stroke + confirmed anterior circulation occlusion demonstrated by CTA or MRA?

A

Thrombectomy

58
Q

What should be offered within 24 hours for a patient with an acute ischaemic stroke + confirmed posterior circulation occlusion demonstrated by CTA or MRA?

A

Thrombolysis (IV Alteplase) + Thrombectomy

59
Q

Headache Red Flags?

A

1) Sudden onset + severe
2) Age >50
3) Neck pain/stiffness, photophobia
4) Fever
5) Papilloedema
6) New onset neuro deficit
7) Vomiting
8) Dizziness and visual disturbances / atypical aura (over an hour)

60
Q

What is Giant Cell Arteritis?

A

Granulomatous medium/large vessel vasculitis

large vessel vasculitis of the head, scalp, arms, neck

61
Q

Who does GCA tend to affect?

A

More females than males
Common in Scandinavia
Over 50 yrs old

62
Q

Common association with GCA?

A

Polymyalgia Rheumatica - (neck, shoulders,back,hip)

1) Stiffness
2) Aching
3) Pain

Jaw/ Tongue claudication
Fever
Headache

63
Q

What Anaemia is seen in GCA?

A

Normocytic Normochromic

64
Q

Lab signs for GCA?

A

Increased ESR
Increased LFTs (ALP)
Increased IgGs and complements

(CK not elevated as no muscle damage)

65
Q

What would be the most common diagnosis of GCA?

A

Triad of Anaemia, Fever, Headache and high ESR in an elderly female (>50)

Confirmed by temporal artery biopsy

66
Q

Treatment of GCA?

A

Steroids! fast

67
Q

Complications of GCA?

A

BLINDNESS
Aortic aneurysm

Heart attack/ stroke (rarer)

68
Q

What is the most likely cause of an Extradural haematoma

A

Trauma to the head fractures the temporal bone and tears the middle meningeal artery

69
Q

which foramen does the middle meningeal run through?

A

Foramen Spinosum

70
Q

what is the difference between a facial palsy caused by an upper or lower motor neurone lesion?

A

Upper motor neurone lesion spares the upper head e.g ‘wrinkle forehead/ raise eyebrows’

71
Q

What is Bells Palsy?

A

Lower motor neurone palsy of the facial nerve (7th)

Causing:

1) Facial droop on one side of the face
2) Cant close one eyelid
3) flat wrinkles on one side of forehead

72
Q

At what age are you more likely to get Myasthenia Gravis?

A

Women: Under 40

Men : Over 60

73
Q

What muscles are weakened in Myasthenia Gravis that is useful for diagnosis?

A

Weakness of extra-ocular muscles causing:

1) Diplopia
2) Ptosis (droopy eyelid)

74
Q

What is a Myasthenic Crisis?

A

Weakness of breathing muscle = life threatening

75
Q

What type of hypersensitivity reaction is Myasthenia Gravis and Multiple Sclerosis?

A

MG - type II (antibody mediated - AChR / MuSK)

MS - type IV (cell-mediated- T cell crosses brain barrier, activated by myelin, sends signal to allow more T cells across barrier)

76
Q

MS Risk factors?

A

Female
Vit D deficiency
HLA-DR2

77
Q

What is Charcots Neurological Triad?

A

1) Dysarthria (dysfunctional eating, talking, swallowing)
2) intention tremor (muscle weakness, spasms, ataxia, paralysis)
3) Nystagmus (Optic Neuritis, greying of vision, pain, double vision)

Linked to MS

78
Q

What neuro condition is associated with small cell lung cancer?

A

Lambert-Eaton Syndrome

waddling gait, hyporeflexia

79
Q

Treatment of Myasthenia Gravis?

A

Pyridostigmine (acetylcholinesterase inhibitor)

Steroids

Thymectomy

80
Q

What is given to someone if they have confirmed anterior circulation occlusion and their symptoms were within 6 hours?

A

Thrombolysis and Thrombectomy

81
Q

What is given to someone if they have confirmed anterior circulation occlusion and their symptoms were between 6 and 24 hours ago?

A

Thrombectomy

82
Q

What is given to someone if they have confirmed posterior circulation occlusion and their symptoms were less than 24 hours ago?

A

Thrombolysis and Thrombectomy

83
Q

What visual defects are caused by:

Temporal lesions?

A

contralateral superior quadranopia

PITS (Parietal-Inferior, Temporal-Superior)

84
Q

What visual defects are caused by:

Parietal lesions?

A

contralateral inferior quadranopia

PITS (Parietal-Inferior, Temporal-Superior)

85
Q

What visual defects are caused by:

Diabetes Insipidus due to craniopharyngioma

A

lower bitemporal hemianopia

86
Q

What visual defects are caused by:

Pituitary macroadenoma

A

Upper bitemporal hemianopia

87
Q

What visual defects are caused by:

Occipital cortex lesion?

A

Macula sparing homonymous hemianopia

88
Q

What visual defects are caused by:

Optic chiasm?

A

Bitemporal hemianopia

Danny's Phase 3A Medicine (10 decks)

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