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Phase 2a Medicine > Neurology > Flashcards

Neurology Flashcards

1
Q

What is a dermatome?

A

Area of skin supplied by a single spinal nerve

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2
Q

What is a myotome?

A

Volume of muscle supplied by a single spinal nerve

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3
Q

Where does light touch travel in the brain to?

A

Fasciculus gracilis and cuneatus on both sides

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4
Q

What % of strokes are embolic?

A

85%

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5
Q

What can embolus at a vertebral artery cause?

A
  1. Deafness
  2. Dizziness
  3. Cerebral disease
  4. Problems with motor coordination
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6
Q

What are the types of intercranial haemorrhage?

A
  1. Extradural
  2. Subdural
  3. Subarachnoid
  4. Intracerebral
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7
Q

What layer of the meninges forms part of the BBB?

A

Pia mater

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8
Q

Where does the circle of Willis lie?

A

Subarachnoid space

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9
Q

What can cause extradural haemorrhage?

A
  1. Trauma
  2. Fractured skull
  3. Bleeding from middle meningeal artery
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10
Q

What are the signs of extradural haemorrhage?

A
  1. Lucid period
  2. Rapid rise in ICP
  3. Coma
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11
Q

What is the pathophysiology of subdural haemorrhage?

A
  1. Bleeding from bridging veins, low pressure so stops soon
  2. Days later haematoma starts to autolyse
  3. Increase in oncotic and osmotic pressure sucks water into haematoma
  4. Gradual rise in ICP
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12
Q

Who is at risk of subdural haemorrhage?

A
  1. Alcoholics
  2. Dementia
  3. Shaken babies
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13
Q

What can cause subarachnoid haemorrhage?

A

Berry aneurysms

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14
Q

What is the pathophysiology of subarachnoid haemorrhage?

A

Rupture of arteries forming circle of Willis

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15
Q

What are the symptoms of subarachnoid haemorrhage?

A
  1. Sudden onset severe headache
  2. Photophobia
  3. Reduced consciousness
  4. Thunderclap headache
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16
Q

What methods can be used to investigate vessels?

A
  1. Angiogram
  2. CT
  3. MRI
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17
Q

What level do common carotid arteries bifurcate?

A

C3-C4

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18
Q

Where does the cervical ICA run?

A

Behind and then medial to ECA

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19
Q

Where does the petrous ICA run?

A

Penetrates temporal bone and runs horizontally in carotid canal

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20
Q

Where does the cavernous ICA run?

A

In cavernous sinus

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21
Q

What does cavernous ICA supply?

A
  1. Dura mater
  2. CN 3-6
  3. Posterior pituitary
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22
Q

What are the key branches of the supraclinoid ICA?

A
  1. Ophthalmic artery
  2. Superior hypophyseal arteries
  3. Posterior communicating artery
  4. Anterior choroidal artery
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23
Q

Which MCA branches run laterally to limen insulae?

A

Lateral lenticulostriate branches (M1)

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24
Q

Why are the lateral lenticulostriate branches a key territory for infarct?

A

They are terminal branches with no anastomoses

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25
Q

What do lateral lenticulostriate arteries supply?

A
  1. Lentiform nucleus
  2. Caudate nucleus
  3. Internal capsule
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26
Q

Where do most strokes occur?

A

Middle cerebral artery

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27
Q

What does the posterior inferior cerebellar artery (PICA) supply?

A

Medulla and inferiore cerebellum

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28
Q

What artery is usually blocked in strokes of young people?

A

Basilar artery

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29
Q

What supplies primary visual cortex?

A

Posterior cerebral artery

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30
Q

What are the primary headache types?

A
  1. Migraine
  2. Cluster
  3. Tension type
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31
Q

What are the secondary headache types?

A
  1. Meningitis
  2. SAH
  3. GCA
  4. Idiopathic intracranial HTN
  5. Medication overuse headache
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32
Q

What are the risk factors for secondary headache?

A
  1. > 50
  2. Hx of HIV/cancer
  3. Changing personality or cognitive dysfunction
  4. Vomiting without other obvious cause
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33
Q

What is seen on examination for secondary headache?

A
  1. Fever
  2. Altered consciousness
  3. Neck stiffness
  4. Other abnormal neurological exam e.g. weakness
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34
Q

What are the red flags for brain tumours?

A
  1. New headache with Hx cancer
  2. Cluster headache
  3. Seizure
  4. Significantly altered consciousness, confusion
  5. Papilloedema
  6. Other abnormal nerve exam
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35
Q

How long do migraines last?

A

4-72hr

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36
Q

Describe a migraine

A
  1. Unilateral
  2. Pulsing
  3. Moderate/severe
  4. Aggravation by routine physical activity
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37
Q

What other symptoms can occur during a migraine?

A
  1. Nausea and/or vomiting
  2. Photophobia
  3. Phonophobia
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38
Q

How many migraine pt. have auras?

A

20%

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39
Q

What can auras consist of?

A
  1. Fully reversible visual symptoms with positive +/- negative features
  2. Fully reversible dysphasic speech disturbance
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40
Q

How long do tension headaches last?

A

30 mins to 7 days

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41
Q

Describe a tension headache

A
  1. Bilateral
  2. Pressing/tightening quality
  3. Mild or moderate intensity
  4. Not aggravated by routine physical activity
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42
Q

What other symptoms are present with a tension headache?

A
  1. Anorexia

2. Photophobia OR phonophobia

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43
Q

Describe a cluster headache

A
  1. Severe or very severe
  2. Unilateral
  3. Orbital, supraorbital and/or temporal pain
  4. 15-180 min if untreated
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44
Q

What are the accompanying features of cluster headaches?

A
  1. Ipsilateral cranial autonomic features

2. Sense of restlessness or agitation

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45
Q

What happens in episodic cluster headaches?

A

> 2 cluster periods lasting 7 days to 1 year separated by pain free periods lasting >1 month

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46
Q

What happens in chronic cluster headaches?

A

Attacks occur for >1 year without remission or with remission lasting <1 month

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47
Q

What are the characteristics of trigeminal neuralgia?

A
  1. Recurring in paroxysmal attacks from a fraction of a second to 2 mins
  2. Severe intensity
  3. Electric shock like, shooting, stabbing or sharp
  4. Precipitated by innocuous stimuli to affected side of face
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48
Q

What is the Rx for primary headache?

A
  1. Oral triptan and NSAID/paracetamol
  2. Anti-emetic
  3. Topiramate
  4. Propranolol
  5. Amitriptyline
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49
Q

What are the symptoms of meningitis?

A
  1. Headache
  2. Pyraxial
  3. Photophobia
  4. Neck stiffness + pyrexia
  5. Rash
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50
Q

What is the Ix for SAH?

A
  1. CT
  2. LP
  3. Angiography
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51
Q

What is the Rx for SAH?

A
  1. Resuscitation
  2. Nimodipine
  3. Intervention to prevent re-bleeding
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52
Q

What are the symptoms of raised ICP?

A
  1. Worse on waking
  2. Worse coughing, sneezing
  3. Worse lying down
  4. N&V
  5. Papilloedema
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53
Q

What are the risk factors for idiopathic intracranial HTN?

A
  1. Obesity

2. Drugs e.g. tetracycline

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54
Q

What is the symptoms for idiopathic intracranial HT?

A
  1. Raised ICP headache
  2. Visual disturbance
  3. Papilloedema
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55
Q

What are the Ix for idiopathic intracranial HTN?

A
  1. CT
  2. LP (high opening pressure)
  3. MRI
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56
Q

What is the Rx for idiopathic intracranial HTN?

A

Acetazolamide, topiramate, diuretics

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57
Q

What are the criteria for giant cell arteritis (GCA)?

A
  1. > 50
  2. New headache
  3. Temporal artery abnormality (tender, decreased pulsation)
  4. ESR >50
  5. Biopsy abnormality
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58
Q

What are the red flags for GCA?

A
  1. > 50

2. Jaw claudication

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59
Q

What are the main causes of a chronic daily headache?

A
  1. Chronic migraine

2. Medication overuse headache

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60
Q

How often does medication overuse headache occur?

A

> 15 days/month

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61
Q

Describe medication overuse headache

A

Developed or markedly worse during drug use

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62
Q

Give 3 types of drugs that can cause medication overuse headache

A
  1. Ergotamine
  2. Opioids
  3. Triptans
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63
Q

What is the pathophysiology of meningitis?

A
  1. Bacteria enter CSF and replicate as no immune system
  2. Leaky blood vessels let WBC into CSF
  3. Inflammation causes brain swelling
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64
Q

What are the symptoms of meningitis?

A
  1. Headache
  2. Neck stiffness
  3. Photophobia
  4. Fever
  5. Altered consciousness
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65
Q

Which age is most at risk of bacterial meningitis?

A

Children <5 years

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66
Q

What are the complications of bacterial meningitis?

A
  1. Skin scars
  2. Amputation
  3. Hearing loss
  4. Seizures
  5. Brain damage
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67
Q

What is the Rx for bacterial meningitis in primary care?

A

Benzylpenicillin

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68
Q

What is the immediate management for bacterial meningitis in hospital?

A
  1. Stabilise ABCs
  2. Assess Glasgow coma score
  3. Blood cultures
  4. Broad spectrum Abx
  5. Steroids (dexamethasone)
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69
Q

What Abx are given for bacterial meningitis?

A
  1. Ceftriaxone

2. Cefotaxime

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70
Q

What are the indications for neuroimaging before LP?

A
  1. Focal neurological signs
  2. Presence of papilloedema
  3. Continuous or uncontrolled seizures
  4. GCS <12
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71
Q

What are the contraindications to LP?

A
  1. Respiratory or cardiac compromise
  2. Abnormal clotting
  3. Severe sepsis or rapidly evolving rash
  4. Raised ICP
  5. Infection at site of LP
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72
Q

What is the most common meningitis bug?

A

Neisseria meningitidis

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73
Q

Describe neisseria meningitidis

A

Gram negative diplococci (N for Negative)

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74
Q

What is the Dx if Neisseria meningitidis is found in blood culture?

A

Meningococcal septicaemia

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75
Q

Give 3 other common causes of bacterial meningitis

A
  1. Strep. pneumonia
  2. Listeria spp.
  3. Group B strep
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76
Q

What viruses can cause acute meningitis?

A
  1. Herpes simplex virus
  2. Varicella zoster virus
  3. Enterovirus
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77
Q

What can cause chronic meningitis?

A
  1. Mycobacterium tuberculosis
  2. Syphilis
  3. Cryptococcal
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78
Q

What are the risk factors for bacterial meningitis?

A
  1. Students
  2. Travel
  3. Immunosuppressed
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79
Q

What is the CSF appearance in bacterial meningitis?

A

Cloudy

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80
Q

What is the DDx for meningitis?

A
  1. SAH
  2. Primary headache
  3. Flu/viral illness
  4. Sinusitis
  5. Brain abscess
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81
Q

What is given to close contacts of a meningitis pt.?

A

Ciprofloxacin

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82
Q

What is encephalitis?

A

Inflammation of brain parenchyma

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83
Q

What is the most common cause of encephalitis?

A

Herpes simplex virus

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84
Q

What are the early symptoms of encephalitis?

A
  1. Flu like illness
  2. Headache
  3. Fever
  4. Confusion
  5. N&V
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85
Q

What are the late symptoms of encephalitis?

A
  1. Altered GCS (confusion, coma)
  2. Fever
  3. Cognitive impairment
  4. Seizures
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86
Q

What are the Ix for encephalitis?

A
  1. MRI head
  2. EEG
  3. LP
  4. HIV test
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87
Q

What is the Rx for encephalitis?

A
  1. Physio and neuro rehab

2. Aciclovir

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88
Q

What are the long term effects of encephalitis?

A
  1. Severe amnesic syndrome
  2. Neurological deficit
  3. Personality change
  4. Speech problems
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89
Q

What causes tetanus infection?

A

Inoculation through skin with Clostridium tetani spores

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90
Q

What toxins are produced by Clostridium tetani?

A
  1. Tetanolysin

2. Tetanospasmin

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91
Q

What is the pathophysiology of tetanus?

A
  1. Tetanospasmin travels up axons via retrograde flow
  2. Interferes with inhibitory NT release
  3. Excitatory neurons act unopposed (more firing)
  4. Continuous muscle contraction/spasm
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92
Q

What is the incubation period of tetanus?

A

3 to 21 days

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93
Q

What are the signs of generalised tetanus?

A
  1. Risus sardonicus (Satanic smile)

2. Opisthotonos (whole body spasm)

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94
Q

What is the management of tetanus?

A
  1. Vaccine
  2. Muscle relaxants
  3. Paracetamol
  4. Immunoglobulin
  5. Metronidazole
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95
Q

What are the symptom of rabies?

A
  1. Flu-like symptoms
  2. Paraesthesia at bite site
  3. Cerebral dysfunction
  4. Anxiety
  5. Confusion
  6. Agitation
  7. Hydrophobia
  8. Insomnia
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96
Q

What is the Rx for rabies?

A
  1. Supportive

2. Prophylaxis (vaccine, immunoglobulin)

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97
Q

What is the key sign of 3rd nerve palsy?

A

Fixed dilated pupil

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98
Q

What type of thrombosis is OCP a risk for in the venous sinuses?

A

Sagittal sinus thrombosis

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99
Q

What are the names of the holes that allow CSF from ventricles into subarachnoid space?

A

Magendie (midline) and Luschka (lateral)

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100
Q

What is the result of the Magendie and Luschka holes being blocked?

A

Obstructive hydrocephalus

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101
Q

What are the symptoms of cerebellar syndrome?

A
  1. Ataxia
  2. Nystagmus
  3. Drunken feeling
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102
Q

What are the structures associated with the brainstem?

A
  1. CN III-XII
  2. Descending motor tracts (pyramidal)
  3. Ascending sensory tracts (Lemnisci)
  4. Reticular activation
  5. Cerebellar peduncles
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103
Q

What does the reticular activating system control?

A
  1. Alertness
  2. Sleep/wake
  3. REM/non REM sleep
  4. Respiratory centre
  5. Cardiovascular drive
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104
Q

What are the sights of cavernous sinus syndrome?

A
  1. Facial numbness
  2. Paralytic squint
  3. Fixed dilated pupil
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105
Q

What are the consequences of middle ear infection?

A
  1. Deafness

2. Facial palsy

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106
Q

What is the condition associated with rapid changes in serum Na?

A

Central pontine myelonecrosis

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107
Q

What are the criteria for brainstem death?

A
  1. Pupils
  2. Corneal reflex
  3. Caloric vestibular reflex
  4. Cough reflex
  5. Gag reflex
  6. Respirations
  7. Response to pain
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108
Q

What part of the NS is affected in MS?

A

CNS

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109
Q

What is the common age of onset for MS?

A

20-40

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110
Q

What are the risk factors for MS?

A
  1. Caucasian
  2. Female
  3. Latitude
  4. Low Vit D
  5. Genetics
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111
Q

What is the pathophysiology of MS?

A

Exposure to antigen which drives system to produce auto reactive lymphocytes which are detrimental and cause demyelination and inflammation

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112
Q

What is Eutoph’s phenomenon?

A

Remyelinated cells will have thin myelin and pt. never fully recover

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113
Q

What are the most common patterns of MS?

A
  1. Macrophage mediated

2. Antibody mediated

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114
Q

What are the typical symptoms of MS?

A
  1. Optic neuritis
  2. Spasticity
  3. Sensory symptoms
  4. Lhermitte’s sign
  5. Nystagmus, double vision
  6. Bladder and sexual dysfunction
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115
Q

What are the diagnostic criteria for MS?

A
  1. 2+ CNS lesions disseminated in time and space

2. Exclusion of conditions giving a similar clinical picture

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116
Q

What are the Ix for MS?

A
  1. MRI

2. CSF - inflammatory proteins

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117
Q

What is the DDx for MS?

A
  1. SLE
  2. Syphilis
  3. Lyme disease
  4. Sjogren’s syndrome
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118
Q

What are the Rx for MS?

A
  1. Steroids - betaferon
  2. Methylprednisolone
  3. Nataluzimab
  4. Diazepam
  5. Treat symptoms
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119
Q

Describe fatigue in MS

A
  1. Exacerbated by heat
  2. Improved by cool temperatures
  3. Makes other symptoms appear worse
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120
Q

What is the DDx for epilepsy?

A
  1. Hypoglycaemia
  2. Migraine
  3. Postural syncope
  4. TIA
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121
Q

What are the main reasons for loss of consciousness?

A
  1. Cardiac/BP related
  2. Epileptic seizures
  3. Dissociative seizures
122
Q

What is epilepsy?

A

Recurrent, unprovoked epileptic seizures

123
Q

What is an epileptic seizure?

A

A paroxysmal event in which changes of behaviour, sensation or cognitive processes are caused by excessive, hyper synchronous neuronal discharges in brain

124
Q

How long does a seizure last?

A

30-120s

125
Q

What are positive ictal symptoms?

A

Excessive e.g. seeing, hearing, feeling that isn’t there

126
Q

What are postictal symptoms?

A

Follow positive ictal symptoms e.g. weakness, loss of function

127
Q

Give 2 examples of typical seizure phenomena?

A
  1. Lateral tongue bite

2. Deja vu

128
Q

What is syncope?

A

Paroxysmal event in which changes in behaviour, sensation and cognitive processes are caused by an insufficient blood or oxygen supply to brain

129
Q

How long does a syncope last?

A

5-30s

130
Q

What are pre syncopal symptoms?

A
  1. Stars over whole visual field
  2. Noises distorted
  3. Dizzy
  4. Light headed
  5. Vision goes black
131
Q

What is a non-epileptic seizure (NES)?

A

Paroxysmal event in which changes in behaviour, sensation and cognitive function caused by mental processes associated with psychosocial distress

132
Q

What are the factors suggestive of epilepsy?

A
  1. Tongue biting
  2. Head turning
  3. Muscle pain
  4. LOC >5 min
  5. Cyanosis
  6. Postictal confusion
133
Q

What are the factors suggestive of syncope?

A
  1. Prolonged upright position
  2. Sweating prior to LOC
  3. Nausea
  4. Pallor
134
Q

What are 5 factors suggestive of NES?

A
  1. Pelvic thrusting
  2. Long duration
  3. Closed eyes
  4. Ictal crying
  5. No cyanosis
135
Q

What is the first line Rx for structural epilepsy?

A

Carbamazepine or lamotrigine

136
Q

When is genetic generalised epilepsy most common?

A

Childhood

137
Q

What is first line treatment for genetic generalised epilepsy?

A

Valproate or lamotrigine

138
Q

What seizure types are associated with structural epilepsy?

A
  1. Partial seizure with(out) LOC

2. Secondary generalised seizures

139
Q

What seizure types are associated with genetic generalised epilepsy?

A
  1. Absence seizures
  2. Myoclonic seizures
  3. Primary generalised tonic clonic seizures
140
Q

Give 3 drugs that can treat focal seizures

A
  1. Carbamazepine
  2. Phenytoin
  3. Vigabatrin
141
Q

Give 3 drugs that can treat focal and generalised seizures

A
  1. Valproate
  2. Lamotrigine
  3. Topiramate
142
Q

Give 2 drugs that can treat generalised seizures

A
  1. Ethosuximide

2. Rufinamide

143
Q

What are the mechanisms of action of AEDs?

A
  1. Inhibit excitatory cells
  2. Increase activity of inhibitory interneurons
  3. Inhibit post-synaptic cells so it is less sensitive to excitatory NT
144
Q

What are the Rx for refractory epilepsy?

A
  1. Resective surgery
  2. Hemispherectomy
  3. Tractotomy
  4. Electrostimulation
  5. Vagus nerve stimulation
145
Q

What are the symptoms of lateral medullary syndrome on ipsilateral side?

A
  1. Horner’s syndrome
  2. Limb ataxia
  3. Loss of facial sensation
  4. Dysarthria
  5. Dysphagia
146
Q

What are the symptoms of lateral medullary syndrome on contralateral side?

A

Loss of pain and temperature sensation

147
Q

Where is sense lost if there is a lesion to dorsal column?

A

Ipsilateral side

148
Q

What are the symptoms of Brown Squared syndrome at level of lesion?

A

Ipsilateral spinothalamic

149
Q

What are the symptoms of Brown Squared syndrome below lesion?

A
  1. Ipsilateral corticospinal tract dysfunction
  2. Ipsilateral dorsal column dysfunction
  3. Contralateral spinothalamic tract dysfunction
150
Q

What are the causes of secondary damage as a result of head injury?

A
  1. Physiological response to trauma
  2. Effects of hypoxia/ischaemia
  3. Infection
151
Q

What does skull fracture increase risk of?

A
  1. Haematoma
  2. Infection
  3. Aerocele
152
Q

How do extradural haematoma cause death?

A
  1. Brain displacement
  2. Raised ICP
  3. Herniation
153
Q

What is the pathophysiology of subdural haematoma?

A

Tear to bridging veins

154
Q

What are the risk factors for subdural haematoma?

A
  1. Age
  2. Dementia
  3. Alcohol
155
Q

What are the causes of traumatic SAH?

A
  1. Contusion/laceration
  2. Base of skull fracture
  3. Vertebral artery rupture/dissection
  4. Intraventricular haemorrhage
156
Q

What causes superficial cerebral haemorrhage?

A

Severe contusion

157
Q

What causes deep cerebral haemorrhage?

A

Diffuse axonal injury

158
Q

What are the long term effects of diffuse traumatic axonal injury?

A
  1. Thinning of corpus callosum

2. Gliding contusions

159
Q

What are the causes of brain swelling?

A
  1. Congestive brain swelling
  2. Vasogenic oedema
  3. Cytotoxic oedema
160
Q

What are the complications of hypoxia ischaemia (HI)?

A
  1. Infarction

2. Hypoxic ischaemic damage

161
Q

Which brain part is most susceptible to HI?

A

Hippocampus

162
Q

What are the symptoms of chronic traumatic encephalopathy (CTE)?

A
  1. Personality change
  2. Memory problems
  3. Epilepsy
  4. Parkinsonism
  5. Gait problems
163
Q

What is the pathophysiology of CTE?

A
  1. Atrophy
  2. Enlarged ventricles with fenestrated cavuum septum
  3. Tau-positive neurofibrillary and astrocytic tangles
164
Q

What is the diagnostic criteria for CTE?

A

Both neurons and astrocytes effected

165
Q

What innervates muscle spindles?

A

Gamma motor neurones

166
Q

What happens when a muscle is stretched?

A
  1. Afferent impulses from muscle spindles

2. Reflex partial contraction of muscle

167
Q

What are the potential sites of damage to motor neurons?

A
  1. Motor nuclei
  2. Motor neurons
  3. Spinal ventral roots
  4. Peripheral nerves
  5. NMJ
  6. Muscle
168
Q

What are the clinical features of LMN lesions?

A
  1. Muscle tone reduced
  2. Muscle wasting
  3. Fasciculation
  4. Depressed reflexes
169
Q

What is the pathophysiology of MND?

A
  1. Motor neuron damaged
  2. Muscle loses electrical supply
  3. Muscle wastage
170
Q

What are the investigations for LMN conditions?

A
  1. Neurophysiology nerve conduction
  2. MRI head/spine
  3. Bloods e.g. muscle enzymes, peripheral neuropathy screen
  4. LP
171
Q

What are the neural inputs into the final common pathway?

A
  1. Reflex arc
  2. Corticospinal pathway
  3. Extrapyramidal system
  4. Cerebellum
172
Q

What is the corticospinal tract?

A

A major descending pathway connecting LMN and UMN, important in control of voluntary movements

173
Q

Where do most corticospinal tract fibres crossover?

A

Medullary pyramid

174
Q

What are the clinical features of upper motor neuron pathology?

A
  1. Spasticity
  2. Tendon reflexes are brisk
    • Babinski sign
  4. Limb muscle weakness
  5. Emotional lability
175
Q

What is the pattern of limb muscle weakness in UMN pathology?

A
  1. Upper limbs extensors weaker than flexors
  2. Low limbs flexors weaker than extensors
  3. Finer movements severely impaired
176
Q

What are the common causes of UMN pathology?

A
  1. Stroke
  2. MS
  3. Spinal compression
  4. Tumour
  5. MND
177
Q

What are the Ix for UMN pathologies?

A
  1. MRI brain/spine
  2. Blood tests for metabolic disorder
  3. CSF examination e.g. oligoclonal bands
178
Q

What are the cardinal symptoms of brain tumour?

A
  1. Raised ICP symptoms
  2. Progressive neurological deficit
  3. Epilepsy
179
Q

What are the symptoms of raised ICP?

A
  1. Headache
  2. Reduced conscious level
  3. N+V
180
Q

Where are the commonest brain metastases from?

A
  1. Lung
  2. Breast
  3. Colorectal
  4. Testicular
  5. Renal cell
181
Q

What is the most common primary brain tumour type?

A

High grade glioma (HGG)

182
Q

What distinguishes stage of brain tumours?

A
  1. Cellularity
  2. Mitotic activity
  3. Vascular proliferation
  4. Necrosis
183
Q

Describe a low grade glioma (LGG)

A

Slow growing but will undergo anapaestic transformation

184
Q

When is LGG most often diagnosed?

A

Age 35

185
Q

Give 4 prognostic factors for LGG

A
  1. Histology type
  2. Age
  3. Size of tumour
  4. Location
186
Q

What is the median age of onset for HGG?

A

45-60

187
Q

What are the causes of HGG?

A
  1. Ionising radiation
  2. FHx
  3. Immunosuppression
188
Q

What are the symptoms of brain tumours?

A
  1. Headache
  2. Seizures
  3. Focal neurological symptoms
  4. Behavioural changes
189
Q

Describe a typical brain tumour headache

A
  1. Woken by headache
  2. Worse in morning
  3. Postural
  4. N&V associated
190
Q

What are the focal symptoms of brain tumour?

A
  1. Weakness
  2. Sensory loss
  3. Visual/speech disturbance
  4. Ataxia
191
Q

What are the non-focal symptoms of brain tumour?

A
  1. Personality change
  2. Memory disturbance
  3. Confusion
192
Q

What are the signs of brain tumour?

A
  1. Papilloedema
  2. Hemiparesis
  3. Hemisensory loss
  4. Visual field defect
  5. Dysphagia
193
Q

What are the investigations for brain tumour?

A
  1. CT contrast
  2. MRI
  3. Brain biopsy
  4. Molecular markers
194
Q

What are the Rx for HGG?

A
  1. Steroids
  2. Surgery
  3. Radiotherapy
  4. Chemo - temozolomide
195
Q

What are the Rx for LGG?

A
  1. Surgery
  2. Radiotherapy
  3. Chemotherapy
196
Q

What are the symptoms of pituitary tumour?

A
  1. Excessive hormone production
  2. Visual field problems
  3. Inadequate hormone production
197
Q

What are the Rx for secondary brain tumour?

A
  1. Surgery
  2. Radiotherapy
  3. Chemo
  4. Supportive care
198
Q

What form is used in primary care the assess cognitive function?

A

6CIT

199
Q

What are the symptoms of dementia?

A
  1. Memory loss
  2. Problem solving
  3. Language
200
Q

What is seen on the brain of Alzheimer’s (AD) pt.?

A
  1. EX amyloid plaques

2. IC neurofibrillary tangles

201
Q

What are the features seen in AD?

A
  1. Gradual and progressive change in memory function >6m

2. Impaired performance on episodic memory test

202
Q

What lobes tend to be affected in AD?

A

Temporal and parietal lobes

203
Q

What is the DDx for AD?

A
  1. Vascular dementia
  2. Mixed dementia
  3. Dementia with Lewy bodies
  4. Depressive pseudo dementia
204
Q

What are the psychiatric changes in AD?

A
  1. Social withdrawal
  2. Apathy
  3. Delusions
  4. Agitation
205
Q

What are the Ix for dementia?

A
  1. Memory tests
  2. MRI
  3. PET scan
  4. LP (more amyloid)
206
Q

What is seen on a dementia MRI?

A

Atrophy

207
Q

What is the Rx for dementia?

A
  1. Support
  2. Ach inhibitors
  3. Carers
  4. Prevention
  5. Memantine
208
Q

What are functional symptoms?

A

Disorder of function of body, rather than structure

209
Q

What are organic symptoms?

A

Structural problem with body which can be detected by examination or investigation

210
Q

What is depleted in AD?

A

Acetyl choline

211
Q

What is depleted in PD?

A

Serotonin, NA, DA

212
Q

What causes psychosis in PD Rx?

A

Excess DA

213
Q

What are acute neurological pathologies associated with?

A

Delirium or confusional states with prominent impairment of attention

214
Q

What individual factors can affect psychiatric presentation?

A
  1. Age
  2. Sex
  3. Education
  4. Prior psychiatric Hx
215
Q

What are the psychiatric symptoms of Wilson’s disease?

A
  1. Personality change
  2. Mood disturbance
  3. Psychosis
  4. Cognitive impairment
216
Q

What are the psychiatric symptoms of Huntington’s?

A
  1. Subcortical dementia
  2. Anxiety
  3. Personality changes
  4. Hallucinations
217
Q

What are the symptoms of fronto-temporal dementia?

A
  1. Apathy
  2. Anxiety
  3. Egocentricity
  4. Elevated mood
  5. Neglect personal appearance
218
Q

What psychiatric problems can be caused by a stroke?

A
  1. Personality change
  2. Affective disorder
  3. Psychosis
219
Q

What are the causes of transient global amnesia?

A

Migraine-like depression of temporal lobe function

220
Q

What are somatisation disorders?

A

When physical symptoms are caused by mental or emotional factors

221
Q

What is ataxia

A

Descriptive term for loss of coordination, clumsiness, tendency to fall

222
Q

What is the output element of the cerebellum?

A

Purkinje cells

223
Q

What are the symptoms of cerebellar dysfunction?

A
  1. Slurring of speech
  2. Unsteadiness
  3. Stumbles and falls
224
Q

What are the examinations for cerebellar dysfunction?

A
  1. Gait
  2. Limb ataxia
  3. Eye movements
  4. Speech
  5. Sensory ataxia
225
Q

What is the Ix for cerebellar dysfunction?

A

MRI head

226
Q

What are the signs of cerebellar dysfunction?

A
  1. Nystagmus
  2. Dysarthria
  3. Action tremor
  4. Limb ataxia
  5. Gait ataxia
227
Q

What gene is found in 71% of pt. with idiopathic sporadic ataxia?

A

HLA DQ2

228
Q

What toxins can cause ataxia?

A
  1. Alcohol
  2. Phenytoin
  3. Lithium
229
Q

What is the main neurodegenerative cerebellar dysfunction?

A

Multisystem atrophy - C

230
Q

How many strokes are ischaemic?

A

85%

231
Q

How many strokes are haemorrhagic?

A

15%

232
Q

What is the main cause of intracerebral haemorrhagic stroke?

A

High BP

233
Q

What is the DDx for stroke?

A
  1. Hypoglycaemia
  2. Migrainous aura
  3. Mass lesions
  4. Simple partial seizure
234
Q

What is the management for TIA?

A
  1. Assess stroke risk with ACBD2 score
  2. Statin e.g. simvastatin
  3. Antiplatelet e.g. clopidogrel
  4. Treat BP if raised
235
Q

Where do most brain tumours occur in children?

A

Posterior fossa

236
Q

What is the most common neuroepithelial tumour?

A

Astrocytoma

237
Q

What is the pathway of progression of astrocytoma?

A
  1. Cell of origin
  2. Astrocytoma
  3. Anaplastic astrocytoma
  4. Glioblastoma
238
Q

When is oligodendroglioma most common?

A

4th-5th decades

239
Q

Co-deletion of what gene gives a better prognosis of oligodendroglioma?

A

1p19q

240
Q

What gene is mutated in neuroepithelial tumour?

A

IDH1

241
Q

What indicates low grade lesions diagnostically?

A

Rosenthal fibres

242
Q

How do secondary brain tumours often present?

A

More oedema

243
Q

What is one of the major complications of raised ICP?

A

Herniation

244
Q

What is the result of no intervention for internal herniation?

A

Haemorrhage

245
Q

What is the prevalence of PD in >65s?

A

3%

246
Q

What are the symptoms of PD?

A
  1. Bradykinesia
  2. Akinesia
  3. Tremor at rest
  4. Rigidity
247
Q

What are the signs of PD?

A
  1. Shuffling gait
  2. Increased tone
  3. Asymmetrical reduced arm swing
  4. Rest tremor
  5. Decreasing amplitude of repetitive movement
248
Q

What is seen in the brain of a PD pt.?

A

Reduced substantia nigra

249
Q

How is PD diagnosed?

A
  1. Examination and Hx
  2. DaTSCAN - reduced DA
  3. CT head
250
Q

What are the Rx for PD?

A
  1. L-DOPA
  2. DA agonist e.g. ropinirole
  3. COMT inhibitors
  4. MAO-B inhibitors e.g. rasagiline
  5. Anticholinergics
251
Q

What are the side effects of anticholinergics?

A
  1. Cognition
  2. Confusion
  3. Systemic
252
Q

What are the complications of PD?

A
  1. Depression
  2. Dementia
  3. Constipation
  4. Anxiety
  5. Increased urinary frequency
253
Q

What symptoms are NOT seen in PD at the start?

A
  1. Dementia
  2. Incontinence
  3. Symmetry
  4. Early falls
254
Q

What are the symptoms of normal pressure hydrocephalus?

A
  1. Magnetic gait
  2. Incontinence
  3. Dementia
255
Q

How is normal pressure hydrocephalus diagnosed?

A

Enlarged ventricles on CT head

256
Q

What is the Rx for normal pressure hydrocephalus?

A

Surgical shunt

257
Q

What is the Rx for essential tremor?

A
  1. Beta blockers
  2. Primidone
  3. Gabapentin
258
Q

What are the cardinal features of Huntington’s disease (HD)?

A
  1. Chorea
  2. Dementia
  3. Psychiatric problems
  4. Positive FHx
259
Q

What are the signs of HD?

A
  1. Abnormal eye movement
  2. Chorea
  3. Ataxia
  4. Parkinsonism
260
Q

What is the Rx for HD?

A

Treat symptoms

  1. Sulpride
  2. SSRIs
  3. Haloperidol
  4. Risperidone
261
Q

What is mononeuropathy?

A

Problem with one nerve

262
Q

What is polyneuropathy?

A

Problem with many nerves

263
Q

What is the cause of carpal tunnel syndrome?

A

Median nerve entrapment at wrist

264
Q

What are the symptoms of peripheral neuropathies (PN)?

A
  1. Ataxia
  2. Muscle cramp
  3. Weakness
  4. Fasciculations
  5. Atrophy
265
Q

How are axonal PN classified?

A
  1. Symmetrical sensorimotor
  2. Asymmetrical sensory
  3. Asymmetrical sensorimotor
266
Q

What is the presentation of symmetrical sensorimotor PN?

A

Tingling in fingers or toes which moves more proximal then motor symptoms start

267
Q

What is affected in asymmetrical sensory PN?

A

Dorsal root ganglia

268
Q

What is seen on clinical examination in PN?

A
  1. Reduced or absent tendon reflexes
  2. Sensory deficit
  3. Weakness
269
Q

How are PN diagnosed?

A
  1. Nerve conduction test

2. Questionnaires

270
Q

What is seen in demyelinating PN on nerve conduction?

A

Slow conduction velocities

271
Q

What is seen in nerve conduction for PN with axonal problems?

A

Reduced amplitudes of potentials

272
Q

What are 4 causes of axonal PN?

A
  1. HIV
  2. Vasculitis
  3. Porphyria
  4. Hepatitis
273
Q

What systemic disease are associated with PN?

A
  1. DM
  2. Vit B12 deficiency
  3. Coeliac disease
274
Q

What are the main types of Guillain Barre syndrome?

A
  1. Demyelinating
  2. Axonal motor
  3. Axonal sensorimotor
275
Q

What is the presentation of Guillain Barre syndrome?

A

Rapid ascending paralysis and sensory deficits

276
Q

What is the usual cause of Guillain Barre syndrome?

A

Campylobacter GI infection

277
Q

What is the Rx for Guillain Barre syndrome?

A

IVIG plasma exchange

278
Q

What are the Rx for PN?

A
  1. Pain e.g. gabapentin
  2. Cramps e.g. quinine
  3. Balance e.g. physio
279
Q

What does an anterior circulation stroke block?

A

Artery from or off circle of Willis

280
Q

What does posterior circulation stroke block?

A

Basilar or vertebral arteries

281
Q

Stroke to what vessel causes the biggest deficit?

A

MCA

282
Q

What are the symptoms of ACA stroke?

A
  1. Leg weakness
  2. Sensory disturbance in legs
  3. Gait apraxia
  4. Incontinence
  5. Drowsiness
283
Q

How is stroke diagnosed?

A

CT head

284
Q

What are the symptoms of MCA stroke?

A
  1. Contralateral arm and leg weakness
  2. Contralateral sensory loss
  3. Hemianopia
  4. Aphasia
  5. Facial droop
285
Q

What are the symptoms of PCA stroke?

A
  1. Contralateral homonymous hemianopia
  2. Cortical blindess
  3. Headaches unilateral
  4. Prosopagnosia
  5. Visual agnosia
286
Q

What are the symptoms of posterior circulation strokes?

A
  1. Motor deficits
  2. Dysarthria
  3. Vertigo
  4. Visual disturbance
  5. Altered consciousness
287
Q

What is the Rx for stroke?

A
  1. Acitlyse (thrombolysis)
  2. Clot retrieval
  3. Interarterial thrombolysis
  4. Decompressive craniectomy
288
Q

What is the risk management Rx for stroke?

A
  1. Aspirin
  2. Clopidogrel
  3. Statins
  4. Warfarin
  5. Antihypertensives
289
Q

What are the symptoms of SC compression?

A
  1. Pain and stiffness in neck/back
  2. Sciatica
  3. Numbness in limbs
  4. Loss of sensation in feet
  5. Foot drop
290
Q

How is SC compression diagnosed?

A
  1. XR spine (spurs)
  2. CT spine
  3. Bone scan
  4. EMG
291
Q

What is the Rx for SC compression?

A
  1. NSAIDs
  2. Steroids high dose
  3. Radiation therapy
  4. Physical therapy
292
Q

What are the symptoms of cauda equina syndrome?

A
  1. Low back pain
  2. Sciatica
  3. Saddle and perineal hypoesthesia
  4. Bowel disturbance
293
Q

What are the Ix of cauda equina syndrome?

A
  1. MRI

2. Myleogram

294
Q

What is the Rx for cauda equina syndrome?

A
  1. Surgery

2. Catheterisation

295
Q

What nerve does carpel tunnel compress?

A

Median nerve

296
Q

What are the symptoms of carpel tunnel syndrome?

A
  1. Numbness in first three fingers and thumb
  2. Pain that travels up arm
  3. Wrist pain at night
  4. Weakness in hand muscles
297
Q

What are the Ix for carpal tunnel syndrome?

A
  1. Physical exam
  2. XR
  3. Electromyography
  4. Nerve conduction study
298
Q

What is the Rx for carpal tunnel syndrome?

A
  1. Wrist splinting
  2. NSAIDs
  3. Corticosteroids
  4. Surgery
299
Q

What is the pathophysiology of myaesthenia gravis?

A

Breakdown in normal communication between nerves and muscles

300
Q

What are the symptoms are myaesthenia gravis?

A
  1. Ptosis
  2. Diplopia
  3. Impair speaking
  4. Difficulty swallowing
  5. Weak neck muscles
301
Q

What is the Dx for myaesthenia gravis?

A
  1. Neurological exam
  2. Edrophonium test
  3. Ice pack test
  4. Nerve stimulation studies
  5. CT
302
Q

What is the Rx for myaesthenia gravis?

A
  1. Pyridostigmine
  2. Neostigmine
  3. Prednisone
  4. Azathioprine

Phase 2a Medicine (15 decks)

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