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DPD > Neurology > Flashcards

Neurology Flashcards

1
Q

What is Frank’s sign?

A

Diagonal earlobe crease – it is a sign of diabetes mellitus and cardiovascular disease

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2
Q

List a surgical sieve that you can use to consider different types of causes of neurological symptoms

A

Vascular

Infection

Inflammation/Autoimmune

Toxic/Metabolic

Tumour/Malignancy

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3
Q

Describe the main features of:
UMN lesions
LMN lesions

A 
UMN
Hyperreflexia
Hypertonia
Upgoing plantars
Reduced power
LMN
Hyporeflexia
Hypotonia
Wasting
Reduced power
Fasciculations
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4
Q

Where is the lesion likely to be in a patient with widespread bilateral derangement of motor function?

A

Neuromuscular junction

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5
Q

Name an important condition that causes loss of motor function in which the lesion is at the level of the neuromuscular junction.

A

Myasthenia gravis – autoantibodies against nicotinic acetylcholine receptors

NOTE: Lambert-Eaton syndrome has similar symptoms but is caused by a defect in the calcium channel on the presynaptic membrane involved in vesicular exocytosis

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6
Q

What is a major risk factor for botulism?

A

IV drug use

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7
Q

Describe the test used to confirm a diagnosis of botulism.

A

Bioassay – two mice are injected with a serum sample from the patient, and one of the mice is given the botulinum antitoxin. If the mouse without the antitoxin dies, it is botulism

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8
Q

Describe the neurological signs seen in the examination of a patient with botulism.

A

Signs of LMN lesion

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9
Q

What are the six main features of cerebellar disease

A 
D - dysiadochokinesia
A - ataxia
N - nystagmus
I - intention tremor
S - Slurred speech
H - Hypotonia
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10
Q

Using the surgical sieve VIITT, list some causes of cerebellar disease

A

Vascular – bleed in the cerebellar fossa

Infection – TB, varicella zoster, cerebellitis

Inflammation – MS

Tumour – primary or metastases

Toxic/Metabolic – alcohol, phenytoin

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11
Q

Describe how the anatomical level of a sensory lesion affects the area of which the abnormal sensation experienced.

A

Brain – hemisensory

Spinal cord – at spinal cord level (e.g. T10 = umbilicus)

Nerve root (radiculopathy) – dermatome

Mononeuropathy – specific area of skin

Polyneuropathy – gloves and stockings

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12
Q

What is the most common cause of polyneuropathy?

A

Diabetes Mellitus

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13
Q

What is duloxetine and what can it be used to treat?

A

Anti-depressant (SNRI)

It can be used to treat peripheral neuropathy and premature ejaculation

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14
Q

Using the surgical sieve VIITT, list some causes of polyneuropathy.

A

Vascular – no common causes

Infection – HIV

Inflammation – Guillain-Barre syndrome

Toxic/Metabolic – diabetes, amyloidosis, CKD, alcohol, cisplatin, amiodarone, metronidazole, phenytoin, isoniazid, nitrofurantoin

Tumour – paraneoplastic syndrome

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15
Q

Which other drug may be used to treat neuropathic pain?

A

Pregabalin

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16
Q

List the main toxic/metabolic causes of peripheral neuropathy. Suggest investigations that may reveal clues about each of the causes

A

Drugs – history

Alcohol – history + high GGT + high MCV

B12 deficiency – low Hb + high MCV

Hypothyroidism – TFTs

Uraemia – U&Es

Amyloidosis – history of multiple myeloma or chronic infection/inflammation

Diabetes mellitus – history + blood glucose + HbA1c

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17
Q

Explain why myeloma is associated with amyloidosis

A

Myeloma causes increased production of immunoglobulins, which have light chains

The light chains are a precursor to amyloid fibrils

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18
Q

Explain why chronic inflammation/infection is associated with amyloidosis.

A

Inflammation leads to high levels of serum amyloid protein A (an acute phase protein)

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19
Q

List some associated symptoms to ask patients presenting with neurological symptoms.

A 
Impaired vision
Impaired hearing
Headache
Speech disturbance
Weakness
Sensory disturbance
Bowel continence
Urinary continence
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20
Q

List some inflammatory/autoimmune causes of peripheral neuropathy

A

Vasculitis

Connective tissue diseases

Demyelinating polyneuropathy (e.g. Guillain-Barre syndrome)

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21
Q

Describe the appearance of the feet in patients with long-term peripheral neuropathy.

A

High-arched foot (pes cavus)

Clawed toes

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22
Q

What is amaurosis fugax?

A

Painless temporary loss of vision in one or both eyes

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23
Q

List two causes of blurring of the optic disc margin and explain how you would differentiate between them.

A

Papilloedema – NO pain and NO blurring of vision

Papillitis – pain and blurring of vision

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24
Q

What is papillitis?

A

Inflammation of the head of the optic nerve

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25
Q

In which part of the spinal cord do you find the descending inhibitory tracts?

A

Corticospinal tract

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26
Q

What happens if the spinothalamic tract is compressed at a particular level?

A

Impaired/loss of sensation up until the level of the lesion

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27
Q

Define paraparesis

A

Partial paralysis of the lower limbs

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28
Q

State a vascular cause of spastic paraparesis

A

Obstruction of the anterior or posterior spinal arteries

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29
Q

State an infective cause of spastic paraparesis

A

TB of the spine (Pott’s disease)

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30
Q

State an inflammatory (demyelinating) cause of spastic paraparesis.

A

Transverse myelitis (may be associated with infections e.g. chest infections caused by Mycoplasma pneumonia)

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31
Q

What features of the history are necessary for a diagnosis of multiple sclerosis?

A

Two lesions separated in time and space

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32
Q

Which condition causes pain and paraesthesia on the anterolateral thigh and what is it caused by?

Outline the treatment

A

Meralgia paraesthetica

Compression of the lateral femoral cutaneous nerve

Reassure the patient that it isn’t something serious

Avoid tight garments

Lose weight

33
Q

Which pharmaceutical options might you consider if meralgia paraesthetica pain persist despite these treatment?

A

Carbamazepine

Gabapentin

34
Q

What is a radiculopathy?

A

Disease of the nerve roots

35
Q

What is sciatica

A

Pain in the buttock, radiating down the leg below the knee

It is caused by compression of the lumbosacral nerve roots

36
Q

What can cause compression of the nerve roots?

A

Disc herniation

Spinal canal stenosis

37
Q

Describe the main features of Parkinson’s disease

A

Rigidity

Bradykinesia

Resting tremor

Gait instability

38
Q

List some other diseases that cause symptoms that are similar to Parkinson’s disease

A

Progressive supranuclear palsy

Lewy body dementia

39
Q

What is the key feature of progressive supranuclear palsy that helps distinguish it from Parkinson’s disease?

A

Limited upgaze

40
Q

What is the underlying pathological process that causes Parkinson’s disease?

A

Depletion of dopaminergic neurons in the subtantia nigra

41
Q

What is cogwheel rigidity caused by?

A

A tremor superimposed on increased tone

42
Q

What is another name for progressive supranuclear palsy?

A

Steele-Richardson syndrome

43
Q

What are the key features of Lewy body dementia?

A

Parkinsonism

Hallusinations

44
Q

If there are no abnormalities seen on examination and imaging of a patient presenting with confusion, what is the likely cause?

A

Toxic/metabolic

45
Q

What dangerous disease can cause confusion and chest pain?

A

CO poisoning

46
Q

List four causes of confusion with reduced AMTS.

A

Post-ictal

Dysphasia

Dementia

Progressive pseudodementia

47
Q

List some causes of dementia.

A

Alzheimer’s disease

Vascular dementia

Lewy body dementia

Alcoholism

Inherited (e.g. Huntingdon’s disease)

48
Q

What are some important features of the history that you should check in a dementia history?

A

History of ischaemic heart disease/peripheral vascular disease

History/signs of alcohol abuse

Other symptoms (e.g. Huntingdon’s chorea)

49
Q

List a differential diagnosis for confusion and reduced consciousness

A

Hypoglycaemia

Vascular (i.e. bleed)

Infection

Inflammation

Malignancy

Toxic/metabolic

50
Q

What are some distinguishing features of a subdural haematoma?

A

Falls and fluctuating consciousness

51
Q

What are the main symptoms of intracranial infection?

A

Neck stiffness

Headache

52
Q

State an inflammatory cause of confusion with reduced consciousness.

A

Cerebral vasculitis

53
Q

List some investigations you would perform to look for a toxic/metabolic cause of confusion with reduced AMTS.

A

Drug history

U&Es

LFTs

Vitamin deficiencies

Endocrinopathies

54
Q

Which endocrine disease may present with confusion?

A

Cushing’s disease

55
Q

What are the four main diseases that you need to think about when a patient presents in the emergency department with a headache?

A

Meningitis

Giant cell arteritis

Subarachnoid haemorrhage

Migraine

56
Q

List the main symptoms of meningitis

A

Headache

Neck stiffness

Fever

Photophobia

Kernig’s sign

57
Q

What is Kernig’s sign?

A

When the hip is flexed and the knee is at 90 degree, extension of the knee causes pain

58
Q

Describe the presentation of subarachnoid haemorrhage

A

Sudden-onset worst headache ever

59
Q

What is the first investigation that is performed in suspected SAH?

A

CT Head

60
Q

What would you look for when doing a lumbar puncture of a patient with SAH?

A

Xanthochromia (yellow discolouration of the CSF due to the break down of haemoglobin)

61
Q

List the main symptoms of giant cell arteritis

A

Headache

Loss of vision

Jaw claudication

Scalp tenderness

62
Q

Which disease is giant cell arteritis associated with?

A

Polymyalgia rheumatica

63
Q

How do you treat giant cell arteritis?

A

High-dose prednisolone

64
Q

List two investigations that you would perform in a patient with giant cell arteritis

A

ESR

Temporal artery biopsy

65
Q

Describe the features of migraine

A

Unilateral, throbbing pain around the eye

66
Q

List examples of negative and positive auras

A

Negative – dark, black holes

Positive – flashing lights

67
Q

What is the window for thrombolysis in a patient with stroke?

A

Within 4.5 hours of onset of symptoms

68
Q

Which investigation must you perform in stroke patients before giving any treatment?

A

CT Head – exclude haemorrhage

69
Q

Describe the management of a stroke patient who presents > 4.5 hours after the onset of symptoms

A

CT head to exclude haemorrhage

Aspirin (300 mg)

Swallow assessment

Maintain hydration, oxygenation and monitor glucose

70
Q

At what point do you worry about the blood pressure of a patient with a TIA?

A

If the blood pressure rises > 220/120 mm Hg

71
Q

Describe the management of a patient with TIA

A

Aspirin

Risk factor modification

72
Q

List some investigations that you would perform in a patient with a TIA

A

ECG

Echocardiogram

Carotid artery Doppler

73
Q

Why is it important to monitor FVC in a patient with Guillain-Barre syndrome?

A

It can cause respiratory muscle weakness and reduce ventilation

74
Q

How is FVC monitored?

A

Spirometry

75
Q

What must you do if the FVC begins to drop?

A

Ventilate

76
Q

Why is it important to set up a cardiac monitor for patients with Guillain-Barre syndrome?

A

Guillain-Barre syndrome is associated with autonomic neuropathy

77
Q

How is Guillain-Barre syndrome treated?

A

IVIg

78
Q

Construct a simple list of causes of collapse

A

Hypoglycaemia

Cardiac – vasovagal, arrhythmia, outflow obstruction, postural hypotension

Neurlogical – seizure

DPD (4 decks)

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