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Year 3 > Neurology > Flashcards

Neurology Flashcards

1
Q

Fasciculations can be an indication of what?

A

LMN problems

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2
Q

Rather than ask a patient to relax, what is a better method?

A

Ask a patient to be ‘floppy’.

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3
Q

How will the muscles be if hypertonic?

A

Show: Rigidity and spasticity.

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4
Q

Is hypotonia seen in LMN or UMN lesions?

A

LMN.

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5
Q

At which spinal lesions is the Biceps reflex tested?

A

C5/C6

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6
Q

Light touch is used to test which pathways of the upper limbs?

A

Dorsal columns.

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7
Q

Pin-prick is used to test which pathways of the upper limb?

A

Spinothalamic tract.

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8
Q

Which Hz fork is used to test vibration sensation?

A

128Hz tuning fork.

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9
Q

What is proprioception?

A

Joint position sense in space.

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10
Q

Which test would you use to differentiate between Cerebellar Vs. sensory dysfunction in a patient?

A

Romberg’s test

+ = sensory
- (negative) = cerebellar

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11
Q

Does ankle clonus suggest an UMN or LMN lesion?

A

UMN

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12
Q

Brisk means what?

A

Hyperreflexia

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13
Q

Koilonychia

A

Iron deficiency anaemia e.g. malabsorption in Crohn’s disease, GI bleed

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14
Q

Leukonychia

A

Chronic liver disease

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15
Q

Give x3 causes of finger clubbing

A

Liver cirrhosis
Coeliac disease
Inflammatory bowel disease

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16
Q

What disease is Dupuytren’s contracture related with?

A

Alcohol related liver disease.

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17
Q

Is palmar erythema normal pregnancy?

A

Yes.

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18
Q

What is asterixis?

A

Dysfunction in palms often caused by following GI issues;
Uraemia
Liver failure
Hypercapnia

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19
Q

What is important to remember about an AV fistula?

A

Never take blood pressure/ venepuncture from that arm

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20
Q

What is the name of the collections of cholesterol formed abnormally on side of the eyes?

A

Xanthelasma

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21
Q

What is the name of dry edges of the mouth?

A

Angular stomatitis/ cheilitis

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22
Q

Give three possible GI effect signs on the mouth.

A

Candidiasis
Angular stomatitis
Glossitis
Pigmentation

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23
Q

What are the 6Fs of distension?

A 
flatus
foetus
fluid
faeces
Fulminant mass
fat
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24
Q

What is a stoma?

A

A surgical opening of the bowels to allow waste to be diverted outside of your body.

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25
Q

What is rebound tenderness?

A

Sharp release of pressure results in sharp pain.

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26
Q

Where is your spleen located? Can it normally be palpated?

A

Left upper quadrant. Cannot normally be palpated.

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27
Q

Where do you feel for the abdominal aorta?

A

Superior to the umbilicus. Below = branches into iliac arteries.

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28
Q

How to palpate the liver?

A

Start in the right iliac fossa

The liver sounds dull. This is how you know you’ve reached top border of liver.

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29
Q

Will bowels sounds resonant or dull?

A

Resonant

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30
Q

Is fluid filled resonant or dull?

A

Dull

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31
Q

How do you test for ascites?

A

Shifting dullness.

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32
Q

What is the pneumonic for inspection?

A

SWIFT

Scars
Wasting
Involuntary movement
Fasciculations
Tremor
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33
Q

Wasting is an indicator of a lesion at which level?

A

LMN lesion

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34
Q

Is power reduced in an UMN or LMN lesion?

A

Both UMN and LMN.

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35
Q

What is the pneumonic for testing coordination?

A

DANISH

Dysdiadokinesia, ataxia, nystagmus, Intention tremor, slurred speech, hypotonia.

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36
Q

What is dysdiadokinesia?

A

Fast uncoordinated movements. Point is that patient has to move hand as quick as they can to see clumsiness - to see the dysdiadokinesia.

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37
Q

C7 is which dermatome?

A

Middle finger

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38
Q

Is the forehead spared in the UMN or LMN?

A

Forehead sparing = UMN lesion.

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39
Q

What is the Gold standard for diagnosing Gullain-Barre syndrome?

A

Nerve conduction studies.

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40
Q

For TIA, what is the Gold standard as a test for diagnosis?

A

Carotid Doppler Ultrasound

not CT

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41
Q

Which medication type do we use for TIA?

A

Anti-platelets not anticoagulant.

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42
Q

What causes Parkinson’s disease?

A

Loss of dopaminergic neurones in the substantial nigra.

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43
Q

What is Sinemet?

A

Levodopa and Carbidopa.

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44
Q

Which nerve determines taste for the anterior tongue?

A

Chorda tympani branch of the facial nerve.

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45
Q

Which nerve determines general sensory sensation for the anterior tongue?

A

Lingual nerve - a branch of the mandibular branch of the trigeminal nerve.

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46
Q

Which nerve is responsible for the taste of the posterior part of the tongue?

A

Glossopharyngeal nerve.

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47
Q

How does a facial nerve palsy impact the tongue?

A

Taste impairment to the anterior part of the tongue.

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48
Q

What is one way to differentiate between Bell’s and Bulbar palsy?

A

Bell’s palsy = no speech impairment

Bulbar palsy = speech impairment.

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49
Q

How do we assess for Bell’s palsy?

A

Nerve conduction studies

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50
Q

What do reflexes look like in Guillain-barre syndrome?

A

Absent reflexes.

51
Q

How do the reflexes compare in multiple sclerosis Vs Guillain bare syndrome?

A

Multiple sclerosis = brisk reflexes

Guillain barre syndrome = absent reflexes

52
Q

Droopy eyelids, difficulty swallowing, thyroid dysfunction - which neurological condition do these describe?

A

Myasthenia Gravis

53
Q

How do we assess for Myasthenia gravis?

A

Tensilon test.

54
Q

Patient has a frontal headache and pain when brushing over hair on the sides of her head.

A

Giant Cell arthritis/ temporal arteritis.

55
Q

How would Trigeminal Neuralgia be expected to present in a patient?

A

Sharp, intermittent pain in maxillary distribution.

56
Q

How do we assess for Giant cell arteritis? x1 marker, x1 lab study.

A

ESR

Temporal artery biopsy.

57
Q

Which tests do we use to assess for aneurysm?

A

CT/MRI angiogram

not just CT/MRI.

58
Q

Which carcinoma metastasises - squamous cell carcinoma or basal cell carcinoma?

A

Squamous cell carcinoma. BCC does not metastasise.

59
Q

Are both eyes affected in a lesion behind or in front of the optic chiasm?

A

In a lesion behind the optic chiasm; the brain is situated here. In front of the optic chiasm are more likely to be unilateral symptoms.

60
Q

Which are the structures in front of the optic chiasm?

A

Retina, eye, optic nerve.

61
Q

Do schwannomas tend to be benign or malignant?

A

Benign.

62
Q

Do we tend to see Loss of consciousness in Transient ischaemic attacks?

A

No.

63
Q

Name three tests we would do in acute strokes.

A

CT Head
ECG
CXR.

64
Q

Why may we want to do a chest X-ray in someone who has had a stroke?

A

A cerebrovascular accident can cause an impaired GAG reflex = can lead to pneumonia.

65
Q

Thymic dysfunction is commonly associated with which neurological condition?

A

Myasthenia Gravis.

66
Q

Between a migraine and tension headache, which is triggered by physical activity?

A

Migraine is activated by physical activity whereas tension headaches are not.

67
Q

What is the difference in the way in which raised and low intracranial pressures compare?

A

Raised intracranial pressure = headache worse lying down.

Reduced intracranial pressure = headache worse standing up.

68
Q

What are some features on fundoscopy for raised ICP?

A

Optic disc swelling = Blind spots

Constricted fields.

69
Q

Severe occipital headache indicates what?

A

Thunderclap headache = Subarachnoid haemorrhage.

70
Q

What is the most common cause of subarachnoid haemorrhages?

A

Ruptured berry aneurysm - commonly in the circle of Willis, most commonly in the anterior and posterior communicating arteries.

71
Q

Which extra test should we request in seizures and why?

A

ECG; assess for arrhythmic cause of seizures.

72
Q

Describe three signs of Cauda equina syndrome.

A

Lower back pain
Urinary retention
Reduced muscle tone

73
Q

Where is Guillain Barre syndrome often seen? How is power affected in GBS?

A

After an infection e.g. food poisoning.

Reduced power, tingling.

74
Q

Which respiratory dysfunction are those with Guillain Barre syndrome prone to getting?

A

Type 2 respiratory failure.

75
Q

Which of lymphoma or leukaemia are more likely to cause spinal cord compression?

A

Lymphoma.

76
Q

A myeloma is associated with CRAB.

What is CRAB?

A

High calcium
renal failure
anaemia
Bone disease.

77
Q

Which are the most common symptoms in multiple sclerosis?

A

Optic neuritis = blurred vision, pain in one eye, tingling sensation.

78
Q

What is an incredibly important risk factor for multiple sclerosis?

A

Smoking.

79
Q

What are the three features of Parkinson’s disease?

A

Bradykinesia
Rigidity
Tremor

80
Q

What is the Tensilon test used for?

A

Myasthenia Gravis - measures acetylcholine levels.

81
Q

In hypercalcaemia, name two important signs you can often see.

A

Confusion

Dehydration

82
Q

Which treatment is important in hypercalcaemia?

A

IV Fluids’ dehydration.

83
Q

Giant Cell Arteritis is unilateral or bilateral?

A

Unilateral.

84
Q

What is the Meningitis triad?

A

Headache, photophobia, neck stiffness.

85
Q

When must you never do a lumbar puncture?

A

In raised ICP.

86
Q

Polymyalgia rheumatica is associated with which neurological condition?

A

Giant cell arthritis.

= stiffness in shoulders.

87
Q

What do we use to treat GCA?

A

Prednisolone

note: GCA should be treated as an emergency.

88
Q

What is the issue with ANA (anti-nuclear antibody test)?

A

Not a very specific test = raised in many autoimmune conditions.

89
Q

Which test do we use to diagnose SLE?

A

anti-dsDNA. ANA alone is not specific enough.

90
Q

Is a Cerebral infarction more in line with an acute or chronic presentation?

A

Infarction. Think acute.

91
Q

See Opthalmoplegia in the stem. Thinking what as the cause?

A

Demyelinating e.g. multiple sclerosis.

92
Q

Give two key signs of an opiate overdose.

A 
Pinpoint pupils
Respiratory depression (low respiratory rate).
93
Q

Lewy body dementia is associated with which other dementia form?

A

Parkinson’s disease.

94
Q

Which is the main medication we use to treat Alzheimer’s disease?

A

Anti-cholinesterases; want to keep acetylcholine high. Prevent breakdown.

95
Q

Name 3 points associated with Alzheimer’s disase

A

Beta amyloid plaques
Neurofibrillary tangles
Reduced ACh.

96
Q

Name an acetylcholinesterase inhibitor and when it may be used.

A

Donepezil - Used in Alzheimer’s disease.

97
Q

What would we use to treat vascular dementia?

A

Aspirin/ simvastatin.

98
Q

When may pancoast tumours be seen?

A

In Horner’s syndrome.

99
Q

What is Eaton Lambert syndrome associated with?

A

Muscle fatiguability.

100
Q

Which is the most common form of dementia?

A

Alzheimer’s disease

101
Q

Which test would you do following a CT head in someone with a headache?

A

Lumbar puncture; CSF.

102
Q

Name a rapidly progressive dementia.

A

Lewy-body dementia.

103
Q

What information does a lumbar puncture collect?

A

Glucose, protein, white cell count.

104
Q

Are neutrophils or lymphocytes raised in a bacterial infection?

A

Neutrophils. Lymphocytes are raised in viral infections.

105
Q

Give 3 differentials of collapse

A 
Vasovagal
Arrhythmia
Outflow obstruction 
Postural hypotension
Seizure

DNEFG - Glucose!!

106
Q

How will Motor neuron disease present?

A

‘Bulbar signs’ i.e. impairment of the cranial nerves which emerge from the bulb (9,10,11,12). e.g. slurring, drooling + LMN symptoms i.e. fasciculations, wasting.

107
Q

What does a positive Rinne’s test show?

A

Conduction louder on air than bone.

= normal OR sensorineural loss.

108
Q

What does a negative Rinne’s test show?

A

Conduction louder on bone than air

= conductive hearing loss.

109
Q

Name three conductive hearing loss problems

A

Otosclerosis (bilaterally)
Otitis Media
Foreign body.

110
Q

Which lesion - UMN or LMN will spare the forehead?

A

UMN lesion.

111
Q

An UMN lesion will cause the face to look like what?

A

Paralysis of all facial muscles apart from those in the forehead (those that raise the eyebrows).

112
Q

Is Bell’s palsy an UMN or LMN lesion?

A

LMN lesion.

113
Q

From which foramen does the facial nerve leave?

A

The stylomastoid foramen.

114
Q

What is glue ear?

A

Otitis media with effusion (common in children).

115
Q

What is the treatment for glaucoma?

A

Acetazolamide

116
Q

Which two conditions can cause ptosis?

A

Horner’s syndrome

Third nerve palsy

117
Q

Why may we need to do a CT neck/chest in Horner’s syndrome?

A

Pancoast tumour, carotid artery dissection can cause Horner’s syndrome; can press on sympathetic ganglion.

118
Q

Which condition is associated with Berry aneurysms and what may these lead to?

A

Polycystic kidney disease - associated with berry aneurysms which can lead to Subarachnoid haemorrhage.

119
Q

Which is the first line of treatment for meningitis?

A

Antibiotics first; Benzylpenicillin

120
Q

How will a patient with glaucoma present?

A

Dilated pupils
Nausea and vomiting
Redness
Aching

121
Q

How will the pupil look in uveitis?

A

Constricted pupil

- associated with HLA B27.

122
Q

A patient presents with hoarseness and a lump in their neck. What is the cause?

A

Compression of the laryngeal nerve = paraganglioma

123
Q

Which medication are stroke patients on for life?

A

Clopidogrel.

124
Q

Which medical condition is Trigeminal neuralgia associated with?

A

Multiple Sclerosis.

Year 3 (13 decks)

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