Neurology Flashcards
Fasciculations can be an indication of what?
LMN problems
Rather than ask a patient to relax, what is a better method?
Ask a patient to be ‘floppy’.
How will the muscles be if hypertonic?
Show: Rigidity and spasticity.
Is hypotonia seen in LMN or UMN lesions?
LMN.
At which spinal lesions is the Biceps reflex tested?
C5/C6
Light touch is used to test which pathways of the upper limbs?
Dorsal columns.
Pin-prick is used to test which pathways of the upper limb?
Spinothalamic tract.
Which Hz fork is used to test vibration sensation?
128Hz tuning fork.
What is proprioception?
Joint position sense in space.
Which test would you use to differentiate between Cerebellar Vs. sensory dysfunction in a patient?
Romberg’s test
+ = sensory
- (negative) = cerebellar
Does ankle clonus suggest an UMN or LMN lesion?
UMN
Brisk means what?
Hyperreflexia
Koilonychia
Iron deficiency anaemia e.g. malabsorption in Crohn’s disease, GI bleed
Leukonychia
Chronic liver disease
Give x3 causes of finger clubbing
Liver cirrhosis
Coeliac disease
Inflammatory bowel disease
What disease is Dupuytren’s contracture related with?
Alcohol related liver disease.
Is palmar erythema normal pregnancy?
Yes.
What is asterixis?
Dysfunction in palms often caused by following GI issues;
Uraemia
Liver failure
Hypercapnia
What is important to remember about an AV fistula?
Never take blood pressure/ venepuncture from that arm
What is the name of the collections of cholesterol formed abnormally on side of the eyes?
Xanthelasma
What is the name of dry edges of the mouth?
Angular stomatitis/ cheilitis
Give three possible GI effect signs on the mouth.
Candidiasis
Angular stomatitis
Glossitis
Pigmentation
What are the 6Fs of distension?
flatus foetus fluid faeces Fulminant mass fat
What is a stoma?
A surgical opening of the bowels to allow waste to be diverted outside of your body.
What is rebound tenderness?
Sharp release of pressure results in sharp pain.
Where is your spleen located? Can it normally be palpated?
Left upper quadrant. Cannot normally be palpated.
Where do you feel for the abdominal aorta?
Superior to the umbilicus. Below = branches into iliac arteries.
How to palpate the liver?
Start in the right iliac fossa
The liver sounds dull. This is how you know you’ve reached top border of liver.
Will bowels sounds resonant or dull?
Resonant
Is fluid filled resonant or dull?
Dull
How do you test for ascites?
Shifting dullness.
What is the pneumonic for inspection?
SWIFT
Scars Wasting Involuntary movement Fasciculations Tremor
Wasting is an indicator of a lesion at which level?
LMN lesion
Is power reduced in an UMN or LMN lesion?
Both UMN and LMN.
What is the pneumonic for testing coordination?
DANISH
Dysdiadokinesia, ataxia, nystagmus, Intention tremor, slurred speech, hypotonia.
What is dysdiadokinesia?
Fast uncoordinated movements. Point is that patient has to move hand as quick as they can to see clumsiness - to see the dysdiadokinesia.
C7 is which dermatome?
Middle finger
Is the forehead spared in the UMN or LMN?
Forehead sparing = UMN lesion.
What is the Gold standard for diagnosing Gullain-Barre syndrome?
Nerve conduction studies.
For TIA, what is the Gold standard as a test for diagnosis?
Carotid Doppler Ultrasound
not CT
Which medication type do we use for TIA?
Anti-platelets not anticoagulant.
What causes Parkinson’s disease?
Loss of dopaminergic neurones in the substantial nigra.
What is Sinemet?
Levodopa and Carbidopa.
Which nerve determines taste for the anterior tongue?
Chorda tympani branch of the facial nerve.
Which nerve determines general sensory sensation for the anterior tongue?
Lingual nerve - a branch of the mandibular branch of the trigeminal nerve.
Which nerve is responsible for the taste of the posterior part of the tongue?
Glossopharyngeal nerve.
How does a facial nerve palsy impact the tongue?
Taste impairment to the anterior part of the tongue.
What is one way to differentiate between Bell’s and Bulbar palsy?
Bell’s palsy = no speech impairment
Bulbar palsy = speech impairment.
How do we assess for Bell’s palsy?
Nerve conduction studies
What do reflexes look like in Guillain-barre syndrome?
Absent reflexes.
How do the reflexes compare in multiple sclerosis Vs Guillain bare syndrome?
Multiple sclerosis = brisk reflexes
Guillain barre syndrome = absent reflexes
Droopy eyelids, difficulty swallowing, thyroid dysfunction - which neurological condition do these describe?
Myasthenia Gravis
How do we assess for Myasthenia gravis?
Tensilon test.
Patient has a frontal headache and pain when brushing over hair on the sides of her head.
Giant Cell arthritis/ temporal arteritis.
How would Trigeminal Neuralgia be expected to present in a patient?
Sharp, intermittent pain in maxillary distribution.
How do we assess for Giant cell arteritis? x1 marker, x1 lab study.
ESR
Temporal artery biopsy.
Which tests do we use to assess for aneurysm?
CT/MRI angiogram
not just CT/MRI.
Which carcinoma metastasises - squamous cell carcinoma or basal cell carcinoma?
Squamous cell carcinoma. BCC does not metastasise.
Are both eyes affected in a lesion behind or in front of the optic chiasm?
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.
Which are the structures in front of the optic chiasm?
Retina, eye, optic nerve.
Do schwannomas tend to be benign or malignant?
Benign.
Do we tend to see Loss of consciousness in Transient ischaemic attacks?
No.
Name three tests we would do in acute strokes.
CT Head
ECG
CXR.
Why may we want to do a chest X-ray in someone who has had a stroke?
A cerebrovascular accident can cause an impaired GAG reflex = can lead to pneumonia.
Thymic dysfunction is commonly associated with which neurological condition?
Myasthenia Gravis.
Between a migraine and tension headache, which is triggered by physical activity?
Migraine is activated by physical activity whereas tension headaches are not.
What is the difference in the way in which raised and low intracranial pressures compare?
Raised intracranial pressure = headache worse lying down.
Reduced intracranial pressure = headache worse standing up.
What are some features on fundoscopy for raised ICP?
Optic disc swelling = Blind spots
Constricted fields.
Severe occipital headache indicates what?
Thunderclap headache = Subarachnoid haemorrhage.
What is the most common cause of subarachnoid haemorrhages?
Ruptured berry aneurysm - commonly in the circle of Willis, most commonly in the anterior and posterior communicating arteries.
Which extra test should we request in seizures and why?
ECG; assess for arrhythmic cause of seizures.
Describe three signs of Cauda equina syndrome.
Lower back pain
Urinary retention
Reduced muscle tone
Where is Guillain Barre syndrome often seen? How is power affected in GBS?
After an infection e.g. food poisoning.
Reduced power, tingling.
Which respiratory dysfunction are those with Guillain Barre syndrome prone to getting?
Type 2 respiratory failure.
Which of lymphoma or leukaemia are more likely to cause spinal cord compression?
Lymphoma.
A myeloma is associated with CRAB.
What is CRAB?
High calcium
renal failure
anaemia
Bone disease.
Which are the most common symptoms in multiple sclerosis?
Optic neuritis = blurred vision, pain in one eye, tingling sensation.
What is an incredibly important risk factor for multiple sclerosis?
Smoking.
What are the three features of Parkinson’s disease?
Bradykinesia
Rigidity
Tremor
What is the Tensilon test used for?
Myasthenia Gravis - measures acetylcholine levels.
In hypercalcaemia, name two important signs you can often see.
Confusion
Dehydration
Which treatment is important in hypercalcaemia?
IV Fluids’ dehydration.
Giant Cell Arteritis is unilateral or bilateral?
Unilateral.
What is the Meningitis triad?
Headache, photophobia, neck stiffness.
When must you never do a lumbar puncture?
In raised ICP.
Polymyalgia rheumatica is associated with which neurological condition?
Giant cell arthritis.
= stiffness in shoulders.
What do we use to treat GCA?
Prednisolone
note: GCA should be treated as an emergency.
What is the issue with ANA (anti-nuclear antibody test)?
Not a very specific test = raised in many autoimmune conditions.
Which test do we use to diagnose SLE?
anti-dsDNA. ANA alone is not specific enough.
Is a Cerebral infarction more in line with an acute or chronic presentation?
Infarction. Think acute.
See Opthalmoplegia in the stem. Thinking what as the cause?
Demyelinating e.g. multiple sclerosis.
Give two key signs of an opiate overdose.
Pinpoint pupils Respiratory depression (low respiratory rate).
Lewy body dementia is associated with which other dementia form?
Parkinson’s disease.
Which is the main medication we use to treat Alzheimer’s disease?
Anti-cholinesterases; want to keep acetylcholine high. Prevent breakdown.
Name 3 points associated with Alzheimer’s disase
Beta amyloid plaques
Neurofibrillary tangles
Reduced ACh.
Name an acetylcholinesterase inhibitor and when it may be used.
Donepezil - Used in Alzheimer’s disease.
What would we use to treat vascular dementia?
Aspirin/ simvastatin.
When may pancoast tumours be seen?
In Horner’s syndrome.
What is Eaton Lambert syndrome associated with?
Muscle fatiguability.
Which is the most common form of dementia?
Alzheimer’s disease
Which test would you do following a CT head in someone with a headache?
Lumbar puncture; CSF.
Name a rapidly progressive dementia.
Lewy-body dementia.
What information does a lumbar puncture collect?
Glucose, protein, white cell count.
Are neutrophils or lymphocytes raised in a bacterial infection?
Neutrophils. Lymphocytes are raised in viral infections.
Give 3 differentials of collapse
Vasovagal Arrhythmia Outflow obstruction Postural hypotension Seizure
DNEFG - Glucose!!
How will Motor neuron disease present?
‘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.
What does a positive Rinne’s test show?
Conduction louder on air than bone.
= normal OR sensorineural loss.
What does a negative Rinne’s test show?
Conduction louder on bone than air
= conductive hearing loss.
Name three conductive hearing loss problems
Otosclerosis (bilaterally)
Otitis Media
Foreign body.
Which lesion - UMN or LMN will spare the forehead?
UMN lesion.
An UMN lesion will cause the face to look like what?
Paralysis of all facial muscles apart from those in the forehead (those that raise the eyebrows).
Is Bell’s palsy an UMN or LMN lesion?
LMN lesion.
From which foramen does the facial nerve leave?
The stylomastoid foramen.
What is glue ear?
Otitis media with effusion (common in children).
What is the treatment for glaucoma?
Acetazolamide
Which two conditions can cause ptosis?
Horner’s syndrome
Third nerve palsy
Why may we need to do a CT neck/chest in Horner’s syndrome?
Pancoast tumour, carotid artery dissection can cause Horner’s syndrome; can press on sympathetic ganglion.
Which condition is associated with Berry aneurysms and what may these lead to?
Polycystic kidney disease - associated with berry aneurysms which can lead to Subarachnoid haemorrhage.
Which is the first line of treatment for meningitis?
Antibiotics first; Benzylpenicillin
How will a patient with glaucoma present?
Dilated pupils
Nausea and vomiting
Redness
Aching
How will the pupil look in uveitis?
Constricted pupil
- associated with HLA B27.
A patient presents with hoarseness and a lump in their neck. What is the cause?
Compression of the laryngeal nerve = paraganglioma
Which medication are stroke patients on for life?
Clopidogrel.
Which medical condition is Trigeminal neuralgia associated with?
Multiple Sclerosis.
