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Neurology Flashcards

1
Q

Name 3 common sites for metastases to the brain

A

Lung
Breast
Prostate

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2
Q

Risk factors for brain tumours

A

Family syndromes
Ionising radiation
X - Ray exposure
MEN - 1

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3
Q

Signs of ICP

A

Headache
Nausea
vomitting
Papilloedema

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4
Q

Warning signs for a headache

A

worse on:

  • waking
  • bending over
  • lying down
  • coughing
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5
Q

Cerebllar signs

A 
DANISH 
D - Dydiadochockinesis 
A - Ataxia 
N - Nystagmus 
I - Intention tremor
S - Slurred speech
H - hypotonia
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6
Q

Clinical presentation of brain tumour

A 
Paresis of limbs 
Speech disorder
Dysphasia 
Seizures
Personality changes 
Coma
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7
Q

Brain tumour investigations

A
  • MRI with gadolinium contrast

- Biopsy + Histology

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8
Q

Causes of Cauda equina syndrome

A

Lumbar disc herniation

  • L4/5
  • L5/S1

Spinal verterbral fractures

Malignancy

Spinal infection

Spinal stenosis
- AS

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9
Q

CES red flags

A
  • Reduced anal tone
  • Bilateral sciatica
  • Saddle anaesthesia
  • Bowel dysfunction
  • Bladder dysfunction
    Urinary retention
  • Sexual dysfunction
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10
Q

Causes of cranial nerve lesions

A 
Trauma 
Tumour
SLE
Herpes zoster
Palsy
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11
Q

CN3 palsy presentation

A
  • Eye down and out
  • Ptosis
  • Mydriasis
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12
Q

CN4 palsy presentation

A
  • Eye down and In
  • Diplopia when looking down
  • Head tilt
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13
Q

CN7 palsy - UMN presentation

A
  • Contralateral paralysis of facial muscles
  • Forhead sparing
  • Lip drooping
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14
Q

CN7 Palsy - LMN presentation

A
  • Ipsialteral paralysis of facial muscles
  • NO forhead sparing
  • Loss of anterior 2/3 of taste
  • Dry eyes
  • Hyperacusis
  • Lip droop
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15
Q

Causes of CN7 palsy

A

Inflammation of parotid

Middle ear infections

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16
Q

CN9 palsy presentation

A

Uvular deviation

decreased gag reflex

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17
Q

Risk factors for dementia

A 
Age > 65
Family Hx
Downs syndrome 
Smoking 
DM
Head trauma
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18
Q

Genetic RF for dementia

A

Apolipoprotein E-E4

Deterministic gene - APP

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19
Q

Alzehimers

  • Onset
  • Sx and signs
  • pathology/imaging
A
  • gradual
- sx
Aphasia 
Agnosia 
Apraxia 
Loss of STM + LTM
Cognitive impairement 
Disorientated
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20
Q

Vascular

  • Onset
  • Sx and signs
  • pathology/imaging
A
  • Abrupt / gradual
  • Sx
    Stepwise deterioration
    periods of stability
  • Areas of ischaemia present on imaging from previous CVA
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21
Q

Lewy body

  • Onset
  • Sx and signs
  • pathology/imaging
A
  • Insidious
- Sx
Hallucinations 
Parkinsoism 
- Tremor 
- SLowing 
- Rigidity
  • Deposition of abnormal proteins
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22
Q

Charecterisitc features of Alzehimers

A
  • Neurofibrillary tangles

- Beta amyloid plaques

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23
Q

Alzehimers mangement

A 
Cholinesterase inhibitors 
- Donepezil 
- Rivastigime 
- Galantamine 
Improves memeory and cognitive function

NDMA receptor antagonist
- Memantine

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24
Q

Viral causes of encephilitis

A
  • Herpes simplex
  • Varicella zoster
  • CMV
  • EBV
  • MMR
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25
Q

Encephilits presentation

A 
Fever
Headache 
Odd behaviour 
Seizure 
Focal neurological deficits
- Hemiparesis 
- Dysphasia
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26
Q

Encephalitis Investigations

A

1st - LP
2nd - MRI
3rd - swabs

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27
Q

What is recommended in all encephalitis patients

A

HIV testing

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28
Q

Ecepahlitis management

A
  • Aciclovir
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29
Q

Metabolic causes of seizures

A

hypoglycaemia
hyponatraemia
hypoxia

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30
Q

What is the prodrome

A

not part of the seizure

  • changes in mood and behaviour
  • lasts hours to days
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31
Q

what is aura

A

part of a seizure

  • patient is aware
  • strange gut feeling
  • De-javu
  • strange smells
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32
Q

Where is a seizure with aura typically located

A

temporal lobe

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33
Q

What are localising features to a temporal lobe seizure

A
  • automatisms
  • dysphasia
  • dejavu
  • emotional disturbance
  • hallucination of smell/taste
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34
Q

What are localising features to a frontal lobe seizure

A
  • posturing
  • pedalling leg movements
  • jacksonian march
  • motor arrest
  • todds palsy
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35
Q

What are localising features to a parietal lobe seizure

A
  • tingling
  • numbess
  • motor sx
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36
Q

Charecterisitc of a generalsied seizure

A
  • LOC

- bilateral symmetrical motor movements

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37
Q

Features of tonic clonic seizure

A
  • LOC
  • limbs stiffen then jerk
  • eyes open
  • tongue bitten
  • incontinence
  • post ictal confusion
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38
Q

Features of myoclonic seizure

A

Sudden jerk of limb/trunk/face

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39
Q

Causes of status epilepticus

A
  • abruptly stopping anti-epileptic medication
  • alcohol use
  • poor compliance to therapy
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40
Q

Status epilepticus tx

A

1st - Lorazepam
2nd - Phenytoin
3rd - Phenobarbital

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41
Q

Focal seizures tx

A

1st - Carbamazepine / Lamotrigrine

2nd - Sodium valporate

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42
Q

Adverse effects of Sodium valporate

A

Teratogenic
drug induced liver injury
pancreatitis

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43
Q

Adverse effects of carbamezapine

A

Teratogenic
Agranulocytosis
SIADH
Hyponatraemia

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44
Q

Adverse effects of lamotrigrine

A

severe skin reactions

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45
Q

Adverse effects of phenytoin

A

cardiac arrhythmias

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46
Q

What is GCA astrongly linked to

A

Polymyalgia rheumatica

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47
Q

GCA presentation

A 
Unilateral headache 
scalp tenderness
jaw claudication 
blurred vision 
fever
vision loss - painless
peripheral oedema
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48
Q

GCA investigations

A

Clinical presentation

bloods

  • LFTs - Raised ALP
  • FBC - Anaemia

Duplex US of temporal.A

Temporal.A biopsy

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49
Q

Findings from temporal artery biopsy in GCA

A

Multinucleated giant cells

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50
Q

GCA management

A

Prednisolone - 60mg
Asprin - 75mg
Omeprazole

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51
Q

What can occur if patients with GCA stop taking theor steroids

A

Adrenal crisis

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52
Q

What is Guillian barre syndrome

A

Progressive weakness of proximal muscles due to Ab against myselin sheath

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53
Q

GBS aetiology

A

Infection

  • Campylobacter jejuni
  • CMV
  • EBV
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54
Q

GBS presentation

A
  • Symmetrical ascending muscle weakness
  • Pain in back
  • Areflexia
  • Parasthesia
  • Flaccid paralysis
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55
Q

Criteria for diagnosing GBS

A

Brighton

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56
Q

GBS investigations

A

LP
- Raised protein but normal WCC

Nerve conduction studies

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57
Q

GBS differentials

A

Other causes of acute paralyis

  • Stroke
  • Encephalitis
  • S.C compression
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58
Q

GBS managment

A
  • IV immunoglobulins
  • Plasma exchange
  • Enoxaparin
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59
Q

What should you do prior to GBS tx

A

Screen for IgA deficiency

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60
Q

Causes of SAH

A

Aneurysmal

  • ADPKD
  • Atherosclerosis
  • HTN
  • Ruptured berry aneurysm

Non aneurysmal

  • Trauma
  • AV malformations
  • Coagulopathies
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61
Q

SAH presntation - sx

A 
thunderclap headache - occipital 
nausea
vomitting 
collpase
reduced consciousness
seizure
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62
Q

SAH signs

A

Mengism

  • photophobia
  • stiff neck
  • pain on neck flexion

+VE kernigs sign

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63
Q

What is kernigs sign

A

inability to straighten the leg when the hip is flexed to 90 degrees.

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64
Q

SAH investigations

A
  • Non contrast CT
  • LP
    negative CT but hx is suggestive
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65
Q

SAH findings and timings for LP

A
  • 12hrs post sx

CSF analysis

  • elevated red cell count
  • Xanthochromia
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66
Q

SAH management

A
  • ABCDE
  • Fluids
  • Analgesia
  • Anti emetics
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67
Q

What should patients with SAH started on

A

Nimodipine

- reduces vasospasm

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68
Q

SAH complications

A

hydrocephalus
vasospasm - cerebral infarction
hyponatraemia
rebleeding

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69
Q

Subdural haemorrhage pathophsiology

A

Tearing of bridging veins

  • deceleration injury
  • blood accumulates
  • raised ICP
  • brain herniation
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70
Q

SDH risk factors

A 
alcohol excess
epileptics 
old age
trauma 
clotting disorders
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71
Q

EDH clinical presentation

A 
Initial LOC 
Lucid period 
headache 
nausea
vomitting 
drowsiness
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72
Q

EDH presentation - signs

A
  • drop in GCS
  • Positive babinski sign
  • Hypereflexia
  • Blown pupil - ipsilateral
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73
Q

Causes of tension headache

A 
MC SCOLD 
M- missed meals 
C - Conflict 
S - stress 
C - clenched jaw 
O - Over exertion 
L - Lack of sleep 
D - Depression
74
Q

Causes of migraine

A 
CHOCOLATE 
C - chcoclate 
H - hangovers
O - Orgasma 
C - Cheese 
O - Oral pill
L - Lie ins 
A - Alcohol
T 
E - excercise
75
Q

Migraines presentation

A

Aura - cravings / mood changes
Unilateral - pulsating
Worse on movement

With one of the following
Photophobia/ phonophobia
Nausea / vomiting

76
Q

Migranes tx

A

Mild

  • NSAIDs
  • Anti emetics

Severe
- Sumitriptan

77
Q

Migraine prophlaxis

A

1st - Propranolol / Topirmate
2nd - Acupuncture
3rd - Amitriptyline

78
Q

Cluster headache presnetation

A 
Rapid onset 
excrutitating pain (15-180mins)
Lacriamtion 
bloodshot eye 
rhinorrhea
Miosis 
Ptosis 
lid swelling 
nocturnal pain 
vomitting
79
Q

Cluster headache acute tx

A
  • 100% O2

- Sumitriptan

80
Q

Cluster headache prophylaxis

A

Avoid triggers - alcohol

1st - CCB

81
Q

Trigeminal neuralgia presentation

A

unilateral pain

- electryfying/burning/lighting

82
Q

Trigeminal neurlagia causes

A

CN 5 compression

  • cyst
  • tumour
  • MS
83
Q

Trigeminal neuralgia Tx

A

Avoid triggers

Meds
1st - Carbamezapine
2nd - Pheytoin/gabapentin

surgical
- Microvascualr decompression

84
Q

Shingles presentation

A 
Pain + tingling - dermatome 
malaise
myalgia 
fever
headache 
rash - papules + vesicles 
pruritus
85
Q

Shingles investigations

A
  • Clincal dx

- confirmes with PCR testing

86
Q

Shingles differential dx

A

atopic eczema
impetigo
contact dermatitis
migraine

87
Q

shingles risk for reactivation

A 
old age 
immunocompromised 
HIV 
Hodgkins 
BM transplant
88
Q

Shingles tx

A

IV aciclovir

89
Q

Shingles complications

A

Post herpetic neuralgia

  • burning intracable pain
  • poor response to analgesics

tx:
- Amitryptyline

90
Q

What is Huntingtons disease

A

AD condition charecterised by progressive neurodegeneration

91
Q

Huntingtons disease risk factors

A

Family Hx

Longer CAG repeat

92
Q

Huntingtons disease pathophysiology

A

30-40 year olds

Triple CAG disorder - > 36
Anticipation
Mutation on chromosome 4
Polyglutamine disorder
Glutamine accumulates in striatum causing cell death 
Chorea
93
Q

What forms the striatum

A

caudate

putamen

94
Q

HD net effect

A

Decreased - GABA
Decreased - Ach
Increased - dopamine

95
Q

HD clincial presentation

A 
behavioural changes
personality chnages
chorea
poor cordiantion 'dysarthria 
dysphagia 
jerky eye movements
aggression
96
Q

HD investigations

A

genetic testing

CT / MRI
- Atrophy of caudate nucleus

97
Q

HD differential dx

A

other causes of chorea

- stroke of basal ganglia

98
Q

HD - chorea tx

A

Tetrabenazine - dopamine depeting agent

Sulpride - Dopamine receptor antagonist

99
Q

HD - depression tx

A

Sertraline

100
Q

HD - aggression tx

A

Risperidone

- Anti psychotic

101
Q

What is mengingitis

A

Inflammation of meningies - Arachnoid + Pia

Notifiable disease

102
Q

Common organsims causing menigitis in children

A

Neisseris meningitides -
Gram -ve Diplococci

Strep peneumonia

Haemophilius influnzae

103
Q

Common organsims causing menigitis in neonates

A

E.Coli

Strep. Agalactiae - Group B haemolytic strep

104
Q

Common organsims causing menigitis in pregnancy

A

Listeria monocytogenes

105
Q

Meningitis presentation

A 
Heacdache 
neck stiffness 
Fever
Photophobia
Kernigs sign 
Petechial rash 
vomitting
106
Q

What is Brudzinski’s sign and when is it present

A

Hip and knees flex when the neck is flexed

- Meningitis

107
Q

Meingitis investigations

A

Bloods

  • FBC/U+E/Glucose/Coag screen
  • Blood cultures

Imaging

  • CXR
  • CT

LP

  • Protein
  • glucose
  • M&S
  • Cell count
108
Q

Meningococcal septicaemia tx

  • community
  • hospital
A
  • IM Benzylpenicillin

- Cefotaxime

109
Q

Bacterial meningitis tx

A

< 55 y/o
- IV Cefotaxime

> 55y/o or pregnant
- IV Cefotaxime + Amoxicillin

110
Q

Bacterial meningitis prophylaxis

A

Oral ciprofloxacin

111
Q

Viral menignitis tx

A

Aciclovir - herpes simplex

112
Q

What is MND

A

Degeneration of Upper and lower motor neurone disease

113
Q

signs of LMN disease

A

muscle wasting
fascicualtions
reduced tone
reduced reflexes

114
Q

Signs of UMN disease

A

Increased tone
Spactisity
Upgoing plantar reflexes

115
Q

ALS presentation

A

Upper and lower motor neurone signs

  • focal wasting
  • fasciculations
  • spascticity
  • brisk reflexes
  • wrist and foot drop
116
Q

Progressive bulbar palsy

A

Dysarthria
Dysphagia
Choking
Tongue fascicualtions

117
Q

MND management

A

Riluzole - Slows disease progression and extend survival time

118
Q

UMN Lesions presentation

A 
Hypertonia
spasticity 
clasp knife reflex
brisk reflexes 
Positive babinski sign 
clonus 
Upper limb - extensors weaker
Lower limb - flexors weaker
119
Q

LMN lesions presentation

A 
Hypotonia
Flaccid paralysis 
absent reflexes 
fasciculations 
muscle atophy
120
Q

What si multiple sclerosis

A

Chronic inflammatory Auto-immune mediated demylenation of CNS - Oligodendrocytes

121
Q

Multiple sclerosis classification

A
  • RRMS
  • Primary progressive
  • Secondary progressive
  • Progressive relapsing
122
Q

describe Relapsing remitting MS

A

Sx occur in attacks

- relpases and remission

123
Q

common sites for demyelination in multiple sclerosis

A 
optic nerve
spinal cord
brianstem
cerebellum
corpus collosum
124
Q

Multiple sclerosis eye presentation

A 
Optic neuritis 
double vision
pain
Intranuclear opthalmoplegia
conjungate lateral gaze disorder
125
Q

Multiple scerosis presenation

A 
parasthesia 
pain
UMN signs
- Spasticity
- reduced power
- hyper reflexia 
sexual dysfunction 
bladder and bowel dysfunction
Cerebellar - ataxia
126
Q

What is Lhermitte’s sign

A

Elerctic shock down spine when neck is flexed

127
Q

What is Uhthoff’s phenomenon

A

Pre existing sx worsen with increased temp

128
Q

Multiple sclerosis presentation mneumonic

A

DEMYELINATION

D - Diplopia
E - eye movements painful 
      optic neuritis 
M - Motor weakness
nY - Nystagmus 
L - Lhermitte's 
E - Intention tremor 
N - Neuropathic pain
A - Ataxia
T - Talking slurred
I - Impotence
O - Overactive bladder
N - Numbness
129
Q

Multiple sclerosis investigations + diagnostic criteria

A

MRI - demyelination plaques

LP + CSF electrophoresis

McDonald criteria

130
Q

Multiple sclerosis differential dx

A

SLE

Sarcoidosis

131
Q

Multiple sclerosis accute attack management

A

Methylprednisolone

132
Q

Multiple sclerosis - bladder dysfunction tx

A

Anticholinergics

  • Oxybutynin
  • detrusor overactivity
133
Q

Parkinsons disease - mneumonic

A 
TRAPS 
T - Tremor 
R - cogwheel rigidity
A - Akinesia 
P - Postural instbaility 
S - Shuffling gait
134
Q

Parkinsons disease presentation

A 
Resting tremor 
cogwheel rigidity 
Bradykinesia 
- micrographia 
- speech slow 
- difficulty initiating movements
Stooped posture
Shuffling gait 
reduced arm swing 
Depression
135
Q

Parkinsons disease management

A

Levodopa

- Imoroves tremor + bradykinesia

136
Q

What are dopamine agonists

A

used to delay starting L-DOPA

- Ropinirole

137
Q

What are MOA-B inhibitors

A

Monoamine oxidase B inhibitors
Inhibit MOA-B which braks down dopamine

Selegline
Rasagiline

138
Q

What are COMT inhibitors

A

Inhibit Catecho-o-methyl transferase inhibitors

  • Entacapone
139
Q

Causes of peripheral neuropathy

A 
DAVID 
D - DM 
A - Alcohol
V - Vit B12 def
I - Ineffective (GB)
D - Drugs (Isoniazid)
140
Q

what is spinal cord compression

A

medical emergency

spinal cord compression leading to UMN signs + specific sx

141
Q

Spinal cord compression causes

A 
spine trauma 
vertebral tumour 
disc herniation 
disc prolapse 
spinal cord neoplasms
142
Q

Spinal cord compression presentation

A 
Spasticity 
Hyperreflexia 
Hesitancy 
increased frequency 
sensory loss at level below lesion
143
Q

What leads to paraplegia

A

spinal cord lesion

144
Q

What leads to hemiplegia

A

brain lesion

145
Q

Function of corticospinal tracts

A

Motor

decussation - medulla

146
Q

Function of DCML

A

Sensory -
fine touch
propioception
vibration

Decussation - medulla

147
Q

Function of spinothalamic

A

Sensory -
Temperature
Pain
Crude touch

Lateral - pain and temp
Medial - crude touch

148
Q

What is spondylolisthesis

A

Spillage of vertebrae over the one below

149
Q

What is spondylosis

A

Degenerative disc disease

150
Q

What is myelopathy

A

Spinal cord compression - UMN signs

151
Q

What is radiculopathy

A

Spinal root compression

  • LMN signs
  • Pain in dermatome supplied by nerve root
  • meakness in myotome supplies by nerve root
152
Q

Causes of Ischameic stroke

A

Thrombosis - Athermomatous plaque

Embolic
Thromboembloism - Carotid A
Cardioembolic - AF
Cardiac mural thrombi - MI/IE

153
Q

RF for ischaemic stroke

A 
Older age
Hypertension 
Smoking 
Family hx 
DM
AF 
Combined pill
154
Q

Causes of haemorrhagic stroke

A

Ruptured cerebral artery
Trauma
AV malformation
Repurfusion injury - ischaemic stroke

155
Q

RF for haemorrhagic stroke

A 
Haemophillia 
Hypertension 
Ant-coagulation 
Vasculitits 
Older age 
Malignancy
156
Q

Presentation of an ACA stroke

A
  • Contralateral limb weakness
  • Contralateral sunsory disturbance
  • Incontinence
  • Apraxia
  • Drowsiness
  • Dysarthria
157
Q

Presentation of a MCA stroke

A
  • Contralateral limb and sensory loss
  • Contralateral homonymous hemianopia (No sparing)
  • Aphasia
  • Dysphasia
  • Facial droop
158
Q

Presentation of PCA stroke

A
  • Contralateral homonymous hemianopia (Macular sparing)
  • Contralateral sensory loss
  • Memory defecits
  • Vertigo
  • Prospopagnosia
  • Blindness
159
Q

Presentation of stroke in posterior circulation

A

Motor defecits

  • Hemiparesis
  • Facial paralysis
Paraesthesia 
Ipsilateral cranial nerve defecits 
Vertigo 
Nausea 
Vomitting
160
Q

Stroke investigations

A 
DW MRI / CT
ECG
Bloods 
- Glucose - hypoglycaemia 
- FBC - polycythaemia 
- ESR - Vasculitis
161
Q

Stroke - Ischameic management

A

Presents <4.5hrs after sx
Thrombolysis
- IV ALTEPLASE
- clopidogrel after 24hrs

If thrombolysis not appropriate

  • 300mg Asprin (2 weeks)
  • 75mg Clopidogrel
162
Q

Haemorrhagic stroke management

A

Anti-hypertensives

  • Beta blockers
  • CCB

Nimodipine
- prevents vasospasm

Reverse anti-coag

Anticonvulsant

163
Q

Secondary prevention for stroke

A 
Clopidogrel - 75mg 
Atrorvastatin - 80mg
Modifiable RF 
- HTN 
- DM
- Smoking cessation 
- Alcohol
164
Q

Clinical presentation of TIA

A
  • unilateral weakness or paralysis
  • dysphasia
  • ataxia
  • vertigo
  • loss of balance
  • Amaurosis fugax
    Curtain effect
    Clinical sign of ICA
    stenosis
165
Q

TIA investigations

A

Bloods

Carotid. A doppler US
- Stenosis / atheroma

MRI head with diffusion weighted imaging
- detect small infarct
GOLD STANDARD

ECG - Arrhythmias

166
Q

What is the ABCD2 risk score used for

A

Risk of having a stroke following a TIA

167
Q

Describe the ABCD2 risk score

A

A - Age > 65

B - BP > 140/90

C - Clincal features
Unilateral weakness = 2
Dysphasia w/ no weakness = 1

D - Duration
> 60 mins = 2
10-60 mins = 1

D - Diabetes
DM = 1

> 3 - refer to specialist (24hrs)

168
Q

TIA management

A 
300mg Asprin (2 weeks)
75mg Clopidogrel

Stroke secondary prevention

169
Q

SSRIs MOA

A

Inhibit seretonin uptake increases availability in synapse

170
Q

SSRIs examples

A

Citalopram
Sertraline
Fluxetetine

171
Q

SSRIs S/E

A

GI upset
Hyponatraemia
Decrease appetite

Citalopram - Increase QT Interval

172
Q

Anti emetics - recetor targets and exmples

A

D1 - Metclopraminde
H1 - Cyclizine
5-HT3 - Odansetron

173
Q

Benzodiazepenes examples and indications

A

Lorazepam

Status epilepticus

174
Q

Most common cause of a haemorrhagic stroke

175
Q

Cluster headaches prophylaxis

176
Q

Cluster headaches are more common in which group of people?

A

Smokers

Men

177
Q

Common triggers for migranes

A 
Tiredness/stress
 Alcohol 
combined pill
mensruation 
bright lights
178
Q

Migraines prophylaxis

A

Topirmate
Propanolol
Amitryptaline

179
Q

Criteria required for Multiple sclerosis diagnosis

A

McDonald criteria

180
Q

Red flag sx for raised ICP

A

Worse on coughing or straining
Postural - worse on stnading/lying/bending over
Vomitting

181
Q

Trigeminal neuralgia

  • Presentation
  • 1st line
  • Prophlaxis
A

Facial pain
Electric - shooting pain
Worsen overtime

Carbamazepine

CCB

182
Q

Trigeminal neuralgia triggers

A

cold weather
spicy food
caffeine
citrous fruits

Disease summaries (9 decks)

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