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Helena's finals > Neurology > Flashcards

Neurology Flashcards

1
Q

Ascending vs descending spinal cord tracts

A

Ascending - sensory
Descending - motor

Ascending tracts include: dorsal columns, lateral spinothalamic tracts, ventral spinothalamic tract

Descending tracts include: lateral corticospinal tract and the ventral corticospinal tract

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2
Q

What do the ascending tracts do? Name each one with its function

A

Dorsal column-medial lemniscus - deep touch, proprioception, vibration

Lateral spinothalamic tract - pain, temperature

Ventral spinothalamic tract - crude touch

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3
Q

What do the descending tracts do? Name each one with its function

A

Lateral corticospinal tract is for voluntary motor of contra lateral limbs

Ventral/anterior corticospinal tract is for movement of trunk, neck and shoulders

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4
Q

conditions to inform the DVLA

A
  • cataplexy
  • first seizure no driving for 6 months
  • epilepsy can’t drive unless free from seizure for 12 months or withdrawing from treatment
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5
Q

triptans (migrains and headaches) are contraindicated for which disease?

A

coronary artery disease because they cause coronary vasospasm

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6
Q

symptoms of cluster headache

A

sudden onset retro-orbital pain with excessive lacrimation and redness
+ autonomic symptoms ( ptosis, miosis, conjunctival injection and excessive lacrimation)

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7
Q

Mx of cluster headache

A

treatment: high flow oxygen + Sub cut sumatriptan
prophylaxis: verapamil

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8
Q

Mx TIA

A

Patients presenting with a suspected TIA whilst taking anticoagulants or who have a bleeding disorder should have urgent imaging to exclude haemorrhage.

Other patients should be given 300mg of aspirin immediately then assessed by a specialist within 24 hours.

First-line secondary prevention is clopidogrel 75mg once daily.

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9
Q

what do you give to patients that cannot tolerate clopidogrel?

A

aspirin + dipyridamole

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10
Q

conditions for aspirin immediately following TIA/ ischaemic stroke

A

Immediate antithrombotic therapy:
give aspirin 300 mg immediately, unless
1. the patient has a bleeding disorder or is taking an anticoagulant (needs immediate admission for imaging to exclude a haemorrhage)
2. the patient is already taking low-dose aspirin regularly: continue the current dose of aspirin until reviewed by a specialist
3. Aspirin is contraindicated: discuss management urgently with the specialist team

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11
Q

vertigo, hearing loss, tinnitus and an absent corneal reflex, facial weakness

A

vestibular schwannoma aka acoustic neuroma
absent corneal reflex - CN 5
facial palsy - CN7
vertigo, hearing loss, tinnitis - CN8

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12
Q

CN5 vs CN7

A

5 - trigeminal: sensation V1,2,3, motor muscles of mastication
7 - facial: taste, bell’s palsy stuff

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13
Q

which lesions spare forehead? why?

A

upper motor neuron lesion eg strokes ‘spares’ upper face

the forehead receives motor innervation from both hemispheres of the cerebral cortex. A stroke that compromised motor innervation of the face would therefore only result in paralysis of the lower half of the face - the forehead still receiving innervation from the unaffected hemisphere.

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14
Q

comprension + speech production impaired

A

global aphasia

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15
Q

aphasia (aka dysphasia) subtypes

A

can comprehend but speech not fluent - Broca’s (inferior frontal gyrus)

can speak fluently (+neologisms and words dont make sense) but no comprehension - Wernicke’s (superior frontal gyrus)

B before W
comprehend before speak

global - both impaired

conduction aphasia (supramarginal gyrus) = can comprehend and can speak but with neologisms and words dont make sense and can’t repeat

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16
Q

spasticity in multiple sclerosis

A

baclofen

gabapentin

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17
Q

intternuclear opthalmoplegia

A

brainstem problem
affected eye cannot adduct when asked to look in the contralateral direction
classic multiple sclerosis sign

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18
Q

management MS

A

vitamin B, steroids, IV immunoglobulin, plasmapheresis, immunosuppressants (Recombinant beta-IFN), manage symptoms with physical and cognitive therapy. spasticity (baclofen, gabapentin)

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19
Q

normal pressure hydrocephalus

A

Ataxia, urinary incontinence and dementia

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20
Q

bitemporal hemianopia. where is the lesion?

A

lesion of optic chiasm
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour

lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

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21
Q

epiepsy treatment

A

Generalised tonic-clonic seizures
sodium valproate
second line: lamotrigine, carbamazepine

Absence seizures* (Petit mal)
sodium valproate or ethosuximide
sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy

Myoclonic seizures**
sodium valproate
second line: clonazepam, lamotrigine

Focal seizures
carbamazepine or lamotrigine
second line: levetiracetam, oxcarbazepine or sodium valproate

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22
Q

carbmazepine contraindictions

A

absence and myoclonic seizures

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23
Q

status epilepticus treatment

A

Benzo: IV 4mg lorazepam/IV/PR 10mg diazepam, buccal 10mg midazolam repeat after 10mins if seizure does not terminate

if seizure still recurs after 2nd dose, IV phenytoin/ sodium valproate — consult specialists for dose

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24
Q

Subarachnoid haemorrhage management

A

ABC + OXYGEN
Isotonic/normal saline to resuscitate
arterial line (monitor BP specifically) - stop anti-hypertensives
Nimodipine - cerebral vasodilator to stop cerebral ischaemia and improve outcomes
reverse anticoagulation - we want clotting
neurosurgery: surgical clipping, endovascular coil embolization
reduce high ICP: lumbar drainage or ventriculostomy, mannitol

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25
Q

subdural haemorrhage management

A

haematoma <10mm without significant neurological dysfunction
conservative
prophylactic anti epileptics
stop and reverse anticoagulants
ICP lowering regimen: raise head, hyperventilate, sedation (lower anxiety), hyperosmolar therapy (hypertonic saline, mannitol), cooling, decompressive hemicraniectomy

haematoma >10mm or expansile or significant dysfunction
1. ventriculoperitoneal shunt

chronic haematoma — craniotomy

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26
Q

Cushing’s triad

A

Increased ICP –> Cushing’s triadofhypertension, bradycardia, irregular respiration (+ altered mental status, compression of cranial nerves)

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27
Q

indication for emergency intubation

A

A Glasgow coma scale score of 8 or less is in indication for emergency intubation

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28
Q

rhinorrhoea + halo sign

A

CSF!!!!

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29
Q

basilar skull fracture symptoms

A

Basilar skull fracture can lead to injury of any structures at the skull base

The middle meningeal vessels are particularly at risk because they run underneath the relatively thin pterion.–> extradural haematoma

raised ICP

racoon eye bruising + battle sign (behind ear) bruising

rhinorrhoea

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30
Q

Urthoff’s phenomenon

A

Multiple sclerosis

Symptoms worse in heat

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31
Q

Parkinson’s key symptoms

A

Tremor
Rigidity (cog wheeling)
Akinesia (bradykinesia)
Postural instability (falls, hypotension)

dementia, depression, insomnia, hallucinations mask like facial expression, monotonous speech, poor swallow, aspiration pneumonias,

autonomic (multiple system atrophy) — gastric reflux, constipation, postural hypotension, urinary incontinence, erectile dysfunction, cerebellar signs

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32
Q

Parkinsons plus syndromes

A

lewy body - fluctuating cognition, visual hallucinations, early dementia

progressive supranuclear palsy - limited vertical gaze, can’t look down

corticobasal syndrome - unilateral parkinsonism, non-fluent aphasia

multiple system atrophy - autonomic symptoms

vascular parkinsonism - multi-infarcts, lower body

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33
Q

gold standard diagnosis of parkinson’s

A

brain histology (death) is definitive:
staining for alpha synuclein which indicates cell death
Braak stages

in practice: 2/3 TRAP symptoms + reversibility with levodopa

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34
Q

Parkinson’s conservative treatment

A

physio - muscle stiffness

occupational health - practical solutions to things you might find hard like dressing yourself or getting around your house, shower

SALT - dysphagia, speech

diet advice: fibre, higher salt (postural instability)

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35
Q

parkinsons surgical option

A

deep brain stimulation therapy

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36
Q

Parkinsons medical treatments

A
  1. levodopa + carbidopa
  2. dopamine agonists
  3. MAO-B inhibitors
  4. COMT inhibitors
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37
Q

Side effects of levodopa

A

dizzy, lethargy
uncontrollable, jerky muscle movements (dyskinesias) and “on-off” effects, where the person rapidly switches between being able to move (on) and being immobile (off

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38
Q

dopamine agonists side effects

A

hallucinations
increased confusion
compulsive behaviour - gambling, shopping, excessive sexual interest

so they need to be used with caution, particularly in elderly patients, who are more susceptible. + family members watch out for any odd behaviours

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39
Q

how do the parkinsons medications work?

A
  1. levodopa + carbidopa
    levodopa is turned into dopamine
    carbidopa acts to reduce peripheral conversion
  2. dopamine agonists
  3. MAO-B inhibitors
    monoamine oxidase B inhibitors prevent dopamine breakdown
  4. COMT inhibitors
    inhibit Catechol-O-methyltransferase (COMT) prevent dopamine breakdown
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40
Q

which tuning fork for rinnie and webers?

A

512 Hz

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41
Q

what is rinnie’s test

A

512 tuning fork on mastoid process vs in front of pinna
bone vs air conduction
air conduction should be better
Think: telephone rings (ear)

42
Q

what would be an abnormal rinnie’s test?

A

bone conduction is louder

suggests a conductive problem in the same ear

43
Q

what is weber’s test?

A

512 tuning fork on the centre of the forehead. Patient asked if sound is heard louder on one side or not?
normal is when sound does not lateralise

44
Q

conductive hearing loss findings

A

rinnie’s air < bone in affected air OR normal (air>bone)

weber’s localises to affected ear

45
Q

sensorineural hearing loss findings

A

rinnie’s normal air > bone

weber’s localises to UNaffected ear

46
Q

weber’s test mneumonic

A

Sun Caffe
sensorineural - unaffected ear
Conductive - affected ear

47
Q

menier’s disease symptoms

A

sensorineural hearing loss
tinnitis
vertigo
minutes to hours

48
Q

bilateral vestibular schwannomas are seen in which familial disease?

A

neurofibromatosis 2

49
Q

what test to look at patients diability? following what disease?

A

Barthel index – used particularly after stroke
10 tasks and the patient is scored based on the amount of time and assistance needed
- presence of faecal/ urinary incontinence
- help with feeding, transfer, dressing etc
scored 0 to 100. 0 is completeld dependent, 100 is completely independent

50
Q

brain tumours management

A

dexamethasone - oedema
surgery
post-op chemotherapy
radiotherapy

51
Q

migraine prophylaxis - what do you give and when do you

A

topiramate (asthmatics but teratogenic, cleft palate) or propanolol (better for women of childbrearing age)

riboflavin is also effective

> 2 attacks per month

52
Q

ischaemic stroke Mx time for definitive mx

A

thrombolysis (4.5hrs) & thrombectomy (6hrs) from symptom onset

53
Q

investigations for acoustic neuroma/ vestibular schwannoma

A

audiogram

gadalinium-enhanced MRI head

54
Q

where are most acoustic neuroma/ vestibular schwannoma in the brain

A

cerebellopontine angle

55
Q

wrist drop - which nerve effected

A

radial nerve palsy

56
Q

which neurology drug is highly associated with steven johnson syndrome and how do you treat it? after how long of treatment to SJS symptoms typically start to develop?

A

lamotrigine
<2 months of starting it
prodrome of a viral URTI for 2 weeks then rapid onset painful rash on face and limbs

Mx. stop drug, admit, ICU, fluids, IV and NG

57
Q

prophylaxis of cluster headaches

A

verapamil

58
Q

anti-nausea drug for raised ICP causes of nausea

A

haloperidol

59
Q

anti-nausea drug for GI causes of nausea

A

metoclopramide

60
Q

types of motor neurone disease and key points

A

***Amyotrophic Lateral Sclerosis: UMN legs + LMN arms

Primary Lateral Sclerosis Variant: UMN

Progressive Muscular Atrophy Variant: LMN, distal → proximal, best prognosis

progressive bulbar palsy: palsy of tongue, chewing, swallowing, facial muscles due to loss of function of brainstem motor nuclei. worst prognosis. LMN signs only

61
Q

myasthenia gravis medical management

A

mild disease: pyridostigmine

prednisolone (titrate up as intiail worsening of symptoms)
steroid-sparing agents (azathioprine) to avoid side effects

life-threatening exacerbations: IV immunoglobulin/ plasma exchange

malignant thymomas excised

62
Q

most likely dominant hemisphere

A

left

63
Q

global aphasia, which blood supply affected

A

left middle cerebral artery

64
Q

signs of essential tremor

A

tremor arises with sustained muscle tone eg. outstretching arms, improved by alcohol and rest
can also effect the vocal cords

autosomal dominant condition

65
Q

Mx. of essential tremor

A

propanolol

66
Q

explain the cushing’s triad feature of hypertension and bradycardia with raised ICP

A

cerebral perfusion pressure = mean arterial pressure - intracranial pressure

so if ICP rises, to maintain adequate cerebral perfusion, the MAP rises too by a sympathetic reflex

this HTN is then detected by baroreceptors to decrease HR

67
Q

migrains with aura and COCP

A

absolute contradication due to increased stroke risk

migraine with aura type only

68
Q

migraine with menstruation mx

A

mefanamic acid
Or
aspirin, paracetamol, caffeine

69
Q

migraine and HRT

A

it is safe to prescribe HRT for people with history of migraines
but HRT might make the migraines worse

70
Q

electomyography findings

A

neuropathy: increased duration and amplitude of action potentials
myopathy: decreased duration and amplitude of action potentials

71
Q

mx. post lumbar puncture headache

A
  1. analgesia, rest

2. >72 hours – IV caffeine, epidural saline, blood patch

72
Q

what happens if you suddenly stop parkinson’s drugs

A

acute akinesia or neuroleptic malignant syndrome

73
Q

DVLA and seizures

A

first seizure - 6 month seizure seizure free + no findings on brain imaging or epileptiform EEG

epilepsy - 12 month seizure free

withdrawing drugs - no driving for 6 months until last dose

bus driver - 10 year seizure fee

74
Q

secondary prevention after stroke

A

clopidogrel alone is first line

or aspirin and dipyridamole

75
Q

at what point do you start IV phenytoin in status epilepticus

A

2 doses of benzos

76
Q

at what point do you intubate and GA in status epilepticus?

A

45 mins from onset

77
Q

stroke/TIA and DVLA?

A

don’t need to inform DVLA if no residual neurological defect (or if just 1 episode)
1 month off driving

78
Q

which is single biggest risk factor for bell’s palsy?

A

pregnancy

79
Q

signs and symptoms of neuroleptic malignant syndrome

A

pyrexia, muscle ragidity, hypertension, tachycardia, tachypnoea, delirium, confusion

80
Q

trigeminal neuralgia signs and treatment

A

unilateral electric shock like pain in one/more divisions of trigerminal nerve
provoked by light touch, brushing teeth, combing hair

Mx. carbamazepine
refer to neuro if under 50y/o

81
Q

how soon do you start anticoagulation following an ischaemic stroke?

A

14 days

earlier may exacerbate secondary haemorrhage

82
Q

dysarthria vs aphasia

A

dysarthria = motor disorder and find difficult to pronounce and speak words

aphasia = compression, repetition or production of speech

83
Q

Ix for myasthenia gravis

A

single fibre electromyography
CT thorax to exclude thymoma
CK normal
autoantibodies against acetylcholine receptors and anti-muscle-specific tyrosine kinase

84
Q

antibodies in myasthenia gravis

A

autoantibodies against acetylcholine receptors and anti-muscle-specific tyrosine kinase

85
Q

Mx. myasthenia gravis

A
  1. long acting acetylcholinesterase inhibitors eg. pyridostigmine
  2. immunosuppression prednisolone
  3. thymectomy
86
Q

blood test to distinguish between pseudoseizure and actual seizure

A

serum prolactin 10-20 minutes after seizure

87
Q

homonoymous quadrantopias - where is the lesion?

A

contralateral side
PITS
Parietal inferior
Temporal superior

88
Q

craniopharyngiomas symptoms

A

lower bitemporal hemianopia

diabetes inspidus

89
Q

why do you get oedema with brain tumours

A

disruprtion of the blood-brain barrier

give dexamethasone to treat oedema

90
Q

most common primary brain tumour in children

A

pilocytic astrocytoma

91
Q

Total anterior circulation stroke

A

3
Unilateral sensory/motor loss (face, arm and leg)
Higher cerebral function eg. Dysphasia, visuospatial
Homonymous hemianopia

92
Q

Partial anterior circulation stroke

A

2 of:
Unilateral sensory/motor loss (face, arm and leg)
Higher cerebral function eg. Dysphasia, visuospatial
Homonymous hemianopia

93
Q

Lacunar syndrome

A 
1 of: ***of face and arm, arm and leg or all three.
Pure sensory
Pure motor
Sensory-motor stroke
Ataxic hemiparesis
94
Q

Posterior circulation syndrome

A

1 of
Cranial nerve palsy and contra lateral motor or sensory deficit
Bilateral motor or sensory deficit
Cerebellum dysfunction: ataxia, nystagmus, vertigo
Isolated homonymous hemianopia or cortical blindness
Loss of conscious, brain stem problems

95
Q

Which stroke syndrome, no loss of higher cerebral functions

A

Lacunar syndrome

96
Q

lateral medullary syndrome

A

the combination of facial and contralateral body loss of pain sensation along with nystagmus and ataxia

Posterior circulation syndrome subtype

97
Q

What score to assess risk of repeat TIA?

A

ABCD2 score

98
Q

Signs of Alzheimer’s

A 
5 As
Amnesia
Anomia naming
Apraxia doing, calculation, dressing 
Agnosia recognising people
Aphasia speaking
99
Q

Csf analysis in dementia

A

Tau high as it leaks into csf

Beta amyloid low as it deposits into plaque

100
Q

Neuroleptic malignant syndrome cause, key symptoms and treatment

A

2 weeks after new antipsychotic (Dopamine antagonist) ie. excessive dopamine blockade

FEVER
Fever
Encephalopathy confusion, restless
Vital sign dysregulation - BP up or down, high Hr, RR
Enzymes elevated creatinine kinase, myoglobin as muscle breaks down
Rigid and Hyperreflexia, dilated pupils, diaphoresis

Mx. stop cause. Benzodiazepines (lorazepam), Dantrolene (fever) and bromocriptine (d2 agonists)

101
Q

signs of optic neuritis

A

inflammation of optic nerve
- pain on eye movents
- unilateral decrease in visual acuity
- poor discrimination of colours “red desaturaation”
- RAPD
- central scotoma

Helena's finals (22 decks)

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