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Neurology Flashcards

1
Q

Name some causes of cerebellar lesions?

A

MS, tumour, abscess, haemorrhage, chronic alcohol use

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2
Q

What is bells palsy?

A

LMN lesion affecting facial nerve (usually caused by HSV)

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3
Q

Features of bells palsy?

A

LMN weakness of the face, loss of taste on anterior 2/3 tongue, hyperacusis, decreased tear production

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4
Q

Mx of bells palsy?

A

close eyelids with tape, prednisolone

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5
Q

What causes a stroke?

A

cerebral infarction due to embolism or thrombosis (at site of atheromatous plaque)

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6
Q

What is a TIA?

A

transient episode of neurological deficit caused by brain/SC/retinal infarction. This is usually caused by microemboli

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7
Q

Symptoms of a stroke by anatomy?

A

ACA: leg > arm
MCA: arm > leg, facial weakness, controlateral homonymous hemianopia
PCA: visual agnosia

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8
Q

Ix for a TIA/stroke

A

imaging: head CT, doppler US of the carotid
Bloods: FBC, UE, LFT, ESR, CRP, glucose, lipids
ECG

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9
Q

What is the risk score for Rx of a stroke following a TIA?

A

ABCD2

Age >60, BP > 140/90, clinical features, duration of TIA, T2DM

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10
Q

RF prevention following a stroke/TIA?

A

statin, aspirin 75mg daily, control BP

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11
Q

Mx of a patient presenting with a TIA/stroke?

A
  1. Aspirin 300mg (continue then as 75mg daily)
  2. Thrombolysis (IV alteplase) given within 4.5hrs of onset of a stroke
  3. control HTN
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12
Q

What causes a SAH?

A

rupture of berry aneurysm, congenital AVM

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13
Q

Features of SAH rupture?

A

thunderclap headache in the occipital region, vomiting, meningial irritation, loss of consciousness, focal neuro signs, pappilodoema

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14
Q

Ix of a SAH?

A

CT head, LP (shows increased oxybilirubin released from lysis), MR angiography

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15
Q

Mx of a SAH?

A

bed rest, supportive measures, Nimodipine, give IV normal saline

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16
Q

What is a SDH and what causes it?

A

blood in the subdural space following the rupture of a saggital vein due to a minor head trauma. increased Rx in the elderly and alcoholics (atrophic brains)

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17
Q

What is epilepsy?

A

the tendancy to have seizures (seizures are convulsions or transient abnormal events caused by paroxysmal discharge of cerebral neurones

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18
Q

What is a simple and complex partial seizure?

A

simple - only affect one part of the brain, and do not affect consciousness or memory

Complex - affect awareness or memory during/immediately after seizure

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19
Q

Ix for epilepsy?

A

CT head, determine seizure type, EEG with camera footage.

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20
Q

How do you manage status epilepticus?

A

General: O2, IV access, IV thiamine, monitor sats

  1. Lorazepam IV (repeat after 10 minutes) - monitor respiratory rate (causes depression)
  2. Phenytoin IV - ECG monitoring due to arrhythmias
  3. Phenobarbitol
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21
Q

Name some anti-epilpetic drugs and their side effects

A

Sodium Valproate - weight gain, hair loss, liver damage
Lamotrigine - TEN
Carbamezepine - rashes, leucopenia, TEN

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22
Q

Pathological process in Parkinson’s disease?

A

depletion of dopamine-secreting cells in the substantia nigra. These neurones project to striatum and neural circuits in the basal ganglia movement pathways.

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23
Q

Name the main features of Parkinson’s?

A
  1. TREMOR - 4-7Hz resting tremor (pin rolling of the thumb), improves with voluntary movement
  2. RIGIDITY - increased tone in limbs and trunk, limbs resist passive extension (lead pipe rigidity)
  3. AKINESIA - difficulty initiating movement, face expressionless, speech slow
  4. SHUFFLING GAIT - characteristic stoop, poor balance .

Non motor - depression, hallucinations, dementia, impulsive behaviours, insomnia, drooling saliva, dysphagia

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24
Q

Ix for Parkinson’s?

A

head CT, diagnosis is clinical

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25
Q

Name some treatments for parkinson’s plus drug names and side effets?

A
  1. Levodopa (L dopa = dopamine agonist, peripheral decarboxylase inhibitor = carbidopa) - SE = nausea
  2. Dopamine agonist - Ropinirole SE = impulse issues
  3. Monoamine oxidase B inhibitor e.g Selegiline
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26
Q

What are the chemical changes in the brain in Hungington’s?

A

reduced GABA and ACh, dopamine is spared

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27
Q

What is MS?

A

autoimmune disorder of the CNS creating plaques of demyelination within the brain in SC which are disseminated in time and place. there are 2+ distinct clinical episodes of CNS dysfunction with periods of remission. Inflammation mediated by CD4 cells

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28
Q

Name some features of MS based on where the demyelination occurs?

A

Optic neuropathy - optic neuritis, pain, optic atrophy
Brainstem - diplopia, vertigo, dysphagia, nystagmus
SC - numbness, pins and needles, spastic paraparesis, incontinence

29
Q

Ix for MS?

A

MRI brain/SC - show the plaques
EMG - shows electrical potentials are prolonged
CSF - raised protein count, electrophoresis shows oligoclonal IgG bands

30
Q

Management for acute attack of MS and maintaining remission?

A

Acute - methylprednisolone

Maintaining relapse - B interferon, Natalizumab

31
Q

Features of acute bacterial meningitis?

A

headache, neck stiffness, fever, photophobia, vomiting. Positive Kernig and Brudunski sign. Consciousness not normally impaired.
Meningococcal = non-blanching petichial and purpuric rash

32
Q

DD of bacterial meningitis?

A

SAH, migraine

33
Q

Ix for meningitis?

A

Head CT
LP - CSF microscopy (bacterial has low glucose and high protein and looks purulent)
blood cultures, blood glucose, chest x ray,

34
Q

Mx for meningitis?

A
  • if suspect meningococcal - immediate Benpen IM
  • IV fluids if depleted
  • ABx = Cefotaxime
35
Q

Features of acute viral encephalitis?

A

mild fever, headache, drowsy, focal neuro signs, drowsy coma

36
Q

Ix for encephalitis?

A

MRI brain, CSF analysis, EEG

37
Q

3 main features of a brain tumour?

A

focal neuro deficit, new onset epilepsy, raised ICP

38
Q

Features of a raised ICP headache?

A

headache worse with coughing/sneezing/straining, vomiting, pappilodoema
Downward displacement of the brain = resp depression, bradycardia, coma and death

39
Q

What is hydrocephalus? how does it occur?

A

excessive CSF in cranium. Normally due to obstructed outflow of CSF through the ventricles (e.g. due to tumour or congenital malformation

40
Q

Features of hydrocephalus?

A

headache, vomiting, pappilodoema

41
Q

How do you manage a tension headache?

A
  1. Reassure and explain to the patient. Avoid medication overuse.
  2. Tricyclic antidepressants
42
Q

What is a migraine?

A

recurrent headache associated with visual and GI disturbance. Common in women <40

43
Q

Name some precipitating factors of migraines

A

cheese, wine, chocolate, menstruation, lights

44
Q

features of migraines?

A

headache lasting 4 - 72 hours. Associated nausea and vomiting, photophobia. Worse with exertion. Aura (visual flashing lights, unilateral blindness, weakness.

45
Q

Management of migraines pathway?

A

general: avoid precipitants, do not use COCP if get migraines
1. MILD - paracetamol/NSAIDS + metoclopromide (antiemetic)
2. SEV - triptan
PREVENT - B blocker/TCA

46
Q

What is a cluster headache?

A

severe orbital headaches lasting 1-2hrs which occur in clusters. Have autonomic features (lacrimation, red eye, rhinorrhea)

47
Q

How do you manage an acute cluster headache?

A

100% oxygen and a triptan

48
Q

Features of GCA?

A

headache, scalp tenderness, pain in jaw and jaw claudication. Superficial temporal artery is tender and firm. AION

49
Q

Ix of GCA?

A

ESR, FBC, temporal artery biopsy

50
Q

Mx of GCA?

A

high dose prednisolone (reduce guided by ESR)

51
Q

Name some causes of SCC?

A

metastasis, myeloma, degeneration, trauma, osteoporosis, neurofibroma

52
Q

Features of SCC?

A

UMN progressive leg weakness and eventual paralysis. there is sensory involvement and loss sphincter control and urinary incontinence/retention and constipation

53
Q

Ix of SCC?

A

XRay/MRI spine

54
Q

What is MND?

A

relentless and unexplained destruction of upper motor neurons an anterior horn cells in the brain and SC.

55
Q

Presentation of MND?

A

2 main presentations - bulbar palsy/ALS. wasting/fasciculations with UMN signs simultaneously.

56
Q

Ix for MND?

A

clinical diagnosis. EMG might show muscle denervation

57
Q

Mx of MND?

A

Riluzole (Na channel blocker.) ventilation and PEG

58
Q

What is carpal tunnel?

A

entrapment neuropathy of the median nerve travelling to the hand through the carpal tunnel.

59
Q

Name some RF of carpal tunnel?

A

RA, acromegaly, pregnancy, hypothyroid, DM, obesity

60
Q

What sign is positive when testing for carpal tunnel?

A

Tinnels sign - tapping on the carpal tunnel reproduces the pain

61
Q

Name 3 infections which can trigger GBS? which epitope do they share?

A

C.jejuni, EBV, campylobacter - they share the GM1 and GQ1b antigens on peripheral nerves

62
Q

Features of GBS?

A

Progressive limb weakness, reflexes lost, respiratory and cardiac involvement + eye involvement (miller fischer)

63
Q

Ix of GBS?

A

nerve conduction studies, GQ1b antibodies, CSF normal

64
Q

Mx of GBS?

A

IVIG, measure tidal volume, ECG monitoring, DVT prophylaxis

65
Q

What is MG?

A

weakness and fatiguability of the ocular, bulbar and proximal limb muscles. it is due to autoantibodies to the acetylcholine receptors (anti-AChR Abs) at the postsynaptic membrane of the NMJ.

66
Q

Features of MG?

A

fatiguability of muscles on sustained use. ocular muscles, bulbar muscles = difficulty talking and cheswing and swallowing

67
Q

Ix for MG?

A

Anti-AChr and Anti-MUSK antibodies
nerve stimulation tests
CT/MRI mediastinum - thymoma?
tensillon test - IV anticholinesterase results in rapid improvement of symptoms

68
Q

Mx of MG?

A

anticholinesterase - Pyridostigmine PO
corticosteroides (Azathioprine)
IVIG
Thymectomy

Finals (21 decks)

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