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Medicine > Neurology > Flashcards

Neurology Flashcards

1
Q

CSF Findings of Viral Meningitis

A 
Appearance: Clear and colourless
Opening pressure: Normal/ mildly raised
Cell count: 100-300
Cells: Lymphocytes
Glucose: Normal
Protein: Normal/ mildly raised
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2
Q

CSF Findings of Bacterial Meningitis

A 
Appearance: Turbid/ cloudy
Opening pressure: Raised
Cell count: 100-5000 (high)
Cells: Neutrophils
Glucose: Reduced
Protein: Raised
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3
Q

Presentation of Encephalitis

A 
Headache
Fever
Focal neurological signs
Seizures
Encephalopathic behaviour
Confusion
Reduced consciousness
Meningism (approx. 10%)
Acute onset
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4
Q

Tx of Viral Encephalitis

A

IV Aciclovir 10mg/kg every 8hrs for 10-21 days (14 for HSV)
[Ganciclovir for CMV]

Supportive - antiepileptics, dexamethasone if raised ICP
Rehabilitation

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5
Q

Tx of meningitis in community

A

IM Benzylpenicillin 1200mg (>10yrs)

[600mg if 1-10; 300mg if <1yr]

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6
Q

Tx of bacterial meningitis in hospital

A

IV Ceftriaxone 2g BD

(if penicillin allergic - chloramphenicol)

Steroids (reduce complications)
Supportive
Contact tracing and PHE notification

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7
Q

Chemoprophylaxis for bacterial meningitis

A

Single dose Ciprofloxacin (or Rifampicin)

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8
Q

Chronic complications of meningitis

A
  • Hearing loss
  • Cognitive impairment/ learning difficulties
  • Memory loss
  • PTSD/ Psychiatric
  • Focal neurological deficits
  • Epilepsy, seizures
  • Blindness
  • Peripheral gangrene
  • Waterhouse-Friderichsen syndrome
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9
Q

Acute complications of meningitis

A
  • Sepsis
  • Multiorgan failure
  • AKI
  • ARDS
  • DIC
  • Peripheral gangrene
  • Seizures
  • Cerebral oedema
  • Death
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10
Q

Vaccinations for meningitis

A

MenB
MenACWY
Pneumococcal
Hib

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11
Q

Waterhouse-Fridrichsen syndrome

A

Bilateral adrenal haemorrhages - causes Addison’s

e.g. in meningococcal septicaemia

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12
Q

GBS Presentation - symptoms and signs

A

Recent GI/ URTI infection (1-3 weeks before)
Acute onset

SYMPTOMS

  • Progressive symmetrical ascending weakness
  • Mild paraesthesia - usually hands and feet, may precede weakness
  • Respiratory distress - RF
  • CNs may be involved - facial palsy, extra-ocular muscle weakness (diplopia), dysarthria
  • Neuropathic pain - back, legs

SIGNS

  • LMN - Areflexia/ hyporeflexia
  • Flaccid paralysis
  • Paraesthesia - not dermatomal
  • Facial palsy etc
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13
Q

Miller-Fisher syndrome

A

Variant of GBS

Ataxia, Areflexia, Ophthalmoplegia

Some have muscle weakness
Most are +ve for Anti-Ganglioside Abs

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14
Q

Ix for GBS

A

Bedside

  • Neurological examination
  • Obs - HR, RR, BP, sats, temperature, CBG
  • Stool culture (if recent GI infection)
  • Spirometry (monitor progression/ respiratory involvement)
  • ABG

Bloods

  • FBC, U&Es, LFTs, CRP, TFTs, HbA1c, B12, folate, thiamine
  • BBV screen, syphilis serology
  • Anti-ganglioside Abs

Special/ Imaging

  • Nerve conduction studies
  • LP - raised protein but normal WCC

Other - MRI Spine, CXR

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15
Q

Infectious causes of GBS

A 
Campylobacter jejuni (most common; associated with worse prognosis - more severe presentation, faster progression, slower recovery)
CMV
EBV
Hepatitis E
Mycoplasma pneumoniae
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16
Q

Tx of GBS

A

Plasma exchange or IVIG

Supportive

  • Fluids, nutrition
  • Analgesia
  • Respiratory support - monitoring with spirometry, may need intubation for mechanical ventilation
  • CVS monitoring (BP and ECG - risk of hypo/hypertension and arrhythmias)
  • VTE Prophylaxis (PE = leading cause of death)
  • SALT (assess swallowing)
  • Physiotherapy
  • Rehabilitation
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17
Q

Pathophysiology of GBS

A

Acute inflammatory polyneuropathy

‘Molecular mimicry’ - body produces Abs to viral infection but the Abs cross react and attack body’s own cells - causing damage

2 main types

  • Demyelinating - attacks myelin sheath
  • Axonal - causes axonal degeneration
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18
Q

Cubital tunnel syndrome

A

If lean on elbow, sleep with arm hanging off bed or impact on humerus

Ulnar nerve palsy
- Weakness and change in sensation to medial 1&1/2 fingers

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19
Q

Brown Sequard syndrome features

A
  • Ipsilateral paralysis/ hemiplegia (corticospinal tracts)
  • Ipsilateral loss of vibration and proprioception (dorsal columns - decussate in brainstem)
  • Contralateral loss of pain and temperature (spinothalamic - decussates approx. 2 segments higher than enter the cord)
  • Hyperreflexia
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20
Q

Hemisection of cord features

A
  • Ipsilateral paralysis (corticospinal tracts)
  • Ipsilateral loss of vibration and proprioception (dorsal columns - decussate in brainstem)
  • Contralateral loss of pain and temperature (spinothalamic - decussates approx. 2 segments higher than enter the cord)
  • Hyperreflexia
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21
Q

Hemisection of cord/ Brown Sequard causes

A 
Trauma
Neoplasm
Disc herniation
Demyelination
Epidural haematoma
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22
Q

Acoustic neuroma presentation

A 
Unilateral deafness
Vertigo
CN palsies
- V - reduced sensation in branches
- VI - impaired abduction of eye
- IX - uvula deviation away, reduced taste on posterior side of tongue
- X

Progresses to involve cerebellum

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23
Q

L5 Radiculopathy

A
  • Unilateral foot drop
  • Weak foot dorsiflexion, inversio and extension
  • Weak toe extension
  • Weak hip abduction and inversion
  • Sensory loss of lateral thigh and lower leg
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24
Q

DDx foot drop

A
  • L5 radiculopathy
  • Common peroneal nerve palsy
  • Mononeuropathy e.g. diabetes, B12 etc
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25
Q

Present with TIA and on anticogulants/ bleeding disorder, next step…

A

Admit immediately for imaging to exclude a haemorrhage

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26
Q

Present with TIA, Rx steps

A

300mg aspirin
Assessed by specialist within 24 hours

Secondary prevention = 75mg clopidogrel od

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27
Q

Numbness at different and unlinked sites (dissociated sensory loss) - condition?

A

MS

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28
Q

Loss of fine motor function in both upper limbs e.g. struggle to use mobile, dropping things
Gradual onset

A

Degenerative cervical myelopathy

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29
Q

Degenerative cervical myelopathy RFs

A

Smoking
Age
Occupation (high axial load)
Genetics

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30
Q

Degenerative cervical myelopathy

A

Symptoms vary in intensity day-day
Progressive - overall deterioration

Any of…

  • Pain - neck, UL or LLs
  • Loss of motor function - digital dexterity e.g. holding fork, doing up buttoms
  • Leg weakness/ stiffness - gait and imbalance
  • Numbness
  • Autonomic dysfunction - incontinence, impotence
  • Hoffman’s sign

(may be incorrectly diagnosed as carpal tunnel)

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31
Q

Hoffman’s sign

A

Test for cervical myelopathy

Gently flick one finger on the patient’s hand

+ve result = reflex twitching of other fingers on same hand

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32
Q

Gold standard Ix for cervical myelopathy

A

MRI Cervical spine - disc degeneration and ligament hypertrophy

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33
Q

Rx of degenerative cervical myelopathy

A

Urgent assessment by spinal services

  • Early treatment = best chance of recovery
  • Decompressive surgery
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34
Q

Straight leg raise

A

Radicular pathology

Pain in back when leg is raised 30-60 degrees

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35
Q

Expressive dysphasia

A

Wernicke’s - in temporal lobe
(typically inferior division of MCA)

Speech is fluent but content is incomprehensible
Impaired comprehension

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36
Q

Receptive dysphasia

A

Broca’s - frontal lobe
(typically superior division of MCA)

Speech is non-fluent, laboured and halting
Repetition is impaired
Normal comprehension

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37
Q

Neuropathic pain

A

1st line - Amitriptyline, gabapentin or pregabalin

2nd line - try a 2nd 1st line medication

Rescue therapy - tramadol
Localised - topical capsaicin

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38
Q

Migraine acute Rx

A

Triptan + NSAID
OR
Triptan + paracetamol

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39
Q

Migraine prophylaxis

A

If 2 or more attacks/ month

Propranolol or topiramate

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40
Q

Narcolepsy (features, Ix, Rx)

A

Sudden falling asleep in day
Hypersomnolence
Cataplexy - sudden loss of muscle tone, often triggered by emotion
Episodes of sleep paralysis
Visual hallucinations on falling asleep or waking up

Ix - multiple sleep latency EEG

Rx

  • Daytime stimulants e.g. modafinil
  • Nighttime sodium oxybate
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41
Q

Raised ICP causes

A
  • IIH
  • Neoplasm/ SOL
  • Intracranial haemorrhage
  • Hydrocephalus
  • Infection - meningitis
  • Traumatic head injury
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42
Q

Phenytoin SEs

A

Acute
- Dizziness, diplopia, nystagmus, slurred speech, confusion, ataxia

Chronic

  • Peripheral neuropathy
  • Lymphadenopathy
  • Gum hyperplasia
  • Dykinesia
  • Osteomalacia
  • Megaloblastic anaemia

Other

  • Hepatitis
  • TEN
  • Aplastic anaemia

Teratogenic

P450 inducer

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43
Q

Muscle spasms (spasticity) in MS - Rx

A

Baclofen or gabapentin

Physio

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44
Q

Amantadine

A

Dopamine agonist

Rx fatigue in MS

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45
Q

1st line for acute relapse in MS

A

oral or IV Methylprednisolone for 5 days

shortens relapse - but don’t affect degree of recovery

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46
Q

Bladder dysfunction in MS Rx

A

USS to assess bladder emptying

  • If residual volume - intermittent self-catheterisation
  • If no significant residual volume - anticholinergics (reduce urinary frequency)
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47
Q

When do thrombolysis?

A

Symptom onset between 6-24hrs

Confirmed occlusion of anterior or posterior circulation (on CTA or MRA)

Salvageable brain tissue shown (limited infract core volume - on CT perfusion or diffusion weighted MRI)

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48
Q

Thrombolysis for stroke when…

A

Present less than 4.5hrs after onset of symptoms

Excluded haemorrhagic stroke

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49
Q

Autonomic dysreflexia

A

Occurs if spinal cord injury at or above T6

  • Sympathetic spinal reflex but parasympathetic response is prevented
  • triggers - faecal impaction, urinary retention

Extreme HTN and cerebral vasodilation
Flushing and sweating above level of cord lesion

Risk of stroke

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50
Q

Diplopia on walking down stairs

A

CN IV palsy

(Superior oblique - Internal rotation and depresses eye when adducted)
(Palsy - unable to look down when eye is adducted, vertical diplopia, may develop a head tilt)

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51
Q

Differentiate between carpal tunnel syndrome and degenerative cervical myelopathy

A

DCM

  • +ve Hoffman’s test (UMN sign)
  • may have UMN signs (subtle)

Carpal tunnel

  • may have +ve Tinnels
  • may have +ve Phalen’s
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52
Q

Lateral medullary syndrome - what and RFs

A

Ischaemia to lateral medulla oblongata in brainstem

Posterior circulation stroke

  • Vertebral artery or posterior inferior cerebellar artery (PICA)
  • Vertebral artery dissection (commonest in young pts); atherothrombotic occlusion of artery, cerebral embolism

RFs - HTN, smoking, DM

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53
Q

Lateral medullar syndrome - presentation

A 
Ataxia
Dysarthria
Dysphagia
Ipsilateral Horner's syndrome
Ipsilateral loss of pain and temp sensation to the face
Contralateral loss of pain and temp sensation to the body
Vertigo & falling towards side of lesion
Multidirectional nystagmus
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54
Q

ABCD Score for stroke risk in TIA

A 
Age >60 (1)
BP >140/90 (1)
Clinical features - unilateral weakness (2), speech disturbance without weakness (1)
Duration >1hr (2), 10-59mins (1)
DM (1)
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55
Q

Total anterior circulation infarct - Bamford criteria

A 
Contralateral hemiplegia/ paresis 
AND
Contralateral homonymous hemianopia
AND 
Higher cerebral dysfunction (aphasia, neglect etc)
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56
Q

Partial anterior circulation infarct - Bamford criteria

A

2 of:
Contralateral hemiplegia/ paresis
Contralateral homonymous hemianopia
Higher cortical dysfunction (e.g. aphasia, neglect)

OR
Higher cerebral dysfunction alone

57
Q

Lateral pontine syndrome

A

Anterior inferior cerebellar artery

Ipsilateral - facial palsy, nystagmus, deafness and tinnitus, ataxia, facial sensation (CNs V, VII, VIII)
Vertigo, n/v
Contralateral loss of pain and temperature sensation on body

58
Q

Lacunar infarct

A

Deep perforating arteries - supply thalamus and internal capsules

Types:

  • Pure motor
  • Pure sensory
  • Sensorimotor
  • Ataxic hemiparesis

NO EVIDENCE OF higher cortical dysfunction, visual field loss or brainstem dysfunction

59
Q

Essential tremor features

A

Tremor on sustained muscle tone

  • Kinetic e.g. painting
  • Postural - worse if arms outstretched

Improved by alcohol and rest

Autosomal dominant

60
Q

1st line Tx of essential tremor

A

Propranolol

61
Q

Neurogenic thoracic outlet syndrome features

A

Paraesthesia, pain and wasting of hand muscles
+/- autonomic features
Worse on lifting arms above head
Arterial features - Raynaud’s

62
Q

Cervical spondylosis

A

Degeneration of cervical spine

Neck pain
Shooting pains down arms
NOT worsened by lifting arms above head
NO arterial features e.g. Raynaud’s

63
Q

Proximal weakness DDx

A 
Congenital - mitochondrial, 
Muscular dystrophies 
Metabolic - Hypothyroidism, Cushing's
Inflammatory/ autoimmune - dermatomyositis, polymyositis, Myasthenia gravis, Lambert-Eaton
Drugs
64
Q

Bilateral UMN Signs DDx

Pyramidal weakness/ spastic paraparesis

A 
MS
MND (no sensory involv.)
Myelopathy (sensory level) - cervical myelopathy, transverse myelitis, disc prolapse, SOL, trauma, syringomyelia
Brainstem stroke
Hereditary spastic paraplegia
65
Q

Unilateral UMN Signs DDx

A

Intracranial - CVA (stroke), SOL, MS (hemisensory loss)
Brainstem - MS
Spinal cord - Trauma, SOL, abscess, AVM/ haemorrhage (sensory level)

66
Q

Bilateral LMN Signs DDx

A

Impaired Sensation

  • V - vasculitis
  • I - HZV, HIV, Syphilis, leprosy
  • M - Hypothyroidism, DM, Alcohol, B12 deficiency
  • Drugs - Isoniazid, metranidazole, nitrofurantoin, amiodarone
  • D - CMT

Normal sensation

  • GBS
  • Chronic inflammatory demyelinating disease
  • CMT
  • Lead poisoning
  • Amyloidosis
  • Muscular dystrophy
67
Q

Unilateral LMN Signs DDx

A

Radiculopathy - IVD prolapse, spinal stenosis, neoplasm, cervical rib, osteophytes, infection (polio, HZV, CMV)
Plexus - Brachial neuritis, trauma, neoplastic infiltration, thoracic outlet syndrome, congenital (Erb’s/ Klumpke’s palsy)
Peripheral nerve - depends on the nerve

68
Q

Median nerve palsy DDx

A 
Hypothyroidism
DM
Acromegaly
Obesity
Smoking
Repetitive use 
Trauma - fracture
69
Q

Ulnar nerve palsy DDx

A

Compression at elbow - osteophytes, crutches, ITU
Fracture
Surgical damage
DM

70
Q

Radial nerve palsy DDx

A

Trauma - elbow dislocation, fracture (humeral shaft)

Compression at elbow - crutches, saturday night palsy

71
Q

Axillary nerve palsy DDx

A

Shoulder dislocation

72
Q

Common peroneal nerve palsy DDx

A

Trauma - fracture, dislocation
Compression - ski boots, plaster cast
DM

73
Q

Mononeuritis multiplex DDx

A

Vasculitis - GPA, EGPA

Autoimmune - RA, SLE, Sjogren’s, Sarcoidosis

74
Q

UMN and LMN signs

A

MND

Dual pathology - e.g. cervical myelopathy + polyneuropathy

75
Q

Absent ankle (+knee+ reflexes and extensor plantars

A

Subacute combined degeneration of the cord (B12 deficiency)

MND
Syphilis (taboparesis)
Friedreich’s ataxia

76
Q

Cerebellar disease

A

V - Stroke (thromboembolic, haemorrhagic)
A - MS
M - Alcohol
N - SOL
C - Freidreich’s ataxia, spinocerebellar ataxia

77
Q

Finger abduction weakness - nerve root

A

T1

78
Q

Testing point for T1 dermatome

A

Medical epicondyle of elbow

79
Q

RAPD - associated nerve?

A

CN II - Optic nerve

80
Q

Unilateral facial palsy LMN - DDx

A 
VITAMIN CDDEF
I - Bell's (idiopathic)
A - MS
M - DM
I - Ramsay Hunt syndrome (HZV), HIV
N - Acoustic neuroma, parotid tumour
81
Q

Facial palsy UMN DDx

A

Stroke (I/h)
SOL
MS

82
Q

MCA infarct features

A 
Contralteral hemiplegia/paresis and sensory loss
Arms > legs
Contralateral Homonymous Hemianopia
Aphasia
Higher cerebral impairment

MCA supplies superiors temporal lobe and lateral parietal lobe

83
Q

ACA infarct features

A

Contralateral hemi sensory and motor loss
Legs > arms

ACA supplies medial parietal lobe

84
Q

PCA infarct features

A

Contralateral homonymous hemianopia with macular sparing

Visual agnosia

85
Q

Chronic subdural on imaging

A

Hypodense (dark) crescenteric collection around the brain

86
Q

Acute subdural

A

Hyperdense (bright) crescenteric collection around the brain

87
Q

Hypodense (dark) crescenteric collection around the brain

A

Chronic subdural

88
Q

Hyperdense (bright) crescenteric collection around the brain

A

Acute subdural

89
Q

Finger adduction - nerve

A

Ulnar nerve

90
Q

Finger extension - nerve

A

Radial nerve

91
Q

Blood test differentiating seizure and pseudoserizure

A

Prolactin

- more likely to be raised in seizure than pseudoseizure

92
Q

Factors favouring pseudoseizure

A
  • Prolonged duration
  • Rarely in sleep or when alone
  • Waxing and waning course
  • Gradual onset
  • Motor activity = uncoordinated and asymmetric
  • Torso contractions or pelvic thrusting
  • Closed eyes, resistance to opening
  • Not stereotypical
93
Q

Factors favouring seizure

A
  • Deep lateral tongue biting
  • Stereotypical
  • Rhythmical coordinated contraction and relaxation of muscles
  • Eyes rarely closed
  • May occur in sleep
  • Post-ictal phase
  • Prodrome/ aura
  • Raised prolactin
94
Q

Ataxic gait DDx

A 
VITAMIN CDDEF
V - Stroke (posterior circulation)
T - trauma
A - MS
M - Alcohol
N - posterior fossa neoplasm
C - Freidreich's ataxia
D - Antiepileptics
95
Q

Pronation of hand - nerve?

A

Median nerve

96
Q

Pontine haemorrhage

A 
Reduced consciousness/ GCS
Quadriplegia
Miosis (small reactive to light)
- PINPOINT PUPILS POINT TO PONS (or oPiates)
Absent horizontal eye movements

Often secondary to uncontrolled HTN

97
Q

Supracondylar nerve fracture - associated nerve palsy?

A

Ulnar nerve or median

98
Q

Fracture of shaft of humerus - associated nerve palsy?

A

Radial nerve

99
Q

Fracture of proximal humerus - associated nerve palsy?

A

Axillary nerve

100
Q

Radial nerve motor and sensory function

A

Motor

  • triceps
  • brachioradialis
  • supinator
  • extensors
  • abductor poliicis longus

(Elbow extension, wrist extension, supination) - wrist drop

Sensory
- dorsal lateral 3 and half fingers

101
Q

Vagus (X) - palsy features

A

Uvula deviation (to contralateral side)
Loss of gag reflex
Changes in speech and swallowing

102
Q

Normal pressure hydrocephalus

A

Declining cognition (dementia)
Falls - Ataxia
Urinary incontinence

‘WET, WOBBLY & WHACKY’

Rx - ventriculoperiotoneal shunt

103
Q

Left inferior quadrantanopia - where is the lesion?

A

Parietal lobe

PITS - Parietal inferior, temporal superior

104
Q

Superior quadrantanopia - where is the lesion?

A

Temporal lobe

PITS - Parietal inferior, temporal superior

105
Q

Homonymous hemianopia with macular sparing - where is the lesion?

A

Posterior cerebellar artery infarct

106
Q

Posterior cerebellar artery infarct vision change

A

Homonymous hemianopia with macular sparing - where is the lesion?

107
Q

Temporal lobe infarct vision change

A

Superior quadrantanopia

PITS - Parietal inferior, temporal superior

108
Q

Parietal lobe infarct vision change

A

Inferior quadrantanopia

PITS - Parietal inferior, temporal superior

109
Q

Infarct along optic tract - vision loss…

A

Homonymous hemianopia without macular sparing

110
Q

Homonymous hemianopia without macular sparing - where is the lesion?

A

Optic tract infarct

111
Q

Monocular vision loss - where is the lesion

A

Optic nerve/ Eye

112
Q

Bilateral medial temporal lobe involvement on MRI - suggestive of…

A

Encephalitis

113
Q

Basilar artery infarct features

A

Locked in syndrome

Complete loss of movement (tetraplegia)
Preserved vertical gaze and consciousness
Lower CN dysfunction

114
Q

MS CSF findings

A

Oligoclonal bands

115
Q

1st line Tx for myoclonic seizures

A

Sodium valproate

If of child bearing age - use Levetiracetam

116
Q

2nd line for myoclonic seizures (if of childbearing age etc)

A

Levetiracetam

117
Q

1st and 2nd line for Generalised seizures

A

1st - Sodium Valproate

2nd - Lamotrigene, Carbamazepine

118
Q

1st and 2nd line for Focal seizures

A

1st - Carbamazepine

2nd - Levetiracetam, sodium valproate

119
Q

Absence seizures Tx

A

Sodium valproate or Ethosuximide

120
Q

CNs affected by acoustic neuroma?

Ix of choice?

A

V, VII and VIII

  • Unilateral sensorineural hearing loss, tinnitus, vertigo
  • Facial palsy
  • Absent corneal reflex

Ix = MRI of cerebellopontine angle

121
Q

CI to triptan use?

A

Ischaemic heart disease/ CVD

or cerebrovascular disease

122
Q

Multiple system atrophy features?

A

Parkinson’s symptoms
+
AUTONOMIC DYSFUNCTION (from early on) - postural hypotension, incontinence, impotence

123
Q

Parkinson’s plus syndromes…

A

Multisystem atrophy (+autonomic dysfunction)

LBD (visual hallucinations, fluctuations in cognitive impairment)

PSP (Vertical gaze palsy)

Corticobasal degeneration (CBD) (Spontaneous activity by an affected limb, akinetic rigidity)

124
Q

Rx of myasthenia gravis

  • acutely
  • long-term
A

Acutely
- Prednisolone

Long-term
- AChE inhibitors e.g Pyridostigmine, Neostigmine

(Surgical - thymectomy for thymus hyperplasia or thymoma)

Conservative - Physio, SLT, OT

125
Q

Indications for CT head within 1 hour

A
  • GCS <12 on initial assessment or <15 2hrs after injury
  • Focal neurological deficit
  • Post-traumatic seizure
  • > 1 episode of vomiting
  • Suspected open/ depressed/ base of skull fracture
126
Q

CT Head within 8hrs…

A
  • > 65yrs
  • Hx of bleeding/ clotting disorders or on anticoagulation
  • Dangerous mechanism of injury
  • > 30 mins retrograde amnesia if events before injury
127
Q

Signs of basal skull fracture

A

Battle’s sign (bruising behind ear)
Raccoon eyes (bruising around eyes)
Haemotympanum (blood seen to be behind tympanic membrane on otoscopy)
CSF Rhinorrhoea/ Otorrhoea

128
Q

2 main features of Huntington’s

A

Choreoathetosis (involuntary twitching/ writhing)

Dementia

129
Q

In traum/ ?CSF leak, what do you test for in the liquid to check if it is CSF?

1) Routine
2) Gold standard

A

1) Glucose
- present in CSF but not mucus
- very quick test

2) Beta-2-transferrin

130
Q

Mononeuritis multiplex features

A

Affects individual nerves in a random fashion

e.g. CN III palsy (pupil sparing), foot drop, peripheral sensory neuropathy

131
Q

Mononeuitis multiplex causes

A 
V - Vasculitis
I - Advanced HIV
A - Sarcoidosis, amyloisosis
M - DM, alcohol
N - cancer

Most common = DM

132
Q

Dermatomyositis features

A

Inflammatory polyneuropathy

Myositis - pain in muscles and on palpation of muscles
Weakness (myopathy) - proximal muscles

Skin changes - heliotrope rash, Gottron’s papules

Is a paraneoplastic syndrome in approx. 30% so look for malignancy

133
Q

CIs to anti-cholinesterase inhibitors (e.g. used in Alzheimer’s)

e.g. Rivastigmine

A 
Prolonged QT interval
Heart block (2nd/3rd degree)
HR < 50bpm
134
Q

Lower brachial plexus injury features

A

Weakness/ paralysis of small muscles of the hand
Dermatomal sensory loss (lower cervical and upper thoracic areas)
T1 - Horner’s

Klumpke’s (C8-T1)- damage to lower brachial plexus roots

Often an avulsion injury (trauma)

135
Q

Erb’s palsy features

A

Upper brachial plexus nerve roots (C5-6)

Shoulder adduction
Internally rotated arm
Elbow extension
Wrist flexion
(Waiter's tip)

Dermatomal loss of C5-6

Associated with traumatic childbirth and shoulder dystocia

136
Q

1st line prophylaxis for migraines

A

Propranolol

2nd line = topiramate

137
Q

Subacute combined degeneration of the cord features

A

Mixed UMN and LMN signs
Absent ankle reflexes and upgoing plantars

Sensory ataxia (+ve Romberg’s) - due to peripheral neuropathy and dorsal column involvement

B12 deficiency

138
Q

Prescribe antiemetics for migraine?

A

Yes (even if nausea isn’t a major complaint)
- prescribe a prokinetic e.g. metoclopramide alongside analgesia

  • increases efficacy of analgesia
  • reduces nausea

Medicine (6 decks)

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