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Phase 3a > NEUROLOGY (ADULT) > Flashcards

NEUROLOGY (ADULT) Flashcards

1
Q

WHAT ARE THE CAUSES OF UNILATERAL VISUAL LOSS

A

VASCULA

OPTIC NEURITIS OR PAPILLITIS

RETINAL DETACHEMENT

VITREOUS HAEMORRAGE

RETINOPATHY AND MACULAR DEGENERATION

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2
Q

WHAT ARE SOME EXAMPLES OF VASCULAR CAUSES OF UNILATERAL VISUAL LOSS

A

OCCLUSION OF CENTRAL RETINAL ARTERY

OCCLUSION OF CENTRAL RETINAL VEIN

TEMPORAAL ARTERITIS (GIANT CELL)

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3
Q

WHAT IS ANTERIOS ISCHEMIC OPTIC NEUOPATHY

A

OCCLUSION OF POSTERIOS CILLARY ARTERY SUPPLYING THE OPTIC NERVE HEAD

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4
Q

WHAT IS ANTERIOS ISCHEMIC OPTIC NEUOPATHY ASSOCIATED WITH

A

GIANT CELL ARTERITIS

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5
Q

WHAT WOULD YOU FIND ON FUNDOSCOPY FOR ANTERIOR ISCHEMIC OPTIC NEUOPATHY

A

SWOLLEN OPTIC DISK

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6
Q

WHAT ARE THE FINDINGS ON FUNDOSCOPY OF CENTRAL RETINAL ARTERY OCCLUSION

A

A PALE RETINAL DISK W CHERRY SPOTS ON THE MACULA

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7
Q

WHAT DOES THE CENTRAL RETINAL ARTERY SUPPLY

A

THE WHOLE RETINA

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8
Q

WHAT WOULD YOU FIND ON FUNDOSCOPY OF CENTRAL RETINAL VEIN OCCLUSION

A

DILATATION OF BRANCH VEINS

COTTON WOOL PATCHES

MULTIPLE HAEMORRAGES

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9
Q

WHAT TESTS WOULD YOU USE TO DIAGNOSE UNILATERAL VISUAL LOSS

A

MRI

VISUAL EVOKED POTENTIAL

FLUORESCEIN ANGIOGRAPHY

TONOMETRY

USS

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10
Q

WHAT WOULD YOU USE TO DIAGNOSE OPTIC NEURITIS

A

MRI

VISUAL EVOKED POTENTIAL

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11
Q

WHAT WOULD YOU USE TO DIAGNOSE CENTRAL RETINAL VEIN/ARTERY OCCLUSION

A

FLUORESCEIN ANGIOGRAPHY

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12
Q

WHAT WOULD YOU USE TO MEASURE INTRAOCCULAR PRESSURE FOR GLAUCOMA

A

TONOMETRY

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13
Q

WHAT WOULD YOU USE USS TO DIAGNOSE FOR

A

VITREOUS HAEMORRAGES

RETINAL DETACHEMENT

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14
Q

WHAT IS OPTIC NEURITIS

A

INFLAMMATION OF THE OPTIC NERVE CAUSING DAMAGE AND SUBSEQUENT VISUAL LOSS

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15
Q

WHAT IS OPTIC NEURITIS ASSOCIATED WITH

A

MS

TEMPORAL ARTERITIS

SLE

LYME

SYPHILLIS

B12 DEFICIENCE

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16
Q

HOW DOES OPTIC NEURITIS PRESENT

A

DECREASED VISUAL ACUITY OVER DAYS

PAIN MOVING EYE

VISION LOSS EXACERBATED BY HEAT OR EXCERSISE

AFFERENT PUPILLARY DEFECT

INABILITY TO DISTINGUISH COULOR HUES (DYSCHROMATOPSIA)

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17
Q

HOW WOULD YOU MANAGE OPTIC NEURITIS

A

STEROIDS TO SPEED UP RECOVERY

RESOLVES ON ITS OVER AFTER AOUND 6W

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18
Q

WHAT IS OPTIC NEURITIS OFTEN A FIRST PRESENTATION FOR

A

MULTIPLE SCLEROSIS

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19
Q

WHAT IS MULTIPLE SCLEROSIS

A

A CHRONIC DEMYLENATING DISEASE WHICH IS AUTOIMMUNE AND MAY CAUSE NEURODEGENERATIVE AXONIAL LOSS

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20
Q

WHERE DO MULTIPLE SCLEROSIS LESIONS OFTEN OCCUR

A

OPTIC NERVE

BRAIN STEM

BASAL GANGLIA

SPINAL CORD

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21
Q

WHAT ARE THE OPTIC NERVE SYMPTOMS OF MULTIPLE SCLEROSIS

A

REDUCED VISUAL ACUITY OVER DAYS

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22
Q

WHAT ARE THE BASAL GANGLIA SYMPTOMS OF MULTIPLE SCLEROSIS

A

NYSTAGMUS (OFTEN CONTRALATERAL TO AFFECTED EYE)

TREMOUR

SLOWED MOVEMENTS

ATAXIA

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23
Q

WHAT ARE THE SPINAL CORD SYMPTOMS OF MULTIPLE SCLEROSIS

A

PINS AND NEEDLES

MUSCLE SPASM AND MUSCLE WEAKNESS

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24
Q

WHAT ARE THE BRAIN STEM SYMPTOMS OF MULTIPLE SCLEROSIS

A

PYRAMIDAL WEAKNESS ie muscle weakness and spastic parapesis

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25
Q

WHAT ARE SIGNS THAT ARE ASSOCIATED W MULTIPLE SCLEROSIS

A

UMN LESION SIGNS

  • BRISK REFLEXES
  • SPASTIC HYPERTONIA
  • MUSCLE WEAKNESS
  • BABINKKI SIGN AND OTHER PRIMATIVE SIGNS

ALSO

OPTIC ATROPHY

AND CEREBELLAR SIGNS IE ATAXIA AND NYSTAGMUS

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26
Q

WHAT ARE THE CRITERIA REQUIRED TO DIAGNOSE MULTIPLE SCLEROSIS

A

MULTIPLE CNS LESIONS

PLUS

  1. LESIONS ARE DISSEMINATED IN SPACE EITHER CLINICALLY OR ON MRI
  2. ARE DISSEMINATED IN TIME (OVER 1 MONTHS)
  3. SYMPTOMS LAST LONGER THAN 24HRS
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27
Q

WHAT IS THE INVESTIGATION OF MULTIPLE SCLEROSIS

A

MRI

LP

EVOKED POTENTIALS (VISUAL)

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28
Q

IN MULTIPLE SCLEROSIS WHAT WOULD YOU FIND ON LP

A

OLIGOCLONAL BANDS

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29
Q

WHAT ARE THEY TYPES OF MULTIPLE SCLEROSIS

A
  1. BENIGN
  2. RELAPSING REMITTING
  3. SECONDARY CHRONIC PROGRESSIVE
  4. PRIMARY PROGRESSIVE
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30
Q

DESCRIBE BENIGN MULTIPLE SCLEROSIS COURSE

A

NOT NEURODEGENERATIVE. HAS FLARES BUT THEN THERE WILL BE FULL RECOVERY BACK TO NORMAL LEVELS OF ABILITY

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31
Q

DESCRIBE RELAPSING REMITTING CAUSE OF MULTIPLE SCLEROSIS

A

SLOW STEPWISE DECLINE IN ABILITY WITH EACH FLARE.

THERE IS PARTIAL RECOVERY AFTER EACH FLARE

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32
Q

DESCRIBE SECONDARY PROGRESSIVE COURSE OF MULTIPLE SCLEROSIS

A

AT THE START THERE IS STEPWISE DECLINE OF ABILITY WITH PARTIAL RECOVERY AFTER EACH FLARE.

LATER IN THE DISEASE CAURSE THERE IS A STEADY PROGRESSIVE DECLINE IN ABILITY WITHOUT FLARES

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33
Q

DESCRIBE PRIMARY PROGRESSIVE COURSE OF MULTIPLE SCLEROSIS

A

A SLOW AND STEADY DECLINE IN ABILITY WITHOUT FLARES

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34
Q

WHAT IS GIANT CELL ARTERITIS

A

IN INFLAMMATORY DISEASE OF THE LARGE BLOOD VESSELS OF THE HEAD

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35
Q

WHAT IS THE PRESENTATION OF GIANT CELL ARTERITIS

A

HEADACHE

JAW AND TONGUE CLAUDICATION (+POSSIBLE TONGUE NECROSIS)

DECREASED VISUAL ACUITY (OPTIC NEURITIS)

SUDDEN VISUAL LOSS (OPTHALMIC ARTERY OCCLUSION)

PAIN AND TENDERNESS BRUSHING HAIR OR TOUCHING SCALP

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36
Q

WHAT IS GIANT CELL ARTERITIS ASSOCIATED WITH

A

SLE

POLYMYALGIA RHEUMATICS

VARICELLA

RHEUMATOID ARTERITIS

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37
Q

WHAT IS THE DIAGNOSIS OF GIANT CELL ARTERITIS

A

BRUITS

BLOODS: INCREASE IN - CRP - ALP - ESR

BIOPSY OF TEMORAL ARTERY = GOLD STANDARD

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38
Q

HOW DO YOU TREAT GIANT CELL ARTERITIS

A

PREDNISOLONE ASAP TO AVOID BLINDNESS

ALSO CAN ADD IMMUNOSUPPRESSIVE TOCILIZUMAB

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39
Q

what is the Px of proximal myopathy

A

struggle going up and down stairs/hills

crabman syndrome

proximal muscle weakness

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40
Q

what is the commonest causes of proximal myopathy

A

steriods

in inflammatory diseases (SLE)

alcohol

renal/liver failure

bone marrow transplants/chemo/resp diseases

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41
Q

Myesthic syndromes presentation

A

repeated movements causing fatigueability

partial ptosis

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42
Q

treatment of myesthenic syndromes

A

Pyridostigmine

an acetylcolinesterase inhibitor

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43
Q

what do mononeuropathies commonly affect

A

upper limbs

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44
Q

what is a mononeuropathy

A

a disease process of a named nerve

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45
Q

what are common mononeuropathies

A

carpel tunnel syndrome

ulnar nerve palsey

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46
Q

pt reports having pain in their thumb,index and middle finger.

The pain radiates down to the wrist,

worse in the morning

struggles to open jars, texting/taking selfies

what is the diagnosis

A

carpel tunnel syndrome

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47
Q

what is the presentation of an ulnar nerve palsey

A

trouble with fine movements

doing up buttons

paying with coins

makeup

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48
Q

what does the ulnar nerve supply

A

small muscles of the hands

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49
Q

how do oyu check the axillary nerve

A

deltoid for sensation and movement

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50
Q

when does the radial nerve usually get damaged

A

humerous fracture

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51
Q

what is the function of the radial nerve

A

flexion of the wrist

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52
Q

what nerve causes foot drop

A

common perineal nerve

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53
Q

what pathology usually causes a foot drop

A

rediculopathy

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54
Q

what are common causes of peripheral neuropathies

A

diabetes

leprosy

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55
Q

what is the difference between ridiculopathy and neuropathy

A

rediculopathy is a pinched nerve.

Neuropathy is a damaged nerve for whatever reason and can present similarly to a rediculopathy

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56
Q

what are the two types of symptom groups of periferal neuropathy

A

small fibre (C fibre)

early onset symptomsburning pain, numbness

Large fibres (A fibres)

loss of motor function

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57
Q

what is a classic presentation of a diabeteic neuropathies

A

thin, dry, shiny skin,

pigmented skin

hair loss

callusus+ulcers

aka trophic changes

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58
Q

what is the presentation of vertebral pain syndrome

A

pain in neck, radiating to shoulder

ache and discomfort

decreased ROM

no sensory loss or muscle weakness

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59
Q

what is vertebral pain syndrome

A

a myelopathy commonly caused by osteoarthritis of the neck

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60
Q

what would vertebral pain syndrome in the thoracic spine be indicative of

A

cancer mets

wedge fracture

RED FLAG!

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61
Q

what is the presentation of a rediculopathy

A

sharp shooting painful joins in dermatomal pattern

worse on coughing or sneezing

sudden onset usually after doing something manual

not many neurological symptoms

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62
Q

what rediculopathy would cause bicep, thumb and index finger presentations of

pins and needles, weakness

A

6

(biceps has 6 letters, thumb is sixth finger )

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63
Q

what nerve root would cause tricep and middle finger weakness

A

C7

tricep has 7 letters

middle finger (8th finger) = fuck you = 8 letters

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64
Q

what rediculopathy would cause foot drop

A

L5

for dorsi flexion (nnervates dorsum of food)

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65
Q

what rediculopathy would cause innability to raise on tip toes

A

s1

innability to plantar flex

s1 innervates, small toes, side of foot

sole of foot

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66
Q

what normally causes rediculopathies

A

disc prolapse

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67
Q

what would occipital lobe disorder present as

A

contralateral visual disturbances

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68
Q

what would parietal lobe disorder present as

A

contralateral

disturded sensations (not pain)

impared higher sensory processes ie dysgarthia, feeling 3D of objects Dyslexia (reading)

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69
Q

what would frontal (back of) lobe disorder present as

A

hemiparesis

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70
Q

what would frontal (front) lobe disorder present as

A

personality and executive function disorders

must be bilateral for Sx

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71
Q

what would basal ganglia disorders cause

A

if decreased Dopamine (paskinsonianism) there too high control = ridgidity

if increased dopamine = dereased control causing chorea + dystonia (ie hontingtons)

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72
Q

what can cause meningism

A

blood (subarachnoid haemorrage)

pus (infection0

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73
Q

what is the Px of meningism

A

headaches, photophobia, neck stiffness, N+V, systemic Sx

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74
Q

What are causes of raised IC pressure

A

headaches worse in morning, decreased conciousness, N+V,blurred vision (papilloedema), Double visison (paralytic squint).

just not quite right

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75
Q

what can the presentation of pituitary tumour be in males

A

bilateral hemienopia

ED

less body hair

gynecomastia

fatgiue

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76
Q

what can the presentation of pituitary tumour be in females

A

bilateral hemienopia

irregular periods

fatigue

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77
Q

what is a migrane

A

a headache causing moderate to svere pain lasting from hours to days and if often preceeded by an ‘aura’

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78
Q

what is the pain description of a migrane

A

moderate/severe

throbbing + pulsating

worse on moving, photophobia and aversion to sound

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79
Q

what causes an aura

A

unregulated neuron (electic) activity on surface on the brain causing altered perceptions of sensation

often lasting less than an hour

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80
Q

what associated symptoms are there with migranes

A

N+V

tingling in arm or face

speech difficulties

difficulty moving limbs

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81
Q

triggers for migranes

A

bright lights

strong smells

weather changes

stress

lack of sleep

missed meals

alcohol

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82
Q

what parts of a migrain history would you ask

A

date of attach

severiy

duration

treatment used

deatils of associated sx

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83
Q

Ix fir migranes

A

MRI/CT

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84
Q

Mx of migranes

A

PROFYLAXIS:

propranolol

topiramate (antiepileptic)

Amitriptyline (TCA)

ACUTE:

analgesia : paracetamol/aprin/ibruprofen

triptans: sumatriptan (taken at onset)

anti emetics: metoclopramide

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85
Q

what is a cluster headache

A

a severe headache which occurs on one side of the head typically around the eye. PAin lasting for 15mins to 3hrs

pain tends to occur daily for a few weeks then there will be a pain free period

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86
Q

sympoms of cluster headache

A

severely paunful one sided headache with pain ususally behind one eye/temple

lasting form 15min-3hrs

cranial autonomic sx

agitation and restlessness

1-4 attacks every day

pain usually at same times daily

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87
Q

what are cranial autonomic Sx

A

reddening and tearing of eye

drooping of eyelid

smaller pupil o one eye

blocking/running on nose

facial sweating or flushing

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88
Q

who typically gets cluster headaches

A

male

20-40

smoker/drinkier

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89
Q

what are RF for cluster headaches

A

poor sleep

smoking

alcohol

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90
Q

what causes cluster heaaches

A

abnormal activity of the hypothalamus

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91
Q

Mx of cluster headaches

A

oxygen (12-15l/min) for 15-20 min

sumatriptan injections

sumptriptan nasal spray

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92
Q

profylactic Mx of cluster headaches

A

verapamil (CCB)

lithium

corticosteroids

GABApentin

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93
Q

what is a tension headache

A

constant ache that affects both sides of the head mild/moderate pain

usually lasts for 30 minutes to several hours, but can last for several days.

94
Q

triggers for tension headaches

A

stress and anxiety

squinting

poor posture

tiredness

dehydration

missing meals

lack of physical activity

bright sunlight

noise

certain smells

95
Q

Mx of tension headaches

A

Painkillers such as paracetamol or ibuprofen can be used

96
Q

profylactic Mx of tension headaches

A

Regular exercise and relaxation

Maintaining good posture

hydrated

good sleep

up to 10 sessions of acupuncture over a 5- to 8-week period

amitriptyline

97
Q

what is medication overuse headache

A

one of the most common daily headache disorders in the world

taking painkillers or triptans for as little as for 10 consecutive days a month can cause it

98
Q

what medicines can cause MOH

A

caffiene

paracetamol

codiene

triptans (eg. sumatriptan)

ibruprofen and other NSAID

99
Q

who is at risk of MOH

A

those with preexisting headaches such as tension/migraine

100
Q

what are the Sx of MOH

A

stopping painkillers and getting headaches +

poor sleep

anxiety

nausea

101
Q

what is a subarachnoid haemorrhage

A

an uncommon type of stroke

caused by bleed under the arachnoid mater (surface of the brain)

102
Q

what is the Px of a subarachnoid haemorrhage

A

a sudden severe headache unlike anything you’ve experienced before

a stiff neck

N+V

photophobia

blurred vision/diplopia

stroke-like symptoms

  • such as slurred speech and weakness on one side of the body

loss of consciousness

convulsions

103
Q

what can osnet a subaracnoid haemorrage

A

physical effort or straining

  • coughing,
  • going to the toilet,
  • lifting something heavy
  • or having sex.
104
Q

Ix of subarachnoid haemorrage

A

CT + CTA (computed tomography angiography)

LP (RBC)

105
Q

RF for subarachnoid haemorrages

A

known brain aneurysm

smoking

high blood pressure

excessive alcohol consumption

Severe head injurys (traumatic subarachnoid haemorrhage)

106
Q

what is the cause of most subarachnoid haemorrages

A

a ruptured brain aneurysm

107
Q

Mx of Subarachoid haemorrage

A

nimodipine (reduces risk of ischemia, taken for 3 weeks)

morphine + combination of codeine and paracetamol.

+/-

anticonvulsants(phenytoin) and antiemetics (promethazine)

surgery

108
Q

Side effects of Nimodipine

A

flushing

feeling sick

increased heart rate

headaches

a rash

109
Q

what complications can occur due to SAH

A

Hydrocephalus

ischemia (leading to cog impairement)

110
Q

what is myesthenia gravis

A

a muscular disease ausing fatiguability due to the immune system attacking neuromuscular junctions

111
Q

Px of Myesthenia gravis

A

ptosis

impaired swallow

slurred speech (dysarthia)

repetative movements causing fatiguability

SOB

112
Q

what is the staging of Myesthenia gravis

A
  1. occular muscle weakness
  2. difficulty talking + swallowing
  3. resp difficulties
113
Q

how do you Ix Myesthenia gravis

A

nerve conduction studies

anti Ach receptor antibodies

114
Q

how do you Mx Myesthenia gravis

A

galantamine (anticholinesterases)

pyridostigmine (cholinesterase inhibitor)

Methotrexate, rutiximab (immunosuppressants)

Prednisolone (corticosteroids)

Plasmaphoresis - IVIg

Thyrectomy (removal of thymus)

115
Q

what is motor neurone disease

A

a neurodegenerative disorder affecting motor neurons

116
Q

name the types of MND

A
  • ALS
    • amyotropic lateral sclerosis
  • PBP
    • progressive bulbar palsey
  • PP
    • pseudobulbar palsey
  • PMA
    • progressibe muscular atrophy
  • PLS
    • primary lateralising sclerosis
  • MMA
    • Monomelic amyotrophy
117
Q

what is the pathophysiology of ALS

A

death of voluntary muscle neurons

118
Q

what is the pathophysiology of PBP

A

neurone death of bulbar muscles (head and neck)

119
Q

what is the pathophysiology of PP

A

no neuronal death but inability to control facial muscles

120
Q

what are Sx of ALS

A

spastic tetraparesis

wasting

fasiculations

muscle weakness - trouble swallowing/speakingbeing dexterous

121
Q

what is the common cause of mortality of ALS

A

death usually after 3 years due to resp failure, bulbar Sx and pneumonai

122
Q

how do you Ix MND/ALS

A

clinical

EMG supporting evidence

123
Q

How do you manage MND/ALS

A

Riluzole

  • inhibits glutamate release and slows progression
124
Q

what is Guillian-Barre syndrome

A

an acute neuropathy

125
Q

what is the cause of Guillian-Barre syndrome

A

post infections with EBV, campylobacter jejuni, CMV

126
Q

what is the pathophysiology of Guillian-Barre syndrome

A

demyelination causing resp failure via molecular mimicary

127
Q

what is the Px/natural progression of Guillian-Barre syndrome

A

START

  • numbness and tingling in arms and legs
  • arm and leg weakness
  • ptosis and swallowing difficulties
  • muscle pain
  • resp failure (1/4 of cases)

END

128
Q

how do yox Ix Guillian-Barre syndrome

A

LP

  • ++proteins

nerve conduction studies

serium antibodies

Bloods

  • -Na -K (due to innapropriate secretion of antidiuretic hormone

MRI

129
Q

how do you treat Guillian-Barre syndrome

A

IvIg

plasmaphoresis

intubation

daltaparin

rehab phisio

130
Q

what does the cerebellum do

A

controls coordination and movement

131
Q

what can cause cerebellar disorders

A

Tumours / Space occupying lesions

genetic disorders such as wilsons disease

ataxias:

  • genetic/alcohol/periferal neuropathies/ gluten/ vitamin D deficiency/ auoimmune

degeneration disorders ie parkinsons

132
Q

what is the presentation of cerebellar disorders

A

dysdidokinesis

ataxia

nystagmus

intention tremour

scanning and speech (dysarthia)

hypotonia

133
Q

what Ix are required ffor cerebellum disorders

A

Bloods

Mri

134
Q

What is the management of cerbellar disorders

A

underlying cause :

lifestyle or medication changes

vit D, thymine, B12 supplments

rutiximab if autoimmune

135
Q

what is Parkinsons Disease

A

a common neurodegenerative disease most commonly in the elderly

136
Q

what is the pathophysiology of Parkinsons Disease

A

depletion of dopamine secreting cells in substancia nigra

leading to altered neural networks and +++ control from basal ganglia

137
Q

what is the Px of Parkinsons Disease

A

tremour - pill rolling resting tremour

ridgidity - + tone in limbs and trunk

akinesia (difficulty tsarting movement)

expressionless + unblinking, slow monotenous speech, micrographia

postural changes - stooped gait, shuffling gait, poor blaance

138
Q

what is the natural progression of Parkinsons Disease

A

neuropsychiatric Sx

sleep disorders

XS saliva and sweat and GI disturbances

Fatigue and weightloss

death (bronchopneumonia)

139
Q

how do you Ix parkinsons disease

A

clinical

absence of disease on MRI

140
Q

how do you Mx Parkinsons Disease

A

levodopa (dopamine precurser)

Ropinirole (Dopamine agonists)

Seleqine (monoamine oxidase B inhibitor)

Physio

SSRI

stereotatic neurosurgery

141
Q

what are SE of dopamine agonists

A

– impulse control

142
Q

how do monoamine oxidase B inhibiors work

A

inhibit catacbolism of dopamine in brain

143
Q

what is narcolepsy

A

Narcolepsy is a rare long-term brain condition that causes a person to suddenly fall asleep at inappropriate times.

The brain is unable to regulate sleeping and waking patterns normally

144
Q

what is the Px of Narcolepsy

A

excessive daytime sleepiness – feeling very drowsy throughout the day and finding it difficult to concentrate and stay awake

sleep attacks – falling asleep suddenly and without warning

cataplexy – temporary loss of muscle control, often in response to emotions such as laughter and anger

sleep paralysis – a temporary inability to move or speak when waking up or falling asleep

excessive dreaming and waking in the night

145
Q

what are the DD of narcolepsy

A

sleep apnoea

epilepsy

depression

hypothyroidism

a previous head injury

146
Q

how do you Dx Narcolepsy

A

eliminate other DD (MRI, EEG)

sleep analysis

Epworth sleepiness scale

Polysomnography

multiple sleep latency tests

147
Q

what is polysomnography

A

electroencephalography (EEG), which monitors brain waves

electrooculography, which monitors eye movements

EMG

recordings of movements in your chest and abdomen

recordings of airflow through your mouth and nose

pulse oximetry,

ECG

148
Q

what is the The Epworth sleepiness scale

A

The Epworth sleepiness scale is a questionnaire used to assess how likely it is you’ll fall asleep while doing different activities.

undertaken by GP to see if refferal to specialist services is necessary

149
Q

Mx of Narcolepsy

A

sleep hygiene

stimulants: dexamphetamine

Sodium oxybate (helps control loss of muscle control)

antidepressants

150
Q

what is wernicke encephalitis

A

presence of neurological symptoms caused by depletion of B-vitamin reserves, in particular thiamine (vitamin B1)

151
Q

what is the presentation of wernicke encephalitis

A

triad of

  • ophthalmoplegia usually lateral rectus palsy
  • ataxia
  • confusion
152
Q

causes of wernecke encephalitis

A

alcoholics

but it is also in chronically malnusrished

153
Q

Mx of werneckes

A

Thiamine IM/IV until clinically better then suppliment further PO

(+ B12 and other B vitamins)

154
Q

what is korsicoff syndrome

A

wernicke’s encephalopathy if untreated is followed by Korsakoff’s syndrome.

155
Q

what is the Px of Korsicoff

A

permanent:

disorientation, confusion or mild memory loss

undernutrition - for example, the person is very underweight

involuntary, jerky eye movements or paralysis of the muscles that move the eyes

poor balance or unsteadiness, or other signs of damage to a part of the brain called the

156
Q

what would an MRI show of Korsicoff

A

shrunken cerebellum

157
Q

What is the Mx of Korsicoff

A

stop alcohol intake

support and care

158
Q

what is huntingtons

A

is an inherited disorder that results in the death of brain cells. causing too little control over movement coordination causing hyperkinesis

159
Q

Sx of Hyntingtons

A

Chorea :jerky, random, and uncontrollable movements also causing stumbling and clumsiness

(this will then progess to rigidity, writhing motions or abnormal posturing)

difficulty concentrating and memory lapses

depression/ mood swings and personality changes / progressive cognitive impairement

problems swallowing, speaking and breathing

difficulty moving

160
Q

When does Huntingotns present

A

25’s-50’s

161
Q

what genetic mutation causes Huntingtons

A

Repetition of the CAG gene

162
Q

how do you diagnose huntingtons

A

genetic testing

163
Q

what is the Mx of Huntingtons

A

Chlorpromazine /benzos/antipsychotics (chorea- antidopaminergic/ D2 antagosist)

SSRI

164
Q

What drugs induce parkinsonism

A

antipsychotics (neuroleptic drugs)

CCB namely cinnarizine

165
Q

What is Trigeminal Neuralgia

A

Compression of CN V (trigeminal) by loops of blood vessels (rarely by tumours or MS)

166
Q

what is the Px of Trigeminal neuralgia

A

function, sensation and touch affected - usually unilateral

Usually caused by triggers in the trigeminal area ie shaving beards, brushing teeth

Severe pain from face, teeth and mouth - feels like electric shock

pain lasting around 2 minutes with a dull ache afterwards

theres increased production fo saliva and tears

167
Q

how would you investigate trigeminal neuralgia

A

MRI if the patient is young or the cause/presentation is unclear

(patients affected are usually older women)

168
Q

What is the managment of trigeminal neuralgia

A

carbamazipine

glucerol injections

deep brain stimulation

surgical deconpression

169
Q

What is epilepsy

A

recurrent tendancy to have spontaneous, intermittent and abnormal electrical ativity in a part of the brain/generalised accross the brain leading to seizures

170
Q

what are causes of epilepsy

A

idiopathic

stroke

trauma

malignancy

171
Q

what is the presentation of temporal seizures

A

smell/taste abnormalities

auditory phenomena

lip smacking

walking w/o purpose

deja-vu

172
Q

what is the Px of Frontal seizures

A

motor phenomena, repeated movements

may lead to jacksonian march

173
Q

what is the Px of occipital seixures

A

visual phenomena

174
Q

what is the Px of parietal seizures

A

sensory disurbances ie tingling and numbness

175
Q

what is the presentation of an Absence seizure

A

transient LoC <10s

with abrupt onset and termination

kind of like daydreaming/phasing out

176
Q

what is the Px of a myoclonic seizure

A

sudden brief jerking of limb/face/trunk

177
Q

what is the Px of a Tonic seizure

A

sudden increase in tone

often causing fall

178
Q

what is the Px of a tonic -clonic seizure

A

tonic phase: LoC + increased tone

clonic phase : rythmic jerking of limbs

179
Q

what is the Px of an Atonic Seizure

A

no LoC

sudden loss of muscle tone ie drop of hand or fall

180
Q

how do you Ix Epilepsy

A

Video EEG

test lactate to differentiate non - epileptic attacks

181
Q

what is the management of a partial seizure

A

carbamezipine

lamotragine

182
Q

what is the management of a tonic seizure

A

sodiu valproate

carbamezipine is wanting children

183
Q

what is the management of an atonic seizure

A

sodium valproate

184
Q

what is the management of a myoclonic seizure

A

sodium valproate

185
Q

what is a simple seizure

A

aware of what happened

186
Q

what is a complex seizure

A

impaired awareness of what happened

187
Q

what is status epilipticus

A

a medical emergency

seizures lasting >5min

188
Q

what is the managment of satus epilipticus

A

open and maintain airway, gain IV access

Buccal midlazapam/rectal diazapam (community)

IV lorazapam (hospital)

phenytoin if prolonged

189
Q

what are the types of parkinsonism plus

A

a progressivee supranuclear palsy

corticobasal degeneration

multiple system atrophy

dementia with lewi bodies

190
Q

what is the Px of parkinsons + progressive supranuclear palsy

A

parkinsonism

+

postural instability and falls with vertical gaze palsy. Is of a symmetrical onset and has truncal rigidity

191
Q

what is the Px of parkinsons + corticobasal degeneration

A

parkinsons

+

aparxia, aphasia and asterognosis

192
Q

what is the Px of parkinsons + multiple system atrophy

A

aka Shy-drager syndrome

parkinsonism

+ autonomic dysfunction (postural hypotension, bladder dysfunction)

and cerebellar signs

193
Q

what is the Px of parkinsons + dementia w lewi bodies

A

commonest form of parkinsons plus

parkinson

+

variation in cognition, visual hallucination, REM sleep disturbance, orthostatic hypotension

194
Q

what is the pathophysiologies of the 4 types of parkinsonism +

A

progressibe supranuclear: tau tangles

cotricobasal degeneration: tau tangles

multiple system atrophy: cell loss w sunsequent gliosis

lewi body dementia: alpha-synucelin and ubiquitin (lewi bodies)

195
Q

What is Hydrocephalus

A

abnormal accumulation of CSF in ventricles

196
Q

what are the types of hydrocephalus

A

obstructive

non-obstructibe

normal pressure

197
Q

describe the pathophysiology of obstructive Hydrocephalus

A

Impaired outflow due to lesion or stenosis

causing acute drop in conciousness

198
Q

describe the pathophysiology of non-obstructive Hydrocephalus

A

Impaired reabsorbtion due to tumour or meningitis

199
Q

describe the pathophysiology of normal pressure Hydrocephalus

A

isopathic chronic ventricular enlargement with damage of long tracts (UMN lesion)

spasticity, hyperreflexia, and abnormal reflexes

usually in elderly

200
Q

what is the Mx of Hydrocephalus

A

drain

peritoneal shunt

201
Q

What are causes of meningitis in neonates

A

GBS

E COLI

202
Q

What are causes of meningitis in children

A

Haemophylis influenza

neisseria meningitidis

strep pneumoniae

203
Q

what are causes of meningitis in adults

A

neisseria meningitidis

strep pneumoniae

204
Q

what are causes of meningitis in OAP

A

strep pneumoniae

205
Q

what are viral causes of meningitis

A

HIV

enterovirus

206
Q

what are fungal causes of meningitis

A

candida albicans

cryptococcus

207
Q

what is the Px of meningitis

A

headache + neckstiffness

photophobia and fever

if bacterial - intense malaise and fever +/- petechial rash if meningococcal

208
Q

what Ix would you perform for meningitis

A

blood and urine cultures

LP

Blood: lactate

209
Q

what is encephalitis

A

inflammation of the brain

210
Q

what causes encephalitis

A

mainly viral

Mumps

HSV (most commonly)

Enterovirus

Rabies

211
Q

How do you Ix encephalitis

A

MRI
LP (monocytes, lymphocytes, protein)

212
Q

What is Horners syndrome

A

damage to Sympathetic nerves trunk that supplies face

213
Q

what causes horners syndrome

A

Glioma

infarction

neurofibromatosis

T1 brachial nerve lesion

Dissected internal carotid artery

214
Q

what is the presentation of horners syndrome

A

miosis

ptosis

anhydrosis

(on half of face)

215
Q

Pt cant Abduct eye (lateral rectus) what Cranial nerve is involved

A

CN VI

216
Q

Pt cantdepress, rotate or adduct eye (superior oblique) what Cranial nerve is involved

A

CN IV

217
Q

Pt has deviated jaw and tongue what Cranial nerve is involved

A

trigeminal (deviate towards lesion)

218
Q

Pt cant

open eye lid fully (ptosis)

One eye always depressed and abducted (down and out)

with reactive pupil

what Cranial nerve is involved

A

CN III

219
Q

Describe Bells Palsey and the nerve its caused by

A

forhead, half unresponive to movement (so LMN because UMN are unaffected)

CN VII

220
Q

What is LEMS

=

Lambert- Eaton Myasthenic syndrome

A

neuromuscular junctions affected

Where functions of pre synaptic voltage gated Ca2+ channels is impaired by autontibodies resulting in impaired ACh release

Similar to MG but with slighly different presentations

221
Q

what is the difference in presentation between MS and LEMS

A
222
Q

How do yo mx a myaesthenic crisis

A

Intubation

IVIg plasma exchange

223
Q

What is a rediculopathy

A

mechanical compression of a nerve as it leaves the spinal cord

224
Q

What are causes of Rediculopathy

A

Osteopathic growth

disc degeneration and lateral protrusion

verebral collapse

tumour growth

225
Q

what is the px of rediculopathyPa

A

Pain!!

sensory disturbances loss of reflexes

tingling and numbness in dermatomal / myotomal distribution

226
Q

what is the Ix of rediculopathy

A

clinical unless considering surgery then MRI

227
Q

what is the Mx of rediculopathy

A

Rest and analgesia

surgical decompression

228
Q

what is a myelopathy

A

Trauma or compression of the spinal cord causing ‘muscle problems’

229
Q

what are the symptoms of myelopathy

A

depends on tracts affected

but loss of fine otor skills

tingling

not associated with nerve like pain

back may hurt

230
Q

what are the differences between a subdural and extradural haemorrage

A

Phase 3a (22 decks)

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