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Phase 2a - Neurology > Neurology Conditions A > Flashcards

Neurology Conditions A Flashcards

1
Q

Ischaemic Stroke - Description

A

rapid onset focal neurological deficit lasting more than 24 hours due to arterial stenosis or occlusion

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2
Q

Ischaemic Stroke - Causes (7)

A

1) small vessel occlusion
2) large vessel atherothromboembolism
3) cardioembolism (AF, MI, IE)
4) vasculitis
5) sickle cell disease
6) polycythaemia
7) hypoperfusion (inc. caused by sepsis)

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3
Q

Ischaemic Stroke - Risk Factors (13)

A

1) older age
2) male
3) family history
4) Afro-Caribbean
5) transient ischaemic attack
6) atrial fibrillation
7) diabetes mellitus
8) hypertension
9) dyslipidaemia
10) hypercoagubility
11) oral contraceptive pill
12) smoking
13) alcohol

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4
Q

Ischaemic Stroke - Symptoms (General) (4)

A

FAST

1) facial drooping
2) arm weakness
3) slurred speech
4) time (sudden onset)

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5
Q

Ischaemic Stroke - Symptoms (Anterior Cerebral Artery) (6)

A

1) contralateral numbness (esp. leg)
2) contralateral weakness (esp. leg)
3) truncal ataxia
4) gait ataxia
5) incontinence
6) drowsiness

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6
Q

Ischaemic Stroke - Symptoms (Middle Cerebral Artery) (4)

A

1) contralateral numbness (arm+leg)
2) contralateral weakness (arm+leg)
3) dysphasia —> aphasia
4) visuospatial disturbances

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7
Q

Ischaemic Stroke - Symptoms (Posterior Cerebral Artery) (5)

A

1) contralateral homonymous hemianopia
2) cortical blindness
3) visual agnosia
4) prosopagnosia
5) unilateral headache (esp. haemorrhagic)

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8
Q

Ischaemic Stroke - Symptoms (Vertebrobasilar Artery) (5)

A

1) quadriplegia
2) dysarthria
3) dysphasia
4) visual disturbances
5) locked in syndrome

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9
Q

Ischaemic Stroke - Complications (5)

A

1) haemorrhage
2) deep vein thrombosis
3) seizure
4) aspiration pneumonia
5) depression

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10
Q

Ischaemic Stroke - Investigations (5/1)

A

initial
1) urgent head CT (brain parenchyma hypoattenuation, dark)
2) brain diffusion weighted imaging MRI (infarct hyperattenuation, bright)
3) serum glucose (exclude hypoglycaemia/hyperglycaemia)
4) ECG + BP
5) FBC
consider
1) CT/MRI angiogram (identify stenosis/occlusion)

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11
Q

Ischaemic Stroke - Management (5/4/1)

A

conservative
1) nil by mouth until swallowing assessment (aspiration pneumonia)
2) maintain oxygen (>95%)
3) maintain hydration
4) head CT post thrombolysis (24 hours later)
5) CVS risk factor control
medical
1) thrombolysis (IV alteplase) (<4.5 hours of onset)
2) aspirin (24 hours after IV alteplase) (2 weeks)
3) clopidogrel (unknown onset or >4.5 hours of onset) (lifelong)
4) prophylactic anticoagulant (DVT)
surgery
1) thrombectomy (large artery occlusion)

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12
Q

Haemorrhagic Stroke - Description

A

rapid onset focal neurological deficit lasting more than 24 hours due to an intracerebral haemorrhage

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13
Q

Haemorrhagic Stroke - Causes (7)

A

1) cerebral amyloid angiopathy
2) hypertension (Charcot Bouchard aneurysm)
3) aneurysm rupture
4) ateriovenous malformation
5) anticoagulants
6) trauma —> carotid artery dissection
7) subarachnoid haemorrhage

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14
Q

Haemorrhagic Stroke - Risk Factors (7)

A

1) older age
2) male
3) Afro-Caribbean
4) family history
5) hypertension
6) haemophilia
7) anticoagulants

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15
Q

Haemorrhagic Stroke - Symptoms (General) (7)

A 
FAST
1) facial drooping
2) arm weakness
3) slurred speech
4) time (sudden onset)
other
5) neck stiffness
6) severe headache
7) impaired consciousness
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16
Q

Haemorrhagic Stroke - Symptoms (Anterior Cerebral Artery) (6)

A

1) contralateral numbness (esp. leg)
2) contralateral weakness (esp. leg)
3) truncal ataxia
4) gait ataxia
5) incontinence
6) drowsiness

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17
Q

Haemorrhagic Stroke - Symptoms (Middle Cerebral Artery) (4)

A

1) contralateral numbness (arm+leg)
2) contralateral weakness (arm+leg)
3) dysphasia —> aphasia
4) visuospatial disturbances

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18
Q

Haemorrhagic Stroke - Symptoms (Posterior Cerebral Artery) (5)

A

1) contralateral homonymous hemianopia
2) cortical blindness
3) visual agnosia
4) prosopagnosia
5) unilateral headache (esp. haemorrhagic)

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19
Q

Haemorrhagic Stroke - Symptoms (Vertebrobasilar Artery) (5)

A

1) quadriplegia
2) dysarthria
3) dysphasia
4) visual disturbances
5) locked in syndrome

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20
Q

Haemorrhagic Stroke - Complications (5)

A

1) hydrocephalus
2) deep vein thrombosis
3) seizure
4) aspiration pneumonia
5) depression

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21
Q

Haemorrhagic Stroke - Investigations (4/1)

A

initial
1) urgent head CT (brain parenchyma hyperattenuation, bright)
2) serum glucose (exclude hypoglycaemia/hyperglycaemia)
3) ECG + BP
4) FBC
consider
1) CT/MRI angiogram (identify aneurysm, arteriovenous malformation)

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22
Q

Haemorrhagic Stroke - Management (5/3/2)

A 
conservative
1) monitor GCS
2) nil by mouth until swallowing assessment (aspiration pneumonia)
3) maintain oxygen (>95%)
4) maintain hydration
5) CVS risk factor control
medical
1) IV prothrombin complex concentrate + vitamin K (anticoagulant reversal)
2) diuretic (mannitol) (lower ICP)
3) prophylactic anticoagulant (DVT) (once haemorrhage controlled)
surgery
1) craniotomy + drainage (severe)
2) cerebral shunt (hydrocephalus)
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23
Q

Transient Ischaemic Attack - Description

A

rapid onset reversible focal neurological deficit lasting less than 24 hours due to arterial stenosis or occlusion

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24
Q

Transient Ischaemic Attack - Causes (7)

A

1) small vessel occlusion
2) large vessel atherothromboembolism* (esp. carotid)
3) cardioembolism (AF, MI, IE)
4) vasculitis
5) sickle cell disease
6) polycythaemia
7) hypoperfusion (inc. caused by sepsis)

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25
Q

Transient Ischaemic Attack - Risk Factors (13)

A

1) older age
2) male
3) family history
4) Afro-Caribbean
5) transient ischaemic attack
6) hypertension
7) atrial fibrillation
8) diabetes mellitus
9) dyslipidaemia
10) hypercoagubility
11) oral contraceptive pill
12) smoking
13) alcohol

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26
Q

Transient Ischaemic Attack - Symptoms (Anterior Circulation) (5)

A

90%

1) dysphasia —> aphasia
2) contralateral numbness
3) contralateral weakness
4) contralateral hemianopia
5) amaurosis fugax (sudden loss of vision in one eye)

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27
Q

Transient Ischaemic Attack - Symptoms (Posterior Circulation) (6)

A

10%

1) dysarthria —> choking
2) contralateral numbness
3) contralateral hemianopia
4) diplopia
5) vertigo
6) transient global amnesia (episode of amnesia/confusion that resolves within 24 hours)

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28
Q

Transient Ischaemic Attack - Complications (2)

A

1) stroke (30% in 5 years)

2) myocardial infarction (15% in 5 years)

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29
Q

Transient Ischaemic Attack - Investigations (5/2)

A

initial
1) brain diffusion weighted imaging MRI (exclude haemorrhage)
2) serum glucose (exclude hypoglycaemia/hyperglycaemia)
3) ECG + BP
4) FBC
5) carotid artery Doppler ultrasound (stenosis)
consider
1) carotid CT/MRI angiogram (if stenosis)
2) echocardiogram (cardioembolism)

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30
Q

Transient Ischaemic Attack - Stroke Risk (ABCD2) (5)

A

> 6 - immediate specialist referral; >4 - <24 hour specialist referral
A) age >60 years old (1)
B) BP >140/90 (1)
C) clinical features: unilateral weakness (2); speech disturbances without weakness (1)
D) duration: <1 hour (1); >1 hour (2)
D) diabetes mellitus (1)

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31
Q

Transient Ischaemic Attack - Management (3/3/1)

A 
conservative
1) specialist referral (<1 week minimum)
2) no driving (4 weeks)
3) CVS risk factor control
medical
1) aspirin (first 2 weeks)
2) clopidogrel (after 2 weeks)
3) anticoagulant (if cardioembolism)
surgery
1) carotid endarterectomy or stent (>50% stenosis)
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32
Q

Subarachnoid Haemorrhage - Description

A

spontaneous bleeding into subarachnoid space (in between arachnoid and pia)

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33
Q

Subarachnoid Haemorrhage - Causes (4)

A

1) berry aneurysm rupture (80%)
2) arteriovenous malformation (15%)
3) vasculitis
4) idiopathic

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34
Q

Subarachnoid Haemorrhage - Risk Factors (10)

A

1) >50 years old (esp. 50-55)
2) female
3) family history
4) Afro-Caribbean
5) hypertension
6) smoking
7) polycystic kidney disease
8) Ehlers-Danlos syndrome
9) Marfan syndrome
10) aorta coarctation

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35
Q

Subarachnoid Haemorrhage - Symptoms (7)

A

1) sudden severe occipital headache (thunderclap)
2) neck stiffness
3) vomiting
4) collapse
5) seizure
6) coma
7) photophobia

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36
Q

Subarachnoid Haemorrhage - Signs (3)

A

1) Kernig’s sign (inability to extend knee when hip is flexed) (6 hour later)
2) Brudzinski’s sign (when neck is flexed, hip and knee also flex)
3) papilloedema

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37
Q

Subarachnoid Haemorrhage - Complications (7)

A

1) rebleeding (20%)
2) vasospasm —> cerebral ischaemia
3) hydrocephalus
4) cerebral oedema
5) hyponatraemia
6) coma
7) death

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38
Q

Subarachnoid Haemorrhage - Investigations (1/2)

A

initial
1) head CT* (star shaped lesion)
consider
1) lumbar puncture (if CT negative) (xanthochromic - yellow)
2) CT angiogram (number/extent of aneurysms)

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39
Q

Subarachnoid Haemorrhage - Management (0/3/2)

A

medical
1) IV fluids (maintain cerebral perfusion)
2) nimpdipine (CCB) (reduce vasospasm —> cerebral ischaemia risk)
3) dexamethasone (corticosteroid) (reduce cerebral oedema)
surgery
1) endovascular coiling*
2) surgical clipping

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40
Q

Subdural Haematoma - Description

A

accumulation of clotted blood in subdural space (in between dura and arachnoid)

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41
Q

Subdural Haematoma - Risk Factors (5)

A

1) traumatic head injury (esp. decelerating injuries)
2) aging —> cerebral atrophy
3) alcohol —> cerebral atrophy
4) anticoagulation
5) coagulopathy

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42
Q

Subdural Haematoma - Pathophysiology (2)

A

1) rupture of bridging vein between cortex and venous sinus

2) accumulation of clotted blood in subdural space

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43
Q

Subdural Haematoma - Symptoms (Acute) (7)

A

1) headache
2) fluctuating consciousness
3) nausea
4) vomiting
5) seizure
6) coma
7) focal neurological deficit (e.g. hemiparesis)

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44
Q

Subdural Haematoma - Symptoms (Chronic) (4)

A

1) headache
2) fluctuating consciousness
3) cognitive decline
4) personality change

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45
Q

Subdural Haematoma - Complications (5)

A

1) epilepsy
2) stroke
3) cerebral oedema
4) coma
5) death

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46
Q

Subdural Haematoma - Investigations (1/0)

A

initial

1) head CT (diffuse hyperdense crescent shaped mass, shifting of midline structures)

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47
Q

Subdural Haematoma - Management (1/2/1)

A 
conservative
1) anticoagulant/antiplatelet cessation
medical
1) IV mannitol (high ICP)
2) IV prothrombin complex concentrate + vitamin K (anticoagulation reversal)
surgery
1) craniotomy (haematoma evacuation)
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48
Q

Extradural Haematoma - Description

A

accumulation of clotted blood in extradural space (in between skull and dura)

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49
Q

Extradural Haematoma - Risk Factors (1)

A

1) traumatic head injury (temporal/parietal fracture)

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50
Q

Extradural Haematoma - Pathophysiology (3)

A

1) fracture of temporal or parietal bone
2) laceration of middle meningeal artery
3) accumulation of clotted blood in extradural space

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51
Q

Extradural Haematoma - Symptoms (6)

A 
1) post traumatic loss of consciousness —> lucid interval (hours/days) —> decrease in consciousness
high ICP
2) headache
3) nausea
4) vomiting
5) coma
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52
Q

Extradural Haematoma - Investigations (2/0)

A

initial

1) head CT* (hyperdense lemon shaped mass adjacent to skull)
2) skull x-ray

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53
Q

Extradural Haematoma - Management (1/2/1)

A 
conservative
1) anticoagulant/antiplatelet cessation
medical
1) intubation + ventilation
2) IV mannitol (high ICP)
surgery
1) craniotomy (haemotoma evacuation ± blood vessel ligation)
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54
Q

Depression - Description

A

disorders characterised by persistent low mood and anhedonia

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55
Q

Depression - Risk Factors (8)

A

1) >65 years
2) female (2x)
3) family history
4) chronic disease (1/3)
5) postpartum (20%)
6) oral contraceptive pill
7) corticosteroids
8) propranolol

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56
Q

Depression - Symptoms (10)

A

1) low mood*
2) anhedonia* (decreased interest and/or pleasure in all activities)
3) functional impairment
4) sleep disturbances (insomina/hypersomnia)
5) fatigue
6) guilt (inc. worthlessness)
7) weight change
8) libido change
9) poor concentration
10) suicidal intention

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57
Q

Depression - Diagnosis (DSM-5 Criteria) (2/8)

A 
2 week period, ≥5 symptoms nearly everyday, ≥1 major criteria
major criteria
1) low mood
2) anhedonia (decreased interested and/or pleasure in all activities)
minor criteria
1) functional impairment
2) sleep disturbances (insomnia/hyperosomnia)
3) fatigue
4) guilt (inc. worthlessness)
5) weight change
6) libido change
7) poor concentration
8) suicidal intention
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58
Q

Depression - Management (5/3/0)

A 
conservative
1) watchful waiting (2 week GP follow-up)
2) regular exercise (inc. yoga)
3) self-help books
4) psychotherapy
5) cognitive behavioural therapy (inc. computer based)
medical
1) SSRI (e.g. fluoxetine)
2) TCA (e.g. amitriptyline)
3) St. John’s wort
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59
Q

Epilepsy - Description

A

recurrent spontaneous, intermittent, abnormal electrical brain activity manifesting as seizures

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60
Q

Epilepsy - Causes (5)

A

1) idiopathic (2/3)
2) cortical scarring (head injury, cerebrovascular disease, CNS infection)
3) tumour
4) tuberous sclerosis
5) dementia

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61
Q

Epilepsy - Risk Factors (9)

A

1) family history
2) premature birth
3) febrile seizure
4) dementia
5) drugs (e.g. cocaine)
6) head trauma
7) cerebrovascular disease (e.g. stroke)
8) CNS infection (e.g. meningitis)
9) tumour

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62
Q

Epilepsy - Types (7)

A 
focal (57%)
1) simple
2) complex
3) with secondary generalised (2/3 of focal)
generalised (40%)
4) absence (petit-mal)
5) myoclonic
6) tonic-clonic (grand-mal)
7) atonic
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63
Q

Epilepsy - Pathophysiology (Focal) (1)

A

1) electrical discharge limited to one part of the cortex (80% in temporal lobe)

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64
Q

Epilepsy - Pathophysiology (Generalised) (1)

A

1) electrical discharge simultaneously throughout whole cortex

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65
Q

Epilepsy - Phases (4)

A

1) prodromi
2) aura
3) ictus (i.e. seizure
4) post-ictus

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66
Q

Epilepsy - Symptoms (Focal - Temporal) (5)

A

80% of focal

1) deja vu (feeling of unfamiliar feeling familiar)
2) jamais vu (feeling of familiar feeling unfamiliar)
3) auditory hallucinations
4) olfactory hallucinations
5) anxiety —> fear

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67
Q

Epilepsy - Symptoms (Focal - Frontal) (1)

A

1) motor features

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68
Q

Epilepsy - Symptoms (Focal - Parietal) (1)

A

1) sensory features

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69
Q

Epilepsy - Symptoms (Focal - Occipital) (1)

A

1) visual features (e.g. visual hallucinations, visual loss)

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70
Q

Epilepsy - Symptoms (Generalised - Absence) (2)

A

1) <10 second pause in activity (e.g. stops talking mid-sentence)
2) unaware of attack

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71
Q

Epilepsy - Symptoms (Generalised - Myoclonic) (1)

A

1) sudden jerk of limb, face, trunk (e.g. thrown to ground or violently disobedient limb)

72
Q

Epilepsy - Symptoms (Generalised - Tonic-Clonic) (4)

A

1) loss of consciousness
2) still limbs —> jerking limbs (tonic —> clonic)
3) drowsiness (post-ictus)
4) confusion (post-ictus)

73
Q

Epilepsy - Symptoms (Generalised - Atonic) (1)

A

1) sudden loss of muscle tone —> fall

74
Q

Epilepsy - Complications (4)

A

1) head trauma
2) fractures
3) memory loss
4) sudden, unexpected death in epilepsy (SUDEP)

75
Q

Epilepsy - Investigations (3/2)

A 
initial
1) head CT
2) electroencephalogram (not diagnostic)
3) serum glucose (exclude hypoglycaemia/hyperglycaemia)
consider
1) head MRI (identify causative lesion)
2) genetic testing
76
Q

Epilepsy - Diagnosis (1)

A

1) history of >2 unprovoked seizures >24 hours apart

77
Q

Epilepsy - Management (4/4/2)

A

conservative
1) ABCDE (esp. maintain airways)
2) protect from injury
3) check glucose
4) inform DVLA
medical
1) IV diazepam or IV lorazepam x2 (1st line, during seizure)
2) IV phenytoin (2nd line, during seizure)
3) carbamazepine (focal)
4) sodium valproate (generalised)
surgery
1) surgical resection (hippocampal sclerosis or tumour) (70% resolution)
2) neurostimulation system (e.g. vagal nerve stimulation or deep brain stimulation)

78
Q

Parkinson’s Disease - Description

A

progressive neurodegenerative movement disorder due to decreased DA in substantia nigra

79
Q

Parkinson’s Disease - Causes (1)

A

1) unknown

80
Q

Parkinson’s Disease - Risk Factors (6)

A

1) age* (peak onset 55-65 years old)
2) male
3) family history
4) GBA gene mutation (Gaucher’s disease) (5x)
5) MPTP exposure (e.g. cocaine)
6) insecticide/herbicide exposure

81
Q

Parkinson’s Disease - Pathophysiology (6)

A

1) mitochondrial dysfunction and oxidative stress on substantia nigra
2) progressive degeneration of dopaminergic neurones of substantia nigra
3) decreased DA synthesis in the striatum
4) decreased DA release
5) decreased thalamus activity
6) decreased movement

82
Q

Parkinson’s Disease - Symptoms (Non-Motor Prodrome) (3)

A

up to 7 years prior to motor symptoms

1) anosmia
2) urgency
3) constipation

83
Q

Parkinson’s Disease - Symptoms (Parkinson’s Triad) (3)

A

1) tremor (esp. at rest, in hand)
2) rigidity
3) bradykinesia

84
Q

Parkinson’s Disease - Symptoms (Rigidity) (2)

A

1) leadpipe rigidity (sustained resistance to passive movements)
2) cogwheel rigidity (jerky resistance to passive movements)

85
Q

Parkinson’s Disease - Symptoms (Bradykinesia) (5)

A

1) slow movement initiation
2) slow repetition (e.g. blinking)
3) decreased amplitude in action repetition (e.g. micrographia (small handwriting))
4) hypophonia (decreased voice volume)
5) hypomimesis (expressionless face)

86
Q

Parkinson’s Disease - Symptoms (Other) (2)

A

1) fine motor skill difficulty (e.g. buttons)

2) gait (stooped posture, small shuffling steps, narrow base, reduce arm swing, difficulty turning)

87
Q

Parkinson’s Disease - Complications (7)

A

1) aspiration pneumonia
2) depression
3) anxiety
4) REM sleep disorders
5) postural hypotension
6) Lewy body depression
7) dyskinesia

88
Q

Parkinson’s Disease - Investigations (0/2)

A

consider

1) levodopa trial (symptoms improve) (if unclear clinical diagnosis, confirmation)
2) MRI brain

89
Q

Parkinson’s Disease - Management (3/2/1)

A 
conservative
1) SALT (speech and language therapy)
2) physiotherapy (balance, gait)
3) physical activity
medical
1) levodopa* (>70 years old or severe)
2) decarboxylase inhibitor (e.g. co-careldopa) (decreases levodopa SEs, increases levodopa efficacy)
surgery
1) deep brain stimulation (refractory, party DA responsive)
90
Q

Parkinson’s Disease - Management (Delay Levodopa) (3)

A

1) dopamine agonist (e.g. ropinirole)
2) monomanie oxidase b inhibitors (e.g. selegiline)
3) catechol-o-methyl transferase inhibitors (e.g. tolcapone)

91
Q

Migraine - Description

A

recurrent unilateral pulsatile headache

92
Q

Migraine - Risk Factors (3)

A

1) <40 years old (90%)
2) female
3) family history

93
Q

Migraine - Triggers (9)

A 
CHOCOLATE
C) chocolate
H) hangovers
O) orgasm
C) caffeine/cheese
O) oral contraceptive
L) lie-ins
A) alcohol
T) travel
E) exercise
94
Q

Migraine - Symptoms (Aura) (4)

A

15-30%

1) visual hallucinations (e.g. visual sparkles)
2) scotoma (black hole in visual field)
3) hemianopia
4) paraesthesia (fingers to face)

95
Q

Migraine - Symptoms (6)

A

1) unilateral pulsatile headache (moderate —> severe)
2) photophobia
3) phonophobia
4) nausea
5) vomiting
6) motion sensitivity

96
Q

Migraine - Complications (5)

A

1) status migrainosus (>72 hours)
2) migrainous infarction
3) persistent aura
4) seizure
5) depression

97
Q

Migraine - Investigations (0/2)

A

consider

1) lumbar puncture (exclude subarachnoid haemorrhage, meningitis, altered ICP)
2) brain MRI (red flags)

98
Q

Migraine - Diagnosis (5)

A

1) ≥5 headaches lasting 4-72 hours
2) photophobia/phonophobia or nausea/vomiting
+ 2 of
3) unilateral
4) pulsatile
5) impairs or worsened by routine activity

99
Q

Migraine - Management (1/5/0)

A

conservative
1) avoid triggers (CHOCOLATE)
medical
1) NSAID (e.g. aspirin) (moderate)
2) serotonin agonist (e.g. sumitriptan) (severe)
3) antiemetic
4) propranolol or topiramate (anticonvulsant) (prevention, >2 a week) (1st line)
5) amitriptyline (prevention, >2 a week) (2nd line)

100
Q

Tension Headache - Description

A

most common primary headache

101
Q

Tension Headache - Triggers (7)

A

1) stress
2) anxiety
3) noise
4) eyestrain
5) hunger
6) sleep deprivation
7) fatigue

102
Q

Tension Headache - Types (2)

A

1) acute - <15 days/month

2) chronic - >15 days/month for 3 months

103
Q

Tension Headache - Symptoms (2)

A

1) bilateral tight non-pulsatile headache (mild to moderate) (esp. frontal or occipital)
2) scalp muscle tenderness

104
Q

Tension Headache - Management (4/3/0)

A 
conservative
1) reassurance
2) avoid triggers
3) regular exercise
4) stress relief (e.g. massage)
medical
1) paracetamol
2) NSAID (e.g. ibuprofen, aspirin)
3) TCA (amitriptyline) (chronic)
105
Q

Cluster Headache - Description

A

most disabling primary headache

106
Q

Cluster Headache - Risk Factors (5)

A

1) male
2) family history
3) smoking
4) alcohol
5) head trauma

107
Q

Cluster Headache - Types (2)

A

1) episodic - 4-12 week clusters, months-years remission

2) chronic - >1 year, without remission

108
Q

Cluster Headache - Symptoms (7)

A 
1) excruciating unilateral headache (rapid onset)
ipsilateral cranial autonomic symptoms
2) lacrimation (flow of tears)
3) swollen eyelid
4) facial flushing
5) rhinorrhoea
6) miosis (excessive pupil constriction)
7) ptosis (drooping upper eyelid)
109
Q

Cluster Headache - Symptoms (Headache Sites) (4)

A

1) orbital
2) retro- orbital
3) temporal
4) mandibular

110
Q

Cluster Headache - Complications (1)

A

1) depression

111
Q

Cluster Headache - Diagnosis (1)

A

1) >5 cluster headaches

112
Q

Cluster Headache - Management (2/3)

A

conservative
1) smoking cessation
2) avoid alcohol (in cluster)
medical
1) serotonin agonist (sumatriptan) (attack)
2) oxygen (15L 100% for 15 minutes via non-breathable mask) (attack)
3) CCB (verapamil) (prophylaxis)

113
Q

Dementia - Description

A

syndrome characterised by memory loss, and decline of thinking, language, daily living activity

114
Q

Dementia - Causes (5)

A

1) Alzheimer’s disease (50%)
2) vascular dementia (25%) (i.e. stroke)
3) Lewy-body (15%) (Parkinson’s associated)
4) frontotemporal (MND associated)
5) Huntington’s disease

115
Q

Dementia - Symptoms (General) (4)

A

1) amnesia
2) disorientation
3) personality change (inc. mood changes)
4) daily living activities decline

116
Q

Dementia - Symptoms (Lewy Body Triad) (3)

A

1) Parkinsonism
2) visual hallucinations
3) fluctuating course

117
Q

Dementia - Complications (3)

A

1) Parkinson’s disease (25%)
2) pneumonia
3) urinary tract infection

118
Q

Dementia - Investigations (General) (8/3)

A 
initial
1) FBC
2) U+E
3) LFT
4) TFT
5) serum glucose
6) serum vitamin B12
7) urine drug screen
8) brain MRI
consider
1)  FDG-PET
2) single photon emission CT
3) electroencephalogram
119
Q

Alzheimer’s Disease - Description

A

chronic neurodegenerative disorder characterised by memory loss, and decline of thinking, language, daily living activities

120
Q

Alzheimer’s Disease - Risk Factors (9)

A

1) >55 years old
2) female
3) family history
4) genetics (PICALM, CL1, CLU)
5) Down’s syndrome
6) cerebrovascular disease
7) hyperlipidaemia
8) obesity
9) smoking

121
Q

Alzheimer’s Disease - Pathophysiology (6)

A

1) increased production / decreased clearance of β amyloid peptide
2) accumulation of β amyloid peptide
3) formation of dense amyloid oligomer plaques
4) inflammation of plaques forming neuritic plaques
5) synaptic damage and cell death
6) decreased ACh signalling

122
Q

Alzheimer’s Disease - Symptoms (8)

A

1) amnesia
2) disorientation
3) personality change (inc. mood changes)
4) daily living activities decline
5) apathy
6) nominal dysphasia
7) prosopagnosia (late)
8) autoprosopagnosia (late)

123
Q

Alzheimer’s Disease - Complications (2)

A

1) pneumonia

2) urinary tract infection

124
Q

Alzheimer’s Disease - Investigations (8/3)

A 
initial
1) FBC
2) U+E
3) LFT
4) TFT
5) serum glucose
6) serum vitamin B12
7) urine drug screen
8) brain MRI
consider
1) FDG-PET
2) single photon emission CT
3) electroencephalogram
125
Q

Alzheimer’s Disease - Management (4/5/0)

A 
conservative
1) identification bracelet
2) specialist memory service
3) home safety evaluation
4) occupational therapy
medical
1) vitamin E supplement
2) AChEi (e.g. donepezil, rivastigmine, galatamine)
3) antidepressants (e.g. SSRI, TCA)
4) antiglutaminergic (late)
5) antipsychotic (severe)
126
Q

Multiple Sclerosis - Description

A

CNS oligodendrocyte demyelination due to chronic autoimmune inflammation

127
Q

Multiple Sclerosis - Causes (1)

A

1) unknown

128
Q

Multiple Sclerosis - Risk Factors (7)

A

1) 20-40 years old (presentation)
2) female
3) Caucasian
4) vitamin D deficiency (e.g. low sunlight exposure)
5) viral infection (EBV, MMR)
6) autoimmunity
7) smoking

129
Q

Multiple Sclerosis - Types (3)

A

1) primary progressive - worsening disability with no relapses/remissions (10-15%)
2) relapsing remitting - worsening disability with relapses/remissions (80%)
3) secondary progressive - worsening disability with fewer relapses/remissions (2nd to 75% of RRMS)

130
Q

Multiple Sclerosis - Pathophysiology (7)

A

1) unknown cause
2) T cells activate B cells to produce oligodendrocyte (CNS) autoantibodies
3) autoimmune demyelination of oligodendrocytes (CNS)
4) perivenular demyelination plaques form
5) myelin sheath regenerates but is less efficient and temperature dependant
6) repeated autoimmune demyelination of oligodendrocytes (CNS)
7) axonal loss

131
Q

Multiple Sclerosis - Symptoms (8)

A

1) unilateral optic neuritis (eye movement pain and rapid decrease of central vision)
2) dysaesthesia
3) parasaesthesia
4) hypertonia (spasticity) (esp. legs, e.g. leg cramps)
5) bowel dysfunction (urgency, incontinence) (esp. constipation)
6) bladder dysfunction (urgency, incontinence, frequency)
7) erectile dysfunction
8) amnesia

132
Q

Multiple Sclerosis - Symptoms (Brainstem/Cerebellum) (5)

A

1) diplopia
2) vertigo
3) ataxia
4) dysphagia
5) dysarthria

133
Q

Multiple Sclerosis - Signs (2)

A

1) Lhermitte’s sign (neck flexion causes ‘electric shocks’ in trunk and limbs)
2) Uhthoff’s sign (symptoms worsen with heat)

134
Q

Multiple Sclerosis - Complications (6)

A

1) depression
2) mobility impairment
3) osteopenia —> osteoporosis
4) aspiration pneumonia
5) urinary tract infections
6) erectile dysfunction

135
Q

Multiple Sclerosis - Investigations (6/2)

A

initial
1) brain MRI* (perivenular demyelination plaques)
2) spinal MRI* (perivenular demyelination plaques)
3) FBC (normal)
4) TFT (normal)
5) metabolic panel (normal)
6) serum vitamin B12 (normal)
consider
1) lumbar puncture + CSF electrophoresis (oligoclonal IgG bands)
2) evoked potential (delayed visual, auditory, somatosensory)

136
Q

Multiple Sclerosis - Diagnosis (McDonald Criteria) (2)

A

without investigation

1) ≥2 relapses
2) ≥2 objective clinical lesions

137
Q

Multiple Sclerosis - Management (5/5/0)

A

conservative
1) regular exercise
2) physiotherapy
3) smoking cessation
4) avoid stress
5) self-catheterisation
medical
1) PO methylprednisolone (relapse) (IV if severe) (avoid >3/year)
2) dimethyl fumarate (1st disease modifying)
3) alemtuzumab or natalizumab (2nd disease modifying)
4) gabapentin (spasticity, pain, dysaesthesia)
5) tolterodine (urinary frequency)

138
Q

Motor Neurone Disease - Description

A

group of progressive neurodegenerative disorders that affect motor neurones

139
Q

Motor Neurone Disease - Risk Factors (3)

A

1) >40 years old (peak 60)
2) male (1.5x)
3) family history (5-10%)

140
Q

Motor Neurone Disease - Types (4)

A

1) amyotrophic lateral sclerosis (<80%) (UMN+LMN)
2) progressive bulbar palsy (10-20%) (LMN IX-XII)
3) progressive muscular atrophy (<10%) (LMN)
4) primary lateral sclerosis (rare) (UMN)

141
Q

Motor Neurone Disease - Onset Patterns (3)

A

1) limb (most common)
2) bulbar (20%)
3) respiratory (least common)

142
Q

Motor Neurone Disease - Symptoms (Amyotrophic Lateral Sclerosis) (5)

A

UMN+LMN

1) weakness
2) hypertonia (spasticity) (inc. unsteady gait)
3) hyperreflexia
4) clonus (series of involuntary rhythmic muscular contractions and relaxations)
5) cramps

143
Q

Motor Neurone Disease - Symptoms (Progressive Bulbar Palsy) (4)

A

LMN IX-XII

1) pseudobulbar palsy (inc. dysarthria, dysphagia, hypomimesis)
2) dysphonia
3) hypophonia
4) tongue fasciculation (tongue twitching, like a sack of worms)

144
Q

Motor Neurone Disease - Symptoms (Primary Muscular Atrophy) (4)

A

LMN

1) weakness
2) hypotonia (flaccid)
3) hyporeflexia —> areflexia
4) fasciculation (brief spontaneous muscular contraction)

145
Q

Motor Neurone Disease - Symptoms (Primary Lateral Sclerosis) (5)

A

UMN

1) weakness (inc. stumbling, foot drop) (esp. legs)
2) hypertonia (spasticity) (inc. unsteady gait) (esp. legs)
3) hyperreflexia
4) clonus (series of involuntary rhythmic muscular contractions and relaxations)
5) pseudobulbar palsy (inc. dysarthria, dysphagia, hypomimesis)

146
Q

Motor Neurone Disease - Signs (Amyotrophic Lateral Sclerosis) (2)

A

1) split hand sign (thumb sided hand muscle wasting)

2) Babinski sign (dorsiflexion (upward) of big toe when sole of foot is stimulated by blunt instrument)

147
Q

Motor Neurone Disease - Complications (4)

A

1) frontotemporal dementia
2) aspiration pneumonia
3) respiratory failure
4) hepatoxicity (riluzole)

148
Q

Motor Neurone Disease - Investigations (0/5)

A

consider

1) electromyogram
2) nerve conduction studies
3) brain MRI (exclude structural cause)
4) spinal MRI (exclude structural cause)
5) lumbar puncture (exclude inflammatory cause)

149
Q

Motor Neurone Disease - Management (4/3/0)

A 
conservative
1) physiotherapy
2) occupational therapy
3) SALT (speech and language therapy)
4) PEG tube feeding (dysphagia)
medical
1) riluzole (extends life by 3 months)
2) analgesia
3) symptom management
150
Q

Meningitis - Description

A

inflammation of brain meninges due to infection

151
Q

Meningitis - Causes (11)

A

1) Neisseria meningitides*
2) Streptococcus pneumoniae
3) Haemophilus influenzae
pregnant
4) Listeria monocytogenes
neonate
5) Escherichia coli
6) Streptococcus agalactiae
immunocompromised
7) Cytomegalovirus
8) Cryptococcus neoformans
9) Herpes simplex
10) HIV
11) tuberculosis

152
Q

Meningitis - Risk Factors (7)

A

1) <5 years old
2) >65 years old
3) immunocompromised
4) crowding (e.g. university)
5) cancer
6) intrathecal drug administration
7) cochlear implant

153
Q

Meningitis - Symptoms (Early) (4)

A

1) headache (worst ever)
2) fever
3) leg pain
4) cold peripheries

154
Q

Meningitis - Symptoms (Late) (5)

A

1) meningism
2) altered mental state (cerebral oedema)
3) focal neurological deficit (20%)
4) seizures
5) non-blanching petechia (meningococcal septicaemia)

155
Q

Meningitis - Symptoms (Meningism) (3)

A

1) headache (worst ever)
2) photophobia
3) neck stiffness

156
Q

Meningitis - Signs (5)

A

1) Kernig’s sign (inability to extend knee when hip is flexed)
2) Brudizinski’s sign (when neck is flexed, hip and knee also flex)
3) papilloedema
4) hypotension (shock)
5) slow capillary refill (shock)

157
Q

Meningitis - Complications (5)

A

1) meningococcal septicaemia (inc. DIC) (shock)
2) cerebral oedema
3) hydrocephalus
4) seizures
5) hearing loss

158
Q

Meningitis - Investigations (10/0)

A

initial

1) blood culture (before LP) (exclude meningococcal septicaemia)
2) lumbar puncture + CSF studies* (analysis, MS+C, PCR, serology)
3) FBC (anaemia, leucocytosis, thrombocytopenia)
4) U+E (acidosis)
5) LFT
6) high CRP + ESR
7) serum Ca2+ (low)
8) serum Mg2+ (low)
9) serum glucose (low)
10) head CT (exclude stroke, space-occupying lesions)

159
Q

Meningitis - Diagnosis (Lumbar Puncture) (3/3/3)

A 
bacterial
1) neutrophils
2) very high protein
3) low glucose
viral
1) lymphocytes
2) normal protein
3) normal glucose
tuberculosis
1) lymphocytes
2) high protein
3) low glucose
160
Q

Meningitis - Management (1/6/0)

A

conservative
1) notify Public Health England
medical
1) empirical IV ceftriaxone
2) + empirical IV amoxicillin (>60 years old or immunocompromised)
3) IV dexamethasone (cerebral oedema)
4) IM benzylpenicillin (meningococcal septicaemia) (community)
5) IV cefotaxime (meningococcal septicaemia) (hospital)
6) prophylactic ciprofloxacin (contacts)

161
Q

Encephalitis - Description

A

inflammation of brain parenchyma due to infection

162
Q

Encephalitis - Causes (9)

A 
viral*
1) Herpes simplex (1+2)*
2) Varicella zoster
3) Measles
4) Mumps
5) Rubella
non-viral
6) bacterial meningitis
7) tuberculosis
8) malaria
9) aspergillosis
163
Q

Encephalitis - Risk Factors (3)

A

1) <1 years old
2) >65 years old
3) immunocompromised (e.g. HIV, chemo)

164
Q

Encephalitis - Symptoms (Early)

A

systemic viral symptoms

1) headache
2) fever
3) fatigue
4) myalgia
5) nausea

165
Q

Encephalitis - Symptoms (Late) (5)

A

brain symptoms

1) confusion
2) behavioural change (odd encephalopathic behaviour)
3) drowsiness —> coma
4) focal neurological deficit (e.g. hemiparesis)
5) seizures

166
Q

Encephalitis - Complications (5)

A

1) death
2) ischaemic stroke
3) seizures
4) meningoencephalitis
5) neurological sequelae (e.g. aphasia, amnesia, motor problems)

167
Q

Encephalitis - Investigations (9/0)

A

initial

1) lumbar puncture + CSF studies (analysis, MS&C, PCR, serology)*
2) blood culture
3) other cultures (e.g. throat swab, stool culture)
4) FBC (leucocytosis)
5) U+E (hyponatraemia)
6) LFT (high)
7) high CRP + ESR
8) brain high contrast CT (exclude stroke, space-occupying lesions) (inflammation, swelling)
9) electroencephalogram (background slowing)

168
Q

Encephalitis - Management (0/4/0)

A

medical

1) supportive care (e.g. endotracheal intubation)
2) empirical IV aciclovir (ASAP <30 mins, before test results) (herpes simplex, varicella zoster)
3) symptomatic treatment (e.g. antiseizure – phenytoin)
4) IM benzylpenicillin (suspected meningoencephalitis)

169
Q

Shingles - Description

A

infection of dermatome due to reactivation of latent varicella zoster (chickenpox)

170
Q

Shingles - Causes (1)

A

varicella zoster –> herpes zoster

171
Q

Shingles - Risk Factors (5)

A

1) >50 years old
2) HIV
3) corticosteroids
4) malignancy
5) chemotherapy

172
Q

Shingles - Pathophysiology (3)

A

1) varicella zoster remains latent in sensory dorsal root ganglia
2) varicella zoster reactivates due to
decline in cell-mediated immunity
3) varicella zoster travels down sensory afferent neurones to infect dermatomes

173
Q

Shingles - Symptoms (4)

A

1) localised dermatome pain (days-weeks prior to rash)
2) localised dermatome paraesthesia (days-weeks prior to rash)
3) localised dermatome erythematous maculopapular rash –> clear vesicles –> crust (resolution in 2-3 weeks)
4) systemic symptoms (20%) (e.g. headache, malaise, fatigue)

174
Q

Shingles - Complications (3)

A

1) herpes zoster ophthalmicus (inc. blindness)
2) skin lesion superinfection (esp. Staph. or Strep.)
3) post herpetic neuralgia (10%)

175
Q

Shingles - Investigations (0/1)

A

consider

1) blood/rash PCR (immunocompromised)

176
Q

Shingles - Management (1/5/0)

A

conservative
1) varicella zoster vaccine (>70 years old)
medical
1) aciclovir (<72 hours of rash onset)
2) analgesia (e.g. ibuprofen –> opioid)
3) topical antibiotics (skin lesion superinfection)
4) TCA (amitriptyline) (post herpetic neuralgia)
5) antiepileptic (gabapentin) (post herpetic neuralgia)

Phase 2a - Neurology (2 decks)

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