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Neurology disease Flashcards

1
Q

What is the medical term for the inability to recognise faces?
- how can it come about?

A

Prosopagnosia

Damage to the inferotemporal cortex - usually the right side

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2
Q

What is it called when there is reactivation of the genuniculate ganglion of the facial nerve which causes nerve paralysis and rash like symptoms on the external ear?

A

Ramsay - Hunt syndrome

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3
Q

What shape would sub-arachnoid haemorrhages take? and why?

A

Blood would form along the sulci and fissures.

this is because the blood accumulates between the arachnoid and pia which is direct contact with the nervous tissue.

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4
Q

What are some defining features of Guillian Baure syndrome? and what food poisoning can it be a complication off?

A

Starts distally in a glove and sock pattern. affects sensory neurons as well.

Campylobacter infection

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5
Q

What are the genes associated with ADHD and what is their function?

A

DRD4 Receptor 7 - overactivity and impulsiveness

DRD5 - dopamine receptor

DAT1 - Dopamine transporter gene

5HTT - serotonin transporter

5HTr1B - serotonin receptor

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6
Q

If someone lost Ia, Ib, and IIa afferent fibres why would they develop hypotonicity?

A

Due to the lack of stretch reflexes receiving the afferent signal to tense

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7
Q

When carrying out surgery on a AAA, what artery must be carefully avoided, and if it were injured what would occur?

A

Artery of Adamkeiwicz

Anterior spinal artery syndrome

  • loss of urinary and faceal continence
  • motor impairment to lower legs
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8
Q

At what level is the lumbar puncture done?

A

L3/4

or

L4/5

depending exactly where the cauda equina starts

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9
Q

What are the 6 P’s of Pain management?

A

Prevention

Pathology

Physical Therapy

Pharmacology

Procedural

Psychology

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10
Q

What are the time lengths involved with spinal cord shock?

A

30-60 mins after injury.
6 weeks it can last.

Complete loss of sensory and motor innervation

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11
Q

What are the phases of spinal shock?

A
  1. Areflexia and Flaccidity
  2. Initial return of reflexes
  3. Initial hyperreflexia
  4. Spacisity
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12
Q

What’s a serious complication of spinal shock?

A

Neurogenic shock - loss of sympathetic tone

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13
Q

Why is there weakness with upper motor neuron damage?

A

Lack in Alpha motor neuron recruitment

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14
Q

What is one of the first reflexes to come about again after spinal shock?

A

Babinski reflex

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15
Q

What is a differentiating factor between neuroschwannoma tumour and Menier’s disease?

A

Menier’s disease tends to be fluctuating sensorneural hearing loss

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16
Q

Why might there be damage to the facial nerve durign surgery for an accoustic neuroma?

A

Both nerves pass through the internal accoustic meatus, a site which is also a common place for tumour growth.

also both exit off the medulla and the cerebellopontine angle

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17
Q

What is the surgerical procedure in which the eyes are partially sown together and why is it carried out?

A

Tarsorrhaphy

due to the paralysis of orbuclaris oculi - the eye is unable to shut completely.
this would lead to corneal drying and ulceration

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18
Q

Diffuse injuries to the brain usually come about due to what damage occurring?

A

Usually due to axonal injury

- causing sheering of the axons leading to diffuse impairment. usually causing immediate coma.

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19
Q

What are contrecoup injuries?

A

where injury occurs on the opposite of impact, as the brain moves causes damage to the opposite of impact

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20
Q

What is the relationship of CFS, blood volume and brain matter volume within the skull known as?

A

Munro- Kellie hypothesis

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21
Q

When testing hearing loss via Weber’s test, what is normal? and what does lateralising to one side indicate?

A

Normal is that the sound is heard equally on both sides.

if lateralisation then it indicates either:
- conductive hearing loss - to the side it lateralisies too
or

  • neurosensory loss to the opposite site it lateralises too
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22
Q

What is the test done to newborns to test hearing and how does it work?

A

Automated Otacoustic emission AOAE

small implant in ear, which clicks. if brain recieves signal it can be picked up via a computer monitoring brain activity

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23
Q

In the formation of Lewy Bodies, what is precusor protein to these? i.e. the miss folded proteins?

A

Alpha - synuclein

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24
Q

What is the aetiology of frontotemporal dementia?

A

Abnormal gene expression of Tau which leads to Tau tangles within the fronto and temporal portions of the brain

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25
What are the first brain areas to be affected by Alzheimer disease?
Entorhinal first followed by hippocampus
26
What is expressive aphasia and what area is damaged?
speach is non-fluent, laboured and hesitant Broca's area
27
What is Receptive aphasia and what area is damaged?
Sentences make no sense. Patient doesn't have comprehension. Weirnke's area
28
If a patient presents with homonyous hemianopia with central vision vision sparing, where has been injured?
Optic radiations - this is because the central vision has been spared. if there had been no sparing of the central vision then it would be optic tract `
29
Patient presents with weakened facial muscle unilaterally, but is able to lift eyebrows, what is most likely diagnosis and why?
Stroke Not Bells palsy - as the upper facial nuclei recieve dual innervation from both hemispheres so is maintained in UM lesions
30
What sits in front of the sympathetic chain?
Parietal plura
31
What level does the clauda equina start in adults?
L1/ 2
32
What level does the clauda equina start in neonates?
L3
33
Name a tumour that originates near the pituitary and is associated with the cavernosa sinus?
Superaceller Meningioma
34
Name the two types of synapses within the CNS and some features about them.
Gray Type 1 - asymmetrical. - thickened membrane - circular vesciles Gray type 2 - symmetrical - non thickened membrane - clustered vesicles
35
What spinal nerve roots contribute to the sciatic nerve?
L4,5 S1,2,3
36
What is a common aetiology of cavernous sinus thrombosis and what are some symptoms?
Common due to infection around the face, namely: - face tissue - sinuses - ear - teeth signs: - swollen eyes since it drain directly off there - fever - decreased vision
37
What is the legal eye sight requirement for driving in UK?
6/12
38
What is the eyesight of someone legally blind worse than?
6/30
39
What areas are damaged in Wernicke Korascoff syndrome?
Medial dorsal nuclei of the thalamus Mamillary bodies *both paraventricular to the third ventricle
40
What blood vessel would be damaged to cause optic tract damage?
Post cerebral artery
41
What is the test to assess peripheral vision?
Goldmann Perimetry
42
What does swinging light test, test?
Relative afferent pupil defect
43
What are the stages of examing the pupils?
1. size - 1-2 mm differences can be normal 2. Check direct and indirect consensual reponses 3. swinging light test 4. accommodation reflex
44
Define Pain:
An unpleasant sensory and emotional experience associated with actual or potential tissue damage
45
What pain fibres does morphine have action on?
C fibres it does not abolish the effects on A delta fibres.
46
How does neuropathic pain differ from nociceptive?
Nociceptive is tissue damage Neuropathic is nerve damage affecting either the CNS or PNS and is associated with allodynia and chronic sensitisation
47
What are some key symptoms of neuropathic pain?
Burning electric shock like tingling numbness
48
What kind of pain is a rupture disc?
Both: Nociceptive at site of lesion Neuropathic as it squeezes on the nerve roots causing radicular pain along those dermatomes
49
What are characteristics of Prion disease?
Spongiform changes associated with neural loss and the lack of/ inability to produce an inflammatory response
50
Give some examples how Alzheimer's and CJD are similar
Both fatal neurological diseases Both have inherited and sporadic forms Both associated with amyloid deposits Both have increased Beta sheet structure
51
How can Alzheimer's and CJD differ?
Unrelated protein miss folding. Alzheimer's = Amyloid Precursor Protein CJD = PrPc
52
What is the resting tremor rate of someone with Parkinson's?
4-6Hz
53
What drug is given with L-DOPA? and what is its effects?
Carbidopa its a peripherally acting decarboxylase inhibitor preventing L-DOPA being broken down in the peripheries.
54
What are the symptoms of Meniere's disease?
Vertigo +20mins episodes Tinnitus Fluctuating hearing loss fullness of ear
55
Outline the parthenogenesis of Huntington's disease.
Autosomal dominant death of cells within the stiatum. More towards indirect pathway. Leads to more activation of direct.
56
Damage or dysfunctional PFC results in what?
Forgetfullness Impulsive Reduced inhibition Dis-tractability Impairment of working memory and mental flexibility
57
Define dementia
A set of symptoms in which there is: - forgetfulness - reduced cognitive facilities - reduced reasoning - changes in personality - deterioration in personal care *usually chronic and progressive
58
Define Delirium:
An acute disorder of mental state characterised by: - sudden onset confusion - hallucinations - changes in pyschomotor responses - changes in consciousness - disorientation
59
What type of Amnesia is the inability to create memories after the event?
Antrograde
60
What are the two processes that control arousal and what is the consquences to damage of either of them
Top down regulation: Prefrontal/ Limbic/ Parietal. Damage = neglect, inattention Bottom up regulation: Ascending Reticular activating system. Damage = coma, reduced consciouness
61
When carrying out a GCS - what are the four components that are done when assessing each area?
Check - see if there is anything that may disrupt testing - swelling, hearing aid etc. Observe: Watch patient to see if any of the areas occurring spontaneously Stimulate: speak, pressure, commands Rate
62
What do you record if the patient can partake in the assessment?
Not testable
63
For the motor testing, what would you do in the setting of a spinal injury?
Ask patient to move tongue and mouth
64
Where is the first pressure applied during motor testing and what is this followed by? and when might you not use it?
Trapezius squeeze followed by supra-orbital notch, looking for localisation you wouldn't carry this out when there is facial injury
65
Dysregualtion of which dopamine associated pathway is seen in Schizophrenia?
Mesocortical/ mesolimbic pathway Mesolimbic associated with the postive symptoms Mesocortex associated with negative symptoms
66
Name the two types of neuroplascity that can occur?
Synaptic: Increase in neurotransmitter release and upregulation of receptors Structural - axonal sprouting
67
How does the photoreceptor react in response to light?
Become hyperpolarised the decomposition of rhodospin causes release of phosphodiestarase which reduces cGMP levels causing Na2+ to stop entering the cell and as a result hyperpolarises
68
What are the symptoms of horners syndrome?
Miosis - fixed dilated pupil Ptosis - dropping eyelid Anhidrosis of face - lack of sweating
69
Whats the difference between hypertonia and spasticity?
hypertonia is throughout the movement Spasticity is only at beginning and loosens
70
If a patient presents with uvula tracking to one side, what nerve is affected and what other nerve is also likely to be associated?
Vagus nerve affected. Probably glosopharngeal - as they usually are affected together. - would check gag reflex
71
If a person had a tumour in the jugular foramen, what symptoms would they possible present with and why? what is the most common cause?
- lack of sensation posterior 1/3rd of tongue - hoarseness of voice - weakness in trapezius and sternocliodomastoid muscle due to compression of cranials IX, X, XI paraganglioma
72
When testing for suspected CFS leakage, what tests can be done?
Check for glucose - CFS should have glucose in it Beta 2 Transferrin - unique to CFS
73
If the occulomotor is not working - potentially due to compression, what will the position of the eyes be?
Down and out - unopposed activity of trochlear
74
Compression of a sub-arachnoid haemorrhage can often be caused by what abnormalities on the vessels, and one that affects the occulomotor immediately is likely to be found where?
Berry aneurysms along the posterior communicating branch which the occulomotor runs in close approximation with
75
In chronic compression injury to the nerve, outline the two pathological processes and give an example of such an injury:
Ischemia - compression of the vaso nervorum Mechanical compression of the myline shealth blocking conduction - larger diameter affected first Saturday night palsy - spiral groove of humours compressing radial
76
How does botulism cause paralysis?
Blocks exocytosis of ACh
77
How does Myasthia Gravis cause disease?
Antibodies against the ACh receptors
78
Between what scores on a GCS are considered moderate?
9-12
79
Is diffused axonal injury found in all cases of severe head injury?
Yes and is often fatal and has no lucid period
80
What is punch drunk syndrome and what is affected?
A syndrome seen in boxers and alcoholics due to repeated concussions. tremors, slowed movement confusion and speech problems. neurofibllary tangles Amyloid beta formation
81
What is concussion?
Mild traumatic brain injury, associated with temporary loss of brain function
82
When testing the Glossophangeal and vagus nerves what would you do?
Gag reflex Get them to say "Ahh" take a drink of water and see how they swallow
83
Where on the visual pathways can be damaged to produce homonymous hemianopia?
Optic tract Optic radiations (both) - with central vision sparing Inner portions of the calcrine fissure on the primary visual cortex - with central visual sparing
84
Where would cause damage to the central vision only and what is this called?
The most posterior aspect of the visual cortex. Bilateral central scotomas
85
When testing the temporal fields what do you do?
*patient must cover one eye Test red comparison first - using two red coloured instruments Finger waving and moving
86
How do you test homonymous hemianopia?
*patient has both eyes open moving finger
87
What leads to relative defects and absolute defects?
Tumours lead to relative defects in vision Ischemia leads to absolute defects
88
In optic nerve damage what may be seen during a fundoscope examination?
Greying of the optic disc. Not as yellow.
89
A patient who develops loss of sight in the right visual fields and weakness on the right side of body - where is the stroke most likely occurred?
* remember right vision loss = left sided lesion * right sided body loss = left sided lesion The visual tracts and motor tracts run close together in the internal capsule - so infarction there can lead to this
90
Symptoms of cerebellar dysfunction:
Ataxia hypertonia Nystagmus Scanning speech

Medicine 2 (28 decks)

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