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Medicine 2 > Neurology disease > Flashcards

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
Q

What are the first brain areas to be affected by Alzheimer disease?

A

Entorhinal first followed by hippocampus

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26
Q

What is expressive aphasia and what area is damaged?

A

speach is non-fluent, laboured and hesitant

Broca’s area

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27
Q

What is Receptive aphasia and what area is damaged?

A

Sentences make no sense. Patient doesn’t have comprehension.

Weirnke’s area

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28
Q

If a patient presents with homonyous hemianopia with central vision vision sparing, where has been injured?

A

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 `

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29
Q

Patient presents with weakened facial muscle unilaterally, but is able to lift eyebrows, what is most likely diagnosis and why?

A

Stroke

Not Bells palsy - as the upper facial nuclei recieve dual innervation from both hemispheres so is maintained in UM lesions

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30
Q

What sits in front of the sympathetic chain?

A

Parietal plura

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31
Q

What level does the clauda equina start in adults?

A

L1/ 2

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32
Q

What level does the clauda equina start in neonates?

A

L3

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33
Q

Name a tumour that originates near the pituitary and is associated with the cavernosa sinus?

A

Superaceller Meningioma

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34
Q

Name the two types of synapses within the CNS and some features about them.

A

Gray Type 1 - asymmetrical.

  • thickened membrane
  • circular vesciles

Gray type 2 - symmetrical

  • non thickened membrane
  • clustered vesicles
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35
Q

What spinal nerve roots contribute to the sciatic nerve?

A

L4,5 S1,2,3

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36
Q

What is a common aetiology of cavernous sinus thrombosis and what are some symptoms?

A

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

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37
Q

What is the legal eye sight requirement for driving in UK?

A

6/12

38
Q

What is the eyesight of someone legally blind worse than?

A

6/30

39
Q

What areas are damaged in Wernicke Korascoff syndrome?

A

Medial dorsal nuclei of the thalamus

Mamillary bodies

*both paraventricular to the third ventricle

40
Q

What blood vessel would be damaged to cause optic tract damage?

A

Post cerebral artery

41
Q

What is the test to assess peripheral vision?

A

Goldmann Perimetry

42
Q

What does swinging light test, test?

A

Relative afferent pupil defect

43
Q

What are the stages of examing the pupils?

A
  1. size - 1-2 mm differences can be normal
  2. Check direct and indirect consensual reponses
  3. swinging light test
  4. accommodation reflex
44
Q

Define Pain:

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

45
Q

What pain fibres does morphine have action on?

A

C fibres

it does not abolish the effects on A delta fibres.

46
Q

How does neuropathic pain differ from nociceptive?

A

Nociceptive is tissue damage

Neuropathic is nerve damage affecting either the CNS or PNS and is associated with allodynia and chronic sensitisation

47
Q

What are some key symptoms of neuropathic pain?

A

Burning
electric shock like
tingling
numbness

48
Q

What kind of pain is a rupture disc?

A

Both:
Nociceptive at site of lesion

Neuropathic as it squeezes on the nerve roots causing radicular pain along those dermatomes

49
Q

What are characteristics of Prion disease?

A

Spongiform changes associated with neural loss and the lack of/ inability to produce an inflammatory response

50
Q

Give some examples how Alzheimer’s and CJD are similar

A

Both fatal neurological diseases

Both have inherited and sporadic forms

Both associated with amyloid deposits

Both have increased Beta sheet structure

51
Q

How can Alzheimer’s and CJD differ?

A

Unrelated protein miss folding.

Alzheimer’s = Amyloid Precursor Protein

CJD = PrPc

52
Q

What is the resting tremor rate of someone with Parkinson’s?

A

4-6Hz

53
Q

What drug is given with L-DOPA? and what is its effects?

A

Carbidopa

its a peripherally acting decarboxylase inhibitor preventing L-DOPA being broken down in the peripheries.

54
Q

What are the symptoms of Meniere’s disease?

A

Vertigo +20mins episodes

Tinnitus

Fluctuating hearing loss

fullness of ear

55
Q

Outline the parthenogenesis of Huntington’s disease.

A

Autosomal dominant

death of cells within the stiatum. More towards indirect pathway.
Leads to more activation of direct.

56
Q

Damage or dysfunctional PFC results in what?

A

Forgetfullness

Impulsive

Reduced inhibition

Dis-tractability

Impairment of working memory and mental flexibility

57
Q

Define dementia

A

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
Q

Define Delirium:

A

An acute disorder of mental state characterised by:

  • sudden onset confusion
  • hallucinations
  • changes in pyschomotor responses
  • changes in consciousness
  • disorientation
59
Q

What type of Amnesia is the inability to create memories after the event?

A

Antrograde

60
Q

What are the two processes that control arousal and what is the consquences to damage of either of them

A

Top down regulation: Prefrontal/ Limbic/ Parietal.
Damage = neglect, inattention

Bottom up regulation: Ascending Reticular activating system.
Damage = coma, reduced consciouness

61
Q

When carrying out a GCS - what are the four components that are done when assessing each area?

A

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
Q

What do you record if the patient can partake in the assessment?

A

Not testable

63
Q

For the motor testing, what would you do in the setting of a spinal injury?

A

Ask patient to move tongue and mouth

64
Q

Where is the first pressure applied during motor testing and what is this followed by? and when might you not use it?

A

Trapezius squeeze followed by supra-orbital notch, looking for localisation

you wouldn’t carry this out when there is facial injury

65
Q

Dysregualtion of which dopamine associated pathway is seen in Schizophrenia?

A

Mesocortical/ mesolimbic pathway

Mesolimbic associated with the postive symptoms

Mesocortex associated with negative symptoms

66
Q

Name the two types of neuroplascity that can occur?

A

Synaptic: Increase in neurotransmitter release and upregulation of receptors

Structural - axonal sprouting

67
Q

How does the photoreceptor react in response to light?

A

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
Q

What are the symptoms of horners syndrome?

A

Miosis - fixed dilated pupil

Ptosis - dropping eyelid

Anhidrosis of face - lack of sweating

69
Q

Whats the difference between hypertonia and spasticity?

A

hypertonia is throughout the movement

Spasticity is only at beginning and loosens

70
Q

If a patient presents with uvula tracking to one side, what nerve is affected and what other nerve is also likely to be associated?

A

Vagus nerve affected.

Probably glosopharngeal - as they usually are affected together.
- would check gag reflex

71
Q

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?

A
  • 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
Q

When testing for suspected CFS leakage, what tests can be done?

A

Check for glucose - CFS should have glucose in it

Beta 2 Transferrin - unique to CFS

73
Q

If the occulomotor is not working - potentially due to compression, what will the position of the eyes be?

A

Down and out - unopposed activity of trochlear

74
Q

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?

A

Berry aneurysms

along the posterior communicating branch which the occulomotor runs in close approximation with

75
Q

In chronic compression injury to the nerve, outline the two pathological processes and give an example of such an injury:

A

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
Q

How does botulism cause paralysis?

A

Blocks exocytosis of ACh

77
Q

How does Myasthia Gravis cause disease?

A

Antibodies against the ACh receptors

78
Q

Between what scores on a GCS are considered moderate?

A

9-12

79
Q

Is diffused axonal injury found in all cases of severe head injury?

A

Yes and is often fatal and has no lucid period

80
Q

What is punch drunk syndrome and what is affected?

A

A syndrome seen in boxers and alcoholics due to repeated concussions. tremors, slowed movement confusion and speech problems.

neurofibllary tangles
Amyloid beta formation

81
Q

What is concussion?

A

Mild traumatic brain injury, associated with temporary loss of brain function

82
Q

When testing the Glossophangeal and vagus nerves what would you do?

A

Gag reflex

Get them to say “Ahh”

take a drink of water and see how they swallow

83
Q

Where on the visual pathways can be damaged to produce homonymous hemianopia?

A

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
Q

Where would cause damage to the central vision only and what is this called?

A

The most posterior aspect of the visual cortex.

Bilateral central scotomas

85
Q

When testing the temporal fields what do you do?

A

*patient must cover one eye

Test red comparison first - using two red coloured instruments

Finger waving and moving

86
Q

How do you test homonymous hemianopia?

A

*patient has both eyes open

moving finger

87
Q

What leads to relative defects and absolute defects?

A

Tumours lead to relative defects in vision

Ischemia leads to absolute defects

88
Q

In optic nerve damage what may be seen during a fundoscope examination?

A

Greying of the optic disc. Not as yellow.

89
Q

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?

A
  • 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
Q

Symptoms of cerebellar dysfunction:

A

Ataxia

hypertonia

Nystagmus

Scanning speech

Medicine 2 (28 decks)

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