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Neurology - Misc Flashcards

1
Q

Shingles aetiology

A

VZV reactivation

Immunosuppression

  • HIV
  • Steroids
  • Chemo

Age

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2
Q

Shingles presentation

A

Pre-eruptive

  • Itching
  • Burning
  • B symptoms

PAINFUL RASH

  • Dermatomal
  • Small vesicles
  • Clusters

If > 1 dermatome - Consider immunodeficiency or DDx

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3
Q

Herpes zoster ophthalmicus

A

VZV infection in V1

Visual loss
Hutchinson sign - Vesicles on the tip of the nose

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4
Q

Shingles investigations

A

Clinical diagnosis

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5
Q

Shingles management

A

Acyclovir

Pain relief 
- Paracetamol / ibuprofen 
THEN...
- Gabapentin 
- Pregabalin 
- Amitriptyline

Vaccination offered at 70 and 78

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6
Q

Bell’s palsy definition

A

Acute
Idiopathic
Unilateral
Facial nerve palsy

LMNL

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7
Q

Bell’s palsy causes

A

Idiopathic

Infection

  • EBV
  • HSV

SOL - Parotid tumour

GBS

Forceps delivery

^ Risk in pregnancy and diabetes

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8
Q

Bell’s palsy presentation

A

7th nerve palsy

Speech disturbance
Eating disturbance
Dry eyes

Taste - Loss of anterior 2/3

Post-auricular pain and numbness

Hearing - Hyperacusis

Gusto-lacrimal reflex - Crying when you eat

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9
Q

Bell’s palsy investigations

A

Serology
- VZV - Ramsay Hunt syndrome

CT/MRI to check for SOL

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10
Q

Bell’s palsy management

A

Prednisolone

Protect the eye

NO ANTIVIRALS

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11
Q

Bell’s palsy complications

A

Ramsay Hunt syndrome

Permanent in 15%

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12
Q

Spinal cord compression aetiology

A 
Bone mets 
Disc prolapse 
Osteophytes
EDH
Pott's disease 
Infection 
Trauma - Brown sequard syndrome
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13
Q

Spinal cord compression presentation

A

Back pain - Unilateral
Reflexes ^
FND / incontinence - Cauda equina?

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14
Q

Spinal cord compression investigations

A

MRI
Bloods - Serology
FBC/INR - Warfarin
CXR - Mets

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15
Q

Spinal cord compression management

A

Dexamethasone IV

Treat cause

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16
Q

Cauda equina aetiology

A 
Bone mets 
Disc prolapse 
Osteophytes
EDH
Pott's disease 
Infection 
Trauma - Brown sequard syndrome
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17
Q

Cauda equina presentation

A

Back pain
FND
Saddle numbness
Incontinence

Asymmetrical
Areflexia
Atrophic paralysis of leg

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18
Q

Cauda equina investigations

A

PR

Urgent MRI

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19
Q

Cauda equina management

A

Dexamethasone

Surgical decompression

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20
Q

Cauda equina complications

A

Paralysis
Sensory abnormality
Bowel, bladder and sexual dysfunction

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21
Q

MND pathophysiology

A 
Apoptosis of motor neurons 
Superoxide dimutase (SOD1) mutation
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22
Q

MND types

A

Amyotrophic lateral sclerosis - Most common

  • UMN + LMN
  • Loss of neurons in motor cortex

Progressive bulbar palsy - Worst prognosis

  • LMNL
  • CN 9-12

Progressive muscular atrophy - LMN

Primary lateral sclerosis - UMN

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23
Q

UMN signs

A

Upgoing plantars
Increased reflexes
Clonus
Spasticity

NO wasting

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24
Q

LMN signs

A

Fasciculations
Decreased reflexes
Wasting / atrophy

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25
Q

MND presentation

A

UMN signs
LMN signs

Foot drop
Asymmetrical weakness
Wasting - Thenar muscles and anterior tibialis

26
Q

MND bulbar signs

A

Dysphagia
Dysphasia
Dysarthria
Drooling

Emotionally labile

27
Q

MND complications

A 
Aspiration pneumonia 
Respiratory failure 
UTI 
Constipation 
Speech difficulties 
Immobility complications - Pressure sores
28
Q

MND vs MS vs MG

A

MND

  • No sphincter involvement
  • No sensory involvement
  • No ocular involvement

MS
- Sphincter involvement - Incontinence

MG
- Ocular involvement

29
Q

MND investigations

A

Clinical diagnosis

El Escorial diagnostic criteria

EMG

  • Decreased action potential
  • Increased amplitude
30
Q

MND management

A

Spasticity - Benzos
Feed - NG/PEG
Ventilation - NIV
Respiratory failure - Opioids

Physiotherapy
Occupational therapy
Speech and language therapy

RILULOZE!!!

31
Q

MND prognosis

A

2-4 years

Death from respiratory failure

32
Q

Meningitis viral causes

A

HSV
EBV
Mumps
Adenovirus

33
Q

Meningitis bacterial causes

A

Neonates

  • GBS
  • E. Coli
  • Listeria

Adults

  • N. meningitides
  • Strep pyogenes
34
Q

Meningitis presentation

A
  1. Fever
  2. Neck stiffness
  3. Headache

Photophobia
Rash - Purpuric non-blanching

Kernig’s sign
Brudzinski’s sign

Seizures
Coma

35
Q

Meningitis investigations

A

LP - Contraindicated if ICP ^

Blood cultures
PCR - Viral?

FBC 
U/E 
CRP/ESR 
Glucose 
ABG
36
Q

Meningitis LP findings

A

Bacterial

  • Cloudy
  • Polymorphonuclear lymphocytes
  • Protein ^^
  • Glucose - Low

Viral

  • Clear
  • Lymphocytes
  • Protein ^
  • Glucose - Normal or low

TB

  • Cloudy
  • Monocytes
  • Protein ^^^
  • Glucose - Low
37
Q

Meningitis management

A

Community - IV BEN PEN

< 3 months - IV cefotaxime + amoxicillin

> 3 months - IV cefotaxime

Strep P - Dexamethasone
Listeria - Amoxicillin

38
Q

Meningitis prophylaxis

A

Ciprofloxacin

39
Q

Meningitis complications

A

Sensorineural deafness
Abscess
Septicaemia

40
Q

Encephalitis aetiology

A

HSV
Enterovirus

HIV
Mumps 
Measles 
Lyme disease 
TB
41
Q

Encephalitis presentation

A
  1. Personality changes
  2. Fever
  3. Headache

FND
ICP ^
Seizures/coma

42
Q

Encephalitis investigations

A

LP

Blood cultures
PCR

Clotting
ESR

EEG
CT - Temporal lobe involvement

43
Q

Encephalitis management

A

IV acyclovir

44
Q

Cerebral abscess aetiology

A

Strep anginosus

Otitis media
Mastoiditis

Dental infection
Endocarditis

45
Q

Cerebral abscess presentation

A

Symptoms of SOL

  • Headache
  • FND
  • Raised ICP

Symptoms of infection - Fever

46
Q

Cerebral abscess infection locations

A

Otitis media
Mastoiditis

Dental infection
Endocarditis

47
Q

Cerebral abscess investigations

A

CT

  • Halo around lesion
  • Ring enhancement

Bloods

  • Cultures
  • Leukocytosis
48
Q

Cerebral abscess management

A

Ceftriaxone
Fluconazole
Drainage if ICP ^

49
Q

Horner’s syndrome aetiology

A

STC

S - Central

  • Stroke
  • Multiple Sclerosis

T - Preganglionic

  • Tumour - Pancoast
  • Thyroidectomy
  • Trauma
  • Cervical rib

C - Post-ganglionic

  • Cluster headache
  • Cavernous sinus thrombosis
  • Carotid dissection
50
Q

Horner’s syndrome presentation

A

Ptosis
Miosis
Anhidrosis
Enophthalmus

51
Q

Horner’s syndrome investigations

A

Apraclonidine - Affected eye does not dilate
CT - Tumour?
CXR - Pancoast tumour?

52
Q

Anterior cord syndrome aetiology

A

Ischaemia of the anterior spinal artery

- Most commonly due to aortic compromise

53
Q

Anterior cord syndrome investigations

54
Q

Anterior cord syndrome presentation

A

Paralysis
Loss of pain and temperature sensation

Fine touch preserved - Dorsal column

Areflexia

Autonomic failure

  • Urinary/bowel
  • Sexual dysfunction
55
Q

Acoustic neuroma presentation

A

Progressive…

CN8

  • Vertigo
  • Unilateral sensorineural hearing loss
  • Unilateral tinnitus

CN5 - Absent corneal reflex

CN7 - Facial palsy

Bilateral in neurofibromatosis 2

56
Q

Acoustic neuroma investigations

A

ENT referral

MRI - Cerebellopontine angle

57
Q

Acoustic neuroma management

A

Surgery

Radiotherapy

58
Q

Peripheral neuropathy aetiology

A

Motor

  • GBS
  • Infection

Sensory

  • Diabetes
  • B12 deficiency
  • Uraemia

Alcohol
SLE
Thyroid
Chemo/radiotherapy

59
Q

Peripheral neuropathy investigations

A

Bloods

  • FBC
  • E/E
  • LFT
  • Toxicology
  • Cultures - Infection?
  • Anti-Ro and anti-La - SLE
  • Nerve conduction studies - GBS?
60
Q

Neurofibromatosis causes

A
  1. AD - Chromosome 17

2. AD - Chromosome 20

61
Q

Neurofibromatosis 1 presentation

A

SKIN LESIONS

Cafe au lait spots 
Axillary freckles 
Optic lesions 
Scoliosis 
Pheochromocytoma
62
Q

Neurofibromatosis 2 presentation

A

TUMOURS

Bilateral acoustic neuromas
Ependymomas
Schwannomas
Meningioma

3A (31 decks)

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