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Phase 3a conditions list flashcards > Neurology - part 2 > Flashcards

Neurology - part 2 Flashcards

1
Q

What is meningitis?

A

Infection of the meninges

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2
Q

What is the difference between viral vs bacterial meningitis in terms of severity and frequency?

A
  • Viral = more common, less severe
  • Bacterial = less common, more severe
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3
Q

What are some risk factors for meningitis (4)?

A
  • Immunocompromised
  • Neonate
  • Non-vaccinated
  • University student
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4
Q

What are the most common viral causes of meningitis? (4)

A
  • HSV (-2)
  • VZV
  • Enteroviruses (e.g. coxackie)
  • Measles/ mumps
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5
Q

What are the most common bacterial causes of meningitis in 0-3 months (3)?

A
  • GBS = mc
  • Listeria monocytongenes
  • E. coli
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6
Q

What are the most common causes of meningitis in 3 month - 6 year olds (3)?

A
  • N. meningitidis
  • S. pneumoniae
  • H. influenziae (less common due to vaccinations)
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7
Q

What are the two most common causes of meningitis in 6 years - 60 years?

A
  • N. meningitidis
  • S. pneumoniae
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8
Q

What are the three most common causes in over 60s?

A
  • N. meningitidis
  • S. pneumoniae
  • Listeria monocytogenes
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9
Q

What types of meningitis are immunocompromised at risk of (2)?

A
  • Listeria monocytogenes
  • Cyptococcus (fungal)
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10
Q

What type of bacteria are S. pneumoniae and GBS?

A

+ve coccus in chains

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11
Q

What type of bacteria is N. meningitidis?

A

-ve diplococcus

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12
Q

What type of bacteria is HIB?

A

-ve coccobacillus

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13
Q

What type of bacteria is listeria?

A

+ve bacillus

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14
Q

What are the signs/ symptoms of meningitis (7)?

A
  • Meningism - headache, photophobia, neck stiffness
  • N+V
  • Fever
  • Drowsiness
  • Kernig
  • Brudzinski
  • Non-blanching purpuric rash
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15
Q

What is Kernig sign?

A

Flexing hip, then extending knee = PAIN

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16
Q

What is Brudzinski sign?

A

Flexing neck –> involuntary flexion of hips

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17
Q

How is meningitis investigated (2)?

A
  • Bloods + cultures
  • Lumbar puncture
    CT not usually indicated unless signs of raised ICP
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18
Q

What would contraindicate/ delay a LP (3)?

A
  • Sepsis/ meningococcal rash
  • Severe illness
  • Raised ICP
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19
Q

What are some signs of raised ICP (4)?

A
  • Pappiloedema
  • Seizures
  • Focal neurological signs
  • GCS < 12
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20
Q

What are the results of LP for bacteria vs viral vs fungal/TB in terms of appearance?

A
  • Bacterial = cloudy
  • Viral = clear
  • Fungal/ TB = cloudy
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21
Q

What are the results of LP for bacteria vs viral vs fungal/TB in terms of glucose?

A
  • Bacterial = low
  • Viral = normal
  • Fungal/ TB = low
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22
Q

What are the results of LP for bacteria vs viral vs fungal/TB in terms of protein?

A
  • Bacterial = high
  • Viral = normal
  • Fungal/TB = high
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23
Q

What are the results of LP for bacteria vs viral vs fungal/TB in terms of WCC?

A
  • Bacteria = neutrophils
  • Viral = lymphocytes
  • Fungal/TB = lymphocytes
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24
Q

What are the results of LP for bacteria vs viral vs fungal/TB in terms of opening pressure?

A
  • Bacterial = raised
  • Viral = normal
  • Fungal/TB = normal or raised
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25
Q

How is meningitis treated?

A
  • Under 3 months = IV cefotaxime + amoxicillin (for listeria)
  • Over 3 months = ceftriaxone (or cefotaxime) + dexamethasone (+ amoxicillin if over 50)
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26
Q

When should dexamethasone not be given for meningitis (2)?

A
  • NBP rash/ septic shock
  • Under 3 months
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27
Q

What should be given if meningitis is suspected in GP?

A

IM ben pen

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28
Q

What should be given to close contacts of those with meningitis?

A
  1. Ciprofloxacin + vaccine
  2. Rifampicin
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29
Q

Why is cefotaxime given in place of ceftriaxone in neonates?

A

Ceftriaxone can displace bilirubin causing kernicterus

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30
Q

What are some complications of meningitis (4)?

A
  • Sensorineural hearing loss = mc
  • Seizures
  • Focal neurological deficits
  • Waterhouse-friderichsen syndrome
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31
Q

What is Waterhouse-friderichsen syndrome?

A

Adrenal haemorrhage (due to meningococcal septicaemia) –> adrenal insufficiency –> shock

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32
Q

What is encephalitis?

A

Parenchymal

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33
Q

What is the cause of encephalitis (7)?

A
  • HSV-1 - (95%)
  • TB
  • Lymes
  • Meningitis
  • CMV
  • VZV
  • Toxoplasmosis
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34
Q

What is another non-infective cause of encephalitis?

A

Autoimmune encephalitis

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35
Q

What antibodies are usually present in the CSF and blood of those with autoimmune encephalitis?

A

Anti NMDA-R antibodies

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36
Q

What are the signs/ symptoms of encephalitis (5)?

A
  • Seizures
  • Focal neurological deficit
  • Reduced GCS + confusion
  • Fever
  • Headache
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37
Q

How is encephalitis investigated (3)?

A
  • LP
  • CT/ MRI
  • EEG
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38
Q

How should CSF be analysed in those with suspected encephalitis?

A

PCR - for HSV, VZV, etc

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39
Q

What might an EEG show in those with encephalitis?

A

Periodic 2 Hz firing

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40
Q

How is encephalitis treated?

A

IV Aciclovir

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41
Q

What is a brain abscess?

A

Intracranial collection of pus

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42
Q

What are some risk factors for brain abscesses (4)?

A
  • Immunocompromised (HIV, T2DM)
  • Congenital heart disease + endocarditis
  • Neurosurgery
  • Local infection (e.g. ear, mastoiditis)
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43
Q

When are brain abscesses most common in life?

A

30-40 years old

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44
Q

What organisms most commonly cause brain abscesses (4)?

A
  • Strep intermedius
  • Staph aureus
  • Strep pneumoniae
  • TB (in immunocompromised)
    also fungal, parasitic infections (toxoplasmosis)
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45
Q

What are the signs/ symptoms of a brain abscess (3)?

A
  • Fever
  • Headache
  • Focal neurological sign
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46
Q

How would a spinal abscess present (3)?

A
  • Lower back pain
  • Fever
  • Neurological signs (below lesion)
    most have T2DM
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47
Q

How is a brain abscess diagnosed?

A

CT with contrast

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48
Q

What feature would a brain abscess CT show?

A

Ring enhancing lesion

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49
Q

How is brain abscess managed (2)?

A
  • Surgical debridement
  • IV Abx
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50
Q

What antibiotics are used for a brain abscess (3)?

A
  • Ceftriaxone (broad spectrum -ve/ some +ve)
  • Metronidazole (anaerobes)
  • Vancomycin (if from trauma/ neurosurgery)
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51
Q

What constitutes brain death (3)?

A
  • GCS 3 (comatose)
  • Brainstem signs
  • Apnoea > 5 min
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52
Q

What are 2 postures that may be held in patients who are comatosed?

A
  • Decorticate
  • Decerebrate
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53
Q

What is the decorticate position?

A

Fore-arms flexed to chest - lesion in the cortex
good prognosis

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54
Q

What is the decerebrate position?

A

Forearm extended, internally rotated and wrist flexed - lesion at brain stem
poor prognosis

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55
Q

What does it suggest if a decorticate position turns into a decerebrate position?

A

Tonsillar herniation/ coning

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56
Q

What is Gillian barre syndrome?

A

Immune mediated demyelination of the nerves in the PNS (Schwann cells)

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57
Q

What usually precedes guillian barre syndrome?

A

Gastroenteritis
or URTI

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58
Q

What organism commonly causes guillian barre?

A

Campylobacter jejuni

59
Q

What is the pathophysiology of guillian barre?

A

Antibodies produced against campylobacter attack the Schwann cells/ axons in the PNS

60
Q

What is it known as when antibodies produced against a pathogen attack the body?

A

Molecular mimicry

61
Q

What are the signs/ symptoms of guillian barre (5)?

A
  • Ascending symmetrical weakness
  • Reduced reflexes
  • Sensory loss
  • Neuropathic pain (back/leg)
  • Reduced FVC
62
Q

How is guillian barre investigated (3)?

A
  • Nerve conduction studies
  • Lumbar puncture
  • Serology
63
Q

What would nerve conduction studies show in guillian barre?

A

Reduced nerve conduction speed

64
Q

What would LP show in guillian barre (2)?

A
  • Raised protein
  • Normal WCC
65
Q

What is sometimes positive on serology of those with guillian barre?

A

Anti GM1

66
Q

How is guillian barre managed (2)?

A
  • IVIg
  • Plasmapheresis
    for 5 days
67
Q

What is important to monitor in those with guillian barre?

A

FVC

68
Q

What is miller fisher syndrome?

A

Variant of guillian barre, but with descending weakness, starting with the eyes instead of ascending weakness

69
Q

What are the most common types of brain tumours?

A

Secondary metastases

70
Q

Where do brain mets often come from?

A
  • Breast
  • Bone
  • Liver
  • Lungs = mc
    2B + 2L
71
Q

What are the common types of brain tumours (6)?

A
  • Astrocytoma = mc
  • Meningiomas
  • Pituitary adenomas
  • Craniopharyngiomas
  • Vestibular schwannoma
  • Pinealoma
72
Q

What are the 3 types of gliomas?

A
  • Astrocytomas = mc
  • Oligodendrogliomas
  • Ependymomas
    arise from glial cell (protect and support neurones)
73
Q

What is the most aggressive astrocytoma?

A

Glioblastoma multiforme (grade 4)

74
Q

What is a craniopharyngioma?

A

Slow growing tumour near the pituitary gland

75
Q

What can a pinealoma cause?

A

Non communicating hydrocephalus

76
Q

What are some signs/ symptoms of a brain tumour (5)?

A
  • Headache
  • Seizures
  • Focal neuro symptoms
  • N+V
  • Raised ICP Sx
77
Q

What are some red flags for brain tumour headaches (4)?

A
  • Morning headache
  • Headache worsened by valsalvar
  • Vomiting with headache
  • Constant headache
78
Q

What are some symptoms of raised ICP (5)?

A
  • Pappilloedema
  • N+V
  • Seizures
  • CN3,6 palsy
  • Visual field defects
79
Q

How are brain tumours investigated?

A

MRI

80
Q

How does a glioblastoma multiforme appear on a MRI?

A

Ring enhancing lesion (with contrast)

81
Q

How are brain tumours treated (3)?

A
  • Dexamethasone
  • Surgery
  • Chemo/ radiotherapy
82
Q

What is a neuropathy?

A

Any condition affecting the nerves outside of the CNS

83
Q

What are the patterns of neuropathy (3)?

A
  • Mononeuropathy (1 nerve affected)
  • Mononeuritis multiplex (multiple single nerves affected)
  • Polyneuropathy (symmetrical nerves affected, ‘glove + stocking’ distribution)
84
Q

What are some causes of mononeuritis multiplex (4)?

A
  • Vasculitis (e.g. polyarteritis nodosa)
  • Rheumatoid arthritis
  • SLE
  • Diabetes
85
Q

What are some causes of polyneuropathy?

A
  • Alcohol
  • B12 deficiency
  • Chemotherapy
  • Diabetes
  • Every vasculitis
  • Guillian barre
86
Q

What is a radiculopathy?

A

The compression of the nerve at the ROOT

87
Q

What is myelopathy?

A

Compression of spinal cord

88
Q

What are some specific mononeuropathies to be aware of (5)?

A
  • Median nerve (carpal tunnel syndrome)
  • Ulnar nerve
  • Radial nerve
  • L5 radiculopathy
  • Common perineal nerve
89
Q

What are the nerve roots of the median nerve?

A

C6-T1

90
Q

What are some causes of carpal tunnel syndrome (4)?

A
  • RA
  • Acromegaly
  • Hypothyroid
  • Repetitive overuse
91
Q

What are the signs/ symptoms of carpal tunnel syndrome (2)?

A
  • Parasthesia
  • Thenar muscle waisting
92
Q

What two specific tests can indicate carpal tunnel syndrome?

A
  • Tinels
  • Phalens
93
Q

What would a nerve conduction study show in someone with carpal tunnel?

A

Decreased velocity/ amplitude

94
Q

How is carpal tunnel treated (2)?

A
  • 1st = splint
  • Gold = surgery
95
Q

What is the nerve distribution of the ulnar nerve?

A

C8-T1

96
Q

What is the presentation of an ulnar nerve lesion?

A

Claw hand
ulnar nerve should flex pinky + ring

97
Q

What fracture would cause an ulnar nerve lesion?

A

Medial epicondyle

98
Q

What is the nerve distribution of the radial nerve?

A

C5-T1

99
Q

What is the presentation of a radial nerve lesion?

A

Wrist drop “Saturday night palsy”
can’t extend wrist

100
Q

What fracture would cause a radial nerve palsy?

A

Midshaft humorous fracture

101
Q

What is the presentation of L5 radiculopathy vs common peroneal nerve lesion (3)?

A
  • L5 radiculopathy = foot drop + weak inversion + present ankle jerk
  • Common peroneal nerve = foot drop + weak eversion + absent ankle jerk
102
Q

What is the anatomy of the optic nerve (7)?

A

Eye –> optic nerve –> optic chiasm (temporal vision desiccates) –> optic tracts –> lateral geniculate nucleus (thalamus) –> optic radiation –> visual cortex

103
Q

What are the key points relating to visual field defects to know for the exam (6)?

A
  • (left) Optic tract lesion = (right) homonymous hemianopia
  • Homonymous quadrantanopias (temporal = superior; parietal = inferior)
  • Congruous defect = optic radiation lesion
  • Incongruess defect = optic tract lesion
  • Pituitary adenoma = bitemporal superior quadrantanopia
  • Craniopharyngioma = bitemporal inferior quadrantanopia
104
Q

What is the presentation of CN 3,4,6 lesions?

A
  • CN3 = down + out + ptosis
  • CN4 = can’t look down
  • CN6 = impaired abduction
105
Q

CN7 lesion presentation?

A

Non forehead sparing facial droop

106
Q

What frequently causes CN7 lesion?

A

Bells palsy

107
Q

How is bells palsy managed (2)?

A
  • 72 hours PO prednisolone
  • Eye care (as difficult to shut eye)
108
Q

What is sometimes the underlying cause of bilateral bells palsy + optic neuritis?

A

Sarcoidosis

109
Q

How is sarcoidosis investigated (2)?

A
  • CXR
  • Raised serum ACE
110
Q

What is a differential for bells palsy?

A

Ramsay hunt syndrome

111
Q

What is the cause of ramsay hunt syndrome?

A

VZV reactivation

112
Q

What is an additional finding in those with Ramsay hunt syndrome?

A

Blisters in ears (otoscopy)

113
Q

How is Ramsay hunt treated (2)?

A
  • Aciclovir
  • Prednisolone
114
Q

What are the symptoms of a CN5 lesion (4)?

A
  • Masseter muscle (weak on palpation)
  • Loss of sensation in face
  • Lack of corneal reflex
  • Jaw jerk
115
Q

CN8 lesion presentation (2)?

A
  • Sensorineural hearing loss
  • Balance + vertigo problems
116
Q

What is the presentation of CN9/10 lesion (3)?

A
  • Uvula deviation (away from lesion)
  • Weak cough
  • Swallow difficulty
117
Q

CN11 lesion presentation (2)?

A
  • Weak head turn
  • Weak shoulder shrug
118
Q

CN12 lesion presentation (1)?

A

Ipsilateral tongue deviation

119
Q

What are some types of complete cord compression (2)?

A
  • Myelopathy
  • Cauda equina
120
Q

Where does myelopathy usually affect?

A

Cervical spine

121
Q

What are the signs/ symptoms of myelopathy?

A
  • UMN signs BELOW lesion
  • LMN signs AT lesion
122
Q

What are the signs/ symptoms of cauda equina (4)?

A
  • Saddle anaesthesia
  • Low back pain
  • Weakness + parenthesis in legs
  • Faecal incontinence (late sign)
123
Q

What are some partial cord compressions and how do they present?

A
  • Anterior cord = motor Sx
  • Posterior cord = DCML Sx
  • Hemisection (brown sequards) = ipsilateral corticospinal + DCML and contralateral spinothalamic
124
Q

What are some causes of cord compression (5)?

A
  • Trauma
  • Malignancy
  • Arthritis
  • Slipped discs
  • Spinal stenosis (degenerative cervical myelopathy)
125
Q

What is hoffmans sign and what is it suggestive of?

A

Tap middle finger and thumb + index flex
suggestive of cervical spine damage

126
Q

How are cord compressions investigated?

A

Urgent MRI whole cord

127
Q

How are cord compression treated (2)?

A
  • IV dexamethasone
  • Surgical decompression
128
Q

What is horners syndrome?

A

Lesion in the ascending sympathetic chain

129
Q

What are the signs/ symptoms of horners syndrome (3)?

A
  • Miosis
  • Ptosis
  • Anhidrosis
130
Q

What are the causes of horners syndrome (5)?

A
  • Pancoast tumours (upper lobe of lung)
  • Trauma
  • Thyroidectomy
  • Congenital (difference in eye colour)
  • Stroke
131
Q

What are 3 types of muscular dystrophy?

A
  • Duchennes
  • Becker
  • Myotonic dystrophy
132
Q

What is the inheritance of duchennes muscular dystrophy?

A

X-linked recessive
deletion in dystrophin gene

133
Q

What is the inheritance of Beckers muscular dystrophy?

A

X-linked recessive
missense mutation

134
Q

What is the inheritance of Myotonic dystrophy (3 features)?

A
  • Autosomal dominant
  • Trinucleotide repeat
  • Anticipation
135
Q

What is the presentation of myotonic dystrophy?

A

Hand shake and can’t let go

136
Q

What are the signs/ symptoms of duchennes muscular dystrophy (3)?

A
  • Progressive proximal muscle weakness
  • Calf pseudo hypertrophy
  • Gowers sign (patients stand by climbing up body with hands)
137
Q

When does duchennes present?

A

Usually around age 5

138
Q

What is the difference between beckners and duchennes muscular dystrophy?

A

Beckners presents later after 10 years, but similar symptoms

139
Q

What is a common complication of duchennes?

A

Dilated cardiomyopathy

140
Q

How is duchennes investigated?

A
  • Bloods = raised creatinine kinase
  • EMG = abnormal
  • Gold standard = genetic testing
    muscle biopsy no longer gold standard
141
Q

How is duchennes treated?

A

Supportive - corticosteroids can prolong muscle functioning

142
Q

What is the prognosis for duchennes (2)?

A
  • Cant walk at 12 years
  • Die at 25-30
143
Q

Freidrich ataxia next?????

A

Phase 3a conditions list flashcards (25 decks)

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