Neurology Peer Teaching Flashcards
1
Q
Name 3 primary headaches
A
Migraine
Cluster headache
Tension headache
2
Q
Name some secondary headaches
A
Meningitis SAH GCA Medication over use IIH
3
Q
Name headaches which arent primary or secondary headaches
A
Trigeminal neuralgia
Painful neuropathies
4
Q
What is classic migraine
A
Migraine with aura
5
Q
What is common migraine
A
Migraine without aura
6
Q
Name triggers for migraine
A
Cheese OCP Caffeine Alcohol Anxiety Travel Ecercise
7
Q
Give some examples of migraine auras
A
Reversible visual symptoms (unilateral blindness, flashes, fortification)
Reversible dysphagic sppech disturbances, numbness, tingling
8
Q
Features of migraine
A
4-72hrs Unilateral, pulsing Moderate to severe Acitivity = worse N and V Photo/phonophobia
9
Q
First line management of an acute migraine attack
A
Aspirin +- metoclopramide
10
Q
Second line management of an acute attack
A
Sumatriptan
11
Q
Prophylaxis of migraine
A
Propanolol
12
Q
Features of cluster headaches
A
Severe, short lived 15mins- 180mins Unilateral eye pain Ipsilateral autonomic features Headaches in clusters Restless during attack
13
Q
Do migraine patients move around
A
No
14
Q
Do cluster headache patients move around
A
Yes
15
Q
Treatment of an acute cluster headache attack
A
SC sumatriptan
100% Oxygen
16
Q
Cluster headache prophylaxis
A
Verapamil
17
Q
Features of tension headache
A
30 minutes- a week
Bilateral pressing
Not associated with activity or nauseau
18
Q
Treatment for tension headache
A
Reassurance that self limiting. Stress is cause. <15 a month, then paracetamol but be wary of MOH
19
Q
Who more commonly gets cluster headaches
A
Men
20
Q
Who gets giant cell arteritis
A
Over 50s
Associated with polymyalgia rheumatica
21
Q
Symptoms of GCA
A
Headaches Scalp tenderness Jaw claudication Unilateral vision loss Temporal artery tenderness
22
Q
Investigations for GCA
A
ESR (often v high) Temporal artery biopsy
23
Q
Treatment of GCA
A
PO Prednisolone
24
Q
What can cause a headache of raised intracranial pressure
A
Space occupying lesion, intracranial tumour or idiopathic intracranial hypertension
25
Features of a headache of raised intracranial pressue
Generalised ache
Aggravated by bending, coughing or straining.
Worse in morning or after prolonged recumbency
26
Accompanying symptoms fo headache of raised intracranial pressure
Vomiting
Visual obscurations
Progressive focal neurological signs
Papilloedema, enlarged blind spots, reduced visual acuity
27
What investigation do you do for suspected headache of raised ICP
Urgent imaging with CT or MRI
28
Describe idiopathic intracranial hypertension
Fat young women, papilloedema is marked so they might get optic atrophy.
29
3 cardinal presenting symptoms of brain tumours
Symptoms of raised ICP
Progressive neurological defecity
Focal or generalised epilepsy
30
Which cancers met to brain
Lung
Breast
RCC
GI
31
What cells do most brain tumours come from
Glial cells
32
Which tumour makes up 90% of gliomas
Astrocytoma
33
Name two gliomas
Astrocytoma
| Oligodendroblioma
34
What can be used to treat cerebral oedema
IV dexamethasone
35
What can be used to treat raised ICP
IV mannitol
36
What treats glioblastoma multiforme
Temozolamide
37
How do you treat brain tumours
```
IV dexamethasone (for cerebral oedema)
IV mannitol (for ICP)
Anticonvulsants (epilepsy)
Surgical excision
Adjuvant chemo-radiotherapy
```
38
Features of trigeminal neuralgia
Stabbing sharp pain in CN V distribution
Unilateral
Second to 2mins
39
Triggers of trigeminal neuralgia
Washing face
Shaving
Eating
Talking
40
What is the neurological examination like in trigeminal neuralgia
Normal
41
First line treatment of trigeminal neuralgia
Carbamazepine
42
What is a subarachnoid haemorrhage
Spontaneous bleeding into the subarachnoid space
43
What are causes of SAH
Rupture of berry aneurysms
| Congenital AVMs
44
Describe features of SAH
Sudden onset occipital headache
N and V
reduced consciousness
Meningeal irritation signs
45
Name 3 signs of meningeal irritation
Neck stiffness
Kernigs sign positive
Photophobia
46
What is kernigs sign positive
Hip flexed to 90 degrees, then patient cant straighten leg
47
Investigations for SAF
CT head
LP if CT normal
MR angiography
48
What does LP show in SAH
Xanthochromia (only after 12 hours)
49
Management of SAH
Bed rest, analgesia, supportive measures.
| Nimodipine
50
What is nimodipine
CCB
51
Why is a CCB given to SAH patients
Prevents cerebral artery spasm
52
What is a subdural haematoma
Accumulation of blood in the subdural space following rupture of veins running from hemisphere to sagittal sinus
53
Who gets subdurals
Head injury
Elderly
Alcoholic
54
Symptoms of subdural haematoma
```
Headahc
Confusion
Fluctuating LOC
Personality change
Latent period
```
55
Gold standard investigation of subdural haematoma and the finding
CT Head
| Crescent shaped lesion
56
Management of subdural
Surgical removal of the haematoma
57
What is an extradural haematoma
Collection of blood between the dura mater and the skull
58
What causes an extradural
Rupture of the miffle meningeal artery following head injury, usually ssociated with temproal bone skull dracture
59
Extradural presentation
Brief LOC, lucid interval of recovery. If severe headache, decreased consciousness and signs of raised ICP
60
What is the gold standard investigation for extradural and the finding
CT scan
| Biconvex haematoma
61
Treatment of extradural haematoma
Evacuation of the clot through burr holes or open craniotomy
62
What is multiple sclerosis
Inflammatory demyelinating autoimmune disease of the CNS. Characterised by multiple plaques of demyelination in the brain and spine
63
What must plaques be for them to be MS
Disseminated both in time and place
64
Who gets MS
Young adult, women more than men
65
Which sites are most commonly affected by MS
Periventricular region of the hemispheres
Brainstem, cerebellum
Cervical cord
Optic nerves
66
Name the 4 types of MS
Benign
Relapsing remitting
Secondary progressive
Primary progressive
67
Which is the most common type of MS
Relapsing remitting
68
Define relapsing remitting MS
Clearly defined relapses with full recovery or with some residual deficit upon recovery. There is no disease progression between relapses.
69
Define secondary progressive MS
When the disease starts with a relapsing-remitting picture, but eventually recovery from each successive relapse becomes less complete
70
Eye signs in MS
Optic neuritis => optic atrophy
- unilateral visual loss
- painful eye movement
- reduced colour vision
71
Spinal cord lesion sensory symptoms (MS)
```
Numbness
Tingling
Burning
Band like sensation
Lhermittes
Altered temperature sensation
```
72
What is Lhermittes symptom
Electric shock like sensation down the limbs on flexion of the neck
73
When is Lhermittes present
MS
| Vit B12 deficiency
74
Spinal cord lesion motor symptoms (MS)
Weakness
Clumsiness
Tonic spasms
75
Spinal cord lesion sphincter symptoms (MS)
Urinary
Constipation
Faecal incontinence
Erectile dysfunction
76
Cerebellum lesion symptoms (MS)
```
DANISH
Dysdiodochokineasia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
```
77
Best investigation for MS
MRI and gadolinium contrast
78
What does CSF electrophoresis show in MS
Oligoclonal bands of IgG
79
What do you need for diagnosis of MS
Lesions should be disseminated in time (2 attacks) and space (MRI)
80
Acute treatment of MS attack
IV methylprednisolone
81
Chronic treatment of MS
Beta interferon (immune modulation)
mab (natalizumab)
Immunosuppression (azathioprine)
82
Describe pathophysiology of myasthenia gravis
Autoimmune destruction of Ach receptors at NMJ. Depletes working post synaptic receptor sites.
83
What is Myasthenia gravis associated with
Thymoma, RA, SLE, T1DM, Addisons, hyperthyroid (AI)
84
Clinical features of MG
```
Ptosis, eyelid droop after looking up
Diplopia
Myasthenic snarl
Dysarthria
Voice fades
Tendon reflexes normal but faitgue
Sensory exam normal
```
85
Does Myasthenia affect motor or sensory
Only motor
86
Investigations for myasthenia gravis
Antibodies
CT thorax
Ice test
Tensilon test
87
What antibodies do you look for in myasthenia
Anti-AChR
| MuSK
88
What are you looking at on CT thorax for myasthenia
Thymus (thymoma common)
89
What is the tensilon test for myasthenia
Very short acting anti acetylcholinesterase will show improvement in muscle strength
90
Immediate treatment of myasthenia gravis
Pyridostigmine
Prednisolone
Thymectomy
91
What type of drug is pyridostigmine
Acetylcholinesterase inhibitor
92
What is a potential long term consequence of myasthenia
Myasthenic crisis with weakness of respiratory muscles
93
Name 4 treatable causes of delerium
Vitamin B12 deficiency
Folat deficiency
Neurosyphilis
HIV related
94
Describe the onset of alzheimers dementia
Gradual, progressive
95
Vascular dementia onset
Abrupt or gradual
96
Lewy body dementia onset
Insideous, progressive with fluctuations
97
Frontotemporal dementia onset
Insidious onset, 50s and 60s, rapid progression
98
Alzhiemers dementia pathology/ imaging
Generalised atrophy
Beta amyloid plaques
Neurofibrillary tangles
99
Vascular dementia pathology/ imaging
Strokes
Lacunar infarcts
White matter lesions
Vulnerable to cerebrovascular events
100
Pathology/ imaging of lewy body dementia
Generalised atrophy
| lewy bodies in cortex and midbrain
101
Pathology/ imaging of frontotemporal dementia
Frontal and temporal atrophy
| Pick cells and pick bodies in cortex
102
Alzhimers disease signs and symptoms
```
Memory loss
Language defecit
Rapid forgetting
Impaired visuospatial
Normal gate and neuro exam
Late affective disturbances and behaviour
```
103
Vascular dementia signs and symptoms
Focal neurological signs
| Signs of vascular disease
104
Lewy body dementia signs and symptoms
```
Fluctuating cognition
Visual hallucinations
Neuroleptic sensitivity
Shuffling gait
Increased tone
Tremors
Falls
```
105
Frontotemproal dementia signs and symptoms
```
Disinhibition
Socially inappropriate behaviour
Poor judgement
Apathy
Decreased motivation
Poor executive function
```
106
Dementia vs delerium onset
Delerium acute, dementia insidiouds
107
Dementia vs delerium consciousness
Delirium altered, dementia normal
108
Dementia vs delirium course
Dementia progressive deterioration, delirium flucuating
109
Dementia vs delirium sleep wake cycle
Dementia normal, delirium altered
110
Dementia vs delirium speech
Delirium incoherent rapid or slow speech. Dementia difficulty finding words
111
Dementia vs delirium perceptual disturbance
Delirium common, dementia late stage
