NEUROLOGY REVISION NIGHT QUESTIONS Flashcards
What is circled in blue here?
Blue thing is the corpus callosum
What is the part of the brain directly superior to the corpus callosum?
This is the cingulate gyrus The cingulate sulcus is in red in the picture
What is circled here?
Circled in the picture is the anterior lobe of the cerebellum
What is the region of white matter located deep in the cerebellum known as? This part of the cerebellum is where sensory and motor information is brought to and from and inside this deep white matter are the four cerebellar nuclei
This is the arbor vitae
What is the circled blue structure here known as?
This structure circled is the third ventricle
What is in blue and what lobe?
This is the primary somatosensory area located posterior to the central sulcus in the anterior parietal lobe
What nerve is circled here?
This is the oculomotor nerve - emerges anterior to the midbrain
What is circled?
This is the thalamus - relays motor and sensory info to and from the cerebral cortex
What is this?
This is the internal jugular vein
What is this?
This is the odnotid process of the C2 vertebra (odontoid process aka dens, C2 vertebra aka axis)
22 year old female - What is the diagnosis? * Loss of colour vision * Enlargement of blind spot * Hx. of numbness and paresis of left foot Bonus points: * Definition of paresis * First line treatment * Treatment for spasticity Bonus x 10000 point: Associated with trans _ _ _ _ _ m _ _ _ _ _ _ _
The diagnosis is multiple sclerosis * Loss of colour vision is typical * Paresis means weakness - therefore numbness and weakness of left foot 1st line treatment is interferon beta, capaxone or tecfidera (use steroids in acute attack) To treat the spasticity would give baclofen or gabapentin Associated with transverse myelitis
What is transverse myelitis? What is MS defined as?
Transverse myelitis (TM) is a rare neurological condition in which the spinal cord is inflamed. Transverse implies that the inflammation extends across the entire width of the spinal cord. Multiple sclerosis is an inflammatory demyelinating disorder which presents with lesions seperate in location and time of presentation
34 year old female - WHAT IS THE DIAGNOSIS? * Unilateral headache * Gradual onset over 12 hours Bonus points: First line treatment – acute First line treatment – prophylaxis Important medication to remove if she experiences aura
MIgraine First line treatment - aspirin (2nd line is triptans - 5HT1 agonist) First line prophylaxis - propranolol (can try topiramate or amitriptyline) Do not give patient the oral contraceptive with pill in migraine with aura
18 year old male - WHAT IS THE DIAGNOSIS? * Episodes of lip-smacking and inability to answer questions Says he remembers every episode * Describes déjà vu before each episode * Episodes are always the same and less than 3 minutes Bonus points: * First line treatment * Treatment of status epilepticus * From which lobe are his seizures arising
Patient has partial seizures - as his consciousness / awareness are not impaired, likely to be a simple partial seizure The seizures are arising in the temporal lobe 1st line treatment - carbameapine, or lamotrigine Statsu elepticus 1st line - IV lorazepam, buccal midazolam, rectal diazepam
25 year old male - WHAT IS THE DIAGNOSIS? Tackled playing rugby and the lateral aspect of his head collided with the anterior of another’s. Played on Became dozy and began to slip into unconsciousness Bonus points: * Which artery is responsible * Which bony feature overlies this artery Bonus x 10000 points: * From which artery does the damaged artery branch
This is an extradural haematoma Artery responsible is the middle meningeal artery with the bony feature that is the pterion overlying it - weakest part of the skull The middle meningeal artery arises from the external cartoid artery
Bonus x10000 points: How do you elicit Kernig’s sign?
You flex the patients leg when lying supine, the patients knee is unable to extend once flexed due to stiff hamstrings
65 year old male - WHAT IS THE DIAGNOSIS? * Lifetime of manual work on a farm * Hx. of back pain and left testicular pain * Made worse by sitting down * On examination: tenderness over thoracolumbar vertebrae, paravertebral muscle tension, shooting/burning pain over left scrotal skin Bonus points: Which vertebral level At which level do the roots for this nerve exit Which nerve is this and from which plexus does it arise
Answer is slipped disc most likely - worse on sitting down Likely to be the L1/2 nerve root - genitofemoral nerve
50 year old female - WHAT IS THE DIAGNOSIS * Arteriopath * Acute right-sided leg and foot weakness * Associated loss of sensation in the same region * Apparently she’s not always this rude to others Bonus points: * Acute treatment and investigation * Which artery is implicated * Give the percentage of strokes that are haemorrhagic
The diagnosis is stroke Likely to be the anterior cerebral artery that is implicated CT Scan to rule out haemorrhagic and then thrombolyse within 4.5 hours 15 % of strokes are haemorrhagic
17 year old male - WHAT IS THE DIAGNOSIS * Comes in to the clinic after a “messy one” last night * Fell asleep on the pavement. * His left-handed grip is weak, and sensation over his forearm, the thumb and dorsal aspect of the lateral 3 digits (nail-bed sparing) is lost. Left wrist is floppy. Bonus points: Mechanism of injury – do you know the name of this palsy Nerve roots of implicated nerve Why is his wrist floppy and what is this called Which reflexes will be reduced
This patient has a radial nerve palsy (C6-T1) Also known as a saturday night palsy His wrist is floppy due to the radial nerve supplying the extensors of the arm and forearm meaning wrist isnt extending normally
