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3 FoCP > Neurology Week 4 > Flashcards

Neurology Week 4 Flashcards

1
Q

4 core presentations of neurology

A

headaches
confusion/disorientation
weakness
loss of consciousness

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2
Q

10 cardinal neurological symptoms

A 
memory and cognition
tLOC
headache
vision
hearing
speech and swallowing
limb weakness
limb numbness
bladder/bowel disturbance
gait and balance
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3
Q

differences between UMN and LMN lesions (AFTR)

A

UMN VS LMN

atrophy: minimal VS yes
fasciculations: no vs yes
Tone: spastic vs reduced
reflexes: brisk vs diminished

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4
Q

what kind of rigidity does parkinson’s disease have?

A

cogwheeling rigidity AKA lead pipe

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5
Q

what level does the spinal cord end?

A

L1, thereafter is cauda equina

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6
Q

what is the highest level a lesion can be in if there are no upper limb symptoms?

A

T2

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7
Q

definition of syncope

A

transient loss of consciousness due to hypo-perfusion of the brain

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8
Q

what are some cardiac causes of syncope

A

heart block, VT, VF, outflow obstructions

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9
Q

what are some neurogenic causes of syncope?

A

vasovagal, cough syncope, carotid sinus sensitivity

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10
Q

definition of seizure

A

clinical manifestation of abnormal cortical synchronised neuronal discharge

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11
Q

things to ask about when clarifying syncope VS syncope

A 
situation
trigger
warning symptoms
witness account
aftermath
predisposing factors
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12
Q

common situation for seizures to happen?

A

random

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13
Q

what commonly triggers a cardiac syncope?

A

exercise

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14
Q

common aftermatch of seizures

A

muscle aches
lateral tongue bitting
injury

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15
Q

common witness account of syncopes

A

pallor

intermittent jerking

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16
Q

common witness account of sizures

A

cry, stiffened limbs, convulsions, central cyanosis, noisy breathing

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17
Q

questions to ask for ear issues

A 
hearing loss?
otalgia
discharge
noises (tinnitus)
dizziness (vertigo)
phx
fmhx
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18
Q

hearing loss clarifications

A

duration, uni or bilateral, sudden or gradual, constant or variable, trauma? other hx

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19
Q

hx of dizziness

A

precipitating factors? standing/lying/sitting
worse with movement?
vision?
how long, is it constant or episodic

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20
Q

what is the reflex that stabilises our vision when he move our heads

A

vestibulo-ocular reflex

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21
Q

what is vertigo often described as

A

hallucination of movement

room spinning sensation

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22
Q

what does rinnes test +ve and -ve suggest?

A

+ve means air conduction better. can suggest normal hearing, or sensorineural hearing loss

-ve suggest conductive hearing loss

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23
Q

how is webbers test result interpreted

A

equal if normal or bilateral sensorineural loss

lateralises to damaged side in conductive loss

lateralises to normal side in sensorineural loss

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24
Q

what nerve roots do each of the following areas represent

deltoids
thumb
middle finger
nipple
umbilicus
symphysis pubis
medial leg
between 1st and 2nd toe
lateral foot
A 
C5 - deltoids
C6 - thumb
C7 - middle finger
T5 - nipple
T10 - umbilicus
T12 - symphysis pubis
L4 - medial leg
L5 - between 1st and 2nd toe
S1 - lateral foot
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25
what blood supply supplies the dorsal columns
posterior spinal artery
26
what does the MRC power scale 0 - 5 mean
``` 0 means no movement at all 1 means slight twitching 2 can lift up without gravity effect 3 can lift up against gravity 4 can lift up and push back slightly 5 can lift up and push back on examiner (normal) ```
27
what is delirium defined as
acute state of confusion
28
what neurotransmitter plays a key role in delirium
acetylcholine
29
what are the clinical features of delirium
``` impaired consciousness impaired cognitive function perceptual d/o (hallucinations) paranoid delusions psychomotor abnormalities sleep/mood disturbances ```
30
what are some precipitating factors of delirium
``` infection injury malnutrition dehydration iatrogenic immobility forced restraint ```
31
what are some risk factors of delirium
``` underlying brain diseases old age visiual/hearing impairment polypharmacy renal impairment sleep deprivation ```
32
what are some iatrogenic causes of delirium
GA, surgery, drugs, urinary catheter
33
what kind of drugs can cause delirium
opioids, steroids, sedatives.
34
what bloods are important to take in delirium, and why?
``` FBC - infection/anaemia CRP - infection U+E - electrolyte imbalance (Ca, K, Na) TFTs bone profile B12/folate coagulation ```
35
how to treat delirium?
find underlying cause and fix it maintain hydration restore patients eyesight if impaired
36
how to tranquilize dangerous delirious patient?
500mcg haloperidol PO or 1mg IM lorazepam otherwise
37
most common dementia cause
alzheimer's disease
38
key feature of AD?
gradual decline, memory decline
39
key feature of vascular dementia?
step wise deterioration
40
key feature of frontotemporal dementia?
personality and behaviour change.
41
what medication to avoid for lewy body dementia
antipsychotics
42
key feature in lewy body dementia?
visual hallucinations come before Parkinson symptoms fluctuation in cognition, alertness and attention PD features as well
43
difference between speech and language
speech is how you say things language is what you say
44
what is receptive aphasia?
it is when understanding is affected, person hears language but cannot comprehend.
45
describe the 4 types of expressive aphasia
word finding difficulty - know words in head but cannot get it out semantic error - mixing up word meanings, using words wrongly phonemic error - mixing up sounds in the words jargon - gobelrdy gurr, not making any sense with what they say, just sounds
46
define dysarthria
disturbance in speech that results from muscle weakness, paralysis or poor coordination
47
describe flaccid dysarthria and what is it also known as. is it UMN or LMN?
AKA bulbar palsy - LMN cause imprecise articulation, hypernasality, reduced breath control, nasal emission audible
48
describe spastic dysarthria and what is it also known as. is it UMN or LMN?
UMN, AKA pseudobulbar palsy slow/laboured speech low monotonous pitch slow and slurred
49
what kind of dysarthria do huntington's patients have
hyperkinetic dysarthria
50
what patients get hypokinetic dysarthria?
parkinsons
51
describe ataxic dysarthria? cause?
cerebellar system irregular pitch and loudness altered prosody disjointed ups and downs
52
describe apraxia
motor control difficulty, effortful and groping for words agrammatical
53
describe dysphonia
disorder of voice or phonation, roughness, hoarseness, strain
54
3 D's of elderly patient care
delirium, dementia, depression
55
what is assessed in an MMSE?
a bee stung molly then peter caught it ``` appearance behaviour speech mood thought flow/content perceptions cognition insight ```
56
difference between mood and affect?
mood is what the patient thinks and feels in their words affect is what the assessor sees
57
what is required for TACS diagnosis
unilateral weakness of face, arm and leg (or sensory deficit) homonymous hemianopia high cerebral dysfunction (dysphasia, visuospatial disorder e.g. inattention)
58
what is required for PACS diagnosis
2 of the following unilateral weakness of face, arm and leg (or sensory deficit) homonymous hemianopia high cerebral dysfunction (dysphasia, visuospatial disorder e.g. inattention)
59
what is required for POCS diagnosis
one of cerebellar brainstem syndromes loss of consciousness isolated homonymous hemianopia
60
what is required for LACS diagnosis
one of unilateral weakness (or sensory deficit) of face and arm, arm and leg or all three pure sensory stroke ataxic hemiparesis
61
what are the red flags in back pain?
sphincter or gait disturbance saddle anaesthesia progressive motor loss ``` non-mechanical pain fever or weight loss age <20 or >55 thoracic pain previous Ca Hx HIV ```
62
what is the most common acute neuropathy
Guillain Barre syndrome
63
what viruses can trigger GBS
campylobacter jejuni | EBV, CMV
64
what are the clinical features of GBS
progressive bilateral limb weakness and numbness (paraesthesia) absent reflexes can progress to respiratory failure
65
what is myaesthenia gravis caused by
autoimmune destruction of acetylcholine receptors
66
what are the clinical features of myaesthenia gravis
fatiguiability of muscle on sustained or repeated activity that improves after rest ptosis that improves after sleep or with an ice pack weakness progresses from eyes and down leading to difficulty talking, chewing, swallowing and breathing.
67
what is ramsay-hunt syndrome
reactivation of herpes zoster virus in the geniculate ganglion, affecting the 7th CN
68
what are the clinical features of ramsay-hunt syndrome
LMN palsy, herpetic vesicles in external auditory meatus. loss of taste in the front of tongue, and possibly hearing loss and tinnitus.
69
what are some options to intervene when there is airway obstruction
``` head tilt chin lift recovery position nasopharyngeal tube oropharyngeal tube intubation ```
70
what is to be assessed when evaluating breathing?
RR, sats, auscultation
71
what else can be assessed for quick neurological status
pupillary reflex
72
what blood should be quickly assessed in unconscious patient
glucose
73
how to assess GCS and the different values
Eye 1. nothing 2. responds to pain 3. responds to voice 4. spontaneous Verbal 1. nothing 2. groans 3. inappropriate speech 4. confused 5. normal Movement 1. nothing 2. extensor reflex to pain 3. flexion reflex to pain 4. withdraws from pain 5. localises to pain 6. can follow instructions
74
what is the classical triad of meningitis
fever, headache, neck stiffness
75
other symptoms of meningitis
N&V photophobia seizures rash (non-blanching)
76
what is kernigs sign
neck pain on flexion of knee
77
what is brudzinski's sign
involuntary hip flexion when neck is flexed
78
how to investigate for meningitis
bloods | LP
79
what do the different LP values indicate protein glucose WBC/lymphocytes color
viral - normal protein, normal glucose (compared to blood), elevated lymphocytes, low neutrophls bacterial - high protein, low glucose, high neutrophils and lymphocytes fungal/TB - low glucose, high proteins, high lymphocytes and neutrophils
80
contraindications of an LP
``` raised ICP trauma immunocompromised coagulopathy status injury at needle site ```
81
complications of menigitis
``` death seizures brain damage blindness and deafness peripheral gangrene ```
82
additional tasks in meningitis case
reporting to authorities, contact tracing
83
common causes of subarachnoid haemorrhage
70% by berry aneurysms | 10% congenital
84
most common site of a berry aneurysm
anterior communicating artery
85
clinical presentation of SAH
worst ever headache with no prior hx, came on suddenly and reaches max intensity within a minute. photophobia, vomiting, 3rd nerve palsy
86
SOCRATES of SAH
``` S - diffuse O - rapid onset, less than 1 min C - constant/throbbing R - sometimes to the neck A - photophobia, nausea, neck stiffness Think meningitis also T - lasts for more than an hour E - nil S - 10/10 ```
87
complications of an SAH
raised ICP, stroke, hydrocephalus
88
investigations for suspected SAH
CT, LP
89
how to circumvent a traumatic LP?
look for bilirubin as signs of hx of RBC in CSF
90
clinical features of temporal arteritis
few week hx of constant moderate headache on temples. weight loss, malaise jaw claudication scalp tenderness, blurred vision, diplopia, ocular muscle symptoms
91
how to investigate temporal arteritis?
look for inflammatory markers in blood - CRP, ESR temporal artery biopsy
92
clinical features of migraine
episodic severe unilateral throbbing headache. can be associated with visual auras or scotomas. somes vomitting and photo and phonophobia.
93
what is a TIA?
acute loss of focal cerebral function OR acute monocular visual loss, <24hrs, symptoms worst at onset and get better
94
what symptoms are common with middle cerebral artery strokes?
``` UMN facial weakness hemiplegia hemianopia aphasia visiospatial problems (non-dominant hemisphere) ```
95
what symptoms are common in vertebral and basilar artery strokes
``` diplopia nystagmus dysarthria dysphagia bulbar weakness ipsilateral LMN facial weakness respiratory failure/coma contralateral hemiparesis, quadriparesis ```
96
what is the definition of shock?
in adequate organ perfusion due to hypotension or acute circulatory failure resulting in generalised cellular hypoxia
97
how do patients in shock present?
pale, clammy tachypneac talking in short sentences rash in septic shock
98
what symptoms does brain failure cause in shock?
decreased GCS confusion dizziness
99
what symptoms does respi failure cause in shock?
tachypnea agonal breathing cyanosis respi arrest
100
what symptoms does cardiovascular failure cause in shock?
clammy skin cold edema tachy/bradycardia
101
4 types of shock?
hypovolaemic (low blood volume) cardiogenic (heart failure) distributive (vasodilation) obstructive (low SV)
102
example causes of hypovolaemic shock?
massive bleeding | diarrhea
103
example causes of cardiogenic shock?
MI | dysrhythmia
104
example causes of distributive shock?
sepsis | anaphylaxis
105
what kind of shock would a PE cause?
obstructive shock
106
what blood traces would indicate cardiogenic shock?
increased troponin
107
what ECG signs would indicate cardiogenic shock?
inverted T wave
108
5 common types of movement disorders
``` tremors chorea tics myoclonus dystonia ```
109
describe the 5 main types of movement disorders
tremors are rhythmical repeated movements usually in the hands. can be resting or action tremor
110
describe the 3 types of action tremors
``` postural tremor (hands stuck out) intention tremor (amplitude increases over course of action kinetic tremor ```
111
how to differentiate a true intention tremor?
tremors come on during action and amplitude increases over course of action
112
how to describe a tremor?
distribution resting/postural frequency amplitude
113
describe a parkinsonian tremor
asymmetrical onset predominantly resting tremor often coarse pill rolling tremor chin rolling tremor common
114
what is an essential tremor
mainly postural tremor, bilateral onset in upper limbs | often tremor of head
115
what are the 3 main symptoms of parkinsonism
resting tremor rigidity bradykinesia
116
what kind of drugs can cause parkinsonism
antipsychotics sodium valproate metoclopramide dopamine blocking drugs
117
describe chorea
slow moving smooth involuntary body movement often flowing from one body part to another
118
describe hemibalism
abrubt amplitude involuntary movement of limbs often described as "ballistic"
119
describe dystonia
repetitive movements with sustained contractions often bilateral and associated with a stiff neck abnormal postures
120
difference between generalised and focal dystonia
generalised dystonia usually childhood onset, start in lower limb and progresses to whole body - genetic cause focal dystonia usually middle age onset can affect different body parts commonly cervical, blephorospasms(eyelid), jaw opening, spasmodic dystonia and task specific dystonia
121
describe tics
involuntary sudden rapid repetitive non rhythmic stereotyped movements or vocalisation can be suppressed at great psychological tension usually in children but goes away becomes tourettes sd if persists
122
describe myoclonus
burst shock like muscular contractions
123
What does VIVID stand for in headache presentation differentials
``` Vascular Infective Visual threatening Intracranial pressure (space occupying lesion) Dissection ```
124
What would a headache worse when lying down, together with early morning nausea indicate?
Raised intracranial pressure
125
What can cause a space occupying lesion
Bleed/clot, tumor, cyst, abscess,
126
What is the nature of headaches of someone with a growing tumor or abscess
Progressive constant headache
127
What sign will a carotid artery dissection give?
Horners syndrome and neck pain
128
What eye sign will indicate a cavernous sinus thrombosis in someone with a headache
Exopthalmos
129
What type of head ache is severe unilateral and focused over 1 eye?
Cluster headache

3 FoCP (11 decks)

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