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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
Q

what blood supply supplies the dorsal columns

A

posterior spinal artery

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26
Q

what does the MRC power scale 0 - 5 mean

A 
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)
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27
Q

what is delirium defined as

A

acute state of confusion

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28
Q

what neurotransmitter plays a key role in delirium

A

acetylcholine

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29
Q

what are the clinical features of delirium

A 
impaired consciousness
impaired cognitive function
perceptual d/o (hallucinations)
paranoid delusions
psychomotor abnormalities
sleep/mood disturbances
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30
Q

what are some precipitating factors of delirium

A 
infection
injury
malnutrition
dehydration
iatrogenic
immobility
forced restraint
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31
Q

what are some risk factors of delirium

A 
underlying brain diseases
old age
visiual/hearing impairment
polypharmacy
renal impairment
sleep deprivation
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32
Q

what are some iatrogenic causes of delirium

A

GA, surgery, drugs, urinary catheter

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33
Q

what kind of drugs can cause delirium

A

opioids, steroids, sedatives.

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34
Q

what bloods are important to take in delirium, and why?

A 
FBC - infection/anaemia
CRP - infection
U+E - electrolyte imbalance (Ca, K, Na)
TFTs
bone profile
B12/folate
coagulation
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35
Q

how to treat delirium?

A

find underlying cause and fix it
maintain hydration
restore patients eyesight if impaired

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36
Q

how to tranquilize dangerous delirious patient?

A

500mcg haloperidol PO or 1mg IM

lorazepam otherwise

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37
Q

most common dementia cause

A

alzheimer’s disease

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38
Q

key feature of AD?

A

gradual decline, memory decline

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39
Q

key feature of vascular dementia?

A

step wise deterioration

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40
Q

key feature of frontotemporal dementia?

A

personality and behaviour change.

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41
Q

what medication to avoid for lewy body dementia

A

antipsychotics

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42
Q

key feature in lewy body dementia?

A

visual hallucinations come before Parkinson symptoms

fluctuation in cognition, alertness and attention

PD features as well

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43
Q

difference between speech and language

A

speech is how you say things

language is what you say

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44
Q

what is receptive aphasia?

A

it is when understanding is affected, person hears language but cannot comprehend.

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45
Q

describe the 4 types of expressive aphasia

A

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

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46
Q

define dysarthria

A

disturbance in speech that results from muscle weakness, paralysis or poor coordination

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47
Q

describe flaccid dysarthria and what is it also known as. is it UMN or LMN?

A

AKA bulbar palsy - LMN cause

imprecise articulation, hypernasality, reduced breath control, nasal emission audible

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48
Q

describe spastic dysarthria and what is it also known as. is it UMN or LMN?

A

UMN, AKA pseudobulbar palsy

slow/laboured speech
low monotonous pitch
slow and slurred

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49
Q

what kind of dysarthria do huntington’s patients have

A

hyperkinetic dysarthria

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50
Q

what patients get hypokinetic dysarthria?

A

parkinsons

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51
Q

describe ataxic dysarthria? cause?

A

cerebellar system
irregular pitch and loudness
altered prosody
disjointed ups and downs

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52
Q

describe apraxia

A

motor control difficulty, effortful and groping for words

agrammatical

53
Q

describe dysphonia

A

disorder of voice or phonation, roughness, hoarseness, strain

54
Q

3 D’s of elderly patient care

A

delirium, dementia, depression

55
Q

what is assessed in an MMSE?

A

a bee stung molly then peter caught it

appearance
behaviour
speech
mood
thought flow/content
perceptions
cognition
insight
56
Q

difference between mood and affect?

A

mood is what the patient thinks and feels in their words

affect is what the assessor sees

57
Q

what is required for TACS diagnosis

A

unilateral weakness of face, arm and leg (or sensory deficit)

homonymous hemianopia

high cerebral dysfunction (dysphasia, visuospatial disorder e.g. inattention)

58
Q

what is required for PACS diagnosis

A

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
Q

what is required for POCS diagnosis

A

one of

cerebellar brainstem syndromes

loss of consciousness

isolated homonymous hemianopia

60
Q

what is required for LACS diagnosis

A

one of

unilateral weakness (or sensory deficit) of face and arm, arm and leg or all three

pure sensory stroke

ataxic hemiparesis

61
Q

what are the red flags in back pain?

A

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
Q

what is the most common acute neuropathy

A

Guillain Barre syndrome

63
Q

what viruses can trigger GBS

A

campylobacter jejuni

EBV, CMV

64
Q

what are the clinical features of GBS

A

progressive bilateral limb weakness and numbness (paraesthesia)

absent reflexes

can progress to respiratory failure

65
Q

what is myaesthenia gravis caused by

A

autoimmune destruction of acetylcholine receptors

66
Q

what are the clinical features of myaesthenia gravis

A

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
Q

what is ramsay-hunt syndrome

A

reactivation of herpes zoster virus in the geniculate ganglion, affecting the 7th CN

68
Q

what are the clinical features of ramsay-hunt syndrome

A

LMN palsy, herpetic vesicles in external auditory meatus. loss of taste in the front of tongue, and possibly hearing loss and tinnitus.

69
Q

what are some options to intervene when there is airway obstruction

A 
head tilt chin lift
recovery position
nasopharyngeal tube
oropharyngeal tube
intubation
70
Q

what is to be assessed when evaluating breathing?

A

RR, sats, auscultation

71
Q

what else can be assessed for quick neurological status

A

pupillary reflex

72
Q

what blood should be quickly assessed in unconscious patient

A

glucose

73
Q

how to assess GCS and the different values

A

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
Q

what is the classical triad of meningitis

A

fever, headache, neck stiffness

75
Q

other symptoms of meningitis

A

N&V
photophobia
seizures
rash (non-blanching)

76
Q

what is kernigs sign

A

neck pain on flexion of knee

77
Q

what is brudzinski’s sign

A

involuntary hip flexion when neck is flexed

78
Q

how to investigate for meningitis

A

bloods

LP

79
Q

what do the different LP values indicate

protein
glucose
WBC/lymphocytes
color

A

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
Q

contraindications of an LP

A 
raised ICP
trauma
immunocompromised 
coagulopathy status
injury at needle site
81
Q

complications of menigitis

A 
death
seizures
brain damage
blindness and deafness
peripheral gangrene
82
Q

additional tasks in meningitis case

A

reporting to authorities, contact tracing

83
Q

common causes of subarachnoid haemorrhage

A

70% by berry aneurysms

10% congenital

84
Q

most common site of a berry aneurysm

A

anterior communicating artery

85
Q

clinical presentation of SAH

A

worst ever headache with no prior hx, came on suddenly and reaches max intensity within a minute.

photophobia, vomiting, 3rd nerve palsy

86
Q

SOCRATES of SAH

A 
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
Q

complications of an SAH

A

raised ICP, stroke, hydrocephalus

88
Q

investigations for suspected SAH

A

CT, LP

89
Q

how to circumvent a traumatic LP?

A

look for bilirubin as signs of hx of RBC in CSF

90
Q

clinical features of temporal arteritis

A

few week hx of constant moderate headache on temples.

weight loss, malaise

jaw claudication

scalp tenderness, blurred vision, diplopia, ocular muscle symptoms

91
Q

how to investigate temporal arteritis?

A

look for inflammatory markers in blood - CRP, ESR

temporal artery biopsy

92
Q

clinical features of migraine

A

episodic severe unilateral throbbing headache. can be associated with visual auras or scotomas. somes vomitting and photo and phonophobia.

93
Q

what is a TIA?

A

acute loss of focal cerebral function OR acute monocular visual loss, <24hrs, symptoms worst at onset and get better

94
Q

what symptoms are common with middle cerebral artery strokes?

A 
UMN facial weakness
hemiplegia
hemianopia
aphasia
visiospatial problems (non-dominant hemisphere)
95
Q

what symptoms are common in vertebral and basilar artery strokes

A 
diplopia
nystagmus
dysarthria
dysphagia
bulbar weakness
ipsilateral LMN facial weakness
respiratory failure/coma
contralateral hemiparesis, quadriparesis
96
Q

what is the definition of shock?

A

in adequate organ perfusion due to hypotension or acute circulatory failure resulting in generalised cellular hypoxia

97
Q

how do patients in shock present?

A

pale, clammy
tachypneac
talking in short sentences
rash in septic shock

98
Q

what symptoms does brain failure cause in shock?

A

decreased GCS
confusion
dizziness

99
Q

what symptoms does respi failure cause in shock?

A

tachypnea
agonal breathing
cyanosis
respi arrest

100
Q

what symptoms does cardiovascular failure cause in shock?

A

clammy skin
cold
edema
tachy/bradycardia

101
Q

4 types of shock?

A

hypovolaemic (low blood volume)
cardiogenic (heart failure)
distributive (vasodilation)
obstructive (low SV)

102
Q

example causes of hypovolaemic shock?

A

massive bleeding

diarrhea

103
Q

example causes of cardiogenic shock?

A

MI

dysrhythmia

104
Q

example causes of distributive shock?

A

sepsis

anaphylaxis

105
Q

what kind of shock would a PE cause?

A

obstructive shock

106
Q

what blood traces would indicate cardiogenic shock?

A

increased troponin

107
Q

what ECG signs would indicate cardiogenic shock?

A

inverted T wave

108
Q

5 common types of movement disorders

A 
tremors
chorea
tics
myoclonus
dystonia
109
Q

describe the 5 main types of movement disorders

A

tremors are rhythmical repeated movements usually in the hands. can be resting or action tremor

110
Q

describe the 3 types of action tremors

A 
postural tremor (hands stuck out)
intention tremor (amplitude increases over course of action
kinetic tremor
111
Q

how to differentiate a true intention tremor?

A

tremors come on during action and amplitude increases over course of action

112
Q

how to describe a tremor?

A

distribution
resting/postural
frequency
amplitude

113
Q

describe a parkinsonian tremor

A

asymmetrical onset
predominantly resting tremor
often coarse pill rolling tremor
chin rolling tremor common

114
Q

what is an essential tremor

A

mainly postural tremor, bilateral onset in upper limbs

often tremor of head

115
Q

what are the 3 main symptoms of parkinsonism

A

resting tremor
rigidity
bradykinesia

116
Q

what kind of drugs can cause parkinsonism

A

antipsychotics
sodium valproate
metoclopramide
dopamine blocking drugs

117
Q

describe chorea

A

slow moving smooth involuntary body movement often flowing from one body part to another

118
Q

describe hemibalism

A

abrubt amplitude involuntary movement of limbs often described as “ballistic”

119
Q

describe dystonia

A

repetitive movements with sustained contractions
often bilateral and associated with a stiff neck
abnormal postures

120
Q

difference between generalised and focal dystonia

A

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
Q

describe tics

A

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
Q

describe myoclonus

A

burst shock like muscular contractions

123
Q

What does VIVID stand for in headache presentation differentials

A 
Vascular
Infective
Visual threatening
Intracranial pressure (space occupying lesion)
Dissection
124
Q

What would a headache worse when lying down, together with early morning nausea indicate?

A

Raised intracranial pressure

125
Q

What can cause a space occupying lesion

A

Bleed/clot, tumor, cyst, abscess,

126
Q

What is the nature of headaches of someone with a growing tumor or abscess

A

Progressive constant headache

127
Q

What sign will a carotid artery dissection give?

A

Horners syndrome and neck pain

128
Q

What eye sign will indicate a cavernous sinus thrombosis in someone with a headache

A

Exopthalmos

129
Q

What type of head ache is severe unilateral and focused over 1 eye?

A

Cluster headache

3 FoCP (11 decks)

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