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Finals - Systems Paper > Neurosurgery/Neurology > Flashcards

Neurosurgery/Neurology Flashcards

1
Q

ICP cushings triad

A

Widened pulse pressure
Bradycardia
Irregular breathing

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2
Q

Raised ICP treatment

A

IV mannitol
Controlled hyperventilation
Head elevation

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3
Q

Unilateral dilated pupil and no light response in raised ICP

A

CN III compression may secondary herniation

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4
Q

Unilateral dilated pupil and exagerated light response in raised ICP

A

Optic nerve injury

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5
Q

CT scan immedietely when

A

GCS <13 initially or <15 after 2 hours
2 or more episodes vomiting
Skull fracture
Neurological deficit

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6
Q

CT scan within 8h

A

Age >65
Clotting disorders
Dangerous mechanism

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7
Q

Linked to SAH

A

Intracranial aneurysm - APKD

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8
Q

Diagnose SAH

A

1) CT head

2) LP after 12 hours - xanthochromia

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9
Q

SAH treatment

A

Coil by interventional radiologist

Nimodepine - prevent vasospasm

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10
Q

Subdural haemorrhage identify

A

High impact trauma

Fluctuating consciousness

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11
Q

Acute v chronic bleed CT

A

Acute - hyperdense

Chronic - hypodense, often subdural

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12
Q

Vessels in subdural bleed

A

Bridging veins

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13
Q

Vessels in extradural bleed

A

Middle meningeal artery

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14
Q

Identify extradural bleed

A

Low impact trauma, often young

Loses, regains then loses consciousness again (lucid interval)

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15
Q

Diagnose hydrocephalus

A

CT head

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16
Q

Treatment hydrocephalus

A

Acute - external ventricle drain

Long term - ventriculoperitoneal shunt

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17
Q

Triad of normal pressure hydrocephalus

A

Elderly:

  • urinary incontinence
  • dementia
  • gait abnormality
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18
Q

Most common metastasis to brain

A

Lung cancer

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19
Q

Brain tumour worst prognosis

A

Astrocytoma (glioblastoma multiforme

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20
Q

Types of focal seizure

A

Focal aware
Focal impaired

Always starts specific region brain

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21
Q

Types of generalised seizure

A 
Tonic clonic (grand mal)
Tonic
Clonic
Typical absence (petit mal)
Atonic

Starts both sides brain, always unconscious

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22
Q

Diagnose epilepsy

A

After first seizure:

  • EEG
  • MRI
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23
Q

Treat seizure

A

1) Give 5 mins
2) Benzo rectal/under tongue
3) Hospital - status epilapticus

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24
Q

Treatment epilepsy

A

Start epileptic after second seizure, or after first if:

  • neurological deficit
  • abnormal brain imaging
  • abnormal EEG
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25
Treatment generalised tonic clonic seizure
Sodium valproate
26
Treatment absence seizure
Sodium valproate or ethosuximide
27
Treatment myoclonic seizure
Sodium valproate
28
Treatment focal seizure
Carbamazepine or lamotrigine
29
Temporal seizure
Automatism (lip smacking, grabbing)
30
Frontal seizure
Jacksonian march | Post-ictal weakness
31
Parietal seizure
Paraesthesia
32
Occipital seizure
Visual
33
Identify infantile spasm
First few weeks of life Saalam attack (flexion of head and extension of arms) Poor prognosis
34
Identify absense seizure in kids
Onset 4-8y | Lasts few seconds to 30 with quick recovery, many per day
35
Identify Lennox-Gastraut syndrome
Onset 1-5y Infantile spasm in past Atypical absence, fall, jerk
36
Identify benign rolandic epilepsy
Paraesthesia on waking up
37
Identify juvenile myoclonic epilepsy
Onset teens | Infrequent generalised seizures
38
Migraine treatment
1) Triptin and NSAID | 2) Non-oral metochlopramide
39
Migraine prevention
1) Topiramate or propranolol
40
PD plus syndromes
Multiple system atrophy - autonomic dysfunction Dementia with lewy body Progressive supranuclear palsy - problem moving eyes
41
PD treatment
1) Levodopa | 2) Dopamine agonist, MAO-B inhibitor or COMT inhibitor to adjunct
42
PD treatment most common cause impulse control problems
Dopamine agonist therapy
43
PD treatment biggest effect on motor function and ADL
Levodopa
44
PD treatment most adverse effects
COMT inhibitor
45
PD treatment most hallucination risk
Dopamine agonist
46
Example dopamine receptor agonist
Bromocriptine | Cabergoline
47
Example MAOB inhibitor
Selegiline
48
Example COMT inhibitor
Etacapine
49
Diagnose temporal arteritis
Temoral artery biopsy - multinucleated giant cells
50
Treatment temporal arteritis
Urgent high dose glucocorticoid: - prednisolone if no visual lose - IV methylprednisolone if visual loss
51
Treatment bells palsy
Prednisolone | Eye drops
52
Identify essential tremor
Postural tremor worst when arms outstretched | Improved by alcohol and rest
53
Treatment essential tremor
Propranolol
54
Identify guillian barre syndrome
Following infection - compylobacter jejuni Progressive symetrical weakness of all limbs - ascending (legs first) Decreased reflexes
55
Diagnose guillian barre syndrome
LP - increase protein and normal WCC | Nerve conduction studies - decreased velocity
56
Criteria to diagnose guillian barre
Brighton criteria
57
Treatment guillian barre
IV immunoglobulin and supportive
58
Subtypes MS
Relapsing remitting (most common) Secondary progressive Primary progressive
59
Diagnose MS
Contrast MRI | CSF - oligoclonal bands
60
Treatment MS acute
High dose steroids 5d (methylprednisolone)
61
Treatment neuropathic pain MS
Amitriptyline or gabapentin
62
Treatment spasticity MS
1) Baclofen and gabapentin | 2) Diazapam
63
Treatment bladder dysfunction MS
Anticholinergic
64
Identify subacute degeneration cord
B12 deficiency | Dorsal column first - vibration and properioception
65
Treatment acute tension headache
1) Aspirin, NSAID or paracetomol
66
Prophylaxis tension headache
Acupuncture
67
Wernickes encephalopathy triad
Opthalmoplegy/nystagmus Ataxia Confusion
68
Karsakoffs syndrome triad
Antero and retrograde amnesia | Confubulation
69
Cluster headache acute treatment
Oxygen and SC triptin
70
Cluster headache prophylaxis
Verapamil
71
Identify horners syndrome
Miosis (small pupil) Ptosis Anhidrosis (loss of sweating)
72
Location of lesion horners syndrome
Anhidrosis face arms and trunk: - stroke - syringomyelia - MS - tumour Anhidrosis face: - pancoast tumour - cervical rib No anhydrosis: - carotid artery dissection - carotid aneurysm
73
Identify Duchenne muscular dystrophy
Progressive proximal weakness from 5y Calf pseudohypertrophy Gowers sign - uses hands to stand from squated
74
Identify Becker muscular dystrophy
Develops after 10y | Intellectual impairment less common than Duchenne
75
Myasthenia gravis antibody
Acetylcholine receptors
76
Myasthenia gravis treatment long term
Long term acetylcholinesterase inhibitors - pyridostigmine
77
Myasthenia gravis crises treatment
IV immunoglobulins | Plasma electrophoresis
78
Treatment trigeminal neuralgia
Carbamazepine
79
TIA investigation
MRI including diffusion weighting CT consider differentials Urgent carotid doppler
80
TIA treatment
Initially aspirin 300mg and admission Lifelong clopidogrel Carotid artery endarectomy if >70% occlusion
81
Oxford stroke classification
3 criteria: - unilateral hemiparesis or hemisensory loss - homonymous hemianopia - higher cognitive dysfunction (eg dysphagia)
82
Identify anterior cerebral infarct stroke
Contralateral hemiparesis and sensory loss | - lower limbs > upper
83
Identify middle cerebral infarct stroke
Contralateral hemiparesis and sensory loss | - upper > lower
84
Identify lucunar infarct
Pure sensory or motor
85
Identify posterior circulation infarct
1 of: - cerebrallar or brainstem syndrome - isolated homonymous hemianiopia
86
Identify posterior cerebral infarct
Contralateral homonymous hemianopia with macula sparing | Visual agnosia
87
Identify webers syndrome (posterior cerebral that supplies midbrain)
Ipsilateral CN III palsy | Contralateral limb weakness
88
Identify lateral medullary syndrome (posterior inferior cerebellar artery) - also called Wallenberg syndrome
Ipsilateral facial pain and temp loss Contralateral limb pain and temp loss Ataxia and nystagmus
89
Identify lateral pontine syndrome (anterior inferior cerebellar artery)
Similar to laterally medullary syndrome but ipsilateral paralysis and deafness
90
Identify basilar stroke
Locked in syndrome
91
Stroke screening tools
FAST - public | ROSIER - healthcare
92
Stroke diagnosis
Non contrast CT head
93
Stroke acute treatment
Aspirin 300mg once haemorrhage excluded | Statin if cholesterol >3.5
94
Stroke definitive treatment
Thombolysis if <4.5h | Thrombectomy if <6h if proximal anterior or posterior circulation, up to 24h if imaging shows salvagable tissue
95
Stroke secondary prevention
1) Clopridogrel
96
Wernicke aphasia
Fluent speech, comprehension impaired | Lesion superior temporal gyrus
97
Conductive aphasia
Fluent speech, comprehension intact
98
Global aphasia
Non-fluent speech | Comprehension impaired
99
Brocas aphasia
Non-fluent speech Comprehension in tact Lesion in frontal gyrus
100
Differentiate cerebellar hemisphere and vermis lesions
Hemisphere - peripheral ataxia (finger nose) | Vermis - gait ataxia
101
Frontal brain lesion
Brocas aphasia | Disinhibition
102
Parietal brain lesion
Inferior homonymous quadrotonopia | Sensory inattention
103
Temporal brain lesion
Wernickes aphasia Superior homonymous quadrontanopia Auditory agnosia
104
Occipital brain lesion
Homonymous hemianopia with macula sparing | Visual agnosia
105
Identify Brown sequard syndrome
Lateral hemisection of cord: - ipsilateral weakness, proprioception and vibration loss - contralateral loss of pain and temp
106
Identify cataplexy
Sudden and transient loss of muscle tone due to emotion
107
CN III palsy
Ptosis Eye down and out Dilated pupil
108
CN IV palsy
Defective downward gaze (vertical diplopia)
109
CN VI palsy
Defective abduction (hozizontal diplopia)
110
Vagus lesion
Uvula deviates away
111
Hypoglossal lesion
Tongue deviates towards
112
Driving after seizure
First - no driving 6m if normal investigation | Epilepsy - seizure free 12m
113
Driving after stroke
1m
114
Differentiate peroneal nerve lesion and L5 radiculopathy
Peroneal - foot drop and eversion effected | L5 - hip adduction affected to, foot eversion not
115
Identify degenerative cervical myopathy
Decreased motor function, sensory function, autonomic function Hoffman sign - flicking one finger causes rest to flicker
116
Identify intranuclear opthalmoplegia
Impaired adduction same side lesion | Horizontal nystagmus abducting eye contralateral
117
Identify intracranial venous thrombosis
Sudden onset headache Decreased consciusness CN VI palsy
118
Diagnose intracranial venous thrombosis
MRI venography
119
Treatment neuropathic pain
1) Amitriptyline, duloxetine, gabapentin or pregabulin | 2) Tramadol
120
Identify pituitary apoplexy
Sudden onset headache Bitemporal superior quadrantia Occular nerve palsies Pituitary insuffienciency
121
Identify syringomyelia
Collection CSF in spinal cord: - cape like loss of temp, preserved for touch proprioception and vibration - spastic weakness
122
Identify tuberous sclerosis
Epilepsy | Shagren patches - rough over lumbar spin
123
Upper quadrant bitemporal hemianopia
Pituitary tumour
124
Lower quadrant bitemporal hemianopia
Craniopharyngioma
125
Barthel index
Disability after stroke
126
Incubate for what GCS
<8

Finals - Systems Paper (20 decks)

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