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ICSM Year 6 + edits > Passmed: Neuro > Flashcards

Passmed: Neuro Flashcards

1
Q

What are 5-HT3 anatagonists used for and give a example

A

chemotherapy related nausea - medulla oblongata

e.g. ondansetron

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2
Q

Adverse effects of 5-HT3 antagonist

A

Prolonged QT interval
constipation

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3
Q

What is Aphasia?

A

Language / speech difficulties

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4
Q

What is Wernicke’s aphasia

A

Superior temporal gyrus lesion - left inferior MCA

sentences making no sense - word salad, comprehension is impaired

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5
Q

Brocas Aphasia

A

Inferior frontal gyrus - left superior MCA
speech non-fluent and halted
normal comprehension

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6
Q

Conduction aphasia

A

arcuate fasiculus - wernicke to broca

speech fluent but repetition is poor

comprehension normal

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7
Q

Global aphasia

A

all 3 of cond, broca & wernicke

severe expressive and receptive aphasia
gesture communication

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8
Q

Lesions causing gait ataxia

A

cerebellar vermis lesions

hemisphere = finger nose ataxia

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9
Q

What is Autonomic dysreflexia

A

spinal cord injury above T6
trigger: faecal impaction / urinary retention - sympathetic spinal reflex (PS response inhibited by lesion)
unbalanced physio response - extreme hypertension, flushing and sweating above the lesion - haemorrhagic stroke

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10
Q

Mx of Autonomic dysreflexia

A

removal of stimulus and treatment of LT hypertension / bradycardia

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11
Q

Features of Bells Palsy

A

Acute unilateral, idiopathic, facial nerve paralysis

Lower motor neuron facial nerve palsy - forehead spared
Post - auricular pain
Altered taste
dry eyes
hyperacusis - reduced tolerance to sound

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12
Q

Mx of Bells Palsy

A

oral pred within 72 hrs
eye care - prevent keratopathy
eye lubricants, tape eye if cannot close

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13
Q

Follow up and prognosis of Bells Palsy

A

no improvement of paralysis after 3 weeks - refer to ENT
plastic if many months

3-4 month recovery, untreated 15% keep moderate weakness

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14
Q

Nerve that supplies extensor muscle group

A

radial

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15
Q

Abbduction of fingers

rock paper scissors

A

ulner nerve

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16
Q

Features of Carbamazepine

A

Epilepsy - partial seizures & Trigeminal neuralgia, bipolar

binds to sodium channels increase refractory period

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17
Q

Adverse effects of carbmazepine

A

P450 enzyme inducer
dizziness and ataxia
drowsiness
headache
visual disturbances (especially diplopia)
Steven-Johnson syndrome
leucopenia and agranulocytosis
hyponatraemia secondary to syndrome of inappropriate ADH secretion

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18
Q

What is cerebral perfusion pressure

A

net gradient blood flow to brain

sharp rise in CPP - rising ICP
fall in CPP - cerebral ischaemia

arterial - intra cranial pressure

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19
Q

Features of Cluster headache

A

men 3:1
smoker
alcohol
nocturnal sleep

intense sharp stabbing pain one eye,15-2 hrs
restless
4-12 weeks
lacrimation
nasal stuffiness

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20
Q

Mx of Cluster headache

A

acute 0 oxygen and sc triptain

prophylaxis - verpamil

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21
Q

Ocuomotor palsy

A

ptosis
down and out eye
dilated, fixed pupil

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22
Q

Trochlear palsay

A

downward gaze - vertical diplopia

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23
Q

Trigeminal palsy

A

trig neuralgia, loss of corneal reflex, loss of facial sensataion, paralysis of mastication muscles and deviation of jaw to weak side

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24
Q

abducens palsy

A

hroizontal diplopia

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25
Q

facial palsy

A

flaccid paralysis upper and lower face
loss of corneal relfex
loss of taste
hyperacusis

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26
Q

vestibulo palsy

A

hearing loss
vertigo
nystagmus
acoustic neuroma

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27
Q

Glosspharyngeal palsy

A

hypersensitive carotid sinus relfex
loss of gag

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28
Q

vagus palsy

A

uvula deviates away from site
loss of gag

hypoglossal - tongue towards

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29
Q

accessory palsy

A

weakness turing head to other side

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30
Q

Features of degenerative cervical myelopathy

A

RF smoking - intervertbral disk

pain on neck, loss of motor function e.g. digital dexterity
loss of sensroy function
loss of autonomic function
Hoffmans

MRI cervical spine - disc degeneration and ligament hypertrophy

specialist, treatment within 6 months - decompressive surgery

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31
Q

Dermatomes

A

c6 - make 6 with hand - index finger and thumb
c7 - middle finger and palm
c8 - ring + little finger

t4 - nipples
t10 - umbilicus
l1 - inguinal ligament
l5 - big toe and dorsum of foot

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32
Q

DVLA: Neuro specifics

A

Epilepsy
- first - 6 months off if no abnormalities, if are then 12
- multiple - 12 months, 5 yrs then fully restore
- not drive 6 months after last dose if withdrawing

syncope
- single episode and explained - 4 weeks
- unexplained - 6 months
- two or more - 12 months

Other
– stroke - 1 month
- multiple tia - 3 months and inform
- craniotomy - 1 year
- pit tumour - 6 months
- nacrolepsy - control
- chronic e.g. ms - inform dvla

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33
Q

Encephalitis

A

fever, focal features and peripheral lesions
HSV1 - temporal and inferior frontal lobes
CSF - lymphocytosis, elevated protein, PCR for organism
neuroimaging shows - petechial haemorrhages in areas
eeg - lateralised periodic discharges at 2 hz
IV aciclovir

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34
Q

Areas of focal seizures

A

temporal - aure, rising epigastric sensation - one minute, lipsmacking, grabbing, plucking

frontal - head and leg movements, posturing, post-ictal weakness, jacksonian march ( movement of tingling)

parietal - paraesthesia

occiptal - floaters

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35
Q

Indications to start anti-epileptic

A

neurological deficit
brain imaging - structural abnormality
eeg
risk

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36
Q

generalised tonic - clonic seizure

A

M: sodium valproate
F: lamotrigine

37
Q

focal seizure

A

first: lamotrigine
second: carbamazepine

38
Q

absence

A

first: ethosuzimide
second: M: valproate, F: Lamotrigine

39
Q

Myoclonic

A

M; valproate
F: Levetiracetam

40
Q

Tonic

A

M: valproate
F: Lamotrigine

41
Q

GCS

A

Motor - 6 (4 = withdraw from pain, 3 = flexion to pain, 2 extending to pain)

verbal - 5 ( 3 = words)

eye - 4 (2 = to pain)

42
Q

Huntingdon

A

chorea, personality changes, dystonia, saccadic eye movements

43
Q

Features of idiopathic intracranial hypertension

A

young overweight females

pregnany, drugs (COCP, steroids, tetracycline, reintoids, lithium)

headache, blurred vision, papilloedema, enlarged blind spot, sixth nerve palsy

weight loss
carbonic anhydrase inhibitor - acetazolamide
optic nerve sheath decompression

44
Q

Lamotrigine

A

sodium channel blocker
steven johnson syndrome

45
Q

Lateral medullary syndrome

A

posterior inferior cerebellar artery

ataxia + nystagmus

ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. horners
contralateral: limb sensory loss

46
Q

Med overuse headache

A

chronic daily
15 days
opioid use
withdraw triptan and anlgesics abruptly
opioid - gradual withdrawn
e.g. woule get vomiting, hypotension, tachycardia, restlessess, sleep distrubance and anxiety

47
Q

Migraine A to E criteria

A

A - 5 attacks fulfilling below
B - 4-72 hrs headache
C - unilateral, pulsating, moderate pain, aggravation (2)
D - N&V, photophobia (1)
E - not another disorder

Gi distrubance in children

48
Q

Atypical aura symptoms

A

motor weakness
double vision
visual symptoms one eye
poor balance
decreased level of consciousness

49
Q

Acute migraine

A

oral triptan + NSAID/Paracetamol
nasal ifyoung

if not work - oral metoclopramide - caution due to acute dystonic reactions

50
Q

Prophylaxis for migraine

A

quality of life and daily function
propranolol
topiramate - avoid in child bearing age
amitriptyline
10 sessions of acupuncture over 5-8 weeks

51
Q

Migraine and women

A

Preg - paracettamol 1g
COCP - no COCP if have migraine due to risk of stroke
Menstruation - mefanamic acid or combo of aspirin / paracetoml / caffeine
HRT - normal

52
Q

Main features of motor neuron disease

A

UMN + LMN - ALS, PMA, BP

Asymmetirc limb weakness - ALS
wasting of hand muscles
fasciulations
absence of sensory signs

not external ocular muscles
no cerebellar signs
abdominal reflexes preserved

normal motor conduction - MRI to exclude CC compress & myelopathy

53
Q

MS features

A

75% lethargy
two or more relapses
Visual: optic neuritis, atrophy, uhthoff phenomenon (worse vision rise in body temp), internuclear opthalmoplegia
Sensory: Pins, numbness, tri neuralgia, lhermittes parathesai in limbs on neck flexion
Motor: spastic weakness - legs
Cerebellar: Ataxia - acute relapse, tremor
Other: UI, SD, Intellectual deterioration

54
Q

MS Mx

A

Acute: high dose steorid - 5 days
DMARD - natalizumab relapsing
Fatigue - amantadine
Spast - baclofen & gabapentin + physio
Bladder - USS, significant residual - intermittent self cather, no residual volume - anticholinergic
Oscillopsia (oscillating visual fields) - gabapentin

55
Q

Multiple system atrophy

A

predominant parkinsonian MSA-P
predominant cerebellar MSA-C

parkinsonism
autonomic distrubance - ED, postural hypo, atonic bladder,
cerebellar signs

56
Q

Key feature of Myasthenia gravis

A

women and fatigability of muscles
diplopia, proximal muscle weakness, ptosis, dysphaiga

57
Q

Associations of MG

A

thymomas 15%
Autoimmune disorder
thmic hyperplasia 50-70%

58
Q

Ix & Mx of Mysathenia gravis

A

single fibre EMG
antibodies to ACH receptor
- if fail - anti-muscle specific tyorsine kinase
tensilon test - iv edrophonium reduces muscle weakness - (no if cardiac)

long acting ach inhib 0 pyridostigmine
thymectomy

crisis - plasmpheresis & immunoglobulins

59
Q

Neurofibromatosis

A

NF1: cafe au lait, axillary freckles, peripheral neurofibromas, scoliosis, phaeo

NF2: bilateral vestibular schwannomas, intracrianl schwannoms, mengiomas, epdnymomas

60
Q

Neuropathic pain

A

pain damage to nervous system
e.g diabetic neuropathy, post-herpectic neuraliga, trigeminal, prolapsed discs

amitriptyline, duloxetine, gabapentin - try another if not work - switch do not add
tramadol - exacerbatin
capsaicin - localised

carbamazepin e- specific for trigeminal neuralgia

61
Q

Normal pressure hydrocephalus

A

wet, wacky and wobbly
reversible dementia, reduced csf absroption at archnoid villi

ventriculomegaly in absence or sulcal enlargment

shunting is the treatment - can cause seizures, infection and intracerebral haemorrhages

62
Q

Featrues of parkinson disease

A

progressive neurodegenerativve condition of dopaminerigc neurons insubstantia nigra

bradykinesia - short shufflinf steps, reduced arm swiniing

, tremor - rest, worse on stress, better with voluntary movement, pill rolling
and ridigity - lead pipe, cogwheel
- asymmetrical

men

flexed postures, pyschiatric e.g. depression, rem sleep behavour, postural hypotension - autonomic dysfunction

63
Q

Drug induced parkinsonism

A

motor symptoms rapid onset and bilateral
rigidity and res tremor uncommon

64
Q

Parkinson Mx

A

Specialist
motor - levodopa - improvement in motor symptoms
not affecting motor - dopamina agonist - can cause sleepiness, hallucinations, impulse control disorder

65
Q

features of levodopa

A

combineed with decarboxylase inhibitor - carbidopa
- prevents peripheral metabolism

dry mouth, anorexia, palpitations, postural hypotension, psychosis

end dose wearing off - symptoms worse near end
on-off phenomenon - large variation in motor peroformance
dyskinesias at peak doseL dystonia, horea and athetosis (involuntary writhing movements)

do not stop acutely - give as patch to prevent acute dystonia

66
Q

Other parkinson medication features

A

Dopamine rec agonist - bromocriptine, impulse control and daytime somnolence, hallucinations, nasal congestion and postural hypotension

Mao-B - selgiline 0 inhibit breakdown

Amantadine
COMT inh - entacapone
Antimuscarinic - drug induced - tremor and rigidity - procyclidine

67
Q

Peripheral neuropathy

A

motor - GBS, porphyria, lead poisoning, charcot marie tooth, diphtheria

sensory - diabetes, uraemia, leprosy, alcoholism, vit b12, amyloidoisis

alcohol more sensory - decrease absorption of B vitamins

vit b12 0 subacute deg of spinal cord - doral column - distal paraesthesia

68
Q

Adverse affects of phenytoin

A

bind to sodium increase refractory period
inducer of p450 system

acute: dizziens, ataxia - later confusion and seizures

chronic - gingival hyperplasia (exposure of pdgf, hirsutism, megaloblastic anaemia, peripheral neuropathy

fever, rashes toxic epidermal necrolysis, hepatiis, aplsatic anaemia,

tetraogenic - cleft palate and congentical heart disease

trough levels before dose check - adjustment dose, suspect toxicity, detect non adherence

69
Q

Progressive supranuclear palsy

A

parkinson plus

postural instability
impairment of vertical gaze
parkinsonism - bradykinesia

cognitive impair ment - frontal lobe dysfunction

no L-DOPA

70
Q

Pyschogenic non-epileptic seizure

A

pseudo
pelvic thrusting, crying after, gradual
no tongue biting or rasied prolactin

71
Q

Rasied intracranial pressure

A

CPP - arterial - icp

IIH, trauma, infection, tumour, hydrocephalus

headache, vomiting, papulloedmea, cushing tria (wide pulse pressure, bradycardia, ireegular breathing)

neuroimagin,

elevate to 30 degrees, mannitol osmotic diurectic, controlled hyperventilation reduce pCO2, vaso constrict, decrease pressure
removal of csf

72
Q

Roots of reflexes

A

Ankel - s1/s2
knee - l3/l4
bicep - c5/c6
tricep - c7/c8

73
Q

Restless leg syndrome

A

akathisia - night
family history - IDA, diabetes, pregnancy
ferritin exclude IDA
stretching, dopamine agonists - rpinirole, benzo, gabapentin

74
Q

Middle cerebral artery

A

aphasia
contralateral homonymous hemianopia

+ the usual hemiparesis

75
Q

webers

A

posterior cerebral artery that supply midbrain

ipsilateral CN III palsy
contralateral weakness

76
Q

Posterior inferior cerebellar artery

A

wallenburg

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

77
Q

Anterior inferior cerebellar artery

A

lateral pontine

ipsilateral facial parlysis and deafness

78
Q

retinal and basilar artery

A

ret - amurosis fugax
basilar - locked in

79
Q

Lacunar stroke

A

isolated hemiparesis, hemisensory, with limb ataxia
hypertension
basal ganglia, thalamus and internal capsule

80
Q

Criteria assessed for stroke

A

unilateral hemiparesis
homonymous hemianopia
higher cognitic dysfunction

81
Q

Subdural haematoma

A

dural layer
head trauma, lucid interval, gradual decline in consciousness

cresenteric collection not limited by suture lines- hyperdense in comparision- midline shift

small birdging veins - chronic = hypodense and dark in contrast to acute

burr hole decompression

82
Q

Causes of third nerve palsy

A

diabetes
vasculitis
false localising sign
posterior communicaitg artery aneurysm - pupil dilated, often associated with pain, cavernous sinus thrombsis, webers, amyloid

83
Q

Triptans adverse effects

A

tingling, heat, tightness
avoid in IHD and CVD

84
Q

Tuberous sclerosis

A

AD
ash leaf spot under uv light, rough skin over lumbar spine, butterfly rase, fibromate beneath nails, cafe au lait spots,

developmental delay, epilepsy,

kidney issues, heart issues etc

85
Q

Features of vestibular schwannoma

A

vertigo, hearing loss, tinnitus and abset corneal reflex

VIII, V, VII (facial palsy)

MRI cerebellopontine angle

86
Q

PITS

A

Parietal - inferior homonymous quadrantonpoia

temporal = superior

87
Q

Homonymous hemianopia

A

incongruous defects: lesion of optic tract
congruous defects: lesion of optic radiation or occipital cortex
macula sparing: lesion of occipital cortex

88
Q

Homonymous quadrantanopias*

A

superior: lesion of the inferior optic radiations in the temporal lobe (Meyer’s loop)
inferior: lesion of the superior optic radiations in the parietal lobe
mnemonic = PITS (Parietal-Inferior, Temporal-Superior)

89
Q

Bitemporal hemianopia

A

lesion of optic chiasm
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

ICSM Year 6 + edits (28 decks)

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