Pastest Flashcards
cranial nerve that passes through rotundum
maxillary division of trigeminal
innervates parotid
glossopharyngeal
innervates lateral gaze
abducens
superior oblique is innervated by
trochlear
laryngeal muscles are innervated by
branches of the vagus
only part of laryngeal muscles not innervated by recurrent laryngeal branch of vagus
cricothyroid - by external laryngeal nerve
innervates the anterior 2/3rd of tongue
facial
innervates posterior 1/3 of tongue
glossopharyngeal
unilateral headache > 50 yrs
temporal arteritis
first line investigation for temporal arteritis
ESR
age when migraines first present
young woman/man
why no COCP in migraine
oestrogen precipitates migrane
raised ICP will have what symptoms
morning headaches and postural (leaning forward)
triad of parkinson
- resting tremor
- rigidity
- bradykinesia
pathophysiology of parkinsons
neurodegeneration and deposition of inclusion bodies in v pars compact of the substantianigra (midbrain) causing disruption/loss of dopaminergic transmission in basal ganglia
parkinson signs distribution: symmetric or asymmetric
asymmetrical
therapy given in parkinson
levodopa (L-dopa)
non ‘triad’ symptoms of parkinson
stooped posture
shuffling gate
reduced arm swing
monotone voice –> slurring dysarthria
what is normal pressure hydrocephalus
increases ventricle space and CSF without an increase in CSF pressure, usually due to inability of CSF to drain out of brain. Can be a late consequence of subarachnoid haemorrhage
who gets normal pressure hydrocephalus
old people
symptoms of normal pressure hydrocephalus
dementia, urinary incontinenece, gait abnormalities (shuffling)
molloscum contagiosa indicates what
HIV
HIV+ get what type of meningitis
cryptococcal neoformans
sudden onset severe headache
subarachnoid haemorrhage
most common area of subarachnoid haemorrhage pain
occipital
treatment for cryptococcal meningitis
anti fungal: amphotericin +/- fluctosine
what type of organism is cryptococcal neoformans
fungus
risk factors for subarachnoid haemorrhage
berry aneurism or atriovenous malformations
diagnosis of sub arachnid haemorrhage
CT if neg, then CSF
3 classical signs of BACTERIAL meningitis
fever, headache, neck stiffness
name for meningococcal (neisseria meningitidis) rash
petechial rash
treatment for suspected meningococcal meningitis
IM cefotaxime/ceftriaxone
who gets benign intracranial hypertension
fat woman
what is benign intracranial hypertension
increase in CSF production WITHOUT increase in ventricle size
how may benign intracranial hypertension present
headaches and visual disturbance (papilloedema)
what drugs can cause benign intracranial hypertension
steroids and tetracycline therapy
treatment for benign intracranial hypertension
diaretics: thiazides & acetazolamide + weight loss
what will you look for in CSF if suspect sub arachnid haemorrhage but CT doesn’t show anything
xanthochromia (bilirubin from broken RBCs in CSF)
tie scale for xanthocromia
12 hours after onset of symptoms
when will you do angiography in suspected subarachnoid haemorrhage
if want to try fix it
morning headache + vomiting =
raised ICP usually due to space occupying lesion
SOL/bleeds in temporal lobe of brain will cause what visual defects
homonymous superior quadrantanopia (on opposite side of lesion) PITS: parietal = inferior, temporal = superior
SOL/bleeds in parietal lobe of brain will cause what visual defects
homonymous inferior quadrantanopia (on opposite side of lesion) PITS: parietal = inferior, temporal = superior
SOL/bleeds in chiasm of brain will cause what visual defects
bi-temporal heminopia
loss of vision on just one side L/R heminopia
optic tract on opposite side
unilateral vision loss
eye/optic nerve on SAME side
what test is usually abnormal in delirium of any cause
electroencephalogram
what part of brain affected in huntingtons
caudate nucleus degeneration
condition where you get ticks and choreosthesis
huntingtons
dementia in stepwise fashion
vascular
what will be common in someone with vascular dementia
hypertension, heart problems, arrhythmia and diabetes
‘butterfly pattern’ on CT
huntingtons
what part of brain will show ‘butterfly pattern’ on CT
caudate nucleus
best imaging for vascular dementia lesions
MRI (not seen on CT)
accessory nerve innervates what
traps and sternocleidomastoid
accessory nerve arrives from
C1 - 5
accessory passes out skull via
jugular
when does the accessory nerve cross into posterior triangle of neck (where it is prone to injury)
3rd of the way down sternocleidomastoid
a sub dural haematoma lies between what layers
dura and arachnoid
meninigi layer closest to brain
pia
outermost layer of meningis
dura
dura mater has how many layers
2
what is in-between 2 layers of dura mater
venus sinuses
names of 2 layers of dura mater
outer: endosteal layer
inner: meningeal layer
the inner meningeal layer of dura mater forms what 4 structures
4 fibrous septa:
- diaphragma sellae
- falx cerebri
- falx cerebelli
- tentorium cerebelli
function of 4 fibrous flanges/septa of dura mater
stop rotatory displacement of brain
dura mater well innervated?
yes (causes headache)
archnoid mater is attached to what other layer and by what?
pia via filamentous processes
where is CSF located
in sub arachnoid space (between arachnid and pia mater)
extradural heamatoma is located where
between skull and endosteal layer of dura
most common blood vessel implicated in extradural haematoma
middle meningeal artery
middle meningeal artsy located where
beneath pterion
location of subdural haematoma
venous bleeding into gap between dura and arachniod
who gets subdural haematoma and why
elderly and alcoholics due to brain shrinkage, this damages overlying veins, because veins it is usually a slow bleed
blood vessel involved (artery/vein):
subdural haematoma -
extradural heamatoma -
subarachnoid haematoma -
subdural haematoma - vein
extradural heamatoma - artery (middle meningeal)
subarachnoid haematoma -artery (from circle of willis)
facial nerve supplies what glands
lacrimal (eye), submandibular, sublingual
oculomotor innervates what eye muscle
levator palpebrae superioris (lift eye lid)
blinking/screwin eye shut is what cranial nerve
facial
what nerve innervates muscles of mastication
mandibular division of trigeminal
bells palsy, upper or lower motor neurone
lower (facial)
which has forehead sparing: stroke or bells palsy
stroke
why can you get hypersensitivity to sound in bells palsy
because facial nerve innervates stapedius muscles (which dampens down sound)
what is myasthenia gravis
auto Ab to ACh receptors on post synaptic membrane
how may myasthenia gravis present
double vision, weakness and fatigueabiltiy, worse in evening
diagnostic test for myasthenia gravis
nerve conduction study with repetitive nerve stimulation
myasthenia gravis associated with what other condition
thymic hyperplasia or thymus tumour
after diagnosis of myasthenia gravis what other test will you do and why
chest CT because of associating with thymic hyperplasia or thymus tumour
‘panda eyes’
fracture of floor of anterior cranial fossa
crescent shape haematoma on CT
sub-dural haematoma
skull x-ray won’t show base of anterior fossa fracture, but what might you see
fluid leven in spenoidal sinus lateral view
treatment for sub dural haematoma
urgent surgery
wil x-ray show sub dural haematoma
No
first line investigation for extra and sub-dural maenatoma
CT
which head injury do you get lucid interval
extradural haematoma
fasciculations and atrophy indicate what a lesion location
lower motor neurone
tongue will deviate to what side in a lower motor lesion
same (ipsilateral)
what nerve affects tongue
hypoglossal
tongue will deviate to what side in a upper motor lesion
opposite side (contralateral)
nerve for motor supply to tongue
hypoglossal
what nerve for sensory and somatic innervation to posterior 1/3rd of tongue
glossopharyngeal
nerve responsible for sensory role in gag reflex
glossopharyngeal
nerve responsable for efferent limb in gag reflex
vagus
things facial nerve supplies: (many)
motor:
- muscles of facial expression
- buccinator
- stapiduim muscle
parasympathetic:
- lacrimal gland
- sublingual and submandibular salivary glands
- blinking
sensory: taste to anterior 2/3rds
anterior cerebral arteries supply what area of brain
medial aspect of frontal and parietal lobes
stroke in anterior cerebral artery regions will affect what part of body
opposite side, lower limb
middle cerebral arteries supply where
lateral frontal, parietal and superior temporal lobes
occlusion of middle cerebral artery will have what features
upper limb weakness
speech problems
facial weakness
auditory comprehension problems
posterior cerebral artery supplies where
occipital lobe
inferior temporal
thalamus
posterior limb of internal capsule
how will a posterior artery stroke present
weakness in both upper and lower limbs
vision field defects
loss of sensation
3rd nerve palsy present with:
ptosis (eyelid droop)
mydriasis (dilated pupil)
down and out
horizontal and vertical binocular diplopia (double vision)
3rd nerve innervates what eye muscles
superior, inferior, medial rectus muscles, inferior oblique, levator palpera superioris
shine light into left eye, no changes in left eye but consentual in right, what does this tell me?
optic never intact: recognises light
occulomotor not: light is being sensed but not pupillary response
trochlear innervates what eye muscles
superior obligue
abducens innervates what eye muscle
lateral rectus
