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NERVOUS > pathology > Flashcards

pathology Flashcards

1
Q

examples of neurological compression in the spine?

A

cauda equina syndrome and disc prolapse

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2
Q

contraindications for MRI?

A

implanted electronics

claustrophobia

pregnant

tattoos

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3
Q

PET SCAN shows what?

A

used to map out glucose usage

can see tumours, inflammation, infection

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4
Q

how ct of brain appears?

A

black csf
white skull
grey brain - subtle white and grey matter difference

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5
Q

how MRI of brain appears?

A

white csf

better grey-white matter difference

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6
Q

MRI good for?

A

good for soft tissue

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7
Q

US advantage and disadvantages?

A

no radiation
less expensive
moveable

image and interpretation quality based on operator skill

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8
Q

X-rays advantage and disadvantages?

A

highly available
fast

lacks soft tissue detail

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9
Q

ct advantages and disadvantages?

A

rapid
metal and pacemaker tolerance

radiation
expensive

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10
Q

MRI advantage and disadvantages?

A

no radiation
sofft tissue seen
can get physiological info form images

poor metalwork tolerance
slow
expensive
not movement tolerant

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11
Q

radionuclide radiology advantages and disadvantages?

A

can get physio info - perfusion metabolism etc

radio tracer expensive

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12
Q

3 main causes of localised interrupted blood supply? 3

A

atheroma and thrombus

thromboembolism

ruptured aneurysm

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13
Q

TIA ? EXPLAIN

A

transient symptoms - reversible ischameia

tissue still viable

less than 24 hrs

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14
Q

fibrosis in cns referred as?

A

gliosis

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15
Q

thromboembolism in stroke classically from where?

A

left atrium with AF

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16
Q

CAUSES of cerebral artery to have an aneurysm?

A

due to its thin walls - hypertension and weakening of wall aneurysm forms

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17
Q

what is happening in body during cardiac arrest?

A

period of no perfusion and no oxygen

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18
Q

common treatment for intracranial aneurysm?

A

end embolism
surgical clipping
treating complications - infection, infarcts etc

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19
Q

posterior cerebral artery supplies what?

A

perception and visual field

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20
Q

middle cerebral artery supplies what?

A

supplies sensation, strength and language - frontal lob, temporal and parietal etc

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21
Q

what arteries supply cerebellum?

A
  • posterior inferior
  • anterior inferior
  • superior
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22
Q

ataxia is?

damage where?

A

disease - like being drunk - stumbling, slurred speech

damaged cerebellum

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23
Q

foramen munro?

A

inter ventricular foramina - connect lateral with 3rd vent.

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24
Q

what are the names of holes I roof of fourth vent?

A

1 medial - formane magendie

2 lateral - foramen luschka

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25
Q

Parkinson’s disease what is it and what does it involve?

A

disease of basal ganglia
degeneration of neurons in substantial migration and dopaminergic inputs

lack of dopamine

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26
Q

hypokinesia?

A

slowness, difficult to make voluntary movements - increased tone and tremors

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27
Q

huntingtons disease?

A

cortex loss

loss of caudate, putamen and globus paalidus

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28
Q

what part of brain can alcohol affect?

A

cerebellum and cerebellar circuits

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29
Q

amnesia?

A

memory loss

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30
Q

anterograde amnesia?

A

inability to form new memories

anything that happen after injury - unable to recall

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31
Q

retrograde amnesia?

A

cannot access MORE RECENT old memories
leading up to injury

longtime ago events are fine - as better rehearsed and more deeply imbedded

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32
Q

spinal cord tumours split into? 3 explain each

A

extra dural = outside dura
intra-dural - extra medullary = below termination of sc&above termination of dura mater
intra-medullary = within sc substance

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33
Q

cerebral perfusion = ?

A

MAP - ICP

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34
Q

creatine kinase tested in bloods means?

A

elevated if damaged muscle

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35
Q

muscle disease causes? 2

A

congenital - defects in different things

acquired - electrolyte disturbance/endocrine/autoimmune

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36
Q

inflam muscle disease?

A

autoimmune group of diseases

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37
Q

what does cholinesterase do?

A

break down ACH at nmj

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38
Q

what does Ash receptor antibody do?

A

blocks Each receptor and prevents ACH activating receptor and causing contraction at nmj

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39
Q

myasthenia gravis?

A

neuromuscular disorder causing weakness in VOLUNTARY skeletal muscles - defect in contracting etc

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40
Q

MYASTHENIA GRAVIS physiology cause?

A

autoimmune - where ACH receptor antibody prevents nt ach to carry out function and cause contraction

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41
Q

why remove thymus gland in MG?

A

as thymus gland part of immune system - will reduce immunity and ACH receptor antibody

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42
Q

Guillain barre syndrome?

A

autoimmune condition that affects nerves

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43
Q

LMN Lesions signs?5

A 
muscle atrophy/wasting 
muscle weakness 
fasciculations 
no reflexes 
loss of tone - flacid
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44
Q

plantar response - extensor and flexor means UMN/LMN?

A

UMN LESION = extensor up

LMN lesion = flexor down - normal or none

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45
Q

UMN lesions signs? 5

A 
increased reflexes 
muscle weakness 
clonus 
extensor plantar response 
increase tone - spastic
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46
Q

anterior horn cell disease affects what?

A

both upper and lower motor neurone

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47
Q

symptoms of motor neurone disease?

A

pure motor

mix of both UMN AND LMN

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48
Q

EMG?

A

TESTS electrical activity in muscles

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49
Q

drug used to slow progress of MND?

A

riluzole

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50
Q

myelopathy?

A

damage to sc - due to compression - etc due to trauma or herniation etc

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51
Q

arteries of sc?

A

anterior and posterior spinal arteries brnahce sof vertebraal artery

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52
Q

B12 deficient myelopathy?

most likely affect what part pf sc?

A

lack of B12 can lead to damage to SC

dorsal/posterior

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53
Q

sc infarction affects what part of sc?

A

anterior cords

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54
Q

subarachnoid haemorrhage gives what type of headache?

A

thunderclap

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55
Q

primary headache pain pathway explain in cortex?

A

loop structures/pathway

  • cortical structures
  • brainstem
  • trigeminal ganglion

AND
CGRP = a key transmitter in this

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56
Q

migraine -primary or secondary headache?

A

primary headache - no known cause

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57
Q

tension-type headache?

A

band like pressure around head -tightening/pressing quality
primary headache
bilateral

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58
Q

migraine?

feature?

A

primary headache

episodic attacks - painfree then attack etc etc

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59
Q

aura of a migraine?

A

precedes migraine attack -

spreads and d evolves – involving visual,sesnory, speech etc
usually visual - blurry vision/spots etc

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60
Q

stages of migraine?

A

prodrome
aura
attack
postdrome

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61
Q

chronic migraine is classified as?

A

as more than 15 days headache per month

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62
Q

common cause of chronic migraine? e.g. - 3

A

medication overuse -
analgesics
caffeine overdose
opioids

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63
Q

triptans medication for?

A

migraines etc

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64
Q

new daily persistent headache meaning?

A

remember onset with pain becoming continuous and unremitting within 24hrs

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65
Q

neuralgia?

A

stabbing pain due to affected nerve - damaged

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66
Q

trigeminal neuralgia commonly caused by?

A

compression from bv

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67
Q

trigeminal autonomic cephalalgias?
symptoms 2

examples - 5

A

are group of primary headaches disorders

  • uniateral pain
  • ipsliteral cranial autonomic symptoms
=clucter headache 
=paroxysmal hermicarnia 
=SUNCT 
-SUNA
-hemicrania continua
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68
Q

cluster headache?

unilateral/bilateral?

A

type of TAC -
occur in cluster periods
extreme pain
awakens you In the middle of night with intense pain in and around on eye/ noon side of head

unilateral

69
Q

circadian rhythm?

A

internal process that controls sleep-wake cycle

70
Q

abortive treatment?

A

non-specific and migraine specific therapy - include analgesics/triptans - medication fro when you fell migraine arriving or just started

71
Q

greater ocipital nerve block ?

function

A

inject steroid to the nerve

to treat migraine headaches

72
Q

cluster
paroxysmal hemicrania
SUNCT

  • which one most sever pain
A

cluster

73
Q

indometacin is?

A

an NSAID

used for headaches

74
Q

treatment for paroxysmal Hemicrania?

A

indometacin

75
Q

Hemicrania continua? explain path of it

A

strictly unilateral CONTINUOS headache in background
with superimposed exacerbations of more severe pain

type of TAC

76
Q

paroxysmal hemicrania? explain path of it

A

type of TAC

unilateral

77
Q

SUNCT/SUNA?
features?
similar to?

A

TYPE OF TAC
more frequent - no refractory period
like cranial neuralgia

78
Q

high/low pressure in head features?

A

high - headache worse lying down/exercise

low - sitting or standing up triggered

79
Q

thunderclap headache means?

A

high intensity headache reaching max. intensity in less than 1 min- instantaneously

80
Q

hydrocephalus means?

A

raised CSF in brain - increased ICP

81
Q

HIGH PRESSURE headache symptoms? 3

A

headache wakens patient up
progressive focal symptoms
drowsiness

82
Q

papiloedmea is?

a result of what?

A

bilateral disc/optic nerve swelling from pressure from CSF behind eye (as a result of increased ICP)

83
Q

3rd ventricular colloid cyst presents as?

A

sudden headache(raised icp) and loss of consciousness

84
Q

intracranial hypotension common cause?

the cause this leads to?

A

post lumbar puncture

leaves hole, fluid leaks out - when standing CSF holds it up - but less fluid means brain sinks down

85
Q

giant cell arteritis? what is it

A

inflamed large arteries - cranially

86
Q

giant cell arteritis - features to look out for?

A
  • beaded/enlarged temporal arteries

- A NEW headache IN OVER 50YRS

87
Q

ENCEPHALITIS?

A

inflammation/infection of brain substance

88
Q

triad of meningitis symptoms?

and others?

A

fever
neck stiffness
altered mental status

nausea / vomiting
rash
sensitive to light

89
Q

organisms(bacterial/viral) causing meningitis?

A

N. meningitides
strept. pneumoniae

enteroviruses

90
Q

common cause of encephalitis?
(e.g.2)

other cause?

A

viral -
herpes!
entero

autoimmune encephalitis

91
Q

contraindication of lumbar puncture? 3

A

when impending cerebral herniation - due to abnormal ICP
on anticoagulants
if SOL

92
Q

BRAIN ABCESS
causes?
treatment?

A

streptococci organism
anaerobes

surgical drain

93
Q

HIV can cause what to brain?

A

can cause brain infections with patients who have low CD4 cell count

94
Q

microbe cause of Lyme disease?

A

borrelia. B

95
Q

Lyme disease?

A

tick spreading/bite

96
Q

neurosyphilis?

cause?

A

bacterial infection affecting brain
treponema pallidum
spread by sexual activity

97
Q

streptococci - gram positive or negative?

A

positive

98
Q

CJD disease?
caused by?

types of CJD?

A

BRAIN DISORDER CAUSED BY INFECTIOUS prion protein

which build up in level in brain tissue -

SPORADIC - unkown trigger/random

VARIENT - from cattle disease(mad cow) or genetic mutation

99
Q

dementia what is happening physiologically?

A

damage to nerve cells and loss of connections between

100
Q

causes of dementia? 4

A

alzheimers disease
vascular - damage to bv supplying brain
frontotemporal - breakdown of nerves in frontal/temporal region
Lewy body

101
Q

Lewy body?

A

abnormal balloon like protein clumps found in brain

102
Q

pathology of Alzheimers?

A

beta-amyloid plaques and neurofibrillary tangles in brain cortex -leading to loss of neurones and synapses

103
Q

how is depression and dementia associated?

A

depression can be a symptom of dementia

104
Q

medication used in Alzheimers? and explain their actions 2

A

cholinesterase inhibitors - increase nt in synapses
e.g.-donepezil

NMDA ANTAGONIST - memantine - regulates glutamate chemical messenger in brain function

105
Q

main SYMPTOMS OF PARKINSONS? 4

A

bradykinesia - slowed movements
rigidity -stiff muscles
tremor
postural instability

106
Q

pathology of Parkinson’s? 2

A

in basal ganglia

lack of dopamine and presence of Lewy bodies

107
Q

unilateral or bilateral -parkinsons?

A

unilateral -one side then spreads on both sides

108
Q

what scan can be used to see dopamine?

A

dopamine transport scan - spect

109
Q

medications of PARKINSONS? 4

A

LEVODOPA - replace dopamine

COMT inhibitor - prevents levodopa breakdown -prolongs action

MAO-B inhibitor - prevent breakdown of dopamine

dopamine agonists - stimulate dopamine receptor

110
Q

later complications of parkinson?

A

drug induced

levodopa wears off 
leads to dyskinesias - involuntary muscle movements 
and psychiatric (hallucinations)
111
Q

way to deal with drug induced complications of levodopa?

A

use of -
MAO-B inhibitor
COMT inhibitor
slow release levodopa

medications given are time critical - to prevent wear off

112
Q

level of consciousness measured by?

A

how aware and awake you are

113
Q

reasons for decreased gcs? 3

A

seizures
raised icp
toxic/metabolic states - hypoxia/hypoglycaemia

114
Q

glasgow coma scale?

A

3-15

eye opening response
verbal response
motor response

to pain

115
Q

GCS FOR COMA?

A

less than or equal to 8

116
Q

coma causes? 3

A
  • toxic metabolic - hypoxia/ischameic
  • infection - meningitis/encephalitis
  • focal cerebral/tumour
117
Q

what is a stroke?

A

when bv to brain ruptures or bleeds or blockage MORE THAN 24HRS

118
Q

2 types of strokes?

A

ischaemic - clot stops blood supply to brain

haemirragic - blood leaks into brain

119
Q

tia?

A

mini stroke

less than 24hrs and resolves itself

120
Q

risk factors of stroke? 7

A 
AF 
SMOKING 
DIET 
alcohol 
diabetes 
high bp 
genetic
121
Q

basilar artery stroke?

A

ischameia to pons/brianstem

122
Q

hoover sign?

A

testing for leg muscle weakness etc

123
Q

difference between haemorragic/ischameic stroke treatment?

A

ischaemic - remove clot

haemorragic - make blood clot

124
Q

warfarin is what?

A

anti-coag

stop blood to clot

125
Q

which layer of meninges does csf sit?

A

subarachnoid

126
Q

normal levels of protein, glucose, WCC in csf fluid?

A

protein less than 0.45
glucose around 3
WCC less than 3

127
Q

what things are present in csf?

A 
electrolytes - sodium/potassium etc 
protein 
WCC 
glucose 
pH neutral
128
Q

2 MAIN REASONS OF HYDROCEPHALUS?

A
  • block prior to reabsorption - like obstruction in cerebral aqueduct
  • defect in reabsorption by AG
129
Q

ADUEDUCT STENOSIS LEADS TO?

A

hydrocephalus

130
Q

symptoms of hydrocephalus?

A

symptoms of raised ICP
papilloedmea
headache
nerve palsy - abducens - diplopia

131
Q

what balance is kept between what in intracranial cavity? 3

A

balance between
csf
blood venous channels
tissue

132
Q

how to measure ICP?

A

EVD into cranium

133
Q

is our ICP FIXED level in our bodies?

A

no it fluctuates based on response and pulse rate and activatty

134
Q

ICP AND MAP what they do to cerebral flow?

A

MAP - mean arterial pressure pushes blood into brain

ICP - resisting blood into brain

135
Q

CPP?

=?

A

CEREBRAL PERFUSION PRESSURE

=MAP-ICP

136
Q

auto regulation of brain means?

how does it do it? 4 mechanisms

A

ability of brain to maintain constant blood flow in spite pressure fluctuations

  • autonomic innervation - para/symp. - vasodiltion/constriction
  • endothelial mechanisms - sense pressure in vessel and vasodilation/C
  • myogenic auto regulation - muscles in vessels - sense stretch - AND RESPOND
  • metabolic - vasodilate/constrict - cause influence on vessels
137
Q

what nerve palsy associated with raised icp?

A

6th nerve palsy - abducens

or third nerve palsy oculomotor

138
Q

ataxia is seen - where is lesion?

A

cerebellum

139
Q

meningioma? benign/malignant? where?

A

benign

140
Q

mannitol used for?

A

to reduce ICP/ pressure

141
Q

nystagmus seen - where is lesion in brain?

A

cerebellum

142
Q

cauda equina syndrome is?

unilateral/bilateral?

A

all nerves to lower back are compressed

bilateral

143
Q

radiculopathy means?

A

pain in single dermatome. -distrubance here

144
Q

head injury leads to what changes biochemically?

A

amino acid - glutamate increases

which causes increase in Ca influx

this is neurotic which lead to oedema

145
Q

head injury leads to what changes biochemically?

explain pathway to oedema

A

amino acid - glutamate increases

which causes increase in Ca influx

this is neurotic which lead to oedema and swelling

146
Q

nitrous oxide in head injury effects?

A

NO is produced by neurons and cells which have neurotoxic effects - cell injury

147
Q

contusions of brain are associated with areas of what?

WHICH RESULT IN?

A

haemorrhage and lead to bleeding

to raised ICP

148
Q

EXTRADURAL HEAMORRAGE SHAPE?

A

LENS SHAPE - EGG

149
Q

SUBDURAL HAEMORRAGE SHAPE?

A

MOON SHAPE

150
Q

MOST COMMON CAUSE of intracranial haemorrhage?

A

hypertension

151
Q

muscle wastinG in UMN?

A

no only in LMN

152
Q

FASCULITATIONS SEEN IN UMN/LMN?

A

IN LMN

153
Q

SUBARACHNOID - WHERE IS HAMEORRAGE FROM?

A

aneurysm anywhere in circle of willis

154
Q

functional neuro disorder?

A

where there is problem with functioning - like how brain sends/recieves signals - not structural - stroke/ms

DOING PART AFFECTED

155
Q

what is cognition?

what part of brain?

A

higher level activity - enables us to learn, comprehend, communicate, understand etc

involves a lot of areas of brain working together to bring it about

156
Q

mini mental state examination?

what is it?

A

screening tool for cognition checking

not accurate tool - lacks sensitivity and distinguishing etc

157
Q

montreal cogntive assessment?

A

assess cognition -see if any impairment
bed side
brief screen

158
Q

addenbrookes cognitive assessment?

A

to assess cognition impairment
long screen
good at distinguishing disorders
most useful screen

159
Q

cognitive screens?

A

useful tool but limited

160
Q

most common symptom of MS?

then name others

A

OPTIC NERUTITIS

ophthalmoplegia - weakness of eye muscles
diplopia
tremor etc

161
Q

treatment for MS relapses? 2

A

disease modifying treatment for reducing number of relapses

or steroid to help recovery from relapse

162
Q

complication of sinusitis?

A

brain abcess

163
Q

N.meningitidis is what type of organism?

A

gram negative diplococci

164
Q

meningoencephalitis associated with what condition?

A

mumps

165
Q

Gillian barre syndrome?

what is it?
what it affects?

A

immune mediated demyelination of peripheral nerves triggered by infection - motor and sensory affected

peripheral neuropathy

166
Q

what investigations to carry out in Myasthenia gravis?

A

antibody tests

167
Q

what is reuse from Babinski test in UMN?

A

POSITIVE

168
Q

cauda equina syndrome?

A 
lmn lesion 
muscle weakness 
lower back pain 
bladder disturbance 
saddle anaesthesia
169
Q

saddle anaesthesia?

A

loss of sensation in buttons and around that region

NERVOUS (5 decks)

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