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Medicine Phase 2a Neuro > Peer-Teaching 3 > Flashcards

Peer-Teaching 3 Flashcards

1
Q

Example of descending spinal tract

A

Corticospinal

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2
Q

Example of ascending sensory tracts

A

Dorsal column

Spinothalamic

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3
Q

Where do each of these tracts decussate:
Corticospinal
Dorsal column
Spinothalamic

A

Corticospinal - medulla
Dorsal column - medulla
Spinothalamic - almost immediately in spinal cord

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4
Q

What sensation is carried by dorsal column

A

Proprioception, vibration and 2 point discrimination

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5
Q

What sensation is carried by spinothalamic tract

A

Pain and temperature (see other cards for anterior vs lateral)

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6
Q

At what vertebrae do you find the spinal cord

A

Cord extends for C1 (junction with medulla) to L1/2 (conus medullaris)

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7
Q

Where do you take a lumbar puncture

A

L4 (around)

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8
Q

Below L1, the lumbar and sacral nerve roots are grouped together to form what?

A

Cauda equina

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9
Q

What is paraplegia

A

Paralysis of BOTH legs always caused by spinal cord lesion

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10
Q

What is hemiplegia

A

Paralysis of one side of body caused by lesion of the brain

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11
Q

True or False:

Sensory loss usually means spinal cord disease

A

True

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12
Q

What is myelopathy

A

Compression of the spinal cord resulting in upper neuron signs and specific symptoms dependent on where compression is

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13
Q

Causes of myelopathy/spinal cord compression

A

Osteophytes, Disc prolapse (slower onset), Tumour (slow onset)

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14
Q

Signs of spinal cord compression

A

UMN signs

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15
Q

Ix of myelopathy

A

urgent MRI

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16
Q

Tx of myelopathy

A

Surgical decompression and dexamethasone

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17
Q

*Brown-sequard syndrome:

Clinical presentation at level of and below the lesion

A

Below lesion

  • Ipsilateral corticospinal dysfunction
  • Ipsilateral dorsal column dysfunction
  • Contralateral spinothalamic dysfunction

Level of lesion
-Ipsilateral spinothalamic dysfunction (localising sign)

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18
Q

Examples of peripheral neuropathies

A

Radiculopathy
Mononeuropathy
Polyneuropathy

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19
Q

What glial cells are found on cranial nerves

A

Schwann cells as they are peripheral

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20
Q

Describe radiculopathy

A

Compression of nerve root of a LMN

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21
Q

Risk factors of peripheral neuropathy

A 
DAVID:
Diabetes
Alcohol
Vitamin deficiency (B12) 
Infective (GB)
Drugs (isoniazid)
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22
Q

Example of polyneuropathy

A

Multiple/Systemic: diabetes, MS, Guillain Barre etc

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23
Q

Causes of peripheral neuropathies

A

compression, infarction, demyelination, axonal degeneration (lead), infiltration (leprosy)

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24
Q

Risk factors of carpal tunnel syndrome

A

Pregnancy, obesity, hypothyroidism, rheumatoid arthritis, acromegaly, gout

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25
Q

Aetiology of carpal tunnel syndrome

A

NOT repetitive strain injury, idiopathic

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26
Q

Presentation of carpal tunnel syndrome

A

Pain and paresthesia in hand (wake and shake-worse at night)
Loss of sensation Median nerve distribution (palm radial 3)
Wasting of abductor pollicis brevis – wasting of thenar eminence

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27
Q

Investigations of carpal tunnel syndrome

A

PHALENS
and
TINENLS

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28
Q

Treatment of carpal tunnel syndrome

A
  1. conservative: pain relief, split at night
  2. hydrocortisone injection
  3. surgical decompression
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29
Q

What is sciatica

A

L5/S1 lesion = S1 NERVE ROOT COMPRESSION = SCIATICA

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30
Q

Presentation of sciatica

A

Sensory loss/pain in back of thigh/leg/lateral aspect of little toe (essentially in the sciatic nerve distribution)

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31
Q

Causes of sciatica

A

Disc prolapse, Osteoarthritis

treatment is conservative

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32
Q

Ix of sciatica

A

MRI urgent

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33
Q

What is cauda equina syndrome

A

Lesion at or below L1

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34
Q

Causes of cauda equina syndrome

A

Tumours, disc herniation, trauma can cause the compression

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35
Q

Signs of cauda equina syndrome

A

Lumbosacral pain (early), Saddle anesthesia (Do PR), areflexia, fasciculations, Loss of bowel / bladder control, urinary retention (late)

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36
Q

Ix of cauda equina syndrome

A

MRI Spine

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37
Q

Tx of cauda equina syndrome

A

Surgical decompression, high dose dexamethasone

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38
Q

Red flags of cauda equina syndrome

A 
Bilateral sciatica
Bilateral flaccid leg weakness
Saddle anesthesia
Bladder and bowel dysfunction
Erectile dysfunction
Areflexia
39
Q

Quantitive value of raised ICP

40
Q

Signs of raised ICP

A

headache, reduces GCS, vomiting, Pupillary changes, Seizures

41
Q

Features of presentation of ICP

A

Worse in the morning
Made worse by coughing, straining/ bending forward
If prolonged ICP= papilledema, falaring around the optic disc due to obstruction of the venous return form the retina

42
Q

Why is pain in morning from raised ICP worse in morning

A

CSF redistribution when laying flat= increased pressure around the brain

43
Q

Ix of raised ICP

A

Do a head CT and ophthalmology review

44
Q

Tx of raised ICP

A

Mannitol
Surgical (shunt/decompression)
Dexamethasone (tumour)

45
Q

Aetiology of Myasthentia gravis

A

AUTOIMMUNE IgG autoantibodies attach postsynaptic acetylcholine nicotinic receptors at NMJ
Associated with a thymic tumour in 10%

46
Q

Presentation of myasthetia gravis

A

– Characterized by Muscle WEAKNESS AND FATIGABILITY of ocular, bulbar and proximal limb muscles
–Ptosis, talking and chewing problems, swallowing (worse at the end of the day) (can affect any muscle variably)
(Lots of drugs can aggravate Myasthenia Gravis: BBs, Lithium, Some antibiotics)

47
Q

Ix of myasthentia gravis

A

Bedside– count to 50 / keep your arm outstretched
Anti-AChR antibodies in blood (Can also have Anti-MuSK antibodies)
Electromyography – fatigability
CT/MRI – thymus hyperplasia (thymoma)
Tensilon test (rarely performed)

48
Q

Tx of myasthentia gravis

A

1st= Pyridostigmine (acetylcholinesterase inhibitor) + Prednisolone/ azathioprine (Immunosuppression)
2nd= methotrexate/ cyclosporine etc
In crises – IV immunoglobulin, Plasmapheresis
Thymectomy

49
Q

Signs of Duchene Muscular Dystrophy

A

Awkward manner of running with frequent falls & more easily fatigued- Difficulty with motor skills e.g. running & jumping

50
Q

Most common bacterial cause of meningitis

A

Strep pneumoniae

51
Q

Bacteria causing meningitis with worst prognosis

A

Neisseria meningitis

52
Q

Presentation of meningitis (bacterial)

A

Meningisms: fever, headache, stiff neck, photophobia
Fever , +ve kernig’s sign, Brudzinski’s
Non-blanching plupurent rash = meningococcal septicaemia
TREAT FIRST, INVESTIGATE LATER

53
Q

Ix of bacterial meningitis

A

LP and CSF analysis (protein, colour, glucose)
Head CT (If other signs such as papilledema or seizures
Bloods (FBC, culture ect…)

54
Q

Tx of bacterial meningitis

A

GP/community – IM Benzylpenicillin
Hospital – IV cefotaxime (add amoxicillin for listeria cover)
Contacts - Rifampicin, men C vaccine

55
Q

What is Kernigs sign

A

Patient supine with hip flexed 90 degrees

Knee cannot be fully extended

56
Q

What is Brudzinskis sign

A

Neck rigidity

Passive flexion of neck causes flexion of both legs and thighs

57
Q

What is encephalitis

A

Infection of the actual brain parenchyma

Cerebral fluid is often altered (unlike meningitis)

58
Q

Presentation of encephalitis

A

Tends to affect immunocompromised
Can be viral or bacterial (Herpes Simplex Virus is dangerous)
Early symptoms: fever, headache, lethergy, behavoral change
Late symptoms: focal signs, seizures, coma

59
Q

Ix of encephalitis

A

LP (lumbar puncture) = raised lymphocytes, Bloods, Blood Culture, Viral PCR, CT Head

60
Q

Tx of encephalitis

A

immediate high dose I.V acyclovir

61
Q

Risk factors for reactivation of herpes zoster

A

Old age, poor immune system, chickenpox < 18 months age

62
Q

Signs of herpes zoster

A

Dermatomal distribution of rash and pain

63
Q

Tx of herpes zoster

A

Oral acyclovir

64
Q

Pathology of herpes zoster

A

Viral infection affecting peripheral nerves
When latent virus is reactivated in the dorsal root ganglia it travels down theaffected nerve via the sensory root in DERMATOMAL DISTRIBUTION over a period of 3-4 days
Resulting in perineural and intramural inflammation

65
Q

In immunocompromised patients, where is the most common site of reactivation of herpes zoster

A

thoracic nerves followed by the opthalmic division of the trigeminal nerve

66
Q

What is Gullian-Barre syndrome

A

Inflammatory, demyelinating, polyneuropathy in the peripheral nervous system

67
Q

Aetiology of Gullain-Barre syndrome

A

Campylobacter jejuni (also EBV, CMV, HIV, mycoplasma)

68
Q

Sx of Gullain-Barre syndrome

A

Progressive ASCENDING (Distal → Proximal) MUSCLE WEAKNESS FOLLOWING VIRAL ILLNESS (hours/days)
Can be motor and sensory! “walking on rubber”
Loss of reflexes
Vary from mild to severe
Severe can cause respiratory depression

69
Q

Ix of Gullain-Barre syndrome

A

Mainly clinical diagnosis
LP (lumbar puncture) - ↑ protein in CSF, WCC normal, nerve conduction studies
(Vital capacity should be monitored if suspected Respiratory involvement)

70
Q

Tx of Gullain-Barre syndrome

A

IV Ig, Ventilation is respiratory muscles involved, NO STEROIDS

71
Q

What is Creutzfeldt-Jakob disease (also pathology)

A

A neurodegenerative prion disease
Spongiform encethaoplthy and extensive prion protein deposition with florid plaques in the cerebrum and cerebellum
Protein responsible for copper uptake in neurons misfolded → misfolded protein acts as template and causes others to misfold → apoptosis of neurons → cysts and plaques form in the brain giving it a sponge like appearance.

72
Q

Epidemiology of CJD

A

Mainly affects 55-75 years old (1 in 1 million)
Casus: 85%= idiopathic, 14%= gene mutation, 1%= iatrogenic (via contaminated blood transfusion/ unclean surgical instruments)

73
Q

Sx of CJD

A

Ataxia, poor memory, behavioral changes, muscle weakness, myoclonus, dementia

74
Q

What is vCJD

A

Variant Creutzfeldt-Jakob disease (mad cow disease)

75
Q 
Which of these is NOT a red flag for cauda equina syndrome?
Saddle anaesthesia
Urinary incontinence
Areflexia
Loss of bowel control
A

Urinary incontinence

76
Q 
Which is not characteristic of inflammation of the meninges:
Neck stiffness
Photophobia
Headache
Non-blanching rash
A

Non-blanching rash

77
Q

Lesion in left meyers loop, what is the field defect

A

Superior temporal Hemianopia

78
Q 
Child comes into GP, has fever, neck stiffness, non-blanching rash, immediate treatment?
IM Benzylpenicillin
IV Benzylpenicillin
IV cefotaxime
Oral Rifampicin
A

IM Benzylpenicillin

79
Q 
Patient has a raised ICP, fever and cough - which is least appropriate
Ophthamology review
LP
Head CT
Blood culture
80
Q 
Which of these is not a contraindication for thrombolysis
Patient on warfarin
Patient cured from brain cancer
Knee replacement 2 months ago
Patient with DM
A

Patient with Diabetes M

81
Q 
Which of these is a distinguishing feature of epilepsy to syncope
Loss of bladder function
Biting tongue
Patient experiences an aura
Sudden
82
Q 
Man, RTA, 3 weeks later presents to A+E, nausea+vomiting+no fever - diagnosis?
Subdural
Meningitis
Normal pressure hydrocephalus
Extradural
83
Q 
Involuntary, jerky movements, face and hands progressing proximally.
Ix + Tx?
CT + Thrombolysis
EEG + Sodium valproate
CT+ Sodium valproate
EEG + Carbamazepine
A

EEG + Carbazepine

84
Q 
Seizure: Whole body becomes rigid, post-ical myalgia - Diagnosis?
Tonic-clonic
Tonic
Myoclonic
Frontal lobe
85
Q 
Female, unilateral headache 12 hours - most likely diagnosis?
Tension
Cluster
Migraine
Trigeminal neuralgia
86
Q

Number of CAG repeats to be diagnostic of Huntingtons

87
Q

Which symptom of Parkinsons is not treated by a dopamine promoting drug

88
Q 
For which of these conditions would baclofen be a useful treatment?
Parkinsons
Epilepsy
Huntingtons
MS
89
Q

Alert patient with glioma has memory loss and is not responding to commands - where is the tumour (which lobe)?

A

Temporal lobe

90
Q 
Which of these primary tumours can metastasise to brain but not bone:
Breast
Stomach
Kidney
Thyroid
91
Q 
A patients eye movements are slower and jerker than normal, which diagnosis can be excluded?
MND
MS
Myasthentia gravis
Myopathy
92
Q 
In acute tension headache, which is the least useful treatment?
Ibuprofen
Sumatriptan
Aspirin
Amitriptyline
A

Sumatriptan

93
Q 
MND patient: has reduced tone in arms and down going planters, where are his lesions?
UMN
LMN
UMN+LMN
Cranial nerve nuclei
94
Q 
Patient presents to A+E with acute epigastric pain - what type of headache could she be suffered from:
Tension
Cluster
SAH
Trigeminal neuralgia

Medicine Phase 2a Neuro (28 decks)

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