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Medicine Phase 2a Neuro > Peer-Teaching > Flashcards

Peer-Teaching Flashcards

1
Q 
75yr old male
Sudden onset weakness in left arm, slurred speech and L sided facial droop
Resolved in 15 minutes
Smokes 10/day for 30 years
Most likely diagnosis
A

Transient Ischaemic Attack

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2
Q

Define Transient Ischaemic Attack

A

focal, sudden onset, neurological deficit lasting <24hrs, with complete clinical recovery

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3
Q

Causes of TIA

A

Thromboembolism from carotids
Cardioembolism
Hyperviscosity e.g. polycythaemia

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4
Q

What is amaurosis fugax

A

Emboli passes into retinal artery

A curtain descending over my field of vision’

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5
Q

Investigations of TIA

A

ABCD2- Risk score of a stroke
Carotid Doppler- stenosis
CT angiography- stenosis

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6
Q

Treatment of TIA

A 
Modifiable Risk Factors- stop smoking/alcohol, exercise, diet
Aspirin immediately
Clopidogrel
Statin- simvastatin 
Treat BP- Beta Blocker or ARB
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7
Q 
80yr old female
Sudden onset R arm weakness, sensory loss in R arm, difficulty speaking and swallowing
Present for >5hrs with no improvement
PMH: AF, Hypertension, Diabetes
Diagnosis?
A

Stroke

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8
Q

Define stroke

A

Rapid onset of neurological deficit caused by focal, cerebral, spinal or retinal INFARCTION

Rapidly developing signs of focal or global disturbance of cerebral functions, lasting for more than 24HRS or leading to death

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9
Q

Signs and symptoms of MCA stroke

A

Motor Weakness, Hemiplegia
Sensory disturbances
Receptive and Affective Aphasia

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10
Q

Signs and symptoms of ACA stroke

A

Frontal Lobe
Drowsiness
Logical thinking
Personality

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11
Q

Signs and symptoms of PCA stroke

A

Contralateral Hemianopia

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12
Q

Initial investigation of stroke

A

CT scan

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13
Q

Medical Treatment of ischaemic stroke

A

Throbolysis- IV Altepase

Aspirin for 2 wks then clopidogerol

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14
Q

Medical treatment of haemorrhagic stroke

A

Control BP- Beta Blocker/ ARB
Beriplex if warfarin related
Surgery- Clot evation

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15
Q

Conservative treatment of stroke

A

Rehabilitation- Physio, OT

Modifiable Risk Factors- Stop smoking/alcohol, exercise

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16
Q 
50 Year old male
Local shopping
Sudden sharp pain- ‘Feels like he has been kicked in the back of the head’
Neck stiffness
Feels systemically fine
Diagnosis
A

Subarachnoid Haemorrhage

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17
Q

Give example of BV in extradural layer

A

Middle Meningeal Artery

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18
Q

Give example of BV in subdural layer

A

Bridging veins

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19
Q

Give example if BVs in subarachnoid layer

A

Circle of Willis

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20
Q

Main cause of subarachnoid haemorrhage

A

Berry aneurysm

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21
Q

What is a subarachnoid haemorrhage

A

Spontaneous bleed in subarachnoid space

Rupture of artery so raised ICP

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22
Q

What is result of raised ICP

A

Lower consciousness

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23
Q

Signs of subarachnoid haemorrhage

A

Kernigs and Bradzini sign

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24
Q

Ix of SAH

A

CT scan

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25
Q

Tx of SAH

A

Neurosurgeon

26
Q

Causes of subdural haemorrhage

A

RTA

Metastasis cause rupture

27
Q

Pathophysiology of subdural haemorrhage

A

Rupture of bridging veins
Few weeks/months later
Haematoma formation -> Hyperosmotic so draws water from the brain
Raised ICP and midline shift

28
Q

Clinical presentation of SDH

A

Fluctuating consciousness

Headache

29
Q

Ix of SDH

A

CT scan - Sickle shaped, crescent shaped collection of blood

30
Q

Tx of SDH

A

Neurosurgeon - Irrigation

IV Mannitol

31
Q

True or False:

Extradural haemorrhage is a medical emergency

A

True

32
Q

Cause and pathology of extra dural haemorrhage

A

Head injury -> Fracture in temporal/parietal bone -> Rupture of the middle meningeal artery
Rapid collection of blood in extradural space

33
Q

Signs of extradural haemorrhage

A

Decrease consciousness, Signs of raised ICP

34
Q

Complication of EDH

A

Tentornial herniation - death of respiratory arrest

35
Q

Ix of EDH

A

CT scan- biconvex hypodense haematoma

36
Q

Tx of EDH

A

Neurosurgery- irrigation, IV Mannitol

37
Q

Clinical diagnosis of epilepsy

A

2 or more unprovoked seizures with >24hrs apart

38
Q

Define seizure

A

The recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain due caused by excessive, hypersynchronous neuronal discharges

39
Q

Type of epilepsy seizures

A

Generalised

Partial/focal

40
Q

What is Generalised seizure

A

Affects whole cortex with no localising features to one hemisphere

41
Q

What is partial seizure

A

Focal onset with features referred to a lobe

42
Q

Types of generalised seizures

A 
Tonic-clonic
Absence seizure
Myoclonic
Tonic
Atonic
43
Q

Describe generalised tonic-clonic seizure

A

No prodrome or aura.
Tonic Phase- Rigidity ->
Clonic Phase- Rhythmic muscle jerking (seconds to minutes).
Post-ictal- Drowsiness, confusion and coma

44
Q

Describe generalised absence seizure

A

Typically childhood, stops talking mid-sentence- carry on where left off

45
Q

Describe generalised myoclonic seizure

A

Sudden isolated jerk of limb, face or trunk. May be thrown to the ground

46
Q

Describe generalised tonic seizure

A

Sudden sustained stiffening of the body.

Not followed by jerking

47
Q

Describe generalised atonic seizure

A

Sudden loss of muscle tone and cessation. Fall

48
Q

Types of partial seizures

A

Depends on lobe affected

49
Q

Purpose of temporal lobe

A

Memory, Emotion and Receptive speech

50
Q

Describe partial seizure of temporal lobe

A

Aura- Deja-vu, auditory hallucinations, funny smells

Out of body experience, automatisms e.g. lip smacking, chewing, fiddling

51
Q

Purpose of frontal lobe

A

Motor and Thought Processing

52
Q

Describe partial seizure of frontal lobe

A

Jacksonian march - seizure “marches” up or down the motor homunculus starting in face or thumb
Post-ictal Todd’s palsy - paralysis of limbs involved in seizure for several hour

53
Q

Purpose of parietal lobe

A

Sensory disturbances

54
Q

Describe partial seizure of parietal lobe

A

Tingling/numbness

55
Q

What is Todd’s palsy

A

Paralysis of limbs involved in seizure for several hour

Due to focal seizure of temporal lobe

56
Q

Investigations of Epilepsy

A

EEG (electroencephalogram)

57
Q

Tx of epilepsy:
Emergency
Generalised
Partial

A

Emergency (Status Epilepticus)- IV Lorazepam
Generalised- Sodium Valporate, Lamotrigine
Partial/Focal- Carbamezapine

58
Q

List the differences between dementia or delirium

A 
Dementia:
Onset - Insidious (months to years)
Course - Progressive
Duration - months to years
Consciousness - Normal unless severe
Causes - Disorder
Delirium:
Onset - Acute (hours to days)
Course - Fluctuating
Duration - hours to weeks
Consciousness - Altered
Causes - Stroke, Metabolic, Infective etc
59
Q

What is dementia

A

A syndrome that causes memory loss, difficulties with thinking, problem-solving, language and ADL’s

60
Q

Diagnosis of dementia

A

Clinical diagnosis

MMSE- <17/30 serious cognitive impairment

61
Q

Treatment of dementia

A

Healthier Lifestyle
Social Support
Acetylcholinesterase Inhibitor (e.g Rivastigmine)
Control CV Risk Factors

Medicine Phase 2a Neuro (28 decks)

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