Pre-placement/Week one cases Flashcards
What 10 factors would typically be considered in a neurological systems review? It may help to go top to bottom)
1) Headaches
2) Fits, faints and “funny turns”
3) Memory problems
4) Altered vision
5) Hearing difficulties
6) Speech swallowing difficulties
7) Weakness
8) Numbness/tingling
9) Balance or co-ordination difficulties
10) Incontinence or erectile dysfunction
What type of headache can be characterized as a tight band like sensation precipitated by stress?
Tension headache
What type of headache characteristically involves photophobia, neck stiffness and fever?
Meningitis headaches
What type of headache can be characterized by a brief stabbing pain when brushing teeth or chewing?
Trigeminal neuralgia
What type of headache can be characterized with a suddenly appearing excruciating headache?
headache resulting from a subarachnoid haemorrhage
What type of headache can be characterized by its associated facial tenderness and rhinorrhoea?
Sinusitis
What type of headache can be characterized by a unilateral pounding pain often preceded by an aura with multiple triggers that lasts for hours. Accompanied by an aversion to bright lights and loud noises
Migrane headache
What type of headache can be characterized by a 20 minute debilitating episode of retro-orbital pain with red, watering eyes?
cluster headaches
What type of headache can be characterized by a headache triggered by changes in position or by exertion where vision changes occur with leaning forward
Increased ICP
What type of headache can be characterized with pain around the eye, blurred vision with halos around lights?
Acute glaucoma
What type of headache can be characterized as unilateral with scalp tenderness and jaw claudication?
temporal arteritis
What cause of syncope is characteristically triggered by suddenly standing up
postural hypotension
What cause of syncope is characteristically triggered by fear, pain micturation or prolonged standing. Preceded by pallor, nausea or sweating. No associated confusion
vasovagal syncope
What type of syncope is associated with chest pain breathlessness and collapse on exertion
aortic stenosis
What cause of syncope is characteristically triggered by vigorous exercise in a young person
Hypertrophic cardiomyopathy/Cardiogenic syncope
What type of syncope is typically preceded by palpitations or chest pain beforehand and associated with a family history of sudden unexplained death
Arrhythmia/Cardiogenic syncope
What cause of syncope is characteristically triggered by shaving or turning of the head
Carotid sinus hypersensitivity
What type of seizure is typically characterised as being told off by teachers for day dreaming
Absence seizures
What type of seizure typically starts with crying out falling to the floor with a period of stiffness followed by rhythmic jerking that gradually decreases in amplitude and frequency , with a period of confusion that lasts for 30 minutes after
Generalised tonic-clonic seizure
What type of seizure is characterized by a patient being pale and sweaty beforehand, jerking of limbs eyes rolled back with a short duration and no confusion after
Vasovagal syncope
What type of seizure is characterized by violent shaking, head moving side to side, arching back, episodes of stillness before starting again. With forced eye closure
Psychogenic non epileptic attack
What type of seizure is characterized by early morning twitching
Early morning myoclonus
What is the most likely cause for a lower motor neuron facial weakness?
idopathic
What is Ramsay hunt syndrome? What does it need to be distinguished from?
A herpes zoster/shingles infection of the geniculate ganglion of the facial nerve that often causes painful vesicles affecting the external ear and occasionally the face. It needs to be distinguished from bells palsy
Define 0 on the MRC muscle scale
No movement
Define 1 on the MRC muscle scale
Flicker of movement
Define 2 on the MRC muscle scale
Movement with gravity eliminated
Define 3 on the MRC muscle scale
Movement against gravity but not against resistance
Define 4- on the MRC muscle scale
Slight movement against resistance
Define 4 on the MRC muscle scale
Moderate movement against resistance
Define 4+ on the MRC muscle scale
Submaximal movement against resistance
Define 5 on the MRC muscle scale
Normal power
What is the typical CSF/lumbar puncture reading for Guillain Barre syndrome?
Cytoalbuminologic dissociation i.e. normal cell count but elevated protein level
In the case of a patient with suspected Guillain Bare syndrome complaining of worsening SOB what emergencies need to be considered (what questions need to be asked) and what features indicate this is related to GBS and why?
Chest infection and PE need to be considered. You need to ask about fever, sweats & sputum production and leg pain, swelling and redness respectively. If the breathing is worsened by lying flat this occurs most often in neuromuscular ventilatory failure due to a weak diaphragm and is thus indicative of GBS
What signs on examination might indicate Neuromuscular ventilatory weakness?
Worsening neck weakness, reduced chest excursion on deep inspiration, CO2 retention flap
