Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3 MedEd > Rest of acute neuro > Flashcards

Rest of acute neuro Flashcards

1
Q

A 62-year-old woman presents back pain and difficulty walking. On examination there is increased tone and hyper-reflexia in both legs. She has not opened her bowels or passed urine for the previous day. She has a past medical history of breast cancer, diagnosed two years earlier. Which is the most likely diagnosis?

A

Spinal cord compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A 20-year-old woman presents with pins and needles in both legs. Her symptoms rapidly progress over 4 days to include lower extremity weakness to the point that she is unable to mobilise her lower extremities. She reports gastrointestinal symptoms 2 weeks ago. Lumbar puncture reveals mildly elevated protein with no cells and normal glucose.Given the most likely neurological diagnosis which organism is most likely to have caused the gastroenteritis?

Salmonella
Campylobacter Jejuni
E. Coli 0517
Rotavirus
Entamoeba histolytica
A

Campylobacter jejuni

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define GBS

A

Acute autoimmune demyelinating polyneuropathy

affecting the PNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the pathophysiology of GBS

A

AI process attacking myelin sheath or Schwann cells in sensory and motor peripheral nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cause of GBS?

A

Unknown but 2/3rds preceded by an URTI or gastroenteritis 2-3 weeks previously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which type of cell produces myelin

A

Schwann cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the viral causes of GBS (5)

A

CMV, EBV, HepB/C, HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the bacterial causes of GBS (2)

A

campylobacter jejuni, mycoplasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the triad in Miller-Fischer syndrome and the one thing it is without

A

ophthalmoplegia, areflexia & ataxia but NO muscle weakness. In Miller-Fisher syndrome there are antibodies against a specific ganglioside (GQ1b)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the triad of: ophthalmoplegia, areflexia & ataxia but NO muscle weakness known as

A

Miller-Fischer syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Signs of GBS (4)

A

Hypotonia
Flaccid paralysis ( = weakness/paralysis & ↓ muscle tone)
Altered sensation/numbness
Fasciculations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Symptoms of GBS (6)

A

Peripheral neuropathy
Progresses acutely
Ascending paraesthesia & pain
Symmetrical limb weakness
Can also cause facial nerve palsy
Can also have autonomic symptoms (urinary retention, ileus)
If this progresses to resp. paralysis, patients might need ventilatory support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ix for GBS (4)

A

Nerve conduction studies
Lumbar puncture
Spirometry
Bloods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How often should you perform spirometry in a GBS patient

A

Every 6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do you see in the nerve conduction study of a GBS patient

A

Decreased nerve conduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do you see in the lumbar puncture of a GBS patient (3)

A

Albuminocytological dissociation (a hallmark of demyelinating polyneuropathies)
↑ protein (reflects CNS inflammation)
normal glucose & cell count (due to no infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are you looking for in the bloods of a GBS suspected patient

A

Anti-ganglioside AB’s (Miller-Fischer variant)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which AB is present in Miller-Fischer variant GBS

A

anti-ganglioside

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define hydrocephalus

A

Excessive accumulation of CSF in the ventricular

system in the brain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Epidemiology of hydrocephalus

A 
Bimodal distribution (affects the young & 
elderly)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pathophysiology of hydrocephalus

A

Bc you have excess CSF, the ICP increases. CSF also permeates through the ependymal lining into the periventricular white matter. This results in white matter damage and gliotic scarring.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the difference between a communicating and non-communicating hydrocephalus

A

Non-communicating
/Obstructive - Caused by CSF flow obstruction

Communicating
↓ absorption, ↑production of CSF

23
Q

What is a normal pressure hydrocephalus

A

Idiopathic chronic ventricular enlargement but without significantly elevated CSF pressure measured via lumbar puncture

24
Q

What is a hydrocephalus ex vacuo

A

ventricular expansion 2ary to to compensate for brain atrophy (eg in AD)

25
Q

What are the four types of hydrocephalus

A

Communicating
non-communicating
normal pressure
ex vacuo

26
Q

Causes of non-communicating hydrocephalus (5)

A

Stenosis of the cerebral aqueduct
Stenosis of the interventricular foramina
Lesions in 3rd, 4th ventricle
Posterior fossa lesions (tumour, blood) compressing the 4th ventricle
These cause an obstruction in the flow of the CSF flow

27
Q

Causes of communicating hydrocephalus (3)

A

Tumours
Meningitis (typically TB)
Normal pressure hydrocephalus

28
Q

What is a communicating hydrocephalus

A

: the problem is outside the ventricular system – for example, it can be due to reduced absorption or blockage of the venous drainage system or due to increased CSF production

29
Q

Acute onset presentation of hydrocephalus (4)

A

Nausea & vomiting
Headache
Papillooedema

30
Q

Chronic onset presentation of hydrocephalus (4)

A

Cognitive impairment
Unsteady gait
Double vision
CN palsies

31
Q

Normal pressure hydrocephalus presentation (3)

A

Cognitive impairment
Gait apraxia
Hyperreflexia

32
Q

Hydrocephalus Ix (2)

A 
CT/MRI Head – 1st line
Ventricular enlargement
Might show the cause (eg tumour)
CSF analysis
From ventricular drain
May show infection
33
Q

What must you assess before a LP

A

ICP

34
Q

What is a radiculopathy

A

Compression of a nerve root as it exits the spinal cord

35
Q

Causes of spinal cord compression (7)

A 
Trauma
Tumours
Osteoporosis, Corticosteroid Tx
Osteomalacia,
Osteomyelitis
Intervertebral disc disease  (disc herniation)
36
Q

Presentation of spinal cord compression (motor 3, sensory 2, autonomic 3)

A

Motor
Limb weakness (hemiplegia/paraplegia)
UMN symptoms below the level of the lesion
LMN symptoms at the level of the lesion

Sensory
Sensory loss below a specific level
Back pain

Autonomic
Constipation
Urinary retention
Erectile dysfunction

37
Q

Ix for cord compression (8)

A

MRI or CT (MRI is Definitive)
Bloods - FBC, U&Es, calcium, ESR, immunoglobulin
electrophoresis (multiple myeloma)
Urine - look for Bence Jones proteins (multiple myeloma)

38
Q

What do you look for in the urine in multiple myeloma

A

Bence Joyce proteins

39
Q

What is a Bence Joyce protein

A

Protein found in urine in MM

40
Q

What do you do to investigate MM (2)

A

Urine Bence Joyce protein and Ig electrophoresis

41
Q

Define cauda equina syndrome

A

Lumbosacral nerve roots that form the cauda

equina in the spinal canal become compressed

42
Q

Causes of cauda equina (3)

A

Lumbar disc herniation
Tumours
Epidural abscess

43
Q

Presentation of cauda equina (4)

A

LMN symptoms
Perianal anaesthesia
Bladder retention
Leg weakness

44
Q

What is sciatica

A

Lumbosacral nerve root impingement

45
Q

Presentation of sciatica (motor and sensory)

A

Motor: LMN symptoms for the muscles innervated by this spinal root
Sensory: DERMATOMAL pattern
Pain, numbness

46
Q

Causes of radiculopathy (5)

A

Degenerative disc disease, osteoarthritis, spondylolisthesis, tumours, infection

47
Q

Define spondylolisthesis

A

forward displacement of a vertebra on the one below producing pain by compression of the nerve roots

48
Q

What is forward displacement of a vertebra on the one below producing pain by compression of the nerve roots known as

A

Spondylolisthesis

49
Q

How to diagnose sciatica

A

straight leg raise test: If pain in the distribution of the sciatic nerve is reproduced on passive flexion of the straight leg at the hip between 30-70 degrees then it is considered a positive sign (Lasegue’s sign)
This test is sensitive but not very specific

50
Q

A 21-year-old woman presents to A & E with acute onset of left-sided body twitching, lasting for 5 minutes, after a minor accident in which she hit her head. She reports 3 similar episodes in the past month, after her boyfriend broke up with her. Past-medical history includes IBS for which she takes laxatives. Physical examination, laboratory investigations and imaging studies are normal.

What is the most likely diagnosis?

Dissociative seizure
Simple partial seizure
Vasovagal episode
Todd’s palsy
Myoclonic seizure
A

Dissociative seizure

51
Q

What is a dissociative seizure

A

can resemble epileptic seizures

but have NO biological correlate.

52
Q

When should you suspect dissociative seizure (4)

A

Suspect Dissociative seizures if:
Prolonged duration
Hx of abuse, psychological or emotional precipitants

53
Q

Explain GCS scoring

A 
Eyes
4 spontaneous
3 to speech
2 to pain
1 no response
Verbal response
5 oriented to time, person and place
4 confused
3 inappropriate words
2 incomprehensible sounds
1 no response
6 obeys command
5 moves to localised pain
4 flex to withdraw from pain
3 abnormal flexion
2 abnormal extension
1 no response

Y3 MedEd (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions