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PBLs > Week 18 - Nervous System > Flashcards

Week 18 - Nervous System Flashcards

1
Q

What type of motor neuron lesion causes hyperreflexia?

A

Upper motor neuron lesion

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2
Q

What is Parkinson’s disease?

A

Progressive reduction in dopamine in the basal ganglia leading to disorders of movement

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3
Q

What is the typical patient of Parkinson’s?

A

Man around aged 70
Gradual onset of symptoms

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4
Q

What is the classic triad of symptoms for Parkinson’s?

A

Resting tremor
Rigidity
Bradykinesia

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5
Q

What is myasthenia gravis?

A

Autoimmune condition affecting NMJ
Causes muscle weakness that gets progressively worse with activity and improves with rest

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6
Q

How do you elicit fatigability of muscles?

A

Repeated blinking -> ptosis
Prolonged upward gazing -> exacerbate diplopia
Repeated abduction of 1 arm -> unilateral weakness

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7
Q

What is the typical patient of motor neuron disease?

A

60 year old man with an affected relative

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8
Q

What are 4 common signs of lower motor neuron disease?

A

Muscle wasting
Reduced tone
Fasciculations
Reduced reflexes

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9
Q

What are 3 common signs of upper motor neuron disease?

A

Increased tone/spasticity
Brisk reflexes
Upgoing plantar reflexes

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10
Q

What drug can extend survival and slow progression of MND?

A

Riluzole

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11
Q

What are the common causes of death in MND?

A

Respiratory failure
Pneumonia

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12
Q

What is multiple sclerosis?

A

Autoimmune condition involving demyelination in central nervous system

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13
Q

What is a typical patient of MS?

A

Young adult
More likely women

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14
Q

What are key features of optic neuritis?

A

Enlarged central blind spot (central scotoma)
Pain with eye movement
Impaired colour vision
Relative afferent pupillary defect

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15
Q

When is optic neuritis seen?

A

Multiple sclerosis

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16
Q

What is ataxia?

A

Problem with coordinated movement

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17
Q

What is sensory ataxia and in what test is it positive?

A

Loss of proprioception
Results in a positive Rombergs test = lose balance when standing with eyes closed

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18
Q

What lesion causes sensory ataxia?

A

Lesion in the dorsal columns of the spine

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19
Q

Which parts of the visual field do not cross at the optic chiasm and which do?

A

Lateral aspects of vision don’t cross
Medial aspects of vision do cross

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20
Q

Which tract transports information about vibration, proprioception and fine touch?

A

Dorsal column

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21
Q

What information is carried in the dorsal column?

A

Sensory
- Proprioception
- fine touch
- vibration

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22
Q

What are the 2 regions of the dorsal column and where do they carry information from?

A

Fasciculus gracilis = more medial, info from below T6-T8
Fasciculus cuneatus = more lateral, info from above T6-T8 but below the head

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23
Q

What information is carried by the spinothalamic tract?

A

Sensory
- crude touch
- pressure
- pain
- temperature

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24
Q

What tract transmits info on pain, temperature, crude touch and pressure?

A

Spinothalamic

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25
Q

At what level do nerve fibres cross over in the spinothalamic tract?

A

At the level the spinal nerve enters

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26
Q

What type of tract is the corticospinal tract?

A

Motor - pyramidal

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27
Q

What is the function of a pyramidal tract?

A

Conscious control of muscles from the cerebral cortex to the muscles of the body and the face

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28
Q

What is the function of extrapyramidal tracts?

A

Unconscious, reflexive or responsive control of muscles from various brain stem structures

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29
Q

What 3 major cortical areas does the corticospinal tract communicate with?

A

Primary motor cortex
Premotor cortex
Supplementary motor cortex

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30
Q

Where do nerves of the corticospinal tract converge after leaving the cortical areas?

A

Internal capsule

31
Q

At what point does the lateral corticospinal tract cross over?

A

Medulla

32
Q

At what point do neurons of the anterior corticospinal tract cross over?

A

At the level the spinal nerve root enters
This will be in cervical or upper thoracic spinal cord

33
Q

Where do UMNs of the corticospinal tract synapse with LMNs?

A

Ventral horn of the spinal cord

34
Q

What is the main management of an acute attack of MS?

A

High dose steroid therapy
500mg methylprednisolone oral for 5 days
Or
1g methylprednisolon oral for 3-5 days

35
Q

What is the long term management of MS?

A

Disease modifying agents - manage demyelination process
Injectable = beta interferon
Oral = dimethyl fumarate
Monoclonal antibodies = alemtuzumab

36
Q

What happens to visual evoked potentials in demyelination?

A

Decreased amplitude and prolonged latency

37
Q

What drugs can help control spasticity in MS?

A

Baclofen and gabapentin

38
Q

What drugs can help neuropathic pain in MS?

A

Amytriptyline
Gabapentin

39
Q

What are normal levels for WBCs, RBCs, protein, glucose and pressure in a lumbar puncture?

A

WBC = 0-5 cells/uL
RBCs = 0-5 /uL
Protein = 0.15-0.45 g/L (<1% of serum conc)
Glucose = 2.8-4.2 mmol/L (>60% serum conc)
Pressure = 10-20 cm H2O

40
Q

What is clinically isolated syndrome?

A

Unexplained episode of neurological dysfunction
Features are suggestive of MS but do not meet diagnostic criteria
More likely to get MS in next 5 years

41
Q

What is relapsing-remitting MS?

A

No progression between attacks
Unpredictable attacks of neurological dysfunction (>24hrs) followed by recovery

42
Q

What is secondary progressive MS?

A

Initially presents as relapsing remitting
Then gets progression
With or without attacks

43
Q

What is primary progressive MS?

A

Steady progression of disease from onset
No attacks

44
Q

What are the causes of MS?

A

Low vit D
EBV
Smoking
Obesity

45
Q

What types of plaques are seen in relapsing remitting MS?

A

Acute active plaques
Many macrophages

46
Q

What types of plaques are seen in progressive MS?

A

Chronic

47
Q

What are the 3 most common symptoms on presentation of MS?

A

Limb numbness / tingling
Limb weakness
Cerebrellar symptoms

48
Q

What is Uhtoffs phenomenon? When is it seen?

A

Worsening of symptoms on exercise or in warm environments
MS

49
Q

What is Lhermittes phenomenon? When is it seen?

A

Lightening shock pain down spine on flexion of the neck secondary to cervical cord plaque formation
MS

50
Q

How can you characterise a previous episode of optic neuritis on a Fundoscopy?

A

Optic disc pallor
Blurring of optic disc

51
Q

What happens with the relative afferent pupillary defect when light is shone in eye affected by optic neuritis?

A

Pupil of healthy eye will constrict when light is shone in it as will contra lateral pupil
In effected eye when light is shone it will not constrict

52
Q

Which cranial nerve is optic neuritis affecting?

A

Optic nerve (II)

53
Q

What is seen in MS when lesions affect cranial nerves III, IV, VI)?

A

Double vision (diplopia)
Nystagmus

54
Q

What is nystagmus?

A

Repeated involuntary movement of the eye

55
Q

What do lesions in MS affecting CN V do?

A

Cause facial Parasthesia and or weakness in muscles of mastication

56
Q

What can lesions in MS affecting CN VII do?

A

Weakness of facial muscles
Mimics stroke (can still move eyebrows as just UMN)

57
Q

What do lesions in MS affecting CN VIII do?

A

Loss of balance and sensorineural deafness

58
Q

What do lesions in MS affecting CN IX, X and XII do?

A

Loss of motor function to tongue and pharynx causing speech and swallowing problems

59
Q

What do lesions in MS affecting CN XI do?

A

Loss of motor function to sternocleidomastoid and trapezius resulting in neck weakness and hypertonic

60
Q

What are the results of an LP in bacterial meningitis?

A

Cloudy
WBCs = elevated (>100/uL)
Protein = elevated (>0.5g/L)
Glucose = low (<40% serum)
Pressure = elevated [>25)

61
Q

What do these LP results show?
Cloudy
WBCs = elevated (>100/uL)
Protein = elevated (>0.5g/L)
Glucose = low (<40% serum)
Pressure = elevated [>25)

A

Bacterial meningitis

62
Q

What LP results are seen for viral meningitis?

A

Clear
WBCs = elevated (>100/uL)
Protein = elevated (>0.5g/L)
Glucose = normal (>60% serum)
Pressure = normal or elevated

63
Q

What does this LP result show?

Clear
WBCs = elevated (>100/uL)
Protein = elevated (>0.5g/L)
Glucose = normal (>60% serum)
Pressure = normal or elevated

A

Viral meningitis

64
Q

What LP results are seen in tuberculosis meningitis?

A

Opaque, forms a fibrin web when settled
WBCs = elevated
Protein = elevated (1-5g/L)
Glucose = low
Pressure = elevated

65
Q

What do these LP results show?

Opaque, forms a fibrin web when settled
WBCs = elevated
Protein = elevated (1-5g/L)
Glucose = low
Pressure = elevated

A

Tuberculosis meningitis

66
Q

What LP results are seen in fungal meningitis?

A

Clear/cloudy
WBCs = elevated
Proteins = elevated
Glucose = low
Pressure = elevated

67
Q

What do these LP results show?

Clear/cloudy
WBCs = elevated
Proteins = elevated
Glucose = low
Pressure = elevated

A

Fungal meningitis

68
Q

What LP results are seen in subarachnoid haemorrhage?

A

Blood stained initially, with xanthochromia (yellowish) >12 hours later
WBCs = elevated (WBC:RBC 1:1000)
Proteins = elevated
Glucose = normal
Pressure = elevated

69
Q

What does this LP show?

Blood stained initially, with xanthochromia (yellowish) >12 hours later
WBCs = elevated (WBC:RBC 1:1000)
Proteins = elevated
Glucose = normal
Pressure = elevated

A

Subarachnoid haemorrhage

70
Q

What LP results are seen in MS?

A

Clear
WBCs = 0-20 cells/uL
Protein = mildly elevated (0.45-0.75g/l)
Glucose = normal
Pressure = normal
Electrophoresis = oligoclonal bands present

71
Q

What do these LP results show?

Clear
WBCs = 0-20 cells/uL
Protein = mildly elevated (0.45-0.75g/l)
Glucose = normal
Pressure = normal
Electrophoresis = oligoclonal bands present

A

Multiple sclerosis

72
Q

What LP results are seen in Guillain-Barré syndrome?

A

Clear
WBCs = normal
Protein = mildly elevated (>5.5g/L)
Glucose = normal
Pressure = normal

73
Q

What do these LP results show?

Clear
WBCs = normal
Protein = mildly elevated (>5.5g/L)
Glucose = normal
Pressure = normal

A

Guillain-Barré syndrome

PBLs (19 decks)

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