Year 4 Flashcards
What is thoracic outlet syndrome?
A condition caused by compression of the brachial plexus, subclavian artery or subclavian vein at the thoracic outlet.
Does thoracic outlet syndrome typically cause neurogenic or vascular symptoms?
Neurogenic
How are the GCS points broken down into the 3 main groupings?
Motor = 6
Verbal = 5
Eyes = 4
What does a worsening headache despite dosage of opiate being increased suggest?
Medication overuse headache
A lesion of which nerve produces weakness of foot dorsiflexion and eversion, alongside reduced sensation on the dorsum of the foot?
Common peroneal nerve
Which antibodies are seen in myasthenia gravis?
Anti-acetylcholine receptor antibodies
What do pinpoint pupils suggest in stroke?
The pons is the site of the injury.
May also be present in an opiate overdose.
What is Cushing’s reflex?
The physiological response to raised ICP.
Causes 2 key findings -
Hypertension
Bradycardia
Which nerve is responsible for thumb opposition?
Median nerve
What nerve roots are injured in Klumpke’s palsy?
C8 + T1
Presents with weakness of the intrinsic muscles of the hand, flexors of the wrist, and flexors of the fingers.
Which palsy presents with a claw hand?
Klumpke’s palsy
How should different opiates be given in seizure?
Midazolam - mouth
Lorazepam - line (IV)
Diazepam - down below (PR)
Which anti-emetic is given for radiotherapy induced nausea and vomiting?
Ondansetron
Haloperidol is given for what forms of nausea and vomiting?
Those caused by a brain tumor, or due to raised ICP.
Which anti-emetic is advised in those with vestibular nausea and vomiting?
Prochlorperazine
Which anti-emetic is given in GI-related nausea and vomiting?
Metoclopramide
A palsy of which cranial nerve produces horizontal diplopia?
CNVI (abducens)
Which nerve palsy is suspected in those with a ‘down and out’ eye?
CNIII
Palsy of which nerve produces a foot drop?
Common peroneal nerve
What condition that produces severe unilateral headaches, may also be accompanied by autonomic features?
Paroxysmal hemicrania
Treat with indomethacin
What is subacute degeneration of the spinal cord?
Vitamin B12 deficiency which results in impaired function of the dorsal columns, lateral corticospinal tracts and spinocerebellar tracts.
What should a headache linked to valsalva maneouvre raise suspicion of?
Raised ICP
Which drugs should be stopped abruptly in medication overuse headache?
Paracetamol
NSAIDs
Triptans
In medication-overuse headache, can opiates be withdrawn abruptly?
No, taper off over a prolonged period.
Alongside steroids, what should be given in Bell’s palsy?
Eye drops and eyecare advice.
The movement of which muscles is typically spared in motor neurone disease?
Ocular muscles
Palsy of which nerve results in vertical diplopia?
CNIV (trochlear nerve)
What is dysarthia?
The impairment of phonation secondary to muscular weakness.
Why is Alzheimer’s more common in Down’s Syndrome?
As the gene responsible for the condition is found on chromosome 21 - hence, trisomy increases risk.
Which nerve is tested on protrusion of the tongue?
Hypoglossal nerve (CNXII)
What does injury to Wernicke’s area result in?
Issues comprehending language.
Also known as a receptive aphasia.
What does injury to Broca’s area result in?
Impaired ability to produce language.
Also known as an expressive aphasia.
What function is predominately controlled by the dominant hemisphere?
Language
Which 3 spinal tracts are ascending?
DCML
Spinothalamic
Spinocerebellar
Does the gracillus or cuneate tract of DCML supply below T6?
Gracillus
This is found medially.
Where is deeper meaning of sensation derived?
Posterior parietal complex
How is MND diagnosed?
It is a clinical diagnosis
How does transient global amnesia present?
Abrupt onset anterograde amnesia, followed by retrograde amnesia.
Cannot lay down new memories from onset.
How long does transient global amnesia last?
A few hours
Usually a one-off caused by emotion/temperature change.
What area of brain is involved in transient global amnesia?
Hippocampus
This is where short-term memories are stored.
Transient epileptic amnesia is associated with which form of seizures?
Temporal lobe epilepsy
What should be excluded in a patient presenting with memory issues?
Mood disorder
What is the most common form of prion disease?
Creutzfeldt-Jakob disease
What is BSE?
Bovine spongiform encephalopathy - a form of CJD, previously known as ‘Mad Cow’ disease.
What are common features presenting in Alzheimer’s disease?
Apraxia
Forgetfullness
Which form of dementia may be associated with visual hallucinations?
Lewy body dementia
What treatment is used in Alzheimer’s disease?
Any therapies which increase acetylcholine levels.
Two forms of this include cholinesterase inhibitors and NDMA receptor blockers.
What MUST be present for vascular dementia to be diagnosed?
A clear relation between vascular disease and the onset of demential symptoms.
What is a DATscan used for?
Determining dopamine activity within the brain.
Used in PD and DwLB.
What is Cushing’s reflex?
Raised systolic BP, reduced HR.
Associated with raised ICP.
How does brain surgery impact driving?
DVLA needs to be informed.
Cannot drive for 1 year.
What does a headache that wakes the patient with nausea and vomiting suggest?
CNS tumor
Why is LP avoided if signs of raised ICP present?
As may lead to herniation of brain tissue.
Why should those with raised ICP be kept in bed at 30-45degrees incline?
To facilitate venous return
What management options exist for IIH?
Weight loss +/- bariatric surgery
Carbo-anhydrase inhibitors
Diuretics
Which anaesthetic sedative is used in raised ICP?
Propofol
What should be lowered in raised ICP?
CO2 levels
Aim for 4-5kPa. This produces cerebral vasoconstriction, lowering ICP.
Can bacterial meningitis present WITHOUT the petechial rash?
Yes, it is not common for rash to be present.
