1
Q
what is GCS out of
A
15
2
Q
what is each section of GCS and how much do they account for
A
eyes - 4
voice - 5
motor - 6
3
Q
what are the eye classifications for GCS
A
1 = no response
2 = open to pain
3 = open to speech
4 = open spontaneously
4
Q
what are the voice classifications for GCS
A
1 = no response
2 = incomprehensible speech/words
3 = innapropriate responses
4 = confused but can answer questions
5 = oreitnated
5
Q
what are the motor classifications for GCS
A
1 = no movement
2 = abnormal extension - deceberate posture
3 = abnormal flexion - decorticate posture
4 = flexion withdraws from pain
5 = purposeful movement to painful stimulus
6 = obeys command for movement
6
Q
what GCS requires intubation
A
8 or less
7
Q
what is the dorsal column-medial lemniscus pathway for
A
vibration
proprioception
fine touch
8
Q
where does the DCML pathway decussate
A
an ascending tract
decussating in the medulla
9
Q
If a lesion occurs in the spinal cord what will happen to the DCML pathway
A
ipsilateral loss of proprioception and fine touch as decussation occurs in medulla
10
Q
what information does the spinothalamic tract carry
A
pain and temperature
11
Q
where does the spinothalamic tract decussate
A
an ascending tract decussating 1-2 spinal levles above
12
Q
what will be the loss with a spinothalamic injury
A
sensory loss - pain and temperature will be contralateral to the lesion as it decussates in the spinal cord
13
Q
what does the corticospinal tract carry
A
carries motor signals to muscles
14
Q
where does the corticospinal tract decussate
A
a descending tract decussating in the medulla
15
Q
what is lost in damage to the corticospinal tract in the spinal cord
A
ipsilateral LMN injury at the level of the lesion
ipsilateral UMN injury below the level of the lesion
16
Q
what is lost in damage to the corticospinal tract in the brain/before medualla
A
contralateral loss of motor
17
Q
what are the nerve roots for the bicep jerk
A
C5+6
18
Q
what is the nerve root for the tricep reflex
A
C7
19
Q
what is the nerve root for the knee jerk
A
L4
20
Q
what is the nerve rooth for the ankle reflex
A
S1
21
Q
where broadly are the dermatomes of the lower limbs
A
L2 - lateral thigh
L3 - medial thigh
L4 - medial calf
L5 - lateral calf
S1 - little toe
22
Q
where broadly are the dermatomes of the upper limbs
A
C4 - traps
C5 - lateral bicep
C6 - lateral forearm/palmar thumb
C7 - palmar middle finger
T1 - medial forearm/palmar little finger
T2 - axilla
23
Q
where does the radial nerve supply
A
central dorsum of hand
24
Q
where does the ulnar nerve supply
A
dorsum of little finger (+half of ring finger)
25
where does the median nerve supply
dorsal aspect of thumb, index and moddle finger tips
palmar sides of these fingers + central palm
26
nerve roots of median nerve
C5-T1
27
nerve roots of ulnar nerve
C8-T1
28
what myotomes control elbow flexion, shoulder abduction and flexion
C5+6
29
what myotomes control elbow extension, wrist flexion
C7
30
what myotomes control hanf flexion and adduction and abduction
C8 = flex
T1 = add + abd
31
what myotomes control dorsiflexion
L5
32
what myotomes control plantarflexion
S1
33
what are the features of an L5 radiculopathy
foot drop
poor inversion
34
what are the features of a common peroneal nerve injury
foot drop
poor eversion
35
describe a TIA
less than 24 hours transient focal neurology with tissue ischaemia
36
how long can you not drive after a TIA
1 month
37
what investigation is recommended after a resolved TIA
MRI - diffusion weighted and blood sensittive sequence
38
what should a suspected TIA patient be given with resolved neurology and when should they be seen
300mg aspirin initial
urgently within 24 hours of stroke specialist
+ clopidogrel after confirmation of TIA and for dual antiplatelet therapy
continue just clopidogrel after 21 days
if more than 7 days ago should be seen ASAP within 7 days
39
what further investigation should be oreded for a TIA patient
carotid imaging - carotid duplex USS
carotid endartectomy if stenosis >70% (European carotid surgery trial)
40
what is a stroke
>24 hours of focal neurological deficit with tissue infarct
41
causes for ischaemic stroke
atherogenesis
ASD
AF
IE
42
causes for haemorrhagic stroke
trauma
alcoholism
anticoag
berry aneurysm
43
risk factors for stroke
T2DM
HTN
obese
hypercholesterlaemia
male
increasing age
smoking
AF
ADPKD
anticoag
44
how do Oxford Bamford criteria classify strokes
Total anterior circulation
partial anterior circulation
Posterior circulation
Lacunar syndrome
45
what are the features of the oxford/Bamford stroke TACS
3/3 - anterior and middle cerebral arteries
higher cortical dysfunction
Homonymous hemianopia
unilateral hemiplegia + hemisensory loss
46
what are the features of the Oxford/Bamford PACS
2/3:
higher cortical dysfunction
Homonymous hemianopia
unilateral hemiplegia + hemisensory loss
47
what are the features of the Oxford/Bamford POCS
1 of:
isolated vision loss
cerebellar symptoms
contralateral CN palsy
48
what are the features of a lacunar Oxford/Bamford stroke
pure motor
pure sensory
ataxic hemiparesis
49
what are the features localising an ACA stroke
lower limb affected more than upper limb
urinary/faecal incontinence
+/- personality change
50
what features localise a middle cerebral artery stroke
upper limbs affected more than lower limbs
ipsilateral gaze deviation
face droop + forehead spared
Broca/Wernicke impact of dominant hemisphere
51
what are the features localising a posterior cerebral artery stroke
isolated vision change - painful CN3 palsy
homonymous hemianopia
macular sparing (central)
52
what are the features localising a midbrain (PCA) stroke
Weber's
CN 3 ipsilateral palsy + contralateral hemiplegia
53
what are the features of lateral medullary syndrome (AICA) stroke
Wallenberg
ipsilateral spinothalamic face loss
contralateral spinothalamic loss
dysphagia (CN10)
ipsilateral Horner's + ipsilater DANISH
54
diagnosis of stroke
r/o mimic - hypoglycaemia
NCCT head
GS = diffusion weighted MRI
55
when can thrombolysis be given for an ischaemic stroke
<4.5 hours of symptom onset - IV alteplase/tenecteplase
within 9 hours of midpoint of sleep waking with symptoms with imaging to suggest salvageable brain tissue
56
contraindications to thrombolysis
bleeding disorders
IE
uncontrolled HTN
57
when should a thrombectomy be considered with thrombolysis
if in a large artery
58
when should thrombectomy be offered for a stroke
within 24 hours
evidence of prox anterior/posterior circulation blockage
59
medication in the acute management of stroke and secondary
300mg aspirin after CT head rules out bleed - 2 weeks
clopidogrel after
artovastati ndelayed until 48 hours
anticoag if AF
60
what are the scoring tools for stroke
FAST - community
ROSIER - >0 = chance of stroke
61
what bleeds in a subarachnoid haemorrhoage
circle of wIllis
62
what are the causes of a SAH
trauma
mc non-trauma berry aneurysm - anterior communicating artery and anterior cerebral junction
cocaine use
NF
connective tissue disorder
63
risk factors for SAH
aged 45-70
women
black ethnic origine
HTN
smoke
excessive alcohol
64
symptoms of a SAH
occipital 10/10 headache - thunderclap headache
increased ICP symptoms - CN3 palsy, CN6 palsy, Cushing triad (irregular breathing, HTN, bradycardia), N+V
meningisms - kernig and brudzinski
65
diagnosis of SAH
NCCT 1st - hyper-attenutation in subarach spaces (star shaped)
GS = CT angiogram for vessel + LP >12 hours later = xanthochromia
bloods = hyponatraemic
66
treatment for SAH
decrease ICP - dexamethasone (+/- IV mannitol), Burr hole
Nimodipine - decreased artery vasospasm - 21 days
endovascular coiling surgery
second line = clipping
67
complications of SAH
vasospasm
SIADH - fluid restric
hyponatraemic salt loss
hydrocephalus
68
what vessel is injured in Subdural haemorrhage
ruptured bridging vein (dural sinuses)
69
causes of SDH
acute = deceleration injury
chronic = sken baby, low impact trauma, alcoholism
70
symptoms of SDH
acute <3 days onset of trauma
chronic >21 days of trauma (blood pool, clot, osmotic effect = increased ICP)
increased ICP symptoms with headache and decreased GCS
chronic may show increased fatigue
71
diagnosis of SDH
NCCT - hyper/iso.hypo dense crescent shaped haematoma
not suture line confined +/- midline shift
72
treatment for SDH
lower ICP - dexamethasone, raise bed head 30 degrees
craniotomy + clot evac
73
what vessel causes a extradural haemorrhage
rupture middle meningeal artery
74
causes of EDH
low impact trauma
75
symptoms of EDH
Younger patients
initial LOC
lucid interval period - venous shunt out of skull = compensate
rapid symptom deterioration - low GCS, raised ICP, N+V
evidenec of head trauma - Battle sign, Racoon eyes, CSF ottorhoea
76
diagnosis of EDH
NCCT - hyperdense lens +/- midline shift
confined to suture lines
77
treatment for EDH
lower ICP
craniotomy + evac
78
who is at risk of SDH
alcoholics
very old
babies
79
complications of SDH and EDH
cerebral oedema
coning
80
what does a basillar skull fracture normally present with
CSF rhinorrhoea
81
when is a head CT indicated within an hour
head laceration or swelling
82
when is a head CT indicated within 8 hours
no evidence of head trauma in self +/- headache
83
complications of head injury
epilepsy
mood disorder
personality change
84
what are some features of syncope and who is it common in
older and CV morbidity patients
commonly during exertion/posture
pre - pale, clammy, autonomic, chest pain
floppy LOC, eyes closes
immediate recovery + no amnesia
85
what are some features of generalised tonic clonic seizure
brought on by alcohol, low sleep, medications (clozapine)
pre - aura, de ja vu, automatisms
rigid and jerking - symmentrical
eyes open
tongue bite
post-ictal drowsy around 30 mins
Todd paralysis
confused
86
features of non epileptic attack disorder
younger, psych Hx/stress
associated with stress and panic
pre - panicked, unaware, abrupt
violent asymmetrical limb jerking
waking and wanning symptoms
pelvic thrusts
>5 mins
rapid emotional response post-ictal
no amnesia
87
risk factors for epilpesy
congenital - NFT1, tuberous sclerosis, CP
acquired - meningoencephalitis, febrile convulsion
dementia
88
what can decrease the seizure threshold
hypoglycaemia
alcohol
stress
meds
89
what medications can lower the seizure threshold
TCA
lithium
ciprofloxacin
cloxapine
anti-epileptic drug non-adehrence
tramadol
antipsychotics
90
what are the symptoms of a focal seizure
temporal (MC) - visual aura, automatism, Todd paresis
Frontal - motor symptoms, bizzare behaviour, Jacksonian march
Parietal - Vague numbness, ringing
Occipital - visual hallucination, blindness
91
Types of generalised seizures
tonic clonic
absence
tonic/atonic
myoclonic
92
what defines a generalised, focal aware and focal unaware seizure
focal aware = no brain stem involved and focal area
focal unawar = as above + brainstem
generalise = both hemishperes and brainstem
93
how are seizures diagnosed
Bloods - UE cause ruled out
ECg
LSBP
prolactin + lactate
CT head = rule out SOL
EEG = GS
94
what EEG spikes are seen in absence seizures
3 Hz
95
What are the driving rules after a seizures
first unprovoked seizure and no EEG/structural abnormality = 6 months
otherwise 12 months
96
treatment for gen ton clon seizure
Male - valproate
female - lamotrigine/levetiracitam
97
treatment for focal seizures
lamotrigine/levetiractim
98
treatment for absent seizures
ethosuximide
99
treatment for myoclonic seizures
levetiractim (Keppra) female
Valproate male
100
contraidications for valproate
teratogenic - spina bifida, cleft palate
hepatotoxic inkids
101
side effects of lamotrigine
steven johnson syndrome
102
side effects of carbamazepine
P450 inducer
SIADH
ataxic
103
side effects of ethosuximide
agranulocytosis
104
side effects of phenytoin
gingivial hyperplasia
teratogenic
hirstuism
105
complication of epilepsy
status epilepticus (back to back or > 5mins)
106
treatment for status epilepticus
IV loraz (or buccal midaz, rectal diaz)
IV loraz
IV phenytoin/valproate/carbamezapine
IV phenyorbital under specular guidance + ITU
107
Causes of non-epileptic seizures
cardiogenic - MI, arrhythmia = AF, AFL, long QT, WPW, brugada,
reflex (neurogenic) - postural hypo, vasovagal
artery insufficient
systemic
hypoglycaemia
108
what is parkinsons disease
progressive reduction of dopamine in the basal ganglia
109
risk factors for parkinsons disease
idiopathic
fhx
male
110
what is the pathophysiology of parkinsons
decreased nigrostriatral pathways leads to less GABAergic inhibition (indirect pathway with the substantia nigra pars compacta) therefore there is gross cortex inhibition + harder to initiate movement
111
what can exacerbate parkinsons
antipsychotics - HALOPERIDOL
metoclopramide
112
how can you differentiate drug induced from normal parkisons
drug induced often has abilateral resting tremor
113
symptoms of parkinsons - triad + extra
rigidity - cog wheel, lead pipe
bradykinesia - festinant gait + reduced arm swing
resting tremor - pill roll (3-5 Hz)
postural instability
anosmia
hypomimia
micrographia
REM sleep impact
postural hypotension
constipation
erectile dyfunction
114
cogwheel versus lead pipe rigiidty
cog wheel = jerky
lead pipe = smooth througout movement
115
in what other conditions can parkinsons be seen
lewy body dementia (demential/hallucination then parkinsons)
Pakinsons plus - multisystem atrophy, progressive suprenuclear palsy, corticobasal degeneration
Wilson's disease
drug induced
normal pressure hydrocephalus
116
what is parkinsons plus - multisystem atrophy
parkinsons + cerebellar and autonomic
117
what is parkinsons plus - progressive supranuclear palsy
parkinsons + fixed upward gaze
118
what is parkinsons plus - corticobasal degeneration
parkinsons + alien limb
119
diagnosis of Parkinson's
clinical (bradykinesia + 1 other symptom)
MRI = normal
dopamine transport scan - 2 dots instead of 2 commas - SPECT - single photon emission CT
post-exclusion biopsy = loss of dopamine neurones in SNpc
120
general treatment of parkinsosn
MDT - OT, PT, vit D supplements
manage complications - hypersalivation - hyoscine
medical
121
what are the medical treatments available for parkinsons
Co-careldopa (L-dopa + decarboxylate inhibitor)
carbidopa = prevent L-dopa breakdown before enter brain
LDOPA = converted into dopamine
122
what are the adjuvant treatments for Parkinsons medications
COMT-i - entacapone (reduce levodopa breakdown everywhere)
dopamine agonist - ropinerole, bromocriptine
glutamate antagonist - amantadine (manage dyskinesia from levodopa)
MAOB-i - selegine (prior to levodopa and at end of treatment)
123
side effects of COMT-i - entacapone
dyskinesia - worsening L-DOPA effect
124
what are dopamine agonists associated with
pulmonary fibrosis
125
what is last line treatment option for parkinsons disease
Deep brain stimulation
126
side effects of levodopa
motor fluctuations more apparent over time
postural hypotension
dyskinesia
confusion
pyshcosis
chorea
127
Parkinsons tremor versus benign tremor
Parkinsons:
unilater, resting
3-5 Hz
alcohol no impact
Treat - Levodopa
Benign:
Bilateral symmetrical, intention
5-8 Hz
alcohol improves
treat - propranolol
128
what is the inheritance and genetic abnormality in Huntingtons
Autodom Anticipatory CAG trinucleotide repeat expansion on HTT gene on chromosome 4
129
brief patho of huntingtons
increased glutamate and decreased GABA
130
how to define severity of huntingtons
>35 repeats = diagnosis
35-55 repeats - mod
>55 = severe
131
symptoms of huntingtons
subcortical dementia
psychosis
depression
chorea
132
what are the causes of death in huntingtons
Resp arrest
suicide
133
diagnosis of huntingtons
family history
MRI = striatum (caudate + putamen + nucleus accumbens) atrophy
134
treatment for huntingtons
MDT support
genetic counselling
depression - SSRI
psychosis - antipsychotic
chorea - tetrabenazine
135
what are the triggers for migraines
CHOCOLATE
chocolate/cheese
oral contraceptic
caffeine
orgasm
lie ins
alcohol
travel/tired
exercise
136
what are the stages of migraines
prodrome
aura
migraine event
137
symptoms of migraines
unilateral (except kids)
pulsatile
mod-severe headache
exacerbated with motion
+/- photophobia, phonophobia, N+V
hemiplegic ones may look like a stroke
138
treatment for an acute migraine
PO sumatriptan +/- NSAIDs/paracetamol/antiemetic - metoclopramide
139
prophylaxis for migraines
propranolol (or topirimate (teratogenic))
Last line TCA - amitriptyline
140
specialist options for migraines
pizotifen
candersartan
sodium valproate
monoclonal antibodies - erenumab and fremanezumab
141
what are the rules for triptans in the management of an acute attack
take when starting
if it resolves and then reoccurs can take another one
if it does not work first time do not take again
142
contraindications for triptans
HTN
CAD
previous strike
TIA
MI
due to vasoconstriction
143
who normally gets cluster headaches
male
30-40
smoker
144
symptoms of cluster headaches
15mins-3hrs in clusters for 4-12 weeks
periorbital + retroorbital pain with trigeminal autonomic symptoms
miosis
ptosis
rhinorrhoea + lacrimation
145
treatment for an acute cluster headache
SC sumatriptan + 100% high flow O2 via NBM
146
prophylaxis of cluster headaches
verapimil
147
symptoms of a tension headache
mild band like pain around temples
associated with stress
may radiate to traps
148
treatment for tension headache
simple analgesia - paracetamol/NSAIDs
149
what is the most common secondary headache
medication overuse
150
symptoms of medication overuse headache
tension-like (or migraine) symptoms after longstanding medication use
>15 days/month ibuprofen/paracetamol/triptan
>10 days/month codeine/tramadol
151
treatment for medication overuse headache
stop analgesia simple = immediate, opioid = wean
152
symptoms of trigeminal neuralgia
electric shock waves in trigeminal nerve distrubution
exacerbated by talking, touching, shaving
related to MS
153
treatment for trigeminal neuralgia
carbamazepine
154
risk factors for giant cell arteritis
50 +
female
caucasian
155
symptoms of GCA
intermittent jaw claudication
temporal tenderness
amaurosis figax
156
diagnosis of GCA
increased ESR
temporal artery biopsy - granulomatosis, skin lesions, multinucleated giant cells
157
treatment for GCA
prednisolone/methylprednisolone
PO if no vision loss
IV if amaurosis - risk of permanent vision loss
158
what is anterior horn disease
a group of conditions affecting the motor neurones in the anterior horn of the spinal cord, leading to muscle weakness and atrophy
159
what are some anterior horn diseases
SMA
poliomyelitis
MND - ALS
160
what are some causes of anterior spinal artery occulsion
iatrogenic - AAA surgery
atherosclerotic disease
emboli
vasculitis
161
symptoms and tracts affected in anterior spinal artery stenosis
lateral corticospinal: bilateral spastic paresis
lateral spinothalamic: bilateral loss of pain and temp
spinal shock
neurogenic bowedl
sexual dysfunction
162
how is polio spread
contagious faeco-oral spread
163
symptoms of polio
90% asymptomatic
acute flaccid paralysis + muscle atrophy
164
diagnosis and treatment of polio
CSF PCR - polio
prevent IPV vaccine (6 in 1)
monitor FVC
165
complications of polio
bulbar palsy
166
inheritance of SMA and symptoms and treatment
suto recessive
progressive muscle weakness
nusinersen
167
risk factors for motor neurone disease
idiopathic - MC
familial - related to frontotemporal dementia
168
what are the types of MND
amyotrophic lateral sclerosis
pseudobulbar palsy
primary lateral sclerosis
progressive muscle atrophy
169
what are the features of ALS
UMN + LMN
split hand sign => more hand LMN + leg UMN
170
features of pseudobulbar palsy
CN 9 -12
worst prognosis - resp failure
dysarthria - donald duck speech
dysphagia
tongue weakness
face weakness
emotional lability
171
features of primary lateral sclerosis
only UMN features
172
features of progressive muscle atrophy
only LMN
173
what are not features found in MND
snesory
eye
sphincter involvement
174
what are some UMN features
hyperreflexia
hypertonia - rigid and spastic
babinski +ve in >2
arm flexors, leg extensors stronger
175
what are some LMN features
hyporeflexic
hypotonic
fasciculations - esp tongue
widespread weakness
176
diagnosis of MND
3 spinal regions with UMN + LMN signs - clinical
177
management of MND
RILUZOLE - decrease glutamate receptors - increase life 3 months
spascitcity - baclofen
drooling - hyoscine
resp T2 fail - BiPAP
PEG feed
178
what is multiple sclerosis
type 4 hypersensitivity reaction against myelin sheath (oligodendrocytes) of the CNS
179
who is affected by MS
female
20-40
fhx
autoimmunity
associated with trigem neuralgia
180
where in the CNS does MS impact
optic nerve
brainstem
corpus callosum
cerebral peducle
181
types of MS
primary progressive
secondary progressive
relapsing remitting - MC
182
symptoms of MS
more than 2 attacks disseminated in time and place - UMN lesion only
intention tremor, ataxia, dysarthria, neuropathy, fatigue
overactive bladder + impotence
Uthoff phenomena - heat exacerbation
Lhermitte - neck flexion = electric shock pain
eye symptoms
183
what eye symtpoms are seen in MS
diplopia - CN4
optic neuritis - painful red eye, colour desaturation esp red, central scotoma
RAPD (relative afferent pupillary defect) - unequal pupil response to light (affected = dilate with light)
internuclear opthalmoplegia - affected eye wotn adduct, in affected eye abduction nystagmus
pale optic disc
184
diagnosis of MS
McDonalds criteria + MRI with contrast
- shows attacks in space and over time (type 2 white matter hyperintensity)
LP - oligoclonal IgG bands
nerve conduction study - decreased dymelination
185
treatment of acute MS attacks
PO methylprednisolone - mod
IV methylprednisolone - severe
186
long term management of MS
DMARDs
natalizumab
ocrelizumab
IFN-beta - glatiramer
187
other treatments for MS symptoms
spascticity - baclofen
neuropathic pain - gabapentin
bladder - ocybutinin
eyes - prisms
fatigue - modafinil - CNS stimulant
188
what are some viral causes of meningitis
HSV2
mumps
measles
VZV
189
what are some bacterial causes of meningitis
S.pneunomiae
N. meningitidies
HiB
GBS
listeria
190
most common causes of meningitis according to age
<3 monhts - GBS, listeria
3m-6y - S.pneumoniae, N.menin, hiB
6y-60y - S,pneumoniae, N meningitides
60+ - S.pneumoniae, N.menin, Listeria
191
what type of bacteria is GBS
+ve coccus in chains
192
types of bacteris is S.pneumoniae
+ve coccus in chains
193
type of bacteria: N.meningitides
-ve diplococcus
194
types of bacteria: HiB
-ve coccobacillus
195
type of bafcetria: listeria
+ve baccilum
196
symptoms of meningitis
meningisms - headache + neck stiff + photophobia
Kernig/Brudzinski +ve
fever
fatigue
neonate - resp distress, poor feed, dehydrate, low GCS, fever
197
what causes a non-blanching rash
meningococcal meningitis - DIC vs n.meningitides
198
diagnosis of meningitis
bloods, CT head
GS = LP - CI in raised ICP and Non-blanch
199
CSF appearance in bacterial meningitis
cloudy and tubid
high pressure
neutrophil
low glucose
high protein
200
CSF in viral meningitis
clear
normal pressure
lymphocytes
high glucose
high or normal protein
201
CSF in fungal/TB meningitis
fibrinous
normal/high pressure
lymphocytes
low glucose
high or normal protein
202
management of meningitis in community
IM benzypenicillin and refer to secondary care
203
management of meningitis in hospital
<3 months - cefotaxime + amoxicillin IV
>3 months - ceftriaxone IV
dexamethasone
204
prophylaxis to close contacts of meningitis
ciprofloxacin
205
why is ceftriaxone not given to neonates
displaces bilirubin and can cause kernicterus
206
complications of meningitis
sensorineural deafness
207
causess of encephalitis and what is it
brain parenchyma infection and inflammation
HSV1
TB
lyme disease
measles
toxoplasmosis
CMV
208
symptoms of encephalitis
seizures
focal neuro - Mc temporal
fever
change GCS
confused
209
diagnosis of encephalitis
CT head - temporal petechial haemorrhage (toxoplasmosis diffuse Intracranial calcifications)
LP = viral CSF picture (clear, normal pressure, lymphocytes, high glucose, normal protein)
EEG - period 2Hz firing
210
treatment of encephalitis
IV aciclovir - HSV 1
211
what is a brain abscess
pus collection intracranially
212
who are brain abscess common in
male 30-40
immunocomp
T2DM
213
organism causing brain abscess
S.intermedius
S.aureus
HIV = TB, polio
214
risk factors for brain abscess
septic emboli
trauma
mastoiditis
CHD in kids
215
symptoms of brain abscess
fever
headache with red flags
focal neurology
+/- elevated ICP
216
diagnosis of brain abscess
contrast enhanced CT head
ring enhanced lesion
217
treatment for brain abscess
lower ICP (dexa)
empirical ABx - ceftriaxone + metronidazole
218
what is decorticate posturing
arms flexed to chest
cortical lesion
good prognosis
219
what is a deceberate posturing
arms extended + pronated
brainstem lesion
bad prognosis
220
what is myasthenia gravis
an autoimmune condition affecting the NMJ - acetylcholine receptor antibodies bind to postsynaptic ACh receptors = blocked, increase muscle use = more block
221
what is MG associated with
thymoma
222
when does MG tend to affect men and women
60 years old men
40 year old women
223
what medications should be avoided in MG
beta-blocker
aminoglycosides - gentamicin
lithium
CCB
MgSO4
224
symptoms of MG
fatiguability in head and neck worse as day goes on
diplopia and ptosis
jaw fatiguability
talking difficulty
talking difficulty
myasthenic snare
bulbar palsy
225
diagnosis of MG
test fatiguability
serology - ANTI-AChR - post-synapse (+Anti-MuSK, LRP4)
single fibre EMG - fatiguability
CT thorax - thymoma
+tensilon test - edrophonium - not commonly used now
226
treatment of MG
pyridostigmine (long acting acetylcholinesterase inhibitor) (or neostigmine)
sometimes immunosuppresion needed - prednisolone or azathioprine
thymectomy
227
complications of MG
myasthenic crisis:
type 2 resp failure + bulbar palsy
Treat - biPAP, IV plasmaphoresis + IVIg
228
what is Lambert Eaton myasthenic syndrome
antibodies againts voltage gated calcium channels in pre-synaptic memberan on NMJ
Calcium channel destroyed less ACh = weaker signal and reduced muscle contraction
229
symptoms of LEMS
weakness in legs - pelvic girdle + hips
autonomic symptomms - incontinence, erectile dysfunction
improves throughout the day
230
what is LEMS associated with
SCLC (paraneoplastic)
231
diagnosis of LEMS
CXR - SCLC
serology - voltage gated calcium antibodies - presynapse
EMG - incremental increase in activity
232
treatment of LEMs
diaminopyridine (pre-synapse potassium inhibitor = more Ca channels open)
immunosuppress
233
what is Guillain-Barre syndrome
ascending symmetricl polyneuropathy of the PNS, thought to be due to molecular mimicry creating antibodies against the myelin sheath/nerve axon of peripheral neurones
234
symptoms of guillain-Barre
post gastroenteritis - campylobacter jejuni
symmetrical weakness
+/- decreased FVC
235
diagnosis of Guillain barre
LP = increased protein normal WCC
seology - anti-GM1
nerve conduction studies - decreased sped - demyelineation
236
treatment of guillain barre
IVIg + plasmaphoresis - 5 days
monitor FVC
237
what is the most common primary brain tumour and what are some others
astrocytoma (grades 1-4, 4 =glioblastoma most serious) mc
craniopharyngioma
oligodendrocytoma
238
where are mets to the brain common from
breast
bone
lung liver
239
symptoms of a brain tumour
red flag headache
elevated ICP
N=V
focal neuro = progressive
seizures/epilepsy
240
diagnosis of brain tumours
1st - NCCT head
GS = MRI head
241
treatment of brain tumours
decreased ICP - dexamethasone
surgery - primary
chemo/radio - secondary
242
what can cause neuropathy
axon damage
radiculopathy
demyelination
wallerian degeneration
243
types of neuropathy
mononeuropathy - 1 nerve
mononueritis multiplex - multiple single - asymmetrical
polyneuropathy - symm nerve pathology - glove and stocking
244
radiculopathy versus myelopathy
radiculopathy = root compress
myelopathy - spinal cord compress
245
DDx for mononeuritis multiplex
WARDS PLC
wegeners granulomatosis
AIDS
rheumatoid arthritis
diabetes mellitus
sarcoidosis
polyarteritis nodosa
leprosy
carcinoma/chronic infection
246
causes of polyneuropathy
ABCDEG
alcohol
B12 deficiency
carcinoma
DMT2
every vasculitiis
Guillain barre
247
causes of median nerve mononueropathy
carpal tunnel C6-T1
repetitive overuse
underactive thyroid
acromegaly
Rheumatoid arthritis
pregnancy
248
symptoms of carpal tunnel
tingling in palm distribution
wake and shake
tremor
muscle waste
249
symptoms of ulnar nerve mononeuropathy
C8-T1
claw hand
medial epicondly fracture
250
symptoms of radian nerve mononeuropathy
C5-T1
wrist drop/saturday night palsy
midshaft humerus fracture
weak dorsiflexion
251
symptoms of L5 radiculopathy
foot drop
weak inversion
with present ankle jerk
252
symptoms of common peroneal nerve mononeuropathy
foot drop
weak eversion (pEronEal = Eversion)
with absent ankle jerk
fibular head fracture - L4-S1
253
what vision problem would a pituitary adenoma infraseller chiasm compression cause
superior B/L quadranopia
254
what vision problem would a craniopharyngioma supraaseller chiasm compression cause
inferior B/L quadranopia
255
How would a cranial nerve 3 lesion present
down and out
dilated
256
how would a cranial nerve 4 lesion present
diplopia
257
how would a cranial nerve 6 lesion present
impaired abduction
258
how would a cranial nerve 7 lesion present and what is the treatment
bells palsy - LMN damage with non-forehead spraing - prednisolone + eye drops (ramsay hunt = + aciclovir)
259
how would a cranial nerve 8 lesion present
hearing loss (SN) + vertigo/balance change
260
how would a CN 9 and 10 lesion present
bulbar symptoms - swallowing, coughing, uvula deviate contralaterally to CN 10 lesion
261
how would a cranial nerve 11 lesion present
weak head turn (SCM) and shrug (trap)
262
how would a cranial nerve 12 lesion present
ipsilateral tongue deviation
263
what can cause bilateral bell palsy and optic neuritis
Sarcoidosis
264
what can be seen with complete cord compression
myelopathy
cauda equina
265
what are the symptoms of myelopathy
normally cervical = UMN below lesion
no saddle symptoms
266
what are the symptoms of cauda equina
saddle symptoms - incontinence, anaesthesia, erectile dysfunction
usually LMN
weakness,
pain
bilateral
267
what are some examples of incomplete cord compressions
anterior cord
posterior cord
hemisection
268
what would be seen in an anterior cord presentation
motor symptoms - anterior cord syndrome
269
what would be seen in a posterior cord presentation
DCML sx - tabes dorsalis
270
how would a hemisection of the spinal cord present
Brown-Sequard
ipsilateral - corticospinal and DCML deficit
contralateral - spinothalamic (1-2 spinal lvl below onwards)
271
what are the causes of cord compression
trauma
malignancy (KP BLT)
osteophytes
slipped discs
spinal stenosis - eased walking uphill/bending forward
myeloma
RA
C1-C2 ligament interval
272
symptoms of cord compression
back pain
Hoffman sign - flick nail of middle finger - thumb + hand muscle flexion = UMN
deltopectoral reflex
corssed adductors
treacle hands - inappropriate velcroed patient
babinski + clonus
273
diagnosis of cord compression
urgent MRI - whole cord
PR
274
treatment of cord compression
dexamethasone IV
+surgical decompress
275
what is the presentation of a myelopathy
UMN below lesion
LMN at lesion
276
what are some causes of communicating hydrocephalus
rare
TB
meningitis
277
what are some causes of non-communicating hydrocephalus
MC
obstruction in CSF flow
278
risk factors for hydrocephalus
spina bifida
Dandy walker - underdeveloped cerebellum vermis therefore 4th ventricle CSF increase
arnold chiari malformation
279
symptoms of hydrocephalus
sunset downtourned eyes - impaired upward gaze
gross cranial enlargement
+/- ICP elevation symptoms - effect motor and speech milestones
280
diagnosis of hydrocephalus
CT head - ventriculomegaly, obstruction
Query LP - relieve pressure
281
treatment for hydrocephalus
VP shunt
endoscopic ventriculotomy
282
symptoms of normal pressure hydrocephalus
>65
wet - incontinent
wacky - dementia
wobbly - ataxic gait
283
diagnosis and treatment for normal pressure hydrocephalus
LP = normal pressure
CT = ventriculomegaly + succal effacement
treat = VP shunt
284
what is idiopathic intracranial hypertension
benign elevation of ICP
285
risk factors for idiopathic intracranial hypertension
female - 20-30
high BMI
meds - vit A, tetracyclines
pregnant
286
what are the symptoms of idiopathic intrcranial hypertension
increased ICP headache
migraine mimic - flashing and pulsatile tinnitus
bilateral papiloedema
287
diagnosis of IIH
CT head good
MRI head - optic nerve sheath distenstion
LP = >250mm opening pressure
288
treatment for IIH
weight loss
acetazolemide
optic nerve fenestration (nerve decompress)
289
what is a dural venous sinus thrombosis
blood clot in the dural venous sinus can disrupt blood flow and increased ICP
290
where are dural venous sinus thromboses most common
superior saggital sinus
291
risk factors for dural venous sinus thrombosis
factor V leiden deficiency
aPL
SLE
COCP
pregnant
DIC
292
what are the symptoms of dural venous sinus thrombosis
headache - acute, sudden, N+V
focal neuro - motor
seizures - MC GTC
elevated ICP
papilloedema
low GCS
vision change
293
diagnosis of dural venous sinus thrombosis
CT + contrast = empty delta sign
FIRST RULE OUT STROKE WITH NCCT
GS = MR venogram
294
treatment for dural venous sinus thrombosis
LMWH
295
what is menieres
excessive endolymph in ear labrynth (inner ear)
clinical diagnosis
296
symptoms of menieres
ear fullness
drop attacks
vertigo
tinnitus
unidirectional nystagmus
progressive SN hearing loss
Romberg +ve
297
treatment of menireres
prochlorperazine - acute
betahistine - reduce freq.
298
what is the most common type of acoustic neuroma
cerebellopontine tumour
unilateral
299
what cranial nerves are affected with an acoustic neuroma
5 and 8
300
what woudl you suspect with a bilateral acoustic neuroma
NFM 2
301
symptoms of acoustic neuromas
tinnitus
hearing loss
vertigo + CN5 (absent corneal reflex)
302
diagnosis of acoustic neuroma
audiometry, MRI head
303
treatment of acoustic neuroma
urgent ENT
surgery > 40mm
304
what is benign paroxysmal postional vertigo
recurrent attacks of vertifo triggered by postrual change
305
diagnosis of BPPH
Dix-Hallpike manouevre (rotary nystagmus - towards affected ear)
306
treatment of BPPV
Epley manouvre
vestibular rehab
307
symptoms of vestibular neronitis and viral labrynthitis and how to differentiate
both:
post viral infection
N+V
tinnitus
supportive treatment + antihistamine
only viral labrynithitis has SN hearing loss on audiometry
308
symptoms of optic neuritis and how to diagnose
central scotoma
pale optic disc
RAPD
T2 white matter hyperintensity (MRI)
309
symptoms of central retinal artery occlusion
eye stroke
amaurosis fugax (painless)
RAPD
cherry red macular spot
310
what is anterior ischaemic optic neuropathy associated with
GCA
311
what are the symptoms of syringomyelia
collection of CSF within spinal cord - syrinx
cape like loss of spinothalamic tract (upper limb, shoulders, trunk) due to lesion of anterior white commisure
burn self without realising
scoliosis
flaccid paresis
312
diagnosis of syringomyelia
MRI full spine and brain (look for chiari) - paraspinal fluid filled cysts - drain with shunt if persistent or symptomatic
Phase 3A medicine
flashcards
Decks in class (16)
# Cards
-
100 most common drugs in GP218
-
Gynae FC from PPT215
-
Paediatric FC from ppt774
-
COTE FC from ppt93
-
Neurology FC from ppt8
-
Key Obstetric notes198
-
key gynae notes140
-
Key breast medicine notes49
-
key paeds notes295
-
key paeds notes cont.361
-
GP random things21
-
key psych notes254
-
Key neuro notes312
-
key gerries notes135
-
Key sexual health notes133
-
Key public health notes145
