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62 Cards in this Set
- Front
- Back
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what are the features of delirium?
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acute, fluctuating change in mental status ('sun downing')
- inattention - disorganised thinking - illusions, hallucinations, delusions - altered levels of consciousness - the clouding of consciousness and disorientation in delirium is what differentiates it from dementia It can be hyperactive, hypoactive or mixed |
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what are the causes of delirium?
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Drugs
Eyes, ears Low - O2 infection Retention, restraints Ictal Underhydration/ Undernutrition Metabolic Subdural , sleep deprivation |
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What are the effects of anticholinergic overdose
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dry as a bone - decreased secretions
mad as a hatter - delirium Blind as a bat - mydriasis hot as hell - hyperthermia Red as a beet - flushing |
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Patient presents with lower limb weakness 3 weeks after bout of diarrhea
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guillian Barre syndrome
autoimmune scending demyelination - can follow campylobacter infection |
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Recurrent, severe, disabling headache
Usually unilateral and throbbing in nature Sensitivity to light Patients often describe 'going to bed' In women may be associated with menstruation |
Migraine
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Recurrent, non-disabling, bilateral headache
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tension headache
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Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours with clusters typically lasting 4-12 weeks
Intense pain around one eye (recurrent attacks 'always' affect same side) Patient is restless during an attack Accompanied by redness, lacrimation, lid swelling More common in men and smokers |
Cluster headache
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Typically patient > 60 years old
Usually rapid onset (e.g. < 1 month) of unilateral headache Jaw claudication (65%) Tender, palpable temporal artery Raised ESR |
GCA/ temporal arteritis
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what are the Sx of organophosphate poisioning
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SLUDGEM
acetyl choline overload Salivation, Lacrimation Urination Defecation Gastrointestinal motility Emesis Miosis |
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what are the modifiable RF for stroke
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(from most to least)
AF (x5 Hypertension (x4) Smoking (x2-3) DM (x2) IHD (x2) cholesterol |
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what is the most important modifiable RF for stroke
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HTN
(BP reduction of 5-6 mmHg reduces stroke risk by 40%) all = <140/90 DM or renal disease = <130/80 |
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What is the treatment of asymptomatic severe (>70%) carotid stenosis?
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1. aggressive medical
- aspirin and/or clopidogrel -BP control - statin 2. carotid endarterectomy if - stenosis >80% - <75 years old - operation risk <3% |
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how does the presentation of migraine differ in children
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attacks may be shorter-lasting, headache is more commonly bilateral, and gastrointestinal disturbance is more prominent.
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what factors suggest pseudoseizure
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pelvic thrusting
family member with epilepsy more common in females crying after seizure don't occur when alone gradual onset True seizure - tongue biting; raised prolactin |
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How does metoclopramide work as an antiemetic
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D2 receptor antagonist, binds to D2 receptors in the chemoreceptor trigger zone
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what is Cushing's triad of raised ICP
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hypertension, bradycardia, irregular respiration (cheyne stokes)
(also headache, papilloedema, vomitting) |
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what are the causes of a sudden painless loss of vision in one eye
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retinal detachment
vitreous haemorrhage central retinal V/A occlusion ARMD (sudden haemorrhage) |
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patient presents with sudden painless loss of vision in left eye - Hx reveals flashing lights and floaters over the past 24 hrs
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retinal detachement
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Sudden painless loss of vision - fundoscopy shows cherry red spot
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- Retinal artery occlusion
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Sudden painless loss of vision - fundoscopy shows multiple blot and flame haemorrhages- Patient has a Hx of hypertension
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Central retinal vein occlusion
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what is the first line therapy for cluster headache
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sumatriptan
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what is the most common presenting problem in MS?
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optic neuritis
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what reflex is lost in argyl robertson pupil?
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direct pupiliary reflex. Accommodation is maintained
'whores pupil' - accommodating but non reactive to light |
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What is the classical presentation of a cerebral abscess?
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Headache, fever, focal neuro signs
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what is the most sensitive and specific tool for Dx in guillian Barre
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Nerve conduction studies
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what is the first line treatment for trigeminal neuralgia?
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Carbamezapine
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what is the immediate management of temporal arteritis
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Prednisone 1mg/kg stat
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what % of patients presenting with Optic neuritis will be Dx with MS in next 5 years?
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30%
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what pathological changes are seen in alzheimers dementia?
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cortical atrophy
ventricular dilatation neuritic plaques neurofibrillary tangles decrease in cholinergic neurons |
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What is the clinical picture of dementia with lewy bodies
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dmentia with - recurrent visual hallucinations, cognitive fluctuations, or spontaneous extrapyramidal signs.
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what is the normal natural Hx of normal pressure hydrocephalus?
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gait apraxia - incontinence - dementia.
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What is Gerstmann's syndrome?
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acalculia; agraphia; finger agnosia; Left-right confusion ==> dominant parietal lobe lesion.
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what is the pathophysiology of huntington's disease?
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Atrophy of cuadate nucleus and putamen bilaterally
(AD - chorea) |
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What is the pathophysiological basis of Parkinson’s disease
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Loss of dopiminergic neurons in substantia nigra pars compacta
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What would a left hemisection of the spinal cord present with (Brown- Sequard)
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- ipsilateral LMN signs at level of lesion
- ipsilateral UMN signs below the lesion - ipsilateral loss of proprioception and vibration below - contralateral pain and temperature |
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how is guillian Barre syndrome treated?
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normal IV immunoglobulin
Or plasma exchange. |
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How is myaesthenia gravis diagnosed
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clear demonstration of muscle fatigability, typically in the ocular, facial, bulbar or limb muscles. Sensory loss, sphincter disturbance and loss of reflexes are not features of myasthenia gravis.
Rx = pyridostigmine |
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How is Myaesthenia gravis Managed
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- pyridostigmine (not effective in occular MG)
- immunosuppression - steroids, azathioprine - Thymectomy - IVIg or plasmapheresis in emergency |
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what are the hallmark signs of muscle disease?
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proximal, symmetrical limb weakness with preserved sensation.
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what is the inheritance of Duchenne's MD?
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X linked recessive
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how are muscle diseases Dx?
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clinical presentation
Serum CK EMG muscle biopsy (also rule out reversible causes - TFTs, drugs) |
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how is tension headache managed
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- acute = NSAIDS (more effective) or paracetamol
- if recurrent can use TCAs for prophylaxis |
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How is cluster headache managed
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prophylaxis - verapamil; methysergine; lithium
Prednisone for rapid suppression of attacks while commencing above therapy 100% O2 in acute attacks - triptans; ergotamine agents |
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How is Migraine managed?
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Acute
1st = NSAIDs, paracetamol, anti-emetics. 2nd=triptans (in status migrainus = antipsychotic or triptan) Prophylaxis - propranolol - amytryptaline - Na-Valproate - verapamil |
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What side effects of Lithium must be monitored for
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- Thyroid - hypothyroid or euthyroid goitre
- Renal - DI (inhibits ADH at distal tubule) - Cortical - tremor, muscle weakness, extra pyramidal. |
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How does an ACA stroke present?
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- hemiplegia and hemianaesthesia of Lower extremities.
- Incontinence - Frontal lobe changes -behavioural changes, primitive reflexes. - Gaze away |
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How does a MCA stroke present?
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Hemiplegia and hemianaesthesia of upper limbs and face.
Hemianopia Aphasia (Left) (brocas = superior MCA; Wernickes = inferior MCA) Neglect of contralateral limbs (if non dominant - right lesion) |
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What are the characteristic features of a vertebrobasilar stroke?
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Ipsilateral cranial nerve signs with contralateral corticospinal signs
Nsytagmus, vertigo, ataxia Horners syndrome dysarthria and dysphagia (no aphasia or cognitive impairments) |
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How do PCA strokes present -
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contralateral homonymous hemianopia
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what is the most important modifiable risk factor of both haemorrhagic and ischaemic stroke?
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hypertension (reduction of 5-6mmHg reduces stroke risk by 40%)
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when should carotid endarterectomy be considered in asymptomatic carotid stenosis
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- stenosis >80%
- age <75 - expected to live >5 years |
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What is Urthoff's phenomena and
Lhermitte's sign? |
Urthoff's = worsening of MS Sx with heat (hot shower, exercise)
Lhermitte's = Forward flexion of neck causes electric shock down back to limbs - cervical cord MS lesion) |
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What % of MS present initially with relapsing remitting disease?
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80%
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what is the prognosis of MS
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•50% of pts need help walking within 15 years
•Average survival 30 years= Commonly from pyelonephritis from recurrent UTI’s |
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middle aged woman presents with vertigo, feeling of fullness in the ear, low pitched tinnitus and hearing loss - otoscopic examination is normal.
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Meniere's disease
(caused by excess fluid in the inner ear) Rx = Sx (antihistamine anti-emetic) Surgery. |
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patient presents with mixed upper, lower and bulbar motor neuron signs
(rapidly progressive weakness, muscle atrophy and fasciculations, muscle spasticity, difficulty speaking (dysarthria), difficulty swallowing (dysphagia), and decline in breathing ability) |
amyotrophic lateral sclerosis
Rx = Riluzole |
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what is the most common site for hypertensive intracranial bleeds?
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Putamen
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a pure sensory stroke is caused by a lesion of which area of the brain
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ventro posterolateral nucleus of the thalamus
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deficiency of what neurotransmitter causes hyperhydrosis
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Dopamine
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what is a positive Rhombergs sign and what causes it?
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steady with eyes open but not with eyes closed
- caused by peripheral neuropathy with sensory ataxia (in cerebellar disease patient is unsteady with eyes open as well) |
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what is the classic triad of wernicke's encephalopathy?
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ataxia
opthalmoplegia confusion |
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develop rapid flacidity and areflexia over days - when recover have preserved vibration and proprioception but UMN loss
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anterior spinal artery syndrome - affects anterior spinal cord = lose corticospinal tract but retain posterior columns
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