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Finals Revision > 05/06/2021 > Flashcards

05/06/2021 Flashcards

1
Q

acoustic neuroma diagnosis

A

MRI of cerebellopontine angle

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2
Q

axillary freckles

A

neurofibromatosis type 1

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3
Q

NF1

A 
cafe au lait
axillary/groin freckles
Peripheral neurofibromas
Iris hamatomas 
Scoliosis
Pheochromocytoma
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4
Q

NF2

A

Bilateral vestibular schwannomas

Multiple intracranial schwannomas, meningiomas and ependymomas

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5
Q

painful third nerve palsy

A

posterior communicating artery aneurysm

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6
Q

what causes webers

A

midbrain strokes- ipsilateral 3rd nerve palsy with contralateral hemiplegia

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7
Q

what are adenoma sebaceum

A

feature of tuberous sclerosis

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8
Q

tuberous sclerosis inheritance

A

autosomal dominant

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9
Q

cutaneous features of tuberous sclerosis

A 
ash-leaf spots
shagreen patches
adenoma sebaceum
fibromata beneath names
café au lait may be seen
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10
Q

neurological features of tuberous sclerosis

A

developmental delay
epilepsy
intelluctual impairment

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11
Q

where is affected in broca’s aphasia

A

expressive aphasia- left-sided stoke affecting the MCA due to a lesion of the inferior frontal gyrus

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12
Q

where is affected in wernicke’s aphasia

A

Due to a lesion of the superior temporal gyrus. It is typically supplied by the inferior division of the left MCA

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13
Q

MOA of 5-HT 2 antagonists

A

chemoreceptor trigger zone in medulla oblongata

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14
Q

unilateral spastic paresis and loss of proprioception/vibration sensation wth loss of pain and temperature sensation on the opposite side

A

brown-sequard

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15
Q

cluster headache prophylaxis

A

verapamil

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16
Q

acute rescue therapy cluster headache

A

sumatriptan with high flow oxygen

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17
Q

pain and temperature sensation in brown-sequard

A

loss of contralateral

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18
Q

weakness in brown-sequard

A

ipsilateral weakness below lesion

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19
Q

proprioception in brown-sequard

A

ipsilateral loss

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20
Q

loss of corneal reflex

A

acoustic neuroma

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21
Q

assessing stroke in acute setting

A

ROSIER

  • LOC/syncope (1)
  • seizure activity (1)
  • new onset of;
    + asymmetrical facial weakness (1)
    + asymmetric arm weakness (1)
    + asymmetric leg weakness (1)
    + speech disturbance (1)
    + visual field defect (1)
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22
Q

Anterior cerebral artery stroke

A

contralateral hemiparesis and sensory loss, lower extremity > upper

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23
Q

Middle cerebral artery stroke

A

contralateral hemiparesis and sensory loss, lower extremity > upper

contralateral homonymous hemianopia
aphasia

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24
Q

posterior cerebral artery stroke

A

Contralateral homonymous hemianopia with macular sparing

Visual agnosia

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25
Q

weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain) stroke

A

ipsilateral CNIII palsy

Contralateral weakness of upper and lower extremity

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26
Q

posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome) stroke

A

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

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27
Q

Anterior inferior cerebellar artery (lateral pontine syndrome) stroke

A

Wallenbergs

Ipsilateral: facial paralysis and deafness

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28
Q

retinal/ophthalmic artery stroke

A

amaurosis fugax

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29
Q

basilar artery stroke

A

locked-in syndrome

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30
Q

how do lacunar strokes present

A

isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

Strong association with hypertension

Basal ganglia, thalamus and internal capsule

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31
Q

diminished response to repetitive stimulation on EEG

A

myasthenia gravis

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32
Q

management of nausea in parkinsons

A

give domperidone (guy trembling with bottle of demo perignon)

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33
Q

motor eyes pnuemonic

A

LR6 SO4 ao3

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34
Q

diagnosis of carotid artery stenosis

A

duplex ultrasound

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35
Q

Management of neuropathic pain

A

1) amitriptyline, gabapentin or pregabalin

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36
Q

management of status epilepticus

A

ABC
1st- benzodiazepines
2nd- phenytoin or phenobarbital infusion
3rd (refractory status)- general anaesthesia

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37
Q

tremor + high pitched voice

A

essential tremor

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38
Q

features of bell’s

A

> lower motor neuron facial nerve palsy - forehead affected
– in contrast, an upper motor neuron lesion ‘spares’ the upper face

> patients may also notice post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis

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39
Q

who is predisposed to bell\s palsy

A

pregnant women

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40
Q

management of bell’s palsy

A

all patients should get oral prednisolone within 24hrs

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41
Q

parkinsonism + atonic bladder + postural hypotension

A

multi-system atrophy

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42
Q

features of neuroleptic malignant syndrome

A

rigidity
hyperthermia
autonomic instability
altered mental status

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43
Q

what is an arnold-chiari malformation

A

downward displacement, or herniation of the cerebellar tonsils through the foramen magnum

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44
Q

features of arnold chiari malformation

A

non-communicating hydrocephalus
headache
syringomyelia

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45
Q

what is syringomyelia

A

dilatation of a CSF space in the spinal cord

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46
Q

pathophysiology of syringomyelia

A

compression of spinothalamic tracts decussating in the anterior white commisure

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47
Q

symptoms of syringomyelia

A

dissociative loss of sensation of pain, temperature and non-discriminative touch

cape-like distribution of sensory loss

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48
Q

longevity of cluster headaches

A

15 minutes to 2 hours

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49
Q

dose of rectal diazepam in seizures

A

child <1yr 5mg

child 2-11 yrs 5-10mg

adult 10-20 mg

elderly 10 (max 15)mg

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50
Q

thrombectomy target in acute ischaemic stroke

A

6 hours

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51
Q

when can thrombectomy target be increased in acute ischaemic stroke

A

> potential to salvage brain tissue, shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume

52
Q

how to differentiate between common peroneal nerve lesion and L5 radiculopathy

A

if isolated peroneal lesion there will be weakness of foot dorsiflexion and eversion, reflexes will be normal

if L5 there will be weakness of hip abduction

53
Q

features of wernickes encephalopathy and korsakoffs syndrome

A 
Wernickes;
C- onfusion
O- pthalmoplegia
A- taxia
T- hiamine deficiency
Korsakoff's;
R- etrograde amnesia
A- neterograde amnesia
C- onfabulation
K- orsakoff psychosis
54
Q

saturday night palsy

A

compression of the radial nerve against the humeral shaft, possibly due to sleeping in a hard chair

55
Q

laughter -> fall/collapse

A

cataplexy

56
Q

motor innervation of ulnar nerve

A 
medial two lumbricals 
adductor pollicis
interossei
hypothenar muscles 
flexor carpi ulnaris
57
Q

thoracic outlet syndrome causes

A

neurogenic or vascular

58
Q

clinical presentation of neurogenic thoracic outlet syndrome

A

> painless muscle wasting of hand muscles, with patients complaining of hand weakness e.g. grasping

> sensory symptoms such as numbness and tingling may be present

> if autonomic nerves are involved, the patient may experience cold hands, blanching or swelling

59
Q

clinical presentation of vascular thoracic outlet syndrome

A

> subclavian vein compression leads to painful diffuse arm swelling with distended veins

> subclavian artery compression leads to painful arm claudication and in severe cases, ulceration and gangrene

60
Q

fasciculations

A

think MND

61
Q

baseline investigation for MS

A

MRI brain with contrast

62
Q

scale that measures disability or dependence in activities of daily living in stroke patients

A

barthel

63
Q

vertical diplopia

A

trochlear nerve palsy- worse when reading or going down stairs

64
Q 
nerve root landmarks 
C2
C3
C4
C5
C6
C7
C8

T4
T5
T6
T10

L1
L4
L5

S1
S2
S3

A 
C2= Posterior half of skull
C3= high turtleneck shirt
C4= low collar shirt
C5= ventral axial line of upper limb
C6= thumb + index (make a 6)
C7= middle finger + palm of hand
C8= ring + little finger
T4= nipples (T4 at the teat pore)
T5= infra-mammary fold
T6= xiphoid
T10= umbilicus
L1= inguinal ligament L for ligament, 1 for 1nguinal
L4= knee caps (down on alL 4's)
L5= big toe, dorsum of foot, except lateral aspect (L5= largest of all 5 toes)
S1= lateral foot, small toe S1 the smallest 1
S2= genitalia
S3= genitalia
65
Q

commonest neurological manifestation of sarcoidosis

A

facial nerve palsy due to parotid gland enlargement

66
Q

conduction dysphasia

A

speech fluent, repetition poor. comprehension intact

67
Q

controlled hyperventilation

A

reduces CO2, causes vascoconstriction of cerebral arteries and reduced ICP

68
Q

management of generalised tonic-clonic seizures

A

1) sodium valproate

2) lamotrigine, carbamazepine

69
Q

management of absence seizures

A

1) sodium valproate or ethosuximide

70
Q

management of myoclonic seizures

A

1) sodium valproate

2) clonazepam, lamotrigine

71
Q

management of focal seizures

A

1) carbamazepine or lamotrigine

2) levetiracetam, oxcarbazepine or sodium valproate

72
Q

drugs associated with SJS

A 
phenytoin
salicylates
sertraline
imidazole 
nevirapine
carbamazepine
73
Q

large artery acute ischaemic stroke management

A

mechanical clot review

74
Q

klumpke’s paralysis

A

brachial trunks C8-T1

weakness of the hand intrinsic muscles. Involvement of T1 may cause a Horner’s syndrome.

75
Q

erbs palsy

A

brachial trunks C5-6

pronated and medially rotated.

76
Q

Lambert-Eaton syndrome or myasthenia gravis?

A

Weakness in Lambert Eaton improves after exercise, unlike myasthenia gravis; which worsens after exercise

77
Q

features of intracranial venous thrombosis

A

headache

N&V

78
Q

test of venous sinus thrombosis

A

MR venogram

79
Q

what suggests idiopathic parkinsons?

A

asymmetrical symptoms

80
Q

features favouring pseudoseizures

A 
pelvic thrusting
family member with epilepsy
more common in females
crying after seizure
dont occur when alone
gradual onset
81
Q

treatment of idiopathic intracranial hypertension

A

acetazolamide- CAI that reduces the production of CSF

82
Q

facial palsy that spares the upper face

A

UMN lesion

83
Q

surgical third nerve palsy

A

ptosis, enlarged pupil, inability to adduct/supradduct

84
Q

cause of normal pressure hydrocephalus

A

2ry to reduced CSF absorption at the arachnoid villi

- head injury, SAH or meningitis

85
Q

tried in normal pressure hydrocephalus

A

urinary incontinence
dementia
gait abnormality

86
Q

Bitemporal hemianopia- lower quadrant defect

A

inferior chiasmal compression, commonly a pituitary tumour

87
Q

Bitemporal hemianopia- upper quadrant defect

A

superior chiasmal compression, commonly a craniopharyngioma

88
Q

which medicatons are likey to cause inhibition disorders

A

dopamine receptor agonists- ropinirole

89
Q

weakness of foot dorsiflexion and elevation

A

common peroneal nerve lesion

90
Q

screening tests for cause of stroke

A
  • anti-nuclear antibodies(ANA)
  • anti-phospholipid (APL) antibodies
  • anticardiolipin (ACL) antibodies
  • lupus anticoagulant (LA)
  • coagulation factors
  • ESR
  • Homocysteine
  • syphillis serology
91
Q

appearance of chronic subdural haematoma on scan

A

hypodense (dark) crescenteric collection around the convexity of the brain

92
Q

what is autonomic dysreflexia

A

> unbalanced physiological response
characterised by;
extreme hypertension, flushing and sweating above the level of the cord lesion, agitation, and in untreated cases severe consequences of extreme hypertension have been reported, e.g. haemorrhagic stroke.

93
Q

what causes autonomic dysreflexia

A

spinal cord injury at, or above T6 spinal level.

94
Q

management of autonomic dysreflexia

A

removal/control of the stimulus and treatment of any life-threatening hypertension and/or bradycardia

95
Q

smiths fracture injury

A

median nerve- thenar muscle failure

96
Q

cutaenous sensation to the axilla

A

intercostobrachial

97
Q

what is todd’s paresis?

A

post-ictal weakness in focal seizures

98
Q

exacerbating factors in myasthenia gravis

A 
penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracycline
99
Q

syncopal episode vs seizure

A

syncopal episodes have a short post-ictal period

100
Q

management of MND

A

riluzole- prolongs life by about 3 months

resp care= BIPAP

101
Q

the sensation of fine touch, proprioception and vibration are all conveyed in the ____ ______

A

dorsal column

102
Q

what is lhermitte’s sign?

A

indicates disease near the dorsal column nuclei of the spinal cord - tingling in hands when flexes neck

103
Q

management of acute relapse of MS

A

high dose steroids

104
Q

most common inherited sensorimotor neuropathy

A

charcot-marie-tooth

105
Q

treatment of myasthenia gravis

A

Pyridostigmine is a long-acting acetylcholinesterase inhibitor that reduces the breakdown of acetylcholine in the neuromuscular junction, temporarily improving symptoms of myasthenia gravis

106
Q

lesions at T1 will cause

A

finger abduction weakness

107
Q

syringomyelia = ______ sensory loss

A

spinothalamic

108
Q

investigation in suspected acoustic neuroma

A

audiogram and gadolinium-enhanced MRI head scan

109
Q

use of anaesthesia in MG

A

MG: rocuronium ‘rocks’

Suxamethonium sucks

110
Q

when to suspect encaphalitis

A

altered mental status

111
Q

which nerves are affected in vestibular shwanommas?

A

cranial nerves V, VII, VIII

112
Q

managing tremor in drug induced parkinsons

A

procyclidine

113
Q

side effect of cabergoline

A

pulmonary fibrosis

114
Q

long term use of levodopa

A

reduced effectiveness with time

115
Q

symptoms of paroxysmal hemicrania

A

attacks of severe, unilateral headache, usually in the orbital, supraorbital or temporal region

last less that 30 mins

116
Q

management of paroxysmal hemicrania

A

indomethacin

117
Q

management of neuroleptic malignant syndrome

A

stop antipsychotic

IV fluids to prevent renal failure

dantrolene

bromocriptine, dopamine agonist

118
Q

what is internuclear ophthalmoplegia

A

lesion of medial longitudinal fasciculus- a tract that allows conjugate eye movement

119
Q

presentation of internuclear ophthalmoplegia

A

impairment of adduction of ipsilateral aye, contralateral eye adducts however with nystagmus

120
Q

jacksonian movement

A

clonic movements travelling proximally - frontal lobe epilepsy

121
Q

most common psychiatric problem in parkinsons

A

depression

122
Q

headache, fever and focal neurology

A

brain abscess

123
Q

what does loss of proprioception and vibration sense point towards?

A

dorsal columns- subacute combined degeneration of the spinal cord

124
Q

pontine haemorrhage

A

Patients often present with reduces Glasgow coma score, quadriplegia, miosis, and absent horizontal eye movements.

125
Q

barthel index

A

measures disability or dependence in ADL in stroke patients

126
Q

isolated high protein in CSF

A

indicative of GBS

Finals Revision (29 decks)

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