Clinical Medicine

Question 1

Complete cord transection causes

Answer 1

Trauma

Transverse myelitis (usually post-infectious or demyelinative)

Tumour

Radiation injury

Question 2

Syringomyelia pattern

Answer 2

CAPE

Question 3

Causes of mononeuropathy multiplex

Answer 3

Vasculitis of vasa nervorum

Sarcoidosis

Diabetes mellitus

Question 4

MS vs NMO Sphincteric Symptoms

Answer 4

MS: urinary urgency and incontinence
NMO: urinary retention

Question 5

INO sides affected

Answer 5

Typically bilateral

Question 6

What structure is usually affected in incoordination caused by MS?

Answer 6

Middle cerebellar peduncle

Question 7

Structures other than the typical central ones affected in MS

Answer 7

Centrum semiovale

Middle cerebellar peduncle

Question 8

MS Spine MRI lesions

Answer 8

Spine MRI lesions involve the dorsal or lateral spinal cord rather than a dense transverse cross section

Are typically restricted to one or two segments

Question 9

Spinal muscular atrophy

Answer 9

Autosomal recessive

Treatment: Antisense oligonucleotide (ASO)

Question 10

Normal ICP

Answer 10

In adults is 8 to 18 mmHg (15-22 cmH2O)

In children the pressure is about 10-20 cm H2O and it’s even lower in babies.

Question 11

Cushing’s Triad

Answer 11

Bradycardia, change in breathing, increased BP

Question 12

Structures affected by hernias

Answer 12

Transtentorial - uncus herniates and affects pca and 3rd cranial nerve (if squeezes more also cerebral peduncle), in 5% contralateral peduncle and CN 3 could be affected

Subfalcine - cingulate gyrus herniates and ACA affected so paramedian cortex infarction

Central - both temporal lobes herniate and compress midbrain

Question 13

Causes of posterior vermis syndrome

Answer 13

medulloblastomas or ependymomas

Question 14

Intenion tremor most severe association in posterior lobe syndrome

Answer 14

Most severe tremors are associated with damage to the dentatothalamic tract

Not sure if these are for most severe or general causes:

MS
Midbrain infarctions

Question 15

Anterior lobe syndrome cause

Answer 15

alcoholism

Question 16

Titubation associated with?

Answer 16

Paraneoplastic syndrome

Question 17

Spinocerebellar ataxia 2

Answer 17

Genetic condition
Truncal ataxia
Limb ataxia
Wide pace
Eye movement problem
Intention tremor
Titubation

Question 18

How many cardinal features are required to diagnose Parkinson’s?

Answer 18

2 out of 4

Question 19

Parkinsonism vs Parkinson disease

Answer 19

Parkinsonism
– Group of hypokinetic movement disorders that have in common
rigidity & bradykinesia

Question 20

Atypical parkinsonian syndromes

Answer 20

Corticobasal degeneration (CBD)
Progressive Supranuclear Palsy (PSP)
Multiple System Atrophy (MSA)

Question 21

Tourette syndrome

Answer 21

≥2 motor + ≥1 vocal + >1year

Question 22

Medial Temporal Epilepsy does not affect which sense?

Answer 22

Auditory

Question 23

Epileptic Syndrome EEGs

Answer 23

WEST SYNDROME: hypsarrhythmia
DRAVET SYNDROME: generalized spike and polyspikes wave
LENNOX GASTAUT SYNDROME: generalized and focal spike and slow waves
JUVENILE MYOCLONIC EPILEPSY: rapid generalized spike and slow waves discharges
CHILDHOOD EPILEPSY WITH CENTROTEMPORAL SPIKES: centrotemporal spikes

Question 24

REM sleep behaviour disorders are usually associated with what condition?

Answer 24

Parkinson’s disease

Question 25

Narcolepsy Molecular Mechanism

Answer 25

HLA-DQB1*0602 on chromosome 6 is a marker, autoimmune attack against hypocretin neurons (orexin neurons) so less hypocretin 1 (orexin) in CSF, some dominant inheritance

Question 26

What is the most useful factor for classifying dementias?

Answer 26

Pathoaetiology

Question 27

What ages are considered presenile and senile?

Answer 27

Presenile: below 65 Senile: 65 and above

Question 28

Progressive Supranuclear Palsy

Answer 28

Axial rigidity + parkinsonism Fall backward Vertical gaze is affected downward

Question 29

Genes Of Late Vs Early Onset Alzheimer's Disease

Answer 29

Early: APP, PSEN1, PSEN2 Late: APOE4, TREM2

Question 30

Normal pressure hydrocephalus

Answer 30

``` Dementia Magnetic gait Urinary incontinence Parkinsonism When you do imagining you find disproportionate to age enlargement of brain ventricles Treated with ventriculoperitoneal shunt ```

Question 31

How is delirium diagnosed?

Answer 31

Acute onset and fluctuating course, inattention, and either disorganised thinking or altered level of consciousness.

Question 32

If initial investigations are negative for HSE?

Answer 32

Repeat all after 4 days

Question 33

Atypical acute bacterial meningitis presentation

Answer 33

Neck stiffness may be absent in unconscious patients. In elderly, presentation may be atypical with no fever no headache and no neck stiffness just nonspecific confusion

Question 34

Acute bacterial meningitis CT MRI

Answer 34

CT: CT brain in bacterial meningitis can demonstrate sulcal effacement but may be normal. MRI: T1 - Postcontrast T1-weighted MRI often reveals enhancement of the leptomeninges within the cerebral sulci. T2 - MRI typically shows T2 hyperintensity in the cerebral sulci. DWI - Diffusion restriction in the sulci may also be seen on DWI,, but not specific for infectious meningitis.

Question 35

Chronic meningitis is defined as?

Answer 35

Meningitis lasting longer than 1 month without improvement

Question 36

Cerebrovascular complications of TBM

Answer 36

Cerebrovascular complications of tuberculous meningitis that occur typically as multiple or bilateral lesions in the territories of the middle cerebral artery perforating vessels are termed as tuberculous vasculopathy

Question 37

TBM Prognosis

Answer 37

Mortality is greatest in patients younger than age 5 years, older than age 50 years, or in those in whom illness has been present for more than 2 months.

Question 38

Brain abscess and subdural empyema

Answer 38

both are given ceftriaxone and metronidazole (for anaerobes) Subdural empyema is usually by extension from sinusitis or otitis media whereas brain abscesses are usually caused by streptococci and are drained if larger than 2.5 cm or are causing symptoms and limiting LOC (lateral occipital complex)

Question 39

Glucose in meningitis

Answer 39

Glucose is decreased in bacterial (including mycobacterial) and fungal infections and generally normal in viral infections, but it may be decreased in mumps, herpes simplex virus 2 and CMV infection.

Question 40

Headache durations and treatments

Answer 40

SUNCT: 1sec-10min + v. difficult to treat Paroxysmal hemicrania: 2-30min + indomethacin Cluster: 15-180 min + oxygen Trigeminal neuralgia: carbamezepine good Preventive migraine treatment: monoclonal Abs vs CGRP

Question 41

Where is titubation seen

Answer 41

Paraneoplastic syndrome and SCA2

Question 42

Edema and region affected

Answer 42

Vasogenic - white matter Cytotoxic - white and grey Interstitial - periventricular

Question 43

ICP Corticosteroids

Answer 43

Tumour or abscess

Question 44

When to stop hyperventilating for ICP

Answer 44

less than 25 mmhg co2

Question 45

Which type of cardiac arrest is the most common in causing brain hypoxia?

Answer 45

Asystole

Question 46

Secondary prevention of stroke

Answer 46

TIA = aspirin vs clopidogrel AFib = aspirin vs warfarin recap from week 3 note