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Yr 5 - Neuro > Corrections > Flashcards

Corrections Flashcards

1
Q

Mechanism of neostigmine?

A

Cholinesterase inhibitor (stops breakdown of ACh)

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2
Q

1st line mx of myasthenia gravis?

A

Pyridostigmine (cholinesterase inhibitor)

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3
Q

What is the most sensitive test for MG?

A

Single-fibre electromyography (SFEMG)

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4
Q

What imaging should be performed in MG? Why

A

CT or MRI - look for thymoma or thymic hyperplasia

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5
Q

Mx of a myasthenic crisis?

A

IV immunoglobulins & plasmapheresis

Patients may require non-invasive ventilation or mechanical ventilation.

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6
Q

What movements are typically spared in MND?

A

Eye movements

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7
Q

Describe swallowing in the early stages of bulbar-onset amyotrophic lateral sclerosis (ALS)

A

Patients often have more difficulty swallowing liquids than solids in the early stages.

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8
Q

Next step in any patient that is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA?

A

Immediate referral for imaging to exclude haemorrhage

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9
Q

Mx of a post-LP headache?

A

Caffeine & fluids

This is a low pressure headache

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10
Q

How can axillary freckles determine between NF1 and NF2?

A

Axillary freckles = NF1

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11
Q

What test in myasthenia gravis is most specific (and used for diagnosis)?

A

Antibody test for AChR antibodies

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12
Q

What does pabrinex contain?

A

B vitamins & vitamin C

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13
Q

How can multiple system atrophy be differentiated from Parkinson’s disease?

A

In multiple system atrophy, there is more severe & earlier onset of autonomic dysfunction (postural hypotension/erectile dysfunction).

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14
Q

What class of medication is ropinirole?

A

Dopamine agonist

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15
Q

What lobe does HSV-encephalitis typically affect?

A

Temporal lobes

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16
Q

What condition can increase risk of encephalitis?

A

HIV

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17
Q

What are the 2 most common triggers of autonomic dysreflexia?

A

1) urinary retention
2) faecal impaction

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18
Q

Migraine triggers?

Mneumonic: CHOCOLATE

A

Chocolate
Hangovers
Orgasms
Cheese
Caffeine
Oral contraceptive pill
Lie-ins
Alcohol
Travel
Exercise

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19
Q

Give 4 different types of aphasia

A

1) Wernicke’s (repetitive) aphasia

2) Broca’s (expressive) aphasia

3) Conduction aphasia

4) Global aphasia

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20
Q

Wernicke’s (receptive) aphasia is due to a lesion of what?

A

The superior temporal gyrus

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21
Q

What is the superior temporal gyrus typically supplied by?

A

Inferior division of the left MCA

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22
Q

What is the purpose of Wernicke’s area?

A

‘Forms’ the speech before ‘sending’ it to Broca’s area

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23
Q

Result of lesions Wernicke’s aphasia?

A

Sentences that make no sense, word substitution and neologisms but speech remains fluent - ‘word salad’

Comprehension is impaired

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24
Q

Broca’s (expressive) aphasia is due to a lesion of what?

A

Inferior frontal gyrus

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25
Q

What is the inferior frontal gyrus supplied by?

A

Superior divisoin of the left MCA

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25
Q

Features of Broca’s (expressive) aphasia?

A

Speech is non-fluent, laboured, and halting. Repetition is impaired

Comprehension is NORMAL

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26
Q

What is conduction aphasia?

A

Due to lesion in connection between Wernicke’s and Broca’s area

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27
Q

Features of conduction aphasia?

A

Speech is fluent but repetition is poor. Aware of the errors they are making

Comprehension is NORMAL

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28
Q

What is Guillain-Barre syndrome?

A

Immune mediated demyelination of the peripheral nervous system.

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29
Q

Does Guillain-Barre affect PNS or CNS?

A

PNS

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30
Q

What is Guillain-Barre often triggered by?

A

Infection (classically Campylobacter jejuni)

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31
Q

How can hyperventilation be used in patients with ICP?

A

1) Hyperventilation reduces blood carbon dioxide

2) This causes cerebral vasoconstriction

3) This reduces ICP

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32
Q

What is the key diagnostic test in suspected Guillain-Barre syndrome?

A

Lumbar puncture

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33
Q

Classic initial symptoms seen in Guillain-Barre?

A

around 65% of patients experience back/leg pain in the initial stages of the illness

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34
Q

What are the characteristic features of Guillain-Barre?

A

Progressive, SYMMETRICAL weakness of ALL the limbs:

  • the weakness is classically ascending i.e. the legs are affected first
  • reflexes are reduced or absent
  • sensory symptoms tend to be mild (e.g. distal paraesthesia) with very few sensory signs
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35
Q

What is there classically a history of in Guillain-Barre?

A

Gastroenteritis

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36
Q

LP results in Guillain Barre?

A

rise in protein with a WBC count (albuminocytologic dissociation) - found in 66%

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37
Q

What can nerve conduction studies show in Guillain-Barre?

A

decreased motor nerve conduction velocity (due to demyelination)

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38
Q

Features of Guillain Barre?

A
  • limb weakness
  • respiratory muscle weakness
  • cranial nerve involvement e.g. diplopia
  • autonomic involvement e.g. urinary retention
39
Q

What nerve roots does the biceps reflex test?

40
Q

What is the Cushing’s reflex?

A

Physiological nervous system response to increased ICP that results in hypertension and bradycardia.

41
Q

What is Cushing’s triad?

A

1) widening pulse pressure
2) bradycardia
3) irregular breathing

42
Q

What medication can increase the risk of idiopathic intracranial hypertension?

A

Tetracyclines

43
Q

In what condition is an ‘empty delta sign’ seen on venography?

A

Sagittal sinus thrombosis

44
Q

What medication can be used in idiopathic intracranial HTN?

A

Acetazolamide

45
Q

What class of medication is acetazolamide?

A

Carbonic anhydrase inhibitor

46
Q

When assessing the GCS, should you take the best or worse response from both sides?

47
Q

What is cataplexy?

A

A sudden and transient episode of muscle weakness, typically triggered by strong emotions such as laughter, anger or surprise

48
Q

Mx of ALL patients with Bell’s palsy within 72 hours of onset?

A

Oral pred & eye care e.g. artificial tears

49
Q

Mid-shaft humeral fractures are associated with what nerve injury?

A

Radial nerve –> test wrist extension

50
Q

Can drugs for neuropathic pain be used together?

A

Typically used as monotherapy i.e. if not working then drugs should be switched, not added

51
Q

What is a very common early symptom of multiple sclerosis?

52
Q

What CNs are affected in vestibular schwannomas?

A

V, VII and VIII

53
Q

1st line prophylaxis of migraines in those with asthma?

A

Topiramate

54
Q

In those with myasthenia gravis, which commonly used anaesthetic agent are they most likely be resistant to?

A

Suxamethonium

55
Q

What are some medications that can exacerbate myasthenia gravis?

A
  • penicillamine
  • quinidine, procainamide
  • beta-blockers
  • lithium
  • phenytoin
  • antibiotics: gentamicin, macrolides, quinolones, tetracyclines
56
Q

What is springomyelia?

A

A collection of CSF in the spinal cord.

57
Q

What is there a strong assosciation with in springomyelia?

A

A Chiari malformation

58
Q

Mx of autonomic dysreflexia?

A

Removal/control of the stimulus (e.g. removal of faeces/urine) and treatment of any life-threatening hypertension and/or bradycardia

59
Q

What 2 things must be ruled out in status epilepticus before thinking of other causes?

A

1) hypoxia
2) hypoglycaemia

60
Q

To be counted as localising to pain in GCS, what must happen?

A

To be counted as localising, the arm must be brought above the clavicle, else it should be scored as ‘flexing’

61
Q

What is the commonest neurological manifestation of sarcoid?

A

Facial nerve palsy

62
Q

What muscles are typically spared in MND?

A

Ocular muscles

63
Q

Describe loss of taste in Bell’s palsy?

A

Loss of taste of anterior 2/3 of tongue (on the same side as the facial weakness)

64
Q

What is the ONLY cervical nerve root that comes out BELOW the vertebra?

65
Q

Features of CN III palsy?

A
  • eye is deviated ‘down and out’
  • ptosis
  • pupil may be dilated (‘surgical’ third nerve palsy)
66
Q

Lesion to which CN would cause issues with the ability to look downward, causing vertical diplopia?

A

CN IV (trochlear)

67
Q

What is a wide-based gait with loss of heel to toe walking called?

A

Ataxic gait

68
Q

What class of abx can increase the risk of idiopathic intracranial HTN?

A

Tetracyclines e.g. doxycycline

69
Q

Mx of Steven Johnson Syndrome?

A

1) cease the culprit drug

2) hospital admission is required, ideally to an intensive care unit or burns unit

3) fluid replacement via IV, as there is significant fluid loss from the blisters and red, oozing dermis.

4) nasogastric access is required

70
Q

What CN is responsible for the corneal reflex?

71
Q

Which nerve roots does the triceps reflex test?

72
Q

What can nitrous oxide abuse cause?

A

A functional B12 deficiency (the B12 levels will be normal) and can give rise to subacute combined degeneration of the spinal cord like in true B12 deficiency.

73
Q

What 3 types of seizures are seen in JME?

A

1) absence
2) myoclonic
3) tonic clonic

74
Q

What type of infarct can locked in syndrome occur in?

A

Basilar artery infarct

75
Q

What % ICA stenosis is carotid endarterectomy indicated in?

A

> 50%

Most beneficial in >70%

76
Q

Neuroimaging findings in normal pressure hydrocephalus?

A

Ventriculomegaly in the absence of, or out of proportion to, sulcal enlargement

77
Q

What 2 features are seen in Weber’s syndrome?

A

Midbrain stroke:

1) contralateral hemiparesis

2) ipsilateral CN III palsy

78
Q

Minimum time you cannot drive post-stroke?

A

1 month

Need to be assessed by doctor before can drive again

79
Q

What infection is Guillain-Barre syndrome classically triggered by?

A

Campylobacter jejuni

80
Q

What is intranuclear ophthalmoplegia?

A

A cause of horizontal disconjugate eye movement.

Due to a lesion in the medial longitudinal fasciculus (MLF).

81
Q

What is there a lesion in in internuclear ophthalmoplegia?

A

medial longitudinal fasciculus

82
Q

Role of the medial longitudinal fasciculus?

A

controls horizontal eye movements by interconnecting the IIIrd, IVth and VIth cranial nuclei

83
Q

Features of internuclear ophthalmoplegia?

A

1) impaired adduction of the eye on the same side as the lesion

2) horizontal nystagmus of the abducting eye on the contralateral side

84
Q

Give 2 causes of internuclear ophthalmoplegia

A

1) MS

2) vascular disease

85
Q

What is a Colle’s fracture?

A

A fracture of the distal radius that sometimes involves the ulna.

86
Q

Mx of a patient with a neuropathic bladder due to multiple sclerosis?

A

Intermittent self catheterisation

87
Q

What is an isolated result of high protein in the CSF indicative of?

A

Guillain Barre syndrome

88
Q

What should be given next in status epilepticus if 2x doses of IV lorazepam haven’t worked?

A

IV levetiracetam, phenytoin or sodium valproate

89
Q

Features of a CN III palsy?

A
  • ptosis
  • down and out eye
  • dilated, fixed pupil
90
Q

In regard to homonymous quadrantopias, what mneumonic can be used to remember location?

A

PITS

Parietal-inferior, temporal-superior

I.e. a left temporal lobe infact would cause a right superior quadrantopia

a right parietal lobe infarct would cause a left inferior quadrantopia

91
Q

Location of a lesion causing a bitemporal hemianopia?

A

Lesion of optic chiasm

92
Q

Cause of a bitemporal hemianopia if upper quadrant defect > lower quadrant defect?

A

Inferior chiasmal compression, commonly a pituitary tumour

93
Q

Cause of a bitemporal hemianopia if lower quadrant defect > upper quadrant defect?

A

Superior chiasmal compression, commonly a craniopharyngioma

94
Q

What is the key diagnostic test in suspected Guillain Barre syndrome?

A

LP –> increased protein levels with normal WCC

95
Q

How can giving dextrose/glucose before pabrinex affect Wernicke’s encephalopathy?

A

Giving dextrose/glucose before pabrinex can precipitate/worsen wernicke’s encephalopathy.

Yr 5 - Neuro (15 decks)

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