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Yr 5 - Neuro > Corrections 2 > Flashcards

Corrections 2 Flashcards

1
Q

Lesion to which cranial nerve can cause diplopia when looking laterally?

A

CN VI (abducens)

i.e. defective abudction

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2
Q

Features of a CN IV (trochlear) lesion?

A

Palsy results in defective downward gaze → vertical diplopia

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3
Q

Which CN is involved in head & shoulder movement?

A

CN XI (accessory nerve)

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4
Q

Role of CN XII (hypoglossal)?

A

Tongue movement –> tongue will deviate towards the side of the lesion

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5
Q

Role of CN X (vagus)?

A
  • phonation
  • swallowing
  • innervates viscera
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6
Q

Features of CN X lesion?

A

Lesions may result in;

  • uvula deviates away from site of lesion
  • loss of gag reflex (efferent)
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7
Q

1st line mx of focal seizures?

A

lamotrigine or levetiracetam

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8
Q

2nd line mx of focal seizures?

A

Carbamazepine

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9
Q

What should be considered in patients who present with falls soon after a diagnosis of Parkinson’s disease?

A

Investigate for an alternative diagnosis –> e.g. progressive supranuclear palsy (a parkinson plus syndrome)

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10
Q

What is a fasciculation?

A

A spontaneous, involuntary muscle contraction and relaxation (i.e. a muscle twitch)

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11
Q

What is the most common presentation of ALS?

A

Asymmetric limb weakness

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12
Q

What derm feature may be present in tuberous sclerosis?

A

Depigmented ‘ash leaf’ spots

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13
Q

Features of a lacunar stroke?

A

presents with 1 of the following:

1) unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2) pure sensory stroke.
3) ataxic hemiparesis

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14
Q

1st line medications for spasticity in MS?

A

Baclofen & gabapentin

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15
Q

What is the mainstay of mx of cervical myelopathy?

A

Decompressive surgery –> refer to spinal surgery/neurosurgery!

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16
Q

Where is Wernicke’s area?

A

Left temporal lobe (superior temporal gyrus)

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17
Q

Is Broca’s area on the L or the R?

A

L

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18
Q

Mx of MS acute relapse?

A

High-dose steroids (e.g. oral or IV methylprednisolone) for 5 days

It should be noted that steroids shorten the duration of a relapse and do not alter the degree of recovery (i.e. whether a patient returns to baseline function)

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19
Q

Lesions at which nerve root will cause finger abduction weakness?

A

T1

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20
Q

What is a PICA lesion also known as?

A

Lateral medullary syndrome

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21
Q

What is ‘saturday night palsy’?

A

Occur when there is compression of the radial nerve (typically when an intoxicated person falls asleep with their arm draped over a hard surface like a chair back).

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22
Q

Feautres of springomyelia?

A

Cape-like loss of pain and temperature sensation

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23
Q

1st line investigation in springomyelia?

A

MRI spine –> to exclude a tumour or tethered cord

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24
Q

Mx of restless leg syndrome?

A

Dopamine agonist e.g. ropinirole

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25
Q

What is thoracic outlet syndrome?

A

A disorder involving compression of brachial plexus, subclavian artery or vein at the site of the thoracic outlet.

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26
Q

Sensory loss in a common peroneal nerve lesion?

A

Sensory loss over dorsum of foot

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27
Q

What is the most common radiculopathy affecting the lumbosacral spine?

A

L5 radiculopathy

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28
Q

How does L5 radiculopathy typically present?

A

1) Back pain that radiates down the LATERAL aspect of the leg into the foot.

2) Loss of sensation over LATERAL aspect of calf and foot

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29
Q

How does S1 radiculopathy typically present?

A

1) Back pain that radiates down the POSTERIOR aspect of the leg into the foot

2) Strength may be reduced in leg extension (gluteus maximus), foot eversion, plantar flexion, and toe flexion

3) Sensation reduced on the POSTERIOR aspect of the leg and lateral foot

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30
Q

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

A

Ataxic gait

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31
Q

IV mannitol vs IV dexamethasone in raised ICP?

A

IV mannitol –> used to treat raised ICP 2ary to traumatic brain injury

IV dexamethasone –> used to treat ICP 2ary to vasogenic oedema from CNS or neoplasms.

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32
Q

Mechanism of IV mannitol in raised ICP?

A

IV mannitol is a hypertonic agent which increases systemic osmolality, causing an osmotic shift of water out of the brain parenchyma.

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33
Q

What is a cervical rib?

A

A congenital defect in which an additional rib grows from the base of the neck just above the collar bone.

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34
Q

What is a risk of a cervical rib?

A

Thoracic outlet syndrome –> compression of brachial plexus, subclavian artery or vein at the site of the thoracic outlet.

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35
Q

Mx of all patients with degenerative cervical myelopathy?

A

Should all be referred for assessment by specialist spinal services.

Only effective treatment is decompressive surgery.

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36
Q

Mx of a brain abscess?

A

IV 3rd-generation cephalosporin (e.g. cephtriaxone) + metronidazole

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37
Q

What is pituitary apoplexy?

A

A rare and life-threatening complication of a pituitary adenoma.

Sudden enlargement of a pituitary tumour 2ary to haemorrhage or infarction.

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38
Q

Precipitating factors of pituitary apoplexy?

A
  • HTN
  • pregnancy
  • trauma
  • anticoagulation
39
Q

Features of pituitary apoplexy?

A
  • sudden onset headache similar to that seen in SAH
  • vomiting
  • neck stiffness
  • visual field defects: classically bitemporal superior quadrantic defect
  • extraocular nerve palsies
  • features of pituitary insufficiency
    e.g. hypotension/hyponatraemia secondary to hypoadrenalism
40
Q

What imaging is diagnostic in pituitary apoplexy?

A

MRI

41
Q

Mx of pituitary apoplexy?

A

1) Urgent steroid replacement due to loss of ACTH

2) Careful fluid balance

3) Surgery

42
Q

Autonomic dysreflexia can only occur if the spinal cord injury occurs above what level?

A

Above T6

43
Q

Features of a common peroneal nerve lesion?

A

1) Foot drop

2) Weakness of foot dorsiflexion

3) Weakness of foot eversion

4) Weakness of extensor hallucis longus

5) Sensory loss over the dorsum of the foot and the lower lateral part of the leg

6) Wasting of the anterior tibial and peroneal muscles

44
Q

What 2 movements are impacted in a common peroneal nerve lesion?

A

1) foot dorsiflexion

2) foot eversion

3) toe extension

45
Q

Location of sensory loss in a common peroneal nerve lesion?

A

Over the dorsum of the foot and the lower lateral part of the leg

46
Q

Is an ENT referral indicated in simple cases of Bell’s palsy?

A

No - only in refractory cases

47
Q

Which nerve is at risk during fracture of the neck of the humerus?

A

Axillary nerve

48
Q

Which nerve is at risk during shoulder dislocation?

A

Axillary nerve

49
Q

In what condition are subungual fibromas found?

A

Tuberous sclerosis

50
Q

Inheritance of tuberous sclerosis?

A

Autsomal dominant

51
Q

When is a CT head indicated in a TIA?

A

If patient is taking anticoagulants

52
Q

What are the 1st line investigations for patients with a suspected vestibular schwannoma?

A

1) Audiogram
2) Gadolinium-enhanced MRI head

53
Q

When is a combination of thrombolysis AND thrombectomy recommended for patients with an acute ischaemic stroke?

A

In those who present within 4.5 hours

54
Q

WCC findings in NMS?

A

leukocytosis

55
Q

Long-term secondary prevention after 21 days

A
56
Q

What sensory features are seen in MS?

A

1) pins/needles
2) numbness
3) trigeminal neuralgia
4) Lhermitte’s syndrome: paraesthesiae in limbs on neck flexion

57
Q

What motor feature is seen in MS?

A

Spastic weakness: most commonly seen in legs

58
Q

Define spasticity

A

Spasticity is stiff or rigid muscles.

59
Q

Cerebellar features of MS?

A

1) ataxia (more often seen during an acute relapse than as a presenting symptom)

2) tremor

60
Q

Other features seen in MS:

A

1) urinary incontinence
2) sexual dysfunction
3) intellectual deterioration

61
Q

Mx of a myasthenic crisis?

A

1) supportive
2) IV immunoglobulin or plasma exchange

62
Q

Characteristic features of Guillain-Barre syndrome?

A

1) Progressive, symmetrical weakness of all the limbs (typically ascending)

2) Reduced or absent reflexes

3) Sensory symptoms tend to be mild (e.g. distal paraesthesia) with very few sensory signs

63
Q

Pyridostigmine is used in the mx of mysthenia gravis.

What is the mechanism of this?

A

Long-acting acetylcholinesterase inhibitor

64
Q

What is affected in Weber’s syndrome?

A

branches of the posterior cerebral artery that supply the midbrain

65
Q

2 features seen in Weber’s syndrome?

A

1) ipsilateral CN III palsy

2) contralateral weakness of upper and lower extremity

66
Q

What are some drugs that can cause Stevens-Johnson syndrome (SJS)?

A
  • carbamazepine
  • lamotrigine
  • allopurinol
  • sulfonamide
  • phenobarbital
67
Q

Reflexes in Guillain-Barre?

A

Reduced or absent

68
Q

Mx of bladder dysfunction in MS?

may take the form of urgency, incontinence, overflow etc

A

1) get an US first to assess bladder emptying

if if significant residual volume → intermittent self-catheterisation

if no significant residual volume → anticholinergics may improve urinary frequency

69
Q

Mx of oscillopsia in MS (when visual fields appear to oscillate)?

A

Gabapentin

70
Q

Does the parietal lobe carry fibres from the superior or inferior optic radiation?

A

Superior

71
Q

Inferior homonymous quadrantanopias are caused by lesions of what?

A

Superior optic radiations in the parietal lobe

72
Q

Superior homonymous quadrantanopias are caused by lesions of what?

A

Inferior optic radiations in the temporal lobe

73
Q

What 2 TIA mimics require exclusion?

A

1) hypoglycaemia
2) intracranial haemorrhage

74
Q

Mx of TIA:

1) Resolved TIA symptoms, awaiting specialist review within 24 hours

2) Reviewed by specialist, initial 21 days when at high risk of further events

3) Long-term secondary prevention after 21 days

A

1) Aspirin

2) Aspirin + clopidogrel

3) Clopidogrel (75mg)

75
Q

What can be given in TIA in patients at risk of bleeding (i.e. not suitable for dual antiplatelet therapy)?

A

Clopidogrel 300mg loading dose followed by 75mg OD

76
Q

What nerve innervates adductor pollicis?

A

Ulnar nerve

77
Q

What movement is impacted in an ulnar nerve lesion?

A

Lossof thumb adduction due to adductor pollicis weakness

78
Q

What is Arnold-Chiari malformation?

A

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

May be congenital or acquired through trauma.

79
Q

Features of an Arnold-Chiari malformation?

A

1) non-communicating hydrocephalus may develop as a result of obstruction of CSF outflow

2) headache

3) springomyelia

80
Q

Which opioid can sometimes be used in the mx of neuropathic pain?

A

Tramadol (weak opioid agonist and a reuptake inhibitor of serotonin and norepinephrine).

81
Q

What sign is usually seen on CT immediately after symptom onset in an acute ischaemic stroke?

A

Hyperdense artery sign –> this is usually visible immediately in contrast to changes in the parenchyma which usually evolve as the ischaemia within the tissue is established.

82
Q

Where is the chemoreceptor trigger zone located?

A

In the medulla oblongata

83
Q

What nerve is responsible for finger adduction?

A

Ulnar nerve

84
Q

What nerve supplies the sergeants patch?

A

Axillary nerve

85
Q

Which nerve is responsisble for finger & wrist extension?

A

Radial nerve

86
Q

What is Creutzfeldt-Jakob disease characterised by?

A

Rapid onset dementia and myoclonus

87
Q

2 features seen in a posterior cerebral artery lesion?

A

1) contralateral homonymous hemianopia with macular sparing

2) visual agnosia

88
Q

Features of progressive supranuclear palsy?

A

1) postural instability

2) impairment of vertical gaze

3) parkinsonism

4) frontal lobe dysfunction

This is a ‘Parkinson Plus’ syndrome

89
Q

Gold standard investigation for degenerative cervical yelopathy?

A

MRI cervical spine

90
Q

Inheritance of Charcot-Marie tooth disease?

A

Autosomal dominant

91
Q

Features of CN IV (trochelear) dysfunction?

A

1) affected eye deviates superiorly and outwards

2) vertical diplopia (especially noticeable when looking down e.g. reading or walking downstairs)

92
Q

If clopidogrel is contraindicated or not tolerated, what should be given for 2ary prevention following stroke?

A

Aspirin

93
Q

Driving post TIA?

A

Can start driving if symptom free after 1 month - no need to inform the DVLA

94
Q
A

Yr 5 - Neuro (15 decks)

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