Corrections 2 Flashcards
1
Q
Lesion to which cranial nerve can cause diplopia when looking laterally?
A
CN VI (abducens)
i.e. defective abudction
2
Q
Features of a CN IV (trochlear) lesion?
A
Palsy results in defective downward gaze → vertical diplopia
3
Q
Which CN is involved in head & shoulder movement?
A
CN XI (accessory nerve)
4
Q
Role of CN XII (hypoglossal)?
A
Tongue movement –> tongue will deviate towards the side of the lesion
5
Q
Role of CN X (vagus)?
A
- phonation
- swallowing
- innervates viscera
6
Q
Features of CN X lesion?
A
Lesions may result in;
- uvula deviates away from site of lesion
- loss of gag reflex (efferent)
7
Q
1st line mx of focal seizures?
A
lamotrigine or levetiracetam
8
Q
2nd line mx of focal seizures?
A
Carbamazepine
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)
10
Q
What is a fasciculation?
A
A spontaneous, involuntary muscle contraction and relaxation (i.e. a muscle twitch)
11
Q
What is the most common presentation of ALS?
A
Asymmetric limb weakness
12
Q
What derm feature may be present in tuberous sclerosis?
A
Depigmented ‘ash leaf’ spots
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
14
Q
1st line medications for spasticity in MS?
A
Baclofen & gabapentin
15
Q
What is the mainstay of mx of cervical myelopathy?
A
Decompressive surgery –> refer to spinal surgery/neurosurgery!
16
Q
Where is Wernicke’s area?
A
Left temporal lobe (superior temporal gyrus)
17
Q
Is Broca’s area on the L or the R?
A
L
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)
19
Q
Lesions at which nerve root will cause finger abduction weakness?
A
T1
20
Q
What is a PICA lesion also known as?
A
Lateral medullary syndrome
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).
22
Q
Feautres of springomyelia?
A
Cape-like loss of pain and temperature sensation
23
Q
1st line investigation in springomyelia?
A
MRI spine –> to exclude a tumour or tethered cord
24
Q
Mx of restless leg syndrome?
A
Dopamine agonist e.g. ropinirole
25
What is thoracic outlet syndrome?
A disorder involving compression of brachial plexus, subclavian artery or vein at the site of the thoracic outlet.
26
Sensory loss in a common peroneal nerve lesion?
Sensory loss over dorsum of foot
27
What is the most common radiculopathy affecting the lumbosacral spine?
L5 radiculopathy
28
How does L5 radiculopathy typically present?
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
29
How does S1 radiculopathy typically present?
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
30
What is a wide based gait with a loss of heel to toe walking called?
Ataxic gait
31
IV mannitol vs IV dexamethasone in raised ICP?
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.
32
Mechanism of IV mannitol in raised ICP?
IV mannitol is a hypertonic agent which increases systemic osmolality, causing an osmotic shift of water out of the brain parenchyma.
33
What is a cervical rib?
A congenital defect in which an additional rib grows from the base of the neck just above the collar bone.
34
What is a risk of a cervical rib?
Thoracic outlet syndrome --> compression of brachial plexus, subclavian artery or vein at the site of the thoracic outlet.
35
Mx of all patients with degenerative cervical myelopathy?
Should all be referred for assessment by specialist spinal services.
Only effective treatment is decompressive surgery.
36
Mx of a brain abscess?
IV 3rd-generation cephalosporin (e.g. cephtriaxone) + metronidazole
37
What is pituitary apoplexy?
A rare and life-threatening complication of a pituitary adenoma.
Sudden enlargement of a pituitary tumour 2ary to haemorrhage or infarction.
38
Precipitating factors of pituitary apoplexy?
- HTN
- pregnancy
- trauma
- anticoagulation
39
Features of pituitary apoplexy?
- 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
What imaging is diagnostic in pituitary apoplexy?
MRI
41
Mx of pituitary apoplexy?
1) Urgent steroid replacement due to loss of ACTH
2) Careful fluid balance
3) Surgery
42
Autonomic dysreflexia can only occur if the spinal cord injury occurs above what level?
Above T6
43
Features of a common peroneal nerve lesion?
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
What 2 movements are impacted in a common peroneal nerve lesion?
1) foot dorsiflexion
2) foot eversion
3) toe extension
45
Location of sensory loss in a common peroneal nerve lesion?
Over the dorsum of the foot and the lower lateral part of the leg
46
Is an ENT referral indicated in simple cases of Bell's palsy?
No - only in refractory cases
47
Which nerve is at risk during fracture of the neck of the humerus?
Axillary nerve
48
Which nerve is at risk during shoulder dislocation?
Axillary nerve
49
In what condition are subungual fibromas found?
Tuberous sclerosis
50
Inheritance of tuberous sclerosis?
Autsomal dominant
51
When is a CT head indicated in a TIA?
If patient is taking anticoagulants
52
What are the 1st line investigations for patients with a suspected vestibular schwannoma?
1) Audiogram
2) Gadolinium-enhanced MRI head
53
When is a combination of thrombolysis AND thrombectomy recommended for patients with an acute ischaemic stroke?
In those who present within 4.5 hours
54
WCC findings in NMS?
leukocytosis
55
Long-term secondary prevention after 21 days
56
What sensory features are seen in MS?
1) pins/needles
2) numbness
3) trigeminal neuralgia
4) Lhermitte's syndrome: paraesthesiae in limbs on neck flexion
57
What motor feature is seen in MS?
Spastic weakness: most commonly seen in legs
58
Define spasticity
Spasticity is stiff or rigid muscles.
59
Cerebellar features of MS?
1) ataxia (more often seen during an acute relapse than as a presenting symptom)
2) tremor
60
Other features seen in MS:
1) urinary incontinence
2) sexual dysfunction
3) intellectual deterioration
61
Mx of a myasthenic crisis?
1) supportive
2) IV immunoglobulin or plasma exchange
62
Characteristic features of Guillain-Barre syndrome?
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
Pyridostigmine is used in the mx of mysthenia gravis.
What is the mechanism of this?
Long-acting acetylcholinesterase inhibitor
64
What is affected in Weber's syndrome?
branches of the posterior cerebral artery that supply the midbrain
65
2 features seen in Weber's syndrome?
1) ipsilateral CN III palsy
2) contralateral weakness of upper and lower extremity
66
What are some drugs that can cause Stevens-Johnson syndrome (SJS)?
- carbamazepine
- lamotrigine
- allopurinol
- sulfonamide
- phenobarbital
67
Reflexes in Guillain-Barre?
Reduced or absent
68
Mx of bladder dysfunction in MS?
may take the form of urgency, incontinence, overflow etc
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
Mx of oscillopsia in MS (when visual fields appear to oscillate)?
Gabapentin
70
Does the parietal lobe carry fibres from the superior or inferior optic radiation?
Superior
71
Inferior homonymous quadrantanopias are caused by lesions of what?
Superior optic radiations in the parietal lobe
72
Superior homonymous quadrantanopias are caused by lesions of what?
Inferior optic radiations in the temporal lobe
73
What 2 TIA mimics require exclusion?
1) hypoglycaemia
2) intracranial haemorrhage
74
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
1) Aspirin
2) Aspirin + clopidogrel
3) Clopidogrel (75mg)
75
What can be given in TIA in patients at risk of bleeding (i.e. not suitable for dual antiplatelet therapy)?
Clopidogrel 300mg loading dose followed by 75mg OD
76
What nerve innervates adductor pollicis?
Ulnar nerve
77
What movement is impacted in an ulnar nerve lesion?
Lossof thumb adduction due to adductor pollicis weakness
78
What is Arnold-Chiari malformation?
The downward displacement, or herniation, of the cerebellar tonsils through the foramen magnum.
May be congenital or acquired through trauma.
79
Features of an Arnold-Chiari malformation?
1) non-communicating hydrocephalus may develop as a result of obstruction of CSF outflow
2) headache
3) springomyelia
80
Which opioid can sometimes be used in the mx of neuropathic pain?
Tramadol (weak opioid agonist and a reuptake inhibitor of serotonin and norepinephrine).
81
What sign is usually seen on CT immediately after symptom onset in an acute ischaemic stroke?
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
Where is the chemoreceptor trigger zone located?
In the medulla oblongata
83
What nerve is responsible for finger adduction?
Ulnar nerve
84
What nerve supplies the sergeants patch?
Axillary nerve
85
Which nerve is responsisble for finger & wrist extension?
Radial nerve
86
What is Creutzfeldt-Jakob disease characterised by?
Rapid onset dementia and myoclonus
87
2 features seen in a posterior cerebral artery lesion?
1) contralateral homonymous hemianopia with macular sparing
2) visual agnosia
88
Features of progressive supranuclear palsy?
1) postural instability
2) impairment of vertical gaze
3) parkinsonism
4) frontal lobe dysfunction
This is a 'Parkinson Plus' syndrome
89
Gold standard investigation for degenerative cervical yelopathy?
MRI cervical spine
90
Inheritance of Charcot-Marie tooth disease?
Autosomal dominant
91
Features of CN IV (trochelear) dysfunction?
1) affected eye deviates superiorly and outwards
2) vertical diplopia (especially noticeable when looking down e.g. reading or walking downstairs)
92
If clopidogrel is contraindicated or not tolerated, what should be given for 2ary prevention following stroke?
Aspirin
93
Driving post TIA?
Can start driving if symptom free after 1 month - no need to inform the DVLA
94
