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Neurology SB > Extra > Flashcards

Extra Flashcards

1
Q

An 18-year-old male patient describes periods of twitching of the left side of his face that spreads to affect his left arm and shoulder. Afterwards he describes weakness of his left arm

A

Jacksonian seizure/march

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2
Q

what is a Jacksonian seizure/march

A

form of simple complex seizures

seizure spreads from the distal part of the limb toward the ipsilateral face (on same side of body

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3
Q

what is the first line treatment for Delirium in the elderly

A

0.5mg Haloperidol

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4
Q

what causes Wernicke Encephalopathy

A

Thiamine deficiency

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5
Q

what is pathological seen in W.E

A

petechial haemorrhages in mamillary bodies and ventricle walls

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6
Q

Tx for W.E

A

Thiamine replacement

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7
Q

what would developing the inability to acquire new memories and confabulation suggest with the background of W.E.

A

patient has developed Korsakoff’s Syndrome

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8
Q

Urinary incontinence + gait abnormality + dementia = ???

A

Normal pressure hydrocephalus

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9
Q

what would be seen on imaging in normal pressure hydrocephalus

A

enlarged forth ventricle

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10
Q

what is Tx of normal pressure hydrocephalus

A

Ventriculoperitoneal shunting

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11
Q

what is used as a prognostic score in TIAs

A

ABCD2

Age > 60 (1 pt)
Blood pressure > 140/90 (1 pt)
Clinical features - unilateral weakness (2 pts)
- speech disturbance, no weakness (1pt)
Duration of Sx - >60mins (2 pts)
- 10-59 mins (1pt)
Diabetes (1pt)

Total = 7

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12
Q

what is Tx if patient has ABCD2 > 4

A

Aspirin 300mg daily (and Dipyridamole)

measures for secondary prevention

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13
Q

what should be given to stroke patients immediately IF a haemorrhagic stroke has been excluded

A

Aspirin 300mg (as soon as possible)

Thrombolysis (Alteplase)

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14
Q

what are Sx of Brown-Sequard Syndrome

A

IPSILATERAL

  • loss of touch, vibration, proprioception
  • hyper-reflexia
  • extensor plantar reflex

CONTRALATERAL
- loss of pain and temperature

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15
Q

what are Sx/signs seen in Tuberous Sclerosis

A

Café-Au-Lait
“Ash-leaf” spots
Shagreen patches (roughened patches of skin over lumbar spine)
Subungual fibromata

Epilepsy (infantile spasms or partial)
Development delay
Polycystic kidneys

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16
Q

what are the mnemonics of Neurofibromatosis

A

NF1 Chr 17 (Neurofibromatosis has 17 characters)

NH2 Chr 22 (all the 2’s)

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17
Q

what are features of NF1

A 
Cafe-au-lait spot 
Axillary/Groin freckles 
Peripheral Neurofibromas 
Lisch nodules 
Scoliosis
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18
Q

what are features of NF2

A

Bilateral acoustic neuromas

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19
Q

what is seen in ALS

A

LMN signs in the arm

UMN signs in the leg

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20
Q

in familial cases of ALS what gene is affected

A

Chr 21

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21
Q

what is seen in PLS

A

UMN signs only

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22
Q

what is seen in progressive muscular atrophy

A

LMN signs only

Affects distal muscle before proximal

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23
Q

what is seen in Bulbar palsy

A

palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem

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24
Q

what muscles common waste in MN disease

A

small hand muscles

tibialis anterior

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25
Q

what will nerve conduction studies shows in MN disease

A

normal conduction

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26
Q

what will electromyography show in MN disease

A

decrease number of AP with increase amplitude

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27
Q

what anti-glutamate drug is used in ALS

A

Riluzole

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28
Q

what signs show UMN and what shows LMN

A

UMN - extensor plantar

LMN - absent ankle jerk

29
Q

what seizures can carbamazepine exacerbate

A

absence seizures

30
Q

what is a characteristic EEG of an absence seizure

A

bilateral, symmetrical 3Hz (spike and wave) pattern

31
Q

what should a women do if she is pregnant and on anti-epileptic medication

A

stop anti-epileptic medication

take 5mg/day folic acid (prevents neural tube defects)

32
Q

what AED are associated with what birth defects

A

Sodium Valproate = neural tube defects

Phenytoin = cleft palate (expecting mums taking this are given Vit K last month of pregnancy to prevent clotting disorders)

33
Q

what is the gold standard investigation for functional seizures

A

Video Telemetry

34
Q

what drugs lead to drug induced parkinsonism

A

Metoclopramide
Haloperidol
Chlorpromazine

35
Q

Levodopa is sometimes the initial treatment of Parkinsons, what are the side effects of the drug

A 
Dyskinesia
Postural hypotension 
Cardiac Arrhytmias
Nausea and Vomiting
Psychosis 
Reddish discolouration of urine on standing
36
Q

how do MAO-B inhibitors worj

A

inhibits the breakdown of dopamine secreted by the dopaminergic neurones

37
Q

parkinsonsim + impairment of vertical gaze (complain of difficulty reading/going down stairs)

A

Progressive Supranucleur Palsy

38
Q

what is Pick disease

A

frontotemporal lobar degeneration

39
Q

Sx of Pick disease

A 
aggressiveness
inappropriate behaviour 
change in behaviour
apathy 
depression

speech and language abnormalities begin early and progress rapidly

memory less affected than in Alzheimer and may score high on MMSE

40
Q

what is an essential tremor (features)

A

AD condition made worse when arms are outstretched

made better by alcohol and propranolol

41
Q

what is second line treatment in essential tremor if propranolol is contraindicated

A

Primidone (anti-convulsant)

42
Q

what is Creutzfeldt-Jakob Disease (CJD)

A

incurable and universally fatal neurodegenerative disease caused by prion protein

43
Q

Sx of CJD

A

Dementia
Cerebellar ataxia
Myoclonic jerks

44
Q

what are key Ix findings suggestive of CJD

A

EEG = non specific slowing periodic sharp wave complexes (PSWCs) of 1-2 Hz

Prior protein in CSF and in tonsils

Pulvinar sign on MRI

45
Q

Facial Palsy + convergent squint

A

lesion in the pons

46
Q

how does a UMN lesions and a LMN lesion on the face differ

A

UMN lesion - spares upper face i.e. forehead

LMN lesion - affects all facial muscles

47
Q

what is seen on MRI and CSF in MS

A

MRI

  • high signal T2 lesions
  • periventricular plaques

CSF
- oligoclonal bands (and not is serum)

48
Q

ptosis + dilated pupil = ??

A

Third nerve palsy

49
Q

ptosis + constricted pupil = ??

A

Horner’s Syndrome

50
Q

what is Argyll-Robertson pupil and why is it also known as “Whore’s Eye”

A

small irregular pupils that do not react to light but react to accommodation (reduce in size when focusing on a near object)

associated with tertiary syphilis

51
Q

what causes Argyll-Robertson pupil

A

MS, Sarcoidosis, DM, Tertiary Syphilis

52
Q

painful 3rd nerve palsy + headache =

A

posterior communicating artery aneurysm

53
Q

features of 3rd nerve palsy

A

eye deviated ‘down and out’
ptosis
dilated pupil

54
Q

what is Weber’s Syndrome

A

ipsilateral 3rd nerve palsy with contralateral hemiplegia caused by midbrain strokes

55
Q

what is Lambert-Eaton Myasthenia syndrome

A

seen in associated with small cell lung cancer but can occur independently as an autoimmune condition

caused by antibody directed against pre-synaptic voltage gated calcium channel in the PNS

56
Q

what are features of Lambert-Eaton

A

repeated muscle contractions leads to increased muscle strength
limb girdle weakness - proximal more commonly
hyporeflexia
autonomic Sx = dry mouth, impotence
no eye features like myasthenia gravis

57
Q

Tx of Lambert Eaton

A

Immunosuppresion

- prednisolone and/or azathioprine

58
Q

what are features of a vestibular schwannoma

A

HL, vertigo, tinnitus
absent corneal reflex
facial palsy

59
Q

Ix for vestibular schwannoma

A

MRI of cerebellopontine angle

60
Q

drug that can cause demyelinating peripheral neuropathy

A

amiodarone

61
Q

how does alcoholic neuropathy present

A

sensory symptoms present before motor symptoms

62
Q

what does a vitamin B12 deficiency cause

A

subacute combined degeneration of the spinal cord

Dorsal column usually affected first

63
Q

how do nerve conduction studies differ in demyelinating and axonal neuropathy

A

demyelinating

  • reduced conduction velocity
  • normal amplitude

axonal

  • normal conduction velocity
  • reduced amplitude
64
Q

what infection classically triggers Guillain Barre Syndrome

A

Campylobacter jejuni

but also can be Chlamydia, HBV, Mycoplasma pneumonia, CMV, EBV, HZV, HIV

65
Q

what Sx are seen in Guillain Barre Syndrome

A

paralysis noted by weakness in the legs that spreads to upper limbs and face
loss of deep tendon reflexes

66
Q

what is seen in Toxoplasmosis if a CT was done and Tx

A

multiple ring enhancing lesions

Tx = sulfadiazine and pyrimethamine

67
Q

what is Tx of migraine during pregnancy

A

1st line = paracetamol 1g

2nd line = in 2nd and 3rd trimester
- Aspirin 300mg or Ibuprofen 400mg

68
Q

when is the COC pill an absolute contraindication

A

migraine with aura

Neurology SB (23 decks)

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