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MCCQE1 > Medicine- neurology > Flashcards

Medicine- neurology Flashcards

1
Q

Cerebellar signs

A

Disdiadochokinesia

Ataxia

Nystagmus

Intention tremor

Scanning/ staccato/ slurred speech

Hypotonia

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2
Q

LMN signs

A

Flaccid paresis

Hypotonia

Hyporeflexia

Atrophy

Fasciculations

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3
Q

UMN signs

A

Hyperreflexia

Positive Babinski sign (extensor plantar response)

Spasticity

No muscle weakness (early on)

Pyramidal pattern of weakness

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4
Q

Contraindications to lumbar puncture

A
  • Mass lesion causing increased ICP (risk of cerebral herniation)
  • Infection over LP site/suspected epidural abscess
  • Low platelets (<50,000) or anticoagulated
  • Uncooperative patient
  • Confirmed/suspected spinal trauma or congenital spinal abnormalities
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5
Q

CNIII palsy signs

A

Ptosis

Pupil down and out

Pupil dilation

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6
Q

What EEG findings are associated with absence seizures?

A

3 Hz spike and slow wave activity on EEG

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7
Q

EEG findings suggestive of epilepsy

A

Abnormal spikes Polyspike discharges, Spike-wave complexes

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8
Q

Definition of status epilepticus

A

Medical emergency involving unremitting seizure or successive seizures without return to baseline state of >5 min

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9
Q

Vit B12 deficiency signs

A

Macrocytic anemia, pallor, SOB, fatigue, chest pain, palpitations

  • Confusion or change in mental status (if advanced)
  • Decreased vibration sense
  • Distal numbness and paresthesia
  • Weakness with UMN findings
  • Diarrhea, anorexia
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10
Q

Name the disorder

Visual hallucinations

Parkinsonism

Fluctuating cognition

A

Lewy body dementia

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11
Q

Lewy Body dementia is associated with what kind of response to neuroleptics?

A

Severe sensitivity (rigidity, neuroleptic malignant syndrome, extrapyramidal symptoms)

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12
Q

Canadian CT head rules: high risk (5)

A

High risk (for neurosurgical interventions)

GCS score <15 at two hours after injury

Suspected open or depressed skull fracture

Any sign of basal skull fracture (haemotympanum, “panda” eyes, cerebrospinal fluid otorrhoea, Battle’s sign).

Vomiting more than once

Age≥65 years

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13
Q

Canadian CT head rules: medium risk (2)

A

Medium risk (for brain injury on CT) * Persistent retrograde amnesia of greater than 30 minutes Dangerous mechanism of injury (pedestrian struck by vehicle, ejection from vehicle, fall from greater than three feet or five stairs)

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14
Q

Canadian CT head rules exclusion criteria

A

Exclusion criteria

anticoagulant medication or bleeding disorder

age <16 years seizure

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15
Q

Major neuropathological findings in Parkinsons (2)

A
  • Loss of pigmented dopaminergic neurons in the substantiata nigra
  • Lewy bodies
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16
Q

PD investigations (2)

A

PET SPECT

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17
Q

Serum ceruloplasmin is a screening test for what?

A

Wilson disease

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18
Q

Cluster headache characteristics

A

Unilateral Pain in orbital or supra-orbital region

Assoc w nasal congestion or conjunctival injection

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19
Q

The genetic basis of Huntintgons Disease

A

expansion of a CAG repeat encoding a polyglutamine tract in the N terminus of the protein product called Huntingtin

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20
Q

Signs of raised intracranial pressure

A

Headache

Reduced LOC

Papillodema

Reduced HR

Hypertension

Respiratory depression

Maybe apparent VI palsy (paralysis of lateral gaze)

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21
Q

Tonometry measures what?

A

Intraocular pressure. Used for diagnosis of glaucoma.

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22
Q

Optic chiasm lesion results in what?

A

Bitemporal hemianopsia

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23
Q

What does ALS not affect?

A

Bowel + bladder function

Sensation

Mental function

Eye muscles

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24
Q

What is the relationship between smoking and Parkinsons disease?

A

It lowers risk

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25
Q

Typical presentation of myasthenia gravis

A

Fatgued Muscle weakness Improvement with rest Diplopia

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26
Q

What (pathologically) causes the symptoms of Guillan-Barre syndrome?

A

Loss of myelin

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27
Q

Dementia, gait instability + urinary incontinence suggests what?

A

Normal pressure hydrocephalus These symptoms are Adam’s triad (or Hakim’s triad); ‘wet, whacky + wobbly’

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28
Q

What is The Miller Fisher test?

A

High-volume lumbar puncture (LP) with removal of 30–50 ml of CSF.

Gait and cognitive function are typically tested just before and within 2–3 hours after the LP to assess for signs of symptomatic improvement.

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29
Q

First line treatment of normal pressure hydrocephalus

A

Shunting is the first-line treatment. The most common type used to treat NPH is ventriculoperitoneal (VP) shunts

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30
Q

Presentation of Cauda Equina Syndrome

A
  • Severe back pain
  • Saddle anesthesia ie S3 to S5 dermatomes, including the perineum, external genitalia and anus; or more descriptively, numbness or “pins-and-needles” sensations of the groin and inner thighs
  • Bladder and bowel dysfunction, caused by decreased tone of the urinary and anal sphincters.
  • Sciatica-type pain on one side or both sides, although pain may be wholly absent
  • Weakness of the muscles of the lower legs (often paraplegia)
  • Achilles (ankle) reflex absent on both sides.
  • Sexual dysfunction
  • Absent anal reflex and bulbocavernosus reflex
  • Gait disturbance
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31
Q

Typical cause of Cauda Equina Syndrome

A

Herniated lumbar disc below L2

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32
Q

Neuropathic pain criteria (4)

A
  1. Distribution of pain that is neuroanatomically plausible
  2. Hx suggesting disease or lesion of somatosensory system
  3. A Dx test confirming a lesion or disease that can explain neuropathic pain
  4. Neg or pos symptoms confined to the innervation territory of the damaged nervous structure
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33
Q

First line treatments for cluster headaches

A

The evidence-based acute treatments for cluster headaches are 1. subcutaneous sumatriptan 2. intranasal sumatriptan and zolmitriptan 3. high-flow oxygen via a non-rebreather mask 4. in episodic cluster alone, non-invasive vagus nerve stimulation (nVNS).

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34
Q

Diplopia on upward gaze

A

Myasthenia Gravis

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35
Q

Myasthenia Gravis is associated with what pathology?

A

Thymomas

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36
Q

Charcot Marie Tooth mode of inheritance

A

Autosomal dominant

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37
Q

Classical features of Charcot Marie Tooth syndrome

A

High foot arches (pes cavus)

Distal muscle wasting causing “inverted champagne bottle legs”

Weakness in the lower legs, particularly loss of ankle dorsiflexion

Weakness in the hands

Reduced tendon reflexes

Reduced muscle tone

Peripheral sensory loss

38
Q

A neurological disorder associated with genetic anticipation

A

Huntingtons disease Huntington’s chorea displays something called genetic “anticipation”. Anticipation is a feature of trinucleotide repeat disorders. This is where successive generations have more repeats in the gene, resulting in: Earlier age of onset Increased severity of disease

39
Q

UMN facial nerve palsy is associated with what pathology? How can you distinguish between UMN and LMN facial nerve palsy?

A

Usually a stroke UMN - the forehead is spared

40
Q

Treatment for Bell’s palsy if you present within 72h

A

Prednisone

41
Q

Vesicular rash near the ear and LMN facial nerve palsy

A

Ramsay Hunt Syndrome

42
Q

Cause of Ramsay Hunt syndrome

A

Varicella zoster virus

43
Q

Rx Ramsay Hunt syndrome

A

Treatment should ideally be initiated within 72 hours. Treatment is with: Prednisolone Aciclovir Patients also require lubricating eye drops.

44
Q

Benign intentional tremor does what with intentional movement?

A

Gets worse

45
Q

Postural headache worse on standing, lying or bending over- think what?

A

Raised ICP

46
Q

Sudden onset occipital headache

A

Subarachnoid

47
Q

First line Rx trigeminal neuralgia

A

Carbamazepine

48
Q

A virus implicated in multiple sclerosis

A

EBV

49
Q

CSF findings in multiple sclerosis

A

Oligoclonal bands

50
Q

Key features of optic neuritis

A

Central scotoma. This is an enlarged blind spot.

Pain on eye movement

Impaired colour vision

Relative afferent pupillary defect

Note ON is the presenting feature of MS in 20% of cases and 50% of MS pts will get it.

51
Q

Typical presentation Guillain Barre syndrome

A

Symmetrical ascending weakness (starting at the feet and moving up body)

Reduced reflexes

There may be peripheral loss of sensation or neuropathic pain

It may progress to the cranial nerves and cause facial nerve weakness

52
Q

Bilateral acoustic neuromas almost always indicate what?

A

Neurofibromatosis II

53
Q

Inheritance of neurofibromatosis I + II

A

Autosomal dominant

54
Q

Diagnostic criteria for neurofibromatosis I

A

Need 2 of 7:

C – Café-au-lait spots (6 or more) measuring ≥ 5mm in children or ≥ 15mm in adults

R – Relative with NF1

A – Axillary or inguinal freckles

BB – Bony dysplasia such as Bowing of a long bone or sphenoid wing dysplasia

I – Iris hamartomas (Lisch nodules) (2 or more) are yellow brown spots on the iris

N – Neurofibromas (2 or more) or 1 plexiform neurofibroma

G – Glioma of the optic nerve

55
Q

Complications of NF1

A

Migraines

Epilepsy

Renal artery stenosis causing hypertension

Learning and behavioural problems (e.g. ADHD)

Scoliosis of the spine

Vision loss (secondary to optic nerve gliomas)

Malignant peripheral nerve sheath tumours

Gastrointestinal stromal tumour (a type of sarcoma)

Brain tumours

Spinal cord tumours with associated neurology (e.g. paraplegia)

Increased risk of cancer (e.g. breast cancer)

Leukaemia

56
Q

Skin signs of tuberous sclerosis

A
  • Ash leaf spots are depigmented areas of skin shaped like an ash leaf
  • Shagreen patches are thickened, dimpled, pigmented patches of skin
  • Angiofibromas are small skin coloured or pigmented papules that occur over the nose and cheeks
  • Subungual fibromata are fibromas growing from the nail bed. They are usually circular painless lumps that grow slowly and displace the nail
  • Cafe-au-lait spots are light brown “coffee and milk” coloured flat pigmented lesions on the skin
  • Poliosis is an isolated patch of white hair on the head, eyebrows, eyelashes or beard
57
Q

CSF findings in GBS

A

High protein

58
Q

Periodic synchronous bi- or triphasic sharp wave complexes on EEG

A

Creutzfeldt-Jacob disease

59
Q

Classical presentation of CJD

A

Rapid progressive mental deterioration and myoclonus

60
Q

First line agents for migraine prophylaxis

A

Amitryptiline

Venlafaxine

Propanolol

Topiramate

61
Q

Which AED causes kidney stones?

A

Topiramate

62
Q

Trigeminal neuralgia occurs in young people with which disorder?

A

MS

63
Q

Treating MS relapses

A

Relapses can be treated with steroids. NICE recommend methylprednisolone: 500mg orally daily for 5 days 1g intravenously daily for 3–5 days where oral treatment has failed previously or where relapses are severe

64
Q

A drug to slow the progression of ALS

A

Riluzole

65
Q

What is Natazulimab? What has it been associated with?

A

A synthetic monoclonal antibody used to treat relapsing/ remitting MS.

Associated with progressive multifocal leukoencephalopathy

66
Q

First line therapy for Grand Mal seizures

A

Valproic acid

67
Q

Action of valproic acid

A

Increases GABA by altering properties of voltage gated sodium channels

68
Q

Migraine triggers

A

Caffeine withdrawal

Chocolate

Sleep deprivation

Tyramines (red wine, ripe cheese)

Nitrites (processed meats)

69
Q

Most common neurological manifestation of vitamin B12 deficiency

A

Subacute degeneration of the cord

70
Q

Polyneuropathy + dilated cardiomyopathy

A

Thiamine deficiency

71
Q

Effacement of the supra cellar cistern on non-contrast CT is associated with what?

A

Subarachnoid haemorrhage

72
Q

Subarachnoid haemorrhage risk factors

A

Trauma

Berry aneurysm (+polycystic kidney disease)

Female gender

Hypertension

Connective tissue disease (eg Ehlers Danlos)

73
Q

A major complication of subarachnoid haemorrhage + prophylactic treatment

A

Cerebral vasospasm Triple H therapy + calcium channel blockers

74
Q

Diagnostic test for myasthenia gravis

A

The Tensilon test

Using Edrophonium 10mg

75
Q

Rx for benign essential tremor (2)

A

Propranolol (a non-selective beta blocker) Primidone (a barbiturate anti-epileptic medication)

76
Q

Classical presentation of tuberous sclerosis

A

classical presentation is a child presenting with epilepsy found to have skin features of tuberous sclerosis

77
Q

Factors thought to be implicated in multiple sclerosis

A

Multiple genes Epstein–Barr virus (EBV) Low vitamin D Smoking Obesity

78
Q

What is Lhermitte’s sign?

A

Lhermitte’s sign in MS is an electric shock sensation which travels down the spine and into the limbs when flexing the neck.

It indicates disease in the cervical spinal cord in the dorsal column. It is caused by stretching the demyelinated dorsal column.

79
Q

Diagnosis of multiple sclerosis

A

MRI scans can demonstrate typical lesions Lumbar puncture can detect “oligoclonal bands” in the cerebrospinal fluid (CSF)

80
Q

What % of ppl with optic neuritis develop MS?

A

Around 50% of patients with a single episode of optic neuritis will go on to develop MS over the next 15 years

81
Q

Management of spasticity in MS

A

Baclofen, gabapentin and physiotherapy

82
Q

Biggest source of brain mets

A

Lung Breast Skin Kidney GI tract

83
Q
A

Lisch nodules (iris hamartomas)

Neurofibromatosis

84
Q
A

CNIII palsy

85
Q
A

Charcot Marie Tooth

86
Q
A

Shagreen patch

Tuberous sclerosis

87
Q
A

Ash leaf spots

Tuberous sclerosis

88
Q
A

Ramsay Hunt Syndrome

89
Q
A

Normal pressure hydrocephalus

90
Q

Entry point for lumbar puncture

A

L3-L4 or L4-L5

MCCQE1 (20 decks)

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