MRCP Neuro Flashcards
1
Q
Tourrette syndrome hallmark
A
vocal/motor tic
suppressibility
mx: risperidone
2
Q
Huntington symptome
A
Chorea
3
Q
Cavernous sinus thrombosis visual symptoms
A
double vision looking up
4
Q
Isolated 6th nerve palsy
A
unable to abduct (LR6)
due to microvascular lesion i.e diabetes
5
Q
What is prion disease?
A
Creutzfeldt-Jakob disease (CJD) is rapidly progressive neurological condition caused by prion proteins. These proteins induce the formation of amyloid folds resulting in tightly packed beta-pleated sheets resistant to proteases.
6
Q
Features of CJD
A
Features
dementia (rapid onset)
myoclonus
behavioural change
7
Q
MRI findings o CJD
A
MRI: hyperintense signals in the basal ganglia and thalamus
8
Q
What cancer is likely with von Hippel?
A
RCC
9
Q
What extra renal cysts does von Hippel have?
A
pancreatic
liver
epididymal
10
Q
Which dementia presents with hallucination and Parkinsonism?
A
Lewy body
11
Q
Which drug worsens parkinsonism
A
haloperidol
12
Q
What is the treatment for essential tremor?
tremor on outstretched hands
A
propanolol
13
Q
pick bodies
lewy bodies
neurofibrillary tangles
A
frontemporal (tau)
parkinson
alzheimers
14
Q
Foot drop nerve lesion
A
common perineal
15
Q
what is mononeuritis multiplex
A
2 discrete incidents of neuropathies, gradually self resolves
both sensory and motor functions
16
Q
causes of mononeuritis multiplex
A
vasculitis
diabetes
B12 deficiency
sarcoid
amyloid
paraneoplastic
17
Q
MND vs mononeuritis multiples
A
MND- motor only
MM- motor and sensory
18
Q
Lyme disease CSF
A
lymphocytic
protein high
glucose low
erythema migrans
arthritis
19
Q
TB CSF
A
high protein
low glucose
lymphocytic
20
Q
bacterial csf
A
polymorphs
low glucose
high protein
21
Q
Viral csf
A
60-80% plasma glucose
normal/raised protein
lymphocytic
22
Q
elderly with haedache
Usually related to trauma
Alcoholics
confusion weeks later
A
subdural
SUBANANA
23
Q
middle meningeal artery bleed
A
extradural
24
Q
AED not safe in pregnancy
A
phenytoin
25
AED safe in pregnancy
lamotrigine
keppra
26
Second order Horner syndrome causes
pan cost tumour
- miosis
- ptosis
- anhydrosis
second order (pregnaglionic)
- (neutron exits the spinal cord towards head and neck)
27
first order neurone
central neurone
28
third order neuron
post ganglionic from cervical ganglion alon internal carotid artery into cavernous sinus
29
Third order Horner cause
cavernous sinus thrombosis
internal carotid dissection
30
first order horners
craniopharyngioma
stroke
tumour
31
wernicke encephalopathy
IV thiamine
triad:
confusion
ataxia
opthalmoplegia
32
Huntington disease
autosomal dominant
trinucleotide repeat disorder
33
Fragile X syndrome
X linked dominant trinucleotide repeat
34
Fredreich ataxia
autosomal recessive
trinucleotide repeat
35
Median neuropathy
carpal tunnel
36
ulnar radiopathy at elbow
cubital tunnel syndrome
37
radial nerve neuropathy
spiral gorge
wrist drop
38
lateral femoral cutaneous neuropathy
meralgial parathesia
clinical dx
39
peroneal neuropathy
lateral border of knee compression
foot drop and weak foot eversion
sensory oss in dorm and lateral foot border
40
How long do you have to wait for LP after onset of headache for SAH?
12 hrs for breakdown to BR
41
What can nitric oxide toxicity cause?
sensory neuropathy
myelopathy (leg weakness, increased and decreased reflex, sensory neuropathy signs)
42
What is Holmes Adie pupil
women
dilated pupil
unilateral
slow accommodation
poor reflex to light
associated with absent ankle/knee reflex
43
What is the first line treatment for primary generalised epilepsy in under 55 years
lamotrigine
44
What is a risk of lamotrigine?
Steven johnson syndrome (monitor for rash)
45
Rx: Generalised tonic-clonic seizures
males: sodium valproate
females: lamotrigine or levetiracetam
46
Rx: Focal seizures
first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide
47
Rx: Absence seizures (Petit mal)
first line: ethosuximide
second line:
male: sodium valproate
female: lamotrigine or levetiracetam
carbamazepine may exacerbate absence seizures
48
Rx: Tonic or atonic seizures
males: sodium valproate
females: lamotrigine
49
Rx: Myoclonic seizures
males: sodium valproate
females: levetiracetam
50
Dix hallpike vs Epley
Dix hallpike: assessment and diagnosis
Epley: treatment
51
Inherited form of vascular dementia
CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.
52
What is PSP
Progressive supranuclearpalsy
falls
vertical supranuclear gaze palsy
53
Which ab is associated with miller fisher
GQ1b
54
Lambert eaton myasthenia syndrome
a/w small cell lung cancer
autoimmune ab against voltage gated calcium channel in PNS
weak in morning
gains strength with use
55
Mneumonic for cerebellar disease
DANISH
Diadodyskinesia
Ataxia
Nystagmys
Intention tremor
Slurred speech
Hypotonia
56
What are the differential of isolated motor deficiency , normal sensory
MND and multifocal motor neuropathy
57
What is multifocal motor neuroptahy
inflammatory neuropathy causing multifocal demyelination with conduction block
58
What is MND demyelination pattern?
Axonal degeneration
59
when suspecting meningococcal meningitis with non blanching rash what should be given by GP?
IM benpen
60
PITS
Parietal inferior
temporal superior
CONTRALATERAL
61
Miller fisher hallmarks
Triad: ophthalmoplegia, areflexia and ataxia.
eye muscles are typically affected first
usually presents as a descending paralysis
anti-GQ1b antibodies
IgA immunoglobulins should be checked prior to IVIG (risk of anaphylaxis in IgA deficiency)
62
Vestibular schwannoma hallmark
vertigo, hearing loss, tinnitus and an absent corneal reflex.
cerebellopontine angle tumour
CN 5 - trigeminal (reflex)
CN 7 - facial
CN 8 - vestibulocochlear
63
CN with opthalmoplegia
3
4
6
SO4 LR6
64
Spinal tracts
Spinothalamic tract- not that patient
- decuss at spine
- pain and temperature
Corticospinal tract - motor
- decuss at medlla
- LATERAL = LIMBS
- ANTERIOR = AXIAL
dorsal column - feeling very patient
- decuss at medulla
- fine touch and proprioception and vibration
- c before g
- cutaneous fasciculus (upper limb)
- gracilis fasciulus (lower limb)
65
Which part of brainstem (midbrain) presents with failure of vertical gaze?
dorsal midbrain
66
Why alcoholics have hypocalcaemia
nutritional deficit hypomagnesaemia
67
What are the main types of MND?
ALS (most common) - U+L (bulbar, limb, resp)
Progressive bulbar palsy - U+L (facial)
progressive muscular atrophy - LMN (distal weakness)
primary lateral sclerosis - UMN (spastic weakness, hyperrefelxia)
68
Normal pressure hydrocephalus
reversible cause of dementia seen in elderly patients.
wet
wacky
wobbly
68
Treatment for Normal pressure hydrocephalus
CSF shunt
LP
69
What is paralytic polio
polio infection
causing neck pain and stiffness
unilateral flaccid weakness
70
Sciatica at L5/S1
sensory loss in soles of foot
weak plantar flex (S1)
note dorsiflexion by L5
71
LP window for SAH
Xanthochromia will be detectable on a lumbar puncture from 12 hours to 12 days after the onset of a subarachnoid haemorrhage
72
Dermatomes
Dermatomes
Definition: an area of skin that receives its sensory innervation from a single spinal nerve root
Key Dermatomes
C2: posterior head
C3: neck
C4: shoulder
C5: lateral upper arm
C6: lateral forearm & thumb
C7: middle finger
C8: medial hand and little finger
T1: medial forearm
T2: medial upper arm
T4: nipples
T8: xiphisternum
T10: umbilicus
T12: pubic symphysis
L1: groin
L2: anterior thigh
L3: anterior knee
L4: medial shin
L5: dorsal foot and first web space
S1: sole and lateral foot
S2: posterior leg and thigh
S3: ischial tuberosity
S4-5: perianal
73
Myotomes
Myotomes
Definition: a group of muscles that are innervated by a single spinal nerve root.
Key Myotomes
C5: shoulder abduction, deltoid
C6: elbow flexion, biceps
C7: elbow extension, triceps
C8: wrist and finger flexion
T1: finger abduction, interossei
L2: hip flexion, iliopsoas
L3-4: knee extension, quadriceps
L4-S1: knee flexion, hamstrings
L5: ankle and hallux dorsiflexion, extensor hallucis longus
S1: ankle plantarflexion, gastrocnemius
74
Presentation of brownsequard
Brown-Sequard Syndrome
Hemisection of the spinal cord
ipsilateral weakness and loss of fine touch and proprioception
contralateral loss of pain and temperature sensation
75
Treatment for cervical dystonia (torsicollis)
botox
76
Sciatic nerve
L5-S1
Foot drop
| splits into common perioneal and tibial
77
Prophylactic treatment for cluster headache
verapamil
78
Cerebal venous sinus thrombosis presentation
headache
focal neurological deficit
seizures
79
Lateral medullary syndrome (posterior inferior cerebellar artery)
aka Wallenberg's syndrome
**ipsilateral: **
ataxia, nystagmus, dysphagia, **facial numbness, **cranial nerve palsy e.g. **Horner's**
**contralateral: **
**limb sensory loss**
79
Stroke territories and hallmarks
ACA
- legs >arms
MCA
- face > arm >leg
- aphasia
PCA
- visual
- ataxia
- brainstem
80
Cause of lateral medullary syndrome
vertebral artery dissection
81
Migraine with aura
migrating sensory and motor symptoms
speech difficulty
ptosis
82
Syringomyelia hallmarks
describes a collection of cerebrospinal fluid within the spinal cord.
Presents with accidental hand burn without realising
'cape-like' (neck, shoulders and arms)
loss of sensation to temperature
LMN in upper limb
UMN in lower limb
horner's (sympathetic compression)
83
Syringobulbia hallmark
syringomyelia extending up the brainstem (medulla)
83
Hallmark of juvenile myoclonic epilepsy
infrequent generalized seizures
triggered by sleep deprivation/XS alcohol
early morning myoclonic jerks
daytime absences
sudden, shock-like myoclonic seizure (these may develop before seizures)
treatment: usually good response to sodium valproate
84
Pontine stroke hallmarks
contralateral hemiparesis
bulbar signs
ipsilateral 5-8th nerve palsy
85
CN exit of brain
2- cerebrum (1-2)
2- midbrain (3-4)
4- pons (5-8)
4- medulla (9-12)
86
What nerves are involved in bulbar palsy
CN 9-12
87
Treatment for NPH
WET
WACKY
WOBBLY
Mainstay: SHUNT
if CI for shunt then for acetazolamide and repeated LP
88
DVLA rules for post stroke/TIA
Cannot drive for 1 month
89
Hallmark of temporal lobe epilepsy
abdominal pain aura
staring into space
lip smacking
then post ictal phase
90
Which medication should be avoided in dementia and why
haloperidol
risk of extrapyramidal side effects i.e drug induced parkinsonism
91
91
Friederich ataxia
Autosomal recessive
most common early onset hereditary ataxia
GAA repeat trinucleotide
optic atrophy
HOCM
kyphoscoliosis
92
What should be monitored in GBS?
FVC
93
What is the most commonest cause of temporal epilepsy
hippocampal sclerosis
note: it is a partial seizure
94
How is wilson's related to parkinsonism
basal ganglia deposits
95
Investigation findings in MS
MRI
high signal T2 lesions
periventricular plaques
Dawson fingers: often seen on FLAIR images - hyperintense lesions penpendicular to the corpus callosum
CSF
oligoclonal bands (and not in serum)
increased intrathecal synthesis of IgG
Visual evoked potentials
delayed, but well preserved waveform
96
What immunoglobulin is found in MS?
Intrathecal IgG
Oligoclonal bands
97
Lyme disease LP findings
lymphocytic
high protein
normal glucose
98
How to diagnose syringomyelia
MRI
99
What is cushing triad
raised ICP
- bradycardia
- hypertension
- irregular respiration
100
Why does twitching happen in vasovagal syncope
transient hypoxia
101
mutifocal axonal neuropathy and nailfold infarct (vasculitic)
Hep C and cryoglobinaemia
| protein insoluble at low temps
102
Peirpheral neuropathy Predominately motor loss
Guillain-Barre syndrome
porphyria
lead poisoning
hereditary sensorimotor neuropathies (HSMN) - Charcot-Marie-Tooth
chronic inflammatory demyelinating polyneuropathy (CIDP)
diphtheria
103
Peripheral neuropathy Predominately sensory loss
diabetes
uraemia
leprosy
alcoholism
vitamin B12 deficiency
amyloidosi
104
What are the hallmarks of chronic inflammatory demyelinating polyneuropathy
Anti-GM1
Asymmetrical motor neuropathy
usually upper limb
preserved reflexes
motor conduction block on NCS
105
Auto antibody of miller fisher
anti-GQ1b
fisherman drunk and eye patch
106
Hallmark of myasthenia gravis
muscle fatigability with use
extraocular muscle weakness: diplopia
proximal muscle weakness: face, neck, limb girdle
ptosis
dysphagia
Acetylcholine receptor antibody
thymoma
107
treatment for MG acute attack
pyridostigmine
(acetylcholinesterase inhibitor)
30mg QDS for 2-4 days
108
Alcohol withdrawal time frame
6 to 12 = feeling unwell
A day and a bit = have a fit
Deux, Trois = delirium tremens
109
What are the 3 types of frontotemporal lobe degeneration
Frontotemporal dementia (Pick's disease)
Progressive non fluent aphasia
(chronic progressive aphasia, CPA)
Semantic dementia
-The speech is fluent but empty and conveys little meaning.
110
What is semantic memory
ability to put meaning to object presented visually or auditory
111
Pontine haemorrhage
112
Parkinson's plus syndrome
Progressive Supranuclear Palsy (PSP)
Multiple System Atrophy
Corticobasal Degeneration
Lewy Body Dementia
113
Hallmarks of PSP
Pathophysiology: Caused by aggregation of abnormal tau proteins.
Key Features
Parkinsonism (rigidity, bradykinesia)
**Supranuclear Gaze Palsy (lack of eye movement in vertical plane) **
Pseudobulbar Palsy (dysarthria and dysphagia)
Postural Instability (frequent falls)
114
Hallmarks of MSA
Multiple System Atrophy
Pathophysiology: Caused by deposition of abnormal alpha-synuclein proteins.
Key Features
Parkinsonism (prominent rigidity)
Cerebellar Ataxia
Autonomic Dysfunction
115
Hallmarks of Corticobasal Degeneration
Pathophysiology: Caused by aggregation of abnormal tau proteins.
Key Features
**Parkinsonism (unilateral) **
Alien Limb Phenomenon (involuntary, purposeful arm movements)
Dysphasia
Dysarthria
116
Hallmarks of LBD
Pathophysiology: Caused by aggregation of abnormal alpha-synuclein proteins.
Key Features
Parkinsonism
Early-Onset Dementia
Visual Hallucinations
Fluctuating Consciousness
117
What is the difference between supranuclear palsy and doll eye reflex
Doll eye reflex is eye does not move with head movement
supranuclear palsy- eye moves with head movement but on active movement is limited
118
What type of stroke is doll's eye reflex associated with?
Pontine haemorrhage
119
How does anterior spinal artery infarct present?
sparing dorsal column
120
Causes of spastic paresis
| weakness and stiffness in lower limbs
S: syringomyelia
P Para sagittal meningioma
A -aids transverse myelitis
S sclerosis
T trauma tumor
I
C cervical spine OA
121
Hallmarks of inclusion body myositis
slowly progressive weakness
wasting of both proximal muscles and distal muscles,
most apparent in the finger flexors and knee extensors
dysphagia
122
123
Hallmarks of paroxysmal hemicrania
severe, unilateral orbital, supraorbital or temporal headache.
last less than 30 minutes and can occur multiple times a day.
trigeminal autonomic cephalgias which also contains cluster headache, a condition which shares many features with PH.
responsive to treatment with indomethacin.
124
Stroke prevention
clopidogrel
carotid endarterectomy on the symptomatic side >50% stenosis
125
126
Lambert eaton hallmark
association with small cell lung cancer
repeated muscle contractions lead to increased muscle strength
autonomic symptoms: dry mouth, impotence, difficulty micturating
127
128
MRI findings in MS
White matter lesions
129
What cause severe headache and seizures post partum who had epidural
cavernous sinus thrombosis
hypercoagulable state post partum
130
Describe INO
CN3 in mid brain
CN6 in pons
MLF IN BRAINSTEM connects contralateral nuclei
If right MLF lesion (i.e demyelinated from MS or stroke)
Unable to adduct the ipsilateral eye on left gaze
left eye will beat back to right. (nystagmus)
| MLF- medial longitudinal fasciculus
131
What does ring enhances lesion on CT head suggest
Toxoplasmosis
132
Fascioscapulohumeral musculr dystrophy hallmarks
winging of scapula
proximal upper limb weakness
foot drop
facial weakness
| autosomal dominant
132
Nerves of brachial plexus
C5 - thumb
C6- index
C7- middle
C8- ring
T1- pinky
*3 Musketeers - we have 3 fingers Thumb C5, Index C6, Middle C7 and the M for musketeers corresponds to M for Musculocutaneous nerve - roots C5, C6, C7
*Assassinated - remember to assassinate someone you have to make a gun sign 👉🏼 with your Thumb C5 and Index C6, and A for Assassinated is A for Axillary nerve - roots C5, C6
*5 Rats and 5 Mice - 5 means all our fingers (all 5 nerve roots) and the R in rats stands for Radial nerve and M for mice stands for Median nerve
*2 Unicorns - 2 is for the last two fingers left, Ring C8 and Pinky T1 and the U in unicorn corresponds to the U in Ulnar nerve C8, T1
133
What precipitated periodic paralysis
large carb/high salt meal
hypokalaemia
muscle weakness
134
What brachial plexus nerve innervate intrinsic hand muscles
T1
135
What language deficit does MCA stroke present?
aphasia in left MCA stroke
136
What does hemiplegic migraine secondary to COCP increase risk of?
ischaemic stroke hence should be stopped.
137
138
Lumbar canal stenosis hallmarks
neurogenic claudication on walking
flexion whilst cycling relieves nerve compression
139
140
TACS criteria
Total Anterior Circulation Stroke
Vessels Involved:
Anterior Cerebral Artery and Middle Cerebral Artery
Diagnosis Requires ALL THREE Of:
Unilateral Weakness
Homonymous Hemianopia
Higher Cerebral Dysfunction (e.g. dysphasia)
141
PACS criteria
Vessels Involved:
Part of Anterior Circulation
Diagnosis Requires TWO Of:
Unilateral Weakness
Homonymous Hemianopia
Higher Cerebral Dysfunction (e.g. dysphasia)
142
PCA stroke criteria
Vessels Involved:
Posterior Cerebral Artery
Diagnosis Requires Any Of:
Bilateral Motor or Sensory Deficit
Conjugate Eye Movement Disorder
Cerebellar Signs
Isolated Homonymous Hemianopia
Cranial Nerve Palsy AND Motor or Sensory Defect
143
Lacunar stroke criteria
Vessels Involved:
Small Arteries Deep in the Brain
Diagnosis
Pure Sensory Stroke
Pure Motor Stroke
Sensorimotor Stroke
Ataxic Hemiparesis
144
Subacute combined degeneration hallmarks
B12 deficinecy
dorsal columns:
lateral corticospinal tracts and spinocerebellar tracts..
peripheral neuropathy
145
Why should IgA be checked prior to IVIG?
IgA immunoglobulins should be checked prior to IVIG (risk of anaphylaxis in IgA deficiency)
146
Myaesthenia gravis hallmark
eye symptoms
resp symptoms
147
spinobulbar muscular atrophy trinucleotinde repeat
CAA
aka kennedy syndrome
androgen insensitivity
perioral fasciculation
proximal weakness
148
First line treatment for trigeminal neuralgia
carbamazepine
149
What is a consequence of spinal injury and presentation
post traumatic syringomyelia
syrinx form compressing the anterior horn hence STT is compressed (pain and temp) and corticospinal tract (lower motor neuron)
dorsal column spared usually (vibration and fine touch)
150
Spontaneous intracranial hypotension hallmarks
CSF leak.
headache better lying down
connective tissue disorders such as Marfan's syndrome
The leak is typically from the thoracic nerve root sleeves.
MRI with gadolinium: typically shows pachymeningeal enhancement
conservative mx or blood patch
151
Bell's palsy vs stroke
facial weakness both
stroke- sparing eye brows
152
Side effects of topiramate
AED
weight loss
renal stones
153
Side effects of valproate
weight gain
tremor
teratogenic
154
Side effects of carbamazepine
skin rash
nystagmus
155
156
Side effects of lamotrigine
SJS
skin rash
157
158
Side effect of phenytoin
gum hypertrophy
hirsutism
peripheral neuropathy
159
Painful third nerve palsy with dilated eye
surgical
posterior communication artery aneurysm
160
Loss of down gaze suggests
PSP
161
3rd nerve palsy
eye is deviated 'down and out'
ptosis
pupil may be dilated (sometimes called a 'surgical' third nerve palsy)
162
3rd nerve palsy vs horners
3rd cranial nerve palsy causes mydriasis and horner's causes miosis
163
medical vs surgical third nerve palsy
PSNS of oculomotor nerve on surface
- constricts pupils
Surgical third nerve palsy
- external structures are compressing
- headache and pupil dilation
- posterior communicating artery aneurysm.
Medical third nerve palsy:
- Strokes
- no pupil dilatation
164
What does hypodense temporal regions suggest?
herpes simplex encephalitis
| note inflammatory markers may be normal
165
Tibial nerve function
ankle reflex
ankle plantar flexion and inversion
166
common peroneal nerve function
ankle eversion and dorsiflexion
167
femoral nerve motor function
hip flexion
knee extension
168
sciatic nerve forms which 2 nerves
tibial
and common peroneal nerves
169
obturator nerve motor function
hip adduction
170
171
What blood test is useful in distinguishing true seizure vs psychogenic
prolactin level
172
Optic tract lesion
homonymous hemianopia
CONTRALATERAL
173
Occipital cortex lesion
homonymous defect
CONTRALATERAL
174
Migraine management
acute: triptan
prophylaxis:
- betablocker first line
- topiramate (if asthma)
175
Essential tremor management
propanolol and topiramate
| tremor on outstretched hand
176
177
Commonest virus causing viral meningitis
echovirus
coxackie virus
178
Investigation for mononeuritis multiplex
nerve biopsy
179
Conus medullaris syndrome
back pain
spasticity
hyperreflexia
sexual dysfunction
179
What does extensor plantar response mean
babinski sign
180
CMS vs CES
CMS: spinal cord
CES: branch out of spinal cord
181
GBS CSF finding
raised protein
albuminocytological dissociation
182
cluster headache pattern of headache
diurnal variation
183
What is the thrombolysis window for stroke
4.5 hrs
184
What is the acute medication for stroke once haemorrhage ruled out
300mg aspirin
185
What is a benign unilateral dilated pupil
Holme's adie pupil
- reactive accommodation
- poor reaction to light
186
Neurosyphillis pupillary disorder
Argyll-Robertson pupil
Accommodation Reflex Present (ARP) Pupillary Reflex Absent (PRA)
187
vertebral artery dissection vs carotid artery dissection
vertebral: posterior stroke
carotid: ischaemic hemispheric stroke
188
How does carotid dissection cause horner's syndrome?
(third order)
| SNS fibres runs along carotid
189
Extradural haemorrhage hallmark
head injury
middle menigeal artery
EXTRA time (lucid period)
concave
190
IIH vs Venous sinus thrombosis
VST: thunderclap headache, seizures
IIH: worse in morning
191
What AED worsens myoclonic epilepsy
lamotrigine
192
Left parietal stroke sx
Alexia
Agnosia
Ideomotor apraxia
Gerstmann syndrome (left right confusion)
| alex and agneta confused idiot
193
What 3 investigations are used in diagnosis of MS
MRI
LP
VEP (visual evoked potentials)
194
Right parietal stroke sx
visuospacial dysfunction
constitutional apraxia
anosognosia and dressing apraxia
195
Management of MS acute phase
Acute relapse
High-dose steroids for 5 days
196
fingolimod DMARD for relapse reduction
sphingosine 1-phosphate (S1P) receptor modulator
prevents lymphocytes from leaving lymph nodes
197
glatiramer DMARD for MS
myeline analogue
198
Arnold chiari malformation hallmarks
herniation, of the cerebellar tonsils through the foramen magnum.
Malformations may be congenital or acquired through trauma.
Features
non-communicating hydrocephalus
headache
syringomyelia
DOWNBEAT NYSTAGMUS
199
What lesion causes homonymous hemianopia with macular sparing
contralateral occipital lobe (note macular is supplied by collaterals)
200
Lambert eaton myaesthenic syndrome antibody
voltage gated calcium channel
201
Upbeat and downbeat nystagmus
upbeat: brainstem lesion
downbeat: foramen magnum lesion
202
203
GBS CSF cell count
normal WCC
204
Ropinirole funciton
dopamine receptor agonist
205
Proximal myopathy causes
alcoholism
cushing
hyperthyroid
polymyositis
206
# p
MND hallmark
preserved sensation
207
SAH prophylaxis
Nimodipine
208
What cranial nerves does cavernous sinus lesion cause?
CN 3. 4. 5. 6
209
Ramsay hunt syndrome hallmark
Facial palsy
Ear lesion
Tongue and soft palate lesion
Ear pain
Herpes in geniculate ganglion
Bell’s palsy with ear lesion
210
Right face, left arm and leg
Crossed neuro sign
Brain stem lesion
211
Myelin disorder nerve conduction study finding
Reduced conduction velocity
212
Axonal disorder nerve conduction study finding
Reduced action potential amplitude
213
When should phenytoin level be checked after dose change
2 weeks for steady state
214
Why does median nerve compression in carpal tunnel not cause palmar sensory deficit
Palmar nerves do not pass through carpal tunnel
215
Autosomal dominant with anticipiation
Huntington
216
Korsakoff amneisia type
Cannot form new memories
217
Headache and fluent receptive dysphasia
Temporal lobe infarct
218
Critical Illness polyneuropathy and myopathy
Prolonged itu stay consequence
Polyneuropathy - motor and sensory loss
Myopathy- muscle wasting
219
Cardiac medication that can cause peripheral neuropathy
Statin
220
Wernicke triad
ACO
Ataxia
Confusion
Opthalmoplegia I.e nystagmus
221
Radial nerve palsy at spiral groove
Saturday night palsy
222
Risk factor for alzheimer
FHx
Apoe4 gene
Vascular risk
Trauma
Downs
223
Myotonic dystrophy penetrance
Like Huntington earlier with succession
224
Neuroleptic malignant syndrome presentation
rigidity
temperature
confusion
autonomic dysfunction
225
Treatment for Neuroleptic malignant syndrome
Dantrolene
226
3 symptoms of bell's
Facial palsy (affecting eye brows)
hyperacusis
loss of lacrimation
227
Transient global amnesia
abrupt anterograde memory loss
disorientated to time and place BUT NOT PERSON
228
Which TB drug causes peripheral axonal neuropathy
ISONIAZID
229
TB drug side effects
R- drug inducer
I- neuropathy, hepatotoxic
P- hepatotoxic
E- colour blindness
230
Arnold chiari malformation is associated with...
syringomyelia
231
Radiculopathy vs myelopathy
Radiculopathy is a pinched nerve, while myelopathy is compression of the spinal cord
232
232
upper limb pain on coughing and laughing
synringomyelia
233
unilateral hearing loss, headache, tinnitus, mastoid pain, facial numbness
vestibular schwannoma
234
Imaging for vestibular schwannoma
MRI
235
back pain fever weakness high CRP
SPINAL EPIDURAL ABSCESS
236
Connus medullary sydnrome vs cauda equina syndrome
CMS:
sudden onset bilateral
ankle jerk absent
CES:
Unilateral gradual
absent knee and ankle reflex
237
Botulism nerve conduction finding
decrement response on repetitive nerve stimulation
238
Chance of developing MS in 15 years
50% with MRI findings
25% without MRI findings
239
Listeria meningitis risk groups
alcoholism
diabetes
elderly
immunosuppression
| brain stem involvement
## Footnote
q
240
Brainstem meningitis
listeria
241
hemiballism brain lesion
| violent flinging movement of one side of body
subthalamic nucleus
| Mx: dopamine agonist
242
Striatum (caudate nucleus) of the basal ganglia
huntington chorea
243
Frontal lobes lesions
expressive (Broca's) aphasia: located on the posterior aspect of the frontal lobe, in the inferior frontal gyrus
244
Temporal lobe lesion
Wernicke's aphasia:
245
Status epilepticus failed benzo x2, next step
IV Phenytoin
246
247
Lymphocytic CSF
fungal
TB - turbid
viral- clear
248
Gold standard diagnostic method for CJD
LP
RT QUL C PEPTIDE
249
AED thay does not affect liver function
KEPPRA
250
Altitude field defect
ischaemic optic neuropathy
251
enlarged blind spot in eyeq
IIH
252
Focal aware seizures
jacksonian march
253
Myaesthenia gravis autoantibody (IgG) binds to...
post ganglionic nicotinic acetylcholine receptor
254
Merniere hallmark
paroxysmal vertigo and deafness lasting hrs
N+V
255
orbital apex syndrome
256
SAH- aneurysm mx
endovasculuar coil
257
neurofibromatosis type 1
cafe au lait spots
lisch nodule on split lamp
258
