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MRCP Part 1 > MRCP Neuro > Flashcards

MRCP Neuro Flashcards

1
Q

Tourrette syndrome hallmark

A

vocal/motor tic
suppressibility

mx: risperidone

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2
Q

Huntington symptome

A

Chorea

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3
Q

Cavernous sinus thrombosis visual symptoms

A

double vision looking up

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4
Q

Isolated 6th nerve palsy

A

unable to abduct (LR6)

due to microvascular lesion i.e diabetes

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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.

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6
Q

Features of CJD

A

Features
dementia (rapid onset)
myoclonus
behavioural change

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7
Q

MRI findings o CJD

A

MRI: hyperintense signals in the basal ganglia and thalamus

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8
Q

What cancer is likely with von Hippel?

A

RCC

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9
Q

What extra renal cysts does von Hippel have?

A

pancreatic
liver
epididymal

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10
Q

Which dementia presents with hallucination and Parkinsonism?

A

Lewy body

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11
Q

Which drug worsens parkinsonism

A

haloperidol

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12
Q

What is the treatment for essential tremor?

tremor on outstretched hands

A

propanolol

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13
Q

pick bodies

lewy bodies

neurofibrillary tangles

A

frontemporal (tau)

parkinson

alzheimers

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14
Q

Foot drop nerve lesion

A

common perineal

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15
Q

what is mononeuritis multiplex

A

2 discrete incidents of neuropathies, gradually self resolves

both sensory and motor functions

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16
Q

causes of mononeuritis multiplex

A

vasculitis
diabetes
B12 deficiency
sarcoid
amyloid
paraneoplastic

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17
Q

MND vs mononeuritis multiples

A

MND- motor only

MM- motor and sensory

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18
Q

Lyme disease CSF

A

lymphocytic
protein high
glucose low

erythema migrans
arthritis

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19
Q

TB CSF

A

high protein
low glucose
lymphocytic

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20
Q

bacterial csf

A

polymorphs
low glucose
high protein

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21
Q

Viral csf

A

60-80% plasma glucose
normal/raised protein
lymphocytic

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22
Q

elderly with haedache
Usually related to trauma
Alcoholics
confusion weeks later

A

subdural

SUBANANA

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23
Q

middle meningeal artery bleed

A

extradural

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24
Q

AED not safe in pregnancy

A

phenytoin

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25
Q

AED safe in pregnancy

A

lamotrigine
keppra

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26
Q

Second order Horner syndrome causes

A

pan cost tumour

  • miosis
  • ptosis
  • anhydrosis

second order (pregnaglionic)
- (neutron exits the spinal cord towards head and neck)

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27
Q

first order neurone

A

central neurone

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28
Q

third order neuron

A

post ganglionic from cervical ganglion alon internal carotid artery into cavernous sinus

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29
Q

Third order Horner cause

A

cavernous sinus thrombosis
internal carotid dissection

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30
Q

first order horners

A

craniopharyngioma
stroke
tumour

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31
Q

wernicke encephalopathy

A

IV thiamine

triad:
confusion
ataxia
opthalmoplegia

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32
Q

Huntington disease

A

autosomal dominant
trinucleotide repeat disorder

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33
Q

Fragile X syndrome

A

X linked dominant trinucleotide repeat

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34
Q

Fredreich ataxia

A

autosomal recessive
trinucleotide repeat

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35
Q

Median neuropathy

A

carpal tunnel

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36
Q

ulnar radiopathy at elbow

A

cubital tunnel syndrome

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37
Q

radial nerve neuropathy

A

spiral gorge
wrist drop

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38
Q

lateral femoral cutaneous neuropathy

A

meralgial parathesia
clinical dx

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39
Q

peroneal neuropathy

A

lateral border of knee compression
foot drop and weak foot eversion
sensory oss in dorm and lateral foot border

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40
Q

How long do you have to wait for LP after onset of headache for SAH?

A

12 hrs for breakdown to BR

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41
Q

What can nitric oxide toxicity cause?

A

sensory neuropathy
myelopathy (leg weakness, increased and decreased reflex, sensory neuropathy signs)

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42
Q

What is Holmes Adie pupil

A

women
dilated pupil
unilateral
slow accommodation
poor reflex to light

associated with absent ankle/knee reflex

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43
Q

What is the first line treatment for primary generalised epilepsy in under 55 years

A

lamotrigine

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44
Q

What is a risk of lamotrigine?

A

Steven johnson syndrome (monitor for rash)

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45
Q

Rx: Generalised tonic-clonic seizures

A

males: sodium valproate
females: lamotrigine or levetiracetam

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46
Q

Rx: Focal seizures

A

first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide

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47
Q

Rx: Absence seizures (Petit mal)

A

first line: ethosuximide
second line:
male: sodium valproate
female: lamotrigine or levetiracetam
carbamazepine may exacerbate absence seizures

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48
Q

Rx: Tonic or atonic seizures

A

males: sodium valproate
females: lamotrigine

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49
Q

Rx: Myoclonic seizures

A

males: sodium valproate
females: levetiracetam

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50
Q

Dix hallpike vs Epley

A

Dix hallpike: assessment and diagnosis
Epley: treatment

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51
Q

Inherited form of vascular dementia

A

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

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52
Q

What is PSP

A

Progressive supranuclearpalsy

falls
vertical supranuclear gaze palsy

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53
Q

Which ab is associated with miller fisher

A

GQ1b

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54
Q

Lambert eaton myasthenia syndrome

A

a/w small cell lung cancer
autoimmune ab against voltage gated calcium channel in PNS
weak in morning
gains strength with use

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55
Q

Mneumonic for cerebellar disease

A

DANISH

Diadodyskinesia
Ataxia
Nystagmys
Intention tremor
Slurred speech
Hypotonia

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56
Q

What are the differential of isolated motor deficiency , normal sensory

A

MND and multifocal motor neuropathy

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57
Q

What is multifocal motor neuroptahy

A

inflammatory neuropathy causing multifocal demyelination with conduction block

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58
Q

What is MND demyelination pattern?

A

Axonal degeneration

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59
Q

when suspecting meningococcal meningitis with non blanching rash what should be given by GP?

A

IM benpen

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60
Q

PITS

A

Parietal inferior
temporal superior

CONTRALATERAL

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61
Q

Miller fisher hallmarks

A

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)

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62
Q

Vestibular schwannoma hallmark

A

vertigo, hearing loss, tinnitus and an absent corneal reflex.

cerebellopontine angle tumour

CN 5 - trigeminal (reflex)
CN 7 - facial
CN 8 - vestibulocochlear

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63
Q

CN with opthalmoplegia

A

3
4
6

SO4 LR6

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64
Q

Spinal tracts

A

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)

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65
Q

Which part of brainstem (midbrain) presents with failure of vertical gaze?

A

dorsal midbrain

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66
Q

Why alcoholics have hypocalcaemia

A

nutritional deficit hypomagnesaemia

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67
Q

What are the main types of MND?

A

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)

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68
Q

Normal pressure hydrocephalus

A

reversible cause of dementia seen in elderly patients.

wet
wacky
wobbly

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68
Q

Treatment for Normal pressure hydrocephalus

A

CSF shunt
LP

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69
Q

What is paralytic polio

A

polio infection
causing neck pain and stiffness
unilateral flaccid weakness

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70
Q

Sciatica at L5/S1

A

sensory loss in soles of foot
weak plantar flex (S1)

note dorsiflexion by L5

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71
Q

LP window for SAH

A

Xanthochromia will be detectable on a lumbar puncture from 12 hours to 12 days after the onset of a subarachnoid haemorrhage

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72
Q

Dermatomes

A

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

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73
Q

Myotomes

A

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

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74
Q

Presentation of brownsequard

A

Brown-Sequard Syndrome
Hemisection of the spinal cord

ipsilateral weakness and loss of fine touch and proprioception
contralateral loss of pain and temperature sensation

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75
Q

Treatment for cervical dystonia (torsicollis)

A

botox

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76
Q

Sciatic nerve

A

L5-S1
Foot drop

splits into common perioneal and tibial

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77
Q

Prophylactic treatment for cluster headache

A

verapamil

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78
Q

Cerebal venous sinus thrombosis presentation

A

headache
focal neurological deficit
seizures

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79
Q

Lateral medullary syndrome (posterior inferior cerebellar artery)

A

aka Wallenberg’s syndrome

**ipsilateral: **
ataxia, nystagmus, dysphagia, **facial numbness, **cranial nerve palsy e.g. Horner’s

**contralateral: **
limb sensory loss

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79
Q

Stroke territories and hallmarks

A

ACA
- legs >arms

MCA
- face > arm >leg
- aphasia

PCA
- visual
- ataxia
- brainstem

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80
Q

Cause of lateral medullary syndrome

A

vertebral artery dissection

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81
Q

Migraine with aura

A

migrating sensory and motor symptoms
speech difficulty
ptosis

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82
Q

Syringomyelia hallmarks

A

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)

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83
Q

Syringobulbia hallmark

A

syringomyelia extending up the brainstem (medulla)

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83
Q

Hallmark of juvenile myoclonic epilepsy

A

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

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84
Q

Pontine stroke hallmarks

A

contralateral hemiparesis
bulbar signs
ipsilateral 5-8th nerve palsy

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85
Q

CN exit of brain

A

2- cerebrum (1-2)
2- midbrain (3-4)
4- pons (5-8)
4- medulla (9-12)

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86
Q

What nerves are involved in bulbar palsy

A

CN 9-12

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87
Q

Treatment for NPH

A

WET
WACKY
WOBBLY

Mainstay: SHUNT

if CI for shunt then for acetazolamide and repeated LP

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88
Q

DVLA rules for post stroke/TIA

A

Cannot drive for 1 month

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89
Q

Hallmark of temporal lobe epilepsy

A

abdominal pain aura
staring into space
lip smacking
then post ictal phase

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90
Q

Which medication should be avoided in dementia and why

A

haloperidol

risk of extrapyramidal side effects i.e drug induced parkinsonism

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91
Q
A
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91
Q

Friederich ataxia

A

Autosomal recessive

most common early onset hereditary ataxia

GAA repeat trinucleotide

optic atrophy

HOCM

kyphoscoliosis

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92
Q

What should be monitored in GBS?

A

FVC

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93
Q

What is the most commonest cause of temporal epilepsy

A

hippocampal sclerosis

note: it is a partial seizure

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94
Q

How is wilson’s related to parkinsonism

A

basal ganglia deposits

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95
Q

Investigation findings in MS

A

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

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96
Q

What immunoglobulin is found in MS?

A

Intrathecal IgG
Oligoclonal bands

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97
Q

Lyme disease LP findings

A

lymphocytic
high protein
normal glucose

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98
Q

How to diagnose syringomyelia

A

MRI

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99
Q

What is cushing triad

A

raised ICP
- bradycardia
- hypertension
- irregular respiration

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100
Q

Why does twitching happen in vasovagal syncope

A

transient hypoxia

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101
Q

mutifocal axonal neuropathy and nailfold infarct (vasculitic)

A

Hep C and cryoglobinaemia

protein insoluble at low temps

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102
Q

Peirpheral neuropathy Predominately motor loss

A

Guillain-Barre syndrome
porphyria
lead poisoning
hereditary sensorimotor neuropathies (HSMN) - Charcot-Marie-Tooth
chronic inflammatory demyelinating polyneuropathy (CIDP)
diphtheria

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103
Q

Peripheral neuropathy Predominately sensory loss

A

diabetes
uraemia
leprosy
alcoholism
vitamin B12 deficiency
amyloidosi

104
Q

What are the hallmarks of chronic inflammatory demyelinating polyneuropathy

A

Anti-GM1

Asymmetrical motor neuropathy

usually upper limb

preserved reflexes

motor conduction block on NCS

105
Q

Auto antibody of miller fisher

A

anti-GQ1b

fisherman drunk and eye patch

106
Q

Hallmark of myasthenia gravis

A

muscle fatigability with use

extraocular muscle weakness: diplopia

proximal muscle weakness: face, neck, limb girdle

ptosis

dysphagia

Acetylcholine receptor antibody

thymoma

107
Q

treatment for MG acute attack

A

pyridostigmine
(acetylcholinesterase inhibitor)

30mg QDS for 2-4 days

108
Q

Alcohol withdrawal time frame

A

6 to 12 = feeling unwell
A day and a bit = have a fit
Deux, Trois = delirium tremens

109
Q

What are the 3 types of frontotemporal lobe degeneration

A

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
Q

What is semantic memory

A

ability to put meaning to object presented visually or auditory

111
Q

Pontine haemorrhage

112
Q

Parkinson’s plus syndrome

A

Progressive Supranuclear Palsy (PSP)

Multiple System Atrophy

Corticobasal Degeneration

Lewy Body Dementia

113
Q

Hallmarks of PSP

A

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
Q

Hallmarks of MSA

A

Multiple System Atrophy

Pathophysiology: Caused by deposition of abnormal alpha-synuclein proteins.

Key Features

Parkinsonism (prominent rigidity)

Cerebellar Ataxia

Autonomic Dysfunction

115
Q

Hallmarks of Corticobasal Degeneration

A

Pathophysiology: Caused by aggregation of abnormal tau proteins.

Key Features

**Parkinsonism (unilateral) **

Alien Limb Phenomenon (involuntary, purposeful arm movements)

Dysphasia

Dysarthria

116
Q

Hallmarks of LBD

A

Pathophysiology: Caused by aggregation of abnormal alpha-synuclein proteins.

Key Features

Parkinsonism

Early-Onset Dementia

Visual Hallucinations

Fluctuating Consciousness

117
Q

What is the difference between supranuclear palsy and doll eye reflex

A

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
Q

What type of stroke is doll’s eye reflex associated with?

A

Pontine haemorrhage

119
Q

How does anterior spinal artery infarct present?

A

sparing dorsal column

120
Q

Causes of spastic paresis

weakness and stiffness in lower limbs

A

S: syringomyelia
P Para sagittal meningioma
A -aids transverse myelitis
S sclerosis
T trauma tumor
I
C cervical spine OA

121
Q

Hallmarks of inclusion body myositis

A

slowly progressive weakness

wasting of both proximal muscles and distal muscles,

most apparent in the finger flexors and knee extensors

dysphagia

123
Q

Hallmarks of paroxysmal hemicrania

A

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
Q

Stroke prevention

A

clopidogrel

carotid endarterectomy on the symptomatic side >50% stenosis

126
Q

Lambert eaton hallmark

A

association with small cell lung cancer

repeated muscle contractions lead to increased muscle strength

autonomic symptoms: dry mouth, impotence, difficulty micturating

128
Q

MRI findings in MS

A

White matter lesions

129
Q

What cause severe headache and seizures post partum who had epidural

A

cavernous sinus thrombosis

hypercoagulable state post partum

130
Q

Describe INO

A

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
Q

What does ring enhances lesion on CT head suggest

A

Toxoplasmosis

132
Q

Fascioscapulohumeral musculr dystrophy hallmarks

A

winging of scapula
proximal upper limb weakness
foot drop
facial weakness

autosomal dominant

132
Q

Nerves of brachial plexus

A

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
Q

What precipitated periodic paralysis

A

large carb/high salt meal
hypokalaemia
muscle weakness

134
Q

What brachial plexus nerve innervate intrinsic hand muscles

135
Q

What language deficit does MCA stroke present?

A

aphasia in left MCA stroke

136
Q

What does hemiplegic migraine secondary to COCP increase risk of?

A

ischaemic stroke hence should be stopped.

138
Q

Lumbar canal stenosis hallmarks

A

neurogenic claudication on walking
flexion whilst cycling relieves nerve compression

140
Q

TACS criteria

A

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
Q

PACS criteria

A

Vessels Involved:
Part of Anterior Circulation

Diagnosis Requires TWO Of:

Unilateral Weakness

Homonymous Hemianopia

Higher Cerebral Dysfunction (e.g. dysphasia)

142
Q

PCA stroke criteria

A

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
Q

Lacunar stroke criteria

A

Vessels Involved:
Small Arteries Deep in the Brain

Diagnosis

Pure Sensory Stroke

Pure Motor Stroke

Sensorimotor Stroke

Ataxic Hemiparesis

144
Q

Subacute combined degeneration hallmarks

A

B12 deficinecy

dorsal columns:
lateral corticospinal tracts and spinocerebellar tracts..

peripheral neuropathy

145
Q

Why should IgA be checked prior to IVIG?

A

IgA immunoglobulins should be checked prior to IVIG (risk of anaphylaxis in IgA deficiency)

146
Q

Myaesthenia gravis hallmark

A

eye symptoms
resp symptoms

147
Q

spinobulbar muscular atrophy trinucleotinde repeat

A

CAA

aka kennedy syndrome

androgen insensitivity

perioral fasciculation

proximal weakness

148
Q

First line treatment for trigeminal neuralgia

A

carbamazepine

149
Q

What is a consequence of spinal injury and presentation

A

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
Q

Spontaneous intracranial hypotension hallmarks

A

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
Q

Bell’s palsy vs stroke

A

facial weakness both

stroke- sparing eye brows

152
Q

Side effects of topiramate

A

AED

weight loss
renal stones

153
Q

Side effects of valproate

A

weight gain
tremor
teratogenic

154
Q

Side effects of carbamazepine

A

skin rash
nystagmus

156
Q

Side effects of lamotrigine

A

SJS

skin rash

158
Q

Side effect of phenytoin

A

gum hypertrophy
hirsutism
peripheral neuropathy

159
Q

Painful third nerve palsy with dilated eye

A

surgical

posterior communication artery aneurysm

160
Q

Loss of down gaze suggests

161
Q

3rd nerve palsy

A

eye is deviated ‘down and out’
ptosis
pupil may be dilated (sometimes called a ‘surgical’ third nerve palsy)

162
Q

3rd nerve palsy vs horners

A

3rd cranial nerve palsy causes mydriasis and horner’s causes miosis

163
Q

medical vs surgical third nerve palsy

A

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
Q

What does hypodense temporal regions suggest?

A

herpes simplex encephalitis

note inflammatory markers may be normal

165
Q

Tibial nerve function

A

ankle reflex
ankle plantar flexion and inversion

166
Q

common peroneal nerve function

A

ankle eversion and dorsiflexion

167
Q

femoral nerve motor function

A

hip flexion
knee extension

168
Q

sciatic nerve forms which 2 nerves

A

tibial
and common peroneal nerves

169
Q

obturator nerve motor function

A

hip adduction

171
Q

What blood test is useful in distinguishing true seizure vs psychogenic

A

prolactin level

172
Q

Optic tract lesion

A

homonymous hemianopia

CONTRALATERAL

173
Q

Occipital cortex lesion

A

homonymous defect

CONTRALATERAL

174
Q

Migraine management

A

acute: triptan

prophylaxis:
- betablocker first line
- topiramate (if asthma)

175
Q

Essential tremor management

A

propanolol and topiramate

tremor on outstretched hand

177
Q

Commonest virus causing viral meningitis

A

echovirus
coxackie virus

178
Q

Investigation for mononeuritis multiplex

A

nerve biopsy

179
Q

Conus medullaris syndrome

A

back pain
spasticity
hyperreflexia
sexual dysfunction

179
Q

What does extensor plantar response mean

A

babinski sign

180
Q

CMS vs CES

A

CMS: spinal cord
CES: branch out of spinal cord

181
Q

GBS CSF finding

A

raised protein

albuminocytological dissociation

182
Q

cluster headache pattern of headache

A

diurnal variation

183
Q

What is the thrombolysis window for stroke

184
Q

What is the acute medication for stroke once haemorrhage ruled out

A

300mg aspirin

185
Q

What is a benign unilateral dilated pupil

A

Holme’s adie pupil
- reactive accommodation
- poor reaction to light

186
Q

Neurosyphillis pupillary disorder

A

Argyll-Robertson pupil

Accommodation Reflex Present (ARP) Pupillary Reflex Absent (PRA)

187
Q

vertebral artery dissection vs carotid artery dissection

A

vertebral: posterior stroke

carotid: ischaemic hemispheric stroke

188
Q

How does carotid dissection cause horner’s syndrome?

A

(third order)

SNS fibres runs along carotid

189
Q

Extradural haemorrhage hallmark

A

head injury
middle menigeal artery
EXTRA time (lucid period)
concave

190
Q

IIH vs Venous sinus thrombosis

A

VST: thunderclap headache, seizures

IIH: worse in morning

191
Q

What AED worsens myoclonic epilepsy

A

lamotrigine

192
Q

Left parietal stroke sx

A

Alexia
Agnosia
Ideomotor apraxia
Gerstmann syndrome (left right confusion)

alex and agneta confused idiot

193
Q

What 3 investigations are used in diagnosis of MS

A

MRI
LP
VEP (visual evoked potentials)

194
Q

Right parietal stroke sx

A

visuospacial dysfunction
constitutional apraxia
anosognosia and dressing apraxia

195
Q

Management of MS acute phase

A

Acute relapse
High-dose steroids for 5 days

196
Q

fingolimod DMARD for relapse reduction

A

sphingosine 1-phosphate (S1P) receptor modulator
prevents lymphocytes from leaving lymph nodes

197
Q

glatiramer DMARD for MS

A

myeline analogue

198
Q

Arnold chiari malformation hallmarks

A

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
Q

What lesion causes homonymous hemianopia with macular sparing

A

contralateral occipital lobe (note macular is supplied by collaterals)

200
Q

Lambert eaton myaesthenic syndrome antibody

A

voltage gated calcium channel

201
Q

Upbeat and downbeat nystagmus

A

upbeat: brainstem lesion

downbeat: foramen magnum lesion

203
Q

GBS CSF cell count

A

normal WCC

204
Q

Ropinirole funciton

A

dopamine receptor agonist

205
Q

Proximal myopathy causes

A

alcoholism
cushing
hyperthyroid
polymyositis

206
Q

p

MND hallmark

A

preserved sensation

207
Q

SAH prophylaxis

A

Nimodipine

208
Q

What cranial nerves does cavernous sinus lesion cause?

A

CN 3. 4. 5. 6

209
Q

Ramsay hunt syndrome hallmark

A

Facial palsy
Ear lesion
Tongue and soft palate lesion
Ear pain

Herpes in geniculate ganglion
Bell’s palsy with ear lesion

210
Q

Right face, left arm and leg
Crossed neuro sign

A

Brain stem lesion

211
Q

Myelin disorder nerve conduction study finding

A

Reduced conduction velocity

212
Q

Axonal disorder nerve conduction study finding

A

Reduced action potential amplitude

213
Q

When should phenytoin level be checked after dose change

A

2 weeks for steady state

214
Q

Why does median nerve compression in carpal tunnel not cause palmar sensory deficit

A

Palmar nerves do not pass through carpal tunnel

215
Q

Autosomal dominant with anticipiation

A

Huntington

216
Q

Korsakoff amneisia type

A

Cannot form new memories

217
Q

Headache and fluent receptive dysphasia

A

Temporal lobe infarct

218
Q

Critical Illness polyneuropathy and myopathy

A

Prolonged itu stay consequence

Polyneuropathy - motor and sensory loss

Myopathy- muscle wasting

219
Q

Cardiac medication that can cause peripheral neuropathy

220
Q

Wernicke triad

A

ACO

Ataxia
Confusion
Opthalmoplegia I.e nystagmus

221
Q

Radial nerve palsy at spiral groove

A

Saturday night palsy

222
Q

Risk factor for alzheimer

A

FHx
Apoe4 gene
Vascular risk
Trauma
Downs

223
Q

Myotonic dystrophy penetrance

A

Like Huntington earlier with succession

224
Q

Neuroleptic malignant syndrome presentation

A

rigidity
temperature
confusion
autonomic dysfunction

225
Q

Treatment for Neuroleptic malignant syndrome

A

Dantrolene

226
Q

3 symptoms of bell’s

A

Facial palsy (affecting eye brows)
hyperacusis
loss of lacrimation

227
Q

Transient global amnesia

A

abrupt anterograde memory loss
disorientated to time and place BUT NOT PERSON

228
Q

Which TB drug causes peripheral axonal neuropathy

229
Q

TB drug side effects

A

R- drug inducer
I- neuropathy, hepatotoxic
P- hepatotoxic
E- colour blindness

230
Q

Arnold chiari malformation is associated with…

A

syringomyelia

231
Q

Radiculopathy vs myelopathy

A

Radiculopathy is a pinched nerve, while myelopathy is compression of the spinal cord

232
Q

upper limb pain on coughing and laughing

A

synringomyelia

233
Q

unilateral hearing loss, headache, tinnitus, mastoid pain, facial numbness

A

vestibular schwannoma

234
Q

Imaging for vestibular schwannoma

235
Q

back pain fever weakness high CRP

A

SPINAL EPIDURAL ABSCESS

236
Q

Connus medullary sydnrome vs cauda equina syndrome

A

CMS:
sudden onset bilateral

ankle jerk absent

CES:
Unilateral gradual

absent knee and ankle reflex

237
Q

Botulism nerve conduction finding

A

decrement response on repetitive nerve stimulation

238
Q

Chance of developing MS in 15 years

A

50% with MRI findings
25% without MRI findings

239
Q

Listeria meningitis risk groups

A

alcoholism

diabetes

elderly

immunosuppression

brain stem involvement

q

240
Q

Brainstem meningitis

241
Q

hemiballism brain lesion

violent flinging movement of one side of body

A

subthalamic nucleus

Mx: dopamine agonist

242
Q

Striatum (caudate nucleus) of the basal ganglia

A

huntington chorea

243
Q

Frontal lobes lesions

A

expressive (Broca’s) aphasia: located on the posterior aspect of the frontal lobe, in the inferior frontal gyrus

244
Q

Temporal lobe lesion

A

Wernicke’s aphasia:

245
Q

Status epilepticus failed benzo x2, next step

A

IV Phenytoin

247
Q

Lymphocytic CSF

A

fungal
TB - turbid
viral- clear

248
Q

Gold standard diagnostic method for CJD

A

LP

RT QUL C PEPTIDE

249
Q

AED thay does not affect liver function

250
Q

Altitude field defect

A

ischaemic optic neuropathy

251
Q

enlarged blind spot in eyeq

252
Q

Focal aware seizures

A

jacksonian march

253
Q

Myaesthenia gravis autoantibody (IgG) binds to…

A

post ganglionic nicotinic acetylcholine receptor

254
Q

Merniere hallmark

A

paroxysmal vertigo and deafness lasting hrs
N+V

255
Q

orbital apex syndrome

256
Q

SAH- aneurysm mx

A

endovasculuar coil

257
Q

neurofibromatosis type 1

A

cafe au lait spots
lisch nodule on split lamp

MRCP Part 1 (17 decks)

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