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MRCP Part II > Neuro > Flashcards

Neuro Flashcards

1
Q

Causes of complex opthalmoplegia

eye movement weaknesses that cannot be explained by isolated/multiple CN palsies

A 
Myasthenia gravis
Kearns-Sayre (complex progressive external ophthalmoplegia)
Graves ophthalmoplegia
Miller fisher syndrome
Mononeuritis multiplex
Botulinum poisoning
Trauma and local infection
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2
Q

Elevated 14-3-3 in CSF

A

CJD

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3
Q

Creutzfeldt-Jakob MRI findings

A

Hyperintense signals in basal ganglia and thalamus

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4
Q

Features of CJD

A

Rapid cognitive decline
Myoclonus
Extrapyramidal signs
Startle response

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5
Q

Drugs which exacerbate myasthenia gravis

A 
Penicillamine
Beta-blockers
Lithium
Phenytoin
Antibiotics
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6
Q

Myasthenia gravis 1st-line management

A

Pyridostigmine

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7
Q

Pyridostigmine MOA

A

Long-acting acetylcholinesterase inhibitor

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8
Q

Features of Superficial Siderosis

A 
Dementia
Ataxia
Sensorineural hearing loss
Anosmia
Anisocoria
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9
Q

Superficial siderosis pathophysiology

A

Chronic iron deposition in CNS, secondary to SAH/SDH

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10
Q

Syringomelia classic presentation

A

Neck + arm loss of temperature sensation.

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11
Q

Most common primary brain tumour in adults

A

Glioblastoma multiforme

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12
Q

Management of glioblastoma multiforme

A

Surgery followed by chemo-radiotherapy

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13
Q

Second most common primary brain tumour in adults

A

Meningioma

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14
Q

Glioblastoma multiforme prognosis

A

~ 1 year

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15
Q

Fascioscapulohumeral dystrophy inheritance

A

AD

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16
Q

Fasciocapulohumeral dystrophy presentation

A

Shoulder, upper arm and facial muscles affected

Progressive

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17
Q

Motor neuron disease - medical management (in ALS)

A

Riluzole

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18
Q

Riluzole MOA

A

Inhibits glutamate receptors

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19
Q

Idiopathic intracranial hypertension - associated drugs

A
  • Contraceptives
  • Steroids
  • Tetracyclines
  • Vitamin A
  • Lithium
  • Levothyroxine
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20
Q

Idiopathic intracranial hypertension - management

A

Weight loss
Acetazolamide, Topiramate
Repeated lumbar puncture
Surgery: optic nerve sheath decompression/fenestration. Shunt.

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21
Q

MS MRI findings

A

High signal T2 lesions
Periventricular plaques
“Dawson fingers” - hyperintense lesions perpendicular to corpus callosum

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22
Q

MS CSF findings

A 
Oligoclonal bands (and not in serum)
Increased intrathecal IgG
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23
Q

Wernicke’s encephalopathy classic triad

A

Opthalmoplegia/nystagmus
Ataxia
Confusion

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24
Q

Miller-Fisher syndrome classic triad

A

Opthalmoplegia
Ataxia
Arreflexia

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25
Q

Imaging for suspected TIA

A

MRI brain with diffusion-weighted imaging

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26
Q

Features of myotonic dystrophy

A 
Myotonic facies
Frontal balding
Bilateral ptosis
Cataracts
Dysarthria
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27
Q

Which gene is affected in myotonic dystrophy DM1

A

DMPK gene

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28
Q

Which gene is affected in myotonic dystrophy DM2

A

ZNF9 gene

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29
Q

Myotonic dystrophy - DM1 vs DM2 presentation

A

DM1 - Distal weakness more prominent

DM2 - Proximal weakness more prominent

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30
Q

1st-line treatment in Parkinson’s isease if motor symptoms are affecting QOL

A

Levodopa

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31
Q

1st-line treatment in Parkinson’s disease if motor symptoms are NOT affecting QOL

A 
Dopamine agonist, non-ergot (ropinirole)
or
Levodopa
or
MAO-B inhibitor (selegiline)
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32
Q

Parkinson’s disease, patient still symptomatic despite optimal levodopa treatment

A

Add in one of:
Dopamine agonist (ropinirole)
MAO-B inhibitor (selegiline)
COMT inhibitor (entacapone)

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33
Q

Medication for orthostatic hypotension in PD

A

Midodrine

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34
Q

Midodrine MOA

A

Stimulates peripheral alpha adrenoceptors -> increase arterial resistance

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35
Q

Management of drooling in PD

A

Glycopyrronium

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36
Q

Antibodies associaed with Lambert-Eaton myasthenic syndrome

A

Antibodies to voltage-gated calcium channels

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37
Q

Tumours that commonly metastasise to the brain

A 
Lung
Breast
Bowel
Skin (melanoma)
Kidney
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38
Q

Glioblastoma multiforme on imaging

A

Solid tumour, central necrosis, contrast-enhancing ring, vasogenic oedema

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39
Q

Glioblastoma multiforme - histology

A

Pleomorphic tumour cells, bordering necrotic areas

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40
Q

Meningioma - histology

A

Spindle cells in concentric whorls + calcified psammoma bodies

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41
Q

Vestibular schwannoma - histology

A

Antoni A or B patterns + acellular Verocay bodis.

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42
Q

Pilocytic astrocytoma - histology

A

Rosenthal fibres (corkscrew eosinophilic bundle)

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43
Q

Medulloblastoma - histology

A

Small blue cells.

Rosette pattern with mitotic figures.

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44
Q

ePendymoma - histology

A

Perivascular Pseudorosettes

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45
Q

Oligodendroma - histology

A

Calcifications with fried egg appearance

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46
Q

Haemangioblastoma - histology

A

Foam cells and high vascularity

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47
Q

Antibiotic contraindicated in myasthenia gravis

A

Gentamicin - can trigger myasthenic crisis

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48
Q

Antibody in Guillain-Barre

A

anti-GM1

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49
Q

Antibody in Miller Fisher Syndrome

A

anti-GQ1b

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50
Q

Antibodies in myasthenia gravis

A

anti-AChR in 85%

anti-MuSK in 40% of remaining patients (anti-muscle-specific tyrosine kinase)

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51
Q

Anti-aquaporin-4 antibodies associated with

A

Neuromyelitis optica (demyelinating disorder)

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52
Q

Anti-N-methyl D-aspartate receptor associated with

A

Autoimmune encephalitis

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53
Q

Anti-glutamic acid decarboxylase - associated with

A

Stiff man syndrome

+ LADA diabetes

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54
Q

Anti-Hu - associated paraneoplastic syndromes

A

Painful sensory neuropathy
Cerebellar syndrome
Encephalitis

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55
Q

Steele-Richardson-Olszeeski syndrome AKA

A

Progressive supranucelar palsy

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56
Q

Normal CSF opening pressure

A

10 - 20 cm H2O

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57
Q

Normal CSF white cell count

A

0 - 5 cells/uL

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58
Q

Normal CSF glucose level

A

> 60% of serum glucose

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59
Q

Normal CSF protein level

A

<45 mg/dL

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60
Q

CSF white cell count in bacterial meningitis

A

Raised (unless partially treated)

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61
Q

CSF glucose in bacterial meningitis

A

Low (<40% of serum glucose)

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62
Q

CSF glucose in bacterial meningitis

A

Low (<40% of serum glucose)

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63
Q

CSF protein in bacterial meningitis

A

Raised

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64
Q

CSF white cell count in TB meningitis

A

Raised (Lymphcytosis)

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65
Q

CSF glucose in TB meningitis

A

Very low

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66
Q

CSF protein in TB meningitis

A

Raised

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67
Q

Imaging to confirm PD

A

123I-FP-CIT SPECT

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68
Q

Tuberous sclerosis cystic features

A

Glioma

Retinal hamartoma

Heart rhabdomyoma

Lymphangioleiomyoma of lung

Renal angiomyolipoma and polycystic kidneys

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69
Q

Neurofibromatosis 1 - which gene and chromosome

A

Neurofibromin gene on chromosome 17

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70
Q

Neurofibromatosis 2 - which chromosome

A

Chromosome 22

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71
Q

NF1 (Recklinghausen’s) features

A 
Cafe-au-lait spots + axillary freckles
Peripheral neurofibromas
Phaeochromocytomas
Iris hamatomas (Lisch)
Scoliosis
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72
Q

NF2 features

A

Bilateral vestibular schwannomas

Multiple intracranial schwannomas, meningiomas and ependymomas

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73
Q

Tics - treatment options

A

Clonidine

Atypical antipsychotics eg risperidone

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74
Q

Paraneoplastic syndrome associated with Anti-Yo causes what syndrome

A

Cerebellar syndrome

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75
Q

Anti-Ri causes what syndrome

A

Retinal degeneration

76
Q

Kearns-Sayre (mitochondrial disease) features

A 
Onset <20yo
External opthalmoplegia
Retinitis pigmentosa
(Ptosis)
(AV block)
77
Q

Ketamine MOA

A

NMDA receptor antagonist

78
Q

Essential tremor, worsened by

A

Arms outstretched (postural tremor)

79
Q

Essential tremor, improved by

A

Alcohol

Rest

80
Q

HSV encephalitis - CT head findings

A

Medial temporal and inferior frontal changes

81
Q

Most sensitive + specific imaging modality for diagnosing acute stroke

A

Diffusion weight imaging MRI

82
Q

Most sensitive brain imaging modality for chronic ischaemic changes

A

FLAIR MRI

83
Q

Multiple, lower motor neuropathies with nerve studies showing conduction block

A

MMNCB

Multifcal Motor Neuropathy with Conduction Block

84
Q

Causes of a bilateral Bell’s palsy

A 
Bell's Palsy
Lyme disease
Guillain-Barre
Sarcoidosis
Bilateral acoustic neuromas
85
Q

Friedreich’s Ataxia - classic features

A

Onset 10-15years
Cerebellar ataxia
Optic atrophy
Absent ankle jerks/upgoing plantars

86
Q

Freidrich’s Ataxia - non-neurological features

A

HOCM (commonest cause of death)
Diabetes
Kyphoscoliosis
High-arched palate

87
Q

Friedreich’s Ataxia - Inheritance pattern

A

Autosomal recessive, trinucleotide repeat

88
Q

Only licensed medication for PD dementia

A

Rivastigmine

89
Q

Meningitis following ear infection - causative agen

A

Streptococcus pneumoniae

90
Q

Vigabatrin use

A

Antiepileptic used infantile spasms

91
Q

Vigabatrin - monitoring required

A

Visual field testing every 6 months

92
Q

1st line in absence seizures

A

Sodium valproate / Ethosuximide

93
Q

Which anti-epileptic can aggravate juvenile myoclonic epilepsy/absence seizures

A

Carbemazepine

94
Q

Monitoring in clozapine use

A

Monitor FBC (agranulocytosis/neutropenia)

Baseline ECG (myocarditis)

95
Q

Clozapine: adverse effects

A

Agranulocytosis
Myocarditis, QT prolongation
Lowered seizure threshold
Hypersalivation, Constipation

96
Q

Features of ergotism

A

Vasoconstriction:

  • Critical limb ischaemia
  • Cardiac ischaemia
  • Bowel hypoperfusion

Seizure/headache/psychosis

97
Q

Risk of ergotism if ergotamine given with

A

Macrolides

98
Q

Carbemazepine: adverse effects

A

Increased seizures 3-4wks after starting
Agranulocytosis/leucopenia
SIADH
Steven-Johnson syndrome

99
Q

Indication for ventilation in Guillain-Barre

A

FVC < 15-20 ml/kg

100
Q

TACs which respond to indomethacin

A

Paroxysmal hemicrania

Hemicrania continua

101
Q

Hemicrania continua

A

Pain always present, with exacerbations

102
Q

Uncal (transtentorial) herniation - presentation

A

Ipsilateral CN 3 palsy

Contralateral hemiparesis

103
Q

Anti-epileptic which causes hyperammonaemic encephalopathy

A

Sodium valproate

104
Q

Treatment of hyperammonaemic encephalopathy

A

L-carnitine

105
Q

MOA of Sodium valproate

A

Increases GABA activity

106
Q

Sodium valproate used 1st line in

A

Generalised seizures

107
Q

Conditions associated with berry aneurysm

A

APKD

Ehlers-Danlos

Aortic coarctation

108
Q

ECG changes in SAH

A

May show ST elevation

109
Q

Transient global amnesia

A

Temporary episode of amnesia

No neurological abnormality

110
Q

Disorders of PMP22 (myelin) gene

A

HSMN 1
HSMN 2
Hereditary neuropathy with liability to pressure palsies

111
Q

Features of HSMN 1

A

Distal muscle wasting
Clawed toes
Foot drop

112
Q

Inheritence of HSMN 1

A

Autosomal dominant

113
Q

Bilateral leg weakness + HTLV-1 positive

A

Tropical spastic paraparesis

114
Q

Cluster headache - acute treatment

A

Triptan (nasal or s/c)

High flow O2

115
Q

Cluster headache - prophylaxis

A

Verapamil

116
Q

CT head immediately if GCS…

A

< 13 on initial assessment,
or,
< 15 at 2 hours post-injury

117
Q

CT head within 8 hours of injury if

A

Some LOC/amnesia since injury plus:

>65y
Dangerous mechanism
Bleeding/clotting disorder
(+ anyone on warfarin)
>30min retrograde amnesia of events prior to injury
118
Q

Dangerous mechanism of injury (in criteria for CT head)

A

Pedestrian or cyclist struck by motor vehicle

Ejected from motor vehicle

Fall from >1m or >5 stairs

119
Q

Thrombolysis contraindicated if BP uncontrolled over

A

> 200/120 mmHg

120
Q

Thrombolysis contraindicated if lumbar puncture in preceding …

A

7 days

121
Q

Thrombolysis contraindicated if stroke or traumatic brain injury in preceding…

A

3 months

122
Q

Thrombolysis in pregnancy

A

Contraindicated

123
Q

Thrombolysis contraindicated if gastrointestinal haemorrhage in preceding

A

3 weeks

124
Q

Diseases associated with retinitis pigmentosa

A 
Refsum
Usher
Abetalipoproteinemia
Lawrence-Moon-Biedl 
Kearns-Sayre 
Alport's
125
Q

Features of Refsum disease

A 
Retinitis pigmentosum
Ichthyosis
Deafness
Cerebella ataxia
Peripheral neuropathy
126
Q

Features of Usher’s syndrome

A

Leading cause of deaf-blindness

Retinitis pigmentosa

127
Q

Inheritence of Usher’s syndrome

A

Autosomal recessive

128
Q

Von Hippel-Lindau (VHL) inheritence

A

Autosomal dominant

129
Q

Features of VHL (von Hippel lindau)

A

Cerebellar Hemangioma (>SAH)
Retinal Hemangioma (>vitreous haemorrhage)
Renal cysts/renal cell carcinoma (clear-cell)
Phaeochromocytoma

130
Q

CT head immediately if: (skull)

A

Suspected open or depressed skull fracture

Signs of basal skull fracture

131
Q

CT head immediately if: (signs post-injury)

A

Post-traumatic seizure

Focal neurological deficit

> 1 episode of vomiting

132
Q

Which type of brain tumour releases EPO

A

Cerebellar haemangioblastoma

133
Q

Risk factors for retinal vein occlusion

A

Polycythaemia
Glaucoma
HTN
Diabetes

134
Q

Lamotrigine in pregnancy

A

Levels decrease in second trimester

135
Q

Phenytoin in pregnancy

A

Associated with cleft palate

136
Q

Sodium valproate in pregnancy

A

Associated with neural tube defects + neurodevelopmental delay

137
Q

5 causes of upgoing plantars with absent ankle jerks

A 
1  - MND (mixture of UMN + LMN signs)
2 - Friedreich's Ataxia
3 - SCDC
4  - Tertiary syphilis
5 - Dual peripheral + central pathology
138
Q

Mixed upper + lower motor neuron features AND bulbar involvement

A

ALS

139
Q

Phenytoin - chronic adverse effects

A

Peripheral neuropathy
Megaloblastic anaemia
Gingival hyperplasia
Lymphadenopathy

140
Q

Phenytoin - teratogenic effects

A

Cleft palate

Congenital heart disease

141
Q

Phenytoin - acute adverse effects

A

Cerebellar signs

Confusion

142
Q

Young patient with drop in GCS 48 hours after ischaemic stroke

A

Malignant MCA syndrome (brain swelling after infarction causes ICH)

143
Q

Tuberous sclerosis - cutaneous features

A

Ash-leaf spots

Shagreen patches

Adenoma sebaceum

Subungual fibromata

Cafe-au-lait spots

144
Q

Tuberous sclerosis - neurological features

A

Developmental delay

Epilepsy

145
Q

MS - management of acute relapse

A

5 days of high dose methylprednisolone

146
Q

Disease-modifying drugs used in relapsing-remitting MS

A

IFN-beta

Glatiramer acetate

Diethyl fumarate

Teriflunomide

147
Q

Contra-indication to IFN use

A

Deranged LFTs

148
Q

Cluster headache duration

A

15 min - 3 hour

149
Q

Cluster headache features

A

Unilateral around eye/temporal with autonomic dysfunction

150
Q

Why do CT thorax in myasthenia gravis?

A

Exclude thymoma (15%)

151
Q

Lucid interval associated with which type of head injury?

A

Extradural haemorrhage

152
Q

Risk factors for subdural haematoma

A

Old age
ETOH excess
Anticoagulation

153
Q

Management of myasthenic crisis

A

Plasma exchange

IVIG

154
Q

DVLA: One unprovoked seizure

no structural abnormality on brain imaging, no epileptiorm activity on EEG

A

6 months off

155
Q

DVLA: One unprovoked seizure

Structural brain abnormality /epileptiform activity on EEG present or not excluded

A

12 months off

156
Q

DVLA: How long must epileptic be seizure free to qualify for licence

A

12 months

157
Q

DVLA: How long must epileptic be seizure free to restore ‘til 70 licence

A

5 years

158
Q

DVLA: Withdrawal of epilepsy medications

A

No driving from when started withdrawal until 6 months after last dose

159
Q

DVLA: simple faint

A

No restriction

160
Q

DVLA: single, explained and treated, episode of syncope

A

4 weeks off

161
Q

DVLA: single unexplained episode of syncope

A

6 months off

162
Q

DVLA: two or more episodes of syncope

A

12 months off

163
Q

DVLA: stroke or TIA

A

1 month off

Inform DVLA if any residual deficit

164
Q

DVLA: multiple TIAs over short period

A

3 months off

Inform DVLA

165
Q

DVLA: craniotomy

A

1 year off driving

166
Q

DVLA: pituitary tumour with craniotomy

A

6 months off

167
Q

DVLA: pituitary tumour with trans-sphenoidal surgery

A

Can drive when safe to

168
Q

DVLA: narcolepsy/cataplexy

A

Cease driving on diagnosis, restart once ‘satisfactory control of symptoms’

169
Q

DVLA: MS/MND

A

Inform DVLA

Complete PK1 form

170
Q

Progressive weakness affecting finger and wrist flexion initially, think..

A

Inclusion body myositis

171
Q

Features of inclusion body myositis

A

Older patients

Finger and wrist flexor weakness

Mildly raised CK

172
Q

Features of polymyositis

A

Markedly raised CK

Tender muscles

173
Q

Features of diabetic amyotrophy

A

Painful wasting of proximal leg muscles

174
Q

Guillain-Barre - how many have persistent severe weakness

A

15%

175
Q

Guillain-Barre - mortality

A

5%

176
Q

Features of Guillain-Barre

A

Ascending weakness
LMN pattern
Respiratory weakness

177
Q

Features of cavernous sinus thrombosis

A

Periorbital oedema

6th nerve palsy (+/- 3rd/4th)

Pain of upper face and eye

Central retinal vein thrombosis

178
Q

Features of lateral sinus thrombosis

A

6th and 7th nerve palsies

179
Q

Causes of cavernous sinus syndrome

A

Cavernous sinus thrombosis
Tumour
Local infection (sinusitis)
Trauma

180
Q

CSF: causes of an isolated raised protein

A

GBS

CIDP (chronic inflammatory demyelinating polyneuropathy)

181
Q

Features of CIDP (Chronic inflammatory demyelinating polyneuropathy)

A

Similar to GBS but insidious onset

182
Q

Treatment of CIDP

A

Steroids + immunosuppressants

183
Q

Presentation of myasthenia gravis (acute)

A 
Fatigueability
Ptosis
Extraocular weakness
Dysphagia
Respiratory weakness
184
Q

Positive edrophonium chloride test in

A

Myasthenia gravis

185
Q

Medical treatment of Lambert-Eaton myasthenic syndrome

A

3,4-Diaminopyridine

186
Q

Optimal treatment of Lambert-Eaton myasthenic syndrome

A

Treatment of underlying malignancy (usually SCLC)

187
Q

Causes of spastic paraparesis

A 
Tropical spastic paraparesis (HTLV-1)
Hereditary spastic paraparesis
Cerebral palsy
Cord compression
Motor neurone disease
Multiple sclerosis

MRCP Part II (15 decks)

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