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Oishi's Final year flashcards > Neuro > Flashcards

Neuro Flashcards

1
Q

Damage to which parts of the nervous system can cause ptosis?

A

Midbrain
Cervical sympathetic chain (superior tarsal muscle)
Oculomotor nerve (Levator Palpebrae Superioris muscle)

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2
Q

How can the 3 likely causes of ptosis be differentiated?

A

Size of pupil

  • Horner’s syndrome will cause a small pupil
  • III nerve palsy (generally) a large pupil (and associated eye movement abnormalities)
  • Neuromuscular disorders (with the exception of botulism) the pupil size will be normal
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3
Q

What would you expect visual fields to show in raised icp?

A

enlarged blind spots

peripheral constriction of the visual fields

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4
Q

Tx for relapsing remitting MS in between episodes?

A

Beta interferon

Dimethyl fumarate

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5
Q

Which drugs increase the risk of idiopathic intracranial hypertension? COMAAR

A 
Ciclosporin
OCP 
Mineralocorticoids
Amiodarone
Abx (tetracyclines, sulphonamides)
Retinoic acid
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6
Q

Which drugs may exacerbate myasthenia and should be avoided?

A 
penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines
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7
Q

Acute migraine tx?

A

Triptan + NSAID

or triptan + paracetamol

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8
Q

Migraine prophylaxis?

A

topiramate or propranolol

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9
Q

Best tx for initial symptomatic relief in MG?

A

Pyridostigmine (long-acting acetylcholinesterase inhibitor)

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10
Q

What type of headaches are usually completely responsive to indomethacin?

A

Paroxysmal hemicrania

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11
Q

Symptoms of paroxysmal hemicrania?

A

Severe, unilateral headaches
Usually in the orbital, supraorbital or temporal region
Attacks come multiple times a day
Normally <30 mins
Autonomic features e.g. tearing/nasal congestion

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12
Q

Features of temporal lobe focal seizure? (HEAD)

A

Hallucinations (auditory/gustatory/olfactory)
Epigastric rising/Emotional
Automatisms (lip smacking/grabbing/plucking)
Deja vu/Dysphasia (post-ictal)

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13
Q

Features of frontal lobe focal seizure?

A

Head/leg movements, posturing, post-ictal weakness, Jacksonian march

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14
Q

Features of parietal lobe focal seizure?

A

Paraesthesia

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15
Q

Features of occipital lobe focal seizure?

A

Floaters/flashes

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16
Q

Classical hx for an acoustic neuroma?

A

Absent corneal reflex
Vertigo
Hearing Loss
Tinnitus

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17
Q

How to remember homonymous quadrantanopias?

A

PITS (Parietal-Inferior, Temporal-Superior)

superior: lesion of the inferior optic radiations in the temporal lobe (Meyer’s loop)
inferior: lesion of the superior optic radiations in the parietal lobe

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18
Q

Where is the lesion in incongruous defects?

A

optic tract lesion or optic radiation because the fibres are more spread out

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19
Q

Where is the lesion in congruous (complete/symmetrical) defects?

A

optic radiation lesion or occipital cortex

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20
Q

BPPV positive Hallpike manouvre sign?

A

Rotary nystagmus

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21
Q

Which sign differentiates between organic and non-organic lower leg weakness?

A

Hoover’s sign

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22
Q

Causes of a bitemporal hemianopia?

A 
NEOPLASTIC   
Pituitary macroadenoma
Meningioma
Craniopharyngioma
Chiasmatic glioma
NON-NEOPLASTIC
Aneurysm or ectatic carotid artery
Epidermoid cyst
Sarcoid
Dermoid cyst
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23
Q

Where is the lesion in superior quadrantonopia?

A

Inferior optic radiations in temporal lobe

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24
Q

Where is the lesion in homonymous hemianopia?

A

incongruous defects: lesion of optic tract
congruous defects: lesion of optic radiation or occipital cortex
macula sparing: lesion of occipital cortex

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25
Q

Suspected pituitary apoplexy, immediate 1st step?

A

IV hydrocortisone

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26
Q

MND nerve conduction studies?

A

Normal motor conduction

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27
Q

1st line tx for spasticity in MS?

A

Baclofen and gabapentin

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28
Q

What electrolyte abnormality is associated with SAH?

A

Hyponatraemia

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29
Q

NF1 features?

A 
Café-au-lait spots (>= 6, 15 mm in diameter)
Axillary/groin freckles
Peripheral neurofibromas
Iris hamatomas (Lisch nodules) in > 90%
Scoliosis
Pheochromocytomas
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30
Q

NF2 features?

A

Bilateral vestibular schwannomas
Multiple intracranial schwannomas
mengiomas and ependymomas

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31
Q

how to tell the difference between drug induced and idiopathic PD?

A

Asymmetrical symptoms suggests idiopathic Parkinson’s

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32
Q

brain abscess mx?

A

IV 3rd-generation cephalosporin + metronidazole

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33
Q

Long term prophylaxis of cluster headaches?

A

Verapamil

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34
Q

common complication of intraventricular haemorrhages

A

Hydrocephalus

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35
Q

Binocular vision post-facial trauma?

A

depressed fracture of the zygoma

36
Q

Features of C8 radiculopathy?

A

reduced sensation in the C8 dermatome (the medial side of the hand over the little finger)
weakness of the C8 myotome (flexion of the distal interphalangeal and metacarpophalangeal joints)
weakness of elbow extension

37
Q

Cluster headache tx?

A

High flow oxygen or SC triptan (contraindicated in coronary artery disease)

38
Q

Where are you likely to have fractured if you have a wrist drop?

A

Shaft of the humerus (radial nerve damage)

39
Q

Trigeminal neuralgia 1st line tx?

A

Carbamazepine

Failure to respond or age>50 = referral to neuro

40
Q

Where is the lesion in homonymous hemianopia with some macula sparing?

A

Occipital cortex

41
Q

Where is the lesion in someone with family history of early blindness is concerned that he is developing ‘tunnel vision’?

42
Q

Most appropriate anti-emetic to prescribe in Parkinson’s?

A

Domperidone

43
Q

Features of syringomyelia?

A

Affects spinothalamic tracts
Cape like loss of pain and temp sensation
Spastic weakness of lower limbs
Scoliosis over time

44
Q

What is Hoffman’s sign and what can it be used to test?

A

Reflex test to assess for cervical myelopathy
Performed by gently flicking one finger on a patient’s hand.
Positive = reflex twitching of the other fingers on the same hand in response to the flick

45
Q

Features of DCM?

A 
Progressive and presents differently
Pain in neck and arms/legs
Loss of motor function
Numbness
Incontinence
46
Q

Ix for MG?

A
  1. single fibre electromyography: high sensitivity
    CT thorax to exclude thymoma
    CK normal
    autoantibodies
47
Q

Cause of anterior cord syndrome? Features?

A

Flexion-compression injury
Loss of spinothalamic + motor tracts
Leg motor function more affected

48
Q

Cause of central cord syndrome? Features?

A

Cervical spondylosis with a hyperextension injury
Affects motor tracts
Flaccid weakness of arms
Legs generally preserved

49
Q

Cause of posterior cord syndrome? Features?

A 
Hyperextension injury (rare)
Affects dorsal columns
Gait impaired due to impaired proprioception
50
Q

Ix for suspected TIA?

A

MRI brain with diffusion-weighted imaging

51
Q

Mx of TIA?

A

Immediate 300mg aspirin
Specialist r/v immediately and admission if: crescendo, cardioembolic or severe carotid stenosis
TIA clinic within 24hrs: TIA in last 7 days
TIA clinic within 1 week: TIA occurred more than 1 week ago

52
Q

Most common cause of surgical third nerve palsy?

A

posterior communicating artery aneurysm

53
Q

When is Carotid endarterectomy is considered in a patient who has had a TIA?

A

carotid artery stenosis exceeding 70%

54
Q

Best way to check if fluid is CSF?

A

Check for glucose

Gold standard: Beta-2-transferrin

55
Q

What can be used to differentiate between a true seizure and a pseudoseizure?

A

Prolactin

Raised in true epilepsy

56
Q

Features of Broca’s dysphasia and where is the lesion?

A

speech non-fluent, comprehension normal, repetition impaired

Frontal lobe - inferior frontal gyrus

57
Q

Tx for degenerative cervical myelopathy?

A

Cervical decompressive surgery

58
Q

Best imaging modality for demyelinating lesions?

A

MRI with contrast

59
Q

Features of Wernicke’s aphasia and where is the lesion?

A

Superior temporal gyrus
Sentences make no sense, word substitution and neologisms but speech remains fluent - ‘word salad’
Comprehension is impaired

60
Q

Features of Conduction aphasia and where is the lesion?

A

Arcuate fasciculus (connects the frontal and temporal lobes)
Speech is fluent but repetition is poor. Aware of the errors they are making
Comprehension is normal

61
Q

Where must the spinal cord injury be for autonomic dysregulation to occur? Features?
Triggers?

A

Above T6
severe hypertension and flushing and sweating above the level of injury
Triggers: Faecal impaction / urinary retention

62
Q

Best ix for acoustic neuroma (vestibular schwannoma)?

Which cranial nerves do they affect?

A

MRI cerebellopontine angle

V, VII, VIII

63
Q

Bitemporal hemianopia - cause of the lesion?

A

lesion of optic chiasm
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

64
Q

Where is the lesion in a gait ataxia?

A

cerebellar vermis

65
Q

Features of Brown-Séquard syndrome and how does it usually occur?

A

Injury to hemicord
ipsilateral upper motor neurone signs: unilateral spastic paresis
contralateral spinothalamic signs: loss of pain and temp
ipsilateral dorsal column signs: loss of proprioception

66
Q

Ix and Mx of DCM?

A

MRI of the cervical spine

Urgent referral to spinal services for surgery

67
Q

Valproate SEs?

A 
Valproate
Appetite and weight gain
Liver failure
Pancreatitis
Reversible hair loss
Oedema
Ataxia
Tremor + teratogenicity + thrombocytopenia
Encephalopathy
68
Q

CI for prescribing a triptan?

A

Ischaemic heart disease

Cerebrovascular disease

69
Q

Which drugs are associated with the highest chance of inhibition disorders out of the antiparkinsonian medications?

A

Dopamine receptor agonists e.g bromocriptine

70
Q

Cavernous sinus thrombosis features O/E?

A

absent corneal reflex + proptosis
Horner’s syndrome with painful eye movements
i.e. to differentiate it from PICA it affects CN 3-6 not just CN 3

71
Q

What sign might you see on CT head of an ischaemic stroke acutely?

A

Hyperdense MCA sign

72
Q

Findings O/E in common peroneal palsy?

A

Weak ankle dorsiflexion and foot eversion

73
Q

How to differentiate common peroneal palsy and L5 radiculopathy?

A

in L5 radiculopathy, eversion tends to be spared while inversion is weak and sensory involvement tends to be greater

74
Q

Which type of seizures typically are associated with Todd’s paresis?

A

Focal seizures

75
Q

Features in Weber’s syndrome? Where is the infarct?

A

ipsilateral III palsy
contralateral weakness
Infarct: midbrain

76
Q

Features in Lateral medullary syndrome (Wallenburg’s)? Where is the infarct?

A

ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss
Infarct: Medulla (PICA)

77
Q

Rule of 4s for cranial nerves in the brainstem?

A

Midbrain: CN 1-4
Pons: CN 5-8
Medulla: 9-12

78
Q

Features of INO?

A

Ipsilateral inability to ADduct due to medial rectal weakness
Nystagmus in
Opposite eye ABducting

79
Q

Where is the lesion in INO and what are some causes?

A

medial longitudinal fasciculus
multiple sclerosis
vascular disease

80
Q

Tx for low pressure headache post LP?

A

Caffeine (IV fluids) + fluids (epidural saline)

Blood patch

81
Q

Cardinal features of Creutzfeldt-Jakob disease?

A

rapid onset dementia and myoclonus

82
Q

Causes of Mononeuritis multiplex? WARDS PLC

A 
Wegener's
Amyloidosis
Rheumatoid Arthritis
Diabetes
Sarcoid
PAN
Leprosy
Carcinomatosis
83
Q

Complication of base of skull fracture?

A

internal carotid artery dissection

84
Q

SAH complications?

A

Vasospasm - focal neuro deficit + drowsy

Hydrocephalus - drop in GCS

85
Q

How do you confirm vasospasm?

A

CT perfusion scan and digital subtraction

angiography

86
Q

Where is the damage in Internuclear ophthalmoplegia? What symptoms do you get?

A

Medial longitudinal fasciculus (MLF) in the pons

Difficulty conjugating horizontal gaze

Oishi's Final year flashcards (10 decks)

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