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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
Suspected pituitary apoplexy, immediate 1st step?
IV hydrocortisone
26
MND nerve conduction studies?
Normal motor conduction
27
1st line tx for spasticity in MS?
Baclofen and gabapentin
28
What electrolyte abnormality is associated with SAH?
Hyponatraemia
29
NF1 features?
``` Café-au-lait spots (>= 6, 15 mm in diameter) Axillary/groin freckles Peripheral neurofibromas Iris hamatomas (Lisch nodules) in > 90% Scoliosis Pheochromocytomas ```
30
NF2 features?
Bilateral vestibular schwannomas Multiple intracranial schwannomas mengiomas and ependymomas
31
how to tell the difference between drug induced and idiopathic PD?
Asymmetrical symptoms suggests idiopathic Parkinson's
32
brain abscess mx?
IV 3rd-generation cephalosporin + metronidazole
33
Long term prophylaxis of cluster headaches?
Verapamil
34
common complication of intraventricular haemorrhages
Hydrocephalus
35
Binocular vision post-facial trauma?
depressed fracture of the zygoma
36
Features of C8 radiculopathy?
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
Cluster headache tx?
High flow oxygen or SC triptan (contraindicated in coronary artery disease)
38
Where are you likely to have fractured if you have a wrist drop?
Shaft of the humerus (radial nerve damage)
39
Trigeminal neuralgia 1st line tx?
Carbamazepine | Failure to respond or age>50 = referral to neuro
40
Where is the lesion in homonymous hemianopia with some macula sparing?
Occipital cortex
41
Where is the lesion in someone with family history of early blindness is concerned that he is developing 'tunnel vision'?
Retina
42
Most appropriate anti-emetic to prescribe in Parkinson's?
Domperidone
43
Features of syringomyelia?
Affects spinothalamic tracts Cape like loss of pain and temp sensation Spastic weakness of lower limbs Scoliosis over time
44
What is Hoffman's sign and what can it be used to test?
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
Features of DCM?
``` Progressive and presents differently Pain in neck and arms/legs Loss of motor function Numbness Incontinence ```
46
Ix for MG?
1. single fibre electromyography: high sensitivity CT thorax to exclude thymoma CK normal autoantibodies
47
Cause of anterior cord syndrome? Features?
Flexion-compression injury Loss of spinothalamic + motor tracts Leg motor function more affected
48
Cause of central cord syndrome? Features?
Cervical spondylosis with a hyperextension injury Affects motor tracts Flaccid weakness of arms Legs generally preserved
49
Cause of posterior cord syndrome? Features?
``` Hyperextension injury (rare) Affects dorsal columns Gait impaired due to impaired proprioception ```
50
Ix for suspected TIA?
MRI brain with diffusion-weighted imaging
51
Mx of TIA?
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
Most common cause of surgical third nerve palsy?
posterior communicating artery aneurysm
53
When is Carotid endarterectomy is considered in a patient who has had a TIA?
carotid artery stenosis exceeding 70%
54
Best way to check if fluid is CSF?
Check for glucose | Gold standard: Beta-2-transferrin
55
What can be used to differentiate between a true seizure and a pseudoseizure?
Prolactin | Raised in true epilepsy
56
Features of Broca's dysphasia and where is the lesion?
speech non-fluent, comprehension normal, repetition impaired | Frontal lobe - inferior frontal gyrus
57
Tx for degenerative cervical myelopathy?
Cervical decompressive surgery
58
Best imaging modality for demyelinating lesions?
MRI with contrast
59
Features of Wernicke's aphasia and where is the lesion?
Superior temporal gyrus Sentences make no sense, word substitution and neologisms but speech remains fluent - 'word salad' Comprehension is impaired
60
Features of Conduction aphasia and where is the lesion?
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
Where must the spinal cord injury be for autonomic dysregulation to occur? Features? Triggers?
Above T6 severe hypertension and flushing and sweating above the level of injury Triggers: Faecal impaction / urinary retention
62
Best ix for acoustic neuroma (vestibular schwannoma)? | Which cranial nerves do they affect?
MRI cerebellopontine angle | V, VII, VIII
63
Bitemporal hemianopia - cause of the lesion?
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
Where is the lesion in a gait ataxia?
cerebellar vermis
65
Features of Brown-Séquard syndrome and how does it usually occur?
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
Ix and Mx of DCM?
MRI of the cervical spine | Urgent referral to spinal services for surgery
67
Valproate SEs?
``` Valproate Appetite and weight gain Liver failure Pancreatitis Reversible hair loss Oedema Ataxia Tremor + teratogenicity + thrombocytopenia Encephalopathy ```
68
CI for prescribing a triptan?
Ischaemic heart disease | Cerebrovascular disease
69
Which drugs are associated with the highest chance of inhibition disorders out of the antiparkinsonian medications?
Dopamine receptor agonists e.g bromocriptine
70
Cavernous sinus thrombosis features O/E?
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
What sign might you see on CT head of an ischaemic stroke acutely?
Hyperdense MCA sign
72
Findings O/E in common peroneal palsy?
Weak ankle dorsiflexion and foot eversion
73
How to differentiate common peroneal palsy and L5 radiculopathy?
in L5 radiculopathy, eversion tends to be spared while inversion is weak and sensory involvement tends to be greater
74
Which type of seizures typically are associated with Todd's paresis?
Focal seizures
75
Features in Weber's syndrome? Where is the infarct?
ipsilateral III palsy contralateral weakness Infarct: midbrain
76
Features in Lateral medullary syndrome (Wallenburg's)? Where is the infarct?
ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner's contralateral: limb sensory loss Infarct: Medulla (PICA)
77
Rule of 4s for cranial nerves in the brainstem?
Midbrain: CN 1-4 Pons: CN 5-8 Medulla: 9-12
78
Features of INO?
Ipsilateral inability to ADduct due to medial rectal weakness Nystagmus in Opposite eye ABducting
79
Where is the lesion in INO and what are some causes?
medial longitudinal fasciculus multiple sclerosis vascular disease
80
Tx for low pressure headache post LP?
Caffeine (IV fluids) + fluids (epidural saline) | Blood patch
81
Cardinal features of Creutzfeldt-Jakob disease?
rapid onset dementia and myoclonus
82
Causes of Mononeuritis multiplex? WARDS PLC
``` Wegener's Amyloidosis Rheumatoid Arthritis Diabetes Sarcoid PAN Leprosy Carcinomatosis ```
83
Complication of base of skull fracture?
internal carotid artery dissection
84
SAH complications?
Vasospasm - focal neuro deficit + drowsy | Hydrocephalus - drop in GCS
85
How do you confirm vasospasm?
CT perfusion scan and digital subtraction | angiography
86
Where is the damage in Internuclear ophthalmoplegia? What symptoms do you get?
Medial longitudinal fasciculus (MLF) in the pons | Difficulty conjugating horizontal gaze

Oishi's Final year flashcards (9 decks)

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