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FINALS- random flashcards per system > neuro > Flashcards

neuro Flashcards

1
Q

treatment of a brain abscess

A

Brain abscess: IV 3rd-generation cephalosporin (ceftriaxone) + metronidazole

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2
Q

presentation of a brain abscess

A

Fever, headache and features of raised intracranial pressure (vomiting, blurring of vision)

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3
Q

suspected vestibular shwannoma- diagnosis

A

audiogram and MRI head scan

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4
Q

presentation of vestibular schwannoma/ acoustic neuroma

A

The classical history of vestibular schwannoma includes a combination of vertigo, hearing loss, tinnitus and an absent corneal reflex.

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5
Q

what condition can bilateral vestibular schwannoma/ acoustic neuroma commonly occur within?

A

NF2

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6
Q

What is autonomic dysreflexia?

A

clinical syndrome occurs in patients who have had a spinal cord injury at, or above T6 spinal level.

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7
Q

presentation of autonomic dysreflexia

A

extreme hypertension, flushing and sweating above the level of the cord lesion, agitation, and in untreated cases severe consequences of extreme hypertension have been reported, e.g. haemorrhagic stroke.

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8
Q

MS- CSF findings

A

oligoclonal bands

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9
Q

presentation of dyskinesia

A

dystonia, chorea, athetosis

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10
Q

examples and noteable side effect of dopamine agonists

A

bromocrimptine, cabergoline, pergolide

side effect= pulmonary fibrosis

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11
Q

describe a 6th cranial nerve palsy

A

internuclear ophthalmoplegia and conjugate lateral gaze disorder

so problems moving the eye (muscles) with a lateral gaze

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12
Q

presentation of optic neuritis

A

Optic neuritis presents with unilateral reduced vision developing over hours to days. Key features are:

Central scotoma. This is an enlarged blind spot.
Pain on eye movement
Impaired colour vision
Relative afferent pupillary defect

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13
Q

management of MS relapses

A

methylprednisolone

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14
Q

oculomotor palsy presentation

A

‘down-and-out’ eye position, hence the patient’s difficulty with eye adduction

ptosis and inability to adduct eye

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15
Q

presentation of syringomyelia

A

a ‘cape-like’ (neck, shoulders and arms)
loss of sensation to temperature but the preservation of light touch, proprioception and vibration

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16
Q

presentation of encephalitis

A

fever, headache, psych symptoms, seizures, vomit

focal symptoms (aphasia etc)

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17
Q

what cranial nerves does a vestibular schwannoma affect

A

Cranial nerves V, VII and VIII are affected in vestibular schwannomas

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18
Q

trochlear nerve palsy

A

Palsy results in defective downward gaze → vertical diplopia

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19
Q

trigeminal nerve palsy

A

Lesions may cause:
trigeminal neuralgia
loss of corneal reflex (afferent)
loss of facial sensation
paralysis of mastication muscles
deviation of jaw to weak side

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20
Q

abducens nerve palsy

A

Palsy results in defective abduction → horizontal diplopia

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21
Q

facial nerve palsy

A

Lesions may result in:
flaccid paralysis of upper + lower face
loss of corneal reflex (efferent)
loss of taste
hyperacusis

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22
Q

vestibulocochlear nerve palsy

A

Hearing loss
Vertigo, nystagmus
Acoustic neuromas are Schwann cell tumours of the cochlear nerve

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23
Q

glossopharyngeal nerve palsy

A

Lesions may result in;
hypersensitive carotid sinus reflex
loss of gag reflex (afferent)

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24
Q

vagus nerve palsy

A

Lesions may result in;
uvula deviates away from site of lesion
loss of gag reflex (efferent)

25
Q

accessory nerve palsy

A

Lesions may result in;
weakness turning head to contralateral side

26
Q

hypoglossal nerve palsy

A

Tongue deviates towards side of lesion

27
Q

side effects of levodopa

A

dry mouth
anorexia
palpitations
postural hypotension
psychosis

28
Q

epilepsy- localising features of focal seizures- temporal lobe

A

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

29
Q

epilepsy- localising features of focal seizures- frontal lobe

A

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

30
Q

epilepsy- localising features of focal seizures- parietal lobe

A

paraesthesia

31
Q

epilepsy- localising features of focal seizures- occipital lobe

A

flutters/ flashes

32
Q

MS- first line management of spasticity

A

baclofen and gabapentin

33
Q

normal pressure hydrocephalus presentation

A

Urinary incontinence + gait abnormality + dementia

wet, wobbly, wacky

34
Q

encephalitis- CSF findings

A

lymphocytosis, elevated protein

35
Q

what is encephalitis commonly associated with?

A

measles

36
Q

criteria for a total anterior circulation infarct

A

involves middle and anterior cerebral arteries

all 3 of

  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
37
Q

criteria for a partial anterior circulation infarct

A

2 of:
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

38
Q

criteria for a Lacunar infarct

A

involves perforating arteries around the internal capsule, thalamus and basal ganglia
presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

39
Q

criteria for a posterior circulation infarct

A

involves vertebrobasilar arteries
presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia

40
Q

criteria for lateral medullary syndrome

A

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

41
Q

criteria for Webers syndrome

A

ipsilateral III palsy
contralateral weakness

42
Q

what medications should be avoided in myasthenia gravis?

A

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

43
Q

myasthenia gravis- investigations

A

Acetylcholine receptor (ACh-R) antibodies (85% of patients)
Muscle-specific kinase (MuSK) antibodies (10% of patients)
LRP4 (low-density lipoprotein receptor-related protein 4) antibodies (less than 5%)
A CT or MRI of the thymus gland is used to look for a thymoma.

The edrophonium test can be helpful where there is doubt about the diagnosis.

44
Q

treatment of myasthenia gravis

A

Reversible acetylcholinesterase inhibitors (usually pyridostigmine or neostigmine)

Immunosuppression (e.g. prednisolone or azathioprine) suppresses the production of antibodies

Thymectomy can improve symptoms even in patients without a thymoma

Monoclonal antibodies- Rituximab, Eculizumab

45
Q

which anti-emetic is safe to use in Parkinsons and why?

A

domperidone- does not cross the blood-brain barrier

46
Q

clinical signs of idiopathic intracranial hypertension

A

headache
blurred vision
papilloedema (usually present)
enlarged blind spot
sixth nerve palsy may be present (inability to abduct eye)

47
Q

medication overuse headache- how should analegesia (simple and opioids) be discontinued?

A

simple analgesia + triptans: stop abruptly
opioid analgesia: withdraw gradually

48
Q

parkinsons- describe the tremor

A

unilateral tremor that improves with voluntary movement

49
Q

diagnosis of an acoustic neuroma

A

MRI of the cerebellopontine angle

50
Q

characteristic features of CJD

A

Creutzfeldt-Jakob disease is characterised by rapid onset dementia and myoclonus

51
Q

migraine prophylaxis

A

topiramate/ propanolol

52
Q

what medication used in the management of epilepsy must you be cautious with if the patient is on warfarin?

A

sodium valporate

53
Q

what cranial nerves does a vestibular shwannoma effect?

A

Cranial nerves V, VII and VIII

54
Q

what is neurofibromatosis type 2 assosciated with?

A

Neurofibromatosis type 2 is associated with bilateral vestibular schwannomas

55
Q

nerve supplying the innervation to the finger extensors (motor)

A

radial

56
Q

nerve supplying the interossei muscles (adduction of the fingers)

A

ulnar

57
Q

nerve supplying sensation to the lateral shoulder

A

axillary nerve

58
Q

what drugs can cause exacerbations of myasthenia gravis?

A

The following drugs may exacerbate myasthenia:
penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines

FINALS- random flashcards per system (16 decks)

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