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MRCP PART 1 > Neuro > Flashcards

Neuro Flashcards

1
Q

Alzheimer’s is a progressive degeneration of the cerebral cortex with widespread atrophy. What key thing is happening in affected neurones?

A

Amyloid plaque deposits

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2
Q

Alzheimer’s is a progressive degeneration of the cerebral cortex with widespread atrophy. What key thing is happening in affected neurones?

A

Amyloid plaque deposits with reduced Ach production
Neurofibrillary tangles

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3
Q

Gene in some alzheimers ?

A

Apolipoprotein E
[APP, PSEN1, PSEN2 - can think of Persons SENile 1 and 2]

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4
Q

Dementia with hallucinations/sleep disorder in Q. What else might they mention?

A

Lewy body
Parkinsonism

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5
Q

Personality change being a key part of dementia in?

A

Fronto temporal

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6
Q

Some dementia symptoms but starting in 30’s with psychosis and abnormal movements

A

huntingtons

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7
Q

gait disturbance, cognitive impairment, and impaired bladder control

A

normal pressure hydrocephalus

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8
Q

Rapid progression in <50s with myoclonic jerks, seizures and cerebral ataxia

A

prion disease

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9
Q

Uncertain but want to make diagnosis of AD

A

Consider PET CT
CSF for tau protein / amyloid B

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10
Q

AD and DVLA

A

DVLA must be informed

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11
Q

Pharma Rx of AD

A

Cholinesterase inhibitors - Donepezil, rivastigmine, galantamine

NMDA receptor antagonist - memantine

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12
Q

Safest antiepileptic in pregnancy

A

Lamotrigine for labias

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13
Q

Phenytoin can be used in pregnancy - what needs to happen? 3 parts

A

Ensure pt gets folic acid (as affects synthesis)
Vitamin K from 36weeks gestation to counteract possible neonatal coagulopathy

Detailed US scan at 18-20 weeks

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14
Q

Huntington’s - genetics? Which chrom?

A

Huntingtin gene on chromosome 4 -> CAG repeat

Dominant pattern with anticipation

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15
Q

What is the common presentation of juvenile Huntingtons

A

Hypo kinetic, rigid picture with parkinsonism

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16
Q

CT huntingtons

A

Loss of striatal volume and increased size of the frontal horns of the lateral ventricles

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17
Q

Alcohol and diabetes are the most common forms of peripheral neuropathy - what would make you think alcohol rather than diabetes?

A

anaemia with macrocytosis
Derranged LFTs
Low Calcium / Magnesium

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18
Q

Cluster headaches are always UNILATERAL and last 15min - 3 hrs. Often associated with ipsilateral autonomic symptoms. Management for acute attack? Prevention?

A

Acute - Oxygen +/- sumatriptan

Chronic - Verapamil
[Topiramate, valproate, and lithium may be used]

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19
Q

Why avoid haloperidol in dementia

A

More susceptible to extrapyramidal eg parkinsonism side effects

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20
Q

Early Parkinsons associated with what gene?

A

PARK1

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21
Q

Bar antipsychotics which other drugs may cause parkinsonism

A

Metoclopramide
proclorperazine

Valproate, litium

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22
Q

General buzz pathology of Parkinsons

A

loss of dopaminergic neurones in substantial nigra

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23
Q

Parkinsonism with significant autonomic disturbance?

A

Multi-system atrophy

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24
Q

Parkinsonism with prominent cerebella signs

A

Multi system atrophy

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25
Q

Parkinsonism with the inability to look up. If the neck is flexed the gaze will remain to look forward. What is this called? What is the diagnosis?

A

vertical supranuclear gaze palsy

Progressive supranuclear palsy

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26
Q

Early falls in clinical course with parkinsonism consider?

A

Normal pressure hydrocephalus
PSP

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27
Q

Vascular parkinsonism seen in ?

A

Corticobasal syndrome

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28
Q

Parkinsons DVLA

A

Must inform

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29
Q

1st line Rx of parkinsons

A

Levodopa with a dopa-decarboxylase inhibitor Eg
Co-caredopa

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30
Q

Bar co-careldopa/co-beneldopa what other key medication classes in parkinsons

A

Dopamine agonists - pramipexole, ropinirole or rotigotine

MAO-B inhibitors - segeligine, rasagiline
[Do NOT cause rection after consumption of tyramine rich food]

COMT inhibitors - entacapone

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31
Q

Issue with using ergot-derived dopamine agonists eg cabergoline and pergolide?

A

Cardiac fibrosis when used for a long time

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32
Q

Surgical Parkinsons

A

Electrodes into deep brain nuclei -> stimulation of thalamic nucleus

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33
Q

Hemiballism is what? which brain structure is damaged?

A

“hyperkinetic involuntary movement disorder characterized by intermittent, sudden, violent, involuntary, flinging, or ballistic high amplitude movements”

Subthalamic nucleus

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34
Q

Damage to red nucleus leads to?

A

tremor

[Tremor with glass of red wine it pours everywhere]

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35
Q

Damage to ventral pallidum caudate nucleus

A

chorea

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36
Q

Damage to the dentate nucleus causes?

A

ataxia

[Dentists dint pay taxes]

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37
Q

Most common primary brain tumour

A

Glioma

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38
Q

Glioblastoma multiforme looks greyish macroscopically. What features are diagnostic?

A

Vascular proliferation and thombois
Necrosis

Astrocytoma (another main type of glioma) wont have these features above and usually looks whiter

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39
Q

Most commonly inherited polyneuropathy?

A

charcot-marie-tooth disease

[Will present with a slow symetrical weakness/ sensory loss / muscle loss / areflexia]

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40
Q

How does freidrich’s ataxia present? common non neuro issue?

A

slow progressive cerebellar ataxia in young adults / kids (2-25yrs) with absent reflexes

Cardiomyopathy

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41
Q

Rx of migrane acute?

A

Acute
-Analgesia - Aspirin 900mg, NSAID, para
-Sumatriptin

Only sumartriptan at START of headache - not when aura starts

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42
Q

Eg of migrane prophylaxis

A

propranolol
topiramate
amitriptyline

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43
Q

Smoker. Proximal weakness which is worse in morning and gets better with exertion. Assoc symptoms of autonomic Eg Dry mouth. Cause/antibodies? Pathology? Ix? Rx?

A

Lambert-eaten myasthenic syndrome

Paraneoplastic usually associated with small cell lung cancer
-Pre synaptic autoantibodies to voltage gated Ca channels

Nerve conduction studies / CT chest to exclude malignancy

3,4-diaminopyridine [sometimes pyridostigmine / steroids / plasma exchange]

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44
Q

Management of Tics

A

Risperidone if bad

CBT if not

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45
Q

Gillian-barre
Most common bug?
CSF finding?
Rx?

A

C jejuni
Raised protein [can be normal at start]
IVIG + Plasma exchange

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46
Q

Variant Creutzfeldt-Jakob disease gives what finding on MRI? Histology?

A

Increased signal in pulvinar of thalamus

Vacuolar degeneration

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47
Q

What would diffuse white-matter disease on t2 weighting indicate?

A

Vascular dementia

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48
Q

myoclonus
dementia
ataxia
psych/behavioural
Age 20s
=

A

Varient Creutzfeldt-Jakob disease

[Very young]

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49
Q

Differentiate sporadic vs Variant Creutzfeldt-Jakob disease

A

Variant Creutzfeldt-Jakob disease - presents earlier Ie in 20s
Psychiatic prodrome to symptoms
Painful sensory symptoms

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50
Q

Actue slurring of speech, horners syndrome, facial pain and vertigo =?Which vessle?

A

Lateral medullary syndrome
[posterior inferior cerebellar artery syndrome]
Vertebral artery - most common. Then PICA

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51
Q

Anterior vs middle cerebral artery if lower limb more affected?

A

Anterior - paralysis affecting LEGS most

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52
Q

‘Cape like’ distribution loss of pain and temperature? What follow? Pathology?

A

Syringomyelia

Other symptoms if gets bad eg propioception / power moving up from hands / lower limb sx

[May get horners syndrome if involves sympathetic pathways of cervical cord]

Fluid filled cyst in spinal cord

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53
Q

Most common type of MS? Most common mode of presentation

A

Relapsing remitting

Optic neuritis with visual field loss

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54
Q

MS gene risk factor

A

HLA DRB1

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55
Q

2 things on CSF of MS

A

Oligoclonal bands
Intra theacal IgG synthesis

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56
Q

Complete opthalmoplegia of eye. Where is lesion? If raised inflam markers what is it likely?

A

Cavernous sinus (on ipsilateral side)

Tolosa-hunt syndrome (TotalLoss eye) [Granulomatous process]

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57
Q

What do you get in cavernous sinus issues? Eg Neoplastic, vascular, inflamation

A

CN III, IV, VI -> eye muscle weakness
V (trigeminal) - face sensory

Horners syndrome

Facial paraesthesia

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58
Q

Cell type in Lyme disease CSF meningitis

A

Lymphocyte predominant
High protein
Normal glucose

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59
Q

Do you give steroids in GBS

A

no

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60
Q

Loss of pain and temp on face and on CONTRALATERAL side of body? Usual cause?

A

Lateral medullary syndrome

Vertebral artery dissecition -> PICA occlusion

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61
Q

Max time for TIA?

A

24hrs

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62
Q

Who has high risk of berry aneurysms

A

PCKD

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63
Q

Drug of choice for stroke thrombolysis? time frame to treat? When can you do thrombectomy?

A

altepase if <4.5hrs

Thrombectomy (incombination with altepase) <6hrs

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64
Q

PICA occusion leads to? what symptoms

A

Lateral medullary syndrome

nystagmus and vomiting

Ipsilateral pain and temp sensation in face
-Ipsilateral horners
Contra lateral pain and temp in limbs
[but ipsilateral limb ataxia]

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65
Q

Non-epileptic seizures. Important ways of differentiating from true

A

EEG + video
TONGUE biting - virtually never in pseudo
Serum prolactin - temporary raise in real seizures

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66
Q

What happens in loss of dolls eye reflex. When might this be seen.

A

Pupils dont move on head turning
Brainstem death Eg massive pontine haemorrhage

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67
Q

Proptosis not from graves usually?

A

Malignant
Eg tumour in orbital apex

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68
Q

Sudden onset Bilat flaccid weakness and sensory / temperature loss
SPARED proprioception and virbration

A

Anterior spinal artery occulusion

Posterior artery suppilies posterior aspect with proprioception and vibration

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69
Q

Best antiepileptic if liver impairment

A

Lamotrigine - also only one which doesnt interfere with warafrin

[Lamotrigine for liver]

Can use keppra - though will still need dose reduced if severe impairment

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70
Q

First line drugs for epilepsy are as you’d imagine. Keppra, valproate, carbamazepine, lamotrigine…. What is the one for absence seizures?

A

Ethosuximide

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71
Q

All types of MND have weakness in limbs. AML is the most common type and affects UMN/LMN as well as speech and respiratory involvement.
What are some differentiating factors of the others ?
PBP / PMA / PLS

A

Progressive bulbar palsy
-Weakness of facial muscles predominant
-Often emotional liability

Progressive muscular atrophy
-Only LOWER motor neurones

Primary lateral sclerosis
-Progressive SPASTIC weakness of limbs
-Sensation intact
-may still get dysarthria / dysphagia

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72
Q

Only drug for MND

A

Riluzole - only adds a couple months to life expectancy

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73
Q

Condition which may seem similar to MND -
Lower MND involving limbs and bulbar muscles
with - Gynaecomastia and reduced fertility ?

A

Kennedy disease (x-linked spinobulbar muscular atrophy)

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74
Q

Juvinile myoclonic epilepsy - choice of drug?

A

Valproate
-Keppra if want to get preg etc..

Kids like a VK drink

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75
Q

Blurring of disk and Arcuate visual loss usually in what condition

A

Glaucoma

[bow-shaped (arcuate) visual field defect]

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76
Q

Loss of ability to detect size shape and orientation of objects in one hand. MRI of what

A

Head - not C spine

Damage to anterior parietal cortex would cause this

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77
Q

Brown-Séquard syndrome - neurology

A

paralysis and loss of proprioception on the same (or ipsilateral) side as the injury or lesion, and loss of pain and temperature sensation on the opposite (or contralateral) side as the lesion.

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78
Q

Unilateral dilated pupil which contracts slowly and loss of deep tendon reflexes? Option for management
What is hypohidrosis? What name of syndrome if that happens along with above?

A

Holmes-aldie syndrome (pupil)
-Usually due to viral damage at some point
-Reading glasses or pilocarpine drops TDS to constrict pupil

Lack of ability to sweat
Ross syndrome

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79
Q

Syphilis -> bilateral slighly dilated poorly light reactive pupils with normal accommodation.

A

Argyll-robertson pupil

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80
Q

Broca vs wernickes

A

Broca - Frontal lobe
- Pure speech disturbance

Wernikes - Temporal lobe
- Comprehension

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81
Q

Bells palsy linked to which bug?
Symptoms?
Key other cause to rule out?

A

HSV-1

Facial muscles palsy
HYPERacuisus
Reduced salivation
May cause pain usually auricular
Dry eyes

Borrelia burgdoferi serology

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82
Q

Bells palsy - 2 main parts of Rx?
If complete paralysis ?

A

Eye protection - artificial tears
corticosteroids

Often aciclovir +/- surgical decompression

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83
Q

Bells palsy vs UMN lesion if able to wrinkle head

A

Preserved ability to wrinkle forehead is UMN lesion

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84
Q

Hypo/hyperkalaemia and temporary global muscle weakness

A

periodic paralysis

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85
Q

Periodic paralysis with lots of physical deformities

A

andersen-tawil syndrome

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86
Q

Periodic paralysis usually associated with potassium problems. What is the other type

A

Thyrotoxic

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87
Q

Bells palsy with vesicular rash = ?
CSF findings?

A

Ramsay hunt - VZV (Herpes Zoster) in the geniculate nucleus

May have lymphocytosis / mildly raised protein

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88
Q

Painless intermittent diplopia which worsens through day. Ptosis
?

A

Occular myasthenia gravis
[most common initial presentation]

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89
Q

Interossi muscles of hands and sensory medial upper arm nerve root

A

T1

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90
Q

Tricepts muscle and sensory forearm + hand around middle finger nerve route

A

C7

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91
Q

Elbow and wrist extension issues which brachial plexus nerve ? Sensory issues

A

Radial

Sensory lateral forearm and lateral dorsal hand (anatomical snuff box)

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92
Q

Loss of pain and temperature in arm with preservation of proprioception and vibration? (If repeated trauma in question?) How would it progress?

A

Syringomyelia
(if trauma eg repeated rugby scrum - cervical spondylosis)

Wasting of small muscles of hand moving proximally

Increased tone bilat lower limb -> spastic paralysis

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93
Q

Smoking HTN and cocaine are risks for SAH/Aneurysm. What are inherited risks?

A

PKD
Marfan, ehlers-danlos
NF type 1

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94
Q

Fat, headaches, visual disturbance? Key finding on exam?

A

idiopathic intracranial hypertension

-swelling of optic disk /papilloedema

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95
Q

Rx of IIH? If severe headaches?
Surgical? If threat to vision?

A

Acetazolamide / topiramate

Pred if severe headaches

Therapeutic LPs to relieve pressure

May get VP shunt for recurrent disease
Optic nerve fenestration if risk to vision

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96
Q

Differentiate cauda equina and conus medullaris.
Presentation
Reflexes
Pain
Sensory
Sphincters

A

Conus
-Sudden and bilart
-Knee jerk preserved. Anke affected
-more severe back pain, less radicular
-Symetrical and bilat sensory disturbance
-Urinary retention and faecal incontinence early

Cauda
-Slower onset
-Areflexic
-Less severe back pain, more sever radicular pain
-Retention presents late in disease

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97
Q

wants to get preg. On phenytoin and keppra. What is plan

A

Wean to a single agent -
Keep keppra at lowest dose for seizure control

Folic acid 5mg daily

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98
Q

Arnold-chiari nystagmus type?

A

Downbeat

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99
Q

What is most common cause of pendular nystagmus? (movement equal speed both ways)

A

MS

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100
Q

Symptoms of brown sequard

A

Ipsilateral - weakness, vibration and proprioception

Contralateral - Pain and temp

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101
Q

Muscular dystrophy - what is best predictor of death

A

Vital capacity

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102
Q

Differentiate sporadic / varient CJD.

Best Ix

A

Sporadic
-Age 45-75
-Myoclous and dementia
-De novo mutation
-LP/MRI

Variant
-Average age 26
-Psychiatric prodrome
-Painful psych symptoms
-MRI best (EEG/LP less sensitive in this one)

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103
Q

Rx of myoclonus in CJD

A

Clonazepam / valproate

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104
Q

Most common cause of roth spots

A

Subacute bacterial endocarditis

105
Q

Unable to pronate arm. Which nerve

A

Anterior interossus - Branch of median

106
Q

Cushings response to head injury

A

RR - decreases
Bradycardia
systolic BP increase

107
Q

MRI spine findings of Subacute degeneration of spinal cord (eg b12 deficiency)

A

Increased T2 signal in posterior columns

108
Q

MS MRI Spine

A

T2 Diffuse patchy white matter lesions

109
Q

RX ramsay hunt

A

Acyclovir + pred
Lubricating eye drops

110
Q

Flu like illness -> ophthalmoplegia, areflexia and ataxia

A

Miller-fisher syndrome

[variant of gillian barre]

111
Q

Left inferior homonymous hemaniopia where is lesion

A

Right parietal

[Lateral fibres cross at chiasm]

112
Q

Bar CN III, IV and 6, what else goes through cavernous sinus?

A

Maxillary (sensory) branch of CN V

Carotid artery

113
Q

Most common sight issue in IIH

A

Enlarged blind spot
(from optic disk swelling)

114
Q

Prev significant spinal trauma with lower limb wasting. Now loss of pain and temp over upper limbs. What has happened

A

Post-traumatic sryngomyelia

115
Q

Facial weakness, winging of scapular, proximal upper limb weakness, foot drop

A

Fascioscapulohumeral muscular dystrophy

116
Q

Focal seizures usually from which lobe?

A

Temporal

117
Q

Epidural / LP then couple days later
Droswsy, severe headaches, raised ICP eg seizures….

A

Central venous thrombosis

MOST likely Superior sagittal sinus thrombosis

118
Q

For what length of time does xanthachromia remain very specific

A

12hrs after onset for 2 weeks

(100% sensitivity after 2 weeks still)

119
Q

Essential tremor 2 main drugs for Rx

A

Propanolol

[Primidone (barbituate)
Topiramate]

120
Q

Inheritance of tremor? how does age of presentation change whats likely?

A

AD in 50%
If presents after age 40 -> likely sporadic

121
Q

Key drug in neuroleptic malignant syndrome

A

dantrolene

122
Q

EEG of sCJD

A

1-Hz periodic discharges
(myoclonic movements)

123
Q

diabetes insipidus, childhood-onset diabetes mellitus, a gradual loss of vision caused by optic atrophy, and deafness.

A

DI-DM-OA-D
DIDMOAD syndrome also known as
Wolfram syndrome

124
Q

Score for disease status in MS

A

EDSS
Expanded disability status score

125
Q

Usual first line Rx MS with mpred

A

Interferon or
Glatiramer acetate

126
Q

Early highly active RRMS rx

A

Autologus haematopoetic stem cell transplant

127
Q

Relapse of MS doses of pred in hospital

A

Mpred 1g IV 3 days
500mg oral 5 days

128
Q

What happens to pregnant pts with MS

A

Usually get less attacks
still treat with steroids / Plasma exchange if needed

129
Q

Finger drop / radial deviated wrist extension. Nerve?

A

Doral (posterior) interossus nerve

130
Q

Dermatome c5-t1

A

Dermatome
C5: lateral aspect of arm
C6: lateral aspect of forearm and hand
C7: middle finger and ray
C8: medial aspect of hand
T1: medial aspect of forearm

131
Q

Myotome and reflex C5-T1

A

C5: Elbow flexion
-Biceps

C6: Wrist extension
-Supinator
-Biceps

C7: Elbow extension
-Triceps

C8: Middle finger flexion

T1: Little finger abduction

132
Q

Disc prolapse -> loss of triceps reflex. Where

A

C6,7

prolapse affects nerve root below prolapse

133
Q

Multifocal motor neuropathy with conduction block. What is this? Sensory involvement?
Rx first line?

A

Form of MND
No sensory involvement

Treat with IVIg

134
Q

Multifocal motor neuropathy with conduction block. Key findings on EMG?
Rx first line?

A

it is what it says on the diagnosis. Eg right hand and left foot symptoms

Conduction block and No sensory involvement on EMG

Treat with IV Ig

135
Q

What is the most common form of GBS called. WHat is the pattern of peripheral nerve pathology

A

Acute inflammatory demyelinating polyneuropathy
AIDP

Segmental demyelination

136
Q

What is wallerian degeneration

A

Demyelination which occurs distal to a region of focal (axonal) damage.

->Nerve needs to regenerate

137
Q

DDs for subacute lymphocytic meningitis

A

TB
Cryptococcus - if immunocompromised and opening pressure >40cmH2O
Lyme diseae

138
Q

Head injury LOC. Quick recovery
Lucid period
-> quick deterioration ?

A

Extradural
(middle meningeal artery bleed -> more rapid symptoms)

139
Q

cerebral aneurysm which is best Coil or clipping

A

Coil

140
Q

Cerebellar signs and tremor in a young person …

A

Wilsons

141
Q

1st line Ix of wilsons? Gene?

A

24hr urine copper is Ix of choice - raised

Slit lamp - sunflower cataracts / kayser fletcher rings
[Serum ceurloplasumin and copper - usually low/normal]

ATP7B gene - diagnosis

142
Q

Rx Wilsons

A

Avoidance of copper containing foods

Penicillamine - copper chelation

143
Q

Juvenile myoclonic epilepsy first line ?

A

Valproate

144
Q

Differentiate vestibular neuroma and menniers

A

Cancer - unilateral hearing loss, tinnitus and trigeminal neuralgia. Eg absent corneal reflex

Menniers - hearing loss, tinnitus and vertigo
No pain / trigeminal involvement

145
Q

Key risks for vestibular shwannoma

A

Neurofibromatosis

Loss of chromosome p22 gene
[Shwannomin gene which is a tumour suppressor gene)

146
Q

Rx of vestibular schannoma

A

50% small and dont require Rx

Surgery /
radio - ‘gamma knife’ radiotherapy

147
Q

Upbeat nystagmus. Where is lesion

A

Lesion in medulla

148
Q

What is spared in anterior spinal artery occlusion?

A

Sudden onset Bilat flaccid weakness and sensory / temperature loss

SPARED proprioception and virbration

149
Q

What is spared in anterior spinal artery occlusion?

A

Sudden onset Bilat flaccid weakness and sensory / temperature loss

SPARED proprioception and vibration

150
Q

What is spared in anterior spinal artery occlusion?

A

Sudden onset Bilat flaccid weakness and sensory / temperature loss

SPARED proprioception and vibration

151
Q

Older diabetic. Transient weakness eg of face. Then couple of months later weakness / sensory loss of common peroneal. Both recovered spontaneously after couple weeks. Dx?
Rx?

A

Mononeuritis multiplex
Improve BM control

[MS would present <60 usually / UpperMN signs]

152
Q

What can apomorphine be used forr

A

Alleviate late motor Sx Eg dyskinesia of dopamine therapy in parkinsons

153
Q

Numbness medial thigh and reduced hip adduction nerve

A

Obturator

154
Q

Weak hip abduction and Trendelenburg gait nerve

A

Superior gluteal

155
Q

Sciatic nerve route? becomes what?What sx?

A

L5-S2
Becomes tibial and common perineal
-> eg foot drop

156
Q

Pharma rx of tics

A

Risperidone

157
Q

Pregnant then excessive vomiting.. Wide-based gait and double vision. Deficient in what

A

Thiamine (Vit B1)

158
Q

Stroke / TIA DVLA rules

A

No car for 1 month
No HGV for 1 year

159
Q

Homonymous hemianopia with sparing of macula (central field)

A

Occipital stroke

If no sparing may be optic tract

160
Q

CN palsies, horners syndrome, and UMN signs in limbs, sensory change

A

Sryngobulbia

161
Q

Kennedy disease also called

A

x linked spinobulbar atrophy
[like MND but gynecomastia, diabetes and infertile]

162
Q

Weakness of all ankle movements / ankle jerk =

A

Sciatic

163
Q

Drug used in SAH to minimise vasospasm and further infaarct

A

Nimodipine

164
Q

Pyramidal weakness, reduced deep tendon reflexes
Reduced proprioception and vibration but nil else sensory =

A

b12 deficinecy

165
Q

Which infection causes progressive myelopathy with prominent bladder disturbance

A

HTLV-1

166
Q

Bilat weakness in upper limbs.
LMN signs. No sensory involvement
Demyelination and conduction block on EMG /conduction studies.

A

Multifocal motor neuropathy

167
Q

Multifocal motor neuropathy Ix? Antibody? Rx?

A

EMG /conduction studies.
Anti-aminoglycoside [Anti-GM1] antibody 50%
IV Ig

168
Q

What makes you think idiopathic parkinsons rather than one of the parkinsonsoniam cause

A

Asymmetry in idiopathic parkinsons

169
Q

differentiate holmes aidie pupil and physiological aniscoria

A

Aidie - poor constriction to light with normal accommodation
[Due to damage to parasympathetic supply]

Pysiological - difference remains the same in light and dark

170
Q

differentiate holmes aide pupil and physiological anisocoria

A

Aidie - poor constriction to light with normal accommodation
[Due to damage to parasympathetic supply]

Physiological - difference remains the same in light and dark

171
Q

Upper and LMN signs with sensory changes? What if evidence of brainstem involvement Eg CN palsy

A

Syringomyelia

syringobulbia if brainstem involved

172
Q

Brainstem stroke with impaired vertical eye movements. Where is the lesion for eye movements?

A

Dosal midbrain - vertical eye movements

173
Q

Stroke long term secondary prevention? 2nd line?

A

Clopidogrel 1st line
2nd line aspirin + dipyridamole

174
Q

miller fisher syndrome basics presentation

A

Weakness affecting eyes and then progresses distally

175
Q

Phenytoin dose change - how long to check level

A

2 weeks

176
Q

Fevers, lethargy. Painful neuropathies affectting different nerves. Rash. Raised inflam markers. What is the cause of neuropathies? Cause? Ix?

A

Mononeuritis multiplex
[probably caused by vasculitis given rash ]

Nerve biopsy

177
Q

global wasting of the hand muscles damage to?

A

T1 (median and ulnar)

178
Q

HIV progressive memory loss. MRI shows global atrophy and mild white matter hyperintensity?

A

HIV dementia

[PML would usually have some focal neuro symptoms]

179
Q

Pituitary apoplexy (bleeding into adenoma). Ix of choice?

A

MRI brain

[dont need angio as MRI will show adenoma and haemohharge]

180
Q

Paroxysmal vertigo, deafness lasting for hours? Rx acute? Prophylaxis?

What if old and symptoms only short lived?

A

Meniers
Prochlorperazine / cyclizine

Beta histine, low salt +/- diuretics

Vertebrobasilar insufficiency if old and short-lived sx
[no hearing loss in BPPV]

181
Q

Labyrinthitis how long for symptoms

A

Lasts 1-3 weeks and
NO hearing loss

182
Q

Labyrinthitis how long for symptoms? What symptom is absent?

A

Lasts 1-3 weeks and
NO hearing loss

183
Q

Deliver baby -> severe dehydration
Then develop neuro signs Eg seizure / focal weakness what has happened

A

Sagittal sinus thrombosis

184
Q

which artery supplies brocca

A

Middle cerebral

185
Q

Hemiparesis mostly involving llegs

A

Anterior cerebral

186
Q
  1. Unsteady gait, alcoholic, reduced lower limb reflexes, increased tone and spastic bilat . Loss of vibration sense
A

B12 deficiency

187
Q

Injury to the neck. Weakness down left side 4/5. LMN arm, UMN leg. Dx?

A

Cervical myelopathy

[Sryngomyelia would have more likely started as cape-like distribution]

188
Q

Miller fisher syndrome antibody

A

IgG anti‐GQ1b

189
Q

Axonal vs myelin disorder on EMG

A

Axonal - Loss of action potential size (amplitude)

Myelin - Reduction in velocity Or blocks

190
Q

Painful paraesthesia in CJD means what is involved

A

Thalamus

191
Q

Old person with CJD best Ix

A

LP [for RT-QuIC]

192
Q

Right parietal damage in right-handed person -> ?

A

Visual disturbance

193
Q

Arnold chiari nystagmus

A

Downbeat

194
Q

agraphia
acalculia
finger agnosia
left-right disorientation .

A

Gerstmann syndrome

agraphia (inability to write),

acalculia (inability to perform mathematical calculations)

finger agnosia (inability to name, discriminate, or identify fingers)

left-right disorientation (inability to distinguish left from right)

195
Q

Dominant vs non dominant parietal lobe lesion

A

Dominant - Language, agnosia, apraxia, Gesterman syndrome

Non-dominant - Visuospacial, apraxia
-Eg copy a drawing

196
Q

URTI. Now progressive weakness of lower limbs

CSF - lymphocytes, normal protein
?

A

Post viral transverse myelitis

[Will have sensory level sensation loss]

197
Q

Difficulties relaxing grip, facial weakness family Hx?

A

Myotpnic dystrophy type 1
AD

198
Q

Indian with Palpable nodule on skin -> seizure = ?
What is bug causing ?

A

Cysticercosis

Tape worm (Taenia Solium)

199
Q

GBS poor prognosis
Age
speed of sx
Hx of
Finding in blood

A

> 40
Rapid onset / vent requirement
Hx of diarrhoeal illness(campylobacter)
High Anti-GM1 in blood

200
Q

Bar MRI what 2 Ix good for MS

A

Visual evoked potentials (or optic neuritis)

LP

201
Q

Presents as Huntington’s with Fhx but has Asterixis? What is asterixis?

A

Wilsons

Asterixis inability to maintain sustained posture with subsequent brief, shock-like, involuntary movements.

202
Q

IV or oral Mpred in MS attack?

A

Oral .5g for 5 days

IV 1g is reserved for people who need to be admitted for monitoring Eg depression, diabetes

203
Q

Which order of horners if internal carotid?
Syringomyelia?

A

3rd order (postganglionic)

1st order

204
Q

tetnus Abx

A

Penicilin or metronidazole

205
Q

Pupil non-reacctive to light and diminished reflexes globally

A

Holmes aidie

206
Q

Dysarthria and clumsiness + more forgetfulness in 30s. Family hX and has mild hepatomegaly

A

Wilsons

207
Q

Eyes
Loss of adduction with contralateral nystagmus of the other eye. =?
Damage where? If bilateral what is going on?

A

Internuclear opthalmoplegia
-Lesion in medial longitudinal fasiculusis

[Connects CN VI to contralateral CN III]

MS very likely if bbilat

208
Q

Sudden onset unilateral weakness without language disturbance or visual field defect or neglect =

A

Lacunar stroke - affecting the corticospinal tract

209
Q

Lacunar stroke if

A

Pure sensory
Pure motor
Clumsy hand syndrome

210
Q

Severe headaches confusion hypertensive retinopathy on fundoscopy =

A

Hypertensive encephalopathy
Needs iv sodium nitroprusside

211
Q

Primary cervical torticolis Rx

A

Botox

212
Q

What is a chiari type 1 malformation?
Presents with?
Type 2 presents how?

A

Elongated cerebellar tonsils are displaced into the cervical canal through the foramen magnum

-Presents with cerebellar signs (downbeat nystagmus), weakness of the upper limb and sensory issues

Type 2 presents young with features of brainstem dysfunction

213
Q

On lamotrigine and phenytoin. Seizure free 5 years. Presents during preg with seizure. Plan?

A

Slowly withdraw phenytoin and keep lamotrigine

[2 agents significantly more risk of teratogenicity]

214
Q

Amyloid neuropathy presents how

A

Polyneuropathy with Autonomic symptoms eg Postural hypotension

215
Q

Optic neuritis
MRI has >3 white matter lesions what is the chance of developing MS in 5 years?
MRI has 1 lesion, what is the chance of developing MS in 15 years?

A

50%
50%

216
Q

Most common genetic form of vascular dementia ? Cromosome

A

CADSIL
Cerebral Autosomal dominant arteriopathy with sub cortical infarcts and leukoencephalopathy

chrome 19q3 - NOTCH3 gene

217
Q

Most common genetic form of vascular dementia ? Cromosome

A

CADSIL
Cerebral Autosomal dominant arteriopathy with sub cortical infarcts and leukoencephalopathy

chrome 19q3 - NOTCH3 gene

218
Q

Proximal limb aching + headaches then altitudinal visual field loss

A

GCA
[Altitudinal visual field loss very common way to lose vision in ischemic optic neruitis]

219
Q

Differentiate weber and Wallenberg syndrome…Sx? Where is lesion? Usual vessel?

A

Both ipsilateral CN 3 palsy

Weber - Contralateral hemiparesis + hemiparkinsonism
-Midbrain, corticospinal tract and substantial nigra
-Paramedian branches of posterior cerebellar artery

Wallenberg - ipsilateral pain temp loss on face with contralateral pain temp on body
-Midbrain / brainstem
-PICA

220
Q

Syndrome with occlusive disease of internal carotids -> lots of collateral vessels. Presents with recurrent TIAs headaches or seizures? How is it described on cerebral angiogram ?

A

Moya moya
‘hazy’ or ‘puff of smoke’

221
Q

Ipsilateral CN 6 brainstem syndrome?

A

Millard-gubler
Pons

222
Q

Normal pressure hydrocephalus Rx?

A

Shunt

[Only large volume LPs if unfit for surgery]

223
Q

COCP with headache pappilodema and CN 6 palsys. CT low-density area with haemorrhagic component. What ix next?

A

MR Venography
-Likely has CVST

[CTA is not used to look for CVST apparently]

224
Q

CN originates from…

A

Cerebrum - 1 and 2

Midbrain - 3 and 4

Pons - 5,6,7 and 8

Medulla - 9, 10, 11and 12

2/2/4/4

225
Q

Unable to abduct eye and ipsilateral facial weakness - lesion where?

A

Pons

226
Q

Whoh gets statins post stroke?

A

Everyone

227
Q

Parkinsons for 2 years. On sinemet TDS and feels gets off symptoms… what next

A

Increase to QDS

228
Q

Antiepileptic with weight loss and renal stones?

A

Topiramate

229
Q

Most common side effect of lamotrigine?

A

Skin rash

[Some get steven johnsons]

230
Q

Poorly controlled diabetes
Mix of UMN/LMN signs in limbs and weakness
Loss of pinprick sensation to mid shin bilat
Dx?

A

Amyotrophic lateral sclerosis

Loss of sensation is due to complication from diabetes!

231
Q

Beckers inheritance. Where is the wekaness initially?

A

X linked
Proximal (so often develop big calves at first)

232
Q

Charcot-marie-tooth symptoms

A

Purely motor / sensory. Presents in 20s
[NO UMN]

233
Q

Weakness of quadriceps and fingers with asymmetry =? exclude polymyositis?

A

Inclusion body myositis
CK normal (helps rule out polymyositis)

234
Q

Speech aphasia issues, headache
Left hemiparesis -> deteriorate and new R side CN 3 palsy, Where is the lesion?

A

Temporal lobe with haemorrhage/oedema -> brainstem compression

[Not midbrain initially as doesn’t explain speech]

235
Q

Booze. wakes with weakness brachioradialis, wrist and finger extension =

A

‘Saturday night palsy’
radial nerve at spiral groove

236
Q

Acoustic neuromas often affect which extra nerve? Sx?

A

Trigeminal sensory ranch - loss of corneal reflex first sign

237
Q

When vit k in coagulopathy

A

If INR >2

238
Q

R limb weakness with L CN 6 and facial weakness. Lesion where?

A

Left Pons

239
Q

Pins and needles start in foot and run up body to arm . Happens often

A

Focal aware seizure
[new name for parital seizures]

240
Q

GQ1B antibodies in

A

MIller fisher syndrome

241
Q

Right-sided upper limb with fasciculations and wasting. Conduction block on EMG = Antibodies common?

A

Multifocal motor neuropathy
[Conduction block on EMG key to Dx]

Anti GM-1

242
Q

Presents as encephalitis. Inflam markers normal. Lesions in both temporal lobes =?

A

HSV encephalitis
[Often has normal inflam markers]

243
Q

BPPV which for Dx which for Rx?

A

Dix-hallpike
Epley

244
Q

60s presents with difficulty naming things or recognising faces?

Unable to verbalise things normally - - main issue is phone conversations?

Where are the lesions in these conditions

A

Semantic dementia
-Temporal lobe

Progressive non-fluent aphasia
-Left perisylvian region

[types of FTD]

245
Q

Given Abx for sinusitis. Severe headache
CSF - Lymphocytosis, mild low glucose, mild elevated protein

A

Partially treated bacterial meningitis

Looks similar to viral

246
Q

Common peroneal sensory

A

Dorsum of foot
[basically same as motor]

247
Q

Which Abx make MG worse? cardiac?

A

Aminoglycosides and fluoroquinolones

B blockers
Procainamide

248
Q

Exposure to nitrous oxide leads to what neurological manifestation? Who is at risk?

A

Sensory and weakness
presents similar to B12 deficiency and people who have b12 deficiency much more at risk

[due oto methionine synthesis ]

249
Q

Long-term use of antiepileptic which leads to lymphadenopathy and Dupuytren’s contracture ?

A

Phenytoin

250
Q

How to prevent neuropathy with isoniazid prescription

A

Pyridoxine

251
Q

First line primary generalised epilepsy in men

A

Valproate
Lamotrigine

252
Q

Alternating nystagmus - where is lesion

A

Cerebellum

253
Q

Nystagmus in pons lesion

A

Upbeat

254
Q

Facial weakness and sensation issues + tinnitus. Where is lesion

A

Cerebellopontine angle
V, VII, VIII all close together here

255
Q

Medical fasciculus lesion. Right or left if left eye fails to adduct

A

Left

256
Q

What do you need to check before giving Igs in rx of gillian barre? Why?

A

IgA levels
Risk of anaphylaxis when giving Ig to IgA deficiency

257
Q

Child, ataxia and UMN signs

A

Friedrich’s ataxia

CMT - no UMN

258
Q

Ocular MG Rx initial

A

Pyridostigmine 30mg QQDS

MRCP PART 1 (22 decks)

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