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Phase 3a > Neuro > Flashcards

Neuro Flashcards

1
Q

Which type of muscle fibre is rich in myoglobulin

A

Type I

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2
Q

What does myoglobulin do

A

supplies oxygen to your muscles

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3
Q

What are the main symptoms of myopathy

A

Proximal weakness
Hypotonia
Wasting (or fatty infiltration)
BUT reflexes are preserved

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4
Q

What would be raised on blood tests in myopathy

A

Creatine phosphokinase

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5
Q

What is a myopathic unit on a EMG?

A

Small, short-duration, spiky polyphasic units

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6
Q

What is the inheritance pattern of myotonic dystrophy type I

A

Autosomal dominant

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7
Q

What is the type of mutation in myotonic dystrophy type I

A

Expanded trinucleotide repeat (CTG)
Within the myotonic protein kinase gene on chromosome 19

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8
Q

Symptoms of myotonic dystrophy

A

Progressive muscle weakness, particularly in upper limbs
Myotonia
Many other symptoms (cataracts, frontal balding, dysarthria and dysphagia..)
Fatigue

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9
Q

Is myotonic dystrophy inheritance worse through females or males

A

Females, with anticipation.

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10
Q

What are the characteristics of metabolic myopathies

A

Exercise intolerance/pain/fatigue
Sometimes have periodic paralyses with high or low potassium

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11
Q

What is the inheritance pattern of periodic paralysis channelopathies

A

Autosomal dominant

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12
Q

What is the most common age range for inflammatory myopathies?

A

Middle age, classically:
Polymyositis and dermatomyositis (30/40 yr old woman)
Inclusion body myositis: over 50s male

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13
Q

What is the management for polymyositis and dermatomyositis

A

Corticosteroids +/- immunosuppression and removal of tumour if present

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14
Q

What is the treatment for inclusion body myositis

A

Supportive management (no treatment)

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15
Q

What is the definitive investigation for muscle disease

A

Muscle biopsy (determines fibre type, inflammation, dystrophic and histochemical changes)

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16
Q

What is the classical gait in Duchenne

A

Waddling gait

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17
Q

Where does pseudo-hypertrophy happen in Duchenne’s

A

Calves

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18
Q

What is a common cause of death in Becker’s muscular dystrophy

A

Cardiac arrhythmias

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19
Q

Characteristics of myopathies due to thyrotoxicosis

A

Shoulders mainly
Brisk reflexes
+/- fasciculations and atrophy

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20
Q

What drugs can cause myopathy

A

Steroids
Satins
Potassium-losing drugs
(also: chloroquine, amiodarone, doxorubicin, Zidovudine)

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21
Q

What type of virus is polio virus

A

Enterovirus

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22
Q

What percentage of patients with poliomyelitis have paralysis

A

0.1%

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23
Q

Symptoms of poliomyelitis

A

Abortive: self limiting GI and resp symptoms
Non-abortive: features of abortive with meningism. Complete recovery
Paralytic: abortive symptoms -> non-abortive -> myalgia and asymmetrical paralysis. Sometimes resp failure but usually lower limbs in children. Can cause bulbar involvement.

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24
Q

How is poliomyelitis distinguished from GBS

A

Polio doesn’t have sensory symptoms and has asymmetry

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25
Q

CSF findings in poliomyelitis

A

Same as viral meningitis
Raised protein
Increased no. lymphocytes
Normal glucose
Increased numbers of polymorphs initially

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26
Q

Prognosis for polio

A

If there is good resp support, often low mortality and good improvement in muscle power. In affected limbs in children, bone growth is retarded, resulting in a wasted, shortened limb

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27
Q

Which type of neurofibromatosis has peripheral predominance

A

Type I

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28
Q

Characteristics of neurofibromatosis type 1

A

Neurofibromas along peripheral nerves
Café-au-lait spots (>5 or >1.5cm)
Cutaneous fibromas
Scoliosis
Endocrine abnormalities
Neural tumours

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29
Q

Characteristics of neurofibromatosis type 2

A

Vestibular schwannomas (previously called acoustic neuromas)
Other intracranial and intraspinal tumours

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30
Q

Wernicke-Korsakoff syndrome has a deficiency of which vitamin

A

B1 (thiamine)

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31
Q

What are the two phases of Wernicke-Korsakoff’s

A

Acute phase: Wernicke’s encephalopathy
Chronic phase: Korsakoff’s psychosis

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32
Q

Triad symptoms of Wernicke’s encephalopathy

A

Ocular signs
Ataxia
Confusion
(e.g. nystagmus, broad-based gait, amnesia)

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33
Q

What symptom is classical of Korsakoff’s psychosis

A

Confabulation
(poor short-term memory so makes it up)

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34
Q

What are the symptoms of Horner’s syndrome

A

Unilateral Miosis (constricted pupil)
Partial ptosis
Ipsilateral anhidrosis

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35
Q

Causes of Horner’s syndrome

A

Lesion at any level of the sympathetic pathway (e.g. tumour, stroke, disease, aneurysm, dissection)

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36
Q

What is an acute painful Horner syndrome until proven otherwise?

A

Dissection of the ipsilateral internal carotid artery

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37
Q

What does Normal Pressure Hydrocephalus cause

A

Reversible dementia
Triad: Urinary incontinence, dementia and gait abnormalities
Can look like Parkinson’s but doesn’t respond to L-Dopa
Over several months

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38
Q

What is the management for Normal Pressure Hydrocephalus

A

Ventricle-peritoneal Shunt

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39
Q

What causes Normal Pressure Hydrocephalus

A

Impaired CSF reabsorption
Triggered by a head injury or bleed.

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40
Q

Symptoms of acute hydrocephalus

A

Nausea
Vomiting
Diplopia
Fluctuating conscious level
Papilloedema
Ataxia of gait

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41
Q

Symptoms of headache of raised ICP

A

Headache aggravated by: bending, coughing, straining, in the morning. Getting worse and worse
With:
Vomiting
Visual obscurations
Progressive focal neuro signs
Papilloedema

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42
Q

What is tonsillar herniation

A

When a space-occupying lesion causes the cerebellar tonics to herniate through the foramen magnum causing brainstem compression and death - ‘coning’

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43
Q

What are the three subtypes of cerebral palsy

A

Spastic (90%)
Dyskinetic
Ataxic

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44
Q

What percentage of cerebral palsy is due to hypoxic-ischaemic encephalopathy

A

10%

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45
Q

How does cerebral palsy present in infancy

A

Abnormal tone and posture
Delayed motor milestones
Feeding difficulties

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46
Q

What are the symptoms of anterior spinal artery syndrome

A

Segmental pain
Urinary retention
Flaccid -> spastic paraparesis (corticospinal)
Loss of pain and temperature sensation below lesion (spinothalamic)
areflexia -> hyperreflexia

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47
Q

What are the three sections of the GCS

A

Eye opening
Verbal responses
Motor responses

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48
Q

GCS: eye opening scale

A

1-4 AVPU

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49
Q

GCS: verbal response scale

A

1- None
2 - Incomprehensible sounds
3 - Inappropriate words
4 - Disorientated speech
5 - Orientated speech

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50
Q

GCS: motor response scale

A

1- None
2 - Extensor response to pain (Decerebrate response)
3 - Flexor response to pain (Decorticate response)
4 - Flexion/withdrawal to pain
5 - Localisation of painful stimulus
6 - Obeys commands

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51
Q

What is ADEM

A

Acute disseminated encephalomyelitis
Demyelination within the CNS
Presents following a viral infection or vaccination
Can cause encephalitis

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52
Q

What are the three places that oculomotor disorders can arise from

A

Supranuclear (cerebral hemispheres)
Internuclear (brainstem)
Infranuclear (nerves supplying muscles of the eye)

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53
Q

What are the features of Creutzfeldt-Jakob disease

A

Memory problems
Behavioural changes
Poor coordination
Visual disturbances
(rapidly progressing dementia +/- myoclonus = always assume prion disease until proven otherwise)

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54
Q

What is the classical CT appearance for cerebral abscess

A

Ring enhancing lesion
Central area of low density
Surrounding area of oedema

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55
Q

Which is the first line treatment for absence seizures?

A

Sodium valproate

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56
Q

What is the first line treatment for focal seizures?

A

Carbemazepine

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57
Q

What is first line treatment for Bell’s palsy?

A

Prednisolone

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58
Q

What is the first line treatment for Guillain Barré syndrome?

A

IVIG

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59
Q

What is first line treatment for Ramsey-Hunt syndrome?

A

Prednisolone and acyclovir

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60
Q

What is Ramsey-Hunt syndrome?

A

Shingles in the facial nerve

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61
Q

In what order does diabetic polyneuropathy happen? (the different sensory modalities)

A

First numbness and tingling
Then proprioceptive balance issues
Then motor function

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62
Q

What can Vit B12 deficiency cause?

A

Peripheral neuropathy
Subacute combined degeneration of the cord
Optic neuropathy
Dementia/encephalopathy

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63
Q

What can unusually cause Horner’s syndrome?

A

T1 nerve root involvement

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64
Q

What is a Pancoast tumour

A

Squamous cell lung carcinoma at the apex of the lung - often causes brachial neuropathy

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65
Q

How would you treat fatigue as a symptom of MS?

A

Modafinil or Amantadine

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66
Q

How could you treat tremor in MS?

A

Clonazepam

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67
Q

How could treat pain symptoms in MS?

A

Amitryptiline

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68
Q

How could you treat spasticity in MS?

A

Baclofen

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69
Q

What is Meralgia Paraesthetica

A

Compression of the lateral cutaneous nerve of the thigh under the inguinal ligament

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70
Q

What are the symptoms of Meralgia Paraesthetica

A

Shooting pains on the outside thigh
Numbness and painful tingling over area, highly sensitive to light touch and heat

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71
Q

What is Lhermitte phenomenon in MS?

A

Shooting pains along the limbs following flexion of the neck

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72
Q

What does the segmental medullary artery supply?

A

Branches of the cervical parts of the vertebral arteries. Supply the surface and the inside of the spinal canal at each segmental level

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73
Q

How many anterior and posterior spinal arteries?

A

One anterior, one posterior

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74
Q

What is Jacksonian march?

A

Twitching starts in the limb then ascends to trunk and then to arm (part of epilepsy)

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75
Q

What does spinal MND look like?

A

Mixed picture with UMN and LMN signs

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76
Q

What does primary lateral sclerosis MND look like?

A

Mostly UMN signs

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77
Q

What does progressive muscular atrophy MND look like?

A

Mostly LMN signs

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78
Q

In any major bleed with Warfarin, what do you give for management

A

Stop warfarin
Vitamin K 5mg IV
Prothrombin Complex concentrate

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79
Q

What are the classic findings on an MRI head and spine for MS?

A

Juxtacortical and paraventricular lesions as well as spinal cord lesions

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80
Q

What is autonomic neuropathy a common complication of?

A

Poorly controlled diabetes
Symptoms e.g. gastroparesis, postural hypotension

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81
Q

What is Charcot Marie Tooth?

A

Hereditary motor and sensory peripheral neuropathy

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82
Q

What is the most common genetic mutation Charcot Marie Tooth?

A

Mutation in the peripheral myelin protein 22 (PMP22) gene

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83
Q

What is the different between Charcot Marie Tooth Type 1 and Type 2?

A

Type 1 is demyelinating (PMP22)
Type 2 is axonal

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84
Q

What are the key clinical features of Charcot Marie Tooth?

A

Thickening and enlargement of the nerves themselves
Symmetrical distal muscular atrophy (champagne bottle legs, claw hands)
Pes cavus (arched feet)

85
Q

How is Charcot Marie Tooth diagnosed?

A

Nerve conduction studies
Genetic testing

Patients with type one have reduced conduction velocity whereas this is normal in type 2

86
Q

What is the medial longitudinal fasciculus?

A

A brainstem structure connecting the 3rd and 6th cranial nerve nuclei on opposite sides of the brainstem to coordinate horizontal conjugate gaze (abduction of one eye with the adduction of the other)

87
Q

With internuclear ophthalmoplegia, is the lesion ipsilateral or contralateral to the eye that can’t adduct?

A

Ipsilateral

88
Q

How do you diagnose Creutzfeldt-Jakob disease?

A

Tonsil biopsy (used to be brain biopsy but now know that there are extra neural sites - tonsils and olfactory mucosa)

89
Q

How does Cretuzfeldt-Jakob disease present?

A

Rapidly progressive dementia, psychiatric impairment, myoclonus

90
Q

What does an EEG show in Creutzfeldt-Jakob disease?

A

Periodic sharp-wave complexes

91
Q

What is the difference between sporadic and variant Creutzfelt Jakob disease on MRI?

A

Sporadic - high signals in the posterior thalamus
Variant - high intensity in the caudate and putamen (basal ganglia)

92
Q

What is Mannitol?

A

Osmotic diuretic used to reduce intracranial pressure

93
Q

What is Acetazolamide used for?

A

Treats idiopathic intracranial hypertension

94
Q

What are the four Parkinson-plus syndromes?

A

Progressive supra nuclear palsy
Multiple system atrophy
Cortico-basal degeneration
Lewy body dementia

95
Q

How does progressive supranuclear palsy present?

A

Parkinsonism and vertical gaze palsy

96
Q

How does multiple system atrophy present?

A

Parkinsonism and early autonomic features: postural hypotension, incontinence, impotence

97
Q

How does cortico-basal degeneration present?

A

Parkinsonism and spontaneous activity involving the affected limb or akinetic rigidity of that limb

98
Q

How does Lewy body dementia present?

A

Parkinsonism and fluctuations in cognitive impairment and visual hallucinations, often before Parkinsonian features develop

99
Q

What are the five main ways that MS presents?

A
  • Sensory disease (patchy paraesthesia)
  • Optic neuritis (loss of central vision and painful eye movements)
  • Internuclear ophthalmoplegia (a lesion in the medial longitudinal fasciculus of the brainstem)
  • Subacute cerebellar ataxia
  • Spastic paraparesis (transverse myelitis, including Lhermitte’s sign).
100
Q

What are oligoclonal bands in the CSF indicative of?

A

Autoimmune processes in the CSF
MS
Lyme disease
SLE
Neurosarcoid

101
Q

What are the initial symptoms of Lyme disease?

A

Fever, rigours, migratory polyarthritis , myalgia,
Characteristic erythema migraines rash with central clearing

102
Q

What are later complications of Lyme disease?

A

Large joint monoarthritis
Unilateral or bilateral facial nerve palsy
Neuropathic pain
Palpitations

103
Q

Which drugs can worsen the symptoms of myasthenia gravis?

A

Beta blockers
several antibiotics and antimalarials
Lithium and other drugs used in psychiatry

104
Q

How do you clinically distinguish encephalitis from meningitis

A

Encephalitis has altered mental state whereas meningitis does not

105
Q

What is Miller-Fisher syndrome?

A

Similar to GBS (follows a viral infection) but starts in the eyes not peripherally

106
Q

What is the triad in Miller-Fisher syndrome?

A

Ataxia, areflexia and ophthalmoplegia

107
Q

Interferon beta is used to treat what condition?

A

Relapsing and remitting MS

108
Q

Myasthenia gravis is associated with what condition in the chest?

A

Thymoma

109
Q

How is diazepam administered?

A

Rectally

110
Q

How is midazolam administered?

A

Buccally

111
Q

How is lorazepam administered?

A

IV

112
Q

In the case of a suspected subarachnoid haemorrhage but a negative cT, what is the next best investigation to do?

A

Lumbar puncture (as long as there is no raised ICP)
This is performed 12 hrs after the onset of the headache to look for xanthochromia

113
Q

Why can Isoniazid (TB treatment) cause polyneuropathy?

A

Isoniazid causes B6 deficiency which can cause polyneuropathy

114
Q

When is a stroke classified as a TACI (total anterior cerebral infarct) - Bamford/Oxford classification

A

Contralateral hemiparesis or hemiplegia AND
Contralateral homonymous hemianopia AND
Higher cerebral dysfunction

115
Q

When is a stroke classified as a lacunar infarct? LACI

A

Pure motor stroke, pure sensory stroke, sensorimotor stroke, or ataxic hemiparesis

116
Q

When is a stroke classified as a PACI?

A

2 of the following, or higher cerebral dysfunction alone:
- Contralateral hemiparesis or hemiplegia AND
Contralateral homonymous hemianopia AND
Higher cerebral dysfunction

117
Q

What arteries are affected in a tACI?

A

Anterior AND Middle cerebral arteries

118
Q

What artery is affected in a PACI

A

Anterior OR Middle cerebral arteries

119
Q

When is a stroke classified as a POCI

A

Cerebellar dysfunction, OR
Conjugate eye movement disorder, OR
Bilateral motor/sensory deficit, OR
Ipsilateral cranial nerve palsy with contralateral motor/sensory deficit, OR
Cortical blindness/isolated hemianopia.

120
Q

What arteries are affected in a POCI?

A

Vertebrobasilar arteries and the associated branches

121
Q

Which condition causes multiple ring enhancing lesions on MRI?

A

Toxoplasmosis

122
Q

What are periventricular ring enhancing lesions on MRI indicative of?

A

Primary cerebral lymphoma, caused by Epstein-Barr virus

123
Q

What nerve is likely to be damaged in fracture of the fibular head (e.g. in a head on collision, car into pedestrian)?

A

Common fibular nerve (common perineal nerve) - wraps round the head of the fibula
Causes foot drop because it innervates tibias anterior muscle which dorsiflexes the ankle

124
Q

Positive Trendelenbur’s test, weak abduction in the affected hip is indicative of injury to which nerve?

A

Superior gluteal nerve

125
Q

What is the path of the tibial nerve?

A

Branches off the sciatic nerve, follows the popliteal vessels, crossing to the medial side and running down to the posteriomedial side of the ankle.
Then divides into the medial and lateral plantar nerves to innervate the flexors and small muscles of the foot

126
Q

How would obturator nerve injury present?

A

Medial thigh or groin pain
Weakness with leg adduction
Sensory loss in the medial thigh of the affected side

127
Q

Are extradural haemotoma source of bleeding arterial or venous?

A

Middle meningeal artery

128
Q

Are subdural haemotoma source of bleeding arterial or venous?

A

Venous

129
Q

Acute cord compression in the setting of anticoagulation and possible iatrogenic dural puncture (ie.e epidural) is suspicious of what?

A

Epidural haemotoma

130
Q

After a one-off seizure (first seizure), how long can you not drive for?

A

6 months

131
Q

What is apraxia

A

The inability to visualise movement (e.g. follow instructions on movement)

132
Q

What causes apraxia?

A

Corticobasal degeneration

133
Q

What are the symptoms of corticobasal degeneration

A

Apraxia
Parkinsonian features
Alien limb phenomenon

134
Q

What is the first line management for myaesthenia gravis

A

Pyridostigmine

135
Q

How does Pyridostigmine work?

A

Cholinesterase inhibitor

136
Q

What is first line management for a subdural haemotoma?

A

Burr hole craniotomy

137
Q

What is the commonest cause of an intracerebral haemorrhage?

A

Hypertension

138
Q

What is benign positional paroxysmal vertigo?

A

The presence of debris in the semicircular canals causing vertigo on head movement

139
Q

How do you treat BPPV (benign positional paroxysmal vertigo)?

A

Epley manoeuvres

140
Q

What can present with nocturnal headaches that occur around the same eye and are accompanied by nausea, watering of the eye, redness of the eye?

A

Acute angle glaucoma
Cluster headaches

141
Q

What is used for prophylaxis in cluster headaches?

A

Verapamil

142
Q

What is the underlying pathology in primary lateral sclerosis MND?

A

Degeneration of the Betz cells in the motor cortex

143
Q

In sternocleidomastoid neuropathology, weakness in the sternocleidomastoid leads to weakness turning the head in the same or opposite direction?

A

Opposite direction

144
Q

What is Nimodipine?

A

Calcium receptor antagonist

145
Q

What does Nimodipine do?

A

Acts in the cerebral vasculature to decrease risk of vasospasm in patients with subarachnoid haemorrhage

146
Q

Hoe does autoimmune encephalitis present in it’s earliest stage?

A

Fever, headaches, diarrhoea and upper respiratory tract infection

147
Q

What is the anti-epileptic of choice in women of reproductive age with tonic-clonic seizures?

A

Lamotrigine

148
Q

What is the management for haemorrhagic strokes?

A

Reversal of anticoagulants (beriplex/octaplex/vit K) and aggressive BP control
Systolic blood pressure should be kept <140mmHg within an hour of admission and ideally above 120mmHg. Use of GTN or labetalol for this

149
Q

How do cluster headaches normally present?

A

Short lasting, frequent, perio-orbital, sometimes with additional features such as lacrimation

150
Q

Why is recommended that women with epilepsy breastfeed after giving birth to their child?

A

So that the baby can withdraw from the medication slowly

151
Q

What is mononeuritis multiplex?

A

A type of peripheral neuropathy, where multiple separate nerves start to be affected, either at the swim time or sequentially,
Affects both sensory and motor

152
Q

What are risk factors for mono neuritis multiplex?

A

Diabetes
Vasculitis
Immune diseases
Infections
Sarcoidosis
Rarely, certain jelly fish stings

153
Q

What nerve innervates the triceps?

A

C7-8

154
Q

What can cause transient proteinuria?

A

Seizures
Strong infections
Pregnancy
Heavy exercise

155
Q

How is respiratory function monitored in GBS?

A

FVC

156
Q

What are the features of a medical third nerve palsy?

A

Double vision
Dropping of eyelid
Eye deviated inferiorly and laterally

157
Q

What is a common cause of medical third nerve palsy?

A

Diabetes

158
Q

What are the features of a surgical third nerve palsy?

A

Painful and dilated pupil

159
Q

What is Weber’s syndrome

A

Midbrain stroke

160
Q

What are the features of Weber’s syndrome?

A

Ipsilateral third nerve palsy
Contralateral hemiparesis

161
Q

What causes the triad of ‘wet, wobbly and weird’? (urinary incontinence, poor mobility, not himself)

A

Normal pressure hydrocephalus

162
Q

What would you see on CT head if someone had Normal pressuer hydrocephalus?

A

enlarged ventricles and absent sulci

163
Q

What is first line drug management for Alzheimer’s?

A

Donezapil
(Memantine is second line)

164
Q

What class of drug is Donezapil?

A

Acetylcholinesterase inhibitor

165
Q

What does GBS usually show on LP?

A

Isolated rise in protein

166
Q

What can cause intermittent dizzy spells

A

BPPV
Vestibular neuritis - this often follows and upper resp infection

167
Q

What is Cushing’s reflex?

A

When ICP rises, sometimes it activates both the sympathetic and the parasympathetic systems
Increased BP, decreased HR, irregular breathing

168
Q

What type of tremor is autosomal dominant and often increases during times of anxiety or stress?

A

Essential tremor

169
Q

What is the management of status epilepticus?

A

2 attempts at using benzodiazepines to stop
If unsuccessful - IV Phenytoin

170
Q

What can Phenytoin cause/what do you need to monitor?

A

Can cause bradycardia and hypotension - monitor ECG and BP

171
Q

What does the DDANISH or cerebellar dysfunction stand for?

A

Dysdiadochokinesia
Decomposition of movement
Ataxia
Nystagmus
Intention tremor
Scanning speech/staccato
Hypotonia

172
Q

What neurological condition can b12 deficiency cause?

A

Subacute combined degeneration of the spinal cord
Polyneuropathy, sensory ataxia,
e.g. after a terminal ileum resection for Crohns

173
Q

What is the gold standard investigation in investigating vascular abnormalities in the brain (e.g. after a subarachnoid haemorrhage)?

A

Digital subtraction catheter angiography (DSA)

174
Q

What is Klumpke’s palsy?

A

Damage to the lower brachial plexus

Small hand muscle paralysis
Ptosis
Dermatomal sensory disturbance

175
Q

What is the earliest that you can do an LP in suspected SAH?

A

12 hours (sufficient time for RBC breakdown to form xanthochromia)

176
Q

Is a contrast or non-contrast CT better for SAH?

A

Non-contrast

177
Q

What is the management of idiopathic intracranial haemorrhage?

A

Weight loss and close monitoring

178
Q

What is second line management of idiopathic intracranial haemorrhage?

A

Acetazolamide

179
Q

What is hepatitis C related cryoglobulinaemia?

A

Cryoglbulinaemia are proteins that become insoluble at reduced temperatures. This causes a vasculitic syndrome including neuropathy.

180
Q

What is mononeuritis multiplex?

A

Sub-acute painful multifocal neuropathy

181
Q

What does vasculitic neuropathy look like?

A

Mononeuritis multiplex and systemic inflammation

182
Q

Generalised tonic-clonic seizure after head trauma with rapid recovery and no post-ictal confusion is consistent with what?

A

Reflex anoxic seizure - caused by overactivity of the vagus nerve, causing vasodilation and collapse froma temporary reduction in cerebral perfusion

183
Q

What does a hyper-intense lesion indicate in a stroke?

A

Haemorrhage not infarct

184
Q

What is an important side effect of Ropinirole (used in Parkinson’s) that you need to monitor for?

A

Impulsivity - pathological gambling, hypersexuality

185
Q

How does Friedrich’s ataxia present?

A

Frequent falls and lower limb weakness and gait abnormalities
Signs on examination: cerebellar and mixed UMN and LMN signs
Involvement of the dorsal columns can lead to impaired proprioception and vibration sense
Other clues: high-arched palate, pes cavus, kyphoscoliosis
Non motor features: hypertrophic obstructive cardiomyopathy, reduced visual acuity, T1DM, deafness

186
Q

What neuropsychological finding is most likely to suggest a right parietal lesion in a right-handed woman?

A

Visual inattention/neglect

187
Q

When should Sumatriptan be taken?

A

Once the headache starts but not during the aura phase

188
Q

When is a decompressive hemicraniectomy considered in stroke?

A

In patients less than 60 years old who have severe stroke symptoms, reduced consciousness and an infarct of at least 50% of the MCA territory

189
Q

What is subacute combined degeneration of the cord caused by?

A

B12 deficiency

190
Q

What does pyridoxine (B6) deficiency cause?

A

Sensory neuropathy - can be induced by Isoniazid s it is now always co-prescribed with Pyridoxine

191
Q

What are the classic signs of internuclear opthalmoplegia?

A

Failure to adduct on the affected side and nystagmus on the contralateral side

192
Q

What is the first-line treatment for trigeminal neuralgia?

A

Carbemazepine

193
Q

What is the first line treatment for an acute cluster headache?

A

Nasal triptan

194
Q

What is the CSF profile in GBS?

A

Raised protein with a normal white cell count

195
Q

What are the features of Wilson disease?

A

Cerebellar signs, tremor and rhythm abnormalities in a young patient

196
Q

What is the inheritance pattern in Wilsons disease?

A

Autosomal recessive

197
Q

Thrombectomys are best for thrombus where?

A

Proximal middle cerebral artery or internal carotid artery

198
Q

Which opiate can cause seizures?

A

Tramadol (lowers seizue threshold). Can also cause delirium and impotence

199
Q

What is the clinical picture of cervical spondylosis?

A

UMN signs in lower limbs
LMN in upper limbs
Pain on neck flexion (Lhermitte’s sign)

200
Q

A frontal mass on CT that crosses the midline in a teenager is most likely to be what type of tumour?

A

Grade 4 astrocytoma, known as glioblastoma multiforme

201
Q

What type of ataxia does a positive Romberg’s sign indicate?

A

Sensory ataxia rather than cerebellar ataxia

202
Q

How does Brown Sequard Syndrome present?

A

Ipsilateral paralysis, loss of vibration and position sense and hyperreflexia below the level of the lesion
Contralateral loss of pain and temperature sensation usually beginning about two to three segments below the level of the lesion

203
Q

What would you see on a CT in someone who had a cerebral abscess?

A

Ring enhancing lesion

204
Q

Why do you get homonymous hemianopsia wiht macular sparing when there is a bleed on just one side of the brain?

A

Because the macular is supplied by both sides of the brain

205
Q

What is the first line treatment for Wilson’s disease?

A

Penicillamine

206
Q

What are the potential risks of using Penicillamine?

A

Drug induced lupus
Drug induced myaesthenia gravis

207
Q

What is diabetic amyotrophy?

A

Asymmetric muscle wasting often seen in the thighs

208
Q

What does a ‘Lentiform-shaped heterogenous hyper-dense extra-axial collection adjacent to the left squamous temporal bone’ suggest?

A

Extra-dural haemmorrhage

209
Q

Why is hyperventilation an important part of the management of a raised ICP?

A

To keep the CO2 levels within normal limits
High carbon dioxide levels cause the cerebral vessel to dilate, increasing the blood flow to the brain and increasing the ICP further

Phase 3a (12 decks)

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