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Phase 3A > Neuro > Flashcards

Neuro Flashcards

1
Q

What are the characteristics of Progressive Supranuclear Palsy?

A
  • Backward falls
  • Slow vertical saccades (hummingbird sign on MRI)
  • impairment of vertical gaze
  • parkinsonism
  • frontal lobe dysfunction
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2
Q

Which spinal columns are affected in B12 deficiency?

A
  • Dorsal column (vibration and proprioception)
  • Lateral corticospinal tracts (fine movements of limbs)
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3
Q

CSF analysis for viral encephalitis?

A

Raised protein, lymphocytes
Normal glucose

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4
Q

What is Brown-Sequard syndrome?

A

A syndrome with a lesion affecting one half of the spinal cord, often after trauma

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5
Q

What neurological signs are found with B-S syndrome?

A
  • Contralateral loss of pain and temperature
  • Ipsilateral loss of sensation to light touch, vibration and proprioception
  • Ipsilateral UMN pattern weakness below the lesion
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6
Q

First line treatment for trigeminal neuralgia?

A

Carbamazepine

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7
Q

How do you tell the difference between Partial and Complete Androgen Insensitivity?

A

Partial would have ambiguous genitalia

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8
Q

TACS stroke signs?

A
  • Unilateral weakness
  • Homonymous Hemianopia
  • Cerebral dysfunction
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9
Q

PACS stroke signs?

A

2 of the following:
- Unilateral weakness
- Homonymous Hemianopia
- Cerebral dysfunction

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10
Q

Posterior circulation stroke signs? (POCS)

A
  • Cerebellar syndrome
  • Loss of consciousness
  • Isolated homonymous hemianopia
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11
Q

Lacunar stroke signs? (LACS)

A
  • Unilateral weakness
  • Sensory stroke
  • Ataxic
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12
Q

What is an important side effect of sodium valproate?

A

Hepatotoxicity

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13
Q

What is cafe au lait spots associated with?

A

Neurofibromatosis Type 1

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14
Q

What anti-emetic should be given to someone with Parkinsons?

A

Domperidone

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15
Q

What is Ménière’s disease?

A
  • Vertigo
  • Tinnitus
  • Hearing loss
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16
Q

What is the treatment for spasticity in MS?

A

Balcofen / Gabapentin

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17
Q

If a patient presents with TIA symptoms in the last 7 days when should they see a specialist?

A

Within 24 hours

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18
Q

Why can Parkinsons cause postural hypotension?

A

Due to autonomic dysfunction

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19
Q

What is the most common hereditary peripheral neuropathy?

A

Charcot-Marie Tooth syndrome

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20
Q

What is syringomelia?

A

Cape-like loss of temperature and pain sensation due to compression of spinothalamic tract fibres

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21
Q

What drugs are common precipitants of myasthenia crises?

A

Beta-blockers

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22
Q

How does a focal-aware seizures commonly present?

A

Sudden changes in the senses whilst the patient remains fully conscious

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23
Q

What are the features of Conduction dysphasia?

A
  • Fluent Speech
  • Poor reptition
  • Comprehension is intact
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24
Q

What is the preferred way to support nutrition in patients with MND?

A

PEG

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24
Q

What is the preferred way to support nutrition in patients with MND?

A

PEG

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25
Q

When should a carotid endardectomy be done?

A

Patient who has had a TIA with carotid artery stenosis over 70%

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26
Q

What does progressive perisperhal neuropathy with hyporeflexia suggests?

A

Guillan-Barre

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27
Q

What does hypsarrythmia on EEG suggest?

A

Infantile spasms

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28
Q

What is the inheritance of essential tremor?

A

AD

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29
Q

Treatment for essential tremor?

A

Propranolol

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30
Q

What is Weber’s syndrome?

A

A midbrain stroke with occlusion of the posterior cerebral artery

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31
Q

How does Weber’s syndrome present?

A

Ipsilateral cranial nerve 3 palsy and contralateral weakness

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32
Q

What is the first line management of a patient with raised ICP?

A

Elevating the head of the bed to 30 degrees

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33
Q

Treatment for Bells palsy

A

Prednisolone

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34
Q

What type of seizure do Lip smacking + post-ictal dysphasia associate with?

A

Temporal lobe

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35
Q

What do Sudden onset headache, visual field defects + evidence of pitutary insufficiency suggest?

A

Pituitary apoplexy

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36
Q

What are mid-shaft humeral fractures associated with?

A

Radial nerve injury

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37
Q

Which type of haematoma presents several weeks after the initial head injury?

A

Subdural

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38
Q

What type of epilpepsy are clonic movements that travel proximally assoicated with?

A

Frontal-lobe

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39
Q

What should you rule out in patients having acute recurrent seizures?

A

Hypoxia and Hypoglycaemia

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40
Q

What is the second line management for Bells palsy when steroids have not improved symptoms?

A

Urgent referral to ENT

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41
Q

What is C/I in patients with CAD and cluster headaches?

A

Triptans due to risk of coronary vasospasm

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42
Q

What cranial nerve palsy causes defective eye abduction and horizontal diplopia?

A

CN 6

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43
Q

What is used for long-term prophylaxis of cluster headaches

A

Verapamil

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44
Q

What is used to treat cerebral oedema in patients with brain tumours?

A

Dexamethasone

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45
Q

What type of dementia is associated with MND?

A

Fronto-temporal

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46
Q

What does Hoovers sign = distinguish between?

A

Organic and non-organic lower leg weakness

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47
Q

What does Barthel index measure?

A

disability or dependence in activities of daily living in stroke patients

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47
Q

What does Barthel index measure?

A

disability or dependence in activities of daily living in stroke patients

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48
Q

What does Urinary incontinence + gait abnormality + dementia suggests?

A

Normal pressure hydrocephalus

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49
Q

Which artery is affected in amaurosis fugax?

A

retinal/opthalmic/internal carotid artery

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50
Q

What would occlusion of the basilar artery present with?

A

Locked in syndrome

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51
Q

Treatment for status epillepticus in prehospital setting?

A

PR diazepam or buccal midazolam

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52
Q

If both upper and lower part of the face are affected, what does this suggest?

A

LMN pathology (think Bell’s palsy)

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53
Q

What is the management of Bells palsy?

A

Oral corticosteroids within 72 hours

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54
Q

What does a postural headache within normal imaging suggests?

A

Idiopathic intracranial HTN

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55
Q

Motor GCS section?

A
  1. Obeys commands
  2. Localises to pain
  3. Withdraws from pain
  4. Abnormal flexion to pain (decorticate posture)
  5. Extending to pain
  6. None
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56
Q

Verbal GCS section?

A
  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None
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57
Q

Eye opening GCS section?

A
  1. Spontaneous
  2. To speech
  3. To pain
  4. None
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58
Q

What should a GCS below 8 indicate?

A

Review by anaesthetist with possible intubation/ventilation

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59
Q

What does loss of visual fields in the superior aspect indicate?

A

Lesions of optic radiations in the temporal lobe

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60
Q

What does loss of visual fields in the inferior aspect indicate?

A

Lesions of optic radiations in the parietal lobe?

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61
Q

What is carbamazepine used for in epilepsy?

A

Focal epilepsy - not GTC as it may exacerbate these

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62
Q

Seizure medications in men

A

Generalised: sodium valproate
Focal: lamotrigine/leviteracetam

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63
Q

What are unilateral tinnitus, vertigo and deafness associated with?

A

Acoustic neuroma

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64
Q

What is labyrinthitis?

A

Inflammation of the inner ear, that usually occurs following a viral infection and results in vertigo and hearing loss.

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65
Q

Treatment for Wernickes encephalopathy?

A

Pabrinex (IV Vit B/C)

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66
Q

Triad of Wernicke’s encephalopathy?

A
  • Nystagmus
  • Opthalmoplegia (double vision)
  • Ataxia
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67
Q

What is Ramsay Hunt syndrome?

A

LMN lesion caused by reactivation of the varicella zoster virus in the facial nerve

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68
Q

What is multiple system atrophy?

A

Parkinsonism plus autonomic features (erectile dysfunction, postural hypotension, atonic bladder)

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69
Q

What type of inheritance is Charcot-Marie-Tooth?

A

Autosomal dominant

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70
Q

What is first line for absence seizures in child/adolescents?

A

Ethosuximide

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71
Q

What is prophylaxis for migraines/

A

Topiramate/Propranolol

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72
Q

What does loss of corneal reflex indicate?

A

Acoustic neuroma

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73
Q

What is one of the first signs of brain metastases?

A

CN6 palsy presenting as diplopia

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74
Q

What do asymmetrical symptoms indicate in Parkinsons?

A

Idiopathic cause

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75
Q

What is autonomic dysreflexia?

A

A condition characterised by high blood pressure in the context of a spinal cord injury, usually above the level of T6

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76
Q

Treatment of autonomic dysreflexia?

A

Removal of stimulus and treatment of any life-threatening HTN/bradycardia

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77
Q

What is a wide-based gait with loss of heel to toe walking

A

Ataxic gait

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78
Q

When might someone have a high stepping gait?

A

Foot drop

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79
Q

Common cause of brain abscess?

A

Ascending infection from ear or frontal sinuses

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80
Q

Features of brain abscess?

A

Headache, fever and focal neurology

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81
Q

Treatment of idiopathic intracranial HTN?

A

Acetazolamide - a carbonic anhydrase inhibitor

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82
Q

What blood test helps to differentiate between seizures and pseduoseizures?

A

Prolactin - elevated in true seizures

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83
Q

Investigation of choice for acoustic neuroma?

A

MRI of the cerebellopontine angle

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84
Q

What is the mechanism of hyperventilation to help reduce ICP?

A

Reduce blood CO2 to induce cerebral vasoconstriction

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85
Q

Seizures vs Syncope?

A

Syncopal episodes are associated with a rapid recovery and short post-ictal period

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86
Q

What would damage to the radial nerve present as?

A

Inability to extend the wrist

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87
Q

What would damage to the ulnar nerve present as?

A

Weakness of the ring and the little fingers

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88
Q

Which column conveys fine touch, proprioception and vibration?

A

Dorsal

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89
Q

What are axillary freckles indicative of?

A

Neurofibromatosis Type 1

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90
Q

What is the MRI finding of normal pressure hydrocephalus?

A

Ventriculomegaly without/in proportion to sulcal enlargement

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91
Q

What is lethargy a very common early symptom of?

A

MS

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92
Q

First line for spasticity in MS?

A

Baclofen and gabapentin

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93
Q

What is Webers syndrome?

A

Midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis

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94
Q

What is Charcot-Marie tooth?

A

Sensory and peripheral neuropathy with no UMN signs

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95
Q

Side effects of levodopa?

A
  • Psychosis
  • Postural HTN
  • Cardiac arrythmias
  • ‘On Off’ effect
  • drug induced dyskinesias
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96
Q

In trauma, what do you test for to confirm if fluid from nose/ear is CSF?

A

Glucose

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97
Q

First line for ocular MG?

A

Pyridostigme

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98
Q

Cause of subdural haemorrhage?

A

bridging veins between cortex and venous sinuses

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99
Q

What kind of headache commonly follows an LP?

A

Low-pressure headache

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100
Q

What does Weakened dorsiflexion, inversion and eversion of the ankle indicate?

A

L5 nerve lesion

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101
Q

What does Obese, young female with headaches / blurred vision suggest?

A

IIH

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102
Q

What would contralateral homonymous hemianopia with macular sparing and visual agnosia indicate?

A

Posterior cerebral artery - Webers

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103
Q

What medications are associated with intracranial idiopathic HTN?

A

Tetracyclines Abx, Contraceptives, Steroids, Lithium

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104
Q

What does it mean that Parkinsons drugs are critical?

A

They should not be stopped on acute admissions and should be taken on time

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105
Q

Falling to the ground and laying motionless?

A

Atonic seizure

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106
Q

What nerves does absent triceps reflex correspond to?

A

C7-C8

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107
Q

S/E of triptans?

A

Tightness of the throat and chest

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108
Q

How do you differentiate between a stroke involving the anterior inferior cerebellar artery and the posterior inferior cerebellar artery?

A

Anterior would have facial paralysis and deafness

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109
Q

What is a hyper dense collection on CT suggestive of?

A

Haemorrhage

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110
Q

What is empty delta sign on venography suggestive of?

A

Saggital sinus thrombosis

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111
Q

Which migraine medication is likely to cause EP side effects?

A

Metoclopramide

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112
Q

Mechanism of sodium valproate?

A

Inhibition of the P450 system

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113
Q

What would fracture of the shaft of the humerus cause?

A

Wrist drop

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114
Q

What should be given to patients not responding to BDZ in status epileptics?

A

Phenytoin

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115
Q

What does CT head showing temporal lobe changes suggest?

A

Herpes simplex encephalitis

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116
Q

What does diffusion-restricting lesion suggests?

A

Abscess

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117
Q

What is gait ataxia caused by?

A

cerebellar vermis lesions

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118
Q

What does reduced GCS, paralysis and bilateral pin point pupils suggest?

A

Pontine haemorrhage

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119
Q

What screening tool can be used to assess likelihood of stroke?

A

ROSIER

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120
Q

What is the treatment for restless leg syndrome?

A

Dopamine agonists e.g. ropinirole

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121
Q

Lower half of facial weakness, dry mouth, ear pain?

A

Bells

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122
Q

Treatment of brain abscess

A

3rd gen cephalosporin + metronidazole

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123
Q

What cancer is associated with myasthenia gravis?

A

Thyoma

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124
Q

What is a complication of raised ICP?

A

Herniation - loss of consciousness and diplopia

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125
Q

Which Parkinsons medication is linked to impulse control disorders (impulsivity)

A

Dopamine agonists

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126
Q

When can anti-epileptic drug be stopped?

A

Seizures free for 2 years and them stopped over 2-3 months

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127
Q

What is recommended for patients with an acute ischaemic stroke who present within 4.5 hours?

A

Thrombolysis and Thrombectomy

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128
Q

What condition is hyperacusis linked with?

A

Bells palsy

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129
Q

What reflex is a response to raised ICP?

A

Cushings - bradycardia and hypertension

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130
Q

Secondary prevention of stroke?

A
  1. Clopidogrel
  2. Aspirin + MR Dipyridamole if clopidogrel not well tolerated
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131
Q

What is paroxysmal hemicrania?

A

Severe uniltateral headache, usually in the orbital, supraorbital or temporal region in women - treated with indomethacin

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132
Q

How are drugs for neuropathic pain used?

A

Monotherapy - if one does not work, it should be switched for another

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133
Q

MND vs MG

A

MND will usually be ocular sparing

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134
Q

Extradural vs subdural?

A

Extradural is limited by the suture lines

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135
Q

Acute vs chronic haematoma?

A

Acute appears hyper dense and chronic appears hypodense

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136
Q

If falls occur soon after a Parkinsons diagnosis, what should be considered?

A

Progressive Supranuclear Palsy

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137
Q

What is the key investigation in diagnosis of Guillan Barre syndrome?

A

Lumbar Puncture

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138
Q

Side effects of carbamazepine?

A
  • Dizziness and ataxia
  • Drowsiness and Headache
  • Diplopia
  • Hyponatreaemia secondary to SIADH
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139
Q

What area of the brain is the haemorrhage in subarachnoid?

A

Between arachnoid mater and the pia mater

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140
Q

What area of the brain is the haemorrhage in subdural?

A

Between the arachnoid mater and the inner layer of the dura mater

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141
Q

What area of the brain is the haemorrhage in extradural?

A

Between the dura mater and the skull

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142
Q

Symptoms of neurosphyilis?

A

loss of proprioception and vibration sensation. No motor deficit

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143
Q

What is a C/I to triptans?

A

Ischaemic heart disease

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144
Q

What is Wernicke’s aphasia?

A
  • Fluent speech
  • Don’t make sense
  • Difficulty understanding others
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145
Q

What is Broca’s aphasia?

A
  • Laboured, non fluent speech
  • Understand what others are saying
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146
Q

What arteries are involved in TACS?

A

Anterior and Middle Cerebral Artery

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147
Q

Which CN supplies taste for anterior 2/3rds of the tongue?

A

Facial (7)

148
Q

Which CN supplies taste for posterior 1/3 of the tongue?

A

Glossopharyngeal (9)

149
Q

Presentation of Herpes Simplex Encephalitis?

A

Fever, headache, vomiting, seizures -> typically affects temporal or inferior frontal lobe

150
Q

A lesion with which CN may cause nystagmus?

A

CN8

151
Q

Which arteries are involved in posterior circulation stroke?

A

Vertebrobasilar arteries

152
Q

What is the most common hereditary ataxia?

A

Frederick’s ataxia

153
Q

How does Frederick’s ataxia present?

A
  • Loss of lower limb reflexes
  • Cerebellar ataxia
  • Optic atrophy
  • Spinocerebellar tract dysfunction
154
Q

Duchennes vs Beckers?

A

Becker onset > 10 years, Duchenne onset < 5 years

155
Q

Craniopharyngioma vs Pituitary tumour?

A

Both have bitemporal hemianopia but CP will have a lower that is worse than upper

156
Q

What syndrome is lamotrigine associated with?

A

Steven-Johnson syndrome

157
Q

Neurofibromatosis vs Tuberous Sclerosis?

A

NF - pigmented spots
TB - depigmented spots

158
Q

What chromosome is defective in neurofibromatosis T1?

A

17

159
Q

Laughter leading to fall/collapse?

A

Cataplexy

160
Q

What is associated with a congenital hydrocephalus?

A

Arnold-Chiari malformation

161
Q

Low CSF headache worse on standing and improve when lying flat associated with connective tissue disorder?

A

Spontaneous intracranial hypotension

162
Q

What is a meningioma?

A

A benign tumours that arise from the arachnoid cap cells of the meninges but are typically located next to the dura

163
Q

What is the gold standard for diagnosis venous sinus thrombosis?

A

MR Venogram

164
Q

Features of Neuroleptic Malignant Syndrome?

A
  • Fever
  • Muscle rigidity
  • Delirium with confusion
  • HTN and tachycardia
  • AKI may develop in severe cases
165
Q

What does isolated result of high protein in the CSF suggests?

A

Guillan-Barre

166
Q

Management of Bells palsy except prednisolone

A

Artificial tears and advise eye taping at night

167
Q

Presentation of subacute combined degeneration of the spinal cord?

A

Loss of proprioception and vibration sensation, muscle weakness and hyperreflexia

168
Q

What type of seizures is pulling of clothes associated with?

A

Temporal lobe seizures

169
Q

Management of symptomatic chronic subdural bleeds?

A

Burr hole evacuation

170
Q

Management of degenerative cervical myelopathy?

A

Cervical decompressive surgery

171
Q

What should be investigated in those having a stroke < 55?

A

Thrombophilia and autoimmune screening

172
Q

Subdural vs extradural on CT?

A

SD - crescent/concave shaped
ED - convex/lemon shaped

173
Q

What area of the brain is affected when there is lip smacking + post-ictal dysphasia?

A

Temporal lobe

174
Q

Location of the lesion if someone presents with Wernicke’s aphasia?

A

superior temporal gyrus

175
Q

Location of the lesion if someone presents with Broca’s aphasia?

A

inferior frontal gyrus

176
Q

Will amaurosis fugax present with atherosclerosis of ipsilateral or contralateral side?

A

Ipsilateral

177
Q

What blood abnormality can phenytoin cause?

A

Macrocytic anaemia due to altering folate mechanism

178
Q

Lambert Eaton vs MG?

A

Weakness in Lambert Eaton improves after exercise, unlike myasthenia gravis; which worsens after exercise

179
Q

What is forehead sparing UMN or LMN?

A

UMN - so forehead not affected

180
Q

What are psychiatric co-morbitidities a risk factor for?

A

Psychogenic non-epileptic seizures

181
Q

What is a common cause of 3rd nerve palsy where there is pain and dilated pupils?

A

Posterior communicating artery aneurysm

182
Q

What should be prescribed for chemo-related N+V?

A

Ondansetron

183
Q

What should be given before giving folate to a patient?

A

Vitamin B12

184
Q

What would happen if you gave folate to a patient who is deficient in B12?

A

Subacute degeneration of the spinal cord

185
Q

What is the gold standard investigation for cervical myelopathy?

A

MRI spine

186
Q

What condition is associated with subungual fibromata?

A

Tuberous Sclerosis

186
Q

What condition is associated with subungual fibromata?

A

Tuberous Sclerosis

187
Q

Where in the brain does ondansetron act?

A

Medulla oblongata

188
Q

What condition is associated with diminished response to repetitive stimulation on EMG?

A

Myasthenia Gravis

189
Q

What would ipsilateral cranial nerve findings and contralateral weakness findings suggest?

A

Brainstem

190
Q

What condition is associated with adenoma sebaceum?

A

Tuberous Sclerosis

191
Q

What are the investigations of choice for vestibular schwannomas?

A

audiogram and gadolinium-enhanced MRI head scan

192
Q

Treatment for migraines associated with menstruation?

A
  • Triptans for acute
  • Mefenamic acid/Aspirin
193
Q

What is Progressive bulbar palsy?

A

A type of MND associated with palsy of the tongue, muscles of chewing/swallowing ude to loss of function of the brainstem motor nuclei

194
Q

Typical presentation of primary lateral sclerosis (MND)

A

UMN signs only

195
Q

Typical presentation of Progressive muscular atrophy (MND)

A

LMN signs only

196
Q

UMN signs?

A
  • Spasticity, rigidity
  • Hyperreflexia
  • Normal nerve conduction
  • Hypertonia
197
Q

LMN signs?

A
  • Hypotonia
  • Hyporeflexia
  • Abnormal nerve conduction
  • Fasiculations and fibrillation
198
Q

Menieres vs Acoustic neuroma?

A

Menieres would have attacks with a duration of several hours whereas acoustic neuroma would be progressively getting worse

199
Q

What condition presents with wasting of the thenar eminence associated with sensory loss to the palmar aspect of lateral (radial) three fingers

A

Carpal tunnel

200
Q

First lines for neuropathic pain?

A

Amitriptyline, duloxetine, gabapentin or pregabalin

201
Q

What improves the tremor found in patients with Parkinsons?

A

Voluntary movement

202
Q

Which psychiatric condition is most associated with Parkinsons?

A

Depression

203
Q

Eye deviates supero-laterally -> problem with downward gaze and vertical diplopia

A

Trochlear nerve

204
Q

Eye deviates medially -> problem with lateral gaze and horizontal diplopia

A

Abducens nerve

205
Q

How are absence seizures brought on?

A

Hyperventilation

206
Q

What is the investigation of choice for narcolepsy?

A

multiple sleep latency EEG

207
Q

What can ‘down and out’ position of the right eye be suggestive of?

A

Raised ICP

208
Q

Sensation of sensation of fine touch, proprioception and vibration are conveyed in which column?

A

Dorsal column

209
Q

What does inferolateral deviation of the eye suggest?

A

CN3 palsy - down and out eye

210
Q

What are Exomphalos and diaphragmatic herniae assoicated with?

A

Malrotation

211
Q

bitemporal superior quadrantanopia

A

Pituitary adenoma

212
Q

bitemporal inferior quadrantanopia

A

Craniopharyngioma

213
Q

Inferior homonymous quadrantanopia?

A

inferior visual field defect due to lesion in superior optic radiations in the parietal lobe

214
Q

What type of seizures is Jacksonian march?

A

Focal aware

215
Q

Presentation of thoracic outlet syndrome?

A
  • Muscle wasting of the hands
  • Numbness and tingling
  • Possibly autonomic symptoms
216
Q

What is persistent foetal bradycardia an indication for?

A

Cat 1 C-section

217
Q

What will dominant hemisphere middle cerebral artery strokes cause?

A

Aphasia

218
Q

How does Steven-Johnson syndrome normally present?

A
  • Up to 2 months after starting an anti-convulsant
  • Prodromal illness which mirrors a viral resp infection
  • Red rash which starts on trunk and spreads to face/limbs
219
Q

Management of SJ syndrome?

A

Cease all medications, obtain IV access and begin fluid therapy

220
Q

Which Parkinsons medication is most likely to cause disinhibition?

A

Dopamine agonists e.g. ropinirole

221
Q

What blood test results would be in neuroleptic malignant syndrome?

A

Raised CK and raised WCC

222
Q

What condition is associated with adduction of the ipsilateral eye, the contralateral eye abducts, however with nystagmus.

A

Internuclear ophthalmoplegia

223
Q

What condition is assoicated with roughened patches of skin over lumbar spine?

A

Tuberous Sclerois

224
Q

What does alcohol often help improve?

A

Benign Essential Tremor

225
Q

What are the first line treatments for essential tremor?

A

Propranolol / Primidone

226
Q

What should be normal in a patient with a benign essential tremor?

A

DAT scan

227
Q

What is an appropriate first line investigation for benign essential tremor?

A

Bedside FVC assessment

228
Q

Signs of tuberculous meningitis?

A
  • High CSF Pressure
  • High protein
  • Very low glucose
  • Significantly elevated CSF count
  • High temperature
229
Q

Malignant meningitis vs TB meningitis?

A

TB meningitis will generally have a raised temperature

230
Q

What is the most common recessive ataxia in the UK? f

A

Freiderich

231
Q

What area of the brain is degenerated in Freiderich ataxia?

A

Dorsal root ganglion

232
Q

Impairment of tandem walk in seen indicates what disease?

A

Cerebellar

233
Q

Papillitis vs Papilloedema of raised ICP?

A

Papillitis presents with pain on eye movement and will have visual loss

234
Q

What is myelopathy a disease of?

A

Spinal cord

235
Q

How to differentiate between a fixed dilated pupil caused by a squeeze on the parasympathetic fibres of the third nerve and a blind eye?

A

Testing for indirect pupillary reflex -

236
Q

What is the typical pattern of weakness associated with myelopathy?

A

Proximal, symmetrical

237
Q

Commonest causes of generalised axonal neuropathy in the UK?

A

Diabetes and Alcohol

238
Q

Fasciculation potentials and normal motor unit potentials are assoicated with what condition?

A

Benign cramp fasciculation potentials

239
Q

Proximal muscle weakness and muscle pain is characteristic of which condition?

A

Polymyositis

240
Q

Hand paraesthesia that wakes the patient at night suggetss what condition?

A

Carpal tunnel

241
Q

What is the imaging of choice for someone who has had a TIA with no risk of bleeding?

A

MRI brain with diffusion-weighted imaging

242
Q

What commonly develops following LP?

A

Postural headache - treated with caffeine and fluids

243
Q

What is the treatment for pituitary apoplexy?

A

Urgent corticosteroids

244
Q

Treatment for reducing relpase in MS?

A

Monoclonal antibodies such as natalizumab

245
Q

What does delta sign on MR venography suggest?

A

Saggital sinus thrombosis

246
Q

What is Neurofibromatosis type 2 assoicated with?

A

Vestibular Schwannomas

247
Q

What happens to ICP in normal pressure hydrocephalus?

A

It rises intermittently

248
Q

What is between the posterior cerebral artery and the superior cerebellar artery?

A

Occulomotor nerve

249
Q

What is the pathophysiology of MS?

A

Autoimmune demyelination of the CNS and axonal loss of the oligodendrocytes

250
Q

Which cells are not affected in MS?

A

Schwann cells

251
Q

What are the 2 specialised cells in the CNS?

A
  • Nerve cells
  • Neuroglia e.g astrocytes, oligodendrocytes
252
Q

What are Schwann cells?

A

Glial cells of the PNS which myelinate axons

253
Q

What condition has Antibodies to voltage-gated calcium channels?

A

Lambert-Eaton syndrome

254
Q

Juvenile myoclonic epilepsy is classically associated with

A

seizures in the morning/following sleep deprivation

255
Q

Definition of postural hypotension?

A

Drop of 20

256
Q

Atonic seizure presentation?

A

Sudden loss of muscle tone leading to a fall with no loss of consciousness

257
Q

What sign on MRI suggests encephalitis?

A

Bilateral medial temporal lobe involvement

258
Q

What is Ramsay Hunt syndrome?

A

Bells + severe pain and hearing loss

259
Q

What kind of ptosis does Horners cause?

A

Partial

260
Q

Most common cause of right third occulomotor nerve palsy?

A

Diabetes

261
Q

What does posterior cerebral artery supply and what visual loss will you see?

A

Corresponding occipital cortex -> contralateral visual field

262
Q

Investigation of choice for encephalitis?

A

Viral CSF PCR

263
Q

Signs of parietal lobe damage?

A

Visual inattention, apraxia,

264
Q

DMARD used for MS?

A

Beta interferon

265
Q

Mechanical thrombectomy provides most benefit for strokes in which location?

A

Proximal MCA and internal carotid artery thrombosis

266
Q

Surgical management of SAH?

A

Endovascular coiling

267
Q

Enlarged blind spots and constriction of the visual filed?

A

Idiopathic Intracranial HTN

268
Q

Burning pain, ear ache, vertigo, weakess?

A

Ramsay-Hunt - herpes virus

269
Q

Which tumour assoicated with Meigs syndrome (pleural effusion, ascites)

A

Fibroma

270
Q

Risk factors for subdural haematoma?

A

Recent trauma (falls), anticoag use, older age

271
Q

What clinical feature is part of optic neuritis?

A

Red desaturation

272
Q

Vertigo with no tinnitus or hearing loss and recent viral illness?

A

Vestibular neuritis

273
Q

Gold standard imvestigation for SAH?

A

Digital subtraction catheter angiography

274
Q

Signs of Primary Lateral Sclerosis?

A

Only UMN features

275
Q

Signs of progressive muscular atrophy?

A

Only LMN signs

276
Q

MRI findings of Huntingtons?

A

Atrophy of caudate nucleus and putamen

277
Q

Drugs to help with faitgue in MS?

A

Modafanil/Amantadine

278
Q

Which epilepsy has seizures in the morning/following sleep deprivation?

A

Juvenile Myoclonic

279
Q

2nd line for focal seizures?

A

Carbamazepine

280
Q

What medication can exacerbate absence seizures?

A

Carbamazepine

281
Q

Medication for tonic/atonic seizures?

A

Males - Sodium Valproate
Females - Levetiracetam

282
Q

What is lateral medullary syndrome?

A

Occlusion of posterior inferior cerebellar artery

283
Q

Tx for agitation in autoimmune encephalitis?

A

Risperidone/Quetiapine

284
Q

Vesicular rash around the external ear canal + LMN palsy?

A

Ramsay Hunt Type 2

285
Q

First line investigation for acute presentation of GBS?

A

Vital Capacity - assess respiratory failure

286
Q

Personality changes are more likely to occur in what type of stroke?

A

anterior cerebral artery strokes

287
Q

Cushing’s triad?

A

bradycardia, hypertension and irregular/abnormal breathing

288
Q

Vertigo when turning head to one side?

A

Benign Positional Paroxysmal Vertigo

289
Q

Cause of BPPV?

A

Debris in the semicircular canals

290
Q

Diagnostic investigation for BPPV?

A

Hallpike maneouvre

291
Q

Treatment of BPPV?

A

Epley maneouvre

292
Q

embolic infarcts confined to one hemisphere of the brain?

A

Source is after the heart but before the brain -> carotids

293
Q

What are oligoclonal bands?

A

distinct bands of IgG on Western Blot

294
Q

‘string of beads’ appearance on MRI angiography

A

Fibromuscular dysplasia

295
Q

First line investigation for suspected Alzheimers?

A

Serum B12 levels - rule out reversible causes of cognitive decline

296
Q

Temporal arteritis vs Trigeminal neuralgia?

A

TN will normally not have any visual/eye involvement

297
Q

Vestibular neuritis vs Labyrinthitis

A

VN will have no hearing loss

298
Q

Cause of Freireich?

A

triple repeat in the FXN gene encoding the frataxin protein

299
Q

What condition is assoictaed with high-arched palate, pes cavus, and kyphoscoliosis?

A

Friederich

300
Q

What is acute vestibular syndrome?

A

vestibular neuronitis and labyrinthitis

301
Q

When is LP most sensitive after SAH?

A

12 hours following

302
Q

SOD1 mutation?

A

Familial ALS

303
Q

If FH and sounds like ALS?

A

Not sporadic (more common) - familial ALS

304
Q

2nd line autoantibody check for MG?

A

Positive muscle-specific tyrosine kinase antibodies

305
Q

Unilateral supratentorial arterial bleed

A

Extra-dural haematoma

306
Q

Side effects of topiramate?

A

weight loss, renal stones and cognitive and behaviour changes

307
Q

Medications which can cause ototoxicity?

A
  • Gentamicin
  • Furosemide
  • Vancomycin
308
Q

Alpha-synuclein cytoplasmic inclusions would be found with which condition?

A

Lewy-body dementia

309
Q

Common peroneal vs L4/5 radiculopathy?

A

Normal foot inversion in common peroneal

310
Q

What reduces morbidity and mortality in bacterial meningitis?

A

Dexamethasone IV -> should be given within 4 hours of starting Abx

311
Q

All CN lesions are ipsilateral except which?

A

Trochlear

312
Q

Absent corneal reflex indicates a lesion where?

A

Pons

313
Q

Absent corneal reflex indicates a lesion where?

A

Pons

314
Q

Emergency opthalmic condition affecting the aqueous humour?

A

Acute glaucoma - drainge of AH becomes blocked

315
Q

Symptoms of glaucoma

A
  • Rise in Intraocular pressure
  • Pain
  • Red eye
  • N+V
  • Blurred vision
316
Q

Tx of glaucoma?

A
  • Pilocarpine eye drops
  • Acetazolamide 500mg
    -Steroids/Beta-blockers
  • Surgical management is definitive
317
Q

Vitreous Haemorrhage

A
  • Haemorrhage into vitreous humour
  • Prevents light travelling from lens to retina
  • Caused by diabetes, trauma, macular degeneration
318
Q

Presentation and Tx of Vitreous Haemorrhage?

A
  • Floated, haze and shadows
  • Visual loss in severe cases
  • Tx is stop the cause and then repair with laser
319
Q

Retinal detachment

A
  • Retina pulled away from the underlying surface
  • Flashers/Floaters/Curtain over past of vision
  • Needs scleral buckle surgery/vitrectomy
320
Q

Central Retinal Vein Occlusion

A
  • Dilatation of branch veins (due to backflow)
  • Cotton wool spots
  • Retinal haemorrhages
  • Mild cases don’t need Tx
  • Severe cases need steroid injections/Anti VEGF
321
Q

Central retinal artery occlusion

A
  • Occular equivalent of stroke (same risk factors)
  • Cherry red spot in macula
  • Pale optic disc
  • Relative afferent pupillary defect
  • Tx includes ocular massage, increased blood oxygen content and acetazolamide
322
Q

Optic Neuritis

A
  • Inflammation of the optic nerve
  • MS, B12 deficiency, Lymes, Syphilis, HIV
  • Pain, reduced acuity, RAPD
  • Resolves in around 6 weeks
323
Q

What is clinically isolated syndrome?

A

First episode of symptoms due to inflammatory demyelination

324
Q

Lhermittes?
Uhthoffs?

A

L - electric shock like sensation on neck flexion
U - increase in body temp worsens neurology

325
Q

Cardiac Syncope

A
  • Arrhythmias
  • Valvular pathology e.g aortic stenosis
  • ECG/Echo
326
Q

Pathophysiology of neurogenic syncope

A

Inappropraite active activation of PNS (vagus) and decrease of SNS

327
Q

Components of ABCD2 scoring system?

A

Age >60
BP >140/90
Clinical features
- Unilateral - 2points
- Speech impairment with no weakness - 1
Duration - >60 1 point
D - Diabetes

328
Q

What supplies the anterior and posterior half of the spinal cord?

A

Anterior - spinothalamic and corticospinal - anterior spinal artery
Posterior - dorsal - 2 posterior spinal arteries

329
Q

Anterior cord syndrome

A
  • Anterior part is damaged
  • Bilateral loss of pain/temperature and bilateral spastic paralysis
  • Fine touch, proprioception and vibration preserved
330
Q

Posterior cord syndrome

A
  • Fine touch, proprioception and vibration affected
  • Pain/temperature preserved
331
Q

What is associated with Chiari malformation?

A

Syringomyelia

332
Q

What is spinal cord concussion?

A
  • Transiet loss of spinal cord function, usually resolves within 48 hours
333
Q

What is spinal stenosis?

A

Spinal canal narrows to compress on the cord, presenting with glute/leg pain on walking/standing

334
Q

CN3,4 and 6 lesions

A

3 - Ptosis, down and out, dilated fixed pupil
4 - Defective downward gaze, vertical diplopia
6 - Defective abduction, horizontal diplopia

335
Q

CN5/7 lesions

A

5 - loss of corneal reflex, loss of focial sensation, paralysis of mastication, deviation of jaw to weak side
7 - paralysis of upper/lower face, loss of taste, hyperacusis

336
Q

CN8,9,10 lesions

A

8 - hearing loss, vertigo, nystagmus
9 - hypersensitive carotid sinus reflex, loss of gag reflex
10 - uvual deviates way from lesion

337
Q

CN11,12 lesions

A

11 - weakness turning head to opposite side
12 - tongue deviates toward side of lesion

338
Q

What is lyme disease?

A

Caused by the spirochaete Borrelia burgdorferi

339
Q

Presentation of Lyme disease

A
  • painless, bulls eye rash at site of stick bite
  • headaches, fever, lethargy
  • Later features include heart block, meningitis, pericarditis
340
Q

Investigations for lyme disease?

A
  • ELISA antibodies
341
Q

Management of tick bite/confirmed lyme?

A

Tick bites - remove it and then wash
Doxycycline if early disease otherwise Ceftriaxone

342
Q

What is Jarisch-Herxheimer reaction?

A

Fever, rash tachycardia after first dose of Abx - Lyme disease

343
Q

shooting pains along the outer aspect of the upper leg?

A

Meralgia Paresthetica

344
Q

What causes pseudobulbar palsy?

A

bilateral lesion affecting the corticobulbar tracts

345
Q

Presentation of pseudobulbar palsy?

A

spastic tongue, a slow thick (“hot-potato”) speech, a brisk jaw jerk reflex, and emotional lability

346
Q

Where is the lesion for internuclear opthalmoplegia?

A

Medial longitudinal fasciculus on the side that fails to adduct

347
Q

Presentation of PICA?

A

Dysphagia
ipsilateral Ataxia,
ipsilateral Nystagmus,
Vertigo,
Anaesthesia (Ipsilateral facial numbness and contralateral pain loss on the body)
ipsilateral Horner’s syndrome

348
Q

What is Devics disease?

A

Optic neuritis
Transverse myelitis
Positive NMO-IgG (an antibody targeting aquaporin 4

349
Q

pupil-sparing third nerve palsy, associated with foot drop in a diabetic?

A

Mononeuritis multiplex

350
Q

left-sided ring enhancing lesion

A

cerebral abscess

351
Q

Ulnar claw

A

Ulnar nerve neuropathy

352
Q

What does owl’s eye on axial imaging suggest?

A

Anterior spinal artery occlusion

353
Q

Px of Horners

A
  • Ptosis (dropped eyelid)
  • Miosis (contricted pupils)
  • Anhidrosis (loss of sweating)
  • Enopthalmos
354
Q

Venous sinus thrombosis Px?

A
  • Hx of VTE/COCP
  • Severe headache but less insidicous than SAH
  • N+V
  • Subtle neurology
355
Q

Mechanism of action of ondansetron?

A

5-HT3 anatgonist

356
Q

What type of MRI should be used for MS?

A

With contrast

357
Q

What cranial nerves are affected in vestibular schwannoma?

A

5,7,8

358
Q

Creutzfeldt-Jakob disease is characterised by what?

A

Rapid onset dementia and myoclonus (twitching, jerks)

359
Q

Medical treatment for neuroleptic malignant syndrome?

A

Bromocriptine

360
Q

Big risk factor for Bells?

A

Pregnancy

361
Q

normal motor conduction on nerve conduction studies

A

MND

362
Q

Tx for acute phosphotaemia in adults?

A

Intravenous infusion of phosphate polyfusor

363
Q

WHat nerves do thumb adduction and abduction?

A

Adduction - ulnar
Abduction - median

364
Q

Signs of spinal cord compression?

A

UMN - below the lesion
LMN - at the lesion

365
Q

Dangling hand over the edge of bed?

A

Carpal tunnel

366
Q

Centro-temporal spikes?

A

Benign Rolandic Epilepsy

367
Q

Tx for Lambert Eaton

A

Amifampridine

Phase 3A (10 decks)

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