neuro Flashcards
(126 cards)
1
Q
which parkinsons medication is most likely to cause inhibition disorders?
A
ropinirole (dopamine receptor agonist)
2
Q
what are the features of bells palsy?
A
acute unilateral idiopathic facial nerve paralysis
- lmn palsy - forehead affected (umn spares forehead)
- post-auricular pain, altered taste, dry eyes, hyperacusis
3
Q
what is the management of bells palsy?
A
oral pred
artificial tears, eye taping
?refer to ent, ?plastics if no paralysis improvement
4
Q
what is degenerative cervical myelopathy?
A
disc degen, ligament hypertrophy, cord signal change
5
Q
what are the features of DCM?
A
neck pain, loss of motor function in upper limb, loss of sensory function, loss of autonomic fn (urinary or faecal incontinence and/or impotence)
hoffman’s sign - flick hand - +ve = fingers twitch
6
Q
secondary prevention in TIA?
A
clopidogrel 75mg daily
7
Q
management TIA?
A
300mg aspirin acutely
8
Q
which cranial nerves are affected in vestibular schwannomas? (acoustic neuroma)
A
cn V, VII and VIII
9
Q
how does drug induced parkinsonism present?
A
bilateral sx
remain at presenting level
10
Q
how does idiopathic parkinsons present?
A
difficulty with fine movts
inc tone
resting tremor
often asymmetrical sx
11
Q
if a patient presents to primary care with seizue episodes, what is the management?
A
refer to neuro - antiepileptics must be started by specialists
12
Q
what type of visual field defects do parietal lesions cause?
A
contralateral inferior quadranopia
13
Q
what type of visual field defects do temporal lobe lesions cause?
A
contralateral superior quadranopia
14
Q
what type of visual field defect would a patient with sx of diabetes insipidus have?
A
craniopharyngioma - lower bitemporal hemianopia
15
Q
how do you differentiate a focal impaired awareness seizure from an absence seizure?
A
FIA - ?longer, motor phenomena, automatisms, aura
absence - often child, up to 30s, recollection of event, no automatisms
16
Q
what are the sx of acoustic neuroma?
A
vertigo, unilateral sensorineural hearing loss and tinnitus cnviii
absent corneal reflex cnv
facial palsy cnvii
17
Q
mgt ischaemic stroke for first 14 days?
A
300mg aspirin OD
after 14d - clopidogrel 75mg long term + statin if cholesterol over 3.5
18
Q
what is the mgt for myoclonic seizures?
A
m - sodium valproate
f - levetiracetam
19
Q
what is the mgt for absence seizures?
A
ethosuximide
2L m- valproate, f- lamotrigine or levetiracetam
(carbamazepine may exacerbate)
20
Q
what is the mgt for tonic/atonic seizures?
A
m - sodium valproate
f - lamotrigine
21
Q
what is the mgt for focal seizures?
A
focaL - Lamotrigine/Levetiracetam
1L - lamotrigine or levetiracetam
2L - carbamazepine, oxcarbazepine, zonisamide
22
Q
what is the mgt for generalized tonic-clonic seizures?
A
m - SV
f - lamotrigine or levetiracetam
23
Q
what is the management for peritumoural vasogenic oedema?
A
IV dexamethasone
24
Q
how does a lacunar stroke present?
A
pure motor hemiparesis
pure sensory stroke
sensorimotor stroke
ataxic hemiparesis
dysarthria/clumsy hand syndrome
25
how does a TACS present?
3Hs
Hemiplegia/sensory loss
Homonymous hemianopia
Higher dysfunction
26
what type of diet is most likely to be effective in reducing seizure frequency in epilepsy?
ketogenic diet
27
how do focal aware seizures present?
sudden but short-lived change in senses (which may be taste, smell, tactile, or visual) during which the patient remains fully conscious
typically remain conscious, accompanied with sweating, twitching or gaze deviation
28
how does myasthenia gravis present?
muscle fatigability
- extraocular muscle weakness - diplopia
- proximal muscle weakness
- ptosis
- dysphagia
29
what is MG associated with?
- thymomas
- autoimmune disorders
- thymic hyperplasia
30
what is the investigation of choice for MG?
antibody screen - pts have abs against acetylcholine receptors
31
how does trigeminal neuralgia present?
unilateral brief electric shock-like pains, abrupt in onset and termination, limited to one or more divisions of the trigeminal nerve
pain evoked by light touch, including washing, shaving, smoking, talking, and brushing the teeth, and frequently occurs spontaneously
32
what is the management for trigeminal neuralgia?
carbamazepine
33
how does an AICA stroke present?
sudden onset vertigo and vomiting
ipsilAterAl fAciAl pArAlysis
34
how does a PICA present?
sudden onset vertigo and vomiting
dysphagia
ipsilateral facial pain and temp loss
contralateral LIMB pain and temp loss
ataxia
35
what is broca's aphasia?
brocas - broken - word flow broken (expressive)
36
what is wernicke's aphasia?
wernicke's - what? - doesn't understand a command (receptive)
37
how do you manage a patient with a suspected TIA if they are on warfarin/DOAC/have a bleeding disorder?
admit and arrange CT head to rule out haemorrhage before giving aspirin
38
how does normal pressure hydrocephalus present?
triad
1. urinary incontinence
2. gait disturbance
3. dementia
(magnetic gait specific finding NPH)
39
what is seen on imaging in NPH?
ventriculomegaly without sulcal enlargement
40
how is status epilepticus managed?
ABC - airway adjunct, oxygen, check blood glucose
1L IV benzos - prehospital PR diazepam or buccal midazolam
41
upper vs lower bitemporal hemianopia pathology?
Upper - pitUitary lesion
lOwer - craniOpharyngiOma
42
what dose of rectal diazepam do you give in status?
10mg
43
what is the most common neurological consequence of meningitis?
sensorineural hearing loss
(then seizures, focal neuro deficits, sepsis, abscess, brain herniation, hydrocephalus)
44
what are the features of neuroleptic malignant syndrome?
FEVER
Fever
Encephalopathy
Vitals dysregulation - in HR + RR
Enzyme - CK increase
Rigidity
45
what are the mechanisms of action of the 3 main antiemetics?
1, 2, 3
1. cyclizine h1 receptor
2. metaclopramide d2 receptor
3. ondansetron 5ht3
46
how does a pca stroke present?
contralateral homonymous hemianopia with macular sparing
visual agnosia
47
what syndrome is caused by a posterior inferior cerebellar artery infarct (PICA)?
lateral medullary syndrome
48
how to remember tibial vs peroneal nerve lesion presentation
TIPPED
Tibial nerve - Inversion - Plantarflexion
Peroneal nerve - Eversion - Dorsiflexion
49
how does spontaneous intracranial hypOtension present?
worse when upright
low csf - usually from a leak, associated with marfan's
50
what needs to be considered when starting a phenytoin infusion?
cardiac monitoring - pro-arrhythmogenic effects
51
what is the treatment pathway for neuropathic pain?
1L: amitriptyline, duloxetine, gabapentin, or pregabalin
2L: tramadol as 'rescue therapy' for exacerbations
topical capsaicin for localised neuropathic pain
52
what drug is used for long term prophylaxis of cluster headaches?
verapamil
53
which blood vessels are affected in subdural haemorrhage?
bridging veins between cortex and venous sinuses
54
which blood vessels are affected in subarachnoid haemorrhages?
vessels of circle of willis, eg basilar and anterior circulating arteries
55
what is the mechanism of action of pyridostigmine?
long acting acetylcholinesterase inhibitor
used in MG
56
how to remember status mgt?
oh my lord phone the anaesthetist
O - O2
M - buccal midazolam or rectal diazepam
L - IV lorazepam
P - IV phenytoin
A - rapid induction of anaesthesia
57
what eye defect is most commonly associated with raised ICP?
3rd nerve palsy due to herniation (down and out, ptosis, sometimes pupil dilation)
58
where would the lesion be if there was a left homonymous hemianopia?
right optic tract (not nerve) - R optic radiation or occipital cortex
59
what condition is chiari malformations associated with?
syringomyelia - dilatation of csf space within spinal cord - loss of pain sensation, temp and non-discriminative touch. cape like distribution
60
how does an mca stroke present?
contralateral hemiparesis
sensory loss
upper extremity affected more
contralateral homonymous hemianopia
aphasia
61
which antiemetic causes extrapyramidal side effects?
metaclopramide
62
how does guillain barre present?
- progressive, symmetrical weakness of all limbs
- classically ascending
- hypOreflexia
- maybe mild sensory sx or none
- often hx of gastroenteritis
63
how is GBS investigated?
LP - raised protein, normal WCC
nerve conduction studies - dec motor nerve conduction velocity
64
what is brown sequard syndrome?
lateral hemisection of the spinal cord
65
how does brown sequard syndrome present?
ipsilateral weakness and proprioception/vibration loss
contralateral pain/temp loss
66
what is the management for acute stroke within 4.5h?
thrombolysis and thrombectomy
67
where is broca's area?
inferior frontal gyrus (frontal lobe)
68
where is wernicke's area?
superior temporal gyrus (temporal lobe)
69
what are the symptoms of normal pressure hydrocephalus?
wet - incontinence
wacky - dementia
wobbly - gait apraxia
70
which drugs can exacerbate myasthenia gravis?
penicillamine
quinidine, procainamide
beta blockers
lithium
phenytoin
abx: gentamicin, macrolides, quinolones, tetracyclines
71
what does a cnvi palsy present with?
contralateral defective eye abduction and horizontal diplopia
72
rhyme to remember nerve roots and their actions?
s1/2 button my shoe
l3/4 kick the door
c5/6 pick up sticks
c7/8 close the gate
73
what medications are used for spasticity in MS?
baclofen and gabapentin
74
what is the treatment for a focal seizure in a man?
lamotrigine or levetiracetam
75
in a patient with leg weakness and no arm weakness or aphasia, which vessel is likely to be affected?
ACA
76
what imaging is used for MS?
MRI brain and spine with contrast - shows demyelinating lesions
77
what sign is seen on MR venography in sagittal sinus thrombosis?
empty delta sign
78
how does sagittal sinus thrombosis present?
headache
diplopia
bilateral papilloedema
79
what is first line for post herpetic neuralgia?
don't - duloxetine
get - gabapentin
pain - pregabalin
again - amitriptyline
80
how does trochlear nerve palsy present?
defective downward gaze, vertical diplopia
81
how does subacute combined degeneration of the cord present?
dorsal columns and lat corticospinal tracts
loss of proprioception and vibration sense
spasticity and brisk knee reflexes
babinski positive
82
first line tx for parkinsons disease?
levodopa - if motor sx affecting QoL
if not, dopamine agonist, levodopa, mao-B inhibitor
83
what are the side effects of phenytoin?
P - p450 interactions
H - hirsutism
E - enlarged gums
N - nystagmus
Y - yellow skin
T - teratogen
O - osteomalacia
I - interaction with B12 metabolism
N - neuropathies
84
what are the features of a low pressure headache?
post lumbar puncture
young women with low BMI
within 24-48h after LP
worse upright
improves in recumbent position
85
how are anti-epileptic drugs stopped?
can be considered if seizure free for over 2 years, stop AEDs over 2-3months
86
what medication is used for cluster headache prophylaxis?
verapamil
87
how does pontine haemorrhage present?
reduced GCS, paralysis and bilateral pin point pupils
88
what is cushings triad (raised ICP)?
widening pulse pressure
bradycardia
irregular breathing
89
which medications are associated with idiopathic intracranial hypertension?
- tetracycline abx (like doxycycline)
- isotretinoin
- contraceptives
- steroids
- levothyroxine
- lithium
- cimetidine
90
how does CJD present?
rapid onset dementia and myoclonus
91
what is lhermitte's sign?
tingling in hands when flexing neck/electric shock sensations down spine
indicates disease near dorsal column nuclei of cervical cord
92
what type of stroke does contralateral homonymous hemianopia with macular sparing and visual agnosia indicate?
posterior cerebral
93
which antiepileptic drug is most associated with wt gain?
sodium valproate
94
what drugs increase the risk of IIH?
COMAAR
ciclosporin
oral contraceptives
mineralocorticoids
amiodarone
antibiotics (tetracyclines, sulphonamides)
retinoic acid
95
which nerve is at risk in a fracture of the humeral shaft?
radial nerve
96
what is weber's syndrome?
midbrain stroke
characterised by ipsilateral CNIII palsy and contralateral hemiparesis
97
what type of visual field defect does Primary open angle glaUcoma cause?
Unilateral Peripheral visual field loss
98
what nerve does saturday night palsy affect?
radial nerve
99
what is tuberous sclerosis?
AD condition
neurocutaneous features
100
what are the features of tuberous sclerosis?
ash leaf spots
shagreen patches
adenoma sebaceum
fibromata beneath nails
cafe au lait (moreso neurofibromatosis)
devt delay
epilepsy
intellectual impairment
101
what are the features of neurofibromatosis?
axillary/groin freckles
pheochromocytomas
NF2 - acoustic neuromas
iris hamartomas
ocular hamartomas
AD
102
how does multi-system atrophy present?
- parkinsonism
- autonomic disturbance
> erectile dysfunction
> postural hypotension
> atonic bladder
- cerebellar signs
103
how do jacksonian march seizures present?
clonic movt travelling proximally
104
which lobe is associated with jacksonian march?
frontal lobe
105
what are the most important initial investigations in status epilepticus?
ABDCE - hypoxia
BM - hypoglycaemia
106
how does extradural haemorrhage appear on CT?
BICONVEX mass
107
how does subdural haemorrhage appear on CT?
crescent
108
how is acute relapse of MS managed?
methylprednisolone
109
how does venous sinus thrombosis present?
headache
nausea and vomiting
reduced consciousness
110
what is the effect of rocuronium in MG?
rocuronium rocks !
(hyperefficacious)
111
what is the effect of suxaemethonium in MG?
Suxaemethonium sucks !!
hypoefficacious
112
what is the effect of suxamethonium in MG?
Suxamethonium sucks !!
hypoefficacious
113
what is found in CSF of pts with MS?
oligoclonal bands
114
how does lambert-eaton syndrome present?
- repeated muscle contractions lead to inc muscle strength
- limb-girdle weakness
- hyporeflexia
- autonomic sx
115
what drug is used in the management of IIH?
acetazolamide - carbonic anhydrase inhibitor
116
what is the pattern of typical migraine aura?
spreading scintillating scotoma
(jagged crescent)
117
what is the mechanism of action of memantine?
NMDA receptor agonist
118
which tumours most commonly metastasise to the brain?
- lung
- breast
- kidney
- melanoma
- colorectal
119
how is acute myasthenic crisis managed?
plasmapheresis and ivig
120
what is the preferred method of nutrition for patients with MND?
PEG tube
121
what medications are used to treat neuroleptic malignant syndrome?
dantrolene in some cases
bromocriptine (dopamine agonist)
122
above which level of spinal cord injury does autonomic dysreflexia occur?
above T6
123
what is uhthoff's phenomenon?
neurological sx exacerbated by increases in body temp
(associated with MS)
124
what is uhthoff's phenomenon?
neurological sx exacerbated by increases in body temp
(associated with MS)
125
what medication is used for restless leg syndrome?
dopamine agonists - ropinirole
126
what medication is used for restless leg syndrome?
dopamine agonists - ropinirole
