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FRACP Exam > Neuro > Flashcards

Neuro Flashcards

1
Q

HLAB1502 ass with what drug?

A

Carbamazapine and lamotragine - risk of SJS

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2
Q

What antiepileptic effects the COC?

A

Topiramate - reduces concentration
Carbamazepine and phenytoin are strong inducers of the cytochrome p450 and lamotrigine is a weak inducer reducing concentration.

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3
Q

What is the MoA of Levetiracetam?

A

Binding of the synaptic vesicle protein SV2A

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4
Q

What AED are sodium channel blockers?

A
  • Phenytoin
    • Carbamazipine
    • Lamotragine
    • Lacosamide
    • Topiramate
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5
Q

What is the MoA of Gapapentin in epilepsy?

A

Voltage gated calcium channel blockers: Alpha2delta

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6
Q

The COC reduces concentration of what AED?

A

Lamotragine

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7
Q

What AED induces the metabolism of warfarin (reduced INR)

A

Carbamazipine

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8
Q

What are the side effects of leveteracetam?

A

Fatigue, thrombocytopenia, blurred vision, memory, personality, irritability, mood swings, increased suicidality

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9
Q

What is used for tuberous sclerosis complex epilepsy?

A

Everolimus and sirolimus (mTOR)

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10
Q

What AED causes weight loss?

A

Topiramate

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11
Q

MoA Perampanel

A

blocks post synaptic AMPA receptor

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12
Q

What is lennox gastaut syndrome

A

Severe epileptic encephalopathy
Poor prognosis
Intellectual disability

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13
Q

What epilepsy syndromes do kids grow out of?

A

Benign rolandic epilepsy, juveline myoclonic epilepsy

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14
Q

What is rasmussen encephalitis

A

inflammatory disorder of uncertain, probably immune-mediated, pathogenesis that affects one cerebral hemisphere
Anti NMDA, andti LGI1 antibody

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15
Q

Fibrillations and sharp waves at rest on EMG suggest what kind of neuropathy

A

More in keeping with an axonal neuropathy rather than demyelinating neuropathy e.g alcohol neuropathy

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16
Q

What is the most important risk factor for sudden unexpected death in epilepsy (SUDEP)

A

Frequent generalised tonic clonic seizures

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17
Q

What phase of sleep do sleep related epileptic seizures occur?

A

Non-rapid eye movement (NREM) sleep tends to facilitate epileptiform discharges and seizures

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18
Q

Nocturnal seizure disorder in adolescents diagnosis name?

A

Sleep-related hypermotor epilepsy (SHE)

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19
Q

What is the pattern of inheritance of sleep related hypermotor epilepsy?

A

25% of SHE is inherited as autosomal dominant, with mutations in the CHRNA4 gene, which encodes for the alpha 4 subunit of the neuronal nicotinic acetylcholine receptor mutation.

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20
Q

What is Locked in syndrome?

A

Complete paralysis of all voluntary muscles except for the ones that control the movements of the eyes.
Caused by damaged to the pons, a part of the brainstem.

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21
Q

The lateral spinothalamic tract conveys

A

Sensory impulses regarding pain and temperatur

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22
Q

What is Brown-sequard syndrome

A

Resulting from hemisection of the spinal cord. It manifests with weakness or paralysis and proprioceptive deficits on the side of the body ipsilateral to the lesion and loss of pain and temperature sensation on the contralateral side

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23
Q

What are the features of intranuclear opthalmoplegia - INO

A

The affected eye shows impairment of adduction.
The contralateral eye abducts, however with nystagmus
Lesion is in the medial longitudinal fasciculus of the affected eye

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24
Q

Progressive supranuclear palsy features

A

Impaired downward gaze
Progressive gait freezing within three years
Repeated unprovoked falls within three years

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25
Q

Nerve conduction studies for axonal neuropathy

A

Reduced amplitude with preserved conduction velocity

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26
Q

Nerve conduction studies for demyelinating lesions

A

Slow conduction velocity, prolonged distal motor latencies, partial conduction block.

27
Q

Features of migraine

A

Unilateral
Recurrent
Any head or neck structure above C4 can cause headache
Duration 4-72 hours
Moderate to severe

28
Q

What are headache red flags?

A

Systemic features - fever, myalgia, wt loss
Neuro signs or sx
Sudden onset
Age >50 and progressive
Pattern change from previous

29
Q

What are the autonomic symptoms with trigeminal autonomic cephalgias

A

Unilateral eye redness, tearing, miosis +/- ptosis
Rhinorrhea or nasal stuffiness
Fullness or tinnitus in the ear

30
Q

Features of Cluster headache

A

Severe headache and restless, 1-8 attacks/day, 15min-3hours
Clusters for 6-12.
Ipsilateral blocked nose, rhinorrhea, lacrimation, miosis, partial ptosis.
Photophobia and phonophobia usually unilateral.

31
Q

How to treat TACs?

A

Triptans
Greater occipital nerve injection
Oral corticosteroid if short clusters
Verapamil

32
Q

What are the features of Paroxysmal Hemicrania

A

Duration 2-30minutes
More frequent than cluster headache
>8/day
Autonomic symptoms

33
Q

What are the features of Hemicrania continua

A

Unilateral pain
Cranial autonomic sx unilaterally
3-5 attacks/day
Present for months

34
Q

How to treat Hemicrania continua and paroxysmal Hemicrania?

A

Indomethacin
Greater occipital nerve injection

35
Q

SUNCT - Short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/ cranial autonomic symptoms

A

Brief, severe stabbing headache with autonomic features can be single stab, recurrent stabs, sawtooth pattern

36
Q

What is in the CHADSVASC score?

A

Age <65 = -, 65-74 = 1, >75 = 2
Sex - Female = 1
CHF - Yes = 1
HTN - Yes = 1
Prev stroke/TIA = 2
PVD = 1
Diabetes = 1

37
Q

What deficit do you get with anterior cerebral artery blockage?

A

Leg>arm>face, Motor&raquo_space; sensory
Dysphasia if on dominant side

38
Q

What deficie with MCA blockage?

A

Face/Arm > Leg
Dysphasia, dyspraxia/neglect
Homonomous hemianopia
Motor and sensory

39
Q

What deficit with posterior cerebral artery block ?

A

Homonomous hemianopia, behavioural change

40
Q

What deficie with basilar artery occlusion?

A

Locked in syndrome, vertigo, ataxia, diplopia, isolated limb symptoms

41
Q

Where is the lesion in Gerstman Syndrome.

A

Stroke in Inferior parietal lobule of dominant hemisphere, angular and supramarginal gyri

42
Q

What are the clinical features of Gerstman syndorme?

A

Dysgraphia/agraphia, dyscalculia, finger agnosia, Left/right disorientation +/- aphasia +/- apraxia

43
Q

What are the clinical features of lateral medullary syndrome?

A

Contralateral trunk/limb numbness
IPSILATERAL facial numbness, skew deviation, dysphagia, horners syndrome, limb ataxia
Palatal myoclonus, vertigo/nystagumis
reduced gag

44
Q

Where is the lesion in Lateral medullary syndrome?

A

Lateral medulla - vertebral artery, posteroir inferior cerebellar artery, superior middle and inferior medullary artery

45
Q

What is top of the basilar syndrome?

A

Basilar artery thrombus, present with somnolence, hallucinations, dream like behaviour, motor function otherwise preserved. Dilated pupils + gaze problem
If missed can progress to locked in syndrome

46
Q

When an individual denies heir blindness (Anton syndrome) this is due to ?

A

Bilateral posterior cerebral artery infarction (patient blind but not aware they are blind)

47
Q

What is the window for thrombolysis?

A

4.5 hours from onset

48
Q

Hot cross bun sign?

A

MSA

49
Q

Hummingbird/penguin sign?

A

PSP

50
Q

WHat is the antibody target in NMOSD ( neuromyelitis optica)

A

Aquaporin 4 receptor
Activates complement

51
Q

What MRI spine lesions are seen?

A

Long lesions traversing multiple levels

52
Q

What are the core clinical features of NMOSD?

A

Optic neuritis
Acute myelitis
Area posera syndrom e(intractable hiccups, nausea or vommiting
Acute brainstem syndrome
Symptomaic cerebral syndrome

53
Q

What are the lobes of the brain?

A

Frontal, pariental, temporal, and occipital

54
Q

What is the function of the frontal lobe?

A

Personality, executive function, primary motor cortex

55
Q

What is the function of the parietal lobe?

A

Touch sensation, 2 point descrimination, pain, temp

56
Q

What is the funciton of the temporal lobe>

A

Information processing, sensory input - auditory, language, processing memories

57
Q

What is the function of the occipital lobe?

A

Vision

58
Q

Pressure on the optic chiasm causes what kind of visual loss?

A

Bipolar ( lateral vision) hemianopia - cant see the outside half on both eyes

59
Q

What would produce a homonomous hemianopia?

A

Occipital lobe lesion/stroke or pressure on the contralateral optic track

60
Q

At what level of would you expect autonomic dysreflexia with spinal cord injury?

A

Autonomic dysreflexia can complicate SCI above T6

61
Q

What is brown Sequard sydrome / findings?

A

Spinal cord hemisection with ipsilateral paralysis, loss of vibration and position sense, and hyperreflexia below the spinal level. Contralateral loss of pain and temperature sensation is also evident.

62
Q

What is anterior cord syndrome?

A

Anterior spinal artery cord infarct
Loss motor function + pain/temp with relative sparing of proprioception and vibration.
Acute:flaccid paralysis and loss of deep tendon reflexes

63
Q

What is posterior cord syndrome?

A

Posterior spinal artery. Loss of proprioception and vibratory sense loss of posterior column

64
Q

What is central cord syndrome?

A

Loss of tendon reflexes
Loss of pain/temp in one or several adjacent dermatomes at the site of lesion, caused my disruption of the crossing spinothalamic fibres
Relatively normal sensation at levels above and below.

FRACP Exam (15 decks)

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