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MSRA LS > NEURO > Flashcards

NEURO Flashcards

1
Q

acoustic neuroma features?

A

DVT plus absent corneal reflex

vertigo, hearing loss, tinnitus and an absent corneal reflex.

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2
Q

woman has a TIA: unilateral weakness or sensory loss,
tx?

how does this differ in crescendo TIA- 2 TIAs in 7 days?

A

give aspirin 300 mg immediately, unless
1. the patient has a bleeding disorder or is taking an anticoagulant (needs immediate admission for imaging to exclude a haemorrhage)
2. the patient is already taking low-dose aspirin regularly: continue the current dose of aspirin until reviewed by a specialist
3. Aspirin is contraindicated: discuss management urgently with the specialist team

Specilaist revie

clopidogrel is recommended first-line (as for patients who’ve had a stroke)
aspirin + dipyridamole should be given to patients who cannot tolerate clopidogrel

how does this differ in crescendo TIA- 2 TIAs in 7 days?
CT head and aspirin

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3
Q

when to think idiopathic intracranial hypertension?

A

Obese, young female with headaches / blurred vision

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4
Q

typical symptoms seen in Parkinson’s disease?

A

Resting tremor + bradykinesia + rigidity

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5
Q

cluster head ache description?
tx?

A

Episodic, intense, unilateral eye pain, lacrimation, restless
Tx is oxygen, then subcutaneous triptan

Prophylaxis: verapamil

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6
Q

side effect of excess vitamin B6 (pyridoxine) ingestion?

A

peripheral neuropathy

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7
Q

horizontal diplopia
nerve damage?

A

cranial nerve 6 abducens

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8
Q

GCS points?

A

Motor (6 points) Verbal (5 points) Eye opening (4 points). Can remember as ‘654…MoVE’

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9
Q

root?

A
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10
Q

had shingles and now has post-herpetic neuralgia.
tx?

A

amitriptyline, duloxetine, gabapentin or pregabalin first-line.

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11
Q

sensory loss to the little finger and wasting of the hypothenar eminence.

nerve damage?

A

ulnar nerve

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12
Q

contraindication to triptan use in migraine?

A

cardiovasular diease

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13
Q

sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened).

A

cataplexy

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14
Q

Common peroneal nerve lesion

A

weakness of foot dorsiflexion
weakness of foot eversion
weakness of extensor hallucis longus
sensory loss over the dorsum of the foot and the lower lateral part of the leg
wasting of the anterior tibial and peroneal muscles

side note: L5 damage only causes foot drop but no effect on eversion

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15
Q

in a young person… features should prompt investigation for a secondary cause of headaches?

A

headache triggered by coughing

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16
Q

migraine
tx?
prophylaxis?

A

acute: triptan + NSAID or triptan + paracetamol
prophylaxis: topiramate or propranolol

side note: Propranolol is preferable to topiramate in women of childbearing age (i.e. the majority of women with migraine)

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17
Q

long term mx of stroke?

A

Aspirin 300 mg daily for 2 weeks then clopidogrel 75 mg daily long-term

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18
Q

Huntington’s disease is due to a defect in the huntingtin gene on chromosome…?..

A

4

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19
Q

Guillain-Barre syndrome
presentation?

A

ascending paralysis

c.jejuni

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20
Q

Phenytoin s/e
montioring?

A

megaloblastic anaemia (secondary to altered folate metabolism)
peripheral neuropathy

Phenytoin levels do not need to be monitored routinely but trough levels, immediately before dose should be checked if:
adjustment of phenytoin dose
suspected toxicity
detection of non-adherence to the prescribed medication

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21
Q

Fasciculations’ - think …..?

A

MND

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22
Q

where is the lesion- macular sparing?

A

Occipital cortex

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23
Q

A 54-year-old man complains of sweating, headaches and ‘tunnel vision’.

lesion eye?

A

optic chiasm

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24
Q

early blindness, now tunnel vision

where is the lesion?

A

retina

common presentation of retinitis pigmentosa.

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25
Q
A

tuberous sclerosis
adenoma sebaceum

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26
Q

Which of the following complications is classically associated with parotid gland surgery?

A

Parotid pathology can cause a lower motor neurone facial palsy

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27
Q

Which one of the following features of migraine is more common in children?

A

Gastrointestinal disturbance

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28
Q

Generalised tonic-clonic seizures
tx in females vs males?

A
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29
Q

focal seizure tx

A
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30
Q

absense seizure tx

A
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31
Q

myocloninc seizure tx?

A
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32
Q

tonic or atonic seizure tx?

A
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33
Q

most appropriate for secondary prevention of stroke- already taken high dose aspirin for 14 days?

A

Clopidogrel is the preferred antiplatelet for secondary prevention following stroke

34
Q

what dermatome supplies thumb, index finger, middle finger, palm, ring finger

A
35
Q

CT head showing temporal lobe changes

A

think herpes simplex encephalitis

36
Q

Primary open angle glaucoma in right eye
damage visual field tract?

A

Unilateral peripheral visual field loss

37
Q

20-year-old man presents with recent episodes of severe, stabbing pain in the right eye.
has clear nasal discharge during the episodes.

dx? trigger?
tx?
prophylaxis?

A

Alcohol is a common trigger for cluster headaches

38
Q

ischemic stroke identified in 3 hrs
mx?

A

A combination of thrombolysis AND thrombectomy is recommend for patients with an acute ischaemic stroke who present within 4.5 hours

side note: BP MUST BE CONTOLLED- CAN GIVE B BLOCKER

39
Q

man right sided numbness, poorly controlled htn, diabetes. ct shows no haemorrhage.

dx?

A

lacunar infarct

A patient having a lacunar stroke would present with either a purely motor, a purely sensory or a mixed motor and sensory deficit

40
Q

typical aura in migraine?

A

Typical aura include a spreading scintillating scotoma (‘jagged crescent’)

41
Q

A maximum of …?…. doses of IV benzodiazepines can be administered during convulsive status epilepticus

A

two!!

42
Q

Peripheral neuropathy is a known adverse effect of WHICH ANTI EPILEPTIC DRUG?

A

PHENYTOIN

43
Q

Parkinson’s disease - most common psychiatric problem is

A

depression

44
Q

Useful for managing tremor in drug-induced parkinsonism

A

Procyclidine

45
Q

PARKINSONS Has been associated with pulmonary fibrosis

A

Cabergoline

46
Q

PARKINSONS: which medication Often has a reduced effectiveness with time

A

Levodopa

47
Q

Neuropathic pain responds poorly to opioids.
if standard treatment failed which opioid is it most EFFECTIVE?

A

TRAMADOL

48
Q

DVLA informing and TIA?

A

Can start driving if symptom free after 1 month - no need to inform the DVLA

49
Q

test is used to determine whether your fingers or thumbs flex involuntarily in response to certain triggers.

name of this sign?

A

hoffmans sign

50
Q

neurodegenerative disorder involving death of neurones in the substantia nigra

A

parkinsons

51
Q

Which vitamin, present in Pabrinex, can prevent progression of symptoms to Wernicke’s encephalopathy?

A

B1 aka thiamine

52
Q

Common sites of lacunar strokes are…

A

basal ganglia, thalamus and internal capsule

53
Q

…..artery?…. is affected in ‘locked-in’ syndrome.

A

BASILAR ARTERY

54
Q

confused 6 weeks post at RTA. what injury in brain?

A

subdural haematoma
can present several weeks after the initial head injury

55
Q

Patients cannot drive for ….?… following a first unprovoked or isolated seizure if brain imaging and EEG normal

A

6 months

56
Q

amaurosis fugax.

What part of the brain anatomy is affected with this type of stroke?

A

retinal/ophthalmic artery

57
Q

Unilateral tinnitus associated with deafness is likely to be a feature of

A

The classical history of vestibular schwannoma includes a combination of vertigo, hearing loss, tinnitus and an absent corneal reflex

58
Q

CT head of an elderly patient
unilateral crescentic lesion in the right frontoparietal area.

dx? artery?

A

Subdural haemorrhage results from bleeding of damaged bridging veins between the cortex and venous sinuses

59
Q

Bilateral acoustic neuromas are associated with —-what genetic condition—–??

A

neurofibromatosis type 2

60
Q

type of seizure?

surroundings like a dream
Lip smacking is an example of an automatism - an automatic, repetitive act

A

focal impaired awareness

61
Q

presentation of myasthenia gravis? tx?

associated with?

A

dysphagia, diplopia, ptosis

long-acting acetylcholinesterase inhibitors
pyridostigmine is first-line

THYMOMA

62
Q

most common symptom of posterior circulation stroke

A

dizziness

think posterior–posture… dizzy

63
Q

bleeding gums— what antiepileptic med?

A

phenytoin

63
Q

bleeding gums— what antiepileptic med?

A

phenytoin

64
Q

first-line for spasticity in multiple sclerosis

A

Baclofen and gabapentin

65
Q

bells palsy craniel nerve?

A

7 LMN

66
Q

…?….. help in the diagnosis of Guillain-Barre syndrome

A

Nerve conduction studies

67
Q

appropriate anti-emetic in parkisnsons

A

domeridone

side note: Cyclizine is an antihistamine which, like prochlorperazine, may exacerbate Parkinson’s disease.

68
Q

episodes of suddenly smelling burnt rubber-despite there being none in her presence. lasting 2 mins

seizure type?

A

A woman suddenly has the sensation of smelling roses whilst at work. She is conscious throughout - focal aware seizure

69
Q

essential tremor tx?

A

Essential tremor is an AD condition that is made worse when arms are outstretched, made better by alcohol and propranolol

70
Q

ALS

long term mx for food if they can swallow?

A

Percutaneous gastrostomy tube (PEG)

71
Q

A POCI (posterior circulation infarct) involves … what artery…?

A

vertebrobasilar arteries

72
Q

multiple sclerosis complains of tingling in her hands which comes on when she flexes her neck.

sign?

A

Lhermitte’s sign

73
Q

Hyperacusis - along with one sided lower facial parylsis, young person,

what condition?

A

Hyperacusis is when everyday sounds seem much louder to you than they should.

bells palsy

74
Q

antiepileptic drugs is most associated with weight gain?

A

SODIUM VALPORATE

75
Q

how to manage pain relief in neuropathic pain?

A

Drugs for neuropathic pain are typically used as monotherapy, i.e. if not working then drugs should be switched, not added

76
Q

Parkinson’s disease medications: higher risk of hallucinations?

A

Ropinirole

77
Q

parkinsons 1st line tx?

A

if the motor symptoms are affecting the patient’s quality of life: levodopa

if the motor symptoms are not affecting the patient’s quality of life: dopamine agonist (non-ergot derived), levodopa or monoamine oxidase B (MAO‑B) inhibitor

78
Q

dose of rectal diazapem in adult?

A
79
Q

a loss of dexterity in both hands.
struggling to type at work and use her mobile phone.
Her symptoms have been deteriorating gradually over the preceding months.

dx?

A

Degenerative cervical myelopathy leads to loss of fine motor function in both upper limbs.

80
Q

stroke definitive mx is thrombolysis and thrombectomy for acute ischaemic attack.

what is the the time frame for each?

A

thrombectomy 6hrs

thrmobolysis 4.5 hours

81
Q

speech non-fluent,

WHAT PART BRAIN DAMAGED?

A

FRONTAL LOBE

brocas dysphasia

MSRA LS (22 decks)

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