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NEURO Flashcards

1
Q

anti-VGCC antibodies associated with what syndrome

A

lambert eaton

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2
Q

triptan MOA

A

5 HT1 agonist

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3
Q

STROKE: Haemorrhagic stroke excluded- when should anticoagulant for AF be started

A

after 14 days :
until brain imaging has excluded haemorrhage, and usually not until 14 days have passed from the onset of an ischaemic stroke’

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4
Q

stroke thrombolysis timeframe
and criteria

A

within 4.5 hrs of onset
and
If Imaging has def excluded haemorrhage

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5
Q

stroke thrombectomy: timeframe

A

within 6 hrs onset

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6
Q

PITS used in what type of visual defect

A

Homonymous quadrantopia

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7
Q

tuberous sclerosis inheritance

A

autosomal dominant

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8
Q

tuberous sclerosis CFs
cutaneous, neuro, and others

A

Cutaneous:
Shagreen patches
Ash leaf spots (UV light)
angiofibromas over nose
cafe au lait spots

neuro features:
Developmental delay
epilepsy
intellectual impairment

Other:
retinal hamartoma(white plaque on retina)
polycystic kidneys
lung cysts
rhabdomyomas of the heart

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9
Q

Bitemporal hemianopia

A

lesion of optic chiasm

upper quadrant more affected: inferior chiasmal compression, commonly a pituitary tumour

lower quadrant more affected= superior chiasmal compression, commonly a craniopharyngioma

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10
Q

Homonymous quadranopia

A

superior: lesion of the inferior optic radiations in the temporal lobe (Meyer’s loop)
inferior: lesion of the superior optic radiations in the parietal lobe
mnemonic = PITS (Parietal-Inferior, Temporal-Superior)

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11
Q

Homonymous hemianopia

A

Homonymous hemianopia
incongruous defects: lesion of optic tract
congruous defects: lesion of optic radiation or occipital cortex
macula sparing: lesion of occipital cortex

CRIT
Cong=radiation

Incong=tract

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12
Q

guillian barre common triggered by

antibodi

A

campylobacter

anti-GQ1b antibodies

miller fisher= variant

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13
Q

first line anti seizure medication males myoclonic seizures

A

sodium valproate

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14
Q

cerebellar syndrome symptoms+ mneumonic

A

DANISH:
D - Dysdiadochokinesia, Dysmetria (past-pointing), patients may appear ‘Drunk’
A - Ataxia (limb, truncal)
N - Nystamus (horizontal = ipsilateral hemisphere)
I - Intention tremour
S - Slurred staccato speech, Scanning dysarthria
H - Hypotonia

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15
Q

which antipsychotic /anti epileptic associated w SJS

A

lamotrigine

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16
Q

Palatal myoclonus == where in brain affected

A

olivary nucleus

PALATE=FOOD=OLIVE

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17
Q

wernickes aphasia comes from which brain region

A

temporal lobe- brodmann 22 in sup temporal gyrus

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18
Q

brocas aphasia from which brain region

A

frontal lobe

BRODIE= frontal lobe

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19
Q

mneumonic for

A
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20
Q

what is brocas aphasia

A

BEROCCA to FRONT the cold

expressive aphasia- cannot speak fluently

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21
Q

wernickes aphasia

A

comes up TIME and TIME again— TEMPORAL lobe

wernickes= fluent aphasia

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22
Q

degenerative cervical myelopathy symptoms

A
  • neck/arm/leg pain
  • Loss of motor function (digital dexterity, arm/leg weakness/stiffness=impaired gait
  • Loss of sensory function causing numbness
  • Loss of autonomic function (urinary or faecal incontinence and/or impotence) - these can occur and do not necessarily suggest cauda equina syndrome in the absence of other hallmarks of that condition
  • Hoffman’s sign: is a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.
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23
Q

gold standard Ix Degenerative cervical myelopathy and management

A

MRi cervical spine
Mx DCM= urgent spinal surgery referral

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24
Q

what is syringomyelia
CFs

A

collection of CSF within spinal cord,
CFs:
cape like (neck shoulder arms) loss of sensation to pain- BUT light touch and proprioception preserved
spinothalamic sensory loss (pain and temperature)

spastic weakness, upgoing plantars, neuropathic pain horners syndrome)rare-

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25
Q

Phenytoin side effects + mneumonic

and how to monitor levels of it

A

HOT MALIKA
H - hirsutism and facial feature coarsening
O- osteomalacia
T - teratogenic
M- megaloblastic anemia
A- arrhythmia in high dose
L- lymph node enlargement
I- insulin decrease
K- vitamin K decrease
A- ataxia in high dose

serum trough levels taken STRAIGHT BEFORE NEXT DOSE

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26
Q

when can stop AEDs

A

when seizure free over 2 years , taper dose over 2-3 months

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27
Q

treatment ramsay hunt syndrome

A

oral aciclovir and oral corticosteroids

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28
Q

post stroke management meds

A

300mg aspirin for 2 weeks and then 75mg clopi life long

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29
Q

hypodense (dark), crescentic collection around the convexity of the brain, hypodense collection around the convexity of the brain that is not limited to suture lines.

A

chronic haematomas

LIMITED TO SUTURE LINES= EXTRA dural

not limited to suture lines-subdural

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30
Q

A CT head with contrast is performed, which shows a solitary ring-enhancing lesion in the left temporal lobe.

and which treatment

A

brain abscess- treat with antibiotics

IV CEFTRIAXONE and IV METRONIDAZOLE

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31
Q

neuroleptic malignant syndrome

CFs

Tx

A

rare antipsychotic side effect
and when parkinsons meds suddenly stopped

pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion

A raised creatine kinase

Tx: DANTROLENE and supportive measures

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32
Q

treatment neuroleptic malignant syndrome

A

admit
iv fluids
bromocriptine ocreotide

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33
Q

A 55-year-old man presents complaining of visual disturbance. Examination reveals a right congruous homonymous hemianopia with macula sparing. Where is the lesion most likely to be?

A

left occiptal cortex

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34
Q

which antisickness medications is most likely to precipitate extrapyramidal side-effects?

A

metoclopramide

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35
Q

von Hippel-Lindau syndrome

A

autosomal dominant condition predisposing to neoplasia. It is due to an abnormality in the VHL gene located on short arm of chromosome 3

Features
cerebellar haemangiomas: these can cause subarachnoid haemorrhages
retinal haemangiomas: vitreous haemorrhage
renal cysts (premalignant)
phaeochromocytoma
extra-renal cysts: epididymal, pancreatic, hepatic
endolymphatic sac tumours
clear-cell renal cell carcinoma

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36
Q

Normal pressure hydrocephalus TRIAD of symtpoms

A

TRIAD:
-. urinary incontinence
-. dementia and
-. bradyphrenia/gait abnormality

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37
Q

management normal pressure hydrocephalus

A

Management
ventriculoperitoneal shunting
around 10% of patients who have shunts experience significant complications such as seizures, infection and intracerebral haemorrhages

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38
Q

trigeminal neuralgia management

A

carbamazepine first line

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39
Q

laughter and collapse = ?

A

cataplexy= narcolepsy

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40
Q

Lip smacking + post-ictal dysphasia are localising features of a ? lobe seizure

A

TEMPORAL lobe seizure

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41
Q

how long not allowed to drive after first seizure, but imaging and eeg normla

A

6 months

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42
Q

TACS stroke criteria (3)

A

ALL 3 NEEEDED TO BE TACS:

  1. Unilateral weakness (and/or sensory deficit) of the face, arm and leg
  2. Homonymous hemianopia
  3. Higher cerebral dysfunction (dysphasia, visuospatial disorder)
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43
Q

PACS criteria

A

2 of the TACs crieteria needed:
1. Unilateral weakness (and/or sensory deficit) of the face, arm and leg
2. Homonymous hemianopia
3. Higher cerebral dysfunction (dysphasia, visuospatial disorder)

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44
Q

LACs criteria

A

presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

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45
Q

Posterior circulation infarcts POCS criteria

A

presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia

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46
Q

what arteries affected IN TACS

A

Middle and Anterior cerebral arteries

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47
Q

what arteries affected in PACS

A

smaller arteries of anterior circulation e.g. upper or lower division of MCA

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48
Q

what arteries affected IN LACS

A

Arteries around the internal capsule, thalamus and basal ganglia

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49
Q

what arteries affected in POCS

A

Vertebrobasilar arteries

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50
Q

another name for lateral medullary syndrome

A

wallenbergs syndrome

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51
Q

what is lateral medullary syndrome

which aa affected

CFs

cerrebellar and brainstem features

A

post inferior cerebellar artery PICA

Cerebellar CFs
ataxia
nystagmus

BRAINSTEM CFs
ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss

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52
Q

what is webers syndrome

A

ipsilateral III palsy
contralateral weakness

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53
Q

status epilepticus time

A

single seizure lasting OVER 5 mins
OR
= 2 seizures within a 5-minute period without the person returning to normal between them

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54
Q

first line med for absence seizure

A

ethosuxamide

but if female adult - lamotrigine

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55
Q

which anti epileptic drug can exacerbate absence seizures

A

carbamazepine

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56
Q

focal seizure first line AED

A

lamotrigine

if u FOCUS you can get a LAMBO

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57
Q

which AED can cause visual defects

A

vigabatrin

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58
Q

BPPV treatment and diagnosis

A

DIAGNOSIS= DIX HALLPIKE (D AND D)

MANAGEMENT= EPLEY

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59
Q

when should LP be done post subarach haemorrhage

A

12 hours post symptom onset

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60
Q

procyclidine MOA

A

antimuscarinic

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61
Q

A 65-year-old gentleman presents with progressive dementia and behavioural abnormalities. On closer questioning, he seems to have deficits in concentration, memory and judgement difficulties. There is a family history of psychosis. During the consultation, you notice the patient’s gait is ataxic with a notable jerk of his left hand and general hypokinesia. There is also nystagmus during horizontal gaze. Romberg’s and Dix-Hallpike tests are negative. What is the most likely diagnosis?

A

Creutzfeldt-Jakob disease

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62
Q

cabergoline severe lung side effect

A

pulmonary fibrosis

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63
Q

Miller Fisher syndrome -

A

areflexia, ataxia, ophthalmoplegia

variation of guillan barre syndrome

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64
Q

restless leg syndrome- which blood test to diagnose

A

serum ferritin

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65
Q

Which AEDs cant breastfeed on

A

no need to change- all AEDs ok for breastfeeding

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66
Q

ondansetron moa
and where in the brain does it act

A

5ht3 antagonist
affects medulla oblongata

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67
Q

myoclonic seizures first line treatment

A

sodium valproate- in males
females ; lamotrigine - levetiracetam

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68
Q

migraine treatment in pregnancy
1st line
second line

A
  1. paracetamol
  2. ibuprofen 400mg
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69
Q

foot drop nerve

A
  • common peroneal nn
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70
Q

ropinirole MOA

A

dopamine agonist

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71
Q

SAH investigation

A

ct non contrast

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72
Q

CNs

A

OOOTOAFVGVAH
OLFACTORY
OPTIC
OCULOMOTOR
TROCHLEAR
TRIGEMINAL
ABDUCENS
FACIAL
VESTIBULOCOCHLEAR
GLOSSOPHARYNGEAL
VAGUS
ACCESSORY
HYPOGLOSSAL

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73
Q

intracranial venous thrombosis

gold standard ix

A

Ix gold standard- MRI

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74
Q

myasthenia gravis - which antibodies

CFs

Proximal or distal mms affected ?

Mx

Acute myasthenic crisis mx

A

antibodies against anticholinesterase

mm weakness as day progresses
diplopia (extraocular mm weakness)
PROXIMAL mm weakness- neck, face, limb girdle

Mx: pyridostigmine- long acting AChE inhibitors
prednisolone initially
Long term- immunosuppression#

Mx acute myasthenic crisis-
IVIG
plasmaphoresis

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75
Q

Demyelination of the central nervous system is the pathophysiology in ??

A

Multiple sclerosis

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76
Q

Demyelination of the PERIPHERAL nervous system is the pathophysiology in ???

A

Guillan barre syndrome

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77
Q

hoffman sign used in ? spine conditio

A

DCM
a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.

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78
Q

what neuro condition is improved by alcohol?

A

essential tremor

79
Q

Essential tremor CFs
Mx
inheritance

A

CFs
postural tremor- worse if hands outstretched
improved by alcohol and rest
most common titubation cause

Mx=
propanolol (if pt has asthma give primidone)
primidone (barbituate)

Inheritance= aut dom

80
Q

Lambert Eaton syndrome
antibody
CFs

Ix and results

Mx

A

Lambert eaton == myasthenic syndrome, commonly ass’d with SCLC
Anti VGCC antibody (voltage-gated calcium channel)

CFs
repeated muscle contractions lead to increased muscle strength (in contrast to myasthenia gravis)
waddling gait

Lower limb weakness first
Hyporeflexia
dry mouth, impotence, difficulty weeing

Ix
EMG - increment in muscle action potentials after exercise.

Mx
Tx underlying condition eg SCLC
Immunosuppression- azathioprine , prednisolone
IVIG sometimes

81
Q

MRI is performed which reveals bilateral asymmetric and poorly marginated hyperintense T2-weighted and FLAIR lesions within the subcortical white matter. A lumbar puncture reveals no oligoclonal bands in the CSF.

patchy haemorrhagic changes

Dx?

A

acute disseminated encephalomyelitis

(Enchephalomyeltis= lnflam. Of white matter ) by meaning.
*In herpes simplex it is encephalitis.
*So, mentioning lesions in white matter means ADEM.

82
Q

Acute disseminated encephalomyelitis
CAUSES/triggers

time frame

Mx

A

autoimmune demyelinating disease of the central nervous system.

post viral resp infec
weeks-months post infection

Management involves intravenous glucocorticoids and the consideration of IVIG where this fails.

83
Q

eyes DOWN AND OUT== nn palsy?
ipsi/contralat?

A

3rd nerve oculomotor nn palsy
ptosis (levator palpabrae affected too)
ipsilateral

can be associated with uncal herniation AND raised ICP

84
Q

most common complication post meningitis

A

SNHL

85
Q

upbeat nystagmus and
downbeat mystagmus
causes

A

upbeat nystagmus= cerebellar vermis lesion
VERMIN RUN UP PIPES

downbeat nystagmus=
arnold chiari malformation

86
Q

migraine +COCP why CI?

A

signif increase risk of stroke

87
Q

first line meds for spasisity in MS

first line non med mx

A

baclofen
gabapentin
physio

88
Q

Acute MS relapse Tx

A
  1. High dose steroids pred
89
Q

Drug options for reducing the risk of relapse in MS

A

natalizumab
ocrelizumab
fingolimod
beta interferon
glatiramer acetate

90
Q

Restless leg syndrome medication

A

ropinirole

91
Q

Diabetic neuropathy, myasthenia gravis and Guillain Barre syndrome would cause??UMN OR LMN signs

A

LMN signs only

92
Q

cannot drive how long post stroke/TIA

A

1 month if one episode

if multiple TIAs=== 3 months

93
Q

wake up stroke rules

A

if patient was previously well and wakes up with stroke symptoms:

mechanical thrombectomy within 24 hrs

AND IF CT
shows ACA infarct and LIMITED infarct core

94
Q

Internuclear ophthalmoplegia occurs mostly in which neuro condition

CFs

A

MS -
Internuclear ophthalmoplegia occurs due to a lesion in the medial longitudinal fasciculus

CFs:
horizontal eye movement issues
impaired adduction of the eye on the same side as the lesion
horizontal nystagmus of the abducting eye on the contralateral side

95
Q

severe serotonin syndrome treatment

A

CYPROHEPTADINE

96
Q

LEARN THIS:

Midbrain: vertical gaze palsy
Pons: horizontal gaze palsy

pON: horizONtal gaze palsy

A

Midbrain: vertical gaze palsy
Pons: horizontal gaze palsy

pON: horizONtal gaze palsy

97
Q

SIADH- urinary sodium and urinary osmolality raised or low or normal

A

SIADH = Everything in Urine is ‘high’ (Raised urinary Sodium and raised urinary Osmolality)

98
Q

distal muscle weakness and atrophy, weak ankle dorsiflexion, depressed tendon reflexes, and pes cavus foot deformity

?condition

A

charcot marie tooth disease

99
Q

Charcot-Marie-Tooth disease

A

peripheral neuropathy

affects distal mms

frequent ankle dislocations
high arches
hammer toes
pes cavus foot (high arched feet)
distal mm weakness and atrophy
hyporeflexia

100
Q

spastic paraparesis = UMN or LWM

causes

A

UMN signs
eg hyper brisk reflexes
increased tone

conditions causing spastic paraparesis:
demyelination e.g. multiple sclerosis
cord compression: trauma, tumour
parasagittal meningioma
tropical spastic paraparesis
transverse myelitis e.g. HIV
syringomyelia
hereditary spastic paraplegia
osteoarthritis of the cervical spine

101
Q

What brain lobe causes chorea

A

chorea- Caudate nucleus

102
Q

First fit/seizure/unprovoked seizure and EEG and brain imaging normal – how long cannot drive?

A

6 months

103
Q

Subacute combined degeneration of spinal cord- where does it affect
cause

A

Vit B12 deficiency cobalamin
dorsal columns + lateral corticospinal tracts are affected

joint position and vibration sense lost first then distal paraesthesia
upper motor neuron signs = HYPERREFLEXIA develop in the legs, classically extensor plantars, brisk knee reflexes, absent ankle jerks

dorsal columns and lateral corticospinal tract- loss of vibration and priorioception

mm weakness and HYPERREFLEXIA

104
Q

MND treatment

A
  1. NIV better than medication
  2. Riluzole- decreased glutamate receptor stimulation
105
Q

Types of motor neuron disease (4) and what is the most severe type
which is the most common
best prognosis

A

worst= 1. progressive bulbar palsy

  1. progressive musulcar atophy- BEST prognosis
    LMN only
    distal mms affected first
  2. Primary lateral sclerosis
    UMN only
  3. Amylotrophic lateral sclerosis- 50% pts
    mix UMN and LMN– MOST COMMON TYPE
106
Q

first line imaging for suspected stroke

A

NC CT head

107
Q

what can cause Anti-NMDA receptor encephalitis

CFs

Tx

A

ovarian teratoma in half adult female pts

CFs
agitation, hallucinations, delusions and disordered thinking; seizures, insomnia, dyskinesias and autonomic instability

Tx
immunosuppression IV steroids, IGs, rituximab, cyclophosphamide or plasma exchange, alone or in combination. Resection of teratoma is also therapeutic

108
Q

cause of CT head showing temporal lobe changes -

A

herpes simplex encephalitis

109
Q

Tachycardia with lower limb hyporeflexia and flaccid paralysis and urine retention

A

GBS

110
Q

Guillan barre syndrome
CFs
UMN or LMN
weakness pattern

A

CFs
LMN signs only
hyporeflexia
flaccid paralysis
weakness is ascending- Legs affected first

111
Q

creutzfeldt jakob disease
cfs
ix
mx

A

CFs
myoclunus and dementia

Ix
CSF normal
EEG= biphasic high amplitude sharp waves
MRI: hyperintense signals in the basal ganglia and thalamus

Mx

112
Q

myotonic dystrophy

CFs

Ix
Tx

A

distal weakness initially
autosomal dominant
diabetes
dysarthria
LOSS of red reflex - due to bil cataracts , bilateral ptosis
small testicles
Aortic regurg

a trinucleotide repeat disorder

113
Q

treatment myasthenic crisis

A

IVIG or plasma phoresis

114
Q

PITS– if left eye affected- which side is the lesion?

A

the opposite side

Left parietal lobe = right inferior homonymous quadrantanopia
Left temporal lobe = right superior homonymous quadrantanopia
Right occipital lobe = left homonymous hemianopia with macular sparing
Right parietal lobe = left inferior homonymous quadrantanopia

115
Q

prophylaxis cluster headache med

A

verapamil

116
Q

treatment wests syndrome

A

vigabatrin and steroids
has a poor prognosis

117
Q

conduction dysphasia brain area affected

A

arcuate fasciculus (arcuate sounds like articulate)

118
Q

hemiballism- ipsi or contralateral to affected brain side

can be caused by damage to WHERE in the brain

A

contralateral

subthalamic nucleus affected

119
Q

what condition is common after SAH

A

SIADH

119
Q

? klumpes paralysis

A

T1 nerve damage
damage to innervation of intrinsic hand muscles - ulnar nerve

120
Q

nerve damage causing erb duchenne paralysis- winged scapula

A

C5 C6

can be caused by birth trauma- breech presentatio

121
Q

trinucleotide repeats for
friedrichs ataxia
huntingtons chorea
myotonic dystrophy
fragile x

A

Freidrich’s ataxia- GAA- gaa so many a’s
huntingtons chorea- CAG (posh- caggie)
myotonic dystrophy- CTG (T in the middle)
fragile x - CGG (XX=GG)

122
Q

which condition ass’d with low orexin (hypocretin) levels

A

narcolepsy cataplexy

123
Q

brown sequard syndrome

A

lateral hemisection of SC

IPSILATERAL loss of vibration and proprioception and weakness

CONTRALATERAL loss of pain and temperature

important eg pain and temp cross over first

124
Q

medication over use treatment

A

IMMEDIATELY stop meds
including stopping triptans

only slowly withdraw opiods

125
Q

ischaemic stroke long term tx

A

clopidogrel only
if clopi is CI or not tolerated:
give aspirin and dypiridamole

126
Q

barthel scale used for

A

measures disability or dependence in activities of daily living in stroke patients

127
Q

sub dural or extra dural-
head injury with initial LOC but then regained conciousness and then LOC again

which vessel affected

A

EXTRADURAL- USUALLY caused by blunt force trauma

middle meningeal artery is the primary pathology in extradural haematomas.

128
Q

diffuse axonal injury cause

A

diffuse axonal injury occurs as a result of mechanical shearing following deceleration, causing disruption and tearing of axons

129
Q

lamotrigine MOA=

A

sodium channel blocker
can causE SJS

130
Q

how is lambert eaton syndrome different to MG

A

lambert eaton syndrome— repeated mm contractions IMPROVE symptoms

MG= repeated contractions==> fatigue

131
Q

neuromyelitis optica VS MS

A

Both MS and neuromyelitis optica:
Optic neuritis
Acute myelitis

Neuromyelitis ONLY
BRAIN MRI not meeting MS criteria
NMO-IgG seropositive status

132
Q

The MRI finding of enhancement of the mamillary bodies due to ??

A

wernickes encephalopathy caused by XS alcohol

133
Q

Hyperintense T2 signal extending across the spinal cord, between the levels of T9 and T12====?

cause and ass’d infections

A

Transverse myelitis

caused by viral infection - such as varicella, herpes simplex, EBV and HIV

134
Q

DIFFERENCE between parkinsons and progressive supranuclear palsy

A

Progressive supranuclear palsy
- impairment of vertical gaze (down gaze worse than up gaze - patients may complain of difficultly reading or descending stairs)

135
Q

POST LP headache treatment

A

blood patch
IV caffeine
epidural saline
to prevent subdural haematoma
Typical features
usually develops within 24-48 hours following LP but may occur up to one week later
may last several days
worsens with upright position
improves with recumbent position

136
Q

dopamine receptor agonists used in the management of Parkinson’s disease is least associated with pulmonary, retroperitoneal and pericardial fibrosis?

A

ropinirole

137
Q

foster kennedy syndrome
where is the tumour
ipsi and contralateral CFs

A

frontal lobe tumour
ipsilateral optic atrophy
contralateral papillodema

138
Q

baclofen MOA

A

GABA agonist

139
Q

where is medial longitudinal fasciculus located
(affected by internuculear opthalmoplegia)

A

medial longitudinal fasciculus is located in the paramedian area of the midbrain and pons

140
Q

gerstmanns syndrome
cfs
cause
defect where in the brain

how to decide right or left parietal side affected

A

type of parietal lobe lesion

CFs
alexia, acalculia, finger agnosia and right-left disorientation

RIGHT LEFT disorientation

common post stroke

if patient is right handed (will show right left disorientation), so the dominant side=left side in brain= LEFT parietal lobe affected

141
Q

drugs causing tinnitus

A

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

142
Q

drugs causing peripheral neuropathy

A

IAM Very Numbed
I isoniazid
A amiodarone
M metronidazole
V vincristine
N nitrofurantoin

143
Q

Friedreich’s ataxia
CFs
cause

A

cause GAA chr 9
aut rec

absent ankle jerks
cerebellar ataxia
optic atrophy
DM
cardiomyopathy
kyphosis
spinocerebellar degeneration
high arched palate
GAA, can’t look Friedreich in the eye because he has nystagmus, optic atrophy, diabetic retinopathy and is looking at the floor (kyphoscoliosis).

144
Q

CADASIL mutation- ?

what is cadasil

A

NOTCH 3 MUTATION
aut dom
CADASIL is a rare cause of multiple cerebral infarctions

onset of migraines in middle age, followed by recurrent TIAs and strokes, and resulting in neuro-cognitive decline, psychiatric problems and dementia. MRI often shows multiple widespread hyper-intense lesions in the white matter, basal ganglia, thalamus and pons.

145
Q

STATUS EPILEPTICUS MX

A

First-line drugs are IV benzodiazepines such as diazepam or lorazepam
can repeat after 10 mins

ongoing established seizing== give IV phenytoin

45 mins == Induce GA

146
Q

Ataxic telangiectasia

A

aut rec

Ataxia telgenectasia: All the As
ATM gene
Ataxia + abnormal movements
IgA deficency, frequent infections
Angiomas
A lot of cancers (all the Ls)

147
Q

conductive hearing loss +tinnitus + family hx=?

A

otosclerosis

Mx= hearing aid
stapedectomy

148
Q

medications that exacerbate myasthenic crisis

A

PPP LGBQA
Procainamide
phenytoin
penicillamine

Lithium
Gentamicin
Beta blockers
Quinine
Antibiotics- macrolides, quinines tetracyclines

149
Q

manage drooling of saliva in people with Parkinson’s disease

A

glycopyrronium bromide

150
Q

Left trochlear nerve palsy vertical diplopia - which way willl head tilt to compensate

A

head tilts to the right

151
Q

management confirmed aneurysm caused SAH

A

nimodipine to prevent vasospasm
coil

152
Q

4 functions of facial nn cn7

A

face ear taste tear
Supply - ‘face, ear, taste, tear’
face: muscles of facial expression
ear: nerve to stapedius
taste: supplies anterior two-thirds of tongue
tear: parasympathetic fibres to lacrimal glands, also salivary glands

153
Q

LMN causes of facial nn palsy

A

Bell’s palsy
Ramsay-Hunt syndrome (due to herpes zoster)
acoustic neuroma
parotid tumours
HIV
multiple sclerosis*
diabetes mellitus

154
Q

what is the only UMN cause of facial nn palsy

A

STROKE

155
Q

wernickes vs korsakoff symptoms

A

COAT RACK

156
Q

POOR PROGNOSTIC feature GBS

A

Poor prognostic features
age > 40 years
poor upper extremity muscle strength
previous history of a diarrhoeal illness (specifically Campylobacter jejuni)
high anti-GM1 antibody titre
need for ventilatory support

157
Q

Unicentric Castleman’s disease

A

Unicentric Castleman’s disease is a lymphoproliferative disorder associated in a subset of cases with HIV and HHV-8. Patient’s with unicentric Castleman’s disease tend to be asymptomatic and lymphadenopathy is constrained to one lymph node group.

Biopsy of the lymph node commonly shows regressed germinal centres surrounded by prominent mantle zones.

158
Q

GBS nerve conduction study shows:

A

decreased velocity

159
Q

transient global ischaemia

A

acute onset anterograde amnesia= cannot make new memories
anxiety
REPEATING questions

resolves fully within 24 hrs

160
Q

neurofibromatosis

A

NF1
Chr 17
skin patches, scoliosis, freckles,
phaeochromocytomas

NF2
Chr 22
schwannomas
bil acoustic neuroma
meningioma

161
Q

treatment neuroleptic malignant syndrome

treatment serotonin syndrome

A

neuroleptic= bromocriptidine

serotonin- cyproheptadine

162
Q

gingival hyperplasia causes

A

Gingival Hyperplasia
PANiC
Phenytoin
AML
Nifedipine
Cyclosporin
CCB

163
Q

Painful third nerve palsy

A

Posterior communicating artery aneurysm

164
Q

slow relaxing grip =

A

myotonic dystrophy

165
Q

otitis externa tx

A

topical steroid and amynoglycoside

166
Q

when to give prednisolone in bells palsy

A

within 72 hrs onset

167
Q

whcih type of anti epileptic causes visual field defect

A

V for Vigabatrin - V for Visual field defects

168
Q

p smacking + post-ictal dysphasia are localising features of a ???lobe seizure

A

Focal awareness impaired, temporal lobe

169
Q

what vein damaged in subdural haematoma

A

bridging veins

170
Q

how to remember what is used in acute to treat migraine

and how to prevent migraine

A

5-HT agonists used when you are in agony
5-HT antagonists used when you are not

171
Q

what CFs of cavernous sinus
orbital apex syndroe

superior orbital fissure syndrome

A

3, 4, 6 involvement with 1st division of trigeminal and there is proptosis, vision loss and fixed dilated pupil = orbital apex syndrome

only proptosis and fixed dilated pupil - superior orbital fissure syndrome.

Cavernous sinus etiology is varied but absence of proptosis with pupillary sparing can be seen only in cavernous sinus etiology.

172
Q

CFs of spastic paresis

A

Spastic paraparesis describes a upper motor neuron pattern of weakness in the lower limbs

173
Q

selegilineMOA

A

selegiline= MAO B Inhibitor

174
Q

Bilateral spastic paresis and loss of pain and temperature sensation==?

A
  • anterior spinal artery occlusion
175
Q

if LMN lesion= where in the face is affected

A

forehead affected

in contrast, an upper motor neuron lesion ‘spares’ the upper face

176
Q

important side effect of topiramate

A

migraine prophylaxis

can cause closed angle glaucoma

177
Q

contraindication to triptan use

A

prev cardiovascular IHD

178
Q

distinguish a diagnosis of vestibular neuronitis rather than viral labyrinthitis.

A

vestibular neuronitis = absence of hearing loss

viral labyrinthitis = normal hearing

179
Q

charcot marie tooth inhertance

A

aut dom

180
Q

acute disseminated encephalomyelitis

A

no oligoclonal bands

post viral illness (weeks)
motor weakness, encephalopathy, seizures and coma
MRI imaging which reveals poorly-defined hyperintensities in the subcortical white matter.

181
Q

motion sick ness meds

A

HCP

Hyoscine
Cyclizine
Promethazine

182
Q

brocas = which artery and side affected

A

LEFT MCA

183
Q

prolactinoma Cfs and biochem

A

hypogonadism
low sex hormones

positive galacctorrhoea

184
Q

fascioscapulohumeral muscular dystrophy CFs
inheritance

A

aut dom

Features
facial muscles are involved first - difficulty closing eyes, smiling, blowing etc
weakness of the shoulder and upper arm muscles
abnormal prominence of the borders of the shoulder blades - ‘winging’
lower limb: hip girdle weakness, foot drop

IMPORTANT TO PREDICT PROGNOSIS= FVC

185
Q

is botulisim exo or endo toxin

A

botulism is an exotoxin

186
Q

seligine MOA

A

MOA B inhibitor

187
Q

difference between ramsey hunt and herpes zoster opthal

A

ramsey hunt = ear involvement and tongue involvement == FACIAL NERVE

herpes zoster opthalmicus== eg trigem nn distrubution only plus vesicles

188
Q

UMN causes and how it affects face

A

UMN lesion is only caused by stroke

Upper face SPARED

189
Q

what type of ACH receptor affected in MG

A

NICOTINIC AChE receptors

190
Q

what causes RAPD

A

optic nerve lesion or severe retinopathy

191
Q

how to distinguis neuroleptic malignant syndrome vs serotonin

A

neuroleptic syndorme has NO CLONUS

serotonin syndrome= HAS MYOCLONUS

192
Q

reduce risk relapse in ms

A

natalizumab antagonises alpha-4 beta-1-integrin found on the surface of leucocytes

ocrelizumab anti cd20
fingolimod
sphingosine 1-phosphate (S1P) receptor modulator

interferon beta

193
Q

which antipsychotic is CI in parkinsons for old ppl

A

DO NOT GIVE HALOPERIDOL– movement disorder

therefore give IM Loraz

M R C P (18 decks)

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