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Phase 2a mocks > Neuro > Flashcards

Neuro Flashcards

1
Q

Headache, particularly painful when touching right temple, pain spreads to jaw. Very high ESR.

Diagnosis and potential complication?

A

Giant cell arteritis!

Blindness. GCA is a medical emergency!!

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2
Q

What lobe is most commonly effected in complex seizure?

A

Temporal lobe

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3
Q

Which vitamin is deficient in Wernicke encephalopathy?

A

B1 (thiamine)

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4
Q

What is a common initial symptom of MS?

A

Optic neuritis

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5
Q

What is the most common complaint with MG?

A

Weakness worse after exertion

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6
Q

What is Horner’s syndrome? What kind of tumour can cause it?

A

Damage to sympathetic nerves
- anhydrosis (reduced sweating)
- miosis (pupil constriction)
- ptosis

Pancoast tumour can cause it.

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7
Q

Describe the consequences of Brown-Sequard syndrome

A

Ipsilateral loss of position, vibration sensation, and motor control at the level of the lesion

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8
Q

What are the lower MN sings?

A

Everything goes down!!

-hyporeflexia
-hypotonia
- negative babinski sign
- flaccid paralysis

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9
Q

Artery likely to be affected: stoke affecting the right lower limb

A

left anterior cerebral artery

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10
Q

First line pharmacological management of subarachnoid haemorrhage

A

Nimodipine (CCB)

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11
Q

Most appropriate first line investigation for suspected MS

A

MRI head (shows demyelination where CT cannot)

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12
Q

What is the first line acute treatment for migraines?

A

Sumatriptan

Serotonin 5-HTI receptor agonist

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13
Q

Early personality change is a key feature of which type of dementia?

A

Frontorotemporal dementia

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14
Q

What are the non motor symptoms of Parkinson’s?

A
  • REM sleep disorder
  • postural hypotension
  • constipation
  • depression
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15
Q

What is the name of the only life prolonging drug available to those with MND?

A

Riluzole

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16
Q

What tests should be done to diagnose MS? Give reasons for each

A

MRI and lumbar puncture

MRI: look for plaques
LP: look for oligoclonal bands in the CSF

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17
Q

Describe the mechanism of disease behind Alzheimer’s

A

Accumulation of beta-amyloid plaques and neurofibrilary tangles, resulting in memory loss

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18
Q

Pain in hand at night, progressively worse, tingling in index and middle fingers.

Most likely diagnosis?

A

Carpal tunnel syndrome

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19
Q

What clinical test is used to help diagnose Carpal tunnel’s?
Would result would indicate?

A

Phalen’s test
Inability to maintain wrist flex for longer than 1 min

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20
Q

What symtoms would a C7 compression cause?

A

Pain in the hand
Weakness with elbow extension

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21
Q

What symptoms would a L2-3 compression cause?

A

Pain in the inner leg

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22
Q

What would a L5 compression cause?

A

Pain in the outer leg
Weakness with dorsiflexion of the ankle

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23
Q

What would a S4 compression cause?

A

Pain and weakness with the perianal area, resulting in bladder and bowel dysfunction

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24
Q

How can you clinically distinguish between a common perineal nerve palsy and an L5 reticulopathy ?

A

If ankle eversion is affected = common perineal nerve palsy
If ankle inversion is weak = L5 reticulopathy

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25
Q

Give 4 clinical features of cauda equina syndrome

A
  • saddle anaesthesia
  • lower back pain radiating down both legs (bilateral sciatica)
  • urinary incontinence
  • loss of anal tone
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26
Q

How is cauda equina managed?

A

Surgical decompression

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27
Q

What does claw hand and elbow pain indicate?

A

Ulnar nerve damage

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28
Q

What is the first line management of trigeminal neuralgia?

A

Carbemazepine

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29
Q

Describe the pathology of granulomatosis with polyangiitis

A

Autoimmune condition associated with necrotising granulomatous vasculitis, effecting the respiratory tract and kidneys

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30
Q

List 3 respiratory symptoms of granulomatosis with polyangiitis

A
  • epistaxis
  • sinusitis
  • nasal crusting
  • haemoptosis
  • dyspnoea
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31
Q

What effect does granulomatosis with polyangiitis have in the kidneys?

A

Rapidly progressive glomerulonephritis

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32
Q

What facial deformity is seen in granulomatosis with polyangiitis?

A

Saddle shape nose

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33
Q

List 4 medications used in migraine prophylaxis

A

Βeta blocker e.g. propranolol
Amitrytyline
Anti convulsant e.g. Topiramate
Botulinum toxin type A

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34
Q

List 4 investigations done in suspected dementia

A
  • Mini mental state assessment
  • MRI
  • CSF analysis
  • confusion screen
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35
Q

Dementia presentation: stepwise deterioration. Which type?

A

Vascular dementia

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36
Q

Describe the pathology of myasthenia gravis

A

Autoimmune disease caused by AChR antibodies that attack the post synaptic side of the neuromuscular junction, causing reduced muscle contraction
Mainly effects the muscles of the eyes and face

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37
Q

Give 4 features of MG

A
  • fatiguability
  • ptosis
  • diplopia
  • dysphasia
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38
Q

How is MG diagnosed?

A

Single fibre electromyography

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39
Q

What are the three management steps of MG?

A
  1. Pyridostigmine (long acting Ach inhibitor)
  2. Prednisolone
  3. Thymectomy
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40
Q

Describe the pathology of MS

A

Autoimmune demyelination of the CNS - affecting oligodendrocytes

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41
Q

What symptoms would a temporal lobe seizure cause?

A

Automatisms e.g. lip smacking, fiddling, chewing

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42
Q

What symptoms would a frontal lobe seizure cause?

A

Motor features e.g. peddling movements of the legs, ‘Jacksonian march’

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43
Q

What is the clinical difference between complex partial and simple partial seizures ?

A

Complex partial seizures cause a loss of awareness during the seizure, and post ictal symptoms such as confusion.

Simple partial seizures do not cause this

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44
Q

Dysarthria, dysphasia, regurgitation, choking.
Nasal/hoarse speech, flaccid tongue, absent jaw jerk.
Most likely diagnosis?

A

Progressive bulbar palsy

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45
Q

What cranial nerves can be affected in PBP?

A

9, 10, 11, 12

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46
Q

What symptoms can a cerebellar tumour cause?

A
  • headache, drowsiness, vomiting - due to raised ICP
    DAHSING:
  • dysdiadochokinesia
  • ataxia
  • slurred speech
  • hypotonia
  • intention tremor
  • nystagmus
  • gait abnormality
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47
Q

What investigation is contraindicated in suspected cerebellar tumour and why?

A

Lumbar puncture!
Due to raised ICP, risk of immediate coning

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48
Q

Most common causative bacteria of meningitis in adults?

A

Streptococcus pneumoniae

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49
Q

Most common causative bacteria of meningitis in Immunocompromised adults and the elderly ?

A

Listeria monocytogenes

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50
Q

What is the first line investigation for meningitis?

A

Blood cultures

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51
Q

From CSF analysis, name 4 factors that would indicate that the causative organism of meningitis is bacterial instead of viral?

A
  • increased neutrophils
  • increased protein levels
  • decreased glucose levels
  • cloudy CSF appearance
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52
Q

Name 3 contraindication to performing a lumbar puncture

A
  • signs of raised ICP e.g. headache, vomiting
  • coagulopathy
  • focal neurology
  • cardio vascular compromise e.g. bradycardia and hypertension
  • infection at the site of LP
  • decreased GCS
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53
Q

What prophylactic antibiotic treatment would be offered to the partner of a pt with meningitis?

A

Oral ciproloxacin

54
Q

What is the medical terms for a feeling of curtains coming down over a pts eyes?

A

Amaurosis fugax

55
Q

Suspected GCA biopsy. What artery is it taken from and describe the appearance of the cells?

A

Temporal artery
Multinucleated giant cells

56
Q

What medicated is urgently prescribed in GCA?

A

Prednisolone

57
Q

Is someone were to abruptly stop taking Prednisolone, what is the potential complication?

A

Adrenal crisis

58
Q

If GCA isn’t treated urgently, what is a potential complication?

A

Blindness

59
Q

Severe unilateral headache, around the orbital region. Right eye is blood shot, slight ptosis.
Diagnosis and 2 other features that would be seen on examination?

A

Cluster headache

  • rhinorrhoea
  • lid swelling
  • lacrimation
  • miosis
  • sweating
60
Q

What is the acute treatment for cluster headache?

A

100% O2 and SC sumatriptan

61
Q

What drug is used as cluster headache prophylaxis?

A

CCB e.g. verapamil

62
Q

What is encephalitis?

A

Inflammation of the brain parenchyma usually caused by virus

63
Q

What is the most common infective cause of encephalitis in Immunocompromised pts?

A

Herpes simplex virus - type 1

64
Q

What would be the diagnostic investigation in a patient with encephalitis?

A

Lumbar puncture with CSF viral PCR testing

65
Q

What would be the first line treatment of viral encephalitis?

A

IV Acyclovir (antiviral)

66
Q

Name 3 migraine triggers

A
  • cheese
  • chocolate
  • oral contraceptive pill
  • caffeine
  • alcohol
  • anxiety/stress
  • menstruation
  • bright lights
67
Q

What is the immediate medical management for migraines?

A

simple analgesia e.g. paracetamol
triptans e.g. sumatriptan

68
Q

Alzheimer’s disease: risk factors (3)

A
  • increasing age
  • family history of alzheimers
  • Down syndrome
  • caucasian ethnicity
  • reduced physical/cognitive activity
69
Q

What are some hallmark features of Alzheimer’s on CSF/bloods/MRI

A
  • extracellular deposition of of beta amyloid plaques
  • tau neurofibrillary tangles
  • damaged synapses
  • cortical atrophy
70
Q

What is the first line medication used in management of Alzheimer’s?

A

Acetylcholinesterase e.g., donepezil, galantine, rivastigmine, memantine

71
Q

List 5 symptoms of Parkinson’s

A
  • bradykinesia
  • resting tremor
  • rigidity
  • dementia
  • REM sleep disturbance
  • constipation
72
Q

What is the pharmacological management for Parkinson’s?

A

Levodopa, dopamine agonists, COMT/MAO-B inhibitor

73
Q

List 3 causes of Guillain-Barre syndrome

A
  • Campylobacter jejuni infection
  • Cytomegalovirus
  • Epstein Barr Virus
74
Q

List 4 clinical features expected in Guillain-Barre syndrome

A

Motor weakness – often distal and ascending
Paraesthesia
Respiratory involvement
Autonomic involvement – HR changes, BP changes, urinary control symptoms

75
Q

How is GBS diagnosed?

A

Lumbar puncture, showing increased CSF proteins

76
Q

What is the treatment for GBS?

A
  • IV immunoglobulins
  • plasma exchange
  • supportive care in ITU
77
Q

Acute onset facial drooping.
Give 3 DD

A
  • Bell’s palsy
  • Stoke
  • TIA
78
Q

Pt with unilateral facial drooping whose forehead wrinkles when asked to raise eyebrows. What DD is excluded and why?

A

Bell’s palsy is excluded.
Bell’s palsy is a LMN lesion of the facial nerve, so is not forehead sparing. Stroke and TIA are forehead sparing due to the bilateral innervation of the temporalis muscle (as stroke/TIA have UMN signs)

79
Q

Facial drooping that self resolves within 24hrs. Diagnosis?

A

TIA

80
Q

What type of medication should be added for TIA pt?

A

Aspirin and clopidogrel

81
Q

How do you work out pack years?

A

Number of packs smoked per day X number of years smoking

82
Q

Pt that appears to understand what you are saying, but is struggling to speak and is slurring his words. What type of aphasia is this?

A

Expressive aphasia / Brocca’s aphasia

83
Q

What is an ABCD2 score? What are each of the points?

A

Score for the risk of a pt that had a TIA will experience a stroke in the following days
Age >60 = 1
Blood pressure = 1
Clinical features (unilateral weakness = 2, speech disturbance = 1)
Diabetes = 1
Duration (>60mins = 2, 10-59mins = 1)

84
Q

GS diagnostic test for generalised tonic clonic seizure

A

EEG

85
Q

List 2 medications that are used to manage generalised tonic clonic seizures in a young female

A

lamotrigine or levetiracetam

86
Q

What medication is used first line for males with generalised tonic clonic seizures?

A

Sodium valporate

87
Q

A 23-year-old man comes into A&E from a car accident, with a brief loss of consciousness but improved temporarily, but is deteriorating again. He has a headache, his pupil is dilated, his breathing has become deep and irregular and he is confused.
What type of haemorrhage is this likely to be and what is the most likely affected artery?

A

Extradural haemorrhage
Middle meningeal artery

88
Q

Describe what is seen on CT of extradural haemorrhage

A

Hyperdense mass that is biconvex shaped and adjacent to the skull

89
Q

How is raised ICP treated?

A

IV mannitol

90
Q

A 20-year-old female comes in after a night out and fell asleep on her stomach. She woke up with numbness
and tingling in her hand and it was relieved by dangling it over the edge of the bed and shaking it out.

What is this syndrome called and what nerve is affected?

A

Carpal tunnel syndrome
Median nerve

91
Q

Name two clinical tests used to examine suspected carpal tunnel

A

Phalen’s test
Tinel’s test

92
Q

What are the nerve roots of the median nerve?

A

C6, C7, C8, T1

93
Q

Define epilepsy

A

The recurrent tendency of spontaneous intermittent abnormal electrical activity in part of the brain manifesting in seizures

94
Q

Define epileptic seizure

A

Paraoxysamal event that causes change of behaviour / cognitive processes due to hyper synchronous neuronal discharges in the brain

95
Q

Define syncope

A

Paraoxysamal event that causes change of behaviour / cognitive processes due to a lack of oxygen or blood flow

96
Q

Define non-epileptic seizure

A

Paraoxysamal event that causes change of behaviour / cognitive processes due to mental processes associated with psycho social distress

97
Q

Give 2 RFs for epilepsy

A
  • family history
  • premature birth
  • dementia
  • use of drugs e.g. cocaine
  • stroke
98
Q

What 2 categories can epileptic seizures be classified into?

A

Primary generalised,
Partial / focal

99
Q

What is the 1st line treatment for migraine

A

NSAIDs + sumatriptan

100
Q

What is the diagnostic criteria for MS?

A

2+ lesions disseminated by space and time AND exclusion of differential diagnoses

101
Q

They have primary progressive multiple sclerosis. Explain the course of this disease in regards to disability

A

disability over time

/

102
Q

MS spinal cord lesion symptoms?

A
  • numb/tingling limbs
  • leg weakness
  • bladder/sexual dysfunction
  • Lhermitte’s sign (electric shock sensation on neck flexion)
103
Q

What affect does heat have on patients with MS and why is this the case?

A

Worsens symptoms – new myelin ineffective

104
Q

What is the Glasgow coma scale used for?

A

Measure of a patients state of consciousness

105
Q

Subdural haematomas can also present as personality changes or unsteadiness. Give a differential diagnosis that should be considered

A

Stoke, dementia, CNS masses

106
Q

In a subdural haematoma where does the bleeding come from?

A

Between the cortex and venous sinuses

107
Q

Between which two meningeal layers do subdural haematomas form?

A

Internal dural layer and arachnoid layer

108
Q

Alcoholics are at a higher risk of subdural haematomas, why is this?

A

Alcohol causes the veins to become thin walled making them more likely to bleed

109
Q

How does ACUTE subdural haematoma appear on CT?

A

Crescent shaped, hyper dense mass

110
Q

What is the preferred management for subdural haematoma?

A

Decompression surgery e.g. craniotomy

111
Q

First line imaging investigation for suspected stroke

A

Head CT

112
Q

What is the pattern of inheritance of huntingtons disease?

A

Autosommal dominant

113
Q

Acute treatment of subarachnoid haemorrhage?

A

Nimodipine

114
Q

Raised ICP treatment?

A

IV mannitol

115
Q

Curative surgery for epilepsy

A

Respective surgery of affected area
Hemispherectomy

116
Q

Parkinson’s Pathophysiology

A
  • loss of dopamine in the substantia nigra of the pars compacta.
  • Normally dopamine stimulates movement from the basal ganglia by inhibiting the inhibitory pathway of the striatum therefore allowing movement.
  • In Parkinson’s the amount of dopamine is reduced, therefore there is less inhibition of the inhibitory pathway, therefore less movement.
117
Q

By what mechanism does pyridostigmine help treat Myasthenia Gravis?

A

An anticholinesterase, increasing the availability of Acetylcholine in the synapse.

118
Q

What is the triad presentation in bacterial meningitis?

A
  • headache
  • neck stiffness
  • fever
119
Q

List 2 of the common bacterial causes of meningitis in children.

A

Neisseria meningitis
Streptococcus pneumonia/pneumococcus
Haemophilus influenza

120
Q

How would you manage someone with suspected meningococcal septicaemia?

A

Immediate IV cefotaxime
Do not perform lumbar puncture due to risk of coning cerebellar tonsils/raised intracranial pressure
Confirm diagnosis with blood cultures instead

121
Q

Give 3 differences between an epileptic seizure and a non-epileptic seizure

A
  • eyes closed in non-epileptic, open in epileptic
  • epileptic involves incontinence
  • epileptic involves tongue biting
  • non epileptic involves hip thrusting
  • non epileptic tends to last longer
122
Q

Give 3 different types of generalised seizure

A
  • Tonic clinic
  • clonic
  • absence
123
Q

Give the diagnostic criteria for GCA

A
  • age >50
  • temporal artery tenderness
  • new headache
  • giant cells / neutrophils on temporal artery biopsy
124
Q

Describe the management of GCA

A

High dose corticosteroids e.g. Prednisolone
Methotrexate

125
Q

Drug classes given for acute management of migraine?

A

NSAIDs and Triptans

126
Q

Secondary headaches examples

A
  • meningitis
  • encephalitis
  • GCA
  • medication overuse e.g. paracetamol
  • venous thrombosis
  • tumour
  • subarachnoid haemorrhage
127
Q

How long does an attack of trigeminal neuralgia last for?

A

1-180 seconds

128
Q

Subarachnoid haemorrhage risk factors

A
  • smoking
  • alcohol
  • hypertension
  • bleeding disorder
  • Ehlers Danilo’s syndrome
  • polycystic kidney disease
129
Q

Subarachnoid haemorrhage first line management

A

Head CT

130
Q

Subarachnoid haemorrhage lumbar puncture.

Describe initially and after a few hours

A

Initial = uniformly bloody CSF
After a few hours = xanthochromic (yellow) CSF

131
Q

List the layers of the scalp and the meninges starting from most superficial

A

SCALP
- Skin
- dense Connective tissue
- epicranial Aponeurosis
- Loose connective tissue
- Periosteum

DAP
- Dura mater
- Arachnoid mater
- Pia mater

Phase 2a mocks (11 decks)

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