Neuro Flashcards
What type of headache typically occurs on one side of the head and pounding or throbbing in nature?
Migraine without aura
Other than paracetamol/NSAIDS, what drug can be used to treat migraine?
sumatriptan 50mg
(first line as paracetamol can lead to medication overuse headaches)
What two investigations can you use to investigate meningitis by lying the patient down?
A patient has meningitis caused by neisseria mengitidis and has reduced GCS + fever. What’s the diagnosis?
Meningococcal septicaemia
GP / hospital antibiotics to give for meningitis?
If a patient with meningitis is immunocompromised/over 55 years what antibiotic should you consider?
Amoxicillin
Give four cardinal signs of Parkinson’s?
How does dopamine stimulate movement?
Dopamine inhibits the indirect pathway and excites the direct pathway within the basal ganglia.
What four types of drugs can be given in Parkinson’s?
What is co-benyldopa made up of?
levodopa + benserazide
Give 3 symptoms specific to a MCA stroke patient.
- Contralateral loss of motor skills + sensation in upper limbs
- Contralateral face drop
- Hemianopia
Give five red flag symptoms associated with headaches.
What drug can be given to reduce intracranial pressure?
What three signs/symptoms make up Cushing’s triad?
Give five differences between upper and lower motor neurone lesions.
L5 radiculopathy and common peroneal nerve damage both result in foot drop and toe extensor weakness. What differentiates them?
Common peroneal damage = ankle EVERSION affected
L5 radiculopathy = ankle INVERSION affected
Damage to the deep peroneal nerve results in loss of sensation where?
(deep peroneal = branch of the common peroneal)
First dorsal webspace
What group of muscles do you expect wastage of with claw hand?
Hypothenar muscles (flexors in forearm also supplied by ulnar but you’d see less wastage in these)
What’s the ulnar paradox?
“closer to the paw, the worse the claw”
- more distal damage of the ulnar nerve leads to a great exaggeration of claw hand.
(ulnar nerve supplies the medial aspect of flexor digitorum profundus, and damage leads to damage in flexion - less flexion power in medial digits = less claw hand)
First line treatment for trigeminal neuralgia?
What’s the medical term for a nosebleed?
Epistaxis
Medical term for coughing up blood?
Haemoptysis
Granulomatosis with polyangiitis commonly presents with what shaped nose? Why does this happen?
Saddle shaped nose
Due to perforation of the septum
Which antibody can be tested for to investigate potential granulomatosis with polyangiitis?
c-ANCA
Four drugs that can be used for prophylaxis of migraines?
What scan is not routinely used to diagnose dementia?
CT (MRI produces clearer images of soft tissue and doesn’t expose patient to radiation)
What’s the medical term for a fever?
pyrexia
Which type of dementia exhibits a stepwise deterioration pattern?
What are the signs of fronto-temporal dementia?
What are the signs of Lewy Body dementia?
Give four signs of Alzheimer’s dementia
What’s the medical term for speech difficulties?
Dysarthria
What’s the medical term for swallowing difficulties?
Dysphagia
Huntington’s disease displays anticipation. What is anticipation?
What gene on which chromosome is mutated in Huntington’s?
What does ACA stroke cause?
Contralateral lower limb weakness
In which meningeal space is CSF contained?
Which type of haemorrhage is caused by a berry aneurysm bursting? What does it look like on CT?
What two things is a subarachnoid haemorrhage associated with?
What’s the source of subdural haemorrhages and what does it look like on CT?
What artery usually causes an epidural haemorrhage? How does it appear on CT?
What is myasthenia gravis?
- Autoimmune condition
- AChR antibodies
- Attack acetylcholine receptors on post-synaptic membranes.
What disease is myasthenia gravis linked with?
What cells are affected by MS?
Four disease patterns of MS?
Two diagnostic tests for MS?
- MRI (1st line)
- LP (“oligoclonal bands” can be detected - bands of immunoglobulins)
Most common presenting complaint of MS?
unilateral optic neuritis
What symptoms are typical with frontal lobe focal seizures? (2)
What symptoms are typical with temporal lobe focal seizures? (2)
What symptoms are typical with parietal lobe focal seizures? (2)
What symptoms are typical with occipital lobe focal seizures? (2)
What’s the difference between simple and complex seizures?
What cranial nerves are affected in bulbar palsy?
How do you distinguish pseudobulbar palsy from bulbar palsy?
Symptoms of cerebellar damage?
When are LPs contraindicated?
- infected skin over the puncture site
- increased ICP from any space-occupying lesion (mass, abscess), can cause coning
- trauma or mass in lumbar vertebrae.
Which muscles are supplied by the radial nerve?
Muscles supplied by the median nerve?
What does damage to the axillary nerve cause?
Bells palsy affects what cranial nerve?
CN VII - Facial nerve
What are found on a temporal artery biopsy in giant cell arteritis?
Multinucleated giant cells
What three things are used to diagnose giant cell arteritis?
What’s the major complication that a person with giant cell arteritis is at risk of?
Blindness
Deficiency in which vitamin can lead to Wernicke’s encephalopathy?
Three symptoms of Wernicke’s encephalopathy?
Two symptoms of Korsakoff’s syndrome?
What is Uhthoff’s phenomena?
- transient worsening of neurological symptoms related to a demyelinating disorder (such as multiple sclerosis)
- when the body becomes overheated in hot weather, exercise, fever, saunas, or hot tubs.
What virus causes infectious mononucleosis and what neurological condition is this associated with?
- EBV
- MS (infection causes a 32x increased risk)
What two features would you see in the LP fluid in viral meningitis?
What happens to glucose levels of the CSF in bacterial meningitis?
CSF is cloudy and CSF glucose is low due to bacteria using it up
What’s the cause of Horner’s syndrome and what are the three symptoms of it?
What type of lung tumour can cause Horner’s?
Pancoast tumour of the apex of lung.
What does Brown-Sequard syndrome cause?
- Contralateral loss of pain and temperature 2 levels below lesion
- Ipsilateral loss of motor skills and proprioception + vibration sensation at level of the lesions
When can mannitol be given in a sub-arachnoid haemorrhage?
- reduced GCS
- focal neurological signs
(indicate a raised ICP)
What drug is given to all patients with a SAH and what does it do?
Nimodipine = CCB - prevents vasospasm and therefore brain ischaemia
MC cause of GBS?
Which headaches have an association with family history and have a daily occurrence pattern?
Good description of MS presentation?
Neurological symptoms disseminated in time and space
Three main differences between myasthenia gravis and Lambert-Eaton syndrome?
What drug can combat Lambert-Eaton syndrome?
Lesions to which cranial nerve causes “down and out’?
Which nerve palsy would cause this?
Abducens
What nerve palsy would cause an eye to rotate inwards and upwards?
Trochlear (controls superior oblique which helps to move eye down and out)
What urinary symptom can be present in Parkinson’s?
Urinary urgency (think of David running to the loo)
What drug can be used against MND?
Riluzole
Three classic features of Charcot-Marie-Tooth syndrome?
- weakness in lower legs
- distal muscle wasting (inverted champagne bottle)
- pes cavus
A 20 year old female has a tonic-clonic seizure, what is first line treatment?
Lamotrigene
What two tests can be used to test for Carpal tunnel syndrome?
In myasthenia gravis, are muscurinic or nicotinic ACh receptors targeted?
Nicotinic
What’s the mnemonic for remembering which reflexes are supplied by which vertebrae?
S1-S2 tie my shoe
L3-L4 kick the door
C5-C6 pick up sticks
C7-C8 shut the gate
What does compression of C6 nerve cause?
- Pain in forearm
- Elbow flexion weakness
What does compression of C7 nerve cause?
- Pain in hand
- Elbow extension weakness
Where would you get pain with an L2-L3 nerve compression?
- Upper leg interior
- Upper leg anterior
Compression of which nerve vertebrae would cause bladder and bowel dysfunction?
S4
What’s the mnemonic for remembering which reflexes are supplied by which vertebrae?
S1-S2 tie my shoe
L3-L4 kick the door
C5-C6 pick up sticks
C7-C8 shut the gate
How does myasthenia gravis present?
- muscle weakness (especially in face)
- diplopia + ptosis
- improves w rest
What test can be done to assess a patient’s proprioception?
What test can be done to assess vestibulocochlear pathology?
Give two causes of cauda equina syndrome other than a tumour.
Give five symptoms of cauda equina syndrome.
MC trigger of Guillain-Barré syndrome?
Damage to which nerve causes wrist drop?
Radial nerve
Damage to which nerve causes wrist drop?
Radial nerve
Give a differential of meningitis
Subarachnoid haemorrhage
Give three bacteria that can cause meningitis.
What is a non-blanching rash a sign of in meningitis?
DIC caused by meningococcal meningitis
Difference in WBC in CSF in meningitis between bacterial and viral?
Bacterial = neutrophilia
Viral = Lymphocytosis
What’s the pathophysiology behind a pancoast tumour of the apex of the lung causing Horner’s syndrome?
Tumour presses on:
- Intercostal nerves
- Brachial plexus
- Sympathetic chain (causing Horner’s
What drug is given for prophylactic treatment in meningitis?
What’s the most common causative bacteria of meningitis in pregnant women?
What’s the technical term for a patient having blood vision and a feeling of a curtain coming down over their vision.
Acute management for a cluster headache?
Prophylactic treatment for cluster headaches?
Definition of encephalitis?
MC cause of encepahilits?
Diagnosis method for encephalitis?
Treatment of encephalitis?
What treatment is given to manage Alzheimer’s? Give two examples of the type of drug.
Give two acetylcholinesterase inhibitors used to treat myasthenia gravis.
Management of Guillain Barre?
Give 4 presenting symptoms of Guillain Barre
Give a test that can be used to help diagnose Guillain Barre
What cranial nerve is affected in Bell’s palsy?
Do you get forehead sparing in Bell’s palsy?
Do you get forehead sparing in UMN or LMN lesions?
Management after a TIA?
Antiplatelet
e.g aspirin or clopidogrel
Inheritance of Duchenne’s muscular dystrophy?
What scoring system is used to assess the risk of stroke after a TIA?
(>4 = referral to specialist)
What are the categories and values for ABCD2?
Two differentials for generalised tonic-clonic seizure?
- Syncope
- Non-epileptic seizure
What neurotransmitter supplies sympathetic innervation to the skin?
Acetylcholine
Two causes of asterixis?
Diagnosis of rhabdomyolysis?
What tract carries pain and temperature sensation from 2 levels below where it enters the spinal cord?
Spinothalamic
What’s the diagnostic criteria for MS?
McDonald criteria. 2 or more neurological attacks disseminated in time and space.
