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Finals: Speciality Blocks > Neuro > Flashcards

Neuro Flashcards

1
Q

What are the triad characteristics of Hunting’s disease

A

Dominant inheritance
Choreoathetosis (involuntary sudden movements often of the muscles in the arms, legs, face, and body)
Dementia

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2
Q

Patients with Huntington’s disease are more likely to experience behavioural changes and depression.
What is the first line medication to treat depression in this patient group

A

Selective serotonin reuptake inhibitors (SSRIs)

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3
Q

What medication has the most evidence-base to managed the choreoathetosis for Hunting’s Disease

A

Tetrabenazine

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4
Q

What are the 4 key signs of bacterial meningitis

A

Fever
Lethargy
Vomiting
Non-blanching rash

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5
Q

An Extradural Haemorrhage is a collection of blood between which layers of the skull?

A

The inner surface of the skull and the outer layer of the dura

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6
Q

Extradural haemorrhage is commonly caused by a tear in which artery?

A

Middle meningeal artery

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7
Q

Patient’s with Extradural haemorrhage often present with a palsy of which cranial nerve?

A

6th cranial nerve (abducen’s nerve)

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8
Q

What is the gold standard investigation to diagnose an extradural haemorrhage

A

CT head
Demonstrates a hyperdense bi-convex shape and are limited by the cranial sutures (they can’t cross over the sutures).
Egg-shaped, Emergency (arterial bleed)

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9
Q

Young patient with a traumatic head injury that has an ongoing headache. They have a period of improved neurological symptoms and consciousness followed by a rapid decline over hours is a typical Hx of what type of intracranial bleed?

A

Extradural haemorrhage

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10
Q

Expressive dysphagia i.e. ability to understanding of speech, but difficulty producing words.

Which part of the brain does this deficit localise to?

A

Broca’s area

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11
Q

Receptive dysphasia i.e. inability to understand speech but able to generate words. Typically present with a patient speaking in “word salad” as a result of their impaired understanding

Which part of the brain does this deficit localise to?

A

Wernicke’s area

Remember Word Salad - Wernicke’s

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12
Q

First line for the treatment of trigeminal neuralgia

A

Carbamazepine

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13
Q

What is the classic triad presentation of Devic’s disease (also known as neuromyelitis optica)

A

Transverse myelitis

Optic neuritis

Positive serum NMO-IgG (antibodies against aquaporin-4)

Typically relapsing-remitting

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14
Q

Serum NMO-IGG (antibodies against aquaporin-4) is highly suggestive of what condition

A

Devic’s disease (also known as neuromyelitis optica)

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15
Q

MRI reveals a spinal ring-enhancing lesion - what condition is this most likely to be

A

Spinal epidural abscess

A spinal epidural abscess may present with a spastic paraparesis but would also cause a fever and spinal pain

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16
Q

Voltage-gated potassium channel antibodies in CSF

Specific for what condition

A

Autoimmune encephalitis

Typically presents with sub-acute cognitive impairment, altered consciousness, seizures, and abnormal movements

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17
Q

Likely Dx:

Fatigable muscle weakness affecting limb muscles, extra-ocular muscles (drooping eyelids, diplopia), facial muscles (difficulty smiling or chewing), and bulbar muscles (change in speech or difficulty swallowing)

Symptoms are worse after prolonged movement or at the end of the day.

A

Myasthenia Gravis

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18
Q

Myasthenia gravis is an auto-immune disease characterised by antibodies against what kind of receptors?

A

Nicotinic acetylcholine receptors on muscle fibres.

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19
Q

What antibody is most likely to be positive in myasthenia gravis

A

Acetylcholine receptor antibody (depends in serum)

If negative or equivocal - check for muscle-specific tyrosine kinase antibodies

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20
Q

If ACh receptor antibody is positive and you now strongly suspect Myasthenia gravis.

What investigation might you consider doing

A

CT chest as MG is strongly associated with abnormalities of the thymus, and imaging to look for thymic hyperplasia or thymoma is warranted to evaluate the role of thymectomy

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21
Q

What is the first-line treatment in ocular myasthenia gravis

A

Anticholinesterase inhibitors e.g. pyridostigmine

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22
Q

First-line therapy in generalised myasthenia gravis

A

Immunosuppressive therapy e.g. prednisolone

AND

Anticholinesterase inhibitors e.g. pyridostigmine

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23
Q

What is used when the anticholinesterase inhibitor do not control symptoms of myasthenia gravis completely

A

Corticosteroids

A second-line immunosuppressant such as azathioprine is frequently used to reduce the dose of corticosteroid.

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24
Q

What medication can be used to induce temporary remission in severe relapses of myasthenia gravis, particularly where bulbar or respiratory function is compromised or before thymectomy.

A

Plasmapheresis

OR

Infusion of intravenous immunoglobulin

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25
Q

Function of Acetylcholinesterase inhibitors i.e. anticholinesterases

A

Inhibit the breakdown of acetylcholine in the synaptic cleft, increasing acetylcholine concentrations in the synaptic cleft, and increasing activation of nicotinic acetylcholine receptors at the neuromuscular junction.

Used in the management of myasthenia gravis

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26
Q

Likely Dx:

Balance issues leading to recurrent falls and vertical gaze palsy

A

Progressive supranuclear palsy (Parkinson’s plus syndrome)

Presents with parkinsonism with additional features.

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27
Q

What are the triad of characteristic features of Parkinsonism

A

Unilateral resting tremor
Cogwheeled rigidity
Bradykinesia (slow movements)

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28
Q

What medication can be used in the treatment of essential tremor

A

Propranolol OR primidone

Once patients are reassured that there is nothing more serious going on, they may elect not to commence pharmacotherapy

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29
Q

When is the disease activity for multiple sclerosis defined as Active

A

At least two clinically significant relapses occur within the last 2 years

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30
Q

When is the disease activity for multiple sclerosis defined as Highly active

A

Unchanged/increased relapse rate or by ongoing severe relapses compared with the previous year, despite disease-modifying drug treatment

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31
Q

When is the disease activity for multiple sclerosis defined as Rapidly evolving severe relapsing- remitting

A

> =2 disabling relapses in 1 year

AND EITHER

> = 1 gadolinium-enhancing lesions on brain magnetic resonance imaging (MRI)
OR
Significant increase in T2 lesion load compared with a previous MRI.

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32
Q

What are the two types of disease patterns for Multiple sclerosis

A

Relapsing-remitting (which may become secondarily progressive) - most common

Primary progressive.

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33
Q

What would be found in the CSF for multiple sclerosis

A

Oligoclonal bands

These reflect various immunoglobulins seen on CSF electrophoresis and indicate the presence of an auto-immune process in the CNS

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34
Q

Imaging modality for multiple sclerosis

A

MRI with contrast- will show periventricular white matter lesions

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35
Q

First line management of an acute relapse of multiple sclerosis

A

Oral methylprednisolone

IV methylprednisolone should be considered as an alternative if oral methylprednisolone has failed or is not tolerated

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36
Q

What criteria is used to diagnosis multiple sclerosis

A

McDonald criteria

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37
Q

What are the two groups of drugs used in the long term management of relapsing remitting multiple sclerosis

A

Disease modifying therapies (DMTs)
AND
Symptomatic therapies e.g. baclofen

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38
Q

What is the single best investigation to confirm early ischaemic stroke

A

Diffusion-weighted MRI

CT scans are useful for detecting haemorrhagic strokes, but can be normal in the first few hours of an ischaemic stroke

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39
Q

What medication is recommended in the treatment of acute ischaemic stroke if it can be administered within 4.5 hours of symptom onset and if intracranial haemorrhage has been excluded by appropriate imaging techniques

A

Alteplase

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40
Q

Alteplase is recommended in the treatment of acute ischaemic stroke if it can be administered within how many hours since the symptoms onset (haemorrhagic stroke has already been excluded)

A

Within 4.5 hours of symptom onset

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41
Q

Patients with ischaemic stroke or transient ischaemic attack associated with atrial fibrillation should be reviewed for what kind of long-term treatment

A

Anticoagulant

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42
Q

What is the long term treatment following a transient ischaemic attack or an ischaemic stroke (not associated with atrial fibrillation)

A

Clopidogrel

43
Q

What is the name of the stroke classification system

A

Bamford/Oxford classification

44
Q

What can be performed in patients with anterior circulation strokes within 6 hours of symptom onset

A

Mechanical Thrombectomy

45
Q

Mechanical Thrombectomy can be performed in patients with ANTERIOR circulation strokes within how many hours since symptom onset

A

6 hours

46
Q

Mechanical Thrombectomy can be performed in patients with POSTERIOR circulation strokes within how many hours since symptom onset

A

12 hours

47
Q

If it has been greater than 4.5 hours since symptom onset for ischaemic stroke (therefore not in the time window for alteplase).

What is the best management option

A

Oral aspirin (treatment dose 300mg) daily for two weeks

48
Q

If alteplase has been done for ischaemic stroke when should aspirin be started?

A

Aspirin is usually started 24 hours after the treatment following a repeat CT Head that excludes any new haemorrhagic stroke.

49
Q

Secondary stroke prevention

A

Mnemonic HALTSS:

Hypertension: anti-hypertensive therapy should be initiated 2 weeks post-stroke.

Antiplatelet therapy (if stroke associated with AF anticoagulant e.g. Rivaroxaban or Apixiban, otherwise clopidogrel is initiated 2 weeks post-stroke.

Lipid-lowering therapy e.g. atorvastatin

Tobacco (smoking cessation)

Sugar: screened for diabetes and managed appropriately.

Surgery: patients with ipsilateral carotid artery stenosis more than 50% should be referred for carotid endarterectomy.

50
Q

What is the gold standard investigation in assessing for the underlying cause of subarachnoid haemorrhage

A

CT angiography of the head

Once the acute condition is managed she needs to be assessed for an underlying cause

51
Q

What is the gold standard investigation for diagnosing a subarachnoid haemorrhage

A

CT head

Will show hyperdense material in the subarachnoid space

52
Q

If the CT head does not confirm the diagnosis of subarachnoid haemorrhage what is the next best investigation?

A

Lumbar puncture (After least 12 hours after symptom onset)

Will show Xanthochromia (which can lead to pink or yellow coloured CSF) and an increase in cerebrospinal fluid (CSF) bilirubin

53
Q

Diagnosis of subarachnoid haemorrhage -> CTPA complete.

Refer to neurosurgeons. What options do they have to fix a ruptured aneurysms

A

Endovascular techniques exist for coiling or stenting SAH bleed.

Surgical techniques include clipping.

54
Q

What does Romberg’s positive indicate

A

Positive if there is a significant increase in unsteadiness upon closure of the eyes

Suggests that the ataxia is sensory in nature

55
Q

What are the 6 features of cerebellar dysfunction

A

Acronym DANISH:

i) Dysdiadochokinesia (an inability to perform rapid alternating hand movements)
ii) Ataxia (a broad-based, unsteady gait)
iii) Nystagmus (involuntary eye movements)
iv) Intention tremor (seen when the patient is asked to perform the ‘finger-nose test’)
v) Slurred speech
vi) Hypotonia

56
Q

What is the best description for this motor phenomenon of epilepsy:

Unilateral leg twitching initially which spreads up and causes movement in the trunk and eventual arm

A

Jacksonian march

Due to the propagation of electrical activity through the primary motor cortex

57
Q

How would Todd’s paresis present

A

Focal, often unilateral, weakness following a seizure

58
Q

Likely Dx:

Unilateral deafness and vertigo occurring later, in addition to left-sided lesions of cranial nerves V, IX and X

A

Acoustic neuroma

59
Q

What is the manoeuvre that is diagnostic of benign positional paroxysmal vertigo (BPPV)

A

Hallpike manoeuvre

The presence of debris in the semicircular canals of the ears causes vertigo upon head movement.

60
Q

What is the manoeuvre that is first line in treatment benign positional paroxysmal vertigo (BPPV)

A

Epley manoeuvres treat BPPV by clearing the debris.

61
Q

Treatment of Ménière’s disease

A

Antihistamines and bed rest

62
Q

Treatment of Ramsay Hunt syndrome

A

Aciclovir and prednisolone.

63
Q

What are the three medications that most commonly cause ototoxicity

A

Aminoglycoside antibiotics eg. gentamicin, vancomycin
Loop diuretics eg. furosemide

64
Q

The uvula will deviate ___ the side of the lesion

A

AWAY

65
Q

Tongue will point ______ the side of the lesion

A

TOWARDS

66
Q

Polycystic kidney disease can be associated with what kind of aneurysms

A

Berry aneurysms - which can rupture causing a subarachnoid haemorrhage

67
Q

Acute Management of suspected acute bacterial meningitis

A

IV ceftriaxone

Addition of IV amoxicillin in young/old patients to better cover listeria, and IV aciclovir if viral encephalitis is suspected.

68
Q

Inheritance pattern for Myotonic dystrophy

A

Autosomal dominant pattern.

Trinucleotide repeat disorder affecting muscle-specific chloride channels

69
Q

Likely Dx:

Pt in their 20s
Frontal balding
Slow relaxing grip
Gradually worsening weakness in his hands

A

Myotonic dystrophy

70
Q

How is myotonic dystrophy diagnosed

A

Genetic testing

71
Q

Likely Dx

Ipsilateral impairment of the adducting eye
Nystagmus in the abducting eye

A

Internuclear ophthalmoplegia (the side of the eye that cannot adduct)

72
Q

Triad of features for normal-pressure hydrocephalus.

A

Urinary incontinence
Dementia
Gait abnormality

“Wet, Wobbly and Wacky”

All of which have developed over several months

73
Q

First-line treatment for normal pressure hydrocephalus

A

Ventriculo-peritoneal shunting

74
Q

What measure is used to monitor respiratory involvement in Guillain-Barré syndrome

A

Forced vital capacity (FVC)

If it is dangerously reduced, intubation and admission to the Intensive Care Unit may be necessary

75
Q

Management of Guillain-Barré syndrome

A

Conservative measures e.g. monitoring of ventilation (with serial spirometry and ABG) ± ventilation

Medical management with IV immunoglobulin and, if ineffective, plasmapheresis.

76
Q

What is the most common cause of medical third (oculomotor) nerve palsy,

A

Diabetes mellitus

77
Q

Difference between medial and surgical third nerve palsy

A

Medical: Painless and down and out pupil

Surgical: Painful and dilated pupil (due to compression of the outer parasympathetic fibres)

78
Q

What is the one disease modifying treatment available for motor neurone disease

A

Riluzole (an antiglutamatergic drug which dampens motor nerve firing) has been shown to prolong life by 3 months.

79
Q

prophylaxis for cluster headache

A

Verapamil

80
Q

managing an acute attack of cluster headache

A

100% oxygen via non-rebreathable mask with a subcutaneous or nasal Triptan

81
Q

First line management of Trigeminal neuralgia

A

Carbamazepine

82
Q

Inability to abduct thumb after a Colle’s fracture

Injury to what nerve?

A

Median nerve

The median nerve supplies the motor supply for the radial half of the fingers in the hand

83
Q

Urinary incontinence + gait abnormality + dementia =

A

normal pressure hydrocephalus

84
Q

Infected followed by 1-3 weeks of lower back and leg pain along with paraesthesia and weakness is pathognomonic of what condition

A

Guillain-Barre syndrome

85
Q

Features of Brown-Sequard syndrome

A

Caused by lateral hemisection of spinal cord.

Same sided weakness and proprioception/vibration loss

Loss of pain/temperature on the opposite side to the hemisection

86
Q

Feature of Subdural haemorrhage on CT head

A

Sickle-shaped
Slow (venous bleed)

87
Q

Features of a temporal lobe seizure

A

An aura occurs in most patients
typically a rising epigastric sensation
also psychic or experiential phenomena, such as déjà vu

automatisms (e.g. lip smacking/grabbing/plucking) are common

88
Q

Obese, young female with headaches / blurred vision - pathognomonic for

A

idiopathic intracranial hypertension

89
Q

First line treatment for transient ischaemic attack

A

Aspirin 300mg immediately with specialist review within 24 hours

90
Q

Neuroleptic malignant syndrome is a rare but dangerous condition seen in patients taking what medication.

A

Antipsychotic medication.

91
Q

Neuroleptic malignant syndrome is a medical emergency.

Management

A

Immediate cessation of the dopamine antagonist (or restarting or continuing of the dopamine agonist)
AND
Supportive measures (rehydration, cooling, and treatment of rhabdomyolysis if present).

92
Q

Investigation for Narcolepsy

A

Multiple sleep latency EEG

93
Q

Management of Nacrolepsy

A

Daytime stimulants (e.g. modafinil) and nighttime sodium oxybate

94
Q

First line medication for Absence seizures

A

Ethosuximide

95
Q

Lamotrigine for all epilepsies expect?

A

Myotonic epilepsy

96
Q

Carbamazepine is contraindicated in what type of epilepsy?

A

Juvenile myoclonic epilepsy

Absent epilepsy (worsens the symptoms)

97
Q

Drugs that cause Stevens-Johnson syndrome

A

CLASP:
Carbamazepine
Lamotrigine
Allopurinol
Sulfonamide
Phenobarbital

98
Q

First line management of bells palsy

A

Oral prednisolone

eye care is important to prevent exposure keratopathy e.g. artificial tears and eye lubricants and taping the eyes closed if they are unable to close the eye at bedtime

99
Q

‘Cape-like’ features (neck, shoulders and arms):
loss of sensation to temperature but the preservation of light touch, proprioception and vibration

Classic examples are of patients who accidentally burn their hands without realising

Pathognomonic of what condition

A

Syringomyelia

Caused by a collection of CSF within the spinal cord

100
Q

Gold standard investigation for syringomyelia

A

Full spine MRI with contrast to exclude a tumour or tethered cord

101
Q

DVLA guidelines for a patient with a first unprovoked or isolated seizure if brain imaging and EEG normal

A

Patients cannot drive for 6 months

102
Q

Define Status epilepticus

A

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

103
Q

Serotonin syndrome can present in a very similar manner to neuroleptic malignant syndrome (NMS).

One main difference is that serotonin syndrome presents when in comparison to NMS

A

Serotonin syndrome presents over hours rather than days like in neuroleptic malignant syndrome

104
Q

WHat is the key differentating symptom when comparing Posterior Inferior Cerebellar Artery stroke to lateral pontine syndrome (in which facial weakness - not numbness - is the key)

A

PIKACHU –> PICA can’t chew

People with posterior inferior cerebellar artery stroke will have dysphagia

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