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Neuro Flashcards

1
Q

What is the name for not being able to extend the knee when the hip is flexed?

A

Kernig’s sign

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2
Q

What condition can Kernig’s sign be seen in?

A

Meningitis

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3
Q

What investigations should be ordered in a patient with suspected meningitis?

A

Blood culture, lumbar puncture, CRP, ESR, head CT, serum meningococcal and pWneumococcal PCR, throat swabs

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4
Q

What antibiotic should be given to patients with neisseria meningitidis?

A

IV cefotaxime

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5
Q

Give 7 signs of Parkinson’s disease.

A

Resting tremor, bradykinesia, resting tremor, increased tone/rigidity, stooped posture, decreased arm swing, decreased amplitude or accuracy of repetitive movement

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6
Q

How does dopamine normally stimulate movement?

A

It inhibits the inhibitory pathway of the striatum, allowing movement.

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7
Q

What is the first line treatment of Parkinson’s disease?

A

Levodopa

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8
Q

How does levodopa work?

A

Levodopa is a precursor molecule to dopamine. It therefore increases the amount of dopamine available to act upon receptors.

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9
Q

What drug is given with levodopa?

A

Carbidopa

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10
Q

Why is carbidopa given with levodopa?

A

It inhibits peripheral metabolism of levodopa

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11
Q

What are the two second line treatments for Parkinson’s disease?

A

Dopamine agonists - pramipexole, ropinirole

MAO/COMT inhibitors

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12
Q

How do MAO/COMT inhibitors work?

A

They reduce the metabolism of dopamine - more available

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13
Q

Give 2 conditions that are associated with Parkinson’s.

A

Depression, dementia

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14
Q

What symptoms are specific to a MCA stroke?

A

Contralateral motor weakness of upper limbs
Contralateral loss of sensation of the upper limbs
Hemianopia
Dysphasia
Aphasia
Face drop

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15
Q

What symptoms are specific to a ACA stroke?

A

Contralateral motor weakness of the lower limbs

Contralateral loss of sensation of the lower limbs

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16
Q

Which arteries does a total anterior circulation stroke involve?

A

Anterior and middle cerebral arteries

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17
Q

What is the difference between a partial and total anterior stroke?

A

A partial stroke has two of the following criteria, whereas a total has all 3:

  • Homonymous hemianopia
  • Unilateral hemiparesis or hemisensory loss
  • Higher cognitive dysfunction e.g dysphasia
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18
Q

What type of stroke is AF a risk factor for?

A

Ischaemic stroke

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19
Q

Give 6 red flag symptoms associated with headache.

A 
Altered consciousness
Confusion 
New headache with a history of cancer
Papilloedema 
Cluster headache
Seizure
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20
Q

What drug is given to reduce ICP?

A

IV Mannitol

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21
Q

Give 4 lower motor neuron signs.

A

Decreased tone
Decreased reflexes
Muscle wasting
Fasciculations

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22
Q

Give 4 upper motor neuron signs

A

Brisk reflexes
Increased tone
Babinski’s sign
Minimal muscle atrophy - muscle weakness

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23
Q

How does normal pressure hydrocephalus present?

A

Dementia
Urinary incontinence
Unsteady gait

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24
Q

What are the pathological findings in normal pressure hydrocephalus?

A

CSF pressure is normal, but the ventricles are dilated

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25
Q

In a right superior homonymous quadrantanopia where would the lesion be?

A

Meyer’s loop - left temporal optic radiation

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26
Q

In a right inferior homonymous quadrantanopia, where would the lesion be?

A

Left parietal optic radiation

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27
Q

What is dysarthria?

A

A motor disorder where the muscles of speech are damaged, paralysed or weakened

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28
Q

Where in the brain is affected to cause chorea in Huntington’s?

A

Striatum of the basal ganglia (caudate nucleus)

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29
Q

What pattern of inheritance does Huntington’s show?

A

Autosomal dominant

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30
Q

What kind of mutation is seen in Huntington’s?

A

A trinucleotide repeat - CAG

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31
Q

What are the features of Huntington’s disease?

A

Chorea
Personality changes
Dystonia
Saccadic eye movements

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32
Q

After what age do Huntington’s symptoms typically start to develop?

A

35

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33
Q

Which neurones are affected in Huntington’s disease?

A

GABAnergic and cholinergic neurons

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34
Q

What is the first line medication for chorea in Huntington’s disease?

A

Tetrabenazine

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35
Q

What is the first line treatment of behavioural problems in Huntington’s?

A

SSRIs - citalopram or fluoxetine

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36
Q

What is the first line treatment of psychosis in Huntington’s?

A

Haloperidol

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37
Q

What kind of motor neuron symptoms does Huntington’s result in?

A

UMN

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38
Q

What type of hypersensitivity reaction is Guillain-Barre syndrome?

A

Type 4

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39
Q

Which infection classically causes Guillain-Barre syndrome?

A

Campylobacter jejuni

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40
Q

What is the characteristic feature of Guillain-Barre syndrome?

A

Progressive, symmetrical weakness of all limbs

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41
Q

What is the initial presenting feature of Guillain-Barre syndrome in many patients?

A

Back/leg pain

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42
Q

What are the first line investigations for Guillain-Barre syndrome?

A

Lumbar puncture

Nerve conduction studies

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43
Q

What will a lumbar puncture in a patient with Guillain-Barre syndrome show?

A

CSF with raised protein, and normal cell counts

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44
Q

What is the first line treatment for Guillain-Barre syndrome?

A

IV immunglobulins or plasma exchange

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45
Q

What features are typical of a temporal lobe seizure?

A

Lip-smacking, recurrent sense of deja vu, and postictal dyphasia.

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46
Q

What kind of features will a lesion below L1 cause?

A

Lower motor neuron symptoms

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47
Q

What are the symptoms of cerebellar disease?

A

Mnemonic DANISH

D - dysdiadochokinesia 
A - ataxia
N - nystagmus 
I - intention tremor
S - slurred, stachato speech
H - hypotonia
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48
Q

What is the classic history of extra dural haemorrhage?

A

Brief loss of consciousness, followed by a lucid period ad then a quick deterioration

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49
Q

What is an extra dural haemorrhage commonly caused by?

A

Trauma to the head, which leads to a tear in the middle meningeal artery

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50
Q

What is the classic presentation of a subarachnoid haemorrhage?

A

Sudden onset of thunderclap headache
Occiptal headache
Signs of meningism

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51
Q

What is the most common cause of subarachnoid haemorrhage?

A

Berry aneurysm

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52
Q

What is the history of a subdural haemorrhage?

A

Typically more chronic:

  • Headache
  • Cognitive decline
  • Fluctuating consciousness
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53
Q

What is the classic triad of symptoms in Parkinson’s disease?

A

Bradykinesia, rigidity, tremor

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54
Q

What is the acute management of cluster headache?

A

100% high flow oxygen

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55
Q

What is the prophylactic treatment of cluster headache?

A

Verapamil

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56
Q

What symptoms other than pain around the eye are seen in cluster headache?

A

Ipsilateral watering of the eye, red eye, nasal congestion and constricted pupil/drooping eyelid

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57
Q

What is the first line medication for patients with focal seizures?

A

Carbamezapine

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58
Q

What is the first line medication for patients with generalised seizures?

A

Sodium valproate

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59
Q

How long must patients be seizure free before they can drive?

A

12 months

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60
Q

What is the first line acute management to terminate a seizure?

A

Benzodiazepines

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61
Q

What are the first line investigations after a patient first has a seizure?

A

Electroencephelogram (EEG), MRI

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62
Q

What features are typical of a frontal lobe seizure?

A

Proximal spread of clonic jerking

Affected muscles remain weak after seizure (called post ictal Todd’s paralysis)

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63
Q

What features are typical of a temporal lobe seizure?

A

Pre-seizure aura/hallucinations
Lip smacking during seizure
Post-ictal confusion

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64
Q

What features are typical of an occipital lobe seizure?

A

Flashing and floaters

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65
Q

What features are typical of a parietal lobe seizure?

A

Non-specific sensory symptoms - paraethesia

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66
Q

Which limbs does an anterior cerebral artery stroke typically affect?

A

Lower limbs

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67
Q

Which limbs does a middle cerebral artery stroke commonly affect?

A

Upper limbs

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68
Q

What symptoms does a basilar artery stroke cause?

A

Locked in syndrome - complete paralysis of all muscles apart from the eyes

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69
Q

What is the initial management of a suspected TIA?

A

300mg aspirin daily

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70
Q

What is the first line long term anti-thrombotic therapy for patients who have had a confirmed TIA?

A

75mg clopidogrel daily

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71
Q

What are the symptoms of brown-sequard syndrome?

A

Ipsilateral weakness below the lesion
Ipsilateral loss of proprioception and vibration
Contralateral loss of pain and temperature

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72
Q

Where does the cauda equina begin?

73
Q

What kind of symptoms does cauda equina syndrome cause?

A

Lower motor neuron symptoms

74
Q

What kind of symptoms does a spinal cord compression present with?

A

UMN symptoms above the lesion

LMN symptoms below the lesion

75
Q

How long after infection does Guillain-Barre syndrome typically develop?

76
Q

Which infection classically causes Guillain-Barre syndrome?

A

Campylobacter jejuni

77
Q

What is the first line investigation for suspected stroke?

78
Q

Give an example of a benzodiazepine.

A

Clonazepam

79
Q

What is the first line treatment for temporal arteritis?

A

Oral prednisolone

80
Q

Give 3 symptoms of cauda equina.

A

Inability to open bowels/urinate
Reduced anal tone
Saddle anaethesia

81
Q

What is the first line treatment of myasthenia gravis?

A

Acetylcholinesterase inhibitors

82
Q

Name 2 acetylcholinesterase inhibitors.

A

Pyridostigmine

Neostigmine

83
Q

How long after the onset of symptoms can IV alteplase be given for acute ischaemic stroke?

84
Q

Who does Wernicke’s encephalopathy typically affect?

A

Alcoholics

85
Q

What symptoms are seen in Wernicke’s encephalopathy?

A

Ataxia, opthalmoplegia, confusion

86
Q

What is the cause of spina bifida?

A

Multifactorial

87
Q

What receptors are found in the sympathetic nervous system?

A

Adrenergic and nicotinic

88
Q

What receptors are found in the somatic nervous system?

A

Acetylcholine

89
Q

What mutation is found in patients with Huntington’s?

A

36 or more CAG repeats

90
Q

What is the best prognostic treatment of motor neuron disease?

91
Q

What happens in a tonic seizure?

A

The patient goes tense and stiff

92
Q

What happens in a tonic-clonic seizure?

A

The patient goes tense and stiff, then has muscle tensing and relaxing

93
Q

What is the first line treatment of tension headache?

A

Paracetamol

94
Q

What are the CSF findings in bacterial meningitis?

A

High protein
Low glucose
High neutrophil polymorphs

95
Q

What are the CSF findings in viral meningitis?

A

High or normal protein
Normal glucose
High lymphocytes

96
Q

What are the CSF findings in fungal meningitis?

A

High protein
Low glucose
High lymphocytes

97
Q

What is a complication of temporal arteritis?

A

Blindness (amaurosis fugax)

98
Q

Why can temporal arteritis cause blindness?

A

Emboli occluding the retinal artery

99
Q

What type of seizures is Jacksonian march associated with?

A

Frontal lobe seizure

100
Q

What is Jacksonian march?

A

Where the seizures ‘march’ up and down the motor homonculus

101
Q

What is the definition of multiple sclerosis?

A

An autoimmune demyelinating condition causing lesions disseminated in time and space

102
Q

What is a common initial symptom of multiple sclerosis?

A

Optic neuritis

103
Q

What is Uhthoff’s phenomenon?

A

When symptoms (of MS) are worse with heat

104
Q

What virus is a risk factor for MS?

105
Q

What type of symptoms does motor neuron disease present with?

A

Upper and lower motor neuron symptoms

106
Q

What is the first line for bacterial meningitis in a primary setting?

A

IM benzylpenicillin

107
Q

What is the first line for bacterial meningitis in a secondary setting?

A

IV benzylpenicillin or IV ceftriaxone

108
Q

What is the treatment of viral meningitis?

A

Analgesia, antipyretic and hydration

109
Q

What is the second line treatment of viral meningitis?

110
Q

What symptoms are seen in Horner’s syndrome?

A

Anhydrosis (reduced sweating), miosis (pupil constriction), ptosis (eyelid droop)

111
Q

Give a cause of Horner’s syndrome.

A

A pancoast tumour (rare tumour in the apex of the lung)

112
Q

What sensory deficits are seen in Brown-sequard syndrome?

A

Ipsilateral loss of proprioception, vibration and motor function at the level of the lesion
Contralateral loss of pain and temperature sensation 2 levels below the lesion

113
Q

Which vessel are extradural haematomas associated with?

A

Middle meningeal artery

114
Q

What drug is given after subarachnoid haemorrhage to prevent vasospasm?

A

Nimodipine

115
Q

What is the most common cause of Guillain-Barre syndrome?

A

Campylobacter jejuni

116
Q

What symptoms can cluster headache cause other than pain?

A

Rhinorrhoea, ptosis, red eyes, lacrimation

117
Q

What is the most appropriate first line investigation for MS?

118
Q

What is the classic history of an extradural haemorrhage?

A

Loss of consciousness, followed by a lucid period, then rapid onset of neurological defecits

119
Q

What kind of brain bleeds are common in elderly patients who have fallen?

120
Q

Why are elderly patients more susceptible to subdural bleeds?

A

They have smaller brains and more fragile bridging veins

121
Q

What is the first line acute treatment of migraine?

A

Sumatriptan

122
Q

What is the first line cluster headache prophylaxis?

123
Q

What type of dementia causes early memory loss?

A

Alzheimer’s

124
Q

What type of dementia causes early personality changes?

A

Fronto-temporal

125
Q

What type of personality changes are seen in fronto-temporal dementia?

A

Aggression, disinhibition, hypersexuality

126
Q

What type of progression does vascular dementia cause?

A

Stepwise progression

127
Q

What is the only life prolonging medication available for MND?

128
Q

What is baclofen used for?

A

To treat cramps in MND

129
Q

What other investigation should also be ordered in suspected MS?

A

Lumbar puncture

130
Q

What type of weakness is associated with Charcot-Marie Tooth syndrome?

A

Champagne bottle weakness - wasting of the muscles in the lower legs

131
Q

What is the first line treatment of generalised seizures in women of child bearing age?

A

Lamotrigine

132
Q

What symptoms are likely seen in a brain tumour?

A 
Headache
Behavioural changes
Nausea
Speech problems 
Weakness
133
Q

What is the pathophysiology of Alzheimer’s disease?

A

Buildup of extravascular beta amyloid plaques and neurofibrillary triangles in the brain

134
Q

What is the cause of fronto-temporal dementia?

A

Atrophy of the frontal lobe

135
Q

What is Phalen’s test used for?

A

Carpal tunnel syndrome

136
Q

What is a positive Phalen’s test result?

A

The patient is only able to flex their wrist for a maximum of 1 minute

137
Q

Which receptors are affected in myasthenia gravis?

A

Nicotinic acetylcholine receptors of the neuromuscular junction

138
Q

Up to a 1/5 of myasthenia gravis patients also have what other condition?

139
Q

What cells predominate in the CSF of someone with bacterial meningitis?

A

Neutrophils

140
Q

What is the first line prophylaxis of migraine?

A

Topiramate

141
Q

What other medications can be used for migraine prophylaxis?

A

Beta blockers

Tricyclic antidepressants - amitriptyline

142
Q

What is the definition of stroke?

A

Sudden onset of neurological defecits, due to ischaemic or haemorrhagic compromise of blood supply to the brain

143
Q

What tract carries sensation of pain and temperature?

A

Spinothalamic tract

144
Q

What tract carries sensation of proprioception, vibration and fine touch?

A

Doral column lemniscus pathway

145
Q

Where does the dorsal column lemniscus pathway decussate?

A

Medulla oblongata

146
Q

What is the name for a loss of sensation in the genital area?

A

Saddle anaesthesia

147
Q

Give 4 causes of cauda equina syndrome.

A

Trauma
Disc herniation
Tumours
Spine metastases

148
Q

What is the first line management of cauda equina?

A

Lumbar decompression surgery

149
Q

What is the first line investigation of cauda equina?

A

Emergency MRI spine

150
Q

What distinguishes meningitis from meningococcal septicaemia?

A

Non-blanching petechial rash + signs of septic shock

151
Q

What two signs will be positive on examination in meningitis?

A

Kernig’s sign

Brudzinski’s sign

152
Q

What is Brudzinski’s sign?

A

When the neck is flexed in a patient with meningitis, the hips and knees will also flex

153
Q

What are the two most common causative organisms o bacterial meningitis?

A

Neisseria meningitidis

Streptococcus pneumoniae

154
Q

What is the gold standard investigation for meningitis?

A

Lumbar puncture

155
Q

What is the treatment of meningitis in the community?

A

IM benzylpenicillin

156
Q

What is the treatment of meningitis in hospital?

A

IV cefotaxime/ceftriaxone (3rd generation cephalosporins)

157
Q

What are the risk factors for folate deficiency?

A

Alcohol
Crohn’s
Age
Diet

158
Q

How long should a patient who has had a single TIA stop driving for?

159
Q

How long should a patient who has had multiple TIAs stop driving for?

A

3 months - inform the DVLA

160
Q

How long should a patient who has had a single seizure stop driving for?

A

6 months - inform the DVLA

161
Q

What is the prophylactic treatment of cluster headache?

162
Q

What is the immediate managment of cauda equina?

A

Immediate surgical decompression

163
Q

What medications are recommended by NICE for migraine prophylaxis?

A

Topiramate
Propanalol
Amitriptyline
Acupuncture

164
Q

What is the first line prophylaxis of migraines?

A

Beta blockers

165
Q

When is topiramate used for prophylaxis of migraines?

A

When beta blockers are unsuitable e.g in asthma

166
Q

What is the resting tremor seen in Parkinson’s often described as?

A

Pill rolling tremor

167
Q

What is Charcot’s neurological triad?

A

Dysarthria, nystagmus, intension tremor

168
Q

What condition is Charcot’s neurological triad seen in?

A

Multiple sclerosis

169
Q

What is relapsing-remitting MS?

A

Flare ups are followed by a period of reduced symptoms - this baseline sees progressive disability with each remission.

170
Q

What is progressive relapsing MS?

A

Progressive increase in disability with intermittent flares that resolve to the increasing baseline

171
Q

What is the prophylactic treatment of meningitis?

A

Ciprofloxacin

172
Q

What is the pathophysiology of Alzheimer’s disease?

A

Extra-neuronal beta amyloid plaques
Intra-neuronal neurofibrally triangles
Cortical atrophy

173
Q

Give 4 risk factors for Alzheimer’s disease.

A

Family history
Caucasian
Increasing age
Down’s syndrome

174
Q

What is the Oxford classification of stroke?

A

Assesses the following criteria:

  • Unilateral hemiparesis
  • Homonymous hemianopia
  • Higher cognitive dysfunction
175
Q

What is the first line treatment of trigeminal neuralgia?

A

Carbamezapine

176
Q

What cells are targeted in MS?

A

Oligodendrocytes

177
Q

What constitutes a complex partial seizure?

A

The patient is not aware of goings on during the seizure, and is confused afterwards

178
Q

Which nerve opens the fist?

A

Radial nerve

Neurology (37 decks)

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