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3a follow up > Neuro > Flashcards

Neuro Flashcards

1
Q

What is Wallenberg syndrome also known as?

A

Lateral Medullary syndrome

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2
Q

Symptoms of lateral medullary syndrome? (LMS)

A

Horner’s Syndrome
Cerebellar signs - ataxic gait
Contralateral sensory loss of limbs
Ipsilateral sensory loss of face

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3
Q

What is the likely arterial lesion in LMS

A

Posterior inferior cerebellar artery

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4
Q

Nerve roots for biceps reflex?

A

C5-C6

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5
Q

Baseline investigation for MS?

A

MRI brain with contrast - view demyelinating lesions

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6
Q

What is Guillain-Barre syndrome (GBS)

A

Immune-mediated demyelination of peripheral nervous system

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7
Q

Most common cause of GBS?

A

Campylobacter jejuni

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8
Q

Characteristic features of GBS?

A

ASCENDING weakness
Progressive, symmetrical weakness of all limbs
Reflexes reduced/absent
Few sensory signs
Hx gastroenteritis

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9
Q

Investigations for GBS?

A

Lumbar puncture - raised protein, normal WCC
Nerve conduction studies - reduced signals

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10
Q

Management of GBS?

A

Supportive
VTE prophylaxis
IVIG
Plasmapheresis

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11
Q

Pattern of signs in GBS?

A

Flaccid weakness and hyporeflexia

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12
Q

When should thrombolysis be given for stroke?

A

Within 4.5 hours

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13
Q

Contraindications for thrombolysis

A

Prev. haemorrhage
Seizure at onset of stroke
Neoplasm
LP in prev 7 days
Stroke/traumatic brain injury in last 3 months
Oesophageal varices
Uncontrolled HTN
Pregnancy

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14
Q

How soon should thrombectomy be given?

A

Within 6 hours, ideally give with IV thrombolysis

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15
Q

Secondary prevention after ischaemic stroke?

A

1st line - Clopidogrel
2nd line - Aspirin + dipyridamole

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16
Q

Most likely cause of encephalitis

A

Herpes simplex

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17
Q

Features of Wernicke’s encephalopathy?

A

Confusion, ataxia, nystagmus. ophthalmoplegia, peripheral neuropathy

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18
Q

Extradural haemorrhage caused by damage to which vessels?

A

Middle meningeal artery

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19
Q

Subdural haemorrhage caused by damage to which vessels?

A

Bridging veins between cortex and venous sinuses

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20
Q

Subarachnoid haemorrhage caused by damage to which vessels?

A

Berry aneurysm rupture

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21
Q

Presentation of extradural haemorrhage?

A

Sudden onset following a brief lucid interval

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22
Q

Presentation of subdural haemorrhage?

A

Chronic - 4-7 weeks following injury, gradual onset confusion

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23
Q

Presentation of subarachnoid haemorrhage?

A

thunderclap headache, acute onset

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24
Q

What is myasthenia gravis?

A

Autoimmune condition causing destruction of ACh receptors at neuromuscular junction

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25
Q

Symptoms of MG?

A

Muscle fatigability
Extraocular - diplopia
Muscle weakness
Ptosis
Dysphagia

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26
Q

Which cancer is associated with MG?

A

Thymoma

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27
Q

Investigations for MG?

A

Antibodies for ACh receptors
Tensilon test
Single fibre electromyography

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28
Q

What is the tensilon test?

A

IV edrophonium reduces muscle weakness temporarily

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29
Q

Management of MG?

A

Acetylcholinesterase inhibitors - pyridostigmine
Immunosuppressoin
Thymectomy

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30
Q

Myasthenia gravis exacerbating factors?

A

Penacillamine, BBs, lithium, phenytoin, Abx (gentamicin, macrolides, quinolones, tetracyclines)

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31
Q

What is Miller Fisher syndrome?

A

Variant of Gullain-Barre

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32
Q

Symptoms of Miller Fisher syndrome

A

Ophthalmoplegia, areflexia, ataxia
Descending rather than ascending symptoms

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33
Q

Which part of the brain most affected by HSV encephalitis?

A

Temporal lobes

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34
Q

Temporal lobe seizure symptoms?

A

Lip smacking, dysphasia

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35
Q

First line treatment for absence seizure in children

A

Ethosuximide

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36
Q

Describe parkinsons tremor

A

Unilateral tremor which improves with voluntary movements

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37
Q

Parkinsons triad

A

Bradykinesia, rigidity, termor

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38
Q

What is Weber’s syndrome + symptoms?

A

Midbrain stroke
Ipsilateral III palsy (down and out)
Contralateral weakness

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39
Q

Which vessel affected in Weber’s syndrome?

A

Branches of the posterior cerebral artery

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40
Q

Migraine prohylaxis treatments?

A

Propranolol
Topiramate (CI in childbearing women)

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41
Q

Treatment for idiopathic intracranial hypertension?

A

Carbonic anyhdrase inhibitor - Acetazolamide

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42
Q

Presentation of idiopathic intracranial hypertension?

A

Chronic headache, worsen in morning
Worsens on coughing/straining
Papilloedema
Clear CT

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43
Q

Presentation of cluster headache?

A

Unilateral
Pain around eye and tearing
Runny nose
40-60 mins
Multiple episodes

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44
Q

Acute management of cluster headaches?

A

High flow oxygen and triptans

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45
Q

Preventative management of cluster headaches?

A

Verapamil

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46
Q

Normal pressure hydrocephalus symptoms

A

Wet, wacky and wobbly
Urinary incontinence
Dementia
Gait abnormality

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47
Q

Imaging findings for NPH?

A

CT - ventriculomegaly out of proportion to sulcal enlargement

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48
Q

Management of NPH?

A

Ventriculoperitoneal shunting

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49
Q

What is autonomic dysreflexia?

A

Clinical syndrome in pts with spinal cord injury T6 or above

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50
Q

Physiology of autonomic dysreflexia?

A

Faecal impaction/urinary retention»triggers afferent signals»sympathetic spinal reflex»normal parasympathetic response prevented by cord lesion

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51
Q

Features of autonomic dysreflexia?

A

Extreme hypertension
Flushing and sweating above the level of the cord

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52
Q

Management of autonomic dysreflexia?

A

Removal/control of stimulus
Treatment of hypertension/bradycardia

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53
Q

21y/o male w/ unilateral facial palsy following trauma. R sided facial nerve paralysis and watery discharge from nose

A

Petrous temporal fracture (basal skull fracture)

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54
Q

Which nerve palsy causes impaired downward gaze?

A

CN IV - Trochelar

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55
Q

What is syringomyelia?

A

Collection of CSF in the spinal cord

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56
Q

Syringomyelia symptoms?

A

‘Cape-like’ (neck, shoulders arms):
loss temperature sensation
spastic weakness
neuropathic pain

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57
Q

Migraine triggers?

A

C - chocolate
H - hangovers
O - orgasms
C - cheese/caffeine
O - oral contraceptive
L - lie-ins
A - alcohol
T - travel
E - exercise

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58
Q

Facial nerve palsy symptoms?

A

Face, ear, taste, tear
- Hyperacusis
- Reduced tearing
- Reduced salivation

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59
Q

Driving rules following first seizure?

A

Inform DVLA, no driving until 6 months seizure free

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60
Q

Presentations of lacunar strokes?

A

Complete one sided sensory loss OR
unilateral motor disturbance affective face/arm/leg/all 3
Ataxia hemiparesis

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61
Q

What is total anterior circulation infarct?

A

Middle and anterior cerebral arteries.
Unilateral hemiparesis +/- hemisesnory loss of face, arm and leg
Homonymous hemianopia
Higher cognitive dysfunction

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62
Q

What is a partial anterior circulation infarct?

A

Smaller arteries of ant. circulation
2 of bamford classifications

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63
Q

What are the Bamford classification criteria?

A
  1. unilateral hemiparesis +/- hemisensory loss of the face, arm and leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
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64
Q

What is a posterior circulation infarct?

A

Verterobasilar arteries
1 of following:
Cerebellar or brainstem syndromes
Loss of consciousness
Isolated homonymous hemianopia

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65
Q

Anterior cerebral artery stroke

A

Contralateral hemiparesis and sensory loss
Lower > upper extremity

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66
Q

Middle cerebral artery stroke

A

Contralateral hemiparesis and sensory loss
Upper > lower extremity

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67
Q

Posterior cerebral artery stroke

A

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

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68
Q

Anterior inferior cerebellar artery stroke

A

Lateral pontine syndrome
Similar to Wallenbergs but:
Ipsilateral facial paralysis and deafness

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69
Q

What is amaurosis fugax

A

Loss of vision due to stroke in retinal/ophthalmic artery (ipsilateral)

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70
Q

Locked in syndrome

A

Caused by stroke to basilar artery. Paralysis of voluntary muscles except eyes

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71
Q

What must be monitored during phenytoin infusion (during status epilepticus)

A

Cardiac monitoring - arrhythmias

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72
Q

First line management for TIA?

A

Aspirin 300mg and specialist review in 24 hours

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73
Q

Which tool measures disability/dependence in ADLs in stroke patients?

A

Barthel index

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74
Q

Treatment for suspected encephalitis

A

Aciclovir

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75
Q

What is Broca’s dysphasia (expressive)?

A

Non-fluent speech, repetition impaired, comprehension normal

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76
Q

What is Wernicke’s (receptive) dysphasia?

A

Impaired language comprehension, repetition of words and phrases also impaired.
Fluent speech but lacking meaning - word salad

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77
Q

Which vessel supplies Broca’s area?

A

Superior division of left MCA - inferior frontal gyrus

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78
Q

Which vessel supplies Wernicke’s area?

A

Inferior division of left MCA - superior temporal gyrus

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79
Q

What is conduction aphasia?

A

Fluent speech, repetition poor. Aware of errors they are making. Comprehension normal

80
Q

Antiplatelet of choice for TIA?

A

Clopidogrel

81
Q

Reflexes in GBS

A

Reduced/absent

82
Q

What is Brown-Sequard syndrome?

A

Spinal cord hemisection (injury to one side of the spinal cord)

83
Q

Symptoms of brown-sequard?

A

Unilateral spastic paresis and loss of proprioception/vibration.
Loss of pain and temperature sensation on contralateral side

84
Q

Which tracts are damaged in Brown-Sequard?

A

Corticospinal tract
Spinothalamic tract
Dorsal columns

85
Q

Which nerve affected in trouble going downstairs/double vision?

A

CN IV - Trochlear

86
Q

Symptoms of pituitary apoplexy?

A

Sudden onset headache
Visual field defects
Hypotension

87
Q

Which area of the brain for homonymous quandrantanopia?

A

PITS
Parietal - inferior
Temporal - superior

88
Q

Cause of visual homonymous hemianopia?

A

Contralateral optic tract

89
Q

First line treatment for spasticity in MS?

A

Baclofen and Gabapentin

90
Q

How should MND patients have nutrition delivered?

A

PEG tube (percutaneous gastrostomy)

91
Q

What are the EMV scores for GCS?

A

Eyes - 4 Verbal - 5 Motor - 6

92
Q

What is the eye scale for GCS?

A

1 - None
2 - To pain
3 - To speech
4 - Spontaneous

93
Q

What is the verbal scale for GCS?

A

1 - None
2 - Sounds
3 - Words
4 - Confused
5 - Orientated

94
Q

What is the motor scale for GCS?

A

1 - None
2 - Extending to pain
3 - Abnormal flexion to pain
4 - Withdraws from pain
5 - Localises to pain
6 - Follows command

95
Q

When to refer a Bell’s Palsy patient to ENT?

A

If no improvement after 2 weeks with steroids - urgent referral

96
Q

Which nerve for ankle dorsiflexion?

A

Common peroneal nerve

97
Q

Acoustic neuroma symptoms?

A

Vertigo, hearing loss, tinnitus and absent corneal reflex.

98
Q

What is acoustic neuroma?

A

Vestibular schwannoma

99
Q

In which condition is acoustic neuroma commonly seen?

A

Neurofibromatosis type 2

100
Q

What is menieres disease?

A

Disorder of the inner ear of unknown cause

101
Q

Symptoms of Meniere’s disease?

A

Vertigo, tinnitus and hearing loss (sensorineural)

102
Q

Differences between acoustic neuroma and menieres?

A

Onset -
Menieres lasts minutes to hours
AN progressive onset and constant hearing loss

103
Q

What is the first line treatment for trigeminal neuralgia?

A

Carbamazepine

104
Q

Which anti-epileptic is first line in women of childbearing age?

A

Levetiracetam

105
Q

Which blood test can differentiate between pseudoseizures and true epileptic seizures?

A

Prolactin

106
Q

How to manage an acute relapse of MS?

A

Course of steroids

107
Q

Which lobe is most common in a seizure preceded by aura?

A

Temporal

108
Q

Which antiepileptics are common causes of stevens-johnson syndrome?

A

Lamotrigine, carbamazepine, phenytoin

109
Q

Which anti-epileptics are safest in women of childbearing age?

A

Levetiracetam and lamotrigine

110
Q

What is cataplexy?

A

Sudden and transient episode of muscle weakness

111
Q

What are common triggers of cataplexy?

A

Strong emotions - laughter, anger, surprise

112
Q

What are the investigations for syringomyelia?

A

MRI spine with contrast + brain MRI

113
Q

When is mannitol used?

A

Raised ICP - causes an osmotic shift of water out of the brain parenchyma

114
Q

Palsy of which nerve causes wrist drop?

A

Radial nerve

115
Q

Drug treatment for brain abscess?

A

Ceftriaxone and Metronidazole

116
Q

Signs of brain abscess on CT?

A

Ring enhancing lesion

117
Q

Which antiepileptic can cause megaloblastic anaemia?

A

Phenytoin

118
Q

Why give B12 before replacing folate in macrocytic anaemia?

A

Can precipitate subacute degeneration of the spinal cord

119
Q

Symptoms of subacute degeneration of the spinal cord?

A

Distal tingling/burning - symmetrical and legs/arms
Loss of proprioception and vibration
Sensory ataxia

120
Q

What is degenerative cervical myelopathy?

A

Degenerative spinal cord compression

121
Q

Risk factors for idiopathic intracranial hypertension?

A

High BMI
Female sex
Pregnancy
Certain drugs

122
Q

Which drugs increase risk of idiopathic intracranial hypertension?

A

COCP
Steroids
Tetracyclines
Retinoids
Lithium

123
Q

Which type of dementia is associated with MND?

A

Frontotemporal dementia

124
Q

Causes of GBS?

A

Campylobacter jejune
CMV
Zika virus
Influenza virus
EBV
Hepatitis A, B, C, E

125
Q

Why should repeat ABGs not be carried out in patients with diaphragmatic paralysis?

A

Changes in ABG occur after the onset of resp compromise - late in identifying problem

126
Q

Histopathological findings in Parkinson’s?

A

Loss of dopaminergic neurons in substantia nigra
Presence of levy bodies
Presence of eosinophilia cytoplasmic inclusions

127
Q

CT findings for Parkinson’s?

A

Normal CT/no findings

128
Q

Different types of MND?

A

ALS - amyotrophic lateral sclerosis
PLS - primary lateral sclerosis
PMA - progressive muscular atrophy
PBA - progressive bulbar palsy

129
Q

Symptoms of ALS?

A

Both LMN and UMN
Typically LMN in arms, UMN in legs

130
Q

Symptoms of primary lateral sclerosis?

A

UMN signs only

131
Q

Progressive muscular atrophy symptoms?

A

LMN signs only
Affects distal muscle before proximal
Carries best prognosis

132
Q

Progressive bulbar palsy symptoms?

A

Palsy of the tongue
Muscles of chewing/swallowing
Facial muscles
Due to loss of function of brainstem motor nuclei
Carries worst prognosis

133
Q

What is global aphasia?

A

Severe expressive and receptive aphasia
May still be able to communicate using gestures

134
Q

What is Charcot-Marie-Tooth disease?

A

Hereditary peripheral neuropathy resulting in predominantly motor loss

135
Q

Symptoms of Charcot-Marie-Tooth?

A

History of frequently sprained ankles
Foot drop
High-arched feet
Hammer toes
Distal muscle weakness/atrophy
Hyporeflexia
Stork leg deformity

136
Q

What is the Cushing reflex?

A

Nervous system response to increased intracranial pressure

137
Q

Obs in Cushing reflex?

A

Bradycardia, bradypnoea, hypertension, wide pulse pressure

138
Q

Which Parkinson’s drug has the highest chance of inhibiton of behaviours?

A

Dopamine receptor agonists e.g. ropinirole

139
Q

Red flags for headache needing CT?

A

Vomiting without obvious cause
Impaired level consciousness
Worsening headache w/ fever
Sudden onset
Headache triggered by cough/sneeze
Recent head trauma

140
Q

Most common causes of brain metastases?

A

Lung cancer

141
Q

Key features of tubular sclerosis?

A

Childhood seizures
Shagreen patch - roughened skin over lumbar spine

142
Q

What is lambert-eaton syndrome?

A

Autoimmune disease affecting the presynaptic voltage-gated calcium channel in the PNS

143
Q

Symptoms of Lambert-Eaton?

A

Repeated muscle contractions = increased muscle strength
Hyporeflexia
Limb-girdle weakness

144
Q

Which cranial nerves are affected in vestibular schwannomas?

A

III - Oculomotor
VII - Facial
VIII - Vestibulocochlear

145
Q

Intubate when GCS is below what score?

A

8

146
Q

Criteria for carotid endartectomy?

A

Stenosis >50%

147
Q

First two causes which should be ruled out in status epilepticus?

A

Hypoxia
Hypoglycaemia

148
Q

Reflex findings in subacute degenerations of the spinal cord?

A

Hyperreflexia

149
Q

Symptoms of multiple system atrophy?

A

Parkinsonism
Cerebellar signs
Autonomic disturbance:
Erectile dysfunction, postural hypotension, atonic bladder

150
Q

CNIII palsy vs Horner’s syndrome?

A

CN III = ptosis and dilated
Horner’s = ptosis and constricted

151
Q

Which alternative should be used if a Parkinson’s patient cannot orally take their levodopa?

A

Transdermal patch - dopamine agonist e.g. rotigotine

152
Q

Symptoms of Lateral pontine syndrome?

A

Ipsilateral facial weakness and DEAFNESS
Loss of temperature and pain ipsilateral face and contralateral body
Ataxic gait
Lean towards the side of the lesion
Dizziness

153
Q

Vessel affected in Lateral pontine syndrome?

A

Anterior inferior cerebellar artery

154
Q

Contraindication for triptan use?

A

Ischaemic heart disease

155
Q

Most common causes of upper/lower quadrantanopia?

A

Upper = pituitary tumour
Lower = craniopharyngioma

156
Q

Most common trigger for cluster migraines?

A

Alcohol

157
Q

Most common genetic mutation associated with Charcot-Marie-Tooth?

A

PMP22 duplication

158
Q

Symptoms of optic neuritis?

A

Pain
Vision loss
Decreased visual acuity
Impaired colour vision
Central scotoma

159
Q

Drugs for MS shown to reduce flare ups?

A

Natalizumab
Beta-interferon

160
Q

Which gene marker is associated with narcolepsy?

A

HLA-DR2

161
Q

First line treatment for myoclonic seizures in women?

A

Levetiracetam

162
Q

First line treatment for tonic or atonic seizures in women?

A

Lamotrigine

163
Q

DVLA rules for those with established epilepsy/recurrent seizures?

A

12 months

164
Q

Signs of non-epileptic seizures?

A

Pelvic thrusting
Much more common in females
Crying after seizure
Con’t occur when alone
Gradual onset
Eyes closed during episode
Normal prolactin levels

165
Q

Drug used for raised ICP?

A

Mannitol

166
Q

Symptoms of cauda equina syndrome?

A

Saddle anaesthesia
Loss of anal tone
Urinary retention/incontinence
Hypotonia of lower limbs
Lower limb weakness
Absent reflexes

167
Q

Why does orthostatic hypotension result in syncope?

A

Cerebral hypoperfusion

168
Q

MRC grading for muscle strength?

A

0 - no muscle movement
1 - trace of contraction
2 - movement at the joint with gravity eliminated
3 - movement against gravity, but not against added resistance
4 - movement against an external resistance with reduced strength
5 - normal strength

169
Q

Charcot-Marie-Tooth inheritance pattern (type 1)?

A

Autosomal dominant

170
Q

DVLA rules after TIA?

A

Can drive if symptom free after 1 month - don’t need to inform DVLA

171
Q

Vestibular schwannoma investigations?

A

Audiogram and gadolinium-enhanced MRI head

172
Q

Symptoms of craniopharyngioma?

A

Inferior bitemporal hemianopia
Diabetes insipidus

173
Q

When and how should anti-epileptics be stopped/reduced?

A

If seizure free for >2 years
AEDs stopped over 2-3 months

174
Q

First line treatment for focal seizures? (Regardless of gender)

A

Lamotrigine or levetiracetam

175
Q

Common cause of painful third nerve palsy?

A

Posterior communicating artery aneurysm

176
Q

Characteristic symptoms of pontine haemorrhage?

A

Reduced GCS
Paralysis
Bilateral pin point pupils

177
Q

Primary areas of the brain affected in Alzheimer’s?

A

Cortex and hippocampus

178
Q

Management of myasthenic crisis?

A

IVIG and plasmapheresis

179
Q

Drugs to be avoided in myasthenia gravis?

A

Beta blockers

180
Q

Adverse effects of triptans?

A

‘Triptan sensations’ - tingling, heat, tightness (e.g. throat and chest), heaviness, pressure

181
Q

GCS threshold for CT head within 1 hour?

A

<12

182
Q

Which vessel affected in homonymous hemianopia with macular sparing?

A

CONTRALATERAL posterior cerebral artery

183
Q

Where is affected in bi-temporal homonymous hemianopia?

A

Optic CHIASM

184
Q

What is affected in total blindness of one eye?

A

IPSILATERAL optic nerve

185
Q

What is affected in one sided homonymous hemianopia (e.g. left)?

A

CONTRALATERAL optic tract

186
Q

What is Kernig’s sign?

A

Hips and knees at 90 degrees -> Extend knees = spinal pain/resistance

187
Q

What is Brudzinski’s test?

A

Lie flat and passive flexion of neck = hips and knees flex involuntarily

188
Q

How long after symptoms should an LP be performed if SAH suspected?

A

12 hours

189
Q

Signs of SAH on lumbar puncture?

A

Xanthochromia (RBC breakdown)

190
Q

Adverse effects of levodopa?

A

Dyskinesia
Postural hypotension
Arrhythmias
N+V
Psychosis
On-off effect

191
Q

Investigations in a young person with a stroke?

A

Thrombophilia and autoimmune screening

192
Q

What is Todd’s palsy?

A

Temporary weakness following a seizure

193
Q

Which airway should be used in a seizing patient?

A

Nasopharyngeal

194
Q

What steps can be taken during a seizure for a patient (non-pharmacological)?

A

Recovery position
Pillow under head
Move items which may cause harm
Call senior

195
Q

Progressive supranuclear palsy symptoms?

A

Postural instability/falls
Impaired vertical gaze
Parkinsonism
Cognitive impairment

196
Q

Which Parkinson’s drugs associated with pulmonary fibrosis?

A

Cabergoline, bromocriptine, ropinirole

197
Q

LP findings in Guillain-Barre syndrome?

A

Raised opening pressure
Raised protein
Normal WCC
Normal RBC
Normal glucose

3a follow up (7 decks)

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