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3A GH > Neuro > Flashcards

Neuro Flashcards

1
Q

causes of blackout

A

syncope [decreased cerebral perfusion]
epilepsy
non-epileptic attacks

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2
Q

what is described: a drop in blood pressure, quickly followed by faster then slower heart rate resulting in poor blood and oxygen flow to the brain which results in temporary loss of consciousness

A

vaso-vagal /neurocardiogenic syncope

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3
Q

epilepsy - definition and cause

A

tendency to recurrent seizures

disordered electrical activity in the brain

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4
Q

triggers for syncope

A

stress, fear, standing, heat, micturition, cough, venepuncture

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5
Q

triggers for epileptic seizure

A 
sleep deprivation
flashing lights
menstruation
alcohol
withdrawal
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6
Q

syncope prodrome vs epilepsy

A

syncope: hot, vision loss, dizzy, pale
epilepsy: aura [visual, auditory, gustatory]

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7
Q

time difference between syncope, non-epileptic seizures and epileptic attack

A

syncope seconds>mins
epilepsy 2>3 mins
N.E.A.s >30mins

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8
Q

phases of generalized tonic clonic seizure

A

tonic phase - rigid
clonic - muscles jerk rhythmically
post-ictal - drowsiness

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9
Q

incontinence and tongue biting in syncope and epilepsy

A

rare in syncope

yes in epilepsy

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10
Q

Ix for blackout

A 
echo
24 hr ECG
CT - rule out tumour
lying and standing BP, table tilt
EEG
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11
Q

eyes and mouth open or closed in tonic clonic vs non-epileptic seizure

A

tonic clonic- open

non-ep - closed

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12
Q

eyes roll up slightly and eyelids flicker. Type of seizure?

A

absence

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13
Q

best investigation for diagnosing MS

A

MRI brain

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14
Q

relapsing and remitting optic neuritis, neurological deficits of cranial nerves and limbs over several years followed by secondary progressive neurological problems. Diagnosis?

A

MS

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15
Q

MS patient with worsening mobility, long term catheter, pyrexia, chest clear. Most appropriate investigation to find cause of current state?

A

MSU

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16
Q

oligoclonal bands in the CSF = ?

A

MS

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17
Q

neuro features of sarcoidosis

A 
bells palsy
neuropathy
meningitis
brainstem and spinal syndromes
space occ lesion
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18
Q

18 yr old. Sudden onset, back pain, numbness, diff walking, proximal thigh weakness, glove and stocking loss of sensation, loss of reflexes. Diagnosis

A

Guillain-Barre syndrome

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19
Q

relapsing remitting MS usual age of onsset

A

15-25

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20
Q

oxybutynin treats

A

urge incont

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21
Q

obesity, morning headaches, enlarged blind spots

A

raised intracranial pressure probably due to idiopathic intracranial HTN

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22
Q

quick assessment of cognitive state

A

AMTS

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23
Q

neurological side effect of TB drug isoniazid

A

peripheral neuropathy

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24
Q

what deficiency is wernicke korsakoff’s due to

A

thiamine

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25
Q

causes of papilloedema

A

tumour
hydrocephalus
cavernous sinus thrombosis, meningitis
idiopathic intracranial HTN

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26
Q

causes of Homonymous hemianopia

A

stroke, tumour

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27
Q

cause of Bitemporal hemianopia-

A

optic chiasm compression e.g. pituitary tumour

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28
Q

3rd nerve palsy signs

A

ptosis, large pupil, eye down and out

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29
Q

nystagmus is due to lesions where

A

cerbellum, vestibular

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30
Q

headache history Red flags?

A

New headache >60yrs
thunderclap
infective sx
hx of malignancy

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31
Q

is proximal/distal weakness caused by a muscle/nerve problem?

A

proximal weakness is muscular

distal weakness is nerve

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32
Q

is peripheral neuropathy sensory or motor

A

Sensory or motor or both

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33
Q

symptoms of GBS

A

parasthesia, weakness, paralysis, numbness, areflexia, balance/coord probs

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34
Q

GBS Tx

A

IVIG

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35
Q

mechanism of GBS

A

complement activation
demyelination by WBCs
/trigger [infection] causes antibodies which attack nerves

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36
Q

name some conditions which can lead to Mononeuritis Multiplex

A 
Vasculitis
RA
DM
SLE
sarcoid
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37
Q

give an examples of a mononeuropathy

A

carpal tunnel syndrome

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38
Q

describe distribution of mononeuropathy, mononeuritis multiplex and polyneuropathy

A

mononeuropthy: one nerve
MM: random individual nerves
polyneuropathy: glove and stocking

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39
Q

Ix of neuropathy

A 
FBC
ESR
glucose
B12
coeliac
TFT
U and E
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40
Q

non-neurological causes of peripheral neuropathy

A 
hypothyroidism
coeliac
B12 deficiency
chronic kidney disease
diabetes
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41
Q

what part of the nervous system is affected by myasthenia gravis and how?

A

neuromuscular jn

autoimmune antibodies bind ACh receptors on post-synaptic membrane

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42
Q

what is the main symptom of MG?

A

fatigue-able muscle weakness

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43
Q

MG worse in morning or evening?

A

evening

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44
Q

what eye symptoms might MG patients experience?

A

diplopia

ptosis

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45
Q

describe link between MG and cancer

A

MG can occur as a PARANEOPLASTIC syndrome in thymoma or bronchogenic carcinoma. Cancer produces the autoimmune antibodies

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46
Q

what is a myasthenic crisis?

A

life threatening manifestation of MG e.g. resp muscles affected

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47
Q

Tx for MG

A

acetylcholinesterase inhib [pyridostigmine]
prednisolone/ [azathoprine] for relapse
thymectomy
IVIG for myasthenic crisis

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48
Q

Ix for MG

A

CT thorax
ACh receptor antibodies
EMG

tensilon test [rarely]

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49
Q

causes of myasthenic crisis

A

Infection
natural disease cycle
under/over dosing of medication

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50
Q

what drugs can cause myopathy?

A

steroids

statins

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51
Q

investigations in myopathy

A 
CK
EMG
CRP
genetics for Duchennes/Becker
biopsy
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52
Q

acute and chronic Tx for migraine

A

acute - NSAIDs, triptans

chronic - BB, amitryptiline

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53
Q

describe cluster headache and some Sx

A

get a number of headaches over a short period, then may have none for yrs.
red painful eye, rhinorhoea

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54
Q

Tx of cluster headaches

A

O2, triptans

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55
Q

treatment of trigeminal neuralgia

A

carbamazepine

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56
Q

what Ix in patient with trigem neuralgia and why?

A

MRI for tumour

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57
Q

ix for GCA

A

temporal artery biopsy

ESR

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58
Q

complication of GCA

A

blindness

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59
Q

what scoring system estimates risk of stroke after TIA

A 
ABCD2
Age >60
BP >140/90
Clinical - 1=speech 2=unilat weakness
Duration - 1= 10-60, 2= >60mins
DM
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60
Q

treatment for TIA

A

aspirin [clopidogrel as alternative intolerant]

+ secondary prevention

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61
Q

acute Mx of ischaemic stroke

A

CT
TPA [tissue plasminogen activator] [alteplase]
then aspirin 24 hrs later

or aspirin alone asap if no TPA

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62
Q

how does an extradural haemorrhage appear on CT

A

elliptical, doesnt follow lobe shape

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63
Q

how does extradural haemorrhage present

A

loss of consciousness after trauma
then lucid phase
then rapid deterioration in GCS
headache dizzy vomiting

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64
Q

causes of extradural heamorrhage

A

skull fracture [parietal bone]

middle meningeal artery rupture

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65
Q

Ix for extradural haemorrhage

A

CT to look at bleed

xray to look for fracture

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66
Q

cause of subdural haemorrhage

A

ruptured bridging veins, falls

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67
Q

people at risk of subdural haemorrhage

A

elderly, alcoholics, epileptics, bleeding disorders

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68
Q

Sx of subdural

A

confusion, headache

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69
Q

Mx subdural

A

conservative, improves by self. Surgery in severe

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70
Q

Mx extradural haem

A

surgery

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71
Q

cause of SAH

A

berry aneurysm

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72
Q

where are berry aneurysms

A

aneurysms at branch points in the circle of willis

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73
Q

associations/ risk factors for berry aneurysms

A

PKD
HTN
ehlers danlos
coarc aorta

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74
Q

symptoms of SAH

A

thunderclap headache

can get meningism - neck stiffness

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75
Q

Ix SAH

A

CT, LP after 12 hrs

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76
Q

what drug do you give to SAH patients before surgery

A

oral nimodipine

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77
Q

what would you see on an LP 12 hrs after SAH

A

yellow csf, xanthachromia

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78
Q

diff between simple and complex partial seizures

A

complex - altered consciousness

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79
Q

treatment for absence seizures and one treatment you should never use and why

A

valproate or ethosuximide

never use carbamaz - makes worse

80
Q

after how many seizures do you start treating someone for epilepsy

A

2

81
Q

MS presentations and how/when do they happen

A

optic neuritis, trigem neur, numbness

dissemminated in time and spacce

82
Q

parkinsons triad of Sx

and 3 other Sx

A

bradykinesia
cogwheel rigidity
resting tremor

[depression
dementia
shuffling gait
sleep disturbance
hypokinesia
postural instability
bladder + bowel dysfn
speech + lang probs
weight loss
swallowing probs]
83
Q

parkinsons pathophysiology

A

Degeneration of dopamine neurons in substantia nigra of basal ganglia

84
Q

Tx for parkinsons

A

levodopa (with co-careldopa [carbidopa] or co-beneldopa)

non-ergot-derived dopamine-receptor agonists [ropinirole]

MAOIs [selegiline]

COMT inhibitors [entacapone] with levodopa

if not controlled: ergot-derived [bromocriptine]

still not controlled: amantadine

85
Q

name some parkinsons plus syndromes and what added systems affected /symptoms

A

lewy body dementia
progressive supranuclear palsy [EYES]
multiple system atrophy [POST HYPO]

86
Q

define parkinson’s plus syndromes

A

classical features of PD plus other additional features that dintinguish them from simple parkinsons

87
Q

what inheritance pattern is huntingdons and therefore how likely is child to get it

A

auto dom, 50%

88
Q

pathophys of huntingdons

& associated gene defect

A

atrophy of striatum [part of basal ganglia] + cortex

CAG repeat in gene that codes for huntingtin protein on chr4

89
Q

symptoms of huntingdons

A

chorea [extra movements]
depression, dementia, personality change,
cognitive impairment, psychiatric illness

90
Q

average age of huntingdon onset

A

40

91
Q

causes of death in huntingdons patients

A

aspiration pneumonia

suicide

92
Q

Ix for huntingdons

A

genetic test

93
Q

Mx of huntingdons

A

tetrabenazine [dopamine-depleting]
olanzapine [dopamine receptor antagonists]
OT/physio
antidepressants/mood stabilisers

94
Q

main features of MND

A

muscle wekaness, wasting, increased or decreased reflexes depending on UMN/LMN affected, fasciculations

95
Q

what symptoms are never present in MND

A

sensory, eye, cerebellum

96
Q

GBS Ix

A

CSF [high protein]

nerve conduction study [features of demyelination]

97
Q

Mx of GBS

A

IVIG

98
Q

GCS - scores for verbal response

A
  1. orientated in time/place/person
  2. confused
  3. inappropriate words
  4. incomprehensible sounds
  5. none
99
Q

GCS scores for eye response

A
  1. spontaneously
  2. to speech
  3. to pain
  4. none
100
Q

GCS score for motor response

A
  1. obeys commands
  2. localises
  3. normal flexion
  4. abnormal flexion
  5. extension
  6. none
101
Q

3rd nerve palsy does what to pupil?

A

fixed dilated

102
Q

are the following likely to be of spine or brain origin?

  1. Radiating limb pain
  2. Bilateral limb deficit
  3. Contralateral deficit
A
  1. radiating limb pain - spine
  2. Bilateral limb deficit - spine
  3. Contralateral deficit - brain
103
Q

C6 nerve root resonsible for which arm action and reflex

A

elbow flexion

biceps reflex

104
Q

C7 nerve root responsible for which arm action and which reflex

A

elbow extension

triceps

105
Q

nerve root responsible for dorsi and plantar flexion of the foot

A

dorsiflexion [standing on heels] - L4, L5

plantar flexion [tip toes] - S1, S2

106
Q

corticospinal motor tract decussates at what level ?

A

medulla

107
Q

spinothalamic sensory tract decussates where?

A

spinal cord

108
Q

posterior column sensory tract decussates where?

A

medulla

109
Q

what is brown sequard syndrome

A

weakness on one side
sensory loss on other
due to damage to one side of spinal cord

110
Q

cerebellar lesion. Deficit on same or ipsilateral side?

A

same side

111
Q

cerebellar symtoms

A

ataxia
nystagmus
intention tremor
slurred speech

112
Q

symptoms of raised intracranial pressure

A

headache, vomiting, visual disturbance, gait unsteadiness

113
Q

signs of raised intracranial pressure on examination of the eyes

A

papilloedema, limitation of upward gaze, reduced visual acuity

114
Q

timeframe for TIA

A

less than 24 hrs

115
Q

63 year old HGV driver. Stopped to take a break and has word finding problems. Rt arm felt ‘heavy’. Improved after 15 minutes. Diagnosis?

A

TIA

116
Q

what factors would constitute a high risk TIA?

A

ABCD score ≥4

> 1 TIA in last 7 days (Crescendo TIAs)

New arrhythmia

Known high grade ipsilateral carotid stenosis

117
Q

immediate management for high risk TIA

A

Aspirin (300 mg daily) start immediately for 2 weeks

118
Q

what investigations might you want to carry out in a patient who has just had a high risk TIA?

A

MRI
Carotid dopplers- to look for significant stenosis of internal carotid artery
24 Hour ECG

119
Q

causes of haemorrhage

A 
HTN
Trauma
Anticoagulation
Tumour 
AVM
120
Q

management of confirmed cerebral haemorrhage

A

surgery

121
Q

Investigation to look for cause of confirmed brain haemorrhage

A

MRI - space occupying lesion or arteriovenous malformation

122
Q

what is todd’s paresis

A

post ictal weakness

123
Q 
23 year old woman
Blurring of vision R eye, Gradual numbness affecting left hand and lip.
Headache
O/E- Normal
Diagnosis?
A

migraine

124
Q

stroke bloods

A

FBC, ESR, clotting, U & E, LFT’s, glucose, cholesterol

125
Q

stroke patient with raised ESR. What other Ix might you consider and why?

A

blood cultures [endocarditis]

temporal artery biopsy [vasculitis]

126
Q

risk of tPA thrombolysis in stroke

A

fatal haemorrhage

127
Q

contraindications for tPA

A 
>4.5 hrs after symptom onset
peptic ulcer
surgery/trauma in last 3 months
haemorrhagic stroke
on heparin
BP >185/110
128
Q

in what situations might you treat HTN immediately in stroke patient

A 
HTN encephalopathy
HTN nephropathy
pre-eclampsia
haemorrhage
aortic dissection
MI
thrombolysis candidates
129
Q

what is the policy on feeding for stroke patients?

A

all stroke patients must remain nil by mouth until theyve had dysphagia screen
IV nutrition
>24 hrs - NG
>7 days - PEG

130
Q

what are ventriculo-peritoneal shunts used for in stroke patients

A

for primary intracranial haemorrhage with hydrocephalus

131
Q

3 options for ANTIPLATELETS in secondary STROKE prevention

A

clopidogrel, aspirin, dipyridamole

132
Q

what is the most common ‘anterior horn cell disease’

A

MND

133
Q

list some long tract (UMN) signs

A 
Spastic gait
Hypertonia
Hyper-reflexia
Babinski
Clonus
Hoffman’s
134
Q

common causes of coma

A 
meningitis/encephalitis
head injury
bleed/SAH
opiates/alcohol
anoxia post MI
epilepsy
hypo
135
Q

adverse complications of Amphetamine + other stimulants

A 
intracranial haemorrhage
ischaemic stroke
seizures
psychosis/delirium
coma
136
Q

define wernickes encephalopathy and give some Sx

A

neuro consequences of thiamine deficiency due to alcohol abuse.
ataxia, confusion, opthalmoparesis

137
Q

define korsakoffs and give some Sx

A

permanent neuro damage due to alcohol abuse (thiamine def) follows wernickes encephalopathy.
Ataxia, confusion, abnormal eye movements

138
Q

what cranial nerve palsy is seen in SAH

A

3rd nerve

139
Q

triad of horners syndrome and cause

A 
constricted pupil
ptosis
anhidrosis
ON ONE SIDE OF FACE
damage to sympathetic nerve supple to eye
140
Q

59-year-old developed acute bilateral flaccid leg weakness.
Had shifted her weight while sitting on the sofa and suddenly felt sharp pain in lower back + R leg.
Legs numb, over 1 hr because unable to move them.
Couldn’t urinate + dribbling incontinence.
Differentials?

A

cauda equina /lower spinal cord lesion (myelopathy)

numbness makes muscular or NMJ unlikely
(sudden onset suggests vascular or compression)

141
Q

Causes of acute/subacute myelopathy

A 
trauma
malignancy (compression)
infection
disc
inflamm (MS/transverse myelitis)
vascular
142
Q

72 yr old with back pain and progressive lower limb weakness, sensory loss and bladder dysfn.
MRI - vertebral destruction and cord compression.
CXR - lung mass.
Dx?

A

lung malignancy spinal mets

143
Q 
18 yr old male
flu-like illness
Tingling feet and hands then slurred speech, facial weakness, limb weakness progressive over days
O/E hyporeflexic, weakness
Diagnosis?
A

GBS

144
Q

warning signs after head injury

A 
change in consciousness
pupils unequal or slow to react
seizures
vomiting
blurred vision
loss of sensation
slurred speech
blood/watery from nose/ears
145
Q

commonest iatrogenic cause of proximal myopathy

A

corticsteroids

146
Q

commonest underlying disease entity for Peripheral neuropathy.

A

diabetes mellitus

147
Q

treatment of benign essential tremor

A

propanolol

2nd line primidone

148
Q

how do you differentiate a clinically isolated syndrome form MS

A

one episode/ one MRI feature

vs MS = 2 separate relapses within 2 years

149
Q

pathophysiology of MS

A

[autoimmune] demyelination in the brain and spinal cord

150
Q

what is found in the CSF in MS

A

^protein

151
Q

MS Tx in pregnancy

A

all drugs contraindicated, steroids not recommended

152
Q

define progressive multifocal leukoencephalopathy

A

opportunistic brain infection caused by JC virus, seen in MS patients who are on disease modifying drugs

153
Q

what causes optic neuritis

A

demyelination of the optic nerve

154
Q

headache + papilloedema -> CT normal. You suspect a sagittal sinus thrombosis. How would you investigate this?

A

CT venogram

155
Q

Ix idiopathic intracranial HTN

A

LP pressure

156
Q

multiple family members with headache, otherwise well. Possible cause

A

CO poisoning

157
Q

what is status epilepticus & main risk

A

when a seizure is not self limiting - medical emergency

cerebral ischaemia due to cardiorespiratory failure

158
Q

management of status epilepticus

A

rectal diazepam/ buccal midazolam

159
Q

risk of tensilon test for MG

A

bradycardia

160
Q

MND Mx

A

riluzole
quinine for muscle cramps
baclofen for spasticity

glycopyronium bromide for secretions
morphine for breathless, ?NIV
antidepressants

OT, PT, palliative

161
Q

microscopic changes in alzheimers brain

A

Amyloid plaques

Neurofibrillary tangles

162
Q

Lewy-body Dementia drug Tx

A

donepazil or rivastigmine

if not tolerated: galantamine or memantine

163
Q

GBS what infections

A

campylobacter, CMV, mycoplasma, zoster, HIV, EBV

164
Q

bulbar palsy denotes disease of the nuclei of which cranial nerves in the medulla?

A

9-12

165
Q

signs of bulbar palsy

A

flaccid fasiculating tongue [like a bag of worms]

quiet/hoarse/nasal voice

166
Q

causes of bulbar palsy

A 
MND
GBS
polio
MG
syringobulbia
brainstem tumour
central pontine myelinosis [rapid correction of hyponat]
167
Q

bulbar and corticobulbar [pseudobulbar] palsies both affect the muscles of swallowing and talking. What is the difference?

A 
bulbar = LMN/ medulla
pseudobulbar = UMN/ pons
168
Q

psuedobulbar/ corticobulbar palsy causes

A

stroke
MND
central pontine myelinosis
MS

169
Q

1st line anti-epileptic for focal/ partial seizure?

A

carbamaz or lamotrigine

170
Q

1st line anti-epileptic for generalised tonic clonic seizure?

A

sodium valproate or lamotrigine

171
Q

1st line anti-epileptic for myoclonic seizure?

A

sodium valproate

172
Q

other possible interventions for epilepsy other than anti-epileptic drugs

A

psych therapies e.g. relaxation/ CBT, [but dont improve freq]

surgery -if single focus

vagal nerve stimulaiton

173
Q

give 2 valproate SEs

A 
abdo pain
alopecia
agitation
anaemia
behaviour change
poor concentration
confusion
deafness 
diarrhoea
drowsy
haemorrhage 
headache
hepatic
menstrual
nausea
nystagmus
seizure
tremor
weight gain
thrombocytopenia
174
Q

Mx of intracranial venous thrombosis

A

anticoag [heparin/LMWH, then warf]
thrombolysis
thrombectomy

175
Q

describe some different clinical presentations of MS

A

red. vision in 1 eye w/ painful movements

double vision

ascending sensory disturbance and/or weakness

problems with balance, unsteadiness or clumsiness

altered sensation travelling down the back and sometimes into the limbs when bending the neck forwards (Lhermitte’s symptom)

176
Q

what bloods would you request in someone with suspected MS to rule out other diagnoses before R/F ing to neuro

A

full blood count

ESR/CRP

liver function tests

renal function tests

calcium

glucose

thyroid function tests

vitamin B12

HIV serology.

177
Q

people involved in the multidisciplinary team looking after someone with MS

A

consultant neurologists

MS nurses

PT, OT

speech and language therapists, psychologists, dietitians, social care and continence specialists

GP

178
Q

modifiable risk factors that you can counsel MS patients on

A

Preg [may get better then worsen Sx after delivery]

smoking increases progression

exercise

vaccine - flu, live ones may be contraindicated if on disease‑modifying therapies

179
Q

define MS

A

chronic, immune-mediated, demyelinating inflammatory condition of the central nervous system, which affects the brain, optic nerves and spinal cord, and leads to progressive severe disability.

180
Q

what are the 4 types of MS

A

relapsing remitting [most common]

secondary progressive [develops from R-R, ^ing disability unrelated to relapses]

primary progressive [gradual worsening, no relapses or remissions]

progressive relapsing [worsening from beginning + relapses]

181
Q

drug treatment for secondary progressive MS [not including Sx management]

A

interferon beta 1b

182
Q

drug treatment for primary progressive +

progressive relapsing MS

A

no specific, interferon beta sometimes used [unlicensed] for primary progressive

183
Q

acute drug management of relapse in relapsing remitting MS

A

Oral methylprednisolone

[IV methylpred if oral failed /not tolerated /hospitalisation required]

184
Q

management of fatigue in MS patients

A

exercise
CBT
Amantadine hydrochloride [unlicensed]

185
Q

what factors might aggravate spasticity in MS patients?

A

constipation, infection, poor mobility aids, pressure ulcers, posture and pain

186
Q

Mx of spasticity in MS

A

1st line: baclofen/gabapent
2nd line: Tizanidine or dantrolene sodium
3rd line: Benzos

187
Q

management of oscillopsia in MS

A

gabapent [1st line]

memantine hydrochloride [2nd]

188
Q

drug treatment for relapsing-remitting MS [not including Sx management]

A

active: beta interferon + glatiramer acetate

OR methyl fumurate + teriflunomide [ORAL]

more active: natalizumab/ alemtuzumab

for highly active or ^risk of PML: fingolimod

189
Q

in a patient already on anticoag for prosthetic valve, who has an ischaemic stroke w/ risk of haemorrhagic transformation, how would you manage their anticoagulation?

A

anticoagulant treatment stopped for 7 days and substituted with aspirin

190
Q

non-pharmacological Mx of parkinsons

A

PT
speech and lang therapy
OT
dietician

191
Q

possible SEs of parkinsons meds

A

psychotic sx
drowsy
sudden onset of sleep

192
Q

parkinsons drug Mx for postural hypotn

A

1st line: midodrine hydrochloride

2nd: fludrocortisone acetate

193
Q

Mx of psychotic Sx in parkinsons

A

reduce parkinsons meds

quetiapine, 2nd line clozapine

194
Q

mx of drooling of saliva in parkinsons

A

1st line: glycopyronium bromide

2nd: botox

195
Q

drug mx of parkinsons dementia

A

rivastigmine/ donepazil/ galantaine

memantine if not tolerated/ contraI

3A GH (8 decks)

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