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Mrcp > Neuro > Flashcards

Neuro Flashcards

1
Q

Trinary incontinence, gait abnormality and dementia

A

Normal pressure hydrocephalus

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2
Q

Features of normal pressure hydrocephalus

A

Trinary incontinence, gait abnormality and dementia

Short shuffling

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3
Q

Features of progressive supranuclear palsy

A

Progressive supranuclear palsy: parkinsonism, impairment of vertical gaze (down gaze worse than up gaze - patients may complain of difficultly reading or descending stairs)

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4
Q

Features of shy dragger

A

A type of multi system atrophy, parkinsonism, autonomic dysfunction (atonic bladder, postural hypotension, erectile dysfunction), and cerebrllar signs

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5
Q

Syndrome that causes hemiplegia on one side and parasthesia on the other

A

Brown Sequard syndrome

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6
Q

First line meds for focal seizures

A

Carbemazipine or lamotrigine

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6
Q

First line meds for focal seizures

A

Carbemazipine or lamotrigine

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7
Q

Treatment of meningeal TB

A

12 months of RIPE and pred

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8
Q

Features of miller fisher syndrome

A

Variant of GBS, ophthalmoplegia, areflexia, ataxia. Eye muscles affected first

Descending paralysis unlike GBS which is ascending,

Anti GQ1b antibodies in 90%

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9
Q

Syndrome with persistent or recurrent complex hallucinations occurring in clear consciousness. BG of visual impairment

A

Charles bonnet syndrome. Usually not transient

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10
Q

What is the most common cause of hereditary cerebral small-vessel disease and vascular cognitive impairment in young adults?

A

CADASIL (also known as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) caused by NOTCH3 mutation

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11
Q

What is CADASIL?

A

cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy -the most common cause of hereditary cerebral small-vessel disease and vascular cognitive impairment in young adults

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12
Q

most common complication following meningitis

A

Sensorineural hearing loss is the most common complication following meningitis

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13
Q

Causes of Horner’s

A

Central lesson: anhidrosis of face arm and trunk
Stroke, Syringomyelia multiple Sclerosis
Preganglionic lesion: anhidrosis of face
Trauma, pancoast Tumour, Thyroidec
Post ganglionic lesion: no anhidrosis
Carotid artery dissection, Carotid aneurysm, Carvernous sinus thrombosis, Cluster headache

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14
Q

Treatment for cluster headaches

A

Subcutaneous sumatriptan and 100% o2

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15
Q

What neuropeptide is associated with narcolepsy

A

low orexin (hypocretin) levels…

You want high levels of you meet a t-rex-in

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16
Q

Treatment for bells palsy

A

Prednisolone

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17
Q

Features of bells palsy

A

Lower motor neuron facial palsy so forehead included

may also notice post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis

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18
Q

Creutzfeldt-Jakob disease features

A

Rapidly (over months) progressive dementia
Myclonus

C cerebellar signs
J jerks (myoclonus)
D dementia

10% familial

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19
Q

Features of bells palsy

A

LMN facial nerve palsy Affecting forehead

Sometimes hyperaccusis, post-auricular pain (can precede), altered taste, dry eye…

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20
Q

Features of bells palsy

A

LMN facial nerve palsy Affecting forehead

Sometimes hyperaccusis, post-auricular pain (can precede), altered taste, dry eye…

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21
Q

patient found to be in AF post TIA

A

Commence 300mg aspirin…. And warfarin

In ischaemic stroke wait two weeks before warfarin in case haemorrhagic transformation

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22
Q

Which viral meningitis can be associated with low CSF glucose

A

Mumps and lymphocytic choriomeningitis

May also be seen in herpes encephalitis

Viral is usually 60-80% of plasma glucose

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23
Q

Treatment for absence seizures

A

sodium valproate and ethosuximideare first-line treatment

Usually resolves by adolescence

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24
Q

Patient with left ulnar nerve palsy, then right radial palsy, then right sided facial palsy… diagnose

A

Mononeuritis multiplex syndrome

E.g. Polyarteritis nodosa

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25
Q

What wasting is carpal tunnel assx with

A

Thenar eminence not hypothenar

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26
Q

Treatment windows for acute ischemic stroke

A

Thrombolysis 4.5 hr — alteplase, once haem excluded

thrombectomy 6hr

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27
Q

Patient presenting with ataxia, nystagmus and reduced sensation ipsilateral facial and contralateral body. Diagnosis and bloods vessel

A

Lateral medullary syndrome.

Posterior inferior cerebellar artery

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28
Q

Patient with extra Dural haematoma suddenly drops GCS and develops eye deviation inferiorly and laterally… Diagnosis

A

3rd nerve palsy due to trans tentorial herniation secondary to raised ICP

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29
Q

Patient with frontal headaches difficulty sleeping and periorbital swelling is treated for severe sinusitis. He develops dysarthria, pyrexia and nystagmus. Diagnosis?

A

Cerebellar abscess

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30
Q

Diagnosis of lewy bodies

A

Usually clinical

But sensitivity of SPECT is around 90% with a specificity of 100%

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31
Q

Features of subacute degeneration of the spine

A

Lateral and dorsal columns
Loss of vibration and proprioception, then distal parasthesia
UMN signs

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32
Q

Features of CJD

A

C cerebellar signs
J jerks (myoclonus)
D dementia

10% familial

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33
Q

What is the diagnosis with patient who lose ability to look up?

A

Parinaud’s syndromeis an inability to move the eyes up and down. It is caused by compression of the vertical gaze center at therostral interstitial nucleus of medial longitudinal fasciculus(riMLF)

Often lose açcommodation reflex, have slight eyelid retraction,

Also Progressive supranuclear palsy sometimes loose vertical gaze

34
Q

Which cranial nerve is source of Ramsey hunt syndrome

A

Reactivation of varicella in geniculate ganglion of cranial nerve 7

35
Q

What treatment for MND extends life longest?

A

NIV extends 7 m

Riluzole extends 3m

36
Q

Good prognostic features of MS

A

Female
Young age of onset
Classical features

37
Q

What is dementia pugilato

A

Pugilato means boxing in italian language.
Dementia pugilistica = punch drunk syndrome
Due to repeated head trauma.

Parkinsonism

38
Q

What meds are contraindicated in absence seizures

A

Carbamazepine, phenytoin, vigabatrin and gabapentin can all worsen them

Treat with Ethosuximide or sodium valproate

39
Q

Treatment of absence seizures

A

Ethosuximide or sodium valproate

40
Q

Which features are more common in drug-induced Parkinson’s rather than Parkinson’s disease

A

Bilat symps are more in drug induced

Rigidity and rest tremor are uncommon in drug induced

41
Q

Where is damage is hemiballism?

A

subthalamic nucleus

Involuntary sudden linging movements

42
Q

What is the cause of post LP headaches

A

Leaking of cerebrospinal fluid from the dura is the most likely explanation for post-lumbar puncture headaches

43
Q

CT signs of HSV encephalitis

A

CT medial temporal and interior frontal changes - petichial patchy haemorrhagic changes
Normal in 1/3

44
Q

Cause and features of neuroleptic malignant syndrome?

A

Pyrexia rigidity, hypertension tachycardia tachypnea, delirium confusion

Either taking antipsychotic meds or Parkinson’s meds stopping /reducing

45
Q

Distinguish between neuroleptic malignant syndrome and serotonin syndrome

A

SS is caused by SSRI maois ecstasy… Onset of hours, increased reflexes, MYOCLONUS, dilated pupils……tx cyproheptadine or chlorpromazine

MMS antipsychotic or stopping PD meds. Raised CK more assx with
Mx dantrolene.

46
Q

Mx of post LP headaches

A

Supportive, analgesia and rest
Blood patch (surg procedure wgere you inject blood into epidural space and the clot “patches” the Dura)
or epidural saline or IV caffeine

47
Q

Causes of cerebellar syndrome

A 
Friedrich's ataxia, ataxic telangiectasia
Cerebellar hemangioma
Stroke
Alcohol
MS
Hypothy
Phenytoin
Paraneoplastic i.e. lung ca
48
Q

What is anti NMDA receptor encephalitis associated with?

Presents with agitation hallucinations disordered thinking

A

Ovarian teratomas are detected in half of all female patients!

49
Q

Patient presents with bilat sensorineural hearing loss. MRI shows bilat vestibular schwannomas. Diagnosis

A

Neurofibromatosis type 2

2 schwannomas, type 2

50
Q

Signs of stroke in middle cerebral artery

A

miDDle cerebral uPPer extremity
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

51
Q

Presentation of syringomyelia

A

Cape-like (neck and arms) loss of sensation of temperature and pain

Due to compression on spinothalamic tract in anterior commissure

52
Q

Distinguish between Lambert Eaton syndrome and MG

A

Both have weakness

LES improves with exercise, MG doesn’t
LES presents later, MG peaks in 3rd or 6th decades

53
Q

What is CADASIL

A

Cerebral auto dominant arteriopathy with subcortical infarcts and leukoencephalopathy

…. Presents w migraine
Multi infarcts
NOCTH3 gene mutation

54
Q

Cerebral toxoplasmosis treatment

A

Sulfadiazine + pyrimethamine

In normal toxo, no treatment required unless severe/immunocompromised

55
Q

Which vessel is most likely implicated with extra dural haem?

A

Middle meningeal artery

56
Q

Which vessel is most likely implicated with sub dural haem?

A

Bridging veins

Fluctuating conciseness

57
Q

Broccas Vs Wernicke’s

A 
Wernicke's is receptive,
Superior temporal gyrus
Fluent
Abnormal comprehension
Can't repeat words or phrases
Brocca's is expressive
Inferior frontal gyrus
Non fluent
Normal comprehension
Can't repeat words or phrases
58
Q

What autonomic symptoms are most likely with GBS?

A

Tachycardia and urinary retention

59
Q

Contra pain/temp loss and weakness, Ipsi facial paralysis and deafness

A

Lateral pontine syndrome

Ant inf cerebellar artery

Without facial palsy/deafness: Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)

Anterior has paralysis

60
Q

Contra pain/temp loss and weakness, Ipsi facial pain and temp loss

A

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)

Would be anterior, and lat pontine if facial paralysis too

61
Q

Transient global amnesia Vs psychogenic amnesia

A

Transient memory loss

Psychogenic can’t remember personal info

62
Q

Features of subacute combined degeneration of spinal cord

A

Lateral and dorsal columns so Loss of proprioception and vibration, then distal paraesthesia

63
Q

sudden and transient loss of muscular tone caused by strong emotion

A

Cataplexy

64
Q

Parkinson’s drug management

A

If motor symps not an issue then Dop R agonist like ropinirole/bromocriptine, or Levodopa/MAO-B inhib

If motor is an issue then Levodopa
Add dop r agonist/MAO-B inhib/COMT if motor worsens or dyskinesia develops

65
Q

Prognosis of Duchennes

A

Usually can’t walk by 12 and need ventilation support by 25

66
Q

Cerebellar ataxia presenting at 1-5yr Vs 10-15yr

A 
1-5 = ataxia telangiectasia
10-15 = Friedreich's ataxia (more common)
67
Q

Which is more common hereditary ataxia? ataxia telangiectasia vs Friedreich’s ataxia

A

Friedreich’s

Presents later but more common
Usually die from HOCM. (90%)
GAA: Friedrich Ataxia =( gAA- friedrich AtAxiA- so many As)

68
Q

Trinucleotide repeats mnemonic

A

GAA: Friedrich Ataxia =( gAA- friedrich AtAxiA- so many As)

HUNT for CAGe

CTG: Myotonic dystrophy = (cTg- myoTonic dysTrophy- T in the middle of both words)

CGG: Fragile X syndrome = (cGG - fraGile XX syndrome- XX and GG)

69
Q

isolated weakness of foot dorsiflexion and eversion. Reflexes normal

A

Common peroneal nerve palsy

Advise to not cross legs.

70
Q

Which brain bleed has lucid interval

A

Extra dural

71
Q

Causes of bilat facial nerve palsy

A 
Sarcoidosis
GBS
Lyme's 
Bilat acoustic neuroma (NF2)
Bells accounts for 25% of bilat cases but only 1% of bells are bilat
72
Q

Cerebellar tonsillar herniation Vs trans tentorium herniation

A

Both can have third CN palsy (down and out,fixed dilated)

Former is from post communicating artery aneurysm
Latter is from intracranial mass (like haematoma from trauma)

73
Q

When do you consider thrombectomy

A

If good baseline, proximal anterior circulation within 6h
Or 6-24h if potential to salvage

Consider with proximal posterior circ

74
Q

Painful third nerve palsy - what do you need to rule out

A

posterior communicating artery aneurysm

75
Q

bilateral vitreous haemorrhage

A

Von Hippel lindau has Retinal and cerebellar haemangiomas

76
Q

Mx after anneurysmal SAH

A

coil, then 21-day course of nimodipine to prevent vasospasm (a calcium channel inhibitor targeting the brain vasculature)

77
Q

Anti epileptic causing visual problems

A

V for Vigabatrin - V for Visual field defects

30%(!)

78
Q

Temporal lobes Vs subcortical white matter on MRI FLAIR

A

Herpes - Temporal lobes

acute disseminated encephalomyelitis - Subcortical white matter

79
Q

ECG of myotonic dystrophy

A

prolonged PR interval is seen in around 20-40% of patients

80
Q

Third nerve palsy with pupillary involvement…

A

Must exclude compressive lesion if pupil involved

81
Q

Alcoholic with bilateral ophthalmoplegia

A

Wernicke’s

82
Q

Wernicke’s aphasia

A

Receptive
Superior temp gyrus

Inf division of L MCA

83
Q

Broca’s

A

Expressive
Inferior frontal gyrus

Superior division, L MCA

Mrcp (21 decks)

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