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Year 6 Passmed > Neuro > Flashcards

Neuro Flashcards

1
Q

Commonest psych manifestation of Parkinson’s?

A

Depression (40%)

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2
Q

Thrombolysis w. alteplase for acute stroke criteria

A

Onset of symptoms <4.5 hours prior AND

Haemorrhage excluded by CT/MRI

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3
Q

Absolute CIs to thrombolysis? (x11)

A 
Prior stroke/TBI in last 3 months
Previous IC haemorrhage
Suspected SAH
Lumbar puncture 7 days prior
GI haemorrhage in 3 weeks prior
Active bleeding
Oesophageal varices Intracranial neoplasm
Seizure during stroke
Cardiac embolus
Pregnancy
Hypertension >200/120
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4
Q

Indications for mechanical thrombectomy in stroke?

A

<6 hours after symptom onset AND proximal anterior/posterior circulation stroke confirmed by CTA/MRI
OR
6-24 hours after symptoms if confirmed proximal Ant/Post occlusion confirmed by imaging AND potential to salvage brain tissue (dwMRI)

NB- Perform with IV alteplase if <4.5hours from symptoms

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5
Q

Acute ischaemic stroke secondary prevention drug regimen?

A

Aspirin + clopidogrel + statin (if cholesterol >3.5)

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6
Q

Neuroleptic Malignant Syndrome Fx -and in who?

A

Tachycardia
Convulsions/Rigidity
Sweating
Seen in pts on antipsychotics recently started/dose change

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7
Q

NEMS Rx

A

Stop antipsychotic
IV fluids (prevent AKI)
Consider Daltreone (reduces muscular contractions)
Consider bromocriptine

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8
Q

NEMS blood findings

A

Raised CK
Raised WCC
Hyperkalaemia
Hypocalcaemia

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9
Q

Valproate side effects (10)

A 
P450 inhibition
Nausea
Teratogenicity
Alopecia
Weight gain
Hyponatraemia
Encaphalopathy
Ataxia
Hepatotoxicity
Thrombocytopaenia
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10
Q

Vestibular schwannoma Fx

A

CN 8 - Tinnitus, vertigo, unilateral sensorineural HL
CN 7 - Facial palsy
CN 5 - Absent corneal reflex

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11
Q

Vestibular schwannoma Ix + Rx

A

MRI of CPA

Urgent ENT referral for surg/radiotherapy

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12
Q

GCS Motor points

A 
6 -obeys commands
5 - Localises to pain
4 - Withdraws from pain
3 - Decorticate posture
2 - Extending to pain
1 - No movement
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13
Q

GCS Eye points

A

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

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14
Q

GCS Verbal points

A 
5 - Oriented
4 - Confused
3 - Words
2 - Sounds
1 - None
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15
Q

Type of antiemetic for chemotherapy related nausea?

A

5HT-3 inhibitors e.g. ondansetron, given with a steroid

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16
Q

Uhthoff’s phenomenon?

A

The worsening of MS symptoms linked to heat exposure -bath, sweating, exercise etc.

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17
Q

Acute MS Rx + desired effect?

A

IV/PO methylpred for <5 days. Speeds recovery from flare up but does not affect scale of recovery.

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18
Q

Role of Beta interferons in MS Rx

A

Long term medication; Reduces flare ups by up to 30%.

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19
Q

Baseline Ix in MS and why?

A

MRI with contrast - as contrast allows fulfilment of dissemination in time criterion.

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20
Q

What are Dawson fingers?

A

Peri-corpus callosum lesions seen on T2 MR imaging in MS

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21
Q

Fx and two types of MSA?

A

Parkinsonism
Autonomic instability
Cerebellar signs

MSA-C is mostly cerebellar
MSA-P is mostly Parkinsonisn

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22
Q

Bedside test for CSF in rhino/otorrhoea?

A

Glucose (+ vs mucous)

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23
Q

Gold standard test fo CSF?

A

Beta-2-transferrin

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24
Q

Under what circumstances should a GP prescribe buccal midazolam as well as refer to epilepsy clinic after a first seizure?

A
  1. Neurological deficit
  2. Structural abnormality
  3. Abnormal EEG
  4. Patient considers risk of recurrence to be unacceptably high
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25
Q

Headache red flags? (13)

A 
Unexplained vomiting
Headaches worse with fever
Headache triggered by cough/postural change
Immunocompromise
Hx of malignancy with brain mets
Thunderclap headache
New onset neurodeficit
New onset cognitive dysfunction
Change in personality
Impaired consciousness
TBI in <3 months
Fx of GCA or narrow angle glaucoma
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26
Q

Idiopathic intracranial hypertension Fx and risk factors?

A

Blurred vision/papilloedema
Headache
Sixth nerve palsy

Risk factors include being female, obese, pregnant and certain medications (steroids, OCP)

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27
Q

IIH Rx

A 
Weight loss
Diuretics
Topiramate
Repeat LPs
Optic nerve sheath decompression and fenestration
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28
Q

Charcot Marie Tooth/Hereditary Sensorimotor Neuropathy Type 1
Inheritance and features?

A

Features begin in puberty

Distal muscle wasting, pes cavus, clawed toes, foot drop, myopathy

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29
Q

Early features of retinitis pigmentosa?

A

Sensation of ‘tunnel vision’

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30
Q

Ankle, Knee, Biceps and Tricpes reflex nerve roots?

A

S1-2
L3-4
C5-6
C7-8 (in that order)

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31
Q

Where would the lesion be found for each of the following types of dysphasia?
Wernicke’s
Conductive
Brocca’s

A

Wernicke’s (receptive) - Superior temporal gyrus
Conductive - Arcuate something
Brocca’s (expressive) - Inferior frontal gyrus

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32
Q

Features of a common peroneal nerve lesion?

A 
Foot drop/ankle dorsiflexion weakness
Eversion weakness
Extensor hallucis longus weakness
Anterior muscle wasting
Numbness on lateral aspect of lower leg and dorsum of foot
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33
Q

What is the role of Riluzole in motor neuron disease?

A

Prevents stimulation of glutamate receptors predominantly in ALS, and has been shown to prolong life by about 3 months.

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34
Q

Time window for thrombectomy in acute ischaemic stroke?

A

6 hours - (thrombolysis <4.5 hours)

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35
Q

What is the role of the facial nerve?

A

Ears: Stapedius msucle controls hearing
Eyes: Lacrimation (and salivation)
Taste: Anterior 2/3 of tongue
Muscles of facial expression

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36
Q

Hyperacusis follows which CN palsy, and what is the mechanism?

A

Facial nerve palsy causes stapedius paralysis

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37
Q

Commonest + other neruological sequelae following meningitis?

A

Commonest is sensorineural hearing loss

Others include epilepsy, abscess formation, paralysis, hydrocephalus

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38
Q

Rx guidelines for medical management of neuropathic pain

A

1st: Amytriptilline, Gabapentin, Duloxetine, Pregabalin
2nd: Tramadol
Topical capsaicin may be useful

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39
Q

Features of a temporal lobe seizure?

A

H - Hallucinations (any modality)
E - Epigastric rising
A - Automatisms (lip smacking)
D - Deja vu, Post ictal Dysphasia

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40
Q

Phenytoin side effects?

A

Acute: Dizziness, diplopia, nystagmus, ataxia, seizures, confusion.
Insidious: Gingival hyperplasia, hirsutism, drowsiness, megaloblastic anaemia, peripheral neuropathy
Idiosyncratic: Fevers, rash, Dupuytren’s contracture, iatrogenic lupus, hepatitis
Teratogenic: Cleft palate and CHD

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41
Q

What is Todd’s paresis?

A

Post-ictal weakness after a focal seizure

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42
Q

Degenerative cervical myelopathy: Fx, Ix, Rx?

A

Fx: Extremity parasthesia, neck/arm pain, clumsiness
Ix: MRI
Rx: Urgent surgical decompression

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43
Q

Where is the lesion in internuclear opthalmoplegia, and what does it cause clinically?

A

Medial longitudinal fasciculus - Causes contralateral coarse nystagmus on abduction failed adduction on ipsilateral side

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44
Q

EEG findings of an absence seizure?

A

Bilateral 3Hz spike and wave pattern

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45
Q

What is mononeuritis multiplex, and how is it different from polyneuropathy?

A

Non-contiguous, asymmetrical/sequential loss of sensory and motor function. This is different to polyneuropathy in that it is asymmetrical.

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46
Q

Causes of a third nerve palsy?

A 
Diabetes
Vasculitis (e.g.Sarcoid)
Central venous thrombosis
Raised ICP
MS
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47
Q

Describe the ataxic gait

A

Wide based gait with impaired heel-to-toe gait

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48
Q

Difference between total and partial anterior circulation infarcts?

A

TACI has 3/3 whereas PACI has 2/3 of:

  1. Hemiparesis/hemisensory loss
  2. Homonymous hemianopia
  3. Higher cognitive dysfunction (e.g. dysphasia)
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49
Q

Features of Lateral Medullary Syndrome?

A

Ipsilateral: Dysphagia, Ataxia, Nystagmus, Facial numbness, Horner’s,
Contralateral: Hemisensory limb loss

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50
Q

Does Charcot Marie Tooth affect motor, sensory or both?

A

Both

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51
Q

Confirmed TIA management?

A

Aspiring 300mg

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52
Q

What percentage of patients with meningitis do not exhibit neck stiffness?

A

30%

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53
Q

What type of headache is polymyalgia rheumatica associated with?

A

Temporal arteritis

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54
Q

Seconadary stroke prevention in those who do not tolerate clopi?

A

Aspirin + dipyridamole lifelong

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55
Q

Cranial nerve responsible for direct response to light?

A

Optic nerve

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56
Q

What would cause bitermporal hemianopia with upper versus lower quadrant defect?

A

Upper quadrant = inferior chaism = pituitary tumour.

Lower quadrant = upper chaism = craniopharyngioma

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57
Q

Which antiepileptic is most associated with weight gain?

A

Sodium Valproate

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58
Q

Presentation of syringomyelia?

A

Cape like anaesthesia distribution

Impaired temperature and pain sensation but fine touch, vibration and proprioception are in tact.

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59
Q

Causes of syringomyelia?

A

Chiari malformation

Others: Tumours, trauma, infection

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60
Q

What is autonomic dysreflexia?

A

Occurs with spinal cord injury at T6 or above.

Characterised by hypertension, sweating, flushing but with no appropriate increase in heart rate

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61
Q

Migraine acute and prophylactic management?

A

Acute: Triptan + NSAID/paracetamol
Prophylaxis: Topiramate or propranolol

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62
Q

TIA definition?

A

By tissue not time now - requires a normal MRI

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63
Q

Which is more severe, Duchenne’s or Becker’s?

A

Duchenne’s, Becker’s often only presents after age of 10

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64
Q

What is Hoffman’s sign and what does it indicate?

A

This is seen in patients with degenerative cervical myelopathy, and describes the phenomenon where flicking of one finger stimulates twitching in other fingers of the same hand.

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65
Q

Technical name for frozen shoulder? Which movement is often most affected and what is the most suitable management option?

A

Adhesive capsulitis, where external rotation is often worst affected. Early physiotherapy is advised.

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66
Q

What are the features of tuberous sclerosis?

A

Neuro: Learning delay, seizures

Cutaneous: Shagreen patches (lumps over cervical spine), ash leaf spots (hypopigmented leaf lesions), adenoma sebaceum (angiofibromas in butterfly distribution over nose), subungual fibromata

Other: Retinal hamartomas (dense white areas on retina), cardiac rhabdomyomata, PKD

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67
Q

What is a Jacksonian march seizure

A

A focal aware seizure which starts by affecting a peripheral body part before quickly marching over the respective foot, hand or face

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68
Q

Neuroleptic Malignant Syndrome tetrad?

A

Hyperthermia
Rigidity
Autonomic instability
Altered mental status

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69
Q

What are the characteristic features of Guillain Barre syndrome?

A

Characteristically, progressive, ascending weakness of all four limbs. Sensory symptoms tend to be mild.
Other Fx may include Hx gasroenteritis, hyporeflexia, CN involvement

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70
Q

What is secondary generalisation with respect to Jacksonian march seizures

A

When the electrical disorder spreads over larger brain areas, developing into a grand mal seizure

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71
Q

What investigations would you do to diagnose GB syndrome?

A

LP - Raised protein with normal WCC

Nerve conduction studies

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72
Q

What are the features of Charcot Marie Tooth disease?

A 
Heredity
Hx of ankle dislocations
Distal muscle atrophy
High foot arch (pes cavus)
Foot drop
Hammer toes
Hypo reflexia
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73
Q

What are the features of an essential tremor?

A

Postural tremor worse if arms outstretched

Improved by alcohol and rest

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74
Q

Management for essential tremor?

A

Propranolol 1st line

Primidone sometimes used

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75
Q

What brain region is affected in Wernicke’s aphasia?

A

Left superior temporal gyrus

76
Q

What brain region is affected in Broca’s aphasia?

A

Left inferior frontal gyrus

77
Q

Signs of lateral medullary syndrome?

A 
Ipsilateral ataxia
Nystagmus
Dysphagia
Facial numbness
Cranial nerve palsy with contralateral hemisensory loss
78
Q

What are the signs of a lacunar infarct?

A

Presents with one of the following:

  1. Unilateral weakness/sensory deficit of face, arm and or leg
  2. Pure sensory stroke
  3. Ataxic hemiparesis
79
Q

What would be the MRI findings in a pt with DCM?

A

Disc generation and ligament hypertrophy with accompany spinal cord signal change

80
Q

What is the management of tremor in drug induced Parkinsonism?

A

Procyclidine

81
Q

What are some side effects of levodopa?

A

Dyskinesia, on-off effect, dry mouth, anorexia, palps, postural hypotension, psychosis, drowsiness

82
Q

Why should levodopa not be acutely stopped?

A

May cause acute dystonia

83
Q

Dopamine receptor agonists may cause what condition which should be monitored for?

A

Pulmonary and cardiac fibrosis

84
Q

Which nerve supplies the interossei muscles?

A

Ulnar nerve

85
Q

What is the management of trigeminal neuralgia?

A

Carbamazepine 100mg BD

86
Q

Secondary prevention following TIA or stroke?

A

Clopidogrel

87
Q

What should all patients with GCS below 8 be considered for?

A

Anaesthetic review and intubation/ventilation

88
Q

Give four causes of postural hypotension with compensatory tachycardia

A

Deconditioning
Dysfunctional heart (AS)
Dehydration (disease, drugs, dialysis)
Drugs (GTN, Parkinson’s, antidepressants)

89
Q

What are the driving laws if a patient has a first unprovoked seizure?

A

Inform DVLA and can only reapply for license after 6 months of being seizure free

90
Q

Visual field defect caused by pituitary adenoma?

A

Bilateral superior quadrantopia

91
Q

Visual field defect caused by craniopharyngioma

A

Bilateral inferior quadrantopia

92
Q

What type of migraine treatment (prophylactic or treatment) are triptans, and when precisely should it be taken?

A

Treatment - should be taken after onset of headache, NOT after onset of aura

93
Q

What are some contraindications to triptan use?

A

PMH ischaemic heart disease or cerebrovascular disease

94
Q

Fx of ACA stroke?

A

Contralateral hemiparesis and sensory loss with lower limbs affected more than upper limbs

95
Q

Fx of MCA stroke?

A

Contralateral hemiparesis and sensory loss with upper limbs affected more than lower limbs.
Contralateral homonymous hemianopia
Aphasia

96
Q

Fx of PCA stroke?

A

Contralateral homonymous hemianopia with macular sparing

Visual agnosia

97
Q

Why is there macular sparing in PCA strokes?

A

The macula receives dual blood supply from the MCA and PCA

98
Q

What are some risk factors for MS?

A

Smoking, previous EBV infection, genetics (HLADRB1*15), vitamin D deficiency

99
Q

What are some other features of Bell’s palsy?

A

Post auricular pain, altered taste, dry eyes, hyperacusis

100
Q

Why do Bell’s patients present with hyperacusis

A

Paralysis of the stapedius muscle so unable to regulate volume effectively

101
Q

What is the acute management of stroke?

A

Control glucose, hydration, sats and temperature
Aspirin 300mg as soon as haemorrhage has been excluded
Commence statin if cholesterol is over 3.5
Regarding AF, do not start anticoagulation until 14 days after the incident - due to risk of haemorrhagic transformation

102
Q

Brown Sequard syndrome results in what neurological pattern due to damage of which tracts?

A
  1. Ipsilateral spastic paresis (lateral corticospinal tract)
  2. Contralateral loss of pain and temperature sensation (Spinothalamic tract)
  3. Ipsilateral loss of proprioception and vibration (dorsal columns)
103
Q

What is the rule regarding first TIA and driving/DVLA?

A

Can start driving if symptoms free for 1 month, no need to inform DVLA

104
Q

What are some factors indicating pseudoseizure may be more likely than seizure

A

Gradual onset and resolution
Ability to control the location of symptoms
Psychiatric link

105
Q

What are the features of NPH?

A

‘Wet, wobbly, wacky’

Urinary incontinence, gait ataxia, dementia

106
Q

What is seen on neuroimaging of NPH, and how is it managed?

A

Hydrocephalus with enlarged 4th ventricle

Management is by ventriculoperitoneal shunting

107
Q

What is an automatism, and what seizure type might they be seen in?

A

A repetitive, automatic behaviour - e.g. lip smacking. They are commonly seen in focal seizures with impaired awareness

108
Q

What are the first and second line medications for secondary stroke prevention?

A
  1. Clopidogrel

2. DAPT

109
Q

Third nerve vs. fourth nerve palsy?

A

Down and out vs. up and out

110
Q

What are some red flag symptoms of trigeminal neuralgia warranting urgent referral?

A 
Sensory changes (SN deafness is common)
Hx of skin or oral lesions which may spread perineurally
Pain only in V1 of CN5, or bilaterally
FHx MS
Age less than 40
111
Q

WHich infection is most strongly associated with GB syndrome?

A

Campylobacter jejuni

112
Q

Which drugs are known to precipitate myaesthenic crises?

A 
Beta blockers
Penicillamine
Quinidine
Lithium
Phenytoin
Abx
113
Q

Gait ataxia is caused by lesisons where in the cerebellum?

A

Vermis

114
Q

What is the management for Bell’s palsy?

A

1mg/kg pred for 10 days with lubricating eye drops

115
Q

What are the signs of a pontine haemorrhage?

A

Reduced GCS
Quadriplegia
Reactive miosis
Absent horizontal eye movements

116
Q

Which antiemetic is most likely to precipitate extrapyramidal side effects?

A

Metoclopramide

117
Q

What may be used for rescue therapy in the case of exacerbations of neuropathic pain?

A

Tramadol

118
Q

What are some features suggestive of MND?

A 
Fasciculations
Absence of sensory involvement
Mixture of upper and lower motor signs
Small hand and tibialis anterior muscle wasting is common
Doesnt affect external ocular muscles
No cerebellar signs
119
Q

Which nerve is most commonly damaged in Colle’s fracture? What is its motor and sensory innervation?

A

Median nerve
Motor: LOAF - Lateral 2 lumbricals, opponens pollicis, abductor pollicis, flexor pollicis
Sensory: Lateral 3.5 fingers

120
Q

What are first line investigations for patients with suspected vestibular schwannoma?

A

Audiography

Gad enhanced MRI

121
Q

What is a Chiari 1 malformation and what is it associated with?

A

Herniation of the cerebellar tonsils through the foramen magnum. This disrupts CSF flow, predisposing to hydrocephalus and syringomyelia.

122
Q

What haematological abnormality may be caused by phenytoin?

A

Megaloblastic anaemia

123
Q

What are some features of a vasovagal episode?

A 
Associated with short post ictal period
External stress (may be psychological)
May be associated with mild-moderate limb twitching/jerking
124
Q

Which drugs most commonly cause Stevens Johnson syndrome

A 
Allopurinol
Lamotrigine
Carbamazepine
Phenytoin
Phenobarbital
Sertraline
Sulfasalazine 
Anti virals/biotics/fungals
125
Q

What is the management for Stevens Johnson syndrome?

A

Stop the causative agent
Admit to ICU
Obtain IV and NG access

126
Q

Name one trigger for cluster headaches

A

Alcohol

127
Q

What is the first line management for idiopathic intracranial hypertension, and how does it work?

A

Acetazolamide is a carbonic anhydrase inhibitor which reduces CSF production, normalisng ICP

128
Q

What non-pharmacological option is best for IIH

A

Weight loss

129
Q

Jacksonian march seizures are a feature of what type of epilepsy?

A

Frontal lobe epilepsy

130
Q

Third nerve palsies occur in the context of which type of herniation within the brain?

A

Transtentorial/uncal

131
Q

Which patient population has three times higher rates of Bell’s palsy than the general population?

A

Pregnant women

132
Q

What would cause the following picture?
Weakened dorsiflexion, inversion and eversion of the ankle with normal plantar flexion, as well as reduced sensation in the first web space between big and second toe

A

L5 lesion

133
Q

Which nerves are frequently injured during axillary dissection causing sensory loss over the axilla?

A

Intercostobrachial

134
Q

Which nerve is responsible for pronation of the forearm?

A

Median

135
Q

What is the management of an acute myaesthenic crisis?

A

Plasmapheresis and IVIG

136
Q

What is the management of NEMS?

A

Dantrolene and Lorazepam

137
Q

What is the management for a thyroid storm crisis?

A

IV hydrocortisone, propranolol, fluids

138
Q

What type of dementia is MND associated with?

A

Frontotemporal

139
Q 
Which of the following is not a use of carbamazepine?
Trigeminal neuralgia
Absence seizures
Bipolar disorder
Temporal lobe epilepsy
Focal impaired awareness seizures
A

Absence seizures

140
Q

Which medications are associated with IIH?

A 
Tetracycline antibiotics
Isotretinoin
Contraceptives
Steroids
Levothyroxine 
Lithium
141
Q

What is the management plan for IIH?

A 
Weight loss
Diuretics e.g. Acetazolamide
Topiramate
Repeated therapeutic LPs
Optic nerve sheath decompression and fenestration or Ventriculoperitoneal shunting
142
Q

What medication is used for long term prophylaxis of cluster headaches, and what is used for acute management?

A

Prophylaxis: Verapamil
Acutely: Sumatriptan + O2

143
Q

Which two drugs are first line in spasticity in MS patients?

A

Baclofen, gabapentin

144
Q

What is the management and prognosis for absence seizures (petit mal)?

A

Ethosuximide and valproate are first line

90-95% are seizure free by adolescence

145
Q

What are some features of cavernous sinus syndrome?

A

Painn, opthalmoplegia, proptosis, trigeminal nerve lesion, Horner’s syndrome

146
Q

What is Lhermitte’s sign, and when is it seen?

A

Parasthesia of the hands on neck flexion. Seen in MS and indicatyes disease near the dorsal column nuclei of the cervical cord.

147
Q

What is Ramsay Hunt syndrome?

A

Herpes zoster infection of the facial nerve causing drooping and hearing loss

148
Q

What diet is an extablished treatment for children with treatment resistant epilepsy?

A

Ketogenic diet

149
Q

What might cause a headache which is worse on standing than it is on lying, in an otherwise well patient?

A

Spontaneous intracranial hypotension

150
Q

What is the commonest neurological manifestation of sarcoidosis?

A

Facial nerve palsy (bilateral)

151
Q

What are the signs of a cholesteatoma?

A

Facial nerve weakness accompanied by a foul smelling ear discharge

152
Q

What differences would be seen on CT between an acute or chronic haemorrhage

A

Acute is hyperdense, chronic are hypodense

153
Q

Subdural haemorrhages result from bleeding of which vessels?

A

Bridging veins - which run between the cortex and venous sinuses?

154
Q

What is the MOA of ondansetron, and what are two side effects?

A

Competitive 5HT-3 antagonist.

Adverse effects include QT prolongation and constipation

155
Q

Which neurofibromatosis is associated with bilateral hearing loss due to vestibular schwannomas?

A

Type 2

156
Q

What might happen if you give folate ONLY to a patient deficient in B12?

A

Subacute combined degeneration of the cord

157
Q

What is subacute combined degeneration of the cord?

A

Caused by B12 deficiency, it involves:
Damage to posterior columns (sensory ataxia with positive Romberg)
Damage to lateral columns (UMN signs)
Damage to peripheral nerves (LMN signs)

158
Q

Acute withdrawal of levodopa may precipitate what?

A

NEMS

159
Q

What is Weber’s syndrome?

A

A midbrain stroke resulting in ipsilateral oculomotor paralysis and contralateral hemiparesis/plegia

160
Q

What does DANISH stand for?

A 
Dysdiadochinesia/Dysmetria
Ataxia
Nystagmus
Intention tremor
Slurred stacato speech
Hypotonia
161
Q

What is cataplexy?

A

Sudden and transient loss of muscle tone caused by strong emotion (laughter/terror etc.)

162
Q

What is the first line management option for myasthenia gravis and how does it work?

A

Pyridostigmine - a long acting anticholinesterase inhibitor

163
Q

What are the features of a T1 lesion, and how is it commonly caused?

A

Weakness of finger aBduction and thumb aDduction
Loss of sensation over medial epicondyle
Commonly caused by a traction injury?

164
Q

Aneurysm of which artery may cause a painful third nerve palsy?

A

Posterior communicating artery

165
Q

List some causes of a athird nerve palsy

A 
Diabetes mellitus
Vasculitides
Uncal herniation with raised ICP
Posterior communicating aneurysm
Weber's syndrome
Cavernous sinus thrombosis
166
Q

Which Parkinsonian disorder might present with unilateral symptoms?

A

MSA

167
Q

What are the features of Arnold-Chiari malformation?

A

Non communicating hydrocephalus
Headache
Syringomyelia

168
Q

The tremor in idiopathic Parkinson’s is usually symmetrical. True or false?

A

False - it is usually asymmetrical. Drug induced parkinsons may cause a bilateral tremor

169
Q

3rd nerve palsy causes miosis (constricted) or mydriasis (dilated)?

A

mydriasis

170
Q

Mid shaft humeral fractures are associated with injury of which nerve? How would you test for this nerve?

A

Radial nerve - test by extension at the wrist

171
Q

True or false:

A Parkinsonian tremor will improve with voluntary movements

A

True

172
Q

Management (1st and second line) for generalised tonic clonic epilepsy?

A

1: Valproate
2: Lamotrigine or carbamazepine

173
Q

What blood test might you do post ictally to differentiate true from pseudoseizures?

A

Prolactin (will be raised 10 minutes after an episode)

174
Q

When is Phalen’s test positive?

A

Carpal tunnel syndrome

175
Q

What cutaneous feature are indicative of NF1?

A

Axillary freckles

176
Q

Abnormal flexion vs extension, which give two GCS points, which gives 3?

A

Abnormal flexion gives 2 points

177
Q

What is the management of restless leg syndrome?

A 
Simple measures such as walking/stretching
Treat any iron deficiency
Dopamine agonists e.g. ropinirole 
Benzos
Gabapentin
178
Q

Which nerve is at risk of injury in a surgical neck of humerus fracture/

A

Axillary nerve?

179
Q

Which nerve roots are affected in Klumpkes palsy, and what is a common complication of this?

A

C8-T1 are affected

T1 involvement often also causes Horner’s syndrome

180
Q

Which nerve roots are injured in Erb’s palsy?

A

C5-6

181
Q

What monitoring must be commenced when starting a phenytoin infusion?

A

Cardiac monitoring due to pro-arrhythmogenic effects

182
Q

What might cause pain and weakness bilaterally on walking which resolves on rest?

A

Lumbar canal stenosis or vascular claudication from PVD

183
Q

Where do 5-HT3 antagonists work?

A

At the chemotherapy trigger zone at the medulla oblongata

184
Q

What is Hoover’s test used for?

A

To discriminate between organic and non-organic lower leg weakness. Normal leg should push down as the patient attempts to raise the affected leg.

185
Q

Which antibodies are seen in Lambert Eaton syndrome?

A

VGCa channel antibodies

Year 6 Passmed (22 decks)

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