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F1/ Part 1 > Neuro > Flashcards

Neuro Flashcards

1
Q

Which medications to be avoided in PD?

A

Metoclopramide
Promethazine
Prochlorperazine
Holoperidol

Domperidone does not pass BBB

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2
Q

What is neurogenic shock?

A

Inadequate tissue perfusion from loss of sympathetic vasoconstrictive tone

Hypotension + bradycardia

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3
Q

What is spinal shock?

A

Complete flaccid paralysis immediately following spinal cord injury - may or may not be asscociated with circulatory shock

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4
Q

MRI head - what is the purpose of T1-weighted vs T2-weighted

A

T1: enhances acute haemorrhage

T2: enhances oedema, infarction, demyelination, chronic haemorrhage

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5
Q

Causes of cerebellar syndromes

A

Vascular lesions - demyelination - tumours etc.

Alcohol - hypothyroidism - phenytoin toxicity - metabolic disorders (eg Wilsons)

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6
Q

What is Kernig’s sign

A

hamstring spasm on trying to straighten leg

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7
Q

Normal lumbar puncture profile

A

Neut: 0
Lymphocytes: <5
Protein: <0.4
Glucose (ratio CSF/ serum): >0.6

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8
Q

Bacterial lumbar puncture profile

A

Neut: +++
Lymphocytes: +
Protein: >1
Glucose (ratio CSF/ serum): <0.4

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9
Q

Viral lumbar puncture profile

A

Neut: +
Lymphocytes: +++
Protein: 0.4-1.0
Glucose (ratio CSF/ serum): usually normal

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10
Q

TB lumbar puncture profile

A

Neut: +
Lymphocytes: +++
Protein: >1
Glucose (ratio CSF/ serum): <0.4

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11
Q

Describe internuclear ophthalmoplegia clinically

A

Lesion in medial longitudinal fasciculus will prevent ipsilateral adduction during conjugate gaze

(Convergence is normally fine)

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12
Q

Describe Lhermitte’s sign

A

Electric shock down spine on neck flexion

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13
Q

Types of MS

A

Relapsing-remitting
Primary progressive
Secondary progressive
Progressive relapsing

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14
Q

Management of tremor in MS

A

Clonazepam

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15
Q

What is GBS?

A

Autoimmune response causing demyelination

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16
Q

What causes GBS?

A 
Infection (usually resp/ gastro)
Malignancy
Pregnancy
Drugs
Vaccination
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17
Q

Symptoms of GBS

A

Progressive ascending weakness, sensory loss, paraesthesia, pain
Dysphasia
Dysarthria

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18
Q

What is shown in CSF in GBS?

A

Increased protein

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19
Q

Causes of facial nerve palsy

A

Bell’s, acoustic neuroma, MS, infarcts, tumours, Lyme disease, sarcoidosis, Ramsay Hunt

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20
Q

Which facial muscles are preserved in UMN lesion

A

Frontalis

Orbicularis oculi

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21
Q

How to clinically help differentiate a facial nerve palsy due to sarcoid

A

Parotid enlargement/ tenderness

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22
Q

Which side more commonly affected in trigeminal neuralgia?

A

R

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23
Q

Triggers for trigeminal neuralgia

A

touching

but also talking, smiling, chewing, swallowing

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24
Q

Horner’s

A

Miosis - ptosis - anhidrosis

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25
Q

What is Horner’s syndrome?

A

Interrupted sympathetic innervation to the eye

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26
Q

Causes of Horners

A

CENTRAL: basal meningitis - demyelinating disease - CVA - basal skull tumours - pituitary tumour - intrapontintine haemorrhage - neck trauma - syringomyelia

PREGANGLIONIC: Pancoast’s - cervical rib - aortic aneurysm/ dissection - lesions of middle ear

POSTGANGLIONIC: Herpes Zoster - migraine - internal carotid dissection

DRUGS: chlorpromazine - levodopa - prochlorperazine - COCP

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27
Q

What is a Holmes-Adie pupil?

A

Normal variant - more common in women

Larger, irregular pupil. Slower (direct and consensual) constriction to light.
Often associated with absent deep tendon reflexes (Holmes-Adie syndrome)

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28
Q

What is an Argyll-Robertson pupil?

A

Miosis, irreg pupil. Absent light reflex (but consensual is intact)

Neurosyphilis - DM - MS - syringobulbia

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29
Q

Foot signs in Friedrich’s Ataxia

A

Hammer-toes

Clubfoot

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30
Q

What is subacute combined degeneration of the spinal cord?

A

B12 deficiency leading to degeneration of the posterior column and corticospinal tracts of the spinal cord

REPLACE B12 BEFORE FOLATE!

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31
Q

Presentation of syringobulbia

A

Dysfunction in cranial nerves

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32
Q

Presentation of syringomyelia

A

Slowly progressive
Loss of pain and temp - sometimes in shawl-like distribution
Muscle atrophy due to extension into anterior horns of spinal cord - begins in hands and p?rogresses proxinally
Lower limb LMN signs
Autonomic dysfunction

33
Q

How does the botulinum toxin paralyse muscles

A

Prevents release of ACh from the terminal end bouton - so muscles can’t respond to nerve impulses

34
Q

How does organophosphates cause death?

A

Prevent destruction of ACh - so muscles like the diaphragm remain depolarised, unable to return to their resting position

35
Q

ANS neurotransmitters

A

All Ach

Except sympathetic postganglionic: NA

36
Q

What causes RAPD?

What is the presentation?

A

Damage anywhere between the retinal ganglion cell layer to the lateral geniculate body

When light is shone on the unaffected eye, both eyes constrict fully and symmetrically
When light is shone in affected eye, both pupils will constrict but to a lesser degree

37
Q

How to confirm a Horner’s syndrome?

A

4% cocaine drops - will dilate unaffected eye only

38
Q

Causes third nerve palsies

A

Idiopathic (25%)

Microvascular

Vascular causes: extradural haematoma (pupil-sparing), posterior communicating artery aneurysm**

**posterior communicating artery runs adjacent to third nerve - may not be picked up on MR angiography (due to vasospasm) - should be repeated

39
Q

Which cranial nerve most susceptible to trauma?

A

CN IV: long, slender, paratentorial course

40
Q

Which cranial nerve defect might involve patient tilting head?

A

CN IV
tilted towards affected side

(part of Bielschowsky sign)

41
Q

Causes sixth nerve palsies?

A

Microvascular disease

External compression: acoustic neuroma, raised ICP

42
Q

Core symptoms of Meniere disease

A

vertigo - tinnitus - fluctuating hearing loss (should be confirmed on audiometry)

(aural fullness increasingly considered a fourth cardinal symptom)

43
Q

How long do acute attacks of Menieres last?

A

Typically minutes - hours

Most commonly 2-3 hours

44
Q

How to manage Menieres

A

May need admission - consider labyrinthine sedatives

For an acute attack: 7/7 prochlorperazine

Consider trial of betahistine prophylaxis

45
Q

Presentation of labyrinthitis

A

SUDDEN onset severe vertigo with N&V
Sensorineural hearing loss + tinnitus
Symptoms may present for up to 72h

LESS LIKELY TO DESCRIBE AURAL FULLNESS

46
Q

Investigations and management labrynthitis

A

Will need an audiogram

Advise to stand still and close eyes!

47
Q

Causes recurrent/ bilateral Bells palsy

A

Sarcoid
Lyme Disease
GBS
HIV

48
Q

What is Bell sign?

A

Eye rolls when they try to close it

49
Q

Treatment of Ramsay Hunt

A

Aciclovir and steroids

50
Q

Dose of prednisolone for Bells Palsy

A

Within 72h symptom onset: 25 mg BD for 10 days

51
Q

When should recovery from Bell’s Palsy occur

A

within 6-9 months, usually no persistent damage

52
Q

Triggers for analgesia overuse headaches

A

Triptans or opioids: >10 days/ month
Paracetamol or NSAIDs: >15 days/ month
Includes in combination

53
Q

Migraine prophylaxis

A

If >2 attacks monthly

Propranolol or topiremate
Or acupuncture

Riboflavin or Mg supplements may help
Reduce caffeine/ other triggers

54
Q

Tension headaches prophylaxis

A

TCA, eg amitriptyline - titrate down over time

Acupuncture

55
Q

What meds are chronic paroxysmal hemicranias responsive to?

A

Indomethacin - cluster headaches dont respond

56
Q

Differentials to cluster headache

A

Chronic paroxysmal hemicrania - occurs several times a day

SUNCT (short-lasting unilateral neuralgiform headache with conjunctival injection and tearing) - up to 100 times/ day - lamotrigine may help

57
Q

Treatment of trigeminal neuralgia

A

Carbamazepine

Second-line: gabapentin, baclofen

Potential surgical mx

58
Q

Primary care mx meningitis

A

IM benzylpenicillin

59
Q

Initial empirical mx meningitis

A

IV ceftriaxone/ cefotaxime for at least 10 days

Add IV amoxicillin if over 50 (chloramphenicol if allergic)

Consider adding IV aciclovir.
Consider adding dexamethasone for 4/7 (with rules regarding when dose can be given/ amounts)

60
Q

What prophylaxis for household contacts of meningitis?

A

Ciprofloxacin or rifampicin

61
Q

Most common causative bug in encephalitis?

A

HSV1 (herpes simplex encephalitis)

62
Q

Triad of encephalitis

A

fever, headache, altered mental state

63
Q

Mx cerebral abscess

A

IV ceftriaxone and neurosurgial opinion

64
Q

**STROKE CLASSIFICATION

A

p.221

65
Q

When should LP be done in suspected SAH?

A

If CT negative

12h to allow red cell lysis to occur

66
Q

Occular problems associated with raised ICP

A

Ptosis
Cranial nerve III and VI palsies
Papilloedema

67
Q

Gait in normal pressure hydrocephalus

A

Magnetic - feet seemingly stuck to floor with small stride

68
Q

What is Beck syndrome?

A

Anterior spinal artery syndrome/ vertebrobasilar occlusion

Ischaemic event causing decrease in blood flow to anterior two-thirds of spinal column.
Commonly caused by aortic pathology (eg aneurysm, dissection).

69
Q

Brown-Sequard

A

Ipsilateral loss of proprioception and vibration sense at the level of the lesion

Contralateral pain/ temp loss below level of lesion

70
Q

Sub-acute combined degeneration of the cord

A

Progressive demyelination of the dorsal columns

71
Q

Signs of Multiple System Atrophy

A

Parkinsonism + cerebellar signs + autonomic dysfunction

72
Q

Signs of Progressive Supranuclear Palsy

A

Parkinsonism + Speech Disturbance + Personality change/ dementia + Vertical gaze palsy

73
Q

Imaging when difficult to diagnose Parkinsons

A

SPECT

74
Q

Causes of sensory neuropathy

A 
Diabetic (most common - may be painful)
B12 deficiency
Alcoholic
Vasculitis
Leporasy
Meds: Isoniazid, vincristine - these are contraindicated in CMT
75
Q

Causes of motor neuropathy

A

GBS
Hereditary sensory neuropathy
Lead poisoning

76
Q

Most common pathogen associated with GBS

A

Campylobacter

77
Q

Autoantibodies in Lambert-Eaton

A

Voltage-gated calcium channel blockers

78
Q

Ice test

A

used in MG - will reduce ptosi if ice is held in a latex glove against patient eyes

F1/ Part 1 (13 decks)

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