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MBBS4 > Neuro > Flashcards

Neuro Flashcards

1
Q

What are the three important genes to remember in the transformation of astrocytoma –> glioblastoma multiforme?
What is the stepwise progression?

A
  1. Rb gene Inactivation
  2. EGFR amplification
  3. Deletion of 10p

Glial cell –> astrocytoma –> anaplastic astrocytoma –> glioblastoma multiforme

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2
Q

Commonest CNS tumour, regardless of age, Across-the-board? What %?

A

Gliomas at 70%

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3
Q

Difference in diagnostics between adult and child astrocytoma?

A 
Adult = immunostain for mutated IDH1
Child = BRAF mutation
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4
Q

Which is the aetiology of glioblastoma multiforme?

A

Mutation in chromosome 10 in 80% of cases (deletion of 10p or 10q!)

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5
Q

What is pachymeningitis? What does it follow? How common?

A

Pachymeningitis = infection of dura.
Follows sinusitis or skull fracture.
Rarer than leptomeningitis (clinical meningitis)

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6
Q

Microbiology of acute pyogenic meningitis - infants, adolescent, adults?

A

infant - e coli
adolescents - (1) neisseria meningitidis, (2) strep pneumoniae
adults - strep pneumoniae

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7
Q

Treatment of acute pyogenic meningitis?

A

IV ceftriaxone - do not delay rx for imaging

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8
Q

Most common pathogen causing fungal meningitis? Name 4 other fungal pathogens that can

A

Cryptococcus neoformans

Candida, histoplasma, aspergillus, mucor mycosis

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9
Q

What are the stages of herniation and what clinical findings at each?

A
  1. Subfalcine (common):
    - Headache
    - Contralateral leg weakness
  2. Transtentorial central:
    - Small but reactive pupils
    - Drowsiness – when the thalamus and midbrain are pushed down towards the 4th ventricle
  3. Transtentorial with temporal/uncal herniation – compression of CN III  ipsilateral dilated pupil
  4. Tonsillar herniation:
    - Obtundation
    - decerebrate posture.
    - Cardiorespiratory arrest with cerebellar herniation.
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10
Q

What is the microscopic feature of a craniopharyngioma? How to remember this

A

Stratified squamous epithelium nests with internal lamellar keratin deposits - craniopharyngioma is derived from pharyngeal roof of Rathke’s pouch

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11
Q

Red flags in a red eye presentation

A

Red flags in a red eye

  • Unilateral disease
  • Blurred vision
  • Pain
  • Photophobia
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12
Q

What is the pathogenesis of MCA deep penetrating branch haemorrhagic stroke?

A

Hypertensive arteriolosclerosis/microaneurysms - small BV changes

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13
Q

Which lesion is hemispatial neglect most commonly associated with?

A

lesion of the right parietal lobe

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14
Q

PCA stroke signs depending on whether cortical or central (deep)

A 
Peripheral (cortical)
	Memory deficits 
	Visual deficits 
o	Homonymous hemianopia 
o	Cortical blindness (if both occipital lobes destroyed)
o	Lack of depth perception
o	Hallucinations

Central (penetrating)
 Thalamus – contralateral sensory loss, spontaneous pain, mild hemiparesis
 Cerebral peduncle – CN 3 palsy with contralateral hemiplegia
 Brain stem – CN palsies, nystagmus, pupillary abnormalities

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15
Q

Commonest location of glioblastoma multiforme?

A

R) frontoparietal region

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16
Q

Aetiology of meningioma + what do you look for on clinical fts

A

50% of meningiomas have NF2 gene mutation - look for signs of neurofibromatosis type 2 - multiple meningiomas and bilateral 8th nerve schwannomas

17
Q

Mutation in going from glial cell –> astrocytoma

A

P53 inactivation

18
Q

Differential diagnosis for ring-enhancing lesion on brain CT?

A

DR MAGICAL
 Demyelinating disease – classically an incomplete ring of enhancement
 Radiation necrosis/rapidly growing tumour
 Metastasis
 Abscess
 Glioblastoma
 Infarct subacute phase
 Contusion
 AIDS –
 Lymphoma = esp in aids pt, or immunocompromised

19
Q

Tetrad of kernicterus features

A

tetrad of kernicterus

  • Vertical gaze palsy
  • Choreoathetosis – movement disorder
  • Dental enamel hypoplasia
  • Sensorineural hearing loss
20
Q

Most seizure prone areas of brain?

A

Temporal lobe + hippocampus

21
Q

Seizure-specific bloods

A

Prolactin - raised 15mins after tonic-clonic

CK - peaks around 6hrs after seizure

22
Q

Most common two types of seizures?

A

Partial complex + tonic-clonic

23
Q

3 different antiepileptic drugs and their first line indications

A

Lamotrigine – first-line Rx focal seizures, and tonic-clonic generalised seizures
Valproate – first-line rx generalised seizures (atypical absence, myoclonic, atonic)
Ethosuximide – first-line rx in typical absence seizures

24
Q

Senile degeneration - pathophysiology

A

Progressive neuronophagia (hippocampus + cerebral cortex) –> decreasing brain mass, slowly progressive

25
Q

3 clinical features of dementia pugilistica? What is it known as?

A

Dementia pugilistica = Chronic traumatic encephalopathy

Progressive dementia
Tremor
Focal neurological deficits

26
Q

Binswanger disease - wtf is it? pathophys?

A

Binswanger disease (subcortical arteriosclerotic encephalopathy/ subcortical vascular dementia)= small vessel damage (arteriolosclerosis) –> small focal infarcts

27
Q

Frontotemporal dementia story

A

Uninhibited Mr. Pick is <65yo, he has weird behaviour, weird speech, aphasia but his short-term memory in tact. He has semantic dementia - (hence issue with long-term storage of associating words with their meaning)

28
Q

4 clinical features of Diffuse Lewy body dementia?

Prognosis?

A

Visual Hallucinations
Delusions
REM sleep disturbances
Severe dementia

Rapidly progressive, early death

29
Q

MS most common sites of demyelination

A

Most common sites of demyelination in multiple sclerosis

  1. Periventricular areas
  2. Brainstem
  3. Cerebellum
  4. Spinal cord
30
Q

MS risk factors

A
  • UV radiation, insufficient vitamin D consumption, cigarette smoking
  • Pathogens: EBV, human herpes virus 6
31
Q

When do you do a LP as an investigation in MS? What will it show and what is the meaning of this?

A

Do LP when MRI result is equivocal.
Shows
- Lymphocytic pleocytosis
- Increased oligoclonal band (IgG fractions) - this means a particularly bad prognosis

32
Q

New drug name for huntingtons

A

Ionis-HTTRx - it is a gene-silencing DNA

33
Q

Mutation in hereditary pancreatitis?

A

SPINK1

34
Q

ALS mutation

A

SOD1 gene on chromosome 21

35
Q

ALS drug?

A

Riluzole - glutamate antagonist -only drug that slows down the progression of ALS

36
Q

What is the name of the neuropathy that presents similarly to ALS? What is the one difference in presentation? What blood test corroborates it?

A

Multifocal motor neuropathy – slowly progressing asymmetrical weakness esp in muscles of distal extremities, muscle atrophy rare. Highly elevated anti-GM1-ganglioside antibody titres.

37
Q

Features of 3rd nerve lesion

A

Ptosis
Divergent strabismus = eye is down + out
Mydriasis, unresponsive to light (direct reflex negative)
Consensual reflex in tact

MBBS4 (15 decks)

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