Neuro COPY Flashcards
1
Q
Causes of complex opthalmoplegia
(eye movement weaknesses that cannot be explained by isolated/multiple CN palsies)
A
Myasthenia gravis
Kearns-Sayre (complex progressive external ophthalmoplegia)
Graves ophthalmoplegia
Miller fisher syndrome
Mononeuritis multiplex
Botulinum poisoning
Trauma and local infection
2
Q
Elevated 14-3-3 in CSF
A
CJD
3
Q
Creutzfeldt-Jakob MRI findings
A
Hyperintense signals in basal ganglia and thalamus
4
Q
Features of CJD
A
Rapid cognitive decline
Myoclonus
Extrapyramidal signs
Startle response
5
Q
Drugs which exacerbate myasthenia gravis
A
Penicillamine
Beta-blockers
Lithium
Phenytoin
Antibiotics
6
Q
Myasthenia gravis 1st-line management
A
Pyridostigmine
7
Q
Pyridostigmine MOA
A
Long-acting acetylcholinesterase inhibitor
8
Q
Features of Superficial Siderosis
A
Dementia
Ataxia
Sensorineural hearing loss
Anosmia
Anisocoria
9
Q
Superficial siderosis pathophysiology
A
Chronic iron deposition in CNS, secondary to SAH/SDH
10
Q
Syringomelia classic presentation
A
Neck + arm loss of temperature sensation.
11
Q
Most common primary brain tumour in adults
A
Glioblastoma multiforme
12
Q
Management of glioblastoma multiforme
A
Surgery followed by chemo-radiotherapy
13
Q
Second most common primary brain tumour in adults
A
Meningioma
14
Q
Glioblastoma multiforme prognosis
A
~ 1 year
15
Q
Fascioscapulohumeral dystrophy inheritance
A
AD
16
Q
Fasciocapulohumeral dystrophy presentation
A
Shoulder, upper arm and facial muscles affected
Progressive
17
Q
Motor neuron disease - medical management (in ALS)
A
Riluzole
18
Q
Riluzole MOA
A
Inhibits glutamate receptors
19
Q
Idiopathic intracranial hypertension - associated drugs
A
- Contraceptives
- Steroids
- Tetracyclines
- Vitamin A
- Lithium
- Levothyroxine
20
Q
Idiopathic intracranial hypertension - management
A
Weight loss
Acetazolamide, Topiramate
Repeated lumbar puncture
Surgery: optic nerve sheath decompression/fenestration. Shunt.
21
Q
MS MRI findings
A
High signal T2 lesions
Periventricular plaques
“Dawson fingers” - hyperintense lesions perpendicular to corpus callosum
22
Q
MS CSF findings
A
Oligoclonal bands (and not in serum)
Increased intrathecal IgG
23
Q
Wernicke’s encephalopathy classic triad
A
Opthalmoplegia/nystagmus
Ataxia
Confusion
24
Q
Miller-Fisher syndrome classic triad
A
Opthalmoplegia
Ataxia
Arreflexia
25
Imaging for suspected TIA
MRI brain with diffusion-weighted imaging
26
Features of myotonic dystrophy
Myotonic facies
Frontal balding
Bilateral ptosis
Cataracts
Dysarthria
27
Which gene is affected in myotonic dystrophy DM1
DMPK gene
28
Which gene is affected in myotonic dystrophy DM2
ZNF9 gene
29
Myotonic dystrophy - DM1 vs DM2 presentation
DM1 - Distal weakness more prominent
DM2 - Proximal weakness more prominent
30
1st-line treatment in Parkinson's isease if motor symptoms are affecting QOL
Levodopa
31
1st-line treatment in Parkinson's disease if motor symptoms are NOT affecting QOL
Dopamine agonist, non-ergot (ropinirole)
or
Levodopa
or
MAO-B inhibitor (selegiline)
32
Parkinson's disease, patient still symptomatic despite optimal levodopa treatment
Add in one of:
Dopamine agonist (ropinirole)
MAO-B inhibitor (selegiline)
COMT inhibitor (entacapone)
33
Medication for orthostatic hypotension in PD
Midodrine
34
Midodrine MOA
Stimulates peripheral alpha adrenoceptors -> increase arterial resistance
35
Management of drooling in PD
Glycopyrronium
36
Antibodies associaed with Lambert-Eaton myasthenic syndrome
Antibodies to voltage-gated calcium channels
37
Tumours that commonly metastasise to the brain
Lung
Breast
Bowel
Skin (melanoma)
Kidney
38
Glioblastoma multiforme on imaging
Solid tumour, central necrosis, contrast-enhancing ring, vasogenic oedema
39
Glioblastoma multiforme - histology
Pleomorphic tumour cells, bordering necrotic areas
40
Meningioma - histology
Spindle cells in concentric whorls + calcified psammoma bodies
41
Vestibular schwannoma - histology
Antoni A or B patterns + acellular Verocay bodis.
42
Pilocytic astrocytoma - histology
Rosenthal fibres (corkscrew eosinophilic bundle)
43
Medulloblastoma - histology
Small blue cells.
Rosette pattern with mitotic figures.
44
ePendymoma - histology
Perivascular Pseudorosettes
45
Oligodendroma - histology
Calcifications with fried egg appearance
46
Haemangioblastoma - histology
Foam cells and high vascularity
47
Antibiotic contraindicated in myasthenia gravis
Gentamicin - can trigger myasthenic crisis
48
Antibody in Guillain-Barre
anti-GM1
49
Antibody in Miller Fisher Syndrome
anti-GQ1b
50
Antibodies in myasthenia gravis
anti-AChR in 85%
anti-MuSK in 40% of remaining patients (anti-muscle-specific tyrosine kinase)
51
Anti-aquaporin-4 antibodies associated with
Neuromyelitis optica (demyelinating disorder)
52
Anti-N-methyl D-aspartate receptor associated with
Autoimmune encephalitis
53
Anti-glutamic acid decarboxylase - associated with
Stiff man syndrome
(+ LADA diabetes)
54
Anti-Hu - associated paraneoplastic syndromes
Painful sensory neuropathy
Cerebellar syndrome
Encephalitis
55
Steele-Richardson-Olszeeski syndrome AKA
Progressive supranucelar palsy
56
Normal CSF opening pressure
10 - 20 cm H2O
57
Normal CSF white cell count
0 - 5 cells/uL
58
Normal CSF glucose level
>60% of serum glucose
59
Normal CSF protein level
<45 mg/dL
60
CSF white cell count in bacterial meningitis
Raised (unless partially treated)
61
CSF glucose in bacterial meningitis
Low (<40% of serum glucose)
62
CSF glucose in bacterial meningitis
Low (<40% of serum glucose)
63
CSF protein in bacterial meningitis
Raised
64
CSF white cell count in TB meningitis
Raised (Lymphcytosis)
65
CSF glucose in TB meningitis
Very low
66
CSF protein in TB meningitis
Raised
67
Imaging to confirm PD
123I-FP-CIT SPECT
68
Tuberous sclerosis cystic features
Glioma
Retinal hamartoma
Heart rhabdomyoma
Lymphangioleiomyoma of lung
Renal angiomyolipoma and polycystic kidneys
69
Neurofibromatosis 1 - which gene and chromosome
Neurofibromin gene on chromosome 17
70
Neurofibromatosis 2 - which chromosome
Chromosome 22
71
NF1 (Recklinghausen's) features
Cafe-au-lait spots + axillary freckles
Peripheral neurofibromas
Phaeochromocytomas
Iris hamatomas (Lisch)
Scoliosis
72
NF2 features
Bilateral vestibular schwannomas
Multiple intracranial schwannomas, meningiomas and ependymomas
73
Tics - treatment options
Clonidine
Atypical antipsychotics eg risperidone
74
Paraneoplastic syndrome associated with Anti-Yo causes what syndrome
Cerebellar syndrome
75
Anti-Ri causes what syndrome
Retinal degeneration
76
Kearns-Sayre (mitochondrial disease) features
Onset <20yo
External opthalmoplegia
Retinitis pigmentosa
(Ptosis)
(AV block)
77
Ketamine MOA
NMDA receptor antagonist
78
Essential tremor, worsened by
Arms outstretched (postural tremor)
79
Essential tremor, improved by
Alcohol
Rest
80
HSV encephalitis - CT head findings
Medial temporal and inferior frontal changes
81
Most sensitive + specific imaging modality for diagnosing acute stroke
Diffusion weight imaging MRI
82
Most sensitive brain imaging modality for chronic ischaemic changes
FLAIR MRI
83
Multiple, lower motor neuropathies with nerve studies showing conduction block
MMNCB
(Multifcal Motor Neuropathy with Conduction Block)
84
Causes of a bilateral Bell's palsy
Bell's Palsy
Lyme disease
Guillain-Barre
Sarcoidosis
Bilateral acoustic neuromas
85
Friedreich's Ataxia - classic features
Onset 10-15years
Cerebellar ataxia
Optic atrophy
Absent ankle jerks/upgoing plantars
86
Freidrich's Ataxia - non-neurological features
HOCM (commonest cause of death)
Diabetes
Kyphoscoliosis
High-arched palate
87
Friedreich's Ataxia - Inheritance pattern
Autosomal recessive, trinucleotide repeat
88
Only licensed medication for PD dementia
Rivastigmine
89
Meningitis following ear infection - causative agen
Streptococcus pneumoniae
90
Vigabatrin use
Antiepileptic used infantile spasms
91
Vigabatrin - monitoring required
Visual field testing every 6 months
92
1st line in absence seizures
Sodium valproate / Ethosuximide
93
Which anti-epileptic can aggravate juvenile myoclonic epilepsy/absence seizures
Carbemazepine
94
Monitoring in clozapine use
Monitor FBC (agranulocytosis/neutropenia)
Baseline ECG (myocarditis)
95
Clozapine: adverse effects
Agranulocytosis
Myocarditis, QT prolongation
Lowered seizure threshold
Hypersalivation, Constipation
96
Features of ergotism
Vasoconstriction:
- Critical limb ischaemia
- Cardiac ischaemia
- Bowel hypoperfusion
Seizure/headache/psychosis
97
Risk of ergotism if ergotamine given with
Macrolides
98
Carbemazepine: adverse effects
Increased seizures 3-4wks after starting
Agranulocytosis/leucopenia
SIADH
Steven-Johnson syndrome
99
Indication for ventilation in Guillain-Barre
FVC < 15-20 ml/kg
100
TACs which respond to indomethacin
Paroxysmal hemicrania
Hemicrania continua
101
Hemicrania continua
Pain always present, with exacerbations
102
Uncal (transtentorial) herniation - presentation
Ipsilateral CN 3 palsy
Contralateral hemiparesis
103
Anti-epileptic which causes hyperammonaemic encephalopathy
Sodium valproate
104
Treatment of hyperammonaemic encephalopathy
L-carnitine
105
MOA of Sodium valproate
Increases GABA activity
106
Sodium valproate used 1st line in
Generalised seizures
107
Conditions associated with berry aneurysm
APKD
Ehlers-Danlos
Aortic coarctation
108
ECG changes in SAH
May show ST elevation
109
Transient global amnesia
Temporary episode of amnesia
No neurological abnormality
110
Disorders of PMP22 (myelin) gene
HSMN 1
HSMN 2
Hereditary neuropathy with liability to pressure palsies
111
Features of HSMN 1
Distal muscle wasting
Clawed toes
Foot drop
112
Inheritence of HSMN 1
Autosomal dominant
113
Bilateral leg weakness + HTLV-1 positive
Tropical spastic paraparesis
114
Cluster headache - acute treatment
Triptan (nasal or s/c)
High flow O2
115
Cluster headache - prophylaxis
Verapamil
116
CT head immediately if GCS...
< 13 on initial assessment,
or,
< 15 at 2 hours post-injury
117
CT head within 8 hours of injury if
Some LOC/amnesia since injury plus:
>65y
Dangerous mechanism
Bleeding/clotting disorder
(+ anyone on warfarin)
>30min retrograde amnesia of events prior to injury
118
Dangerous mechanism of injury (in criteria for CT head)
Pedestrian or cyclist struck by motor vehicle
Ejected from motor vehicle
Fall from >1m or >5 stairs
119
Thrombolysis contraindicated if BP uncontrolled over
> 200/120 mmHg
120
Thrombolysis contraindicated if lumbar puncture in preceding ...
7 days
121
Thrombolysis contraindicated if stroke or traumatic brain injury in preceding...
3 months
122
Thrombolysis in pregnancy
Contraindicated
123
Thrombolysis contraindicated if gastrointestinal haemorrhage in preceding
3 weeks
124
Diseases associated with retinitis pigmentosa
Refsum
Usher
Abetalipoproteinemia
Lawrence-Moon-Biedl
Kearns-Sayre
Alport's
125
Features of Refsum disease
Retinitis pigmentosum
Ichthyosis
Deafness
Cerebella ataxia
Peripheral neuropathy
126
Features of Usher's syndrome
Leading cause of deaf-blindness
(Retinitis pigmentosa)
127
Inheritence of Usher's syndrome
Autosomal recessive
128
Von Hippel-Lindau (VHL) inheritence
Autosomal dominant
129
Features of VHL (von Hippel lindau)
Cerebellar Hemangioma (>SAH)
Retinal Hemangioma (>vitreous haemorrhage)
Renal cysts/renal cell carcinoma (clear-cell)
Phaeochromocytoma
130
CT head immediately if: (skull)
Suspected open or depressed skull fracture
Signs of basal skull fracture
131
CT head immediately if: (signs post-injury)
Post-traumatic seizure
Focal neurological deficit
>1 episode of vomiting
132
Which type of brain tumour releases EPO
Cerebellar haemangioblastoma
133
Risk factors for retinal vein occlusion
Polycythaemia
Glaucoma
HTN
Diabetes
134
Lamotrigine in pregnancy
Levels decrease in second trimester
135
Phenytoin in pregnancy
Associated with cleft palate
136
Sodium valproate in pregnancy
Associated with neural tube defects + neurodevelopmental delay
137
5 causes of upgoing plantars with absent ankle jerks
1 - MND (mixture of UMN + LMN signs)
2 - Friedreich's Ataxia
3 - SCDC
4 - Tertiary syphilis
5 - Dual peripheral + central pathology
138
Mixed upper + lower motor neuron features AND bulbar involvement
ALS
139
Phenytoin - chronic adverse effects
Peripheral neuropathy
Megaloblastic anaemia
Gingival hyperplasia
Lymphadenopathy
140
Phenytoin - teratogenic effects
Cleft palate
Congenital heart disease
141
Phenytoin - acute adverse effects
Cerebellar signs
Confusion
142
Young patient with drop in GCS 48 hours after ischaemic stroke
Malignant MCA syndrome (brain swelling after infarction causes ICH)
143
Tuberous sclerosis - cutaneous features
Ash-leaf spots
Shagreen patches
Adenoma sebaceum
Subungual fibromata
Cafe-au-lait spots
144
Tuberous sclerosis - neurological features
Developmental delay
Epilepsy
145
MS - management of acute relapse
5 days of high dose methylprednisolone
146
Disease-modifying drugs used in relapsing-remitting MS
IFN-beta
Glatiramer acetate
Diethyl fumarate
Teriflunomide
147
Contra-indication to IFN use
Deranged LFTs
148
Cluster headache duration
15 min - 3 hour
149
Cluster headache features
Unilateral around eye/temporal with autonomic dysfunction
150
Why do CT thorax in myasthenia gravis?
Exclude thymoma (15%)
151
Lucid interval associated with which type of head injury?
Extradural haemorrhage
152
Risk factors for subdural haematoma
Old age
ETOH excess
Anticoagulation
153
Management of myasthenic crisis
Plasma exchange
IVIG
154
DVLA: One unprovoked seizure
(no structural abnormality on brain imaging, no epileptiorm activity on EEG)
6 months off
155
DVLA: One unprovoked seizure
(Structural brain abnormality /epileptiform activity on EEG present or not excluded)
12 months off
156
DVLA: How long must epileptic be seizure free to qualify for licence
12 months
157
DVLA: How long must epileptic be seizure free to restore 'til 70 licence
5 years
158
DVLA: Withdrawal of epilepsy medications
No driving from when started withdrawal until 6 months after last dose
159
DVLA: simple faint
No restriction
160
DVLA: single, explained and treated, episode of syncope
4 weeks off
161
DVLA: single unexplained episode of syncope
6 months off
162
DVLA: two or more episodes of syncope
12 months off
163
DVLA: stroke or TIA
1 month off
Inform DVLA if any residual deficit
164
DVLA: multiple TIAs over short period
3 months off
Inform DVLA
165
DVLA: craniotomy
1 year off driving
166
DVLA: pituitary tumour with craniotomy
6 months off
167
DVLA: pituitary tumour with trans-sphenoidal surgery
Can drive when safe to
168
DVLA: narcolepsy/cataplexy
Cease driving on diagnosis, restart once 'satisfactory control of symptoms'
169
DVLA: MS/MND
Inform DVLA
Complete PK1 form
170
Progressive weakness affecting finger and wrist flexion initially, think..
Inclusion body myositis
171
Features of inclusion body myositis
Older patients
Finger and wrist flexor weakness
Mildly raised CK
172
Features of polymyositis
Markedly raised CK
Tender muscles
173
Features of diabetic amyotrophy
Painful wasting of proximal leg muscles
174
Guillain-Barre - how many have persistent severe weakness
15%
175
Guillain-Barre - mortality
5%
176
Features of Guillain-Barre
Ascending weakness
LMN pattern
Respiratory weakness
177
Features of cavernous sinus thrombosis
Periorbital oedema
6th nerve palsy (+/- 3rd/4th)
Pain of upper face and eye
Central retinal vein thrombosis
178
Features of lateral sinus thrombosis
6th and 7th nerve palsies
179
Causes of cavernous sinus syndrome
Cavernous sinus thrombosis
Tumour
Local infection (sinusitis)
Trauma
180
CSF: causes of an isolated raised protein
GBS
CIDP (chronic inflammatory demyelinating polyneuropathy)
181
Features of CIDP (Chronic inflammatory demyelinating polyneuropathy)
Similar to GBS but insidious onset
182
Treatment of CIDP
Steroids + immunosuppressants
183
Presentation of myasthenia gravis (acute)
Fatigueability
Ptosis
Extraocular weakness
Dysphagia
Respiratory weakness
184
Positive edrophonium chloride test in
Myasthenia gravis
185
Medical treatment of Lambert-Eaton myasthenic syndrome
3,4-Diaminopyridine
186
Optimal treatment of Lambert-Eaton myasthenic syndrome
Treatment of underlying malignancy (usually SCLC)
187
Causes of spastic paraparesis
Tropical spastic paraparesis (HTLV-1)
Hereditary spastic paraparesis
Cerebral palsy
Cord compression
Motor neurone disease
Multiple sclerosis
