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AMC MCQ > Neuro Dr Vidhya > Flashcards

Neuro Dr Vidhya Flashcards

1
Q

Headache: Cluster or Migrainous Neuralgia CLINICAL FEATURES

A

TRIAD:
* Retroorbital Headache
* Rhinorrhoea
* Lacrimation

Unilateral headache

Occurs nightly or in the early hours of
the morning

No visual disturbances or vomiting

Hallmark : Cyclical nature of the attacks and at least 5 attacks. Occurs typically in males; Rare in childhood.

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2
Q

Headache: Cluster or Migrainous Neuralgia ACUTE Management

A

1st line: 100% O2 15 L/min for 15 minutes

2nd line: Sumatriptan sc injection or intranasally

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3
Q

Headache: Cluster or Migrainous Neuralgia PROPHYLAXIS (once a cluster starts TO PREVENT FURTHER ATTACKS)

A
  1. For control of attack – Naratriptan
  2. Methysergide
  3. Prednisolone
  4. Lithium
  5. Verapamil
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4
Q

Headache: Tensional Clinical findings

A

Symmetrical bilateral tightness (muscle contraction headaches)

Lasts from 30 minutes to 7 days

Non-pulsating, mild to moderate intensity

No nausea, vomiting, photophobia, or phonophobia

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5
Q

Headache: Tensional Management

A

Relaxation techniques

Lifestyle modifications

Avoid tranquilisers and stronger analgesics

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6
Q

Headache: Tensional Treatment

A
  1. CBT
  2. Mild non-opioid analgesics – aspirin, ibuprofen, paracetamol
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7
Q

Headache: Migraine Clinical Features

A

MC triggered by Stress

Headache lasts 4- 72 “hours”

Unilateral, Pulsatile in nature.

Moderate or severe intensity, inhibiting daily activities associated with nausea, vomiting, photophobia, or phonophobia

Not attributable to another disorder

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8
Q

Headache: MILD
Acute Migraine Management

A

1st line: ASPIRIN OR
PARACETAMOL + METOCLOPRAMIDE

ADVISE LYING DOWN
IN A QUIET DARK COOL ROOM.

COLD PACKS ON THE FOREHEAD OR NECK.

AVOID: COFFEE, TEA, MOVING AROUND TOO MUCH, READING, WATCHING TV

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9
Q

Headache: SEVERE
Acute Migraine Management

A

1st line: TRIPTANS (BEST AT START OF ATTACK)

AVOID IN:

  • CORONARY ARTERY
  • DISEASE
  • ANGINA
  • UNCONTROLLED HYPERTENSION
  • PREGNANCY
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10
Q

Management of Acute Migraine attack during pregnancy

A

Paracetamol is the preferred non-opioid analgesic.

Avoid NSAIDs and
Aspirin in the first trimester and after 30 weeks of gestation

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11
Q

Management of severe refractory Acute Migraine attack during pregnancy

A
  • IV fluids
  • Short course of IV
  • MgSO4 or oral steroids.

NOTE: Beta blockers can cause IUGR and should be weaned off before labour to prevent Fetal bradycardia.

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12
Q

Migraine Prophylaxis

A

1st line: Avoidance of known trigger factors.

Indication: 2 or more
severe migraine attacks per month attacks disrupting the
patient’s well being/lifestyle.

Drugs:
* Beta blockers (Propranolol)
* TCA (Amitryptyline)
* Sodium valproate
* CCBs ( Verapamil, Nifedipine)
* Candesartan
* Sumatriptan
* Gabapentin
* Botulinum toxin into the muscles of the face, scalp or neck

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13
Q

Headache: Temporal
arteritis (Giant cell arteritis) CLINICAL FEATURES

A

Persistent/intermittent unilateral throbbing headache in the
temporal region and scalp sensitivity with localized thickening

With or without loss of pulsation of the Superficial temporal artery.

Age > 50 years

Intermittent blurred vision

Tenderness on brushing hair

Jaw claudication on eating

Hypertension

Polymyalgia Rheumatica

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14
Q

Headache: Temporal
arteritis (Giant cell arteritis) MANAGEMENT

A

1) Very responsive to corticosteroids- start treatment immediately to prevent permanent blindness.

2) Aspirin to prevent ischemic events

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15
Q

Headache: Subarachnoid Hemorrhage CLINICAL FEATURES

A

Presentation: Acute severe headache “thunderclap” (in 75% patients); Loss of consciousness in the remaining 25%.

TRIAD
* Occipital Headache
* Vomiting
* Neck stiffness

Also:
- With or without seizures
- Kernig sign positive

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16
Q

Headache: Subarachnoid Hemorrhage INVESTIGATIONS

A

Dx: 1) CT Head – investigation of
choice

2) Lumbar puncture is used if CT scan is
negative – Homogenous blood staining of CSF
and Xanthochromia are diagnostic of SAH

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17
Q

Headache: Subarachnoid Hemorrhage CT Imagen

A

Areas of hyper density within the cisterns and sulci

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18
Q

Headache: Subarachnoid Hemorrhage Management

A

URGENT REFERRAL!!

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19
Q

Headache: Trigeminal
Neuralgia CLINICAL FEATURES

A

> 50 yo

Almost always unilateral

Presentation:
* Brief paroxysms of pain 1-2 minutes (upto 15 minutes)
* Excruciating burning knife or electric shock like pain.
* Precipitated by talking, chewing, touching trigger areas on face, cold weather, and wind.

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20
Q

Headache: Trigeminal
Neuralgia. Associated diseases

A
  • Multiple sclerosis
  • Neurosyphilis
  • Posterior fossa Tumours
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21
Q

Headache: Trigeminal
Neuralgia Investigation

A

MRI

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22
Q

Headache: Trigeminal
Neuralgia MANAGEMENT

A

1st line: Patient education and reassurance.

2nd line: Carbamazepine (from onset of attack until resolution)

3rd line: Surgery. Just if medical treatment is ineffective: Decompression of the Trigeminal nerve root

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23
Q

CLINICAL FEATURES Idiopathic Intracranial Hypertension (Pseudotumour cerebri)

A
  • Obese young patient
  • Headache
  • Nausea
  • Visual obscuration or blurring (main concern
    from high ICP) check papilledema.
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24
Q

FIRST INVESTIGATION Idiopathic Intracranial Hypertension (Pseudotumour cerebri)

A

CT and MRI are normal.

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25
Q

BEST INVESTIGATION Idiopathic Intracranial Hypertension (Pseudotumour cerebri)

A

Lumbar puncture: Increased CSF pressure 25 cm H2O with Normal CSF analysis.

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26
Q

MANAGEMENT Idiopathic Intracranial Hypertension (Pseudotumour cerebri)

A

1st: URGENT REFERRAL!!

2nd:
* Stop causative drugs
* Weight reduction
* Corticosteroids and diuretics

NOTE: Choice to alleviate
symptoms: Repeated Lumbar Puncture

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27
Q

Medication overuse Headache CLINICAL FEATURES

A

BILATERAL

“Headache all day everyday”

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28
Q

Medication overuse Headache CAUSE

A

NSAIDs, triptans, ergotamine.

Typically with regular use > 15 days per month for 3 months

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29
Q

Medication overuse Headache Treatment

A

Gradual withdrawal of the drugs; Bridging therapy with a short course of steroids or NSAID

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30
Q

GCS

A
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31
Q

MANAGEMENT of Coma of unknown cause in the ED

A

TONG(F) or Coma cocktail

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32
Q

Transient Ischemic Attack (TIA) CLINICAL FEATURES

A
  • Short duration (< 60 minutes)
  • Consciousness preserved
  • Complete clinical recovery in < 24 hours (spontaneous)
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33
Q

Carotid TIAs CLINICAL FEATURES

A

90% ischemic attack in anterior circulation (Carotid)

Unilateral features:
* Amaurosis fugax
* Dysphasia
* Unilateral weakness, paralysis or numbness of face and arm (especially) and leg.

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34
Q

Vertebrobasilar TIAs CLINICAL FEATURES

A

Bilateral or crossed features:

  • Homonymous hemianopia
  • Bilateral blurring of vision, blindness, or diplopia
  • Vertigo
  • Nausea ± vomiting
  • Dysarthria
  • Hemiplegia
  • Ataxia ± bilateral weakness or numbness, drop attacks.
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35
Q

TIA INVESTIGATIONS

A
  1. CT or MRI
  2. Carotid duplex Doppler

NOTE: Also ECG but depends on the question

36
Q

TIA MEDICAL MANAGEMENT

A

FIRST:
Aspirin
or
(Clopidogrel + Aspirin)
or
(Dipyridamole + Aspirin)
or
Ticlopidine

NOTE: Dual therapy within 24 hours and cease at three weeks.

If failed antiplatelet therapy or vertebrabasilar ischemia:
WARFARIN

DOACs for non-valvular, AF >65 yo

37
Q

TIA SURGICAL MANAGEMENT

A

Based on the Carotid duplex Doppler Results (CDUS):

Symptomatic (Ipsilateral TIA or Stroke)
– 70-99%: Intervention
– 50-69%: Grey area- REFER!
– <50%: Observe

Asymptomatic:
> 80%: Non-urgent intervention
< 80%: Annual survillance with CDUS

Surgery: Carotid Endarderectomy

38
Q

STROKES TERRITORIES. Anterior Circulation Arteries

A
  1. Anterior Cerebral Artery
  2. Middle Cerebral Artery
  3. Lenticulo-striate Artery
39
Q

STROKES TERRITORIES. Posterior Circulation Arteries

A
  1. Posterior Cerebral Artery
  2. Basilar Artery
  3. Anterior inferior cerebellar artery
  4. Posterior inferior cerebellar artery
  5. Anterior spinal artery
40
Q

Anterior Cerebral Artery Stroke CLINICAL FEATURES

A
41
Q

Middle Cerebral Artery Stroke CLINICAL FEATURES

A
42
Q

Lenticulo-striate Artery Stroke CLINICAL FEATURES

A
43
Q

Posterior Cerebral Artery Stroke CLINICAL FEATURES

A
44
Q

Basilar Artery Stroke CLINICAL FEATURES

A
45
Q

Anterior inferior cerebellar artery Stroke CLINICAL FEATURES

A

Lateral Pontine Syndrome

  • General
    (VII Nerve Nuclei)
    ↓ Lacrimation
    ↓ Salivation
    ↓ Taste anterior 2/3 of the tongue

(Vestibular nuclei)
Vomiting
Vertigo
Nystagmus

  • Contralateral
    BODY↓ Pain and temperature sensation
  • Ipsilateral
    FACE ↓ Pain and temperature sensation
    Horner syndrome
    Ataxia
    Dysmetria

(Inner ear)
Sensorineural deafness

46
Q

Posterior inferior cerebellar artery Stroke CLINICAL FEATURES

A

Lateral Medullary (Wallenberg) Syndrome

(IX, X, XI Nerves Nucleus)
Dysphagia
Hoarseness
Dysphonia
↓ Gag reflex
Hiccups

Vomiting
Vertigo
Diplopia
Nystagmus (horizontal and vertical)

  • Contralateral
    BODY↓ Pain and temperature sensation
  • Ipsilateral
    FACE ↓ Pain and temperature sensation
    Horner syndrome
    Limb Ataxia
    Dysmetria
47
Q

Anterior spinal artery Stroke CLINICAL FEATURES

A

Medial Medullary Syndrome

48
Q

Lacunar Infartcts Types

A
  1. Pure motor (contralateral)
  2. Pure sensory (contralateral)
  3. Ataxic hemiparesis
  4. Dysarthria-Clumsy hand Syndrome
49
Q

Dominant side- Parietal Lobe Lesion

A

Gerstmann’s Syndrome Tetrad
1. dysgraphia
2. dyscalculia
3. finger agnosia (can’t touch the fingers together)
4. Left to right disorientation

ALSO:
Aphasia, dysphasia
Alexia, dyslexia

50
Q

Non dominant
Parietal lobe lesion

A
  • Geographical agnosia
  • Phonagnosia (difficulty in recognizing familiar voices)
  • Amusia
  • Constructional Apraxia
  • Asomatognosia
  • Anosognosia
  • Spatial neglect
  • Neglect of contralateral limb
  • Dressing apraxia
51
Q

Vertigo

A
  • Peripheral
  • Central
52
Q

Cause for periperal Vertigo

A
  • Labyrinth ( Meniere, Labyrintitis, BPPV, trauma, CSOM)
  • Eight cranial nerve ( Vestibular neuronitis, acustic Neurinoma, drugs)
  • Cervical
53
Q

Cause for central Vertigo

A

*brainstem ( vertebrobasilar insufficiency, infarction)

*cerebellum ( degeneration, tumor)

  • Migrain/Ms
54
Q

Vertigo - Red flags

A
  • neurological symptoms
  • Ataxia out of proportion of vertigo
  • Nystagmus out of propotion of vertigo
  • central Nystagmus
  • central eye movement abnormalities
55
Q

Vestibular neuronitis

A
  • acute vertigo + nausea + vomiting
56
Q

Vestibular neuronitis - Clinic

A
  • young/middle age
  • 50% prior URTI / herpes zoster infection
  • vertigo + imbalance aggrevate with headpostion
  • NO tinitus or hearing loss
  • horizontal nystagmus , oszillation towards healthy ear
57
Q

Drugs causing Vertigo

A
  • Antibiotics ( Mycines, tetracycline)
  • anticonvulsant
  • cardiogenic drugs
  • salycylate
58
Q

Vestibular neuronitis - Management

A
  • Bed rest
  • Medication:
    1. Promethazin
    2. prochlorperazine
    3. ondasentron
    4. diazepam

Self limiting after 5-7 days ( or weeks)

59
Q

Benign paroxismal postional vertigo BPPV- S/S

A

-elderly
-sudden ( induced by changing headpostion)
-attack 10-60sec
-Vertigo while going out of bed/travelling
-no vomitting deafness, tinitus

60
Q

BPPV- Dx/Mx

A

Dx:
- Halpick manoever
- test for vestibular and hearing fct normal

Mx:
- reaessure
- exercise ( eg Cawthorne -Cooksey)
- reposional manoever
- no drugs

61
Q

Meniere

A

Vertigo + vomiting + tinnitus + sensorineural deafness

62
Q

Meniere - S/S

A
  • 20-50a
  • acute onset of vertigo, tinnitus, nausea, vomiting, heaing loss(low tone), nystagmus
  • “ear fullness”
  • attack : 30 min to several hours
63
Q

Meniere - Dx/Mx

A

Dx
- caloric test - impaired vestibular function on effected side

Mx
- acute: prochloperazine or diazepam
- severe: diazepam+prochloperazine
- Prophylaxis: hydrochlorthiazide, refer, low salt diet, smocking and coffee

64
Q

Labyrinthitis - S/S

A
  • young and middle age
  • 50% prior URTI / herpes zoster infection
  • vertigo + imbalance aggrevate with headpostion
  • tinitus or hearing loss (DD to Verstibular neuronitis)
  • horizontal nystagmus , oszillation towards healthy ear
65
Q

Frontal - temporal Dementia - S/S

A

-Insidious onset and slow progression.
-Preservation of memory to late-stage disease.
-Early and prominent personality changes (e.g., apathy, irritability, jocularity, euphoria, loss of personal and social awareness).
-Impaired judgment and insight.
-Mental rigidity and inflexibility.
-Unrestrained exploration of objects and the environment.
-Language difficulties (e.g., problems with word recall, circumlocution, word repetition.

66
Q

Huntington disease

A
  • inherited progressive neurodegenerative disorder
  • characterized by
    –> choreiform movements,
    –> psychiatric problem (irritability, depression, dysphoria, agitation, apathy, anxiety, paranoia, delusions, and hallucinations)
    –> dementia
67
Q

Rett Syndrom

A

-neurodevelopmental disorder
-exclusively in females
- MECP2 gene defect
- initially normal development

68
Q

Rett syndrom - Main Criteria

A

●Partial or complete loss of acquired purposeful hand skills
●Partial or complete loss of acquired spoken language
●Gait abnormalities: impaired (dyspraxic) or absence of ability
●Stereotypic hand movements such as hand wringing/squeezing, clapping/tapping, mouthing, and washing/rubbing automatisms

69
Q

Rett Syndrom - Supportive criteria

A

●Breathing disturbances when awake
●Bruxism when awake
●Impaired sleep pattern
●Abnormal muscle tone
●Peripheral vasomotor disturbances
●Scoliosis/kyphosis
●Growth retardation
●Small cold hands and feet
●Inappropriate laughing/screaming spells
●Diminished response to pain
●Intense eye communication (“eye pointing”)

70
Q

Bells Palsy RF

A

●pregnancy, severe pre- eclampsia
●hypertension
●diabetes
●upper respiratory illnesses such as influenza
●obesity

71
Q

Third nerve Palsy

A

●sudden onset of binocular horizontal, vertical, or oblique diplopia and a droopy eyelid
●ptosis, a large unreactive pupil, and paralysis of adduction, elevation, and depression

72
Q

Fourth nerve Palsy

A

●

73
Q

Six nerve Palsy

A

weakness of abduction
horizontal diplopia

74
Q

Ramsay Hunt Syndrom - Triad

A

ipsilateral facial paralysis
ear pain
vesicles in the auditory canal and auricle

severere + tinnitus, vertigo, hearing loss

75
Q

Ramsay Hunt - Therapy

A
  • Aciclovir and prednisolon
76
Q

Lumbar puncture- Values

A
77
Q
A
78
Q

UMN

A

spastic paralysis
hyperreflexia
presence of a Babinski reflex

Everything is up in UMN disease

79
Q

LMN

A

flaccid paralysis
significant atrophy
fasciculations
hyporeflexia,

everything is down in LMN disease

80
Q

Normal pressure hydrocephalus - Clinic

A

Gait instability (wide-based) with frequent falls
Cognitive dysfunction
Urinary urgency/incontinence
Depressed affect (frontal lobe compression)
Upper motor neuron signs in lower extremities

81
Q

Normal pressure hydrocepahlus - Dx/Mx

A

Dx
Marked improvement in gait with spinal fluid removal: Miller Fisher (lumbar tap) test
Enlarged ventricles out of proportion to the underlying brain atrophy on MRI

MX
Ventriculoperitoneal shunting

82
Q

Idiopathic intracranial hypertension - Clinic

A

Headache
Vision loss; enlarged blind spot
Pulsatile tinnitus
Diplopia; palsy of the abducens nerve (CN VI)
Papilledema

83
Q

Idiopathic intracranial hypertension - RF

A

obese women of childbearing age
Medication( retinoids, tetracyclines, growth hormone)

84
Q

Idiopathic intracranial hypertension - Dx/Mx

A

Dx
Neuroimaging
Lumbar puncture: elevated opening pressure

Mx
Weight loss
Acetazolamide

85
Q

Headache- Differential Symptomes

A
86
Q
A

AMC MCQ (56 decks)

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