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Year 3 > Neuro Misc > Flashcards

Neuro Misc Flashcards

1
Q

3 dopamine agonists used in parkinson’s?

A

Pramipexole
Roprinilole
Apomorphine - acute ‘off’ states

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2
Q

2 Anticholinergics used in Parkinson’s to help tremor?

A

Trihexiphenidyl

Benzhexol

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3
Q

2 COM-T inhibitors used in Parkinson’s?

Why are they used?

A

Entecapone
Tolcapone

Lessen ‘off’ time in levodopa therapy

(monitor LFT’s)

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4
Q

Treatment of dyskinesia assoc w treatment of parkinson’s?

A

Amantidine

NMDA antagonist

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5
Q

What should patients be started on after ischaemic stroke?

A

Give aspirin 300mg PO/PR as soon as haemorrhagic stroke ruled out, and continue for 14 days.

After 14 days:
1st line = Clopidogrel + statin
2nd line = Aspirin + Dipyramidole + statin
3rd line = Dipyramidole + statin

(wait 14 days to minimise the risk of transitioning to haemorrhagic)

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6
Q

Causes of cerebellar dysfunction?

A

PASTRIES

Posterior fossa tumour
Alcohol
multiple Sclerosis
Trauma
Rare causes
Inherited diseases (e.g. Friedrich's ataxia)
Epilepsy treatment
Stroke
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7
Q

35 y/o male presents with difficulty walking. He has his feet wide apart and staggers, and there is loss of normal heel-toe walk. What is this gait?

A

Ataxic - cerebellar disease

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8
Q

Inability to adduct fingers of hand - nerve?

A

Ulnar

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9
Q

Inability to extend fingers of hand- nerve?

A

Radial

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10
Q

What group of people have a 3x higher risk of developing Bell’s Palsy?

A

Pregnant women

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11
Q

How long can you not drive for after TIA?

A

1 month

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12
Q

Rugby player presents after receiving a hard tackle during a match. His arm is hanging loose, it is pronated and internally rotated. What is damaged?

A

Brachial nerve roots C5/6

This describes Erb’s palsy

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13
Q

Which antipsychotic can cause megaloblastic anaemia?

A

Phenytoin - alters folate metabolism

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14
Q

Bitemporal hemianopia predominantly affecting upper quadrants?

A

Pituitary macroadenoma

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15
Q

Bitemporal hemianopia predominantly affecting lower quadrants?

A

Craniopharyngioma

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16
Q

Elderly lady suffering from hypertension is admitted following a intracranial bleed. Over the course of the day she becomes more unresponsive, responding now to supraorbital pain only. What is the most likely diagnosis? Investigation?

A

Hydrocephalus

CT brain

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17
Q

How to differentiate acute and chronic subdural haematoma on CT?

A

Acute - blood is HYPERdense

Chronic - HYPOdense

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18
Q

Medical treatment of delirium?

A

Haloperidol

NOT if Parkinson’s though, give Lorazepam instead

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19
Q

67 y/o man with CVS Hx presents with sudden onset dizziness and vomiting. Exam reveals vertical nystagmus and inability to stand without support. Likely cause?

A

Cerebellar stroke -> urgent CT brain

similar presentation to vestibular neuritis, except patients are usually able to stand without support in this

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20
Q

Patient is hit on head with hammer, depressed open skull fracture evident, GCS 6/15 - initial management?

A

Urgent neurosurgical review, even before CT

Any patient with GCS <8/15 needs urgent neurosurgical review

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21
Q

67 y/o falls down stairs. He has GCS 15/15 and no signs except bruising at mastoid - management?

A

Urgent CT within 1 hour

Battle’s sign -> basal skull fracture

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22
Q

52 y/o woman falls down stairs. Has no neurology, but is unable to turn neck 45 degrees to left and right - management?

A

Immobilise with neck brace and arrange CT neck

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23
Q

Woman has sinusitis. Then a week later develops severe frontal headache with difficulty lifting her right arm and leg. She then has a seizure. What does she have?

A

Cerebral abscess

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24
Q

How does cavernous sinus thrombosis present?

A

Unilateral facial oedema
Photophobia
Proptosis
CN III, IV, V1 and VI palsy

Can be a complication of sinusitis

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25
Q

First line treatment options for neuropathic pain?

A

Amitriptyline
Duloxetine
Pregabalin
Gabapentin

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26
Q

Loss of ability to abduct thumb - nerve?

A

Median

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27
Q

Which medications can cause benign intracranial hypertension?

A 
Tetracyclines
Contraceptives
Steroids
Levothyroxine
Lithium
28
Q

What does taste and general sensory for anterior 2/3 of tongue?

A

Taste - facial (via chorda tympani)

General sensory - CNV1

29
Q

How does corticobasal degeneration present?

A

Parkinsonism
Cortical signs e.g. hyperreflexia, myoclonus, apraxia (difficulty completing simple movements) affecting one limb more than the other.
Can cause ‘alien limb phenomenon’
Prominent gait unsteadiness and falls

30
Q

How does supranuclear palsy present?

A

Symmetrical parkinsonism
Vertical gaze palsy, saccadic eye movements, eventually limitation to eye movement
Chewing and swallowing diffuculty

31
Q

What antibiotic should never be given in myasthenia gravis?

A

Gentamicin

Affects NMJ so can cause respiratory depression

32
Q

What is epilepsy partialis continua?

A

Non-convulsive status

Consciousness preserved but patient is in ‘altered state’, consider this in elderly

33
Q

Are focal or generalised seizures more common in older patients?

A

Focal

In focal seizures the brain in structurally abnormal

34
Q

Side effects of Carbamazepine?

A

Ataxia
Vertigo
Blurred vision
Hyponatraemia

35
Q

Which 2 anticonvulsants shouldn’t be given together?

A

Valproate and Lamotrigine

36
Q

Febrile convulsions are a risk factor for the development of which type of epilepsy?

A

Focal temporal seizures

Febrile seizures can cause sclerosis of mesial temporal lobe

37
Q

Is a lesion of the DOMINANT parietal lobe more likely to present with L/R disorientation or hemispatial neglect syndrome?

A

L/R disorientation

38
Q

Meningioma risk factors:
Genetic condition?
Early life exposure to something?
What sex?

A

NF2
Childhood radiation exposure
Female sex

39
Q

A lesion of which lobe might cause urinary incontinence?

A

Frontal - micturition centre is in frontal lobe

40
Q

A lesion of which lobe is likely to cause a contralateral homonymous hemianopia?

A

Occipital

Will have macular sparing

41
Q

What is Foster Kennedy Syndrome?
What is the usual cause?
What can relieve symptoms whilst awaiting surgery?

A

Ipsilateral optic nerve atrophy, central scotoma and anosmia; contralateral papilloedema

Meningioma in olfactory groove

Dexamethasone whilst awaiting surgery/radio/chemo

42
Q

Which is the most common extra-axial brain tumour of mesenchymal cells?

A

Meningioma

43
Q

What controls consciousness?

Where is it found?

A

Reticular formation

Network of neurones stretching from upper midbrain to lower medulla oblongata

44
Q

A stroke affecting which circulation is most likely to present with decreased consciousness? Why?

A

Posterior

Consciousness mediated by reticular formation in brainstem - posterior stroke is of vertebrobasilar circulation so can affect brainstem

45
Q

What are Verocay bodies?

What are they found in?

A

Cellular areas surrounded by nuclear pallisades

Schwannomas

46
Q

What are hemangioblastomas?

Where are they most commonly found?

A

Benign tumours which are cystic and highly vascular

Most commonly in posterior cranial fossa

47
Q

Which tumour has a ‘butterfly appearance’ on MRI?

A

Glioblastoma multiforme

48
Q

What thyroid panel would be expected in a patient with a functional thyrotropinoma?

A

Increased TSH
Increased T3/T4

-> Cause secondary hyperthyroidism by releasing excess TRH

49
Q

Craniopharyngioma is a rare pituitary tissue tumour. What does it present with?

A

Lower bitemporal hemianopia

Diabetes insipidus

50
Q

Which tumour is associated with Von Hippel Lindau Syndrome?

A

Hemangioblastoma

Along with phaeochromocytoma, renal cell carcinoma, pancreatic cysts

51
Q

Treatment of a tumour that presents with amenorrhoea, galactorrhoea, decreased libido?

A

Cabergoline

Prolactinoma - cabergoline is a dopamine agonist

52
Q

A lesion in which lobe would present with cortical blindness and visual hallucinations?

A

Occipital

53
Q

2 brain tumours associated with NF2?

A

Meningioma

Schwannoma - likely if young and bilateral vestibular schwannoma

54
Q

Hemispatial neglect syndrome would most likely appear with a lesion on the dominant/non-dominant side?

A

Non-dominant

55
Q

Treatment of a tumour which presents with gigantism and acromegaly?

A

1st - Ocreotide (a somatostatin analogue)

2nd - Pegvisomant (GH antagonist)

56
Q

7 symptoms of a frontal lobe lesion?

A 
Disinhibition
Personality change (antisocial behaviour)
Lack of initiative
Impaired memory
Urinary incontinence
Grasp reflex
Anosmia
57
Q

Dominant parietal lobe lesion?

A

Agraphia
Acalculia
R/L disorientation
Finger agnosia (inability to localise fingers)

(gerstmann syndrome)

Also inferior quadrantopia

58
Q

Non-Dominant parietal lobe lesion?

A

Hemispatial neglect
Spatial disorientation
Dressing/Construction apraxia
Inferior quadrantopia

59
Q

Lesion of Dominant temporal lobe?

A

Wernicke’s aphasia
Poor memory
Complex hallucinations (sound, smell, visual)
Superior quadrantopia

60
Q

Non-dominant temporal lobe lesion?

A

Poor music skills
Poor non-verbal memory
Complex hallucinations (sound, smell, visual)

61
Q

21 y/o man assaulted outside of pub 3 hours ago. He drank 3 pints of lager. He has bruising on face around eye. GCS 14 (M6 V4 E4) with some difficulty explaining where he is. Management?

A

Urgent CT head within 1 hour

Do this if GCS < 15 after 2 hours

62
Q

If suspect subarachnoid haemorrhage but CT normal, how long should you wait before confirming with LP?

A

12 hours after headache started

63
Q

What findings prove SAH on LP?

A

Breakdown products from RBC e.g. bilirubin (Xanthochromia)

Presence of RBC’s could be from bloody tap. Wait 12 hours for RBC’s to be broken down.

64
Q

75 y/o man falls and hits head and was unconscious for 1 min. Comes to A&E 2 hours later, GCS 15, no neurological signs. management?

A

CT within 8 hours

Anyone >65y/o who have head injury causing amnesia or unconsciousness should get CT within 8 hours, unless indications suggesting it should be within 1 hour e.g. GCS <15 after 2 hours

65
Q

30y/o nurse has 24 hour Hx of headache, drowsiness, confusion. GCS 13/15. No signs of meningism, and she is confused. Urgent MRI shows bilateral increased signal in both temporal lobes. What is is?

A

Herpes Simplex encephalitis

No meningism, confusion, increased temporal lobe signal

Year 3 (19 decks)

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