Neurology Flashcards
1
Q
Cluster headache features
A
Eye swelling, redness, nasal stiffness, severe pain
2
Q
Cluster headache prophylaxis
A
Verapamil
3
Q
Cluster headache management
A
Oxygen and triptan
4
Q
What antinausea medication is CI in parkinsonism
A
Metoclopramide
5
Q
unprovoked 1st seizure and driving
A
6 months
6
Q
unprovoked 1st seizure and driving
A
6 months
7
Q
Prodrome before Syncope
A
Reflex or neurally mediated syncope
8
Q
Benign positional Vertigo
A
Movement of head
9
Q
Meniere
A
Attacks of vertigo + tinnitus + progressive hearing loss
10
Q
treating MG crisis
A
Plasmapheresis and IV immunoglobulin
11
Q
treating MG crisis
A
Plasmapheresis and IV immunoglobulin
12
Q
Treatment of Neuropathic pain
A
Amitriptyline, Duloxetine, gabapentin and pregabalin
13
Q
Autonomic Dysreflexia
A
Spinal cord injury patients, trigger fecal impaction or urinary retention; extreme hypertension, flushing and sweating.
14
Q
Asymmetrical features, resting tremor, increased tone
A
parkinson’s disease
15
Q
Bilateral symptoms, antidopaminergic drugs
A
Drug induced parkinson
16
Q
Supranuclear palsy
A
Plus syndrome; vertical gaze palsy, Axial rigidity
17
Q
Lewy body dementia
A
Parkinsonism + dementia near onset of symptoms + nocturnal wandering
18
Q
Lewy body dementia
A
Parkinsonism + dementia near onset of symptoms + nocturnal wandering
19
Q
Todd’s Paralysis
A
focal weakness after a focal seizure
20
Q
Chronic presentation after head injury
A
Subdural hepatoma
21
Q
Diagnosis of GBS
A
Nerve conduction study
22
Q
Motor deficit but eye movements spared
A
MND
23
Q
1st line for PD if affected motor symptoms
A
Levodopa
24
Q
Hallucinations, epigastric rising, emotions, Automatisms such as lip smacking, grabbing and plucking, deja vu and dysphasia
A
Temporal lobe epilepsy
25
Head/leg movements, posturing, post-octal weakness and Jacksonian march
Frontal lobe epilepsy
26
Visual flashes and floater during seizure
Occipital lobe
27
Contraindications to triptans
CAD as cause vasospasm
28
Treating Spasticity in MS
Gabapentin and Baclofen
29
History of sinusitis, headache, fever, and focal neurology
BRAIN abscess
30
unilateral facial edema, photophobia, proposes and CN palsy
cavernous sinus thrombosis
31
Pain, opthalmoplegia, proposes, CN5 lesion (ophthalmic ) and Horner’s Syndrome
Cavernous sinus syndrome
32
VF and VT pulseless - ALS
CPR + 1 shock
| Adrenaline after 3rd shock
33
GCS - Important
EVM
E: eye movement- Spontaneous (4), to voice (3), to pain (2)
V: Verbal response: Oriented (5), Confused (4), inappropriate words (3), inappropriate sounds (2) and no (1)
M: Follows command (6), localizes to pain (5), Withdrawal from pain (4), Inappropriate flexion (3), inappropriate extension (2) and no (1)
34
Describe Lhermitte’s sign and associated diseases
Tingling in hands with flexion of neck
| Associated disease - MS and Subacute degeneration of cord
35
What is Uhtoff’s Phenomenon; where is it seen
Worse vision with rise in temperature
| MS
36
Encephalitis cause mostly*
HSV-1; use acyclovir drug
37
Lucid interval
Extra-dural hematoma
38
Biconvex hematoma
Extradural
39
Crescent shaped hematoma
Subdural hematoma
40
Acoustic neuroma best diagnostic test
Cerebellopontine angle MRI
41
Chronic subdural Hematoma - Symptomatic patient - management
Burr hole evacuation
42
Chronic subdural hematoma - Asymptomatic management
Conservative management or high dose steroids
43
Management of acute subdural hematoma
Decompressive surgery
44
What is Nimodipine used for in the management of Hematomas
Prevents secondary cerebral ischemia; increases cerebral vasodilation.
45
1st line for Trigeminal neuralgia
Carbamazepine
46
Loss of ability to produce language, comprehension is intact.
Broca’s Aphasia
47
Wernicke’s Aphasia / receptive aphasia
Impaired comprehension but retained speech, cannot repeat words
48
Both comprehension and language production impaired
Global aphasia
49
Primary progressive aphasia
Gradual loss of language, dementia related
50
CHA2DS2VAS
```
CHF 1
Hypertension 1
Age >75 2
Diabetes 1
Stroke/TIA 2
Vascular disease 1
Age 65-74 1
Female 1
```
51
Management of Status Epilepticus
1st line: Benzodiazepines (rectal diazepam); IV lorazepam (can be repeated after 10-20 minutes
2nd line: Phenytoin or phenobarbital infusion
Refractory status: General anaesthesia
52
IVF increases the risk of what placental abnormality
Placenta previa
53
what risk factor is associated with Vasa previa
Previous C-section
54
Multiple episodes of TLC with quick recovery time; Investigation of choice
24 hour ECG
55
Steven-Johnson syndrome is a side effect of what antiepileptic
lamotrigine
56
Hemonymous hemianopia with macula sparing - stroke
Posterior cerebral artery
57
Ipsilateral ataxia, nystagmus, dysphagia, facial numbness, CN palsy, with contralateral hemisensory loss indicates
Lateral Medullary syndrome
58
Isolated hemisensory loss
Lacunar infarct
59
Post-ictal weakness in a focal seizure is Called
Todd’s paresis
60
Urinary incontinence + Gait abnormality + dementia
Normal pressure hydrocephalus
61
Tumour arising from falx cerebri and pushes on the brain; well defined border between the tumour and brain parenchyma
Meningiomas
62
What is oligoclonal bands most associated with
Multiple Sclerosis
63
Autonomic dysreflexia occurs above what level of spinal cord
Above T6 level
64
Gold standard for Cauda equina syndrome
MRI spine
65
BP management in stroke
>180 mmHG
66
Distended neck veins in Myasthenia may be caused by
Thymomas
67
management of idiopathic intracranial hypertension
Acetazolamide
68
Antipsychotics are 1st line for delirium however they are CI in what condition
Parkinson’s Disease
69
Autosomal Polycystic kidney is associated with what hemorrhage
SAH
70
What is used to treat cerebral edema in patients with brain tumours
Dexamethasone
71
Myasthenia crisis respiratory test
FVC
72
Choice of investigation in GBS
Lumbar puncture
73
Ipsilateral face and contralateral limbs - affected
Lateral medullary syndrome PICA
74
Wernicke’s aphasia (receptive)
Affects the superior temporal gurus; speech is fluent comprehension is impaired
75
Broca’s aphasia
Inferior frontal gurus
| Non-fluent speech, laboured, repitition is impaired and comprehension is normal
76
Patient with lung cancer; high BP + Vomiting and severe headaches
Cerebral metastasis
77
1st line Neuropathic pain
Amitriptyline, Pregabalin, duloxetine and gabapentin
78
Unilateral sensorineural hearing loss- Investigation
MRI - rule out vestibular schwannoma
79
Pituitary tumour in Optic chiasm causes
Bitemporal hemianopia
80
What is Cataplexy
Loss of skeletal muscle tone with strong (usually) positive emotions
81
Double vision, ptosis, dysphagia and slurring speech with day progressing
MG
82
common origin of brain Metastasis
Breast, lung, kidney, thyroid, stomach, prostate and skin
83
Most common primary brain tumour
Glioblastoma
84
Hearing loss, vertigo, tinnitus and absent corneal reflex, Associated to neurofibromatosis type 2
Acoustic neuroma
causes facial numbness, weakness, absent corneal reflex and facial palsy
85
Diagnosis of Acoustic neuroma
Gadolinium enhanced MRI
86
Rinne's Test
air conduction > bone conduction is normal
| Bone conduction > Air conduction - Conductive hearing loss
87
Webers test
Normal = Both ears
| Louder in the normal ear and not louder in the ear with the sensorineural loss
88
Stroke and facial palsy -
Will cause drooping of the face and not the forehead - Contralateral
89
Bell's palsy causes what type of facial palsy
Forehead + Lower face - ipsilateral
90
management of Bell's palsy
prednisolone + antivirals
eHeaye care
no improvement in 3 weeks: refer to ENT
91
headache, nausea, vomiting, papilledema, increased CSF pressure, WCC and signs of infection (sinus or mastoid)
Brain abscess
92
Ring enhancing lesion on CT and signs of infections
Brain abscess
93
Management of community acquired Brain abscess
3rd generation cephalosporin + Metronidazole
94
what can not be seen on CT in a brain metastasis
micrometastasis
95
Unilateral headache of extreme intensity, redness, lid swelling, nasal stiffness, miosis and ptosis, injection of the eyes
Cluster headache
96
Acute management of cluster headache
Triptan and high flow oxygen therapy
| can be aborted using prednisolone
97
Prophylaxis of cluster headache
Verapamil or lithium
98
Mixed syndrome affecting the motor, sensory, and autonomic nerves
Diabetic neuropathy
99
Management of diabetic neuropathy
1st line Amitriptyline, duloxetine, pregabalin, gabapentin
Tramadol for rescue
100
Abrupt onset, short, glazed eyes, and blank stare, normal brain scan, clonus; EEG 3Hz spike and wave
Absence seizure or petit mal
101
Sudden jerk of limb, face and trunk
Myoclonic seizure
102
Sudden loss of muscle tone and causing fall, No LOC, Seizure type
Atonic seizure
103
Clusters of head nodding and arm jerking, EEG shows hypsarrhythmia
West syndrome also called infantile spasms
104
Automatisms include
lip smacking, chewing
105
Automatism, deja vu, jamias Vu, delusional behaviour, emotional disturbance and taste and smell; ANS, automatic speech
Temporal lobe epilepsy
106
Jacksonian march, and todds palsy
Frontal lobe epilepsy
107
Visual phenomena such as spots, lines and flashes causing epilepsy
Occipital lobe epilepsy
108
somatosensory symptoms such as tingling, pain, numbness, pricking, vertigo, distortion of space
Parietal lobe epilepsy
109
Treatment of choice for absence seizures
Ethosuximide
110
Steven johnson syndrome is a side effect of this AED
Lamotrigine
111
cerebellar syndrome, hirtuism, ataxia, nystagmus, dysarthria, gingival hypertrophy are SE of this AED
phenytoin
112
Manage status epilepticus
Lorazepam (2 times)
Phenytoin
Anaesthesia with propofol or thiopental
113
treating partial seizures
Lamotrigine or carbamazepine
114
Common cause of encephalitis in immunucompetent
HSV, Tb and VZV
| Immunocompromised VZV >HSV
115
Personality change, meningeal signs, confusion, low GCS, seizures
Encephalitis
116
CT changes in Encephalitis
Medial temporal and inferior frontal changes - petechial hemorrhage
117
Management of Encephalitis
Acyclovir
118
Fine tremor, worse when arms outstretched, symmetrical, prominent on voluntary movement, worse when tired, absent during sleep and improves with alcohol
Benign essential tremor
119
Management of benign essential tremor
Propranolol and primidone
120
Where does extradural hematoma take place
Between the two layers of dura called periosteal and meningeal layer, causing trauma to middle meningeal artery/Vein.
121
Lucid interval is associated with
Extradural hematoma
122
Cn3 palsy, coma, after a head injury
extradural hematoma
123
CT finding of a Extradural hematoma
Lens shaped; does not cross fissures but crosses falx cerebrii
124
management of extradural hematoma
Craniotoma and evacuation of the clot
125
Bridging veins bleeding causes
Subdural hematoma
126
Subdural hematoma location
between arachnoid and dura
127
Crescent shaped not limited by suture lines; causing mass effect, hyperdense on CT
Acute subdural hematoma
128
Management of acute and chronic subdural hematoma
Acute: Decompressive surgery (raised ICP!)
Chronic: conservative or burr hole decompression
129
Rupture of saccular aneurysms, and AV malformations lead to what type of bleed
Sub-arachnoid hemorrhage
130
Berry aneurysms occur at
```
Post communicating and Internal corotid junction
OR
Anterior communicating and ACA
or
Bifurcation of MCA
```
131
Adult polycystic kidneys, coarctation of aorta and Ehler-danlos are associated with this cranial bleed
SAH
Management surgical: Clipping
132
first line imaging in SAH
CT scan - hyperdense basal cisterns, sulci and ventricular system
133
Confirmation of diagnosis in SAH
Lumbar puncture at 12 hours - Xanthochromia
134
what is used to decrease the cerebral vasospasms in SAH
Nimodipine
135
Headache, fever, photophobia, neck stiffness, CN palsy
Meningitis
136
CSF for bacterial meningitis
```
CSF pressure: raised
Turbid
WBC: neutrophilia/ PMN
Raised protein
Low glucose
```
137
TB meningitis CSF
raised CSF pressure , neutrophilia early and later lymphocytes/ Mononucle
Protein raised and low glucose
138
Viral meningitis CSF
Normal or raised CSF pressure
Raised lymphocytes, mononucleosis
Raised protein - Mild
Normal Glucose
139
Define Kernig's Sign
Neck stiff when leg is straightened with hip at 90
140
Define Brudzinski's sign
Lifting head leads to lifting of legs
141
Management of Meningitis
community Benzyl penicillin
<50: Ceftriaxone
>50: ceftriaxone + ampicillin
Viral: Aciclovir
142
CI to lumbar puncture in meningitis
Thrombocytopenia, unstable - Cardio + resp, coagulation disorder, infection at LP site and neurology such as focal signs
143
what type of meningitis A, C, B causes most cases
B as there is no vaccine
144
PNS disease - demyelinating, AI, both motor and sensory; can cause autonomic problems, follows a diarrheal infection; affects lower limbs and ascends upwards over hours to days
Guillian Barre Syndrome
145
What is Miller-fisher (GBS syndrome)
Opthamoplegia, ataxia and areflexia + GBS signs
146
Common pathogens associated with GBS
C. Jejuni; CMV and vaccines - rabies
147
Initial diagnosis of GBS
Lumbar puncture: elevated protein and increased albumin
148
Gold standard for GBS
EMG and nerve conduction study - slow conduction velocity
149
Management of GBS
IV plasmapharesis and immunoglobulines
150
Unilateral headache throbbing in nature, photophobia and phonophobia, headache, prodrome, aura
Migraine
151
Acute management of migraine
Paracetamol + metoclopramide or domperidone
NSAIDs
Triptans for severe
152
Prophylaxis of migraine
Topiramate or propanolol
153
Increased tone, reflexed and extensor plantar response
UMN
154
Wasting, fasciculations, reduced tone, reduced reflexes, and flexor plantar reflex
LMN
155
LMN in arms and UMN in legs
ALS - MND
156
UMN signs only - type of MND
Primary lateral sclerosis
157
LMN signs only (worst prognosis)
Progressive bulbar palsy- palsy of tongue, jaw, swallowing
158
EMG of MND
reduced APs and increased amplitude
159
Improves survival in MND
Riluzole NMDA inhibitor
160
Multiple plaques of demyelination disseminated in time and space
Multiple Sclerosis
161
Commonest type of MS
Relapsing and remitting
162
Dawson's fingers are associated with
MS - paraventricular veings in brain stem, SC and optic nerves
163
First symptom in MS
optic neuritis
other signs: opthalmoplegia, urinary incontinence, sensory; Lhermitte's Sign: shock-like sensation with neck flexion
Uthoff's phenomenon: Worsening of symptoms with rise in temperature
164
MS affects what cells
Oligodendrocytes
165
Diagnosis of MS
MRI T2 or GD-enhancing
| LP: IgG oligoclonal bands
166
Clinical criteria in MS
McDonald criteria
167
Management of MS
```
Acute relapse: High dose IV methylprednisolone
DMARDs reduces the relapses
Immunosuppressants
fatigue: amantadine
Spasticity- gabapentin or baclofen
Gabapentin for visual field oscillation
```
168
DMD inheritance
X linked recessive
169
Gowers sign
pathpneumonic for muscular dystrophy, where arms are needed to get up from ground
170
Diagnosis of muscular dystrophy
Genetic testing, Raused creatinine kinase, increased Aldolase, LFTs may be increased
171
Cause of death in DMD
Respiratory failure
172
post-synaptic disease of NMJ and pre-synaptic disease
Post-synaptic - MG
| Pre-synaptic- Lambert-Eaton syndrome, tick paralysis and botulism
173
Extra-ocular symptoms, bulbar symptoms, face, neck and limb symptoms - weakness, normal reflexes and increased fatigue
MG
174
Diagnosis of MG
EMG - decreased response, reduced FVC, thymus CT and TFTs
Anti-AChR abs
175
Treatment of MG
Pyridostigmine, steroids, IV and plasmapharesis in crisis
176
Antibodies to presynaptic VG calcium channels at NMH, manifestation of Small cell lung cancer, improves with acitivity, absent reflexes
Lambert-eaton
| can use aminopyridine
177
Treating optic neuritis
High dose steroids
178
Cardinal symptoms of PD
Bradykinesia + resting tremor + rigidity + postural instability
179
SE of L-dopa
```
DOPAMINE
D: dyskinesia
On-off phenomena
Psychosis
low ABP
Mouth dryness
Insomnia
N/V
EDS - day time sleep
```
180
young and fit PD treatment
DA agonist + MOA- inhibitor and L dopa
181
Frail and old PD treatment
L Dopa and MOA inhibitor
182
Autonomic dysfunction such as hypotension and bladder problems, cerebellar signs and rigidity in PD like patient
Multiple system atrophy also called shy drager
183
postural instability - falls, speech + dementia and palsy including vertical gaze in PD like patient
Supranuclear palsy
184
Aphasia, dysarthria, apraxia, rigidity in one limb in PD like patient
Corticobasilar degeneration
185
Visual hallunication + Dementia in PD
Lewy body dementia
186
Radicular pain in the dermatomal distribution and LMN weakness at lesion level
Progressive UMN weakness and sensory loss below the lesion
painless bladder retention
Cord compression
187
Mixed UMN/LMN signs, early constipation and retention, back pain, sacral area and ED
Conud medullaris
188
Saddle anesthesia, back pain, radicular pain down the legs, bilateral flaccid, areflexic lower limb weakness, poor anal tone and incontinence, retention of feces and urine
Cauda equina syndrome
189
Gold standard for Cauda equina investigation
Spine MRI
190
Management of cauda equina
steroids, decompression
191
Wet, instability/wobbly and whacky/ demented
Normal pressure hydrocephalus
