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Dannys Medicine Finals > Neurology > Flashcards

Neurology Flashcards

1
Q

Causes of Peripheral Neuropathy?

A 
A – Alcohol
B – B12 deficiency
C – Cancer and Chronic Kidney Disease
D – Diabetes and Drugs (e.g. isoniazid, amiodarone and cisplatin)
E – Every vasculitis
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2
Q

What is Charcot-Marie-Tooth disease?

A

inherited disease that affects the peripheral motor and sensory nerves. Autosomal dominant mutation which causes dysfunction to myelin and the axons

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3
Q

Classical features of Charcot-Marie-Tooth disease?

A
  • Distal muscle wasting and weakness causing “inverted champagne bottle legs”
    (hands and ankle dorsiflexion weakness)
  • High foot arches (pes cavus)
  • Reduced tendon reflexes and muscle tone
  • Peripheral sensory loss
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4
Q

Management of Charcot-Marie-Tooth disease?

A

SUPPORTIVE MDT
Neurologists and geneticists to make the diagnosis

Physiotherapists to maintain muscle strength and joint range of motion

Occupational therapists to assist with activities of living

Podiatrists to help with foot symptoms and suggest insoles and other orthoses to improve symptoms

Orthopaedic surgeons to correct disabling joint deformities

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5
Q

What indicates NF-2?

A

Bilateral Acoustic Neuromas

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6
Q

What chromosome is NF-1 gene found on and what protein does it code for?

A

Chromosome 17 - codes for neurofibromin which is a tumour suppressor protein

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7
Q

What chromosome is NF-2 gene found on and what protein does it code for?

A

Chromosome 22 - codes for Merlin which is a tumour suppressor protein particularly important in Schwann Cells - therefore SCHWANNOMAS develop

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8
Q

What other tumour is NF-2 associated with?

What are the symptoms?

A

Acoustic Neuromas - tumours of the auditory nerve innervating the inner ear.

Hearing loss
Tinnitus
Balance problems

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9
Q

NF-1 features?

A

CRABBING. 2/7 of:

C – Café-au-lait spots (6 or more) measuring ≥ 5mm in children or ≥ 15mm in adults

R – Relative with NF1

A – Axillary or inguinal freckles

BB – Bony dysplasia such as Bowing of a long bone or sphenoid wing dysplasia

I – Iris hamartomas (Lisch nodules) (2 or more) are yellow brown spots on the iris

N – Neurofibromas (2 or more) or 1 plexiform neurofibroma

G – Glioma of the optic nerve

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10
Q

Complications of NF-1?

A

GLIMMERS
Gastrointestinal stromal tumour (GIST - sarcoma)
Learning problems / Leukaemia
Increased risk of cancer (BREAST/ brain tumours)
Migraines
Malignant peripheral nerve sheath tumours
Epilepsy
Renal artery stenosis - causing Hypertension
Scoliosis / Spinal cord tumours

+ vision loss (secondary to optic glioma)

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11
Q

Cutaneous features of Tuberous Sclerosis?

A

ASH LEAF SPOTS- depigmented ‘ash-leaf’ spots which fluoresce under UV light

SHAGREEN PATCHES roughened patches of skin over lumbar spine

adenoma sebaceum (angiofibromas): butterfly distribution over nose

fibromata beneath nails (subungual fibromata)

POLIOSIS is an isolated patch of white hair on the head, eyebrows, eyelashes or beard

café-au-lait spots* may be seen

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12
Q

Neuro features of Tuberous Sclerosis

A

Epilepsy (infantile spasms/ partial)

Developmental delay / intellectual difficulties

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13
Q

Other features of Tuberous Sclerosis

A

Rhabdomyomas in the heart
Gliomas (tumours of the brain and spinal cord)
Polycystic kidneys
Lymphangioleiomyomatosis (abnormal growth in smooth muscle cells, often affecting the lungs)
Retinal hamartomas

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14
Q

Lambert Eaton syndrome

What condition are features similar too?

What cancer is it associated too?

A

Myasthenia Gravis

Small cell Lung cancer

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15
Q

Lambert Eaton syndrome

Treatment?

A

Amifampridine (allows more acetylcholine to be released)

Other options:

Immunosuppressants (e.g. prednisolone or azathioprine)
IV immunoglobulins
Plasmapheresis

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16
Q

Lambert Eaton syndrome

Features?

A 
Proximal muscle weakness 
hyporeflexia
Diplopia 
autonomic symptoms: dry mouth, impotence, difficulty micturating
Ptosis 
Dysphagia
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17
Q

Lambert Eaton syndrome

What is it?

A

Antibodies produced by the immune system against voltage-gated calcium channels

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18
Q

Localising features of focal seizures

Temporal?

A

HEAD
Hallucinations (auditory/gustatory/olfactory),
Epigastric rising/Emotional,
Automatisms (lip smacking/grabbing/plucking),
Deja vu/Dysphasia post-ictal)

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19
Q

Localising features of focal seizures

Parietal?

A

Paraesthesia

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20
Q

Localising features of focal seizures

frontal?

A

jacksonian march

Head/leg movements, posturing, post-ictal weakness

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21
Q

Localising features of focal seizures

Occipital?

A

Floaters and flashes

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22
Q

L-dopa unwanted effects?

A

Dyskinesia, Drowsiness, Dry mouth
On-off effect
Palpitations, postural hypotension, psychosis
Anorexia

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23
Q

Dopamine receptor agonist examples?

A

bromocriptine, ropinirole, cabergoline, apomorphine

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24
Q

Dopamine receptor agonist unwanted effects?

A

impulse control disorders and excessive daytime somnolence

more likely than levodopa to cause hallucinations in older patients.

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25
Q

Signs of benign essential tremor?

Management of benign Essential Tremor?

A
  • Worse on voluntary movement
  • improved by alcohol
  • symmetrical
  • absent in sleep

Propanolol
Primidone

26
Q

STROKES

Symptoms for ACA stroke?

A

Contralateral hemiparesis and sensory loss, lower extremity > upper

27
Q

STROKES

Symptoms for MCA stroke?

A

Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

28
Q

STROKES

Symptoms for PCA stroke?

A

Contralateral homonymous hemianopia with macular sparing

Visual agnosia

29
Q

STROKES

What symptoms should be assessed when assessing an anterior circulation infarct?

PACI vs TACI

A
  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia

(Total anterior circulation (ACA+MCA) = all 3)

30
Q

STROKE

Lacunar infarct symptoms?

A

presents with 1 of the following:

  1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
  2. pure sensory stroke.
  3. limb ataxia

STRONG ASSOCIATION WITH HYPERTENSION

31
Q

Lateral Medullary syndrome involves what artery?

A

Posterior inferior cerebellar artery

32
Q

Associated effects to Lateral Medullary Syndrome?

A

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

33
Q

lateral pontine syndrome involves what artery?

A

Anterior inferior cerebellar artery

34
Q

Associated effects to Lateral Pontine Syndrome?

A

Ipsilateral: facial paralysis and deafness

35
Q

Stroke in opthalamic artery is associated with what?

A

Amaurosis Fugax

36
Q

Ramsey Hunt Syndrome

what is it?
features?

A

unilateral lower motor neurone facial nerve palsy caused by varicella zoster virus (VCV)

  • Vesicular rash on pinna/ around the ear and sometimes on the anterior 2/3 of the tongue
37
Q

What should be prescribed for LMN palsys as well as prednisolone?

A

Lubricating eye drops

38
Q

Reflex test for Cervical Myelopathy?

A

Hoffman’s sign:

It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.

39
Q

Valproate adverse effects?

A 
Valproate
Appetite and weight gain
Liver failure
Pancreatitis
Reversible hair loss
Oedema
Ataxia
Tremor + teratogenicity + thrombocytopenia
Encephalopathy (hyperammonemic) - L - cartinine may be used as treatment if this develops

P450 inhibitor

gastrointestinal: nausea

hyponatraemia

40
Q

Cavernous sinus thrombosis

What is it a complication of?

Features?

A

Sinusitis

  • unilateral facial oedema
  • photophobia
  • proptosis (Exophthalmos)
  • palsies of the cranial nerves which pass through it (III, IV, V, VI).
41
Q

Brain abscess features?

A

1) Headache
2) Fever
3) Focal Neurology (e.g. CN3/ CN6 palsy secondary to raised ICP)

42
Q

Management of Brain abscess?

A

Surgery (craniotomy)

IV 3rd-generation cephalosporin + metronidazole

43
Q

most common complication of bacterial meningitis?

A

Sensorineural hearing loss

44
Q

Antibiotic prophylaxis of meningitis contacts?

A

ciprofloxacin is now preferred over rifampicin

45
Q

MENINGITIS MANAGEMENT

Initial empirical therapy aged < 3 months?

A

Intravenous cefotaxime + amoxicillin (or ampicillin)

46
Q

MENINGITIS MANAGEMENT

Initial empirical therapy aged 3 months- 50 years?

A

Intravenous cefotaxime (or ceftriaxone)

47
Q

MENINGITIS MANAGEMENT

Initial empirical therapy aged > 50 years

A

Intravenous cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)

48
Q

MENINGITIS MANAGEMENT

Tx for Meningococcal meningitis?

A

Intravenous benzylpenicillin or cefotaxime (or ceftriaxone)

49
Q

MENINGITIS MANAGEMENT

Tx for Pneuomococcal meningitis/ caused by Haemophilus influenzae?

A

Intravenous cefotaxime (or ceftriaxone)

50
Q

MENINGITIS MANAGEMENT

Tx for meningitis caused by Listeria?

A

Intravenous amoxicillin (or ampicillin) + gentamicin

51
Q

Syringomyelia classic presentation?

A

cape-like loss of pain and temperature sensation due to compression of the spinothalamic tract fibres

52
Q

Treatment of Raised intracranial pressure?

A

investigate and treat the underlying cause

head elevation to 30º

IV mannitol may be used as an osmotic diuretic

controlled hyperventilation

removal of CSF, different techniques include:

drain from intraventricular monitor (see above)
repeated lumbar puncture (e.g. idiopathic intracranial hypertension)
ventriculoperitoneal shunt (for hydrocephalus)
53
Q

Raised ICP features?

A

Cushing’s triad

widening pulse pressure
bradycardia
irregular breathing

54
Q

Causes of raised ICP?

A

HIT HIM
head injuries
idiopathic intracranial hypertension
tumours

hydrocephalus
infection
meningitis

55
Q

Normal Intracranial pressure?

A

the normal ICP is 7-15 mmHg in adults in the supine position

56
Q

DCM symptoms?

A 
Pain in neck, upper and lower limbs 
loss of dexterity e.g buttons, holding cutlery
incontinence
numbness
Hoffmans sign
57
Q

Gold standard dx for DCM?

Treatment?

A

MRI of cervical spine

Surgery needed within 6 months

58
Q

Who classically gets Intracranial Hypertension

Risk factor drugs?

A

Young overweight females

COCP, Tetracyclines, Steroids, Lithium

59
Q

Features of Intracranial hypertension?

A

Headache with blurred vision and papilloedema - enlarged blind spot

60
Q

Management of Intracranial Hypertension?

A

Weight loss

Acetazolamide

Dannys Medicine Finals (9 decks)

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