Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Medicine Finals > Neurology > Flashcards

Neurology Flashcards

1
Q

What is the maximum score a patient can get on the Glasgow coma scale?

A

15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the lowest score a patient can get on the Glasgow coma scale?

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the two types of stroke?

A

Ischaemic and haemorrhagic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most common type of stroke?

A

Ischaemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What causes an Ischaemic stroke?

A

Thrombus or embolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are causes of a haemorrhagic stroke?

A

Burst blood vessel
Subarachnoid haemorrhage
Intracerebral bleed

Most common cause = Hypertensive vasculopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 3 main criteria assessed in stroke?

A

Unilateral hemiparesis
Homonymous hemianopia
Higher cognitive dysfunction (eg dysphasia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does a total anterior circulation infarction present?

A

All 3 - unilateral hemiparesis, homonymous hemianopia, higher cognitive dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does a partial anterior circulation infarction present ?

A

Only 2 of unilateral hemiparesis/homonymous hemianopia/higher cognitive dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does a lacunar infarct present?

A

1 of:
Unilateral weakness
Pure sensory stroke
Ataxic hemiparesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does a posterior circulation infarction present?

A

1 of:

Cerebellar/brain stem syndrome

Loss of consciousness

Isolated homonymous hemianopia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the first investigation conducted in stroke? What is the gold standard?

A

Non contrast CT - rule out haemorrhagic stroke

Gold standard = diffusion weighted MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is an ischaemic stroke managed

A

300mg aspirin (continue for 2 weeks)

Thrombolysis with alteplase (if within 4.5 hours of stroke symptoms)

Thrombectomy (if within 6 hours and proximal anterior circulation stroke)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How long within onset of stroke symptoms does alteplase (thrombolysis) need to be administered?

A

Within 4.5 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are contraindications to thrombolysis with alteplase in ischaemic stroke?

A 
Previous intracranial haemorrhage
Seizure at onset of stroke
Suspected subarachnoid haemorrhage 
Lumbar puncture in the last 7 days
Active bleeding
Pregnancy 
Uncontrolled HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What kind of stroke can a thrombectomy be done in?

A

A proximal anterior circulation infarct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How soon within onset of stroke symptoms does thrombectomy need to occur?

A

Within 6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the medical management of stroke?

A

300mg Aspirin daily for 2 weeks
If AF diagnosed on inpatient, wait the 2 weeks before commencing anticoagulants

After 2 weeks is up…

1) Clopidogrel 75mg
Or Aspirin + Dipyridamole

2) Statin
3) Anti-hypertensives

If AF –> Start a DOAC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a subdural haemorrhage?

A

Rupture of the bridging veins between the dura mater and the arachnoid mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is a subdural haemorrhage seen on CT?

A

Crescent shaped
Blood crosses suture lines
If acute - bright lesion (hyper dense)
If chronic - dark lesion (hypodense)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the cause of an acute subdural haemorrhage?

A

High impact trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which people are at risk of a chronic subdural haemorrhage?

A

Alcoholics and the elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is a subdural haemorrhage managed?

A 
Chronic = Decompression with burr holes
Acute = decompressive craniotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is an extradural haematoma?

A

Rupture of the middle meningeal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How does an extradural haematoma look on a CT?
Hyperdense area - Bi-convex/lens shaped | Blood does not cross the suture lines
26
How does an extradural haematoma usually present?
Loss of consciousness followed by a lucid interval and then worsening of symptoms
27
Which type of intracranial bleed is associated with a lucid period?
Extradural haematoma
28
What is an intracerebral haemorrhage ?
A bleed within the brain tissue
29
What is the cause of a subarachnoid haemorrhage?
Ruptured cerebral aneurysm (Berry aneurysm)
30
How does a subarachnoid haemorrhage present?
Sudden severe occipital headache Nausea and vomiting Photophobia Neck stiffness
31
What is seen on lumbar puncture in subarachnoid haemorrhage?
Xanthochromia due to increased bilirubin Normal /raised opening pressure
32
How long after presentation of SAH can you do a lumbar puncture?
Need to wait at least 12 hours from onset of symptoms
33
How is an SAH managed?
Insertion of coil 21 day course of Nimodipine
34
What is multiple sclerosis?
An autoimmune disorder causing demyelination of myelinated neurones
35
What is the most common form of multiple sclerosis?
Relapsing remitting
36
What are some eye features of multiple sclerosis?
Optic neuritis - reduced vision, pain on eye movement Uhthoff’s phenomenon - worsening of vision following rise in body temp Internuclear opthalmoplegia
37
What are some sensory symptoms of multiple sclerosis?
Pins and needles Numbness Trigeminal neuralgia Lhermitte’s syndrome - electric shock sensation in limbs on neck flexion
38
How is multiple sclerosis seen on MRI?
Peri ventricular plaques
39
How is multiple sclerosis see on lumbar puncture?
Oligoclonal bands in the CSF
40
How is an acute relapse of multiple sclerosis managed?
High dose steroids (oral or IV methylprednisolone)
41
What is a disease modifying drug used in multiple sclerosis?
Beta interferon
42
What is motor neurone disease?
Umbrella term for condition that leads to destruction of motor neurones
43
What is the most common type of motor neurone disease?
Amyotrophic lateral sclerosis
44
How does amyotrophic lateral sclerosis present?
LMN signs in the arms | UMN signs in the legs
45
What are upper motor neurone signs?
Increased tone Spasticity Brisk reflexes Upgoing plantar reflexes
46
What are lower motor neurone signs?
Muscle wasting Reduced tone Muscle twitching Reduced reflexes
47
How is motor neurone disease managed?
Riluzole may extend survival by a few months
48
What is Parkinson’s disease?
Condition where there is progressive reduction of dopamine in the substantia nigra
49
What is the triad of symptoms seen in Parkinson’s ?
1. Resting tremor - asymmetrical, pill-rolling 2. Bradykinesia - shuffling gait, micrographia, reduced arm swing 3. Rigidity
50
What other symptoms are seen in Parkinson’s?
``` Depression Drooling of saliva Reduced facial expressions Fatigue Postural hypotension ```
51
What is the first line management of Parkinson’s?
If motor symptoms affecting quality of life - levodopa If motor symptoms not affecting quality of life - can also use a dopamine agonist eg cabergoline/bromocriptine
52
What are side effects of levodopa?
``` Dyskinesia (uncontrollable muscle movements) Dry mouth Anorexia Palpitations Red discolouration of urine ```
53
How can you tell whether a tremor is an essential tremor or due to Parkinson’s ?
Essential tremor is worse on movement and better on resting | Essential tremor is symmetrical
54
How can an essential tremor be managed?
Propranolol
55
How does a generalised tonic clonic seizure present?
Loss of consciousness Tongue biting Tonic and clonic episodes
56
What is first line for a tonic clonic seizure?
Sodium valproate
57
What is first line for absence seizures?
Sodium valproate or ethosuximide
58
What is first line for atonic seizures?
Sodium valproate
59
What is first line for myoclonic seizures?
Sodium valproate
60
How does a temporal lobe focal seizure present?
Hallucinations, memory flashbacks, deja vu
61
How does a frontal lobe focal seizure present?
Head/leg movements, Jacksonian March, post-ictal weakness
62
What is the first line management for focal seizures?
Carbamazepine/lamotrigime
63
How long must you be seizure free to drive?
Single seizure - 6 months Established epilepsy/multiple seizures - 12 months bus drivers etc - 5 years one seizure, 10 years more than one
64
Which anti epileptic drug is used in pregnancy?
Lamotrigine
65
What is status epilepticus?
Either A single seizure more than 5 minutes Or 2 or more seizures within 5 minutes without the patient returning to normal in between
66
How do you manage a patient with status epilepticus?
``` ABCDE Secure the airway Administer oxygen Insert cannula Check blood glucose ``` Administer IV Lorazepam/ Rectal diazepam / Buccal midazolam This can be repeated in 10 mins but only once
67
How do you manage status epilepticus which is still ongoing after two doses of 4mg IV Lorazepam?
IV Phenytoin or Phenoarbital
68
What kind of genetic pattern is Huntington’s?
Autosomal dominant
69
What phenomenon do you witness with future generations of Huntington’s chorea?
Genetic anticipation - successive generations have 1) earlier age of onset 2) increased severity of disease
70
How does Huntington’s present?
Initially cognitive/psychiatric/mood problems Then movement disorders: Chorea Eye movement disorders Dysarthria Dysphagia
71
What is myasthenia gravis?
An autoimmune disorder against acetylcholine receptors in the neuromuscular junction
72
What type of tumour is myasthenia gravis associated with?
Thymoma
73
Which autoantibody is seen in myasthenia gravis?
Acetylcholine receptor antibodies
74
How does myasthenia gravis present?
Muscle fatigabilty - muscles get weaker the more they’re used Extraocular muscle weakness - Diplopia Eyelid weakness - ptosis Facial weakness Jaw fatigue when chewing
75
How is myasthenia gravis managed?
Pyridogstigmine (acetylcholinesterase inhibitor)
76
What is a myasthenia crisis?
Acute worsening of symptoms in someone with myasthenia gravis Respiratory failure
77
How is a myasthenic crisis managed?
Non invasive ventilation | IV Immunoglobulins
78
How does Lambert Eaton myasthenic syndrome present?
Someone with small cell lung cancer Muscle weakness - sometimes improves with use Usually in the proximal leg muscles Can also cause diplopia and ptosis
79
How is Lambert Eaton managed? (Including specific drug)
Treat underlying malignancy Amifampridine (symptomatic)
80
What is a normal intracranial pressure?
7-15
81
What are causes of a raised ICP?
``` Idiopathic intracranial hypertension Traumatic head injury Meningitis Encephalitis Brain Abscess Tumour - endocrine, metastases, primary Hydrocephalus ```
82
How does raised ICP present?
Headache worse in the morning Vomiting Reduced consciousness Papilloedema Cushing's triad - Bradycardia, Raised BP, Bradypnoea
83
How is raised ICP managed? (3 steps)
IV mannitol Head elevation to 30 degrees Controlled hyperventilation
84
How does a parietal lobe lesion present?
Apraxia (inability to perform movements on command) Astereognosis (inability to identify objects by feel) CONTRALATERAL Inferior homonymous quadrantanopia
85
How does an occipital lobe lesion present?
Homonymous hemianopia with macular spearing Cortical blindness (vision loss) Visual agnosia - inability to recognise familiar people/objects
86
How does a temporal lobe lesion present?
Wernickes aphasia - fluent speech but with word substitution CONTRALATERAL Superior homonymous qudrantanopia Auditory agnosia - inability to recognise familiar sounds/voices Difficulty recognising faces
87
How does a frontal lobe lesion present?
Brocas aphasia - non fluent halting speech Disinhibition Perseveration Anosmia
88
What is the most common cancer that metastasises to the brain?
Lung
89
What is the most common primary brain tumour in adults?
Glioblastoma
90
What are first line treatments for neuropathic pain?
Amitripytyline/pregabalin/gabapentin/duloxetine
91
How does trigeminal neuralgia present?
Severe unilateral pain on the face | Triggered by washing/talking/smoking/brushing teeth
92
How is trigeminal neuralgia managed?
Carbamazepine
93
How does a migraine present?
Severe unilateral throbbing headache Nausea Photophobia Phonophobia
94
How does aura present with migraine?
Blurred vision Lines across vision Loss of visual fields Floaters/flashes
95
What is the acute management for migraine?
Triptan + paracetamol/NSAID
96
What is the prophylactic medication for migraine?
Topiramate or propranolol Topiramate is teratogenic
97
What are side effects of triptans?
Tightness Heaviness Pressure
98
What are contra indications for Triptans?
Ischaemic Heart disease or cardiovascular disease Severe or uncontrolled hypertension Concurrent use of an SSRI
99
What is the main risk group for cluster headaches?
Male smokers
100
How do cluster headaches present?
``` Severe unbearable unilateral headaches around the eye Red, swollen watering eye Constricted pupils Ptosis Nasal discharge ``` Presents in clusters eg 3/4 a day for 4-12 weeks then 1-2 years without
101
What is the acute management for cluster headaches?
Subcutaneous sumatriptan High flow oxygen
102
What is the prophylactic medication for cluster headaches?
Verapamil
103
What are the two most common causes of bacterial meningitis in adults?
Neisseria meningitidis and streptococcus pneumoniae
104
What is the most common cause of meningitis in neonates?
Group B strep
105
How does meningitis present?
``` Headache Fever Nausea and vomiting Photophobia Neck stiffness Drowsiness ```
106
How does meningococcal septicaemia present?
Same as meningitis + non-blanching rash
107
What is seen on lumbar puncture in bacterial meningitis?
Cloudy appearance Raised protein Low glucose High neutrophils Positive bacterial culture
108
What is seen on lumbar puncture in viral meningitis?
Clear appearance Normal protein Normal glucose High lymphocytes
109
How can bacterial meningitis be managed in the community?
IM Benzylpenicillin
110
How is bacterial meningitis treated in infants below three months?
IV Cefotaxime + amoxicillin
111
How is bacterial meningitis treated?
``` In the community: IM Benzylpenicillin (if suspected due to meningococcal disease) ``` In hospital: 3months-50yrs: Cefotaxime/ceftriaxone <3 months / >50 years - Cefotaxime + Amoxicillin
112
How is bacterial meningitis treated in those over 50 years of age?
IV Cefotaxime + amoxicillin
113
How are contacts of those with bacterial meningitis treated prophylactically?
All close contacts within seven days must be given oral ciprofloxacin or oral rifampicin
114
What is encephalitis?
Acute inflammation of the brain
115
How does encephalitis present?
Fever Headache Altered mental status (confusion, agitation, irritability) Acute onset of focal neurological symptoms
116
What is the most common cause of encephalitis?
HSV-1
117
What is seen on lumbar puncture in encephalitis?
Raised protein Raised lymphocytes Normal glucose
118
How is HSV-1 encephalitis managed?
IV Aciclovir
119
What is Guillan barre syndrome?
An immune mediated demyelination of the peripheral nervous system Triggered by an infection
120
Which infections most commonly cause Guillan-Barre syndrome?
Campylobacter jejuni Cytomegalovirus Epstein-Barr virus
121
What are characteristic features of Guillan-Barre syndrome?
History of gastroenteritis Initial back/leg pain Progressive symmetrical weakness of all limbs which starts in the legs Reduced reflexes
122
What is seen on nerve conduction studies in Guillan-Barre syndrome?
Decreased motor conduction velocity
123
What is seen on lumbar puncture in Guillan-Barre syndrome?
Raised protein, normal white cell count
124
How is Guillan-Barre syndrome managed?
IV Immunoglobulins Supportive care
125
What is Charcot-Marie-Tooth disease?
Autosomal dominant cause of peripheral neuropathy
126
What are classic features seen in someone with Charcot-Marie-Tooth disease?
(Most common hereditary cause of peripheral neuropathy) History of frequently sprained ankles High foot arches Distal muscle wasting - inverted champagne bottle legs Hammer toes Peripheral sensory loss
127
How does a lower motor neurone facial nerve palsy present?
Affects whole face
128
How does an upper motor neurone facial nerve palsy present?
Forehead sparing
129
What are you worried of when you see facial nerve palsy with forehead sparing?
Stroke
130
What is Bell’s palsy?
An acute unilateral facial nerve paralysis caused by an UMN lesion of the facial nerve
131
Is Bell’s palsy LMN or UMN?
Almost always LMN - NO forehead sparing
132
How is Bell’s palsy managed?
``` Oral prednisolone (if presents within 72 hours of onset) If no improvement within 3 weeks - ENT referral ```
133
A lesion in which nerve commonly presents with foot drop?
Common peroneal nerve
134
What is neurofibramatosis?
A genetic condition that causes nerve tumours to develop throughout the nervous system
135
What is the inheritance pattern of neurofibramatosis?
Autosomal dominant
136
How does neurofibramatosis type 1 present?
Cafe-au-lait spots Lisch nodules (pigments around the iris) Phaeochromocytoma Axillary/groin freckles
137
How does neurofibramatosis type 2 present?
Bilateral acoustic neuromas(vestibular schwannomas) | Leading to hearing loss, tinnitus and balance problems
138
What is tuberous sclerosis?
An autosomal dominant condition causing hamartomas (benign neoplastic growth of tissue)
139
What are skin features seen in tuberous sclerosis?
Depigmeted ash leaf spots Shagreen patches (roughed patches of skin over the lumbar spine) Adenoma sebaceum (butterfly distribution over the nose) Subungal fibromata
140
What neurological features are seen in tuberous sclerosis?
Developmental delay Epilepsy Intellectual impairment
141
How does a brain abscess present?
Headache Fever Focal neurology eg nerve palsy Papilloedema Nausea
142
How is a brain abscess managed?
Craniotomy + debridement of cavity IV Ceftriaxone + metronidazole
143
What is normal pressure hydrocephalus?
A reversible cause of dementia due to decrease CSF absorption Causes dementia + urinary incontinence
144
How does normal pressure hydrocephalus present?
Urinary incontinence Dementia Gait abnormality
145
How is normal pressure hydrocephalus managed?
Ventriculoperitoneal shunt
146
What is multiple system atrophy?
Parkinson’s plus syndrome Parkinson’s + autonomic dysfunction e.g. postural hypotension, constipation
147
What is important to consider in patients taking Levodopa?
Don’t stop suddenly - if can’t take suddenly then prescribe as patch If they stop suddenly can cause neuroleptic malignant syndrome
148
How is postural hypotension treated?
Midodrine
149
Which drugs can cause drug-inducted Parkinson’s?
Anti-psychotics (especially typical anti-psychotics) Metoclopramide Drug induced Parkinson’s is usually bilateral
150
Which lobe is Wernicke’s associated with?
Temporal lobe
151
Which lobe is Broca’s associated with?
Frontal lobe
152
How do you treat a post lumbar puncture headache?
Caffeine and fluids
153
How does a third nerve palsy present?
Down and out position of the eye Ptosis Pupil may be dilated
154
What are causes of a third nerve palsy?
Herniation Aneurysm Weber’s syndrome (stroke of the posterior cerebral artery branches) - which causes ipsilateral third nerve palsy and contralateral hemiplegia
155
Can cranial bleeding cause contralateral or ipsilateral third nerve palsy?
Ipsilateral
156
How does a fourth nerve palsy present (trochlear nerve)?
Defective downward gaze Vertical Diplopia
157
How does a fifth nerve palsy present? (Trigeminal nerve)
Trigeminal neuralgia Loss of corneal reflex Loss of facial sensation Paralysis of the mastication muscles deviation of jaw muscles to weak side
158
How does a sixth nerve palsy present? (Abducens nerve)
Defective abduction in the affected eye Horizontal diplopia
159
How does a stroke in the anterior cerebral artery present?
Contralateral hemiparesis and sensory loss Affects legs more than arms
160
How does a stroke in the middle cerebral artery present?
Contralateral hemiparesis and sensory loss Affects arms more than legs Contralateral homonymous hemianopia Aphasia
161
How does a stroke in the posterior cerebral artery present?
Contralateral homonymous hemianopia with macular spearing Visual agnosia (unable to visually recognise objects) No sensory loss/hemiparesis
162
What is Weber’s syndrome and how does it present?
Stroke of the branches of the posterior cerebral artery that supply the midbrain Ipsilateral third nerve palsy Contralateral arm and leg weakness
163
What is Wallenberg’s syndrome and how does it present?
Posterior inferior cerebellary artery stroke AKA Lateral medullary syndrome Ipsilateral facial pain and temperature loss Contralateral limb/torso pain, and temperature loss Ataxia Nystagmus
164
How does anterior inferior cerebellar artery stroke present?
Ipsilateral facial pain and temperature loss Contralateral limb/torso pain and temperature loss (Same as posterior) except also Ipsilateral facial paralysis and deafness
165
How does a stroke of the ophthalmic artery present?
Amaurosis fugax
166
How does a stroke in the basilar artery present?
Locked in syndrome (complete paralysis except for eyes)
167
What is autonomic dysreflexia?
Occurs in patients who have had a spinal cord injury at or above T6 Hyperstimulation of the nervous system Often triggered by faecal impaction/urinary retention Causes extreme HTN, flushing and sweating, dilated pupils, headache, lightheadedness Can cause haemorrhagic stroke
168
What is Creutzfeldt-Jakob disease?
Rapidly progressive neurological condition due to prion proteins
169
How does Creutzfeldt-Jakob disease present?
Rapid onset dementia Myoclonus
170
What is spyringomyelia?
Collection of cerebrospinal fluid within the spinal cord
171
How does spyringomyelia present?
Loss of pain and temperature sensation to the neck and arms (cape distribution)
172
How is spyringomyelia investigated?
Full spine MRI with contrast
173
Neuro presentation: patient with loss of pain and temperature sensation to neck and arms?
Spyringomyelia Full spine MRI with contrast
174
How does degenerative cervical myopathy present and how is it diagnosed?
Pain Loss of motor function (digital dexterity, holding a fork, doing up buttons) Numbness Urinary/faecal incontinence Hoffmann’s sign Diagnosed with MRI cervical spine
175
What inheritance pattern does Freidrich’s Ataxia have?
Autosomal recessive
176
How does Freidrich’s Ataxia present?
Gait ataxia Kyphoscoliosis Optic atrophy Hypertrophic obstructive cardiomyopathy Pes cavus (high arch)
177
What inheritance pattern does Ataxia telangiectasia have?
Autosomal recessive
178
What are features of ataxia telangiectasia?
Cerebellar ataxia Telangiectasia IgA deficiency (recurrent infections)
179
What is idiopathic intracranial hypertension?
Idiopathic raised intracranial pressure classically seen in young obese females
180
How does idiopathic intracranial HTN present?
Headache - worse on waking, worse when coughing/mvoing head Blurred vision Papilloedema (Presents like raised ICP) Hears a ‘whoosh’ 6th nerve palsy (inability to abduct affected eye)
181
What drugs can cause idiopathic intracranial HTN?
Tetracyclines Steroids COCP Lithium Vitamin A (isotretinoin)
182
How is idiopathic intracranial HTN managed?
Weight loss Acetazolamide (reduces pressure - also used in open angle glaucoma)
183
How does someone with myotonic dystrophy present?
Myotonic face (long, haggard appearance) Progressive weakness and muscle wasting DM1 - distal weakness most prominent DM2 - proximal weakness most prominent Frontal balding Bilateral ptosis Cataracts Dysarthria Myotonia
184
What are the two dystrophinopathies and what is their inheritance pattern?
Duchenne muscular dystrophy and Becker muscular dystrophy Both X-linked recessive
185
How do you differentiate between Duchenne and Becker muscular dystrophy?
Duchenne develops at around 5 years and causes intellectual impairment and calf pseudo hypertrophy Becker muscular dystrophy develops after 10 years and intellectual impairment is less common
186
What is narcolepsy?
A rare condition where the brain loses its ability to regulate the sleep wake cycle Type 1 is associated with cataplexy (sudden loss of muscle tone often triggered by emotion)
187
What is a pituitary apoplexy?
The sudden enlargement of a pituitary tumour (usually a non-functioning adenoma e.g. prolactinoma) This enlargement is secondary to haemorrhage or infarction
188
How does a pituitary apoplexy present?
Sudden onset severe headache (similar to SAH) Vomiting Neck stiffness Bitemporal superior quadrantinopia Severe, acute hypopituitarism - Features of pituitary insufficiency - hyponatraemia, hypotension (secondary to adrenal insufficiency)
189
How is a pituitary apoplexy treated?
Urgent steroid replacement - IV hydrocortisone Careful fluid balance with IV fluids Surgical resection
190
How is restless legs syndrome managed?
Ropinirole
191
What is thoracic outlet syndrome?
Compression of the brachial plexus/subclavian artery/subclavian vein at the site of the thoracic outlet - can be neurogenic or vascular
192
How does neurogenic thoracic outlet syndrome present?
Painless muscle wasting of hand muscle Hand weakness Numbness and tingling of hand
193
How does vascular thoracic outlet syndrome present?
Vein -> painful diffuse arm swelling Artery -> painful arm claudication
194
What is Wernicke’s encephalopathy and how does it present?
Disorder caused by a thiamine deficiency (most commonly seen in alcoholics) Ophthalmoplegia/nystagmus Ataxia Confusion
195
How is chemotherapy related nausea managed?
Ondansetron
196
How is nausea in Parkinson’s managed?
Domperidone
197
What electrolyte abnormality is commonly associated with subarachnoid haemorrhage?
Hyponatraemia Due to SIADH
198
Which cancer is Lambert Eaton Syndrome associated with?
Small cell lung cancer
199
What is autoimmune encephalitis and how does it present?
A form of non-infectious brain inflammation Confusion Seizures Behavioural changes Emotional lability (can switch from laughing to crying easily) Psychosis
200
What is seen on lumbar puncture in autoimmune encephalitis?
Raised lymphocytes in the CSF
201
How is autoimmune encephalitis treated?
First line = IV methylprednisolone + IV immunoglobulins If no response within two weeks – rituximab/Cyclophosphamide 
202
What type of inheritance pattern does myotonic dystrophy have?
Autosomal dominant
203
What type of pituitary tumour is most likely to have a pituitary apoplexy?
Prolactinoma
204
What is nystagmus?
Involuntary rhythmic side-to-side, up and down or circular motion of the eyes Can be horizontal, vertical or rotary
205
Which cancer is Lambert Eaton associated with?
Small cell lung cancer
206
What can be given for spasticity in multiple sclerosis?
Baclofen or Gabapentin
207
How do you manage bladder dysfunction in MS?
First do a bladder ultrasound to assess bladder emptying If poor emptying - intermittent catheterisation If emptying is fine - try an anticholinergic
208
x
x
209
How to medically manage someone with AF who has had a stroke?
Stop their anticoagulants Give Aspirin 300mg for 2 weeks then re-start their anticoagulants
210
Which cranial nerve supplies sensory innervation to the eye?
CN V1 (Opthalmic nerve)
211
What is Hoover’s sign?
Manoevure to distinguish between organic and non-organic paresis of leg
212
What is paroxysmal hemicrania? How is it managed?
Attacks of severe unilateral headache Often associated with autonomic features – Nasal congestion, tearing Management – Indomethacin
213
What blood marker can be used to differentiate a true seizure from a pseudoseizure?
Prolactin – will be rasied in true seizures
214
How to differentiate postural hypotension related to Parkinson’s and postural hypotension related to multi-system atrophy?
In multi system atrophy they occur earlier in the disease
215
What feature on an EEG is defining for an absence seizure?
3Hz spike and wave pattern
216
What is spontaneous intracranial hypotension?
Rare cause of headaches due to CSF leak Headache worse when stood upright RF = Marfan's
217
When should trigeminal neuralgia be referred for urgent specialist assessment?
<40 years Deafness/hearing loss Optic neuritis Family history of MS
218
At what GCS should a patient be intubated?
Less than 8
219
LMN and UMN lesions - contralateral or ipsilateral?
UMN = contralateral LMN = ipsilateral
220
Is Bell's palsy contralateral or ipsilateral?
Ipsilateral
221
Is a UMN or LMN facial palsy more worrying?
UMN more worrying (forehead sparing)
222
Does MS need CT with contrast or without contrast?
With contrast (contrast needed to visualise demyelinated lesions)
223
How can you differentiate between subdural and extradural haematoma by presenting features?
Extradural – BRIEF lucid period and then sudden onset deterioration Subdural – can present several weeks after injury
224
How is cerebral oedema in patients with brain tumours treated?
Dexamethasone
225
What needs to be urgently ruled out in status epilepticus?
Hypoxia and hypoglycemia (check sats and do a capillary blood glucose)
226
Is meningitis or encephalitis more likely to cause seizures?
Encephalitis
227
What antibodies are associated with Lambert Eaton syndrome?
Voltage-gated calcium-channel antibodies
228
What’s the difference between an UMN lesion and LMN lesion? (Pathophysiology)
UMN lesion = lesion above the anterior horn of the spinal cord or motor nuclei or cranial nerves LMMN lesion = lesion which affects nerve fibres travelling from anterior horn of spinal cord to muscles
229
What are causes of papilloedema?
Space occupying lesion – neoplastic or vascular Malignant HTN IIH Hydrocephalus Hypercapnia (build up of CO2 – this is because it triggers vasodilation and cerebral blood volume)
230
How does cerebellar syndrome present?
DANISH ``` Dysdiadokinesia Ataxia Nystagmus (Horizontal) Intentio tremor Slurred speech Hypotonia ```
231
What are causes of cerebellar syndrome?
``` Freidrich’s ataxia Ataxic telangiectasia Stroke Alcohol MS Paraneoplastic – secondary to lung cancer ```
232
How does Brown-Sequard syndrome present?
Ipsilateral weakness below lesion Ipsilateral loss of proprioception and vibration sensation Contralateral loss of pain and temperature sensation

Medicine Finals (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions