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Neurology Flashcards

1
Q

What type of drugs are 5-HT3 antagonists?

A

Antiemetics

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2
Q

Where do 5-HT3 antagonists work?

A

Chemoreceptor trigger zone of the medulla oblongata

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3
Q

Examples of 5-HT3 antagonists

A

Ondanestron

Graniestron

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4
Q

What type of drug is ondansetron?

A

5-HT3 antagonist

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5
Q

What type of drug is graniestron?

A

5-HT3 antagonist

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6
Q

Side effects of 5-HT3 antagonists

A

Constipation

Prolonged QT interval

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7
Q

Drugs causing peripheral neuropathy

A 
Amiodarone
Isoniazid
Vincristine
Nitrofurantoin
Metronidazole
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8
Q

What does the fourth cranial nerve supply?

What are its actions?

A

Superior oblique

Depresses eye, moves eye inwards

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9
Q

Features of fourth nerve palsy

A

Vertical diplopia
Subjective tilting of objects
Head tilt
Affected eye deviates upwards and is rotated out

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10
Q

Lamotrigine - indications

A

second line treatment for generalised and partial seizures

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11
Q

Lamotrigine - mechanism of action

A

Sodium channel blocker

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12
Q

Lamotrigine - side effects

A

Stevens-Johnson syndrome

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13
Q

Treatment for leg cramps

A

1) stretching calves

2) trial of quinine

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14
Q

Features of multiple system atrophy

A

Parkinsonism

Autonomic disturbance causing erectile dysfunction, postural hypotension, atonic bladder

Cerebellar signs

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15
Q

Causes of neonatal seizures

A 
Vitamin B6 deficiency
Hypoglycaemia
Meningitis
Head trauma
Opiate withdrawal
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16
Q

Who is affected by neuroleptic malignant syndrome?

A

Antipsychotics - first few days

Parkinson medication - when reducing dose or suddenly stopped

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17
Q

Neuroleptic malignant syndrome - features

A

Pyrexia
Muscle rigidity
Autonomic lability = HTN, tachycardia, tachypnoea
Agitated delirium with confusion

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18
Q

Neuroleptic malignant syndrome - investigations

A

Raised CK
AKI secondary to rhabdomyolysis
Leukocytosis

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19
Q

Neuroleptic malignant syndrome - management

A

Stop antipsychotics
IV fluids
Dantrolene
Bromocriptine

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20
Q

What is neuroleptic malignant syndrome?

A

Rare but life threatening adverse effect to antipsychotics

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21
Q

Generalised tonic clonic seizures - 1st line

A

Sodium valproate

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22
Q

Generalised tonic clonic seizures - 2nd line

A

Lamotrigine or carbamazepine

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23
Q

Absence seizures - 1st line

A

Sodium valproate or ethosuximide

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24
Q

Myoclonic seizures - 1st line

A

Sodium valproate

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25
Q

Myoclonic seizures - 2nd line

A

Clonazepam or lamotrigine

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26
Q

Focal seizures - 1st line

A

Carbamazepine or lamotrigine

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27
Q

Focal seizures - 2nd line

A

Levetiracetam, oxcarbazepine or sodium valproate

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28
Q

Sodium valproate in pregnancy

A

Causes neurodevelopmental delay in children

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29
Q

In what circumstances would you start antiepileptics after one seizure?

A

Neurological deficit
Structural abnormality
EEG: unequivocal
Patient or family consider risk of another seizure unacceptable

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30
Q

What is Lennox-Gestaut Syndrome?

A

Childhood epilepsy syndrome

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31
Q

Lennox-Gestaut Syndrome - features

A

Atypical abscences, falls, jerks

Moderate to severe mental handicap

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32
Q

Lennox-Gestaut Syndrome - EEG

A

slow spike

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33
Q

Lennox-Gestaut Syndrome - onset

A

1-5 years

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34
Q

What is Infantile Spasms?

A

Childhood epilepsy syndrome

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35
Q

Infantile spasm - other name

A

West’s syndrome

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36
Q

Infantile spasms - features

A

Flexion of head, trunk, limbs then extension of arms - Salaam attack
Lasts 1-2 secs, repeated up to 50 times
Progressive mental handicap

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37
Q

Infantile spasms - EEG

A

Hypsarrhythmia

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38
Q

Infantile spasms - management

A

Vigabatrin, steroids

Poor prognosis

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39
Q

Infantile spasms - onset

A

4-6 months

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40
Q

Benign rolandic epilepsy - features

A

Paraesthesia (e.g. unilateral face), usually on waking

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41
Q

Juvenile myoclonic epilepsy syndrome - other name

A

Janz syndrome

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42
Q

Juvenile myoclonic epilepsy syndrome - onset

A

Teens

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43
Q

Juvenile myoclonic epilepsy syndrome - features

A

Infrequent generalised seizures, often in the morning/following sleep deprivation
Daytime absences
Sudden, shock-like myotonic seizure

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44
Q

Juvenile myoclonic epilepsy syndrome - management

A

sodium valproate

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45
Q

Neurofibromatosis - inheritence

A

Autosomal dominant

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46
Q

Neurofibromatosis type 1 - features

A

cafe au lait spots >6
Axillary/groin freckles

Irish hamatomas (Lisch nodules)

Pheochromocytomas

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47
Q

Neurofibromatosis type 2 - features

A

Bilateral vesticular schwannomas

Multiple intracranial schwannomas, meningiomas, ependymomas

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48
Q

Myotonic dystrophy - inheritence

A

Autosomal dominant

Trinucleotide repeat disorder

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49
Q

What is myotonic dystrophy?

A

Inherited myopathy

Affects skeletal, cardiac, and smooth muscle

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50
Q

Myotonic dystrophy type 1 - features

A

Distal weakness prominent

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51
Q

Myotonic dystrophy type 2 - features

A

Proximal weakness prominent

Severe congenital form not seen

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52
Q

Myotonic dystrophy - investigations

A

Genetic testing

CK may be raised

MRI - cerebellar degeneration

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53
Q

Myotonic dystrophy - features

A 
Myotonic faces - long, haggared
Frontal balding
Bilateral ptosis
Cataracts
Weakness
Diabetes
Testicular atrophy
Dysphagia
Heart block, cardiomyopathy
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54
Q

What is myasthenia gravis?

A

Autoimmune disorder resulting in insufficient functioning acetylcholine receptors

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55
Q

What is the main antibody found in myasthenia gravis?

A

Antibodies to acetylcholine receptors

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56
Q

Myasthenia gravis - associations

A

Thymomas
Autoimmune disorders
Thymic hyperplasia

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57
Q

Myasthenia gravis - features

A 
Muscle fatigability
Extraocular muscles = diplopia
Proximal muscle weakness = face, neck, limb girdle
Ptosis
Dysphagia
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58
Q

Myasthenia gravis - investigations

A

Single fibre EMG

CT thorax to exclude thyoma

CK normal

Antibodies to acetylcholine receptors

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59
Q

Myasthenia gravis - first line management

A

Pyridostigmine - long acting anticholinesterase inhibitor

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60
Q

Myasthenia gravis - second/third line management

A

Immunosuppression - steroids, azathioprine

Thymectomy

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61
Q

Myasthenia gravis - crisis management

A

Plasmaphoresis

IV Ig

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62
Q

Myasthenia gravis - exacerbating drugs

A

Penicillamine

Beta blockers

Lithium

Phenytoin

Gentamicin

Tetracyclines

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63
Q

What is multiple sclerosis?

A

Chronic cell mediated autoimmune disorder characterised by demyelination in the CNS

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64
Q

Multiple sclerosis - types

A

Relapsing remitting
Primary progressive
Secondary progressive

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65
Q

Multiple sclerosis - relapsing remitting

A

Acute attacks followed by periods of remission

85% cases

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66
Q

Multiple sclerosis - primary progressive

A

10% cases
Progressive deterioration from onset
More common in elderly

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67
Q

Multiple sclerosis - secondary progressive

A

Relapsing remitting patients who have deteriorated and have signs/symptoms between relapses
Primary gait and bladder disorders
65% patients with relapsing remitting

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68
Q

Multiple sclerosis - features

A

Lethargy

Optic neuritis

Paraesthesia, numbness, Lhermittes syndrome

Spastic weakness

Ataxia

Urinary incontinence, Sexual dysfunction

Intellectual deterioration

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69
Q

What is Lhermittes syndrome?

A

sudden brief shock that moves down the neck caused by bending the neck forward
associated with MS

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70
Q

Multiple sclerosis - acute relapse management

A

high dose steroids

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71
Q

Multiple sclerosis - chronic management

Treatment for fatigue?

Treatment for spasticity?

Treatment for bladder dysfunction?

A

Beta interferon reduces relapse rate by 30%

Fatigue - amantadine

Spasticity - baclofen, gabapentin

Bladder dysfunction - self catheterisation or anticholingerics

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72
Q

Multiple sclerosis - good prognostic factors

A 
Female
Young age of onset
Relapsing-remitting type
Sensory symptoms only
Long interval between first two relapses
Complete recovery between relapses
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73
Q

What is motor neuron disease?

A

Neurological condition presenting with upper and lower motor neuron signs

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74
Q

Motor neuron disease - features

A

Fasiculations

Mixture of LMN and UMN signs

Wasting of the small hand muscles

No sensory symptoms/signs

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75
Q

Motor neuron disease - Investigations

A

Clinical diagnosis

Nerve conduction studies - normal, exclude neuropathy

EMG - reduced action potentials with increased amplitude

MRI - to exclude cervical cord compression and myelopathy

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76
Q

Motor neuron disease - Management

A

Riluzole - prolongs life by 3 months

Respiratory care - BIPAP at night

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77
Q

Migraine - features

A 
Severe, unilateral, throbbing headache
Nausea
Photophobia, phonophobia
Lasts up to 72 hours
Aura in 1/3rd
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78
Q

Migraine in children

A

Shorter
Bilateral
GI disturbance

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79
Q

Migraine - acute management first line

A

Oral triptans + NSAID/paracetamol

Nasal triptan if age 12-17

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80
Q

Migraine - acute management second line

A

Non-oral metoclopramide

Non-oral NSAIDs/triptans

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81
Q

Migraine - prophylaxis

A

Topiramate or propranolol

Acupuncture

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82
Q

Migraine management if menstrual symptoms

A

Frovatriptan or zolmitriptan

Mefanamic acid

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83
Q

Migrane management in pregnancy

A

Paracetamol

NSAIDs in 2rd or 3rd month

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84
Q

Topiramate in women of child bearing age

A

Teratogenic and reduces effectiveness of oral contraception

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85
Q

Medication overuse headache - features

A

15+ days per month

Develops/worsens whilst taking regular symptomatic medications

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86
Q

Medication overuse headache - which medication is highest risk?

A

Opioids and triptans

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87
Q

Idiopathic intracranial hypertension - features

A 
Headache 
Blurred vision
Papilloedema
Enlarged blind spot
6th nerve palsy
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88
Q

Idiopathic intracranial hypertension - management

A

Weight loss
Diuretics - acetazolamide
Topiramate
Repeated LP

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89
Q

Idiopathic intracranial hypertension - risk factors

A 
Obesity
Female
Pregnancy
Combined oral contraceptive
Steroids
Tetracyclines
Vitamin A
Lithium
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90
Q

Huntington’s disease - inheritence

A

Autosomal dominant

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91
Q

Huntington’s disease - genetics

A

Trinucleotide repeat disorder
Genetic anticipation
Defect in huntington gene on chromosome 4

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92
Q

Huntington’s disease - features

A 
Chorea
Personality change - apathy, irritable, depression
Intellectual impairment
Dystonia
Saccadic eye movements
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93
Q

Huntington’s disease - investigations

A

Genetic testing

MRI/CT

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94
Q

What is Guillain-Barre syndrome?

A

Immune mediated demyelination of the peripheral nervous system, often triggered by infection

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95
Q

Guillain-Barre Syndrome - classical trigger

A

Campylobacter jejuni

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96
Q

Guillain-Barre Syndrome - features

A

Early leg/back pain
Progressive, symmetrical weakness of all the limbs - ascending
Absent reflexes
Respiratory muscle weakness

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97
Q

Guillain-Barre Syndrome - Investigations

A

LP - rise in protein, normal WCC

Nerve conduction studies - reduced motor nerve conduction due to demyelination

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98
Q

Guillain-Barre Syndrome - management

A

IV immunoglobulin

Plasma exchange

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99
Q

Miller Fisher Syndrome - features

A

Descending paralaysis
Opthalmoplegia, areflexia, ataxia
Eye muscles affected first

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100
Q

What is Friedreich’s ataxia?

A

Early onset hereditary ataxia

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101
Q

Friedreich’s ataxia - inheritance

A

Autosomal recessive

Trinucleotide repeat disorder - NO genetic anticipation

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102
Q

Friedreich’s ataxia - onset

A

10-15 years

Presents with gait ataxia and kyphoscoliosis

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103
Q

Friedreich’s ataxia - features

A

Absent ankle jerk/ extensor plantars
Cerebellar ataxia
Optic atrophy

HOCM
Diabetes
High arched palate

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104
Q

Friedreich’s ataxia - prognosis

A

Wheelchair bound by 15 years after diagnosis

Life expectancy 40-50

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105
Q

Duchenne muscular dystrophy - inheritance

A

X linked recessive
Mutation in gene encoding dystrophin
Frame shift mutation = severe form

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106
Q

Becker muscular dystrophy - inheritance

A

X linked recessive
Mutation in gene encoding dystrophin
Non-frame shift mutation = less severe

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107
Q

Duchenne muscular dystrophy - features

A

Progressive muscle weakness from 5 years
Calf pseudohypertrophy
Gowers sign
30% have intellectual impairment

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108
Q

Becker muscular dystrophy - features

A

Develops after age 10

Normal intellect

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109
Q

What is degenerative cervical myelopathy?

A

Spinal cord dysfunction from compression in the neck

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110
Q

Degenerative cervical myelopathy - risk factors

A

Smoking
Genetics
Occupation with heavy axial loading

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111
Q

Degenerative cervical myelopathy - features

A

Pain in neck, upper and lower limbs
Loss of motor function - digital dexerity, arm/leg weakness
Loss of sensory function
Loss of autonomic function - incontinence, impotence
Hoffman’s sign

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112
Q

What is Hoffman’s sign?

A

involuntary flexion movement of the thumb and or index finger when the examiner flicks the fingernail of the middle finger down

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113
Q

Degenerative cervical myelopathy - investigations

A

MRI spine

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114
Q

Degenerative cervical myelopathy - management

A

Early referral to spinal services for decompression surgery

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115
Q

Cluster headaches - frequency of symptoms

A

Occur in clusters lasting 4-12 weeks

Generally a cluster every year

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116
Q

Cluster headaches - features

A

Intense sharp stabbing pain around the eye
Patient restless, agitated
Red eye, lacrimating, lid swelling
Nasal stuffiness

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117
Q

Cluster headaches - how long do symptoms last

A

15mins to 2 hours

Occur 1-2x per day

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118
Q

Cluster headaches - risk factors

A

Male
Smokers
Nocturnal sleep
Alcohol may trigger attack

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119
Q

Cluster headaches - acute management

A

100% oxygen

Sub cut triptan

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120
Q

Cluster headaches - prophylaxis

A

Verapamil

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121
Q

What is Charcot-Marie-Tooth?

A

The most common hereditary peripheral neuropathy

Results in predominantly motor loss

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122
Q

Charcot-Marie-Tooth - features

A 
Foot drop
High arched feet
Hammer toes
Distal muscle weakness and atrophy
Hyporeflexia
Stork leg deformity
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123
Q

Carbamazepine - uses

A

Epilepsy - partial seizures
Trigeminal neuralgia
Bipolar disorder

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124
Q

How does carbamazepine work?

A

Binds to sodium channels to increase their refractory period

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125
Q

Carbamazepine - side effects

A

P450 enzyme inducer

Dizzy
Drowsy
Diplopia

Headaches

Steven Johnson Syndrome

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126
Q

What is Bell’s palsy?

A

Acute, unilateral, idiopathic facial nerve paralysis

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127
Q

Bell’s palsy - features

A

LMN facial nerve palsy - forehead affected

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128
Q

How to differentiate between stroke and Bell’s palsy

A

Bell’s palsy - forehead affected

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129
Q

Bell’s palsy - management

A

Prednisolone within 72 hours
Antivirals in severe cases
Eyecare

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130
Q

Bell’s palsy - prognosis

A

Most make full recovery in 3-4 months

If untreated 15% have severe weakness permanently

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131
Q

Bell’s palsy - follow up

A

If no improvement after 3 weeks refer urgently to ENT

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132
Q

Absence seizures - features

A

Few seconds with quick recovery
Provoked by hyperventilation or stress
Children unaware
May occur multiple times a day

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133
Q

Absence seizures - EEG

A

Bilateral, symmetrical 3Hz spike and wave pattern

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134
Q

Absence seizures - management

A

Sodium valproate or ethosuximide

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135
Q

Wernicke’s aphasia - features

A

Sentences that make no sense but remain fluid “word salad”

Comprehension impaired

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136
Q

Conduction aphasia - features

A

Speech fluent but poor repetition
Aware they are making errors

Normal comprehension

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137
Q

Broca’s aphasia - features

A

Speech is non-fluent, laboured, halting
Repetition impaired

Normal comprehension

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138
Q

Global aphasia - features

A

Severe expressive and receptive aphasia

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139
Q

What location is affected in expressive dysphasia?

A

Broca’s

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140
Q

What location is affected in receptive dysphasia?

A

Wernicke’s

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141
Q

What is ataxia telangiectasia?

A

Inherited combined immunodeficiency disorder

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142
Q

Ataxia telangiectasia - inheritence

A

Autosomal recessive

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143
Q

Ataxia telangiectasia - features

A

Cerebral ataxia

Telangiectasia

Recurrent chest infections due to IgA deficiency

10% risk of malignancy, lymphoma or leukaemia

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144
Q

Onset of ataxia telangiectasia

A

Onset 1-5 years

Abnormal movements

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145
Q

Which antiepileptics should be prescribed by brand?

A

Carbamazepine

Phenytoin

Phenobarbital

Primodine

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146
Q

Drugs causing peripheral neuropathy

A 
Amiodarone
Isoniazid
Vincristine
Nitrofurantoin
Metronidazole
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147
Q

Essential tremor - inheritance

A

Autosomal dominant

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148
Q

Essential tremor - features

A

Postural tremor - worse when arms outstretched

Improved by alcohol and rest

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149
Q

What is the most common cause of head tremor?

A

Essential tremor

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150
Q

Essential tremor -management

A

Propranolol

Primidone

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151
Q

In which conditions is cannabis licensed for use?

A

Chemo induced nausea and vomiting
Chronic pain
Spasticity in MS
Severe treatment resistance epilepsy

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152
Q

Who can prescribe cannabis?

A

Doctors on the specialist register

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153
Q

Lamotrigine - mechanism of action

A

Sodium channel blocker

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154
Q

Lamotrigine - adverse effects

A

Stevens Johnson syndrome

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155
Q

Which medication can be used to treat dementia symptoms in Parkinson’s disease?

A

Rivastigmine

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156
Q

When are antiepileptics stopped?

Over how long a time frame do you stop the drugs?

A

Seizure free >2 years

Drugs stopped over 2-3 months

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157
Q

What is cataplexy?

A

Sudden transient loss of muscular tone caused by strong emotion

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158
Q

Can HRT be given if migraine history?

A

Yes but may worsen migraine

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159
Q

Which vitamin supplement might be helpful in migraine prevention?

A

Vitamin B2

Riboflavin

160
Q

Neuropathic pain - 1st line treatment options (4)

A

Amitriptyline
Duloxetine
Gabapentin
Pregabalin

Used as monotherapy

161
Q

Neuropathic pain - rescue therapy for exacerbations

162
Q

Neuropathic pain - treatment for localised neuropathic pain

A

Topical capsaicin

163
Q

What is allodynia?

A

Nerve pain

164
Q

What type of drugs are linked with impulse control disorders?

A

Dopamine receptor agonists

165
Q

What conditions are associated with Lhermitte’s sign?

A

MS
Subacute combined degeneration of the cord
Cervical stenosis

166
Q

What is Uhthoff Phenomenon?

A

Worsening of symptoms due to increased heat, seen in MS

167
Q

Diazepam in seizure dosage - 1 month to 1 year

168
Q

Diazepam in seizure dosage - 2 years to 11 years

169
Q

Diazepam in seizure dosage - 12 years to 17 years

170
Q

Diazepam in seizure dosage - adult

A

10-20mg

max 30mg

171
Q

Midazolam in seizure dosage - 1 to 2 months

A

300 micrograms per kg

max 2.5mg

172
Q

Midazolam in seizure dosage - 3 to 11 months

173
Q

Midazolam in seizure dosage - 1 to 4 years

174
Q

Midazolam in seizure dosage - 5 to 9 years

175
Q

Midazolam in seizure dosage - 10 to 17 years

176
Q

Midazolam in seizure dosage - adult

177
Q

What causes Hoffman’s sign?

A

Upper motor neuron dysfunction

178
Q

What causes a positive Hoffman’s sign?

A

Degenerative cervical myopathy
MS
Hyperthyroidism

179
Q

Cannabis licensed for chemotherapy induced nausea

180
Q

Cannabis licensed for spasticity in MS

181
Q

What is paroxysmal hemicrania?

A

Attacks of severe, unilateral headache in the orbital, supraorbital or temporal region

182
Q

Paroxysmal hemicrania - features

A

Severe unilateral headache
Autonomic features
Last less than 30 minutes
Occur multiple times per day

183
Q

Paroxysmal hemicrania - management

A

Indomethacin

184
Q

Risk factors for MS

A

Smoking
Previous infectious mononucleosis
Genetics
Low vit D

185
Q

Third nerve palsy - features

A

Eye is ‘down and out’
Ptosis
Dilated pupil

186
Q

Third nerve palsy - causes

A 
Diabetes
Vasculitis 
Posterior communicating artery
Cavernous sinus syndrome
MS
187
Q

Side effects of triptans

A

Tingling, heat, tightness in throat/chest

188
Q

Where is the lesion in a right homonymous hemianopia?

A

right optic tract

189
Q

Where is the lesion in a bitemporal homonymous hemianopia?

A

Optic chiasm

190
Q

If the patient has a right sided hemiplegia, what side would their homonymous hemianopia be?

191
Q

Features of common peroneal nerve injury

A

Foot drop

Weakness of dorsiflexion and foot eversion

Sensory loss over dorsum of the foot and lower lateral part of the leg

Wasting of anterior tibial and peroneal muscles

192
Q

Autonomic dysreflexia - features

A

Extreme hypertension

Flushing

Sweating above the level of cord lesion

Agitation

193
Q

Autonomic dysreflexia - management

A

Removal/control of stimulus

Treatment of life threatening hypertension and/or bradycardia

194
Q

Ankle reflex

195
Q

Knee reflex

196
Q

Biceps reflex

197
Q

Triceps reflex

198
Q

Visual side effects of Topiramate

A

Secondary angle closure glaucoma

Acute myopia

199
Q

What should absent corneal reflex make you think about?

A

Acoustic neuroma

200
Q

Which area of the brain is affected in an inferior homonymous quadrantopia?

201
Q

Which area of the brain is affected in a superior homonymous quadrantopia?

202
Q

Where is the lesion in a bitemporal hemianopia?

A

Lesion of the optic tract

203
Q

What is the cause of bitemporal hemianopia - upper quadrant defect

A

Pituitary tumour

204
Q

What is the cause of bitemporal hemianopia - upper quadrant defect

A

Craniopharyngioma

205
Q

Where is the lesion in homonymous hemianopia with macula sparing?

A

Occipital cortex

206
Q

Where is the lesion in a bilateral homonymous hemianopia?

A

Optic radiation or occipital cortex

207
Q

Where is the lesion in a unilateral homonymous hemianopia?

A

Optic tract

208
Q

If the patient has a right sided hemiplegia, what side would their homonymous hemianopia be?

209
Q

Features of common peroneal nerve injury

A

Foot drop
Weakness of dorsiflexion and foot eversion
Sensory loss over dorsum of the foot and lower lateral part of the leg
Wasting of anterior tibial and peroneal muscles

210
Q

Examples of dopamine receptor agonists

A

Bromocriptine
Ropinirole
Cabergoline
Apomorphine

211
Q

What type of drug is bromocriptine?

A

Dopamine receptor agonist

Used in Parkinson’s

212
Q

What type of drug is ropinirole?

A

Dopamine receptor agonist

Used in Parkinson’s

213
Q

1st line treatment in Parkinson’s if there are no motor symptoms affecting the patient’s life

A

Dopamine agonists

Levodopa

MAO-B

214
Q

What type of drug is Apomorphine?

A

Dopamine receptor agonist

Used in Parkinson’s

215
Q

Side effects of Dopamine receptor agonists

A

Impulse control disorders

Risk of neuroleptic malignant syndrome

Excessive daytime somnolence

Hallucinations

Pulmonary, retroperitoneal and cardiac fibrosis

216
Q

What type of drug is selegiline?

A

Monoamine Oxidase B inhibitor

Used in Parkinson’s

217
Q

Parkinson’s disease - investigations

A

Clinical diagnosis

SPECT scan

218
Q

Examples of COMT inhibitiors

A

Entacapone

Tolcapone

219
Q

Drug induced Parkinson’s - causes

A

Dopamine agonists (used in schizophrenia)

Methydopa

Metoclopramide

Prochlorperazine

220
Q

What type of drug is Tolcapone?

A

COMT inhibitor

Used in Parkinson’s

221
Q

Findings in radial nerve damage

A

Wrist drop

Sensory loss to small area between the dorsal aspect of the 1st and 2nd metacarpal

Paralysis of triceps

222
Q

What are antimuscarinic drugs used for?

A

Drug-induced parkinsonism

223
Q

What type of drug is procyclidine?

A

Antimuscarinic

Used in drug induced Parkinson’s

224
Q

Effect of sodium valproate on P450

A

P450 inhibitor

225
Q

What is levodopa prescribed with?

A

Decarboxylase inhibitor to prevent peripheral metabolism

226
Q

Chronic subdural haemorrhage - who is typically affected

A

Elderly

Alcoholics

227
Q

What type of drug is carbidopa?

A

Decarboxylase inhibitor

Prescribed with levodopa to prevent peripheral metabolism

228
Q

Side effects of levodopa

A

Dyskinesia

Postural hypotension

‘On off’ effect

Acute dystonia if stopped

Hallucinations

229
Q

Where is the lesion in monocular blindness?

A

optic nerve

230
Q

1st line treatment in Parkinson’s if motor symptoms are affecting the patient’s life

231
Q

1st line treatmnet in Parkinson’s if there are no motor symptoms affecting the patient’s life

A

Dopamine agonists
Levodopa
MAO-B

232
Q

Parkinson’s disease - pathophysiology

A

Degeneration of dopaminergic neurons in the substania nigra

233
Q

Parkinson’s disease - key features

A

Bradykinesia
Tremor
Rigidity

234
Q

Where is the lesion in right homonymous hemianopia with macular sparing?

A

Occipital lobe cortex

235
Q

Parkinson’s disease - investigations

A

Clinical diagnosis

SPECT scan

236
Q

Drug induced Parkinson’s - features

A

Rapid onset motor symptoms that are bilateral

Rigidity and rest tremor uncommon

237
Q

Drug induced Parkinson’s - causes

A

Dopamine agonists (used in schizophrenia)

Methydopa

Metoclopramide

Prochlorperazine

238
Q

Causes of Parkinsonism

A 
Parkinson's disease
Drug induced
Progressive supranuclear palsy
Multiple system atrophy
Wilson's disease
Post-encephalitis
Dementia pugilistica (secondary to chronic head trauma)
Toxins - eg CO
239
Q

Radial nerve - patterns of damage

A

Wrist drop
Sensory loss to small area between the dorsal aspect of the 1st and 2nd metacarpal
Paralysis of triceps

240
Q

Sodium valproate mechanism of action

A

Increases GABA activity

241
Q

Sodium valproate adverse effects

A 
Teratogenic 
P450 inhibitor
Nausea
Weight gain
Allopecia
Ataxia, tremor
Hyponatraemia
242
Q

Effect of sodium valproate on P450

A

P450 inhibitor

243
Q

Chronic subdural haemorrhage - presentation

A

Weeks to months of progressive confusion, reduced consciousness, neurological deficit

244
Q

Chronic subdural haemorrhage - who is typically affected

A

Elderly

Alcoholics

245
Q

Damage to ulnar nerve - sensory loss

A

Medial 1 1/2 fingers (palmar and dorsal aspect)

246
Q

Findings in damage to ulnar nerve

A

Claw hand

Wasting and paralysis of intrinsic hand muscles and hypothenar muscles

Sensory loss to medial 1 1/2 fingers

247
Q

Where is the lesion in bitemporal hemianopia?

A

Optic chiasm

248
Q

Where is the lesion in right homonymous hemianopia?

A

Right optic tract

249
Q

Where is the lesion in right superior homonymous hemianopia?

A

Right sided optic radiations - upper fibres

250
Q

Where is the lesion in a right inferior homonymous hemianopia?

A

Right sided optic radiations - lower fibres

251
Q

Where is the lesion in right homonymous hemianopia with macular sparing?

A

Occipital lobe cortex

252
Q

Causes of monocular blindness

A

Optic neuritis
Optic atrophy
Central retinal vein occlusion

253
Q

Causes of bitemporal hemianopia

A

Pituitary adenoma

Craniopharyngioma

254
Q

Causes of right homonymous hemianopia

A

Middle cerebral artery occlusion - left

Tumours

255
Q

Causes of right superior homonymous hemianopia

A

Middle cerebral artery occlusion - left

Tumour in the temporal lobe

256
Q

Causes of right inferior homonymous hemianopia

A

Posterior cerebral artery occlusion - left

Tumour in the parietal lobe

257
Q

Causes of right homonymous hemianopia with macular sparing

A

Posterior communicating artery occlusion - right

Trauma

258
Q

Tuberous sclerosis - features

A

Ash leaf spots
Cafe-au-lait
Shagreen patches - rough patches over lumbar spine

Developmental delay, epilepsy

Retinal hamartomas
Rhabdomyomas of the heart

259
Q

Wernicke’s encephalophy - investigations

A

Decreased red cell transketolase

MRI

260
Q

Wernicke’s encephalophy - management

A

Urgent replacement of thiamine

261
Q

Wernicke’s encephalophy - causes

A

Mainly alcoholics
Persistent vomiting
Stomach cancer
Dietary deficiency

262
Q

What is Wernicke’s encephalophy?

A

Neuropsychiatric disorder caused by thiamine deficiency

263
Q

What is Korsakoff’s syndrome?

A

Wernicke’s encephalophy progresses to Korsakoff’s syndrome if untreated

264
Q

Korsakoff’s syndrome - features

A

Amnesia - both antero and retrograde

Confabulation

265
Q

What is Von Hippel-Lindau syndrome?

A

Autosomal dominant condition predisposing to neoplasia

266
Q

Von Hippel-Lindau syndrome - inheritance

A

Autosomal dominant

267
Q

Von Hippel-Lindau syndrome - features

A

Cerebellar haemangiomas (may cause SAH)

Retinal haemangiomas

Renal cysts

Phaechromocytomas

Clear cell renal carcinoma

268
Q

Vestibular schwannoma - associations

A

Bilateral vestibular schwannoma is seen in neurofibromatosis type 2

269
Q

Vestibular schwannoma - features

A

Vertigo
Hearing loss - sensorineural, unilateral
Tinnitis - unilateral
Absent corneal reflex

270
Q

Vestibular schwannoma - investigations

A

Audiometry

MRI of cerebellopontine angle

271
Q

Vestibular schwannoma - when to refer

A

Urgent referral to ENT if any suspicion

272
Q

Vestibular schwannoma - Management

A

Radiotherapy, surgery, or observation

273
Q

What is tuberous sclerosis?

A

Multisystem disorder characterised by formation of hamartomas in many organs

274
Q

Tuberous sclerosis - inheritance

A

Autosomal dominant

275
Q

Tuberous sclerosis - features

A 
Ash leaf spots
Shagreen patches - rough patches over lumbar spine
Adenoma sebaceum
Subungal fibromata
Cafe-au-lait
Developmental delay, epilepsy
Retinal hamartomas
Rhabdomyomas of the heart
276
Q

Trigeminal neuralgia - features

A

Brief shock like pain in trigeminal divisions
Unilateral
Pain evoked by light touch

277
Q

Trigeminal neuralgia - management

A

Carbamazepine

278
Q

Tuberous sclerosis - when to refer

A

Atypical features eg under age 50
Not responding to treatment
Any red flags

279
Q

What is a TIA?

A

Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal iscaemia, without acute infarction

280
Q

TIA - immediate management

A

Aspirin 300mg UNLESS:

  • bleeding disorder or taking anticoagulant
  • already on aspirin
  • contraindicated
281
Q

TIA - secondary prevention

A

Clopidogrel

Aspirin + dipyridamole if can’t tolerate clopidogrel

282
Q

Stroke - who is a candidate for thrombectomy between 6 and 24 hours?

A

If proximal anterior circulation stroke and potential to salvage brain tissue seen on imaging

CONSIDER if proximal circulation (basiliar or posterior cerebral artery)

283
Q

TIA - who to refer for assessment within 24 hours

A

Had symptoms <7 days ago

284
Q

TIA - who to refer for assessment within 7 days

A

Had symptoms >7 days ago

285
Q

Who is suitable for carotid endarterectomy?

A

Stroke/TIA without significant disability

Stenosis >70%

286
Q

Tension headache - acute management

A

Aspirin, paracetamol or NSAIDS

287
Q

Tension headache - prophylaxis

A

10 sessions of acupuncture over 5-8 weeks

288
Q

What is syringomyelia?

A

Collection of CSF within the spinal cord

289
Q

What is syringobulbia?

A

Fluid filled cavity within the medulla of the brainstem

Often an extension of the syringomyelia

290
Q

Syringomyelia - causes

A

Chiari malformation

Trauma

Tumours

Idiopathic

291
Q

Syringomyelia - treatment

A

Treat the cause

Persistent/causing symptoms - shunt

292
Q

Syringomyelia - features

A

Loss of sensation to temperature only across neck and shoulders

Spastic weakness

Paraesthesia

Neuropathic pain

Upgoing plantars

293
Q

Syringomyelia - investigations

A

Full spine MRI

Brain MRI

294
Q

What is the ROSIER score for?

A

Likelihood of stroke

Stroke likely if score >0

295
Q

ROSIER scoring criteria

A

Exclude hypoglycaemia then assess

LOC/seizure = -1

Seizure activity = -1

Asymmetrical facial/arm/leg weakness = all +1

Speech disturbance = +1

Visual field defect = +1

296
Q

Stroke - immediate management

A

Aspirin 300mg when haemorrhage excluded

Thrombolysis/thrombectomy if candidate

297
Q

Stroke - who is a candidate for thrombolysis?

A

Within 4.5 hours

Haemorrhage excluded

298
Q

Stroke - who is a candidate for thrombectomy within 6 hours?

A

Thrombectomy + thrombolysis

If proximal anterior circulation stroke

299
Q

Stroke - who is a candidate for thrombectomy between 6 and 24 hours?

A

If proximal anterior circulation stroke and potential to salvage brain tissue seen on imaging

CONSIDER if proximal circulation (basiliar or posterior cerebral artery)

300
Q

Stroke - secondary prevention

A

Clopidogrel
Aspirin + MR dipyridamole if clopidogrel not tolerated

Statin if cholesterol >3.5

Start anticoagulant for AF after 2 weeks

301
Q

Stroke - when to start AF treatment

A

Start anticoagulant after 2 weeks

302
Q

Stroke - when to start statin

A

if cholesterol >3.5

After 48 hours

303
Q

What is Reye’s syndrome?

A

Severe progressive encephalopathy in children

accompanied by fatty infiltration of the liver, kidneys and pancreas

304
Q

Reye’s syndrome - associations

A

Aspirin use

Possible viral illness preceeding

305
Q

Phenytoin - teratogenic effects

A

Cleft palate

Congenital heart disease

306
Q

What is thoracic outlet syndrome?

A

Compression of brachial plexus, subclavian artery or vein at the site of the thoracic outlet

307
Q

Phenytoin - chronic side effects

A

Gingival hyperplasia

Hirsutism

Coarse facial features

Megaloblastic anaemia

Peripheral neuropathy

Fever

Drug induced lupus

Hepatitis

308
Q

Phenytoin side effects - mneumonic

A 
P450 inducer
Hirsutism
Enlarged gums
Nystagmus
Yellow/browning of skin
Teratogen
Osteomalacia
Interference with B12 = anaemia
Neuropathies = vertigo, ataxia, headache
309
Q

Sodium valproate side effects - mneumonic

A 
Vomiting
Alopecia
Liver toxicity
Pancreatitis, Pancytopenia
Retention of fat = weight gain
Oedema - peripheral
Anorexia
Tremor
Enzyme inhibitor
310
Q

Vascular thoracic outlet syndrome - features of subclavian vein compression

A

Painful diffuse arm swelling, distended veins

311
Q

Vascular thoracic outlet syndrome - features of subclavian artery compression

A

Painful arm claudication, risk of ulceration and gangrene

312
Q

Vascular thoracic outlet syndrome - which vessels might be affected?

A

Subclavian vein

Subclavian artery

313
Q

Thoracic outlet syndrome - investigations

A

CXR + C spine xray - check for obvious deformity or tumours

CT/MRI spine - cervical root lesions

Venogram/angiogram in vascular TOS

Anterior scalene block - confirms neuro TOS

314
Q

Thoracic outlet syndrome - management

A

Conservative
May need decompression surgery
Surgery generally first line in vascular TOS

315
Q

Normal pressure hydrocephalus - features

A

Urinary incontinence
Dementia and bradyphrenia
Gait abnormality

316
Q

Normal pressure hydrocephalus - management

A

Ventriculoperitoneal shunt

10% have complications - seizure, infection, intracranial haemorrhage

317
Q

Topiramate - effect on contraception

A

Decreases efficiency

Is also teratogenic

318
Q

Topiramate - effect on P450

A

P450 inducer

319
Q

Topiramate - side effects

A 
Reduced appetite, weight loss
Dizziness
Paraesthesia
Lethargy, poor concentration
Acute myopia
Secondary angle closure glaucoma
320
Q

Topiramate - key use

A

Migraine prophylaxis

Avoid in women of child bearing age

321
Q

Phenytoin - mechanism of action

A

Binds to sodium channels increasing their refractory periods

322
Q

Phenytoin - teratogenic effects

A

Cleft palate

Congenital heart disease

323
Q

Phenytoin - acute side effects

A 
Dizziness, ataxia
Diplopia
Nystagmus
Slurred speech
Confusion
Seizures
324
Q

Phenytoin - chronic side effects

A 
Gingival hyperplasia
Hirsutism
Coarse facial features 
Megaloblastic anaemia
Peripheral neuropathy
Fever
Drug induced lupus
Hepatitis
325
Q

Phenytoin side effects - mneumonic

A 
P450 inducer
Hirsutism
Enlarged gums
Nystagmus
Yellow/browning of skin
Teratogen
Osteomalacia
Interference with B12 = anaemia
Neuropathies = vertigo, ataxia, headache
326
Q

Sodium valproate side effects - mneumonic

A 
Vomiting
Alopecia
Liver toxicity
Pancreatitis, Pancytopenia
Retention of fat = weight gain
Oedema - peripheral
Anorexia
Tremor
Enzyme inhibitior
327
Q

Restless leg syndrome - features

A

Uncontrollable urge to move legs - at night, worse at rest
Paraesthesia - crawling or throbbing sensation
Periodic limb movements of sleep

328
Q

Restless leg syndrome - management

A

Walking, stretching, massage
Treat any causes found
Dopamine agonists - pramipexole, ropinirole

329
Q

Restless leg syndrome - causes

A 
FH in 50%
Iron deficiency anaemia 
Uraemia
Diabetes
Pregnancy
330
Q

What is the most important test in restless leg syndrome?

A

Ferritin for IDA

331
Q

What causes absent ankle jerks and extensor plantars?

A

Subacute combined degeneration of the cord

Motor neuron disease

Friedreich’s ataxia

Syringomyelia

Syphilis

332
Q

What is the most common cause of foot drop?

A

Common peroneal nerve lesion

333
Q

Main cause of common peroneal nerve lesion

A 
Compression at the neck of fibula
May be secondary to leg crossing, squatting or kneeling
Baker's cysts
Plaster casts
Weight loss
334
Q

Causes of foot drop

A

Common peroneal nerve lesion
L5 radiculopathy
Sciatic nerve lesion
Superficial/deep peroneal nerve lesion

335
Q

Signs of damage to median nerve

A

Paralysis and wasting of thenar eminence muscles

Sensory loss to palmar aspect of lateral 2 1/2 fingers

Unable to pronate forearm
Weak wrist flexion
Ulnar deviation of wrist

336
Q

GCS - motor

A 
6 = obeys commands
5 = localises to pain
4 = withdraws from pain
3 = abnormal flexion from pain
2 = extending from pain
1 = none
337
Q

GCS - verbal

A 
5 = orientated
4 = confused
3 = words
2 = sounds
1 = none
338
Q

GCS - eyes

A 
4 = spontaneous
3 = to speech
2 = to pain
1 = none
339
Q

Name of CN I

340
Q

Functions of CN I

341
Q

Name of CN II

342
Q

Function of CN II

343
Q

Name of CN III

A

Oculomotor

344
Q

Functions of CN III

A

Eye movement - MR, IO, SR, IR
Pupil constriction
Accomodation
Eyelid opening

345
Q

3rd nerve palsy features

A

Ptosis
Down and out eye
Dilated, fixed pupil

346
Q

Name of CN IV

347
Q

Functions of CN IV

A

Eye movement - SO

348
Q

4th nerve palsy features

A

Defective downwards gaze causing vertical diplopia

349
Q

Name of CN V

A

Trigeminal

350
Q

Functions of CN V

A

Facial sensation

Mastication

351
Q

Name of CN VI

352
Q

Functions of CN VI

A

Eye movement - LR

353
Q

6th nerve palsy features

A

Defective abduction causing horizontal diplopia

354
Q

Name of CN VII

355
Q

Functions of CN VII

A

Facial movement

Taste - anterior 2/3 of tongue

356
Q

Name of CN VIII

A

Vestibulocochlear

357
Q

Functions of CN VIII

A

Hearing

Balance

358
Q

Name of CN IX

A

Glossopharyngeal

359
Q

Functions of CN IX

A

Taste - posterior 1/3 of tongue

360
Q

Name of CN X

361
Q

Functions of CN X

A

Phonation

Swallowing

362
Q

CN X lesion features

A

Uvula deviates AWAY from site of lesion

Loss of gag reflex

363
Q

Name of XI

364
Q

Functions of XI

A

Head and shoulder movement

365
Q

Name of XII

A

Hypoglossal

366
Q

Functions of XII

A

Tongue movement

367
Q

CN XII lesion features

A

Tongue deviates TOWARDS side of lesion

368
Q

Dermatome for thumb and index finger

369
Q

Dermatome for ventral axial line of upper limb

370
Q

Dermatome for middle finger and palm of hand

371
Q

Dermatome for ring and little finger

372
Q

Dermatome for nipples

373
Q

Dermatome for umbilicus

374
Q

Dermatome for knee caps

375
Q

Dermatome for big toe and dorsum of foot

376
Q

DVLA - chronic neurological disorders

A

Inform DVLA

377
Q

Dermatome for genitalia

378
Q

Dermatome for inguinal ligament

379
Q

DVLA - first seizure no structural abnormality and no definite epileptiform activity

A

6 months off

380
Q

DVLA - first seizure if abnormality or definite epileptiform activity

A

12 months off

381
Q

Do DVLA need informing about epilepsy/seizure?

382
Q

DVLA - epilepsy, how long seizure free before may drive?

A

12 months

Once seizure free for 5 years a till 70 license restored

383
Q

DVLA - epilepsy, withdrawing medication

A

Cannot drive whilst medication being withdrawn and until 6 months after last dose

384
Q

DVLA - syncope, simple faint

A

No restriction

385
Q

DVLA - single syncope, explained and treated

A

4 weeks off

386
Q

DVLA - single syncope, unexplained

A

6 months off

387
Q

DVLA - two or more episodes of syncope

A

12 months off

388
Q

DVLA - stroke or TIA

A

1 month off

No need to inform DVLA if no residual defiit

389
Q

DVLA - multiple TIAs

A

3 months off

Inform DVLA

390
Q

DVLA - craniotomy

A

1 year off

391
Q

DVLA - trans-sphenoidal surgery

A

when no debarring residual impairment likely to affect safe driving

392
Q

DVLA - narcolepsy/cataplexy

A

Stop driving on diagnosis

Start when have good control of symptoms

393
Q

DVLA - chronic neurological disorders

A

Inform DVLA

394
Q

Subacute combined degeneration of the cord - features

A 
Loss of vibration and proprioception
Full sensory loss
Paraesthesia
Ataxia
Distal muscle weakness
Dementia
395
Q

Subacute combined degeneration of the cord - causes

A

B12 deficiency causing demyelination

AKT (20 decks)

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