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MRCP > Neurology > Flashcards

Neurology Flashcards

1
Q

What score on ABCD2 requires specialist review within 24 hours

A

All TIAs should have review within 24 hours

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2
Q

What % stenosis would require endarterectomy in a symptomatic patient

A

> 50%

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3
Q

Which artery is involved in the majority of carotid dissections

A

Internal carotid artery

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4
Q

Which condition causes ipsilateral headache, ipsilateral horner’s and contralateral hemisphere signs

A

Carotid artery dissection

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5
Q

When should decompressive hemicraniectomy be considered in acute ischaemic stroke

A

<60yrs with large cerebral infarctions in the MCA

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6
Q

What condition is strongly associated with lacunar strokes

A

Hypertension

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7
Q

What are the common sites of lacunar stroke

A

Basal ganglia, thalamus, internal capsule

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8
Q

Infarct of which artery would lead to contralateral hemiparesis and sensory loss in the lower extremities more than the upper extremities?

A

Anterior cerebral artery

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9
Q

Infarct of which artery would lead to contralateral homonymous hemianopia with macular sparing and pure hemisensory loss

A

Posterior cerebral artery

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10
Q

Infarct of which artery would lead to ipsilateral CNIII palsy and contralateral weakness

A

PCA branches to the midbrain (Weber’s syndrome)

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11
Q

What does lateral medullary syndrome (posterior inferior CA/Wallenberg’s syndrome) cause?

A

Ipsilateral cerebellar signs, ipsilateral Horner’s syndrome, contralateral spinothalamic sensory loss

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12
Q

Infarct of which artery causes similar symptoms of lateral medullary syndrome but with facial paralysis and deafness?

A

Anterior inferior cerebral artery (lateral pontine syndrome)

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13
Q

What signs are associated with infarction of the pontine artery

A

6th nerve palsy, 7th nerve palsy, contralateral hemiparesis

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14
Q

Which condition is syringomyelia strongly associated with

A

Arnold-Chiari Malformation

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15
Q

What condition causes wasting and weakness of the arms, spinothalamic sensory loss and loss of reflexes

A

Syringomyelia

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16
Q

What is the treatment of transverse myelitis

A

IV corticosteroids

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17
Q

Which condition is associated with neurological symptoms most prominent when a patient has their arm above their head?

A

Subclavian steal syndrome

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18
Q

Which deficiency causes degeneration of the posterior and lateral columns of the spinal cord?

A

Vitamin B12 (subacute combined degeneration of spinal cord)

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19
Q

Lesions in which lobe cause Broca’s aphasia

A

Frontal lobe

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20
Q

Lesions in which lobe lead to changes in personality and inability to generate a list rapidly

A

Frontal lobe

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21
Q

What visual change is seen in a lesion of the parietal lobe

A

Inferior homonymous quadrantanopia

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22
Q

What syndrome is caused by a lesion of the dominant parietal lobe

A

Gerstmann’s syndrome (can’t read, write, add up, left-right dissociation)

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23
Q

Wernickes aphasia and superior homonymous quadrantanopia - where is the lesion?

A

Temporal lobe

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24
Q

Which part of the cerebellum is affected to cause gait disturbance

A

Midline

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25
Q

Which part of the cerebellum is affected to cause intention tremor and dysdiadokinesia

A

Hemisphere

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26
Q

What location of lesion causes incongruous defects in vision

A

Lesion of the optic tract

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27
Q

What kind of pathology is most likely to cause upper quadrant bitemporal hemianopia

A

Pituitary tumour

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28
Q

What visual defect will superior compression of the optic chiasm by a craniopharyngioma cause?

A

Lower quadrant bitemporal hemianopia

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29
Q

Which disease is most associated with downbeat nystagmus

A

Arnold-chiari malformation

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30
Q

What pupil defect does Argyll-Robertson cause

A

Miosis (constriction)

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31
Q

Where is the lesion causing Horner’s syndrome if there is only anhydrosis of the face?

A

Pre-ganglionic lesions (pancoast’s tumour, trauma, thyroidectomy, top rib)

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32
Q

What causes a painful third nerve palsy

A

Posterior communicating artery aneurysm

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33
Q

What are the causes of a unilateral lower motor neurone palsy of the facial nerve

A

Bell’s palsy, Ramsay hunt, acoustic neuromas, parotid tumours, MS, HIV, diabetes

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34
Q

Which lesion causes a facial nerve palsy and convergent squint?

A

Pons lesion

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35
Q

Which genes are implemented in Parkinson’s disease

A

Parkin gene, UCHL1

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36
Q

Which category of medication cause impulse control disorders

A

Dopamine receptor antagonists (ropinirole, pramiprexole, rotigotine)

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37
Q

Which disease presents with Parkinsonism, impairment of vertical gaze and cognitive impairment

A

Progressive supranuclear palsy

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38
Q

Which condition presents with Parkinsonism, cerebellar signs and autonomic disturbance

A

Multiple system atrophy

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39
Q

What are neurofibrillary tangles made up of in Alzheimer’s disease

A

Tau protein

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40
Q

Which drug is given in severe Alzheimer’s and what is its mechanism of action

A

Memantine- NMDA antagonist

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41
Q

What does pulvinar sign on MRI brain suggest

A

Variant CJD

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42
Q

What does CJD present with

A

Dementia, ataxia, myoclonic jerks

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43
Q

Where does herpes simplex encephalitis affect in the brain

A

Temporal lobes

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44
Q

What condition causes medial temporal petechial haemorrhages on MRI brain

A

Herpes simplex encephalitis

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45
Q

Which virus causes widespread demyelination in HIV patients/immunosuppressed leading to progressive multifocal leukoencephalopathy (PML)

A

JC virus

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46
Q

What does toxoplasmosis infection show on imaging of the brain

A

Ring enhancing lesions

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47
Q

What does CNS lymphoma show on brain imaging

A

Homogenous enhancement, SPECT positive

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48
Q

Which artery is commonly involved in extradural haematomas

A

Middle meningeal artery

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49
Q

What drug can be used to treat vasospasm in SAH

A

Nimodipine

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50
Q

Which receptors are involved in myaesthenia gravis

A

Post-synaptic Ach receptors

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51
Q

Which receptors are involved in Lambert-Eton Myaesthenic Syndrome

A

Pre-synaptic voltage-gated calcium channels

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52
Q

What is first line treatment of absence seizures

A

Ethosuximide or sodium valproate

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53
Q

What is first line treatment of partial seizures

A

Lamotrigine

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54
Q

What is the MOA of sodium valproate

A

Increases GABA activity

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55
Q

Which condition causes infantile spasm and hypsarrhythmia on EEG

A

West Syndrome

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56
Q

Which chromosome is responsible for lisch nodules and axillary freckles

A

Chr 17 - NF1

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57
Q

Which chromosome is responsible for bilateral acoustic neuromas

A

Chr 22

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58
Q

Which chromosomes are responsible for ash-leaf spots and shagreen patches

A

Chr 9 & 16 (tuberous sclerosis)

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59
Q

What is the MOA of topiramate

A

5-HT antagonist

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60
Q

Which medication can be used in the prophylaxis of cluster headaches

A

Verapamil

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61
Q

What condition is absent corneal reflex associated with

A

Facial nerve lesion, V1 branch lesion, pons/medulla lesion:

  • Acoustic neuroma, vestibular schwannoma
  • subarachnoid haemorrhage, venous thrombosis
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62
Q

Which condition causes headaches and nuchal rigidity in a post-partum lady

A

Cortical vein thrombosis

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63
Q

How long must you take off driving after a first seizure

A

6 months

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64
Q

How long must you take off driving for a TIA or stroke

A

1 month

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65
Q

How long must you take off driving for an unexplained episode of syncope

A

6 months

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66
Q

What is the treatment of Ramsay-Hunt syndrome

A

Oral aciclovir and prednisone

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67
Q

What is the treatment of CMV

A

Ganciclovir

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68
Q

Which drugs may exacerbate a myaesthenic crisis

A

Penicillamine, procainamide, beta-blockers, lithium, phenytoin, gentamicin

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69
Q

Which type of MND has the worst prognosis

A

progressive bulbar palsy

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70
Q

Which treatment increases survival the most in MND

A

NIV

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71
Q

What is the inheritance pattern of myotonic dystrophy

A

autosomal dominant trinucleotide repeat

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72
Q

Which condition presents with slow-relaxing grip, bilateral ptosis and loss of red-light reflex

A

myotonic dystrophy

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73
Q

What is the pathophysiology behind chorea

A

damage to caudate nucleus in basal ganglia

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74
Q

What drug can be used to treat chorea in Huntington’s

A

tetrabenazine

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75
Q

What condition causes involuntary movements on the opposite side to a lesion of the subthalamic nucleus

A

hemiballism

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76
Q

What chromosome is the VHL gene located on

A

chromosome 3

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77
Q

What is the inheritance pattern of Freidrich’s ataxia

A

autosomal recessive trinucleotide repeat

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78
Q

What is the most common cause of death in Freidrich’s ataxia

A

HOCM

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79
Q

What is Lhermitte’s syndrome in MS

A

paraesthesia of limbs with neck flexion

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80
Q

What are the contraindications of beta-interferon in MS treatment

A

depression, epilepsy, liver failure, <18 yrs, walk <100m, <2 relapses in last year

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81
Q

What is the MOA of natalizumab in treatment of MS

A

inhibits migration of leukocytes across BBB

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82
Q

Which antibodies are present in 25% of Guillian Barre patients

A

Anti-GM1 Abs

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83
Q

Which syndrome presents with opthalmoplegia, ataxia and anti-GQ1b Abs

A

Miller Fisher Syndrome

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84
Q

which nerve causes burning thigh pain when compressed

A

lateral cutaneous nerve

85
Q

what is first line treatment of diabetic neuropathy

A

duloxetine, pregabalin, gabapentin, amitriptyline

86
Q

What do nerve conduction studies show in Charcot-Marie-Tooth Disease

A

nerve conduction velocity <30m/s

87
Q

What do NCS show in axonal pathology

A

normal velocity, reduced amplitude

88
Q

Which drugs cause peripheral neuropathy

A

nitrofurantoin, metronidazole, amiodarone, isoniazid, vincristine, TCAs

89
Q

What antibody causes painful sensory neuropathy in SCLC and neuroblastoma

A

Anti-Hu

90
Q

Which antibody causes cerebellar syndrome in ovarian and breast cancer

A

Anti-Yo

91
Q

Which antibody causes stiff person’s syndrome in colorectal cancer

A

Anti-GAD

92
Q

What is shown on muscle biopsy in mitochondrial disease

A

red, ragged fibres

93
Q

Which causes of peripheral neuropathy are predominantly motor loss

A

GBS, porphyria, lead poisoning, Charcot-Marie-Tooth, CIDP, diptheria

94
Q

Which causes of peripheral neuropathy are predominantly sensory loss

A

diabetes, uraemia, leprosy, alcoholism, B12, amyloidosis

95
Q

which haematomas are limited by the suture lines

A

extradural haematomas

96
Q

how will a chronic haematoma appear on CT

A

hypodense

97
Q

which lesion site causes upward gaze palsy and pseudo-argyll robertson pupils

A

dorsal midbrain (Parinaud syndrome)

98
Q

What shows poly-spike and wave discharge on EEG

A

myoclonic seizures

99
Q

When should thrombectomy be offered together with thrombolysis in stroke

A
  • Functional score < 3 on Rankin scale, > 5 on NIHSS

- Proximal anterior circulation occlusion within 6hrs of onset

100
Q

What is first line treatment for spasticity in MS

A

Baclofen, gabapentin

101
Q

Which AED is contraindicated in absence seizures

A

Carbamazepine

102
Q

What is the MOA of baclofen

A

GABA agonist

103
Q

What is the treatment of a brain abscess

A

IV 3rd-generation cephalosporin + metronidazole

104
Q

What class of parkinson’s drug is selegiline

A

MAO-B inhibitor

105
Q

What are the causes of spastic paraparesis (UMN weakness in lower limbs)

A

MS, SCC, parasagittal meningioma, transverse myelitis (HIV), syringomyelia, OA of cervical spine

106
Q

Which part of the hypothalamus that controls satiety is often invaded by craniopharyngiomas in children

A

The ventromedial area of the hypothalamus

107
Q

Which scale is best to measure disability in ADLs after a stroke

A

Barthel index

108
Q

Where does wernicke’s area reside

A

Brodmann area 22 in superior temporal gyrus

109
Q

Which neuropeptide is narcolepsy associated with

A

Orexin (hypocretin)

110
Q

A lesion of which area in the brain leads to inability to read but no inability to write

A

Corpus callosum - infarct of left posterior cerebral artery

111
Q

Where are lesions located that cause congruous visual field defects

A

Optic radiation lesion or occipital cortex

112
Q

Which drugs can cause idiopathic intracranial hypertension

A

COCP, steroids, Tetracyclines, Vitamin A, Lithium

113
Q

What are the causes of absent ankle jerks

A

B12 deficiency, SLE, syphilis, cerebrotendinous xanthomatosis

114
Q

Which condition has high serum cholestanol

A

Cerebrotendinous xanthomatosis

115
Q

Which conditions produce both extensor planters and absent ankle jerks

A

UMN + LMN - SCD of spinal cord, MND, Freidich’s ataxia, syringomyelia, syphilis

116
Q

Which chromosomes are involved in neurofibromatosis

A

NF1 = Chr 17; NF2 = Chr 22

117
Q

Which chromosomes are involved in tuberous sclerosis

A

9 & 16

118
Q

What is a Jacksonian March

A

A focal aware seizure that starts by affecting a peripheral body part and then spreads quickly - can have secondary generalisation

119
Q

What is anisocoria

A

Unequal pupil size

120
Q

Which nerve root is associated with Erb’s palsy

A

C5 (waiter’s tup position)

121
Q

Which nerve roots are damaged resulting in wasting of intrinsic hand muscles and flexion deformities of PIP and DIP joints

A

C8-T1 (Klumpke’s paralysis)

122
Q

Which trinucleotide repeat is seen in Huntington’s disease

A

CAG

123
Q

Which trinucleotide repeat is seen in Friedrich Ataxia

A

GAA

124
Q

Which trinucleotide repeat is seen in Myotonic Dystrophy

A

CTG

125
Q

Which seizure type is typically seen in teenagers after sleep deprivation

A

Juvenile myoclonic epilepsy

126
Q

Which lesion causes weakness of foot dorsiflexion and foot eversion

A

Common peroneal nerve

127
Q

What medication can be used to treat neuroleptic malignant syndrome

A

Bromocriptine

128
Q

Which condition is associated with Anti-NMDA receptor encephalitis

A

Ovarian teratoma

129
Q

Which treatment is commonly used to treat tremor in drug-induced parkinsonism

A

Benzhexol

130
Q

What cholesterol level should a patient be started on a statin after a stroke

A

All patients should have high dose statin after stroke/TIA

131
Q

Occlusion of which circulation is an indication for thrombectomy

A

Proximal anterior circulation if within 6hrs or 24hrs and viable brain tissue

(Posterior cerebral/basilar can be considered for thrombectomy within 24hrs if viable brain tissue)

132
Q

Which type of dysphasia describes fluent speech but poor repetition

A

Conductive dysphasia (affects arcuate fasciculus)

133
Q

What is the clinical presentation of syringomyelia in the upper limbs

A

Cape-like loss of sensation to temperature (preservation of light touch, proprioception and vibration)

134
Q

Which area of the brain do wernike and korsakoff syndrome affect

A

Medial thalamus and mammillary bodies of the hypothalamus

135
Q

What is first line treatment for myoclonic seizures

A

Sodium valproate

136
Q

Which seizure types can carbamazepine exacerbate

A

Absence and myoclonic seizures

137
Q

What do temporal lesions causes

A

Wernicke’s aphasia, superior homonymous hemianopia, auditory agnosia, prosopagnosia (difficulty recognising faces)

138
Q

What do frontal lobe lesions cause

A

Broca’s aphasia, disinhibition, perseveration, anosmia, inability to generate a list

139
Q

What type of aphasia is characterised by normal comprehension, fluent speech but poor repetition and aware of their errors

A

Conduction aphasia

140
Q

Which aphasia is characterised by word finding difficulties

A

Anomic aphasia

141
Q

What is the most common complication following meningitis

A

Sensorineural hearing loss

142
Q

Which drugs are first-line for spasticity in multiple sclerosis

A

Baclofen, gabapentin

143
Q

What is the first investigation that should be performed in a patient with MS who has bladder dysfunction

A

US bladder (post-micturition to assess emptying)

144
Q

Which upper limb condition causes pain in the hand that is relieved by shaking the hand

A

Carpal tunnel syndrome

145
Q

What is seen on examination in carpal tunnel syndrome

A

Weakness of thumb abduction, wasting of thenar eminence, positive Tinel’s and Phalen’s sign

146
Q

What is second line treatment of myoclonic seizures after valproate

A

Clonazepam, lamotrigine

147
Q

Which two anti-epileptics can be used as first line for focal seizures

A

Carbamazepine, lamotrigine

148
Q

Which Parkinson’s plus syndrome typically has cerebellar signs

A

Multiple system atrophy

149
Q

What should pregnant women taking phenytoin be given in the last month of pregnancy

A

Vitamin K

150
Q

What is the genetic mutation seen in CADASIL

A

NOTCH3 mutation on Chr 19

151
Q

Which is more severe - Becker’s or Duchenne’s

A

Duchenne’s (frameshift deletion)

152
Q

Which condition resembles marfan’s but with mild learning disability, downwards lens dislocation and livedo reticularis

A

Homocystinuria

153
Q

Which condition occurs days to weeks after cerebral hypoxia and is characterised by intention myoclonus

A

Lance-Adam’s syndrome

154
Q

What are the risk factors associated with vertebral artery dissection

A

Spinal manipulation, yoga, ceiling painting, judo, nose blowing, minor neck trauma, fibromuscular dysplasia, chronic headache, female

155
Q

Which condition presents with severe occipital headache, neck pain, brainstem and cerebellar signs after head/neck injury

A

Vertebral artery dissection

156
Q

Which condition characteristically causes painless muscle weakness of the finger flexors and quadriceps with modest CK rise

A

Inclusion body myosotis

157
Q

What presents with severe shoulder pain that resolves, followed by progressive upper limb weakness and wasting

A

Brachial neuritis

158
Q

What is the management of paroxysmal hemicrania

A

Indomethacin

159
Q

Infarction of which artery is responsible for locked-in syndrome

A

Basilar artery

160
Q

Which condition is characterised by proximal weakness during the second half of the night, following a day of unusually strenuous exercise

A

Thyrotoxicosis with hypokalaemic periodic paralysis

161
Q

What is the most appropriate initial investigation for CJD

A

EEG

162
Q

What is the most common tumour of the middle ear

A

Glomus jugulare tumour

163
Q

What does meralgia paraesthetica occur due to

A

Entrapment of the lateral cutaneous nerve of the thigh

164
Q

What triad of symptoms is associated with wernicke korsakoff syndrome

A

Ataxia, eye movement abnormalities and impaired cognition

165
Q

What is Anton syndrome

A

Bilateral infarctions of the primary visual cortex (occipital lobes) where patients believe they can see what they cannot

166
Q

Which organism is most likely to cause meningitis from a CSF leak

A

Gram positive cocci (staph aureus/epidermidis)

167
Q

What is the investigation of choice for vertebral artery dissection

A

Magnetic resonance angiography

168
Q

Which disease causing meningitis with flaccid paralysis has had an outbreak in New York

A

West Nile disease

169
Q

What non invasive test is best to diagnose McArdle syndrome

A

Serum lactate after exercise (will not be raised)

170
Q

What is characteristic on LP in GBS

A

Raised protein and normal WCC

171
Q

What is Refsum’s disease

A

Ataxia, hearing loss, retinitis pigmentosa and dry red skin

172
Q

What is the main differential to consider in patients with suspected MND

A

Multifocal motor neuropathy with conduction block (anti-GM1 Abs)

173
Q

What type of enhancement does cryptococcus meningitis display on MRI

A

Leptomeningeal enhancement

174
Q

What type of enhancement is seen with CMV meningoencephalitis on MRI

A

Ependymal enhancement

175
Q

What is an early sign of idiopathic Parkinson’s

A

REM sleep disorder

176
Q

What feature is often present in LEMS but not MG

A

Autonomic dysfunction

177
Q

What does a paraganglioma of the inner ear present with

A

Pulsatile tinnitus + X, XI and XII nerve palsies

178
Q

What is the most rapid diagnostic test in Wilson’s after serum copper and caeruloplasmin

A

Slit lamp test (KF rings)

179
Q

What is the treatment of spontaneous carotid artery dissection in patients with low bleeding risk

A

DAPT

180
Q

What is the strongest risk factor for haemorrhagic transformation of ischaemic stroke

A

NIHSS >15

181
Q

Which condition develops an ‘alien limb’ phenomenon along with rigidity and bradykinesia

A

Corticobasal degeneration

182
Q

What is the most common form of idiopathic generalised epilepsy in young adults

A

Juvenile myoclonic epilepsy

183
Q

Which metabolic abnormality can be 3x the upper limit of normal 10-20 mins after a tonic clonic seizure

A

Hyperprolactinaemia

184
Q

What is the typical management of high grade glioma

A

Surgical resection with adjuvant post-op RT+chemo

185
Q

What is the treatment of BPPV

A

Epley manoeuvre

186
Q

Which condition causes ICH and seizures in patients under 40

A

AV malformation

187
Q

What is the gold standard test for AV malformation

A

MRI head and angiography

188
Q

Which infectious disease can cause a false positive tensilon test

A

Botulism

189
Q

What is seen on CT head in PML

A

Hypodense periventricular lesions

190
Q

Which side has the extensor plantar reflex in Brown-Sequard syndrome

A

Ipsilateral

191
Q

Which brain lesion can cause a dilated fourth ventricle and hydrocephalus

A

Cerebellar

192
Q

In 40% of patients negative for ACh receptor Abs, which Ab is positive in MG

A

Muscle-specific kinase (MuSK) Abs

193
Q

What are the main features of cerebral venous sinus thrombosis

A

Headache, seizures, focal weakness, papilloedema

194
Q

What is the most appropriate initial investigation for sporadic CJD

A

MRI brain

195
Q

What are visual evoked potentials used to assess

A

Optic neuropathy

196
Q

What is the most common cause of tongue deviation

A

Unilateral hypoglossal nerve palsy - malignancy

197
Q

Which condition is associated with an absent delta sign on CT head

A

Venous sinus thrombosis

198
Q

Which nerve root lesions give rise to pre-ganglionic Horner’s syndrome

A

C8, T1

199
Q

Which part of the brachial plexus does radiation plexopathy usually affect

A

Upper brachial plexus

200
Q

What do nerve conduction studies show in MND

A

Normal studies - used to rule out other treatable conditions e.g. multifocal motor neuropathy

201
Q

What is first line testing for myasthenia gravis

A

Anti-Ach receptor antibodies

202
Q

What is the treatment of restless leg syndrome

A

Gabapentin or dopamine agonist (e.g. pramiprexole, ropinirole)

203
Q

Which type of focal epilepsy has localising features of lip smacking and deja vu

A

Temporal

204
Q

What are the features of focal frontal epilepsy

A

Motor - head/leg movements, posturing, marching

205
Q

What 4 groups of symptoms are classically seen in sporadic CJD

A
  • myoclonus
  • dementia
  • ataxia
  • psychiatric/behavioural changes
206
Q

What is the best initial test to diagnose MG

A

Serum Ach receptor Abs

207
Q

What is the BP target in ICH

A

140 mmHg

208
Q

What blood pressure must be achieved in ischaemic stroke before thrombolysis can be given

A

< 185/110

209
Q

Which is the only cranial nerve to have contralateral control

A

CN IV (trochlear) - exits midbrain dorsally then travels ventrally (longest CN in body)

MRCP (16 decks)

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