Neurology Flashcards
(209 cards)
1
Q
What score on ABCD2 requires specialist review within 24 hours
A
All TIAs should have review within 24 hours
2
Q
What % stenosis would require endarterectomy in a symptomatic patient
A
> 50%
3
Q
Which artery is involved in the majority of carotid dissections
A
Internal carotid artery
4
Q
Which condition causes ipsilateral headache, ipsilateral horner’s and contralateral hemisphere signs
A
Carotid artery dissection
5
Q
When should decompressive hemicraniectomy be considered in acute ischaemic stroke
A
<60yrs with large cerebral infarctions in the MCA
6
Q
What condition is strongly associated with lacunar strokes
A
Hypertension
7
Q
What are the common sites of lacunar stroke
A
Basal ganglia, thalamus, internal capsule
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
9
Q
Infarct of which artery would lead to contralateral homonymous hemianopia with macular sparing and pure hemisensory loss
A
Posterior cerebral artery
10
Q
Infarct of which artery would lead to ipsilateral CNIII palsy and contralateral weakness
A
PCA branches to the midbrain (Weber’s syndrome)
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
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)
13
Q
What signs are associated with infarction of the pontine artery
A
6th nerve palsy, 7th nerve palsy, contralateral hemiparesis
14
Q
Which condition is syringomyelia strongly associated with
A
Arnold-Chiari Malformation
15
Q
What condition causes wasting and weakness of the arms, spinothalamic sensory loss and loss of reflexes
A
Syringomyelia
16
Q
What is the treatment of transverse myelitis
A
IV corticosteroids
17
Q
Which condition is associated with neurological symptoms most prominent when a patient has their arm above their head?
A
Subclavian steal syndrome
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)
19
Q
Lesions in which lobe cause Broca’s aphasia
A
Frontal lobe
20
Q
Lesions in which lobe lead to changes in personality and inability to generate a list rapidly
A
Frontal lobe
21
Q
What visual change is seen in a lesion of the parietal lobe
A
Inferior homonymous quadrantanopia
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)
23
Q
Wernickes aphasia and superior homonymous quadrantanopia - where is the lesion?
A
Temporal lobe
24
Q
Which part of the cerebellum is affected to cause gait disturbance
A
Midline
25
Which part of the cerebellum is affected to cause intention tremor and dysdiadokinesia
Hemisphere
26
What location of lesion causes incongruous defects in vision
Lesion of the optic tract
27
What kind of pathology is most likely to cause upper quadrant bitemporal hemianopia
Pituitary tumour
28
What visual defect will superior compression of the optic chiasm by a craniopharyngioma cause?
Lower quadrant bitemporal hemianopia
29
Which disease is most associated with downbeat nystagmus
Arnold-chiari malformation
30
What pupil defect does Argyll-Robertson cause
Miosis (constriction)
31
Where is the lesion causing Horner’s syndrome if there is only anhydrosis of the face?
Pre-ganglionic lesions (pancoast’s tumour, trauma, thyroidectomy, top rib)
32
What causes a painful third nerve palsy
Posterior communicating artery aneurysm
33
What are the causes of a unilateral lower motor neurone palsy of the facial nerve
Bell’s palsy, Ramsay hunt, acoustic neuromas, parotid tumours, MS, HIV, diabetes
34
Which lesion causes a facial nerve palsy and convergent squint?
Pons lesion
35
Which genes are implemented in Parkinson’s disease
Parkin gene, UCHL1
36
Which category of medication cause impulse control disorders
Dopamine receptor antagonists (ropinirole, pramiprexole, rotigotine)
37
Which disease presents with Parkinsonism, impairment of vertical gaze and cognitive impairment
Progressive supranuclear palsy
38
Which condition presents with Parkinsonism, cerebellar signs and autonomic disturbance
Multiple system atrophy
39
What are neurofibrillary tangles made up of in Alzheimer’s disease
Tau protein
40
Which drug is given in severe Alzheimer’s and what is its mechanism of action
Memantine- NMDA antagonist
41
What does pulvinar sign on MRI brain suggest
Variant CJD
42
What does CJD present with
Dementia, ataxia, myoclonic jerks
43
Where does herpes simplex encephalitis affect in the brain
Temporal lobes
44
What condition causes medial temporal petechial haemorrhages on MRI brain
Herpes simplex encephalitis
45
Which virus causes widespread demyelination in HIV patients/immunosuppressed leading to progressive multifocal leukoencephalopathy (PML)
JC virus
46
What does toxoplasmosis infection show on imaging of the brain
Ring enhancing lesions
47
What does CNS lymphoma show on brain imaging
Homogenous enhancement, SPECT positive
48
Which artery is commonly involved in extradural haematomas
Middle meningeal artery
49
What drug can be used to treat vasospasm in SAH
Nimodipine
50
Which receptors are involved in myaesthenia gravis
Post-synaptic Ach receptors
51
Which receptors are involved in Lambert-Eton Myaesthenic Syndrome
Pre-synaptic voltage-gated calcium channels
52
What is first line treatment of absence seizures
Ethosuximide or sodium valproate
53
What is first line treatment of partial seizures
Lamotrigine
54
What is the MOA of sodium valproate
Increases GABA activity
55
Which condition causes infantile spasm and hypsarrhythmia on EEG
West Syndrome
56
Which chromosome is responsible for lisch nodules and axillary freckles
Chr 17 - NF1
57
Which chromosome is responsible for bilateral acoustic neuromas
Chr 22
58
Which chromosomes are responsible for ash-leaf spots and shagreen patches
Chr 9 & 16 (tuberous sclerosis)
59
What is the MOA of topiramate
5-HT antagonist
60
Which medication can be used in the prophylaxis of cluster headaches
Verapamil
61
What condition is absent corneal reflex associated with
Facial nerve lesion, V1 branch lesion, pons/medulla lesion:
- Acoustic neuroma, vestibular schwannoma
- subarachnoid haemorrhage, venous thrombosis
62
Which condition causes headaches and nuchal rigidity in a post-partum lady
Cortical vein thrombosis
63
How long must you take off driving after a first seizure
6 months
64
How long must you take off driving for a TIA or stroke
1 month
65
How long must you take off driving for an unexplained episode of syncope
6 months
66
What is the treatment of Ramsay-Hunt syndrome
Oral aciclovir and prednisone
67
What is the treatment of CMV
Ganciclovir
68
Which drugs may exacerbate a myaesthenic crisis
Penicillamine, procainamide, beta-blockers, lithium, phenytoin, gentamicin
69
Which type of MND has the worst prognosis
progressive bulbar palsy
70
Which treatment increases survival the most in MND
NIV
71
What is the inheritance pattern of myotonic dystrophy
autosomal dominant trinucleotide repeat
72
Which condition presents with slow-relaxing grip, bilateral ptosis and loss of red-light reflex
myotonic dystrophy
73
What is the pathophysiology behind chorea
damage to caudate nucleus in basal ganglia
74
What drug can be used to treat chorea in Huntington's
tetrabenazine
75
What condition causes involuntary movements on the opposite side to a lesion of the subthalamic nucleus
hemiballism
76
What chromosome is the VHL gene located on
chromosome 3
77
What is the inheritance pattern of Freidrich's ataxia
autosomal recessive trinucleotide repeat
78
What is the most common cause of death in Freidrich's ataxia
HOCM
79
What is Lhermitte's syndrome in MS
paraesthesia of limbs with neck flexion
80
What are the contraindications of beta-interferon in MS treatment
depression, epilepsy, liver failure, <18 yrs, walk <100m, <2 relapses in last year
81
What is the MOA of natalizumab in treatment of MS
inhibits migration of leukocytes across BBB
82
Which antibodies are present in 25% of Guillian Barre patients
Anti-GM1 Abs
83
Which syndrome presents with opthalmoplegia, ataxia and anti-GQ1b Abs
Miller Fisher Syndrome
84
which nerve causes burning thigh pain when compressed
lateral cutaneous nerve
85
what is first line treatment of diabetic neuropathy
duloxetine, pregabalin, gabapentin, amitriptyline
86
What do nerve conduction studies show in Charcot-Marie-Tooth Disease
nerve conduction velocity <30m/s
87
What do NCS show in axonal pathology
normal velocity, reduced amplitude
88
Which drugs cause peripheral neuropathy
nitrofurantoin, metronidazole, amiodarone, isoniazid, vincristine, TCAs
89
What antibody causes painful sensory neuropathy in SCLC and neuroblastoma
Anti-Hu
90
Which antibody causes cerebellar syndrome in ovarian and breast cancer
Anti-Yo
91
Which antibody causes stiff person's syndrome in colorectal cancer
Anti-GAD
92
What is shown on muscle biopsy in mitochondrial disease
red, ragged fibres
93
Which causes of peripheral neuropathy are predominantly motor loss
GBS, porphyria, lead poisoning, Charcot-Marie-Tooth, CIDP, diptheria
94
Which causes of peripheral neuropathy are predominantly sensory loss
diabetes, uraemia, leprosy, alcoholism, B12, amyloidosis
95
which haematomas are limited by the suture lines
extradural haematomas
96
how will a chronic haematoma appear on CT
hypodense
97
which lesion site causes upward gaze palsy and pseudo-argyll robertson pupils
dorsal midbrain (Parinaud syndrome)
98
What shows poly-spike and wave discharge on EEG
myoclonic seizures
99
When should thrombectomy be offered together with thrombolysis in stroke
- Functional score < 3 on Rankin scale, > 5 on NIHSS
| - Proximal anterior circulation occlusion within 6hrs of onset
100
What is first line treatment for spasticity in MS
Baclofen, gabapentin
101
Which AED is contraindicated in absence seizures
Carbamazepine
102
What is the MOA of baclofen
GABA agonist
103
What is the treatment of a brain abscess
IV 3rd-generation cephalosporin + metronidazole
104
What class of parkinson's drug is selegiline
MAO-B inhibitor
105
What are the causes of spastic paraparesis (UMN weakness in lower limbs)
MS, SCC, parasagittal meningioma, transverse myelitis (HIV), syringomyelia, OA of cervical spine
106
Which part of the hypothalamus that controls satiety is often invaded by craniopharyngiomas in children
The ventromedial area of the hypothalamus
107
Which scale is best to measure disability in ADLs after a stroke
Barthel index
108
Where does wernicke’s area reside
Brodmann area 22 in superior temporal gyrus
109
Which neuropeptide is narcolepsy associated with
Orexin (hypocretin)
110
A lesion of which area in the brain leads to inability to read but no inability to write
Corpus callosum - infarct of left posterior cerebral artery
111
Where are lesions located that cause congruous visual field defects
Optic radiation lesion or occipital cortex
112
Which drugs can cause idiopathic intracranial hypertension
COCP, steroids, Tetracyclines, Vitamin A, Lithium
113
What are the causes of absent ankle jerks
B12 deficiency, SLE, syphilis, cerebrotendinous xanthomatosis
114
Which condition has high serum cholestanol
Cerebrotendinous xanthomatosis
115
Which conditions produce both extensor planters and absent ankle jerks
UMN + LMN - SCD of spinal cord, MND, Freidich’s ataxia, syringomyelia, syphilis
116
Which chromosomes are involved in neurofibromatosis
NF1 = Chr 17; NF2 = Chr 22
117
Which chromosomes are involved in tuberous sclerosis
9 & 16
118
What is a Jacksonian March
A focal aware seizure that starts by affecting a peripheral body part and then spreads quickly - can have secondary generalisation
119
What is anisocoria
Unequal pupil size
120
Which nerve root is associated with Erb’s palsy
C5 (waiter’s tup position)
121
Which nerve roots are damaged resulting in wasting of intrinsic hand muscles and flexion deformities of PIP and DIP joints
C8-T1 (Klumpke’s paralysis)
122
Which trinucleotide repeat is seen in Huntington’s disease
CAG
123
Which trinucleotide repeat is seen in Friedrich Ataxia
GAA
124
Which trinucleotide repeat is seen in Myotonic Dystrophy
CTG
125
Which seizure type is typically seen in teenagers after sleep deprivation
Juvenile myoclonic epilepsy
126
Which lesion causes weakness of foot dorsiflexion and foot eversion
Common peroneal nerve
127
What medication can be used to treat neuroleptic malignant syndrome
Bromocriptine
128
Which condition is associated with Anti-NMDA receptor encephalitis
Ovarian teratoma
129
Which treatment is commonly used to treat tremor in drug-induced parkinsonism
Benzhexol
130
What cholesterol level should a patient be started on a statin after a stroke
All patients should have high dose statin after stroke/TIA
131
Occlusion of which circulation is an indication for thrombectomy
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
Which type of dysphasia describes fluent speech but poor repetition
Conductive dysphasia (affects arcuate fasciculus)
133
What is the clinical presentation of syringomyelia in the upper limbs
Cape-like loss of sensation to temperature (preservation of light touch, proprioception and vibration)
134
Which area of the brain do wernike and korsakoff syndrome affect
Medial thalamus and mammillary bodies of the hypothalamus
135
What is first line treatment for myoclonic seizures
Sodium valproate
136
Which seizure types can carbamazepine exacerbate
Absence and myoclonic seizures
137
What do temporal lesions causes
Wernicke’s aphasia, superior homonymous hemianopia, auditory agnosia, prosopagnosia (difficulty recognising faces)
138
What do frontal lobe lesions cause
Broca’s aphasia, disinhibition, perseveration, anosmia, inability to generate a list
139
What type of aphasia is characterised by normal comprehension, fluent speech but poor repetition and aware of their errors
Conduction aphasia
140
Which aphasia is characterised by word finding difficulties
Anomic aphasia
141
What is the most common complication following meningitis
Sensorineural hearing loss
142
Which drugs are first-line for spasticity in multiple sclerosis
Baclofen, gabapentin
143
What is the first investigation that should be performed in a patient with MS who has bladder dysfunction
US bladder (post-micturition to assess emptying)
144
Which upper limb condition causes pain in the hand that is relieved by shaking the hand
Carpal tunnel syndrome
145
What is seen on examination in carpal tunnel syndrome
Weakness of thumb abduction, wasting of thenar eminence, positive Tinel’s and Phalen’s sign
146
What is second line treatment of myoclonic seizures after valproate
Clonazepam, lamotrigine
147
Which two anti-epileptics can be used as first line for focal seizures
Carbamazepine, lamotrigine
148
Which Parkinson’s plus syndrome typically has cerebellar signs
Multiple system atrophy
149
What should pregnant women taking phenytoin be given in the last month of pregnancy
Vitamin K
150
What is the genetic mutation seen in CADASIL
NOTCH3 mutation on Chr 19
151
Which is more severe - Becker’s or Duchenne’s
Duchenne’s (frameshift deletion)
152
Which condition resembles marfan’s but with mild learning disability, downwards lens dislocation and livedo reticularis
Homocystinuria
153
Which condition occurs days to weeks after cerebral hypoxia and is characterised by intention myoclonus
Lance-Adam’s syndrome
154
What are the risk factors associated with vertebral artery dissection
Spinal manipulation, yoga, ceiling painting, judo, nose blowing, minor neck trauma, fibromuscular dysplasia, chronic headache, female
155
Which condition presents with severe occipital headache, neck pain, brainstem and cerebellar signs after head/neck injury
Vertebral artery dissection
156
Which condition characteristically causes painless muscle weakness of the finger flexors and quadriceps with modest CK rise
Inclusion body myosotis
157
What presents with severe shoulder pain that resolves, followed by progressive upper limb weakness and wasting
Brachial neuritis
158
What is the management of paroxysmal hemicrania
Indomethacin
159
Infarction of which artery is responsible for locked-in syndrome
Basilar artery
160
Which condition is characterised by proximal weakness during the second half of the night, following a day of unusually strenuous exercise
Thyrotoxicosis with hypokalaemic periodic paralysis
161
What is the most appropriate initial investigation for CJD
EEG
162
What is the most common tumour of the middle ear
Glomus jugulare tumour
163
What does meralgia paraesthetica occur due to
Entrapment of the lateral cutaneous nerve of the thigh
164
What triad of symptoms is associated with wernicke korsakoff syndrome
Ataxia, eye movement abnormalities and impaired cognition
165
What is Anton syndrome
Bilateral infarctions of the primary visual cortex (occipital lobes) where patients believe they can see what they cannot
166
Which organism is most likely to cause meningitis from a CSF leak
Gram positive cocci (staph aureus/epidermidis)
167
What is the investigation of choice for vertebral artery dissection
Magnetic resonance angiography
168
Which disease causing meningitis with flaccid paralysis has had an outbreak in New York
West Nile disease
169
What non invasive test is best to diagnose McArdle syndrome
Serum lactate after exercise (will not be raised)
170
What is characteristic on LP in GBS
Raised protein and normal WCC
171
What is Refsum’s disease
Ataxia, hearing loss, retinitis pigmentosa and dry red skin
172
What is the main differential to consider in patients with suspected MND
Multifocal motor neuropathy with conduction block (anti-GM1 Abs)
173
What type of enhancement does cryptococcus meningitis display on MRI
Leptomeningeal enhancement
174
What type of enhancement is seen with CMV meningoencephalitis on MRI
Ependymal enhancement
175
What is an early sign of idiopathic Parkinson’s
REM sleep disorder
176
What feature is often present in LEMS but not MG
Autonomic dysfunction
177
What does a paraganglioma of the inner ear present with
Pulsatile tinnitus + X, XI and XII nerve palsies
178
What is the most rapid diagnostic test in Wilson’s after serum copper and caeruloplasmin
Slit lamp test (KF rings)
179
What is the treatment of spontaneous carotid artery dissection in patients with low bleeding risk
DAPT
180
What is the strongest risk factor for haemorrhagic transformation of ischaemic stroke
NIHSS >15
181
Which condition develops an ‘alien limb’ phenomenon along with rigidity and bradykinesia
Corticobasal degeneration
182
What is the most common form of idiopathic generalised epilepsy in young adults
Juvenile myoclonic epilepsy
183
Which metabolic abnormality can be 3x the upper limit of normal 10-20 mins after a tonic clonic seizure
Hyperprolactinaemia
184
What is the typical management of high grade glioma
Surgical resection with adjuvant post-op RT+chemo
185
What is the treatment of BPPV
Epley manoeuvre
186
Which condition causes ICH and seizures in patients under 40
AV malformation
187
What is the gold standard test for AV malformation
MRI head and angiography
188
Which infectious disease can cause a false positive tensilon test
Botulism
189
What is seen on CT head in PML
Hypodense periventricular lesions
190
Which side has the extensor plantar reflex in Brown-Sequard syndrome
Ipsilateral
191
Which brain lesion can cause a dilated fourth ventricle and hydrocephalus
Cerebellar
192
In 40% of patients negative for ACh receptor Abs, which Ab is positive in MG
Muscle-specific kinase (MuSK) Abs
193
What are the main features of cerebral venous sinus thrombosis
Headache, seizures, focal weakness, papilloedema
194
What is the most appropriate initial investigation for sporadic CJD
MRI brain
195
What are visual evoked potentials used to assess
Optic neuropathy
196
What is the most common cause of tongue deviation
Unilateral hypoglossal nerve palsy - **malignancy**
197
Which condition is associated with an absent delta sign on CT head
Venous sinus thrombosis
198
Which nerve root lesions give rise to pre-ganglionic Horner’s syndrome
C8, T1
199
Which part of the brachial plexus does radiation plexopathy usually affect
Upper brachial plexus
200
What do nerve conduction studies show in MND
Normal studies - used to rule out other treatable conditions e.g. multifocal motor neuropathy
201
What is first line testing for myasthenia gravis
Anti-Ach receptor antibodies
202
What is the treatment of restless leg syndrome
Gabapentin or dopamine agonist (e.g. pramiprexole, ropinirole)
203
Which type of focal epilepsy has localising features of lip smacking and deja vu
Temporal
204
What are the features of focal frontal epilepsy
Motor - head/leg movements, posturing, marching
205
What 4 groups of symptoms are classically seen in sporadic CJD
- myoclonus
- dementia
- ataxia
- psychiatric/behavioural changes
206
What is the best initial test to diagnose MG
Serum Ach receptor Abs
207
What is the BP target in ICH
140 mmHg
208
What blood pressure must be achieved in ischaemic stroke before thrombolysis can be given
< 185/110
209
Which is the only cranial nerve to have contralateral control
CN IV (trochlear) - exits midbrain dorsally then travels ventrally (longest CN in body)
