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Revision > Neurology > Flashcards

Neurology Flashcards

1
Q

Cranial n nucleus

1,2

A

Cerebral cortex

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2
Q

Cranial n nucleus

3,4

A

Midbrain

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3
Q

Cranial n nucleus

5 6 7 8

A

Pons

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4
Q

Cranial n nucleus

9 10 11 12

A

Medulla

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5
Q

Poorly controlled DM + severe leg/thigh pain
Followed by proximal muscle wasting (shoulder, thighs , quadriceps)
Dx?

A

Diabetic amyotrophy

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6
Q

Chronic alcholic + confusion + ataxia + squint
Dx?
Treatment

A

Wernicke’s encephalopathy

Give thiamine IV

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7
Q

Chronic alcoholism c+-CAS+ amnesia + confabulation

A

Korsakoff psychosis

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8
Q

Old man + gait abnormality and dementia like behaviour changes
+- urinary urgency and incontinence
CT shows enlarged ventricles

A

Normal pressure hydrocephalus

“Wet wobbly wacky grandpa”

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9
Q

Old man + gait abnormality and dementia like behaviour changes
+- urinary urgency and incontinence
+ hx of HTN smoking TIA
MRI shoes multiple lacunar infarcts

A

Vascular dementia

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10
Q

Old pt + sexual or inappropriate comments , urinates on sofa
Loss of social interest and acts inappropriately or impulsively
Over eats and struggles with word choices

A

Frontotemporal dementia - Picks disease

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11
Q

Forgetful elderly, easily gets lost and is unable to do simple tasks
Dx?

A

Alzheimer’s

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12
Q

Acute onset behavioural changes + hallucinations

A

Delirium

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13
Q

Old age + bradykinesia + resting tremors + rigidity +postural instability +- expressionless face

A

Parkinson’s

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14
Q

Shy drager syndrome - features

A

Parkinsonism - bradykinesia, ataxia, resting tremors
Urinary incontinence
Erectile dysfunction
+- postural hypotension - frequent falls

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15
Q

Lewy body dementia

A

Parkinsonism
Dementia
Visual hallucinations
+- delusions

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16
Q

Progressive supranuclear palsy

A

Stiff -frozen posture, axial rigidity - falls backwards, shuffling and freezing gait
Restricted downward gaze

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17
Q

Tremors - absent @ rest and don’t resolve with distraction
Dx
Treatment

A

Essential tremors

Give propanolol

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18
Q

Tremors - absent @ rest , resolve with distraction

A

Psychogenic tremors

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19
Q

Intentional tremors + ataxia + dysarthria + nystagmus

Affected part of brain -

A

Cerebellum
=limb ataxia - cerebellar lobe.
= turn all ataxia - cerebellar vermis

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20
Q

Mechanism of Guillain Barre syndrome

Dx?

A

Autoimmune degeneration of myelin sheets
of the PERIPHERAL neurons

Dx - nerve conduction study

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21
Q

Investigation to confirm myasthenia Gravis

A

Serum skeletal muscle nicotine ach receptor antibody

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22
Q

Features similar to MG but + hyperreflexia +ve for upper neutron signs + normal autoimmune panel
Dx?

A

Amyotrophic lateral sclerosis

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23
Q

Motor sensory and reflexes affected + typical loss of pain and temperature (spinothalamic tract affected)
Dx?

A

Syringomyelia

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24
Q

Syringomyelia+ CN involvement - facial palsy

A

Syringobulbia

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25
Q

Ocular condition associated with multiple sclerosis

A

Optic neuritis

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26
Q

Epidural hematoma

- injury to

A

Middle meningeal a.

Often associated with skull fracture
Lucid interval

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27
Q

Chronic subdural hematoma
Features
What imaging modality is diagnostic

A

Usually elderly +- on anticoagulant or alcoholic
Hx of minor fall +- minor head injury
Slow onset of sx
CT - diagnostic
Surgical evacuation - dramatic improvement

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28
Q

Affected vessel in chronic subdural hematoma

A

Bridging vein - Cerebral vein

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29
Q

Most common cause of SAH

A

Cerebral aneurysm

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30
Q

Common associations of SAH

A

Ehler danlos
ADPKD - association berry aneurysm ; SIADH = HypOnatremia
Excessive alcohol intake - important RF

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31
Q

Dx of SAH

A

Ct w/o contrast , if inconclusive

LP - xanthochromia

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32
Q

Management SAH

A

Nimodipine 5-14 day s

= to diminish anticipated cerebral vasospasm

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33
Q

Unilateral dilated pupil

A

Space occupying lesion

- abscess tumour hematoma

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34
Q

Bilaterally constricted pupil

A

Opiate overdose - morphine, heroin

CVA Affecting brainstem

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35
Q

Bilaterally dilated pupils

A

TCA overdose

Cocaine overdose

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36
Q

Crescent shaped hematoma is characteristic for

A

Subdural hematoma

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37
Q

To identify origin/ site of SAH —>

A

Cerebral angio / CT angio

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38
Q

Likely involved blood vessel in subdural haemorrhage

A

Cerebral vein - rupture of bridging vein

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39
Q

CSF findings in bacterial meningitis

A

Low glucose
High proteins
WBCs - mainly neutrophils

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40
Q

CSF findings - viral meningitis

A

Low glucose
Normal/high protein
WBCs- mainly lymphocytes

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41
Q

CSF findings - TB meningitis

A

Low glucose
High protein
WBCS = early - neutrophils ; later - lymphocytes

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42
Q

Organism causing meningitis

A 
Gram + diplococci - s.pneumonia
-ve diplococci - neisseria meningitidis 
Staph aureus 
Gram + bacilli - listeria mono
-ve coccobacilli - h. Influenza
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43
Q

Turbid/purulent CSF + no rash

A
  • strept pneumoniae
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44
Q

Turbid/purulent CSF + rash

A

Neisseria meningitidis

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45
Q

Tension headache
Duration
Prophylaxis
Treatment

A

Around 30 mins , bilateral
Proph - acupuncture
Tx - pain killer

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46
Q

Migraine
Duration
Management

A

4-72 hrs
1. Sumatriptan
= >17 YO - oral , 12-17 = nasal
2. NSAIDs

Combo therapy
- oral sumatriptan + NSAIDs or
Oral sumatriptan + paracetamol

Transcutaneous vagus n stimulation
Avoid triggers

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47
Q

Migraine prophylaxis

A

Beta blockers or topiramate

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48
Q

Cluster headache
Location
Duration
Management

A 
Always unilateral 
15 min - 3 hrs
100% O2 10 -20 mins
Sumatriptan - nasal or subcutaneous 
If 1st time attack - refer to specialist , may require CT
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49
Q

Cluster headache prophylaxis

A

CCB - verapamil

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50
Q

Treatment migraine vs cluster

A

Migraine - oral sumatriptan
= <17 nasal >17 oral
Cluster - nasal / subcutaneous

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51
Q

Fortification spectra

A

More complicated images that can float in your vision
- aura
Migraine

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52
Q

What medications cant be used in acute phase treatment of migraine

A

Topimarate and propanolol

- they are PREVENTATIVE

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53
Q

Multiple sclerosis
Age
Gender

A

Chronic cell mediated autoimmune disorder
- demyelination in CNS
F>M 3:1
20-40 yo
Acute attacks last 1-2 month followed by remission periods

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54
Q

Most common type of multiple sclerosis

A

Relapsing- remitting MS >85%

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55
Q

Features of MS

A

Visual - optic neuritis
Sensory - trigeminal neuralgia, numbness , pins and needles, paresthesia in limbs on neck flexion
Motor - spastic weakness = legs commonly
Cerbellar - ataxia, dysarthria , nystagmus , tremors

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56
Q

MS features

A

Cerebellum + brainstem + transverse myelitis
Cerebellum - ataxia dysarthria , nystagmus
Brainstem - optic problems , facial numbness, ataxia , dysarthria
TM - weakness, spastic quadriparesis/paraparesis , urgency/retention , stiffness , increased tone and brisk reflexes

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57
Q

Definitive dx test of MS

A

MRI _ demyelination, lesions disseminate in time and place

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58
Q

Treatment of MS
Acute
Long term

A

Acute cases - initial or during relapse
= oral or IV methyl prednisolone

Long term = glatiramer acetate or interferon beta

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59
Q

Dizziness/vertigo + hx of viral URTI

A

Vestibular neuritis

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60
Q

Dizziness/vertigo + hearing loss or tinnitus + hx of vital URTI

A

Labryinthitis

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61
Q

Deafness + vertigo+ tinnitus + pressure/fullness in one ear
Dx
Finding on imagine

A

Ménière’s disease

MRI - normal

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62
Q

Deafness + vertigo + tinnitus
+ cranial n palsy + fullness/pressure
Dx?
What imaging to be done ?

A

Acoustic neuroma - vestibular schwannoma

MRI of cerebellar-pontine angle

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63
Q

Treatment of BPPV

A

Epley’s manoeuvre

Mostly resolves spontaneously

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64
Q

What structure does BPPV involve

A

Semicircular canal - usually

Posterior semi-circular canal

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65
Q

Features of wernicke’s encephalopathy

Causes

A

Confusion + ataxia + squint
Chronic alcoholism
Can be caused by hyperemesis gravidarum, stomach ca
= vitamin B1 deficiency

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66
Q

What happens if wernicke’s encephalopathy not treated

A

Can develop wernicke’s korsakoff syndrome = korsakoff psychosis
CAS+ amnesia + confabulation

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67
Q

2ry prevention of ischemic stroke, TIA

A

Control BP , statins - all patients,
Antiplatelet or anticoagulants - depends on presence of AFib
AFIB —> warfarin or DOAC
No AFIB —> clopidogrel 75 mg OD

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68
Q

Ischemic stroke pt - presents <45 hrs

Management

A

Give thrombolytic therapy
= alteplase

Then
Aspirin 300. Mg 2 weeks + clopidogrel 75mg for life

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69
Q

Acute ischemic stroke mgmt

A

Maintain O2 temp and blood glucose
CT scan head
Thrombolytic therapy if in window ; if > 4.5 hrs or time not given just give aspirin 300mg stat
Aspirin + clopidogrel

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70
Q

Broca vs wernicke’s aphasia

A

Broca - inferior frontal lobe - usually left
- broken speech but they undertsand

Wernicke’s - superior temporal lobe - mostly left
- problem w/ speech comprehension , fluent speech

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71
Q

Antiepileptic drugs in pregnancy

  • before pregnancy
  • established pregnancy
A

B4 -
carbamazepine or lamotrigine
+ folic acid 5mg until 12 weeks

Est. - don’t change drug - even if its sodium valproate

If seizure free for >= 2 years - consider stopping antiepileptics

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72
Q

Cauda equina syndrome
Features
Investigation
Mgmt

A 
Saddle paresthesia 
Inability to initiate voiding 
Back pain 
MRI spine - urgent 
Urgent referral to orth / surgical decompression
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73
Q

Commonest cause of cauda equina

A

Central disc prolapse

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74
Q

Parkinson’s disease

  • pathology
  • features
A

Progressive neuro degeneration of dopaminergic neurons in substantia nigra
= low levels of dopamine
Triad - bradykinesia + resting tremors+ rigidity
Asymmetrical

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75
Q

Main drugs in treatment of Parkinson’s
- general
- for tremors and dystonia
3- nocturnal and early morning hypokinesia and rigidity

A

General
- levodopa, co-careldopa, Cabergoline
= dopamine D2 agonists

Tremors + dystonia
- Benzhexol, orphenadrine
(Anti-cholinergics)

3- controlled release preparations

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76
Q

Sudden cessation of. Co-careldopa can cause

A

Akinesia - inability to move muscles voluntarily

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77
Q

What 2 drugs cant be used in Parkinson patients

A

Haloperidol ,

Metoclopramide

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78
Q

Antiemetic used in Parkinson

A

Levomepromazine

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79
Q

Rapid tranquilliser used in Parkinson’s

A

Lorazepam - IM

80
Q

Delirium vs dementia

A 
Delirium - acute w/ fluctuating sx 
Cause - infection , intoxication ,dehydration etc 
It’s reversible 
Hallucinations and mood changes 
Attention/consciousness - impaired

Dementia - chronic, irreversible , hallucination not common except Lewy body - visual , attention and consciousness normals

81
Q

Huntington’s disease

A

Jerky random uncontrolled movement - chorea

Appear b/w ages 35-45 YO

82
Q

Dx of epilepsy

A

2 unprovoked seizures with > 24 hrs apart

83
Q

Initial dx of obstructive sleep apnoea

Most appropriate/ gold standard investigation

A

Pulse oximetry, overnight breathing pattern study

Gold - polysomnography

84
Q

Treatment of OSA

A

Conservative - weight loss, stop alcohol
CPAP
Rarely - surgical

85
Q

Guillian Barre vs Myasthenia Gravis

A

GBS
- weakness, absent or decreased reflexes, often has pain, no fasciculations
Young age , ascending polyneuropathy , happens after trigger - infection

MG -
Fatigue is hallmark, weakness , no pain or fasciculations , tire easily
D features - droopy eyelid (ptosis), diplopia, dysphoni , dysphagia, dysarthria

86
Q

D features of myasthenia gravis (5)

A 
droopy eyelid (ptosis), 
diplopia, 
dysphonia, 
dysphagia, 
dysarthria
87
Q

Mechanism of guillian barre syndrome

A

Autoimmune degeneration of myelin sheets of PERIPHERAL neurons

88
Q

Dx test for guillian barre

A

Nerve conduction study

89
Q

Test to confirm dx of myasthenia gravis

A

Serum skeletal muscle nicotine Ach receptor antibody

90
Q

Bell’s palsy

Features

A

Facial n palsy
Loss of forehead and brow movement,
Inability yo close eyes + drooping lid
Loss of nasolabial fold and drooping lower lip

In severe cases - dysarthria and difficulty eating

91
Q

Cause of Bell’s palsy

Treatment

A

Viral infection

Prednisolone

92
Q

N that inner ages voluntary muscles of face

A

Facial

Muscles of facial expression

93
Q

N that inner ages involuntary muscles of face

A

Trigeminal

Muscles of mastication and cornea

94
Q

Horners syndrome
Cause
Features

A

Unilateral ptosis miosis and anhydrosis

Caused by. Compression of Ipsilateral sympathetic chain

95
Q

Trigeminal neuralgia

Treatment

A

Meds - carbamazepine = 1st line
Other - lamotrigine, phenytoin, Gabapentin

Surgery - micro vascular decompression

*corneal reflexes intact usually

96
Q

Status epilepticus - def

A

Seizure > 5 mins or

2 or more seizures in a 5 min period w/o person returning to normal in between

97
Q

Management of status epilepticus

A

1- 2 separate doses of (10-20 mins in between)
IV lorazepam - if IV access or in hospital or
Buccal midazolam to rectal diazepam - community

  1. IV phenytoin
  2. Refer to ICU - intubation , IV phenobarbital
98
Q

In suspected stroke

  • initial investigation
  • most appropriate investigation
A

Initial - CT brain
Most appropriate - MRI brain

Ataxia and slurred speech - MRI much better than CT ( lesions of posterior fossa)

99
Q

Hakims triad

A

= normal pressure hydrocephalus
GDU
Gait abnormality - ataxia, waddling gait, imbalance walking
Dementia - behavioural and cognitive changes, forgetful
- reversible
Urinary urgency +- incontinence
ELDERLY

100
Q

Dx of normal pressure hydrocephalus

A

Hakims triad + CT/MRI brain
= enlarged lateral and third ventricles

Lumber infusion test ( nitrate cal infusion test) - new NICE option

101
Q

Treatment of NPH

A

CSF shunt

Ventriculoperitoneal or ventriculopleural or ventriculoatrial

102
Q

Epilepsy vs Non -epileptic attack disorder

A

Epilepsy
- genetic factors , lasts < 2mins, eyes open - if closed easy to open manually , tongue biting , drooling, self injury , incontinence, post octal confusion, slow post ictal EEG

NEAD -
> 2 mins, eye closed and difficult to open manually y, hx of child abuse sexual or physical , post ictal EEG normal

103
Q

If in doubt of a NEAD dx what should be done

A

Dx of NEAXD - video EEG

Video EEG can rule out epilepsy in a patient w/ conversion disorder (attacks of inability to talk + no LOC)

104
Q 
Differentiating tremors
Parkinson’s
Essential 
Psychogenic
Cerebellar
A

Parkinsons - present at rest
Essential - absent @ rest , doesn’t resolve w. Distraction
Psychogenic - absent @ rest, resolves w/ distraction
Cerebellar - intentional (tries to touch nose catch something) + other cerebellar features

105
Q

The likely site of mets to brain

A

Diencephalon

- diabetes insipidus (polyuria, polydipsia)

106
Q

Diabetes insipidus vs SIADH

Location

A

DI - diencephalon
= thalamus, hypothalamus, epithalamus, subthalamus and posterior pituitary

SIADH - cerebrum/cerebellum

107
Q

Diabetes insipidus

A

Cranial - hypothalamus
Not enough ADH produced

Nephrogenic - kidneys fail to respond to ADH

108
Q

Bulbar palsy

A

10,11,12, sometimes 7 n disturbance Rather than corticobulbar tracts (LMN)

LMN signs present 
Gag reflex reduced - bovine cough
Nasal speech
Jaw jerk - normal 
Wasted tongue, fasciculations
Signs in limbs 
Normal emotions
109
Q

Pseudobulbar palsy

A 
Degeneration of corticobulbar pathways 
- 5 7 10 11 12 - UMN 
LMN signs absent 
Gag reflex increased/normal 
Spastic tongue 
Increased jaw jerk
Kabila emotions 
Bilateral UMN
110
Q

What is the bulbar area?

A

Cerebellum medulla pons

Responsible for involuntary functions that keep us alive

111
Q

Bovine cough

A

Non explosive cough - someone unable to close glottis
Seen in vagus n (10) lesions
May be associated with dysphonia

112
Q

Webers syndrome

A

MIDBRAIN infarct - PCA block - post cerebral a.

Ipsilateral oculi motor n palsy
- ptosis , mydriasis, deviated outwards downwards

+ contralateral hemiparesis

113
Q

Wallenberg / lateral medullary syndrome

A

PICA block - post inferior cerebellar a

Ipsilateral horners + loss of pain and temp in FACE
+ contralateral loss of pain and temp LIMBS

114
Q

Sx of cerebellar lesion

A

Ataxia
Intentional tremors
Dysarthria
Nystagmus

115
Q

Most appropriate treatment of alcohol withdrawal

A

Chlordiazepoxide i.e benzos

Next add thiamine vit B1

116
Q

Alcohol withdrawal seizures

Treatment

A

IV lorazepam

Or diazepam

117
Q

Drug to promote alcohol abstinence

A

Disulfiram

118
Q

Drug to reduce alcohol craving

A

Acamprosate

119
Q

Weakness + increased reflexes + fasciculations

A

Motor neurone disease

120
Q

Tumour lysis syndrome

A

Raised urate , K+, phosphate
Low Ca ++

After chemo

121
Q

Important side effects of vincristine (chemo)

A

Chemo induced peripheral neuropathy

SIADH - dilutional hyponatremia

122
Q

Fever + low neutrophils after chemo

A

Febrile neutropenia

Immediate IV ABx

123
Q

Stroke of cerebellum/brainstem

Site :

A

Posterior circulation

- do MRI head

124
Q

Cavernous sinus thrombosis

Features

A 
Chemosis - conjunctival oedema
Proptosis
6th CN palsy - diplopia on lateral gaze
Pain over medial canthus
Severe headache , fever chills hx of sinusitis
125
Q

Pick’s disease

Features

A

Frontotemporal dementia

Disinhibition - frontal lobe 
Struggles w/ word choices - temporal lobe
Disengagement 
Inappropriate/impulsive 
Personality and behaviour changes
Neglects personal hygiene
126
Q

What is characteristic of picks disease

A

Focal gyral atrophy w/ knife blade appearance

Macroscopic changes - atrophy of frontal and temporal lobes

127
Q

Contralateral paralysis + sensory loss (face + arm)
+ Ipsilateral gaze preference
What is affected?

A

Middle cerebra a. - supplies lateral hemisphere

Other features
Aphasia
Homonymous hemianopia

128
Q

What does middle cerebra a. Supply?

A

Lateral part of hemisphere

129
Q

Anterior cerebral a. Supplies

A

Frontal and medial cerebrum

130
Q

Occipital lobe supplied by

A

Posterior cerebral a.

131
Q

Basilar a. Supplies

A

Cerebellum
Brainstem
Occipital

132
Q

Strongest genetic RF for Alzheimer’s

A

APOEE e$ gene

133
Q

Features of Alzheimer’s

A

Elderly
Short term memory loss

After some time - confusion, inability to make decisions, progressive language deficits

Late - disorientation , behavioural changes , death

134
Q

Dx of Alzheimer’s

A

MRI
Single photon emission CT - differentiates from FTD
MMSE - assess cognitive impairment

135
Q

MMSE score

A

25-30 normal
21-24 mild
10-29 moderate
<10 - severe

136
Q

Management of Alzheimer’s

A

Ruvastigmine - 1st line ( mild to mod)
Others - donepezil, galantamine

2nd line
Memantine - NMDA receptor antagonist
Or in severe cases
Suitable for patients with bradycardia , heart block

137
Q

Best advice for mechanical lower back pain

A

Continue or increase mobilisation

Regular analgesia

138
Q

Back pain elicited after repeated contraction

Relieved my movement and changing position

A

Myofascial pain syndrome

139
Q

Parkinsonism + erectile dysfunction + postural hypotension

A

Shy drager syndrome

140
Q

Lewy body dementia
Features
Imaging

A

Dementia
Fluctuating levels of awareness
Mild Parkinsonism
Visual hallucination**

Imaging - MRI brain

141
Q

Presentation similar to myasthenia gravis but w/ increased reflexes (+UMN) + normal autoimmune panel

A

Amyotrophic lateral sclerosis = motor neurone disease

  • MG has normal reflexes , assoc with autoimmune
142
Q

Lambert Eaton syndrome

A

Associated with tumours - e.g lung ca
Same as MG but -
Reflexes absent , elicited after excercise
Increased strength/power of weak muscles after repeating test

143
Q

Syringomyelia

A

Loss of pain and temp

Motor sensory reflexes all affected

144
Q

Syringobulbia

A

Syringomyelia + CN involvement

Syrinx extends to involve brainstem

145
Q

Organic brain damage

Features

A

Memory loss
Agitation
Confusion

146
Q

Willis Ekbom syndrome

What should be done

A

Restless leg syndrome
Check iron - ferritin low - give supplements
If normal -
give dopamine agonist = Ropinirole pramipexole rotigotine
Or Gabapentin , pregabalin

Lifestyle change usually enough - alcohol smoking caffeine sleep etc

147
Q

Dopamine agonist

A

Ropinirole
Pramipexole
Rotigotine

148
Q

Dementia vs depressive pseudodementia

A

Dementia
= progressive , long term sx , mood variations , concealing amnesia , tries to answer questions

Pseudo =
rapid onset, short term sx, consistently depressed mood , short answer negativism, highlight amnesia, fluctuating cognitive impairment

149
Q

Normal grief response

A

Stage 1 - hrs to days
= denial disbelief numbness

Stage 2 - wks - 6 mo
Sadness, grief, hallucination , social withdrawal, guilt etc

Stage 3 - wks to months
Symptoms resolve
Social activities resumed
Memories of good times

Denial & isolation - anger - depression - bargaining - acceptance

150
Q

Inattention/neglect in one side + seizure + neurological deficit
Think of

A

Space occupying lesion - tumour abscess

It’s a feature of parietal lobe lesion

151
Q

Lucid intervals seen in

A

Epidural / extramural hgx

= middle meningeal a.

152
Q

Cervical spondylosis

A

Limited + painful neck movement

Occipital headaches

153
Q

Treatment of absence seizure

A

Sodium valproate

154
Q

Intracranial tumour mgmt

A

High dose dexa - shrink mass
GCS <8 - give mannitol (rapid action)

Intracranial hgx + very low GCS - urgent craniotomy

155
Q 
Sensory n roots 
L1
L2
L3
L4 
L5
S1
A 
L1 - groin , pelvic girdle 
L2 - anterior thigh 
L3 - inner medial thigh and distal anterior thigh 
L4 - inner medial shin 
L5 - lateral shin and dorsum of foot
S1 - lateral foot
156
Q

Amaurosis fugax
Cause
Features

A

Transient occlusion of central retinal a.
Painless temporary unilateral recurrent loss of vision
5-15 mins , resolves in <24 hrs

157
Q

RF of amaurosis fugax

A

Atherosclerosis (neck bruit)
HTN
Giant cell arteritis

158
Q

Tia vs amaurosis fugax

A

TIA - emboli from heart

AF - emboli from internal carotid

159
Q

Medication absolutely CI in migraine w/ aura

A

COCP - increased risk of cardiovascular accident

Best contraception to use - copper IUD

160
Q

Treatment Ménière’s

A

Buccal or IM - prochlorperazine

161
Q

NF 1

  • features
  • association
A

Presents more with skin lesions - cafe au lait
Axillary/ groin freckles, iris hamartoma, scoliosis
Assoc w/ pheochromocytoma

162
Q

NF2

A

CNS tumours

Bilateral acoustic neuroma , schwannoma, meningioma

163
Q

Definitive diagnosis for multiple sclerosis

A

MRI spinal cord and brain

= demyelination , lesions disseminated in time and place

164
Q

Treatment of acute multiple sclerosis

A

IV methylprednisolone

165
Q

Myasthenia gravis association

A

Thyrotoxicosis

166
Q

Lambert Eaton syndrome association

A

Tumours - small cell lung ca

167
Q

Best next modality in TIA

A

Carotid doppler scanning

168
Q

When should carotid endarterectomy

A

Internal carotid a. Stenosis >/= 50% in men

>/= 70% women

169
Q

Rapid correction of hypernatremia can cause

A

Cerebral oedema

170
Q

Suspected meningitis
W/ rash -
W/o rash
Investigation

A

Rash - blood culture

No rash - LP

171
Q

TIA

Driving advice

A

Stop driving at least 1 month
Stop lorry or bus driving 1 year

Inform DVLA if multiple TIA in car driver, 1 TIA in bus/lorry driver

172
Q

Seizure

Driving advice

A

1 year of being seizure free - car driver

5 years seizure free - lorry driver

173
Q

Acute subdural vs SAH

A

Acute subdural - hx of trauma, rapid deterioration

SAH - thunderclap

174
Q

Supranuclear palsy

Features

A

Stiff frozen posture
Axial rigidity
Falling backwards, shuffling freeing gait
Restricted downward gaze

175
Q 
Diabetic amytrophy (proximal diabetic neuropathy)
Features
A

Complication of poorly controlled DM
Severe thigh or leg pain —> proximal muscle wasting (shoulders thighs pelvic girdle )

Usually resolve within months
Good DM control is a must

176
Q

Vascular is neuropathy vs diabetic amyotrophy

A

Similar presentation but w/ raised ESR = vasculitis

177
Q

Treatment of neuropathic pain in diabetics

A

Amytriptiline - 1st line

Or Gabapentin Duloxetine or pregabalin

178
Q

Treatment of trigeminal neuralgia

A

Anticonvulsant - carbamazepine

Others - lamotrigine phenytoin Gabapentin

179
Q

Vascular dementia

Features

A

Dementia +
Hx of HTN smoking TIAs
MRI - multiple lacunar old infarcts

180
Q

Treatment Bell’s palsy

A

High dose prednisolone - 10 days

181
Q

Treatment of Ramsay hunt syndrome

A

Acyclovir

182
Q

Types of spina bifida

A

Occulta - mild. = hairy patch, dimple , dark spot or swelling
Meningocele - sac of fluid
Myelomeningocele - severe “ open spina bifida”
-poor ability to walk , impaired bladder or bowel control , hydrocephalus
-tethered spinal cord and latex allergy

183
Q

Prevention of spina bifida

A

Folic acid during pregnancy

184
Q

Healed UTI w/ persistent high bladder pressure and urinary retention
Management

A

Intermittent self catheterisation

If ongoing UTI - urinary incontinence pads preferred

185
Q

Folic acid in pregnancy

A

0.4 mg / 400ug 1/day for 12 weeks

5mg /day 12 weeks if :
DM , BMI >30 , on antiepileptics, FHx of NTD , prev pregnancy w/ NTD

5 mg whole pregnancy
SCD, thalassemia

186
Q

TIA site of lesion

  • leg
  • face and arms
  • vision and language
A

Leg = anterior communicating a.
Face and arms = middle cerebral artery
Vision and language - posterior cerebral a.

187
Q

Gerstmann syndrome

A

Inability to designate or name different fingers of both hands - finger agnostic
Confusion of R/L side of body
Dyscalculia
Dysgraphia

Word blindness , homonymous hemianopia, lower quandrantopia

188
Q

Lesion in Gerstmann syndrome

A

Inferior parietal lobe - angular gurus pr subjacent white matter of left hemisphere

189
Q

Vessels involved in subdural and epidural hematoma

A

SDH - bridging veins

EDH - middle meningeal a.

190
Q

Acute delirium causes

A

Hyponatremia
Infection, Alcohol withdrawal ,acute MI
Head injury ,DM , thyrotoxicosis

191
Q

Transverse myelitis

Features

A 
Weakness
Spastic quadripartite or paraparesis
Urgency/tension 
Stiffness
Increased tone + brisk reflexes
192
Q

Idiopathic cranial hypertension

Features

A

Bilateral throbbing headache
Assoc w/ nausea vomiting , tinnitus , visual disturbance
Occurs daily, worse in morning
Improves with standing

Obesity is RFv

193
Q

When does Parkinson’s disease dementia occur

A

More than a year after dx of parkinsons

194
Q

Side effects of co-careldopa

A

Dyskinesia
+- Hallucinations
Focal tremors

195
Q

Migraine w/ aura vs stroke/TIA

A

Migraine - gradual onset, word salad , mainly visual sx

Stroke/TIA - sudden , temporary loss of vision , dysarthria

196
Q

Safest anti-epileptic in pregnancy

A

Lamotrigine

Carbamazepine

197
Q

Hoover’s sign

A

Dx of functional weakness of LL

+ve = pt supine , flexion of weak hip against resistance is NOT followed by extension of other normal hip

Normal people or organic cause - flexion of weak hip against resistance - followed by extension of other normal hip
(-ve hoover sign)

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