Neurology Flashcards
Which drugs are used in the acute treatment of migraine?
Simple analgesia +/- triptan
Give 2 examples of first-line preventative agents for migraine.
Topiramate and propanolol
Which agents can be used in the acute treatment of cluster headache?
High-flow oxygen and triptans
Which agent may be used to prevent attacks of cluster headache?
Verapamil
What are the mainstays of treatment for idiopathic intracranial hypertension?
Weight loss, acetazolamide, diuretics, therapeutic LPs
What is the first-line treatment for trigeminal neuralgia?
Carbamazepine
What is the gold-standard test in suspected SOL?
MRI brain
What is the first-line treatment for PD?
Levo-dopa (with dopa decarboxylase inhibitor)
Give causes of a postural tremor.
Essential tremor, anxiety, thyrotoxicosis, physiological
Chorea weeks to months after Group A strep infection is…
Syndenham chorea
Parkinsonism + Autonomic Disturbance suggests…
Multi-System Atrophy
What is the investigation of choice for narcolepsy?
multiple sleep latency EEG
Defective downward gaze and vertical diplopia suggests damage to…
CN IV
What is the first-line drug for Myasthenia Gravis?
Pyridostigmine
Weakness that improves with exercise suggests…
Lambert-Eaton Syndrome
Which myotome is shoulder abduction?
C5
Which myotome is elbow flexion and wrist extension?
C6
Which myotome is elbow extension and wrist flexion?
C7
Which myotome is finger abduction?
T1
Which myotome is hip flexion?
L1,2
Which myotome is big toe extension?
L5
Which myotome is ankle plantarflexion?
S1
Which myotome is knee flexion?
S2
What are the main ascending and descending spinal tracts?
Ascending - DCML and Spinothalamic
Descending - corticospinal
The DCML is responsible for which senses?
Fine touch and proprioception
The spinothalamic tract is responsible for which sensations?
Pain and temperature
Where does the DCML decussate?
Medulla oblongata
Where does the spinothalamic tract decussate?
Within a few spinal levels
Where does the corticospinal tract decussate?
90% of fibres decussate at the medulla → lateral corticospinal tract
What are the first-line agents for MS?
Beta interferons and glatiramer acetate
What is the time limit for thrombolysis in stroke?
4.5 hours
How could you differentiate between epileptic seizures and non-epileptic attacks?
Epileptic seizures same every time, NEAs often fluctuate
Which features would make you more suspicious of a functional neurological disorder?
- Fluctuating
- Explosive onset without any identifiable cause eg. Infarct/bleed
- If involving both sides but aware
How are functional neurological disorders managed?
o Treating precipitating factors eg. Migraine, postural drop
o Neuropsychology input
What causes the tonic phase of an epileptic seizure?
Surge of excitatory energy firing of corticospinal tracts
Which medication should be given for secondary prevention of stroke/TIA?
Clopidogrel
Falls early in Parkinson’s may suggest…
Parkinson’s plus syndrome
Painful third nerve palsy suggests…
PCA aneurysm
What are the 3 signs of an anterior circulatory stroke?
unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
homonymous hemianopia
higher cognitive dysfunction e.g. dysphasia
What should be given in status epilepticus if not responding to BZDs?
Phenytoin
Carotid endarterectomy is considered in which patients with TIA?
> 70% plaque
Which imaging allows for best visualisation of demyelinating lesions?
MRI with contrast
rapid onset dementia and myoclonus suggests…
CJD
Patient slow to release when shaking hand suggests…
Myotonia
How is myotonic dystrophy inherited?
AD
How are Duchenne and Muscular Dystrophies inherited?
X-linked recessive
What is the pathophysiology of Myasthenia Gravis?
Autoimmune - autoantibodies to Acetylcholine Receptor
How could you differentiate Myasthenia Gravis from Lambert-Eaton Myasthenic Syndrome?
MG worsens with exertion, LEMS gets better with exertion
Which malignancy is associated with Lambert–Eaton myasthenic syndrome?
Small cell lung cancer
Give causes of a resting tremor.
Parkinsonism - may be PD, Parkinson’s plus or drug-induced
What is meant by a postural tremor?
Seen when the muscles are working against gravity when, e.g. hands are held outstretched
Give causes of postural tremor.
Essential Tremor, Thyrotoxicosis, Physiological, Anxiety
Which treatments may be effective in Essential Tremor?
Beta-blockers, Intractable cases: Deep brain stimulation/thalotomy
What is the investigation of choice for brain mets?
MRI brain
What is the treatment for meningitis?
Ceftriaxone + Dexamethasone
Add Amoxicillin if > 60 or immunocompromised
Hypsarrhythmia on EEG suggests…
Infantile spasms
Which drug may extend life in MND?
Riluzole
What are the treatment options for lewy body dementia?
Acetylcholinesterase inhibitors
Levo-dopa for motor symptoms
Which medications may be of benefit in frontotemporal dementia?
SSRIs to reduce loss of inhibition etc
Psychotics rarely
What is the imaging of choice for Alzheimer’s disease?
SPECT
Accumulation of which protein is associated with Alzheimer’s dementia?
Amyloid
Accumulation of which protein causes FTD?
Tau
Which biomarker indicates recent seizure?
Prolactin
What are the ‘red flag’ features of headaches?
Worse in the morning Exacerbated by valsalva Immuno-suppressed Known/previous malignancy New onset > 55 yo
Which type of headache has an absolute response to indomethacin?
Paroxysmal hemicrania
What are the first-line agents for generalised tonic-clonic seizures?
Na Valproate (male), Lamotrigine (female)
What is the first-line agent for focal seizures?
Carbamazepine
What are the first-line agents for absence seizures?
Na Valproate & ethusuxomide
Lip smacking + post-ictal dysphasia suggest a focal seizure in which lobe?
Temporal lobe
Which anti-epileptics are enzyme inducers?
Carbamazepine, Phenytoin & Topiramate
What are the contraceptive options for women on enzyme-inducing anti-epileptics?
Depo-Provera, IUD, IUS
What is the guidance about stopping anti-epileptic drugs?
Can be stopped over 2-3 months if seizure-free for 2 years
Are anti-epileptic drugs safe in breastfeeding?
Yes
Limb movements with post-ictal weakness suggests…
Frontal lobe seizures
Which diet is most likely to be effective in epilepsy?
Ketogenic diet
What are the emergency contraceptive options for women taking enzyme-inducing AEDs?
Copper IUD or double dose levonestrogel
Sudden weakness during strong emotions suggests…
Cataplexy
What is the usual time limit for thrombolysis?
4.5 hours
What are the indications for thrombectomy?
proximal anterior circulation occlusion - within 6 hours or 6-24 hours if imaging shows brain tissue could be salvaged
Give 3 features of an anterior circulatory stroke.
Unilateral weakness
Homonymous Hemianopia
Cerebral dysfunction including dysphasia
What is meant by a ‘lacunar’ stroke?
One of:
Sensory or motor only
Sensory-motor symptoms only
Ataxic hemiparesis
Give features of posterior circulation stroke.
CN palsy
Bilateral sensory/motor deficit
Cerebellar dysfunction
Isolated homonymous hemianopia/cortical blindness
LP low gluocse and high protein suggests…
Bacterial meningitis
LP normal glucose and high protein suggests…
Viral meningitis
What is the key CSF feature in TB meningitis?
High protein
Which CNs may be affected by vestibular schwannoma?
CN V, VII or VIII
Which features are now needed for a diagnosis of TIA?
Resolved symptoms AND no acute infarction on imaging
Which myotome is knee extension?
L4
Which dermatome is the thumb?
C6
Which dermatome is the middle finger?
C7
Which dermatome is the pinky finger?
C8
Which nerve roots are tested in the biceps jerk?
C5,6
Which nerve roots are tested in the brachioradialis reflex?
C5, 6
Which nerve roots are tested in the triceps jerk?
C6, 7
Which nerve roots are tested in the patellar reflex?
L3, 4
Which nerve roots are tested in the ankle reflex?
S1, 2
What are the red flags in back pain?
TUNA FISH Thoracic pain Unexplained weight loss Neurological symptoms Age > 50 Fever IVDU Steroid use History of cancer
