Neurology Flashcards
CN3 lesion
Eye movement ‘down and out’
Ptosis and fixed dilated pupil with absent light reflex
Left homonymous hemianopia
Visual field defect to the left
Lesion of the right optic tract
Homonymous quadrantanopias
PITS
parietal inferior, temporal superior
Incongruous defects
Optic tract lesion
Congruous defects
Optic radiation lesion or occipital cortex
CN4 lesion
Defective downward gaze and vertical diplopia
CN6 palsy
Defective eye abduction and horizontal diplopia
Lorazepam TWICE?
Investigation for progressively worsening headache with impaired higher cognitive function
Urgent imaging required
Imaging to view demyelinating lesions
MRI with contrast
Management of brain abcess
IV 3rd generation cephalosporin + metronidazole
CN5 lesion
Loss of corneal reflex
What is hoover’s sign
Differentiates between organic and non-organic lower leg weakness (a sign of leg paresis)
What is Romberg’s test
Investigates the cause of ataxia (+ve = sensory)
What must you do before giving aspirin
Exclude a haemorrhagic stroke
Bitemporal hemianopia
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
What movements are spared in motor neurone disease
Eye movebments
Tetrad of neuroleptic malignant syndrome
Hyperthermia, muscle rigidity, autonomic instability, altered mental status
(often when started on anti-psychotic medication)
Describe the tremor seen in Parkinsons
Unilateral tremor that improves with voluntary movement
First step in the management of obese patients with idiopathic intracranial hypertension
Weight loss
Management of autonomic dysreflexia
Removal/control of the stimulus and treatment of any life-threatening hypertension and/or bradycardia
What anaesthetic agent is contraindicated in myasthenia gravia
Suxamethonium
Give 2 localising features of a temporal lobe seizure
Lip smacking
Post ictal dysphasia
(plucking of clothes)
Treatment of patients with raised ICP
IV mannitol
What nerve is affected if there is weakness of foot dorsiflexion and foot eversion
Common peroneal nerve
3 features of normal pressure hydrocephalus
Urinary incontinence
Gait abnormality
Dementia
Obese young female with headaches and blurred vision
Think idiopathic intracranial hypertension
Most common hereditary sensorimotor neuropathy
Charcot-Marie-Tooth Disease
Treatment of acute migraine
Treatment of migraine prophylaxis
Acute: Triptan + NSAID + paracetamol
Prophylaxis: Topiramate or propanolol
(propanolol preferred in women of childbearing age)
Investigation of choice for narcolepsy
Multiple sleep latency EEG
3 features of normal pressure hydrocephalus
Urinary incontinence + gait abnormality + dementia
1st line drug in the management of ocular myasthenia gravis
Pyridostigmine
3 drugs which exacerbate Parkinson’s
Cyclizine
Prochlorperazine (antihistamines)
Metoclopramide
Anti-emetic used in parkinsons
Domperidone
MOA of sodium valproate
Inhibition of the P450 system
What does myaesthenia gravis show on an EEG
A diminished response to repetitive stimulation
How would you treat a patient with an acute ischaemic stroke who present within 4.5 hours
A combination of thrombolysis and thrombectomy
What scale measures disability or dependence in ADL in stroke patients
The Barthel index
5 most common places for brain tumours to metastasise
Lung Breast Kidney Melanoma Colorectal cancers
Presentation of syringomyelia
Cape-like loss of pain and temperature sensation due to compression of the spinothalamic tract fibres decussating in the anterior white commissure of the spine
What is neuroleptic malignant syndrome and what is it treated with
Life threatening reaction that can occur in response to antipsychotic medication
Treated with bromocriptine (dopamine agonist)
MOA of pydridostigmine and what is it used for
Long acting acetylcholinesterase inhibitor that reduces the breakdown of acetylcholine in the neuromuscular junction
Temporarily improves the symptoms of mysesthenia gravis
Difficulty swallowing is a feature of what neurological condition
Myaesthenia Gravis
Myaesthenia Gravis VS Lambert Eaton
Same but lambert eaton with LUNG CANCER
GCS
Eye Very Much (want to die)
Eye = 4
Verbal = 5
Motor = 6
Head CT showing temporal lobe changes
Herpes simplex encephalitis
CT scan in meningitis
Often unremarkable
CT scan in HIV encephalitis
Changes to white matter and basal ganglia
Presentation of Creutzfeldt-Jakob disease
4 months of general neuro dysfunction
Time target for thrombolysis and thrombectomy
Thrombolysis: 4 hrs
Thrombectomy: 6 hrs
Management if a patient was not suitable for thrombolysis or thrombectomy
Aspirin
Painful third nerve palsy
Posterior communicating artery aneurysm
What medications are associated with idiopathic intracranial hypertension
tetracycline antibiotics isotretinoin contraceptives steroids levothyroxine lithium cimetidine
Diagnostic test for Guillain-Barre
Lumbar Puncture
Young person presenting with a stroke, what investigations must be done to rule out the cause
Thrombophilia and autoimmune screening
What is a holter analysis
Records the hearts rhythm
Most common complication following meningitis
Sensioneural hearing loss
First line treatment for parkinsons (newly diagnosed)
Levodopoa
4 features of progressive supranuclear palsy
Postural instability
Impairment of vertical gaze
Parkinsonism
Frontal lobe dysfunction
Hallmark of myasthenia gravis
Fatiguable painless muscle weakness that improves with rest
Tuberous sclerosis skin presentation
Roughened patches of skin over lumbar spine (shagreen patches)
Laughter followed by fall/collapse
Cataplexy
MRC scale
5: normal
4: against gravity and resistance
3: against gravity
2: gravity eliminated
1: flicker
0: nothing
Management of a medication overuse headache
Simple analgesia: stop
Opioid: withdraw gradually
Classic organism for guillian-barre
Campylobacter
5 features of wernicke’s encephalopathy
nystagmus (the most common ocular sign) ophthalmoplegia ataxia confusion, altered GCS peripheral sensory neuropathy
Wernicke vs Korsakoff
Amnesia and confabulation develop in korsakoff
What is Brown Sequard syndrome the result of
Lateral hemisection of the spinal cord
Frontal lobe seizure
Motor symptoms such as jerking of the limb
Parietal lobe seizure
Paraesthesia
Temporal lobe seizures
Automatisms and hallucinations
De-ja-vu and aura
Occipital lobe seizure
Visual disturbance
Brainstem seizure
Very rare and not well researched
Fracture with wrist in a flexed position with weakness to extension noted on examination
Left mid shaft humeral fracture
Cause of postural hypotension in a patient with parkinsons
The parkinsons
Characteristic of pseudoseizures
Gradual onset
Patient with Bell’s Palsy
No sign of improvement after 3 weeks
Refer urgently to ENT
How long can Bell’s palsy take to recover
12 months
3 features of broca’s dysphagia
speech no fluent, comprehension normal, repetition impaired
Smiths fracture with loss of thumb opposition
Median nerve
Armpit sensation lost during axillary node dissection
Intercostobrachial
Supracondylar fracture gives a weak radial pulse and loss of pronation
Median
Where is broca’s area and what is its blood supply
Middle cerebral artery
It is often in the dominant hemispehre (often left) in the inferior frontal gyrus
Diet in epilepsy
Ketogenic
Which parkinson medication increases inhibition disorders e.g. gambling
Dopamine receptor agonists e.g. Ropinirole
Vertical diplopia - nerve lesion
Trochlear
Aspirin prescription after stroke
high dose (300mg) for 14 days then switch to clopidogrel
Medication that worsens myasthenia
Bisoprolol
Nail bed of the index finger - nerve sensation
Median
First step in managing raised ICP
Elevating the head of the bed to 30 degrees
Acoustic neuromas
- presentation
- management
hearing loss and ringing in the ear
MRI of cerebellopontine angle
Tracts affected (and sx) in subacute combined degeneration of the cord (B12)
Loss of proprioception and vibration sensation, muscle weakness and hyperreflexia
Dorsal columns and lateral corticospinal tracts affected
Conduction aphasia
Speech fluent but repetition poor
Comprehension is relatively intact
Parkinsons with automonomc disturbance (atonic bladder, postural hypotension, erectile dysfunction)
Multiple system atrophy
Medications that can cause a megaloblastic anaemia
hydroxyurea, methotrexate, zidovudine, azathioprine, antiretroviral agents, valproic acid, and phenytoin
Mid-shaft humeral fracture
Test the nerve
Extend the wrist (radial nerve injury)
NICE HEAD CT
Clonic movements travelling up the arm indicates a seizure in what area of the brain
Frontal lobe (jacksonian march) A type of focal aware seizure
GCS below 8 - management
Intubate and ventilate
Most common type of MS
Relapsing remitting
Carotid bruit investigation
Duplex ultrasound (diagnosis of stenosis)
Gold standard investigation for cervical myelopathy
MRI cervical spine
STROKE CLASSIFICATION
What nerve is damaged in a colles fracture
Median
First line treatment of wernickes
Pabrinex IV
Parkinsons symptoms with a symmetrical tremor
NOT idiopathic parkinsons
Drug induced or other cause
Malignancy associated with myasthenia
Thymoma
Most common trigger for cluster headaches
Alcohol
Ptosis and dilated pupil
Ptosis and constricted pupil
Dilated: CN3 palsy
Constricted: Horners
Post RTA patient with extremely high blood pressure, flushing and sweating
Autonomic dysreflexia
Side effect of carbemazapine
Steven Johnson syndrome
Painful erythematous macules evolving to target lesions with mucosal ulceration
First line treatment for trigemninal neuralgia
Carbamazepine
Electric shock pains across the face that worsen when touching the skin
Trigeminal neuralgia
Investigation for vestibular schwannoma
Audiogram and MRI head (gadolinium enhanced)
What is mononeuritis multiplex
painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas
Treatment of guillian-barre
IV immunoglobulin
Biceps reflex nerve root
Triceps reflex nerve root
Biceps: C5-C6
Triceps: C7-C8
Fine tremor in middle aged woman losing weight
Thyrotoxicosis
28 year old with a fine tremor with FHx
Essential tremor
Lateral medullary syndrome signs
PICA lesion
Cerebellar signs
Contralateral sensory loss
Ipsilateral Horners
Side effects of phenytoin
Teratogenic
CYP450 interactions
Loads of adverse effects - if in doubt put phenytoin
Parkinsons drug with reduced effectiveness over time
Levodopa
Parkinsons drug associated with pulmonary fibrosis
Cebergoline
Parkinsons drug useful for managing tremor in drug-induced parkinsons
Procyclidine
Treatment of paroxysmal hemicrania
Indomethacin
Completely responsive
What is paroxysmal hemicrani
Severe attacks of unilateral headaches in the orbital or temporal region
Investigation for optic neuritis
MRI head with contrast as gold standard for MS
Where is the chemoreceptor trigger zone
Medulla
Stroke - CT with or without contrast
WITHOUT
What is the cushing reflex
Physiological nervous system response to ICP that results in hypertension and bradycardia
Bad sign
Autonomic dysreflexia
Faecal impaction and urinary retention are the most common triggers
Hypertension, bradycardia and sympathetic overdrive
Often after a spinal cord injury
Bedside test for CSF
Glucose
Third nerve palsy same or opposite side
Same side
Arnold-Chiari malformation - 2 associations
Cause of congenital hydrocephalus
Syringomyelia
Contraindication for triptans
Ischaemic heart disease
CSF of patients with MS
Oligoclonal bands
First line for spasticity in MS
Baclofen and gabapentin
Syringiomyelia is associated with RA
Management of MS acute relapse
Oral steroids e.g. methylprednisolone
CT aneurysm that does and does not cross suture lines
Does cross suture lines: subdural
Doesn’t cross suture lines: extradural
Chronic subdural on CT
Hypodense (dark)
Gold standard for venous sinus thrombosis
also wtf is it
MR venogram
Severe headache with stroke like sx in woman with DVT FHx and COCP
Which type of neurofibromatosis has vestibular schwannomas
Type 2
What is controlled hyperventilation and when is it used
In patients with raised ICP
Reduced blood CO2 to induce cerebral vasoconstriction
Where is broca’s area
Frontal lobe
Only opioid appropriate to consider in neuropathic pain
Tramadol
Pituitary apoplexy management (from pituitary adenoma)
Urgent steroids
Blood test to differentiate true seizures and pseudoseizure
Prolactin
Prophylaxis of cluster headaches
Verapamil
Cause of gait ataxia
Lesion in cerebellar vermis
Condition associated with subungual fibromatoma
Tuberus sclerosis
Inheritance of charcot marie tooth
autosomal dominant
Side effect of triptans
Tightness of the throat and chest
RTA need to intubate - with what
Cuffed endotracheal tube
Eye defect in primary open angle glaucoma
Unilateral peripheral visual field loss
Stroke with right sided hemiplegia, where is the eye defect
Right
Unilateral deafness or tinnitus
Acoustic neuroma
What is hyperacusis and what condition is it found in
Noises sound louder than usual
Bell’s Palsy
Bell’s palsy - is there a sensory deficit
NO!
When would you perform carotid endardectomy
If stenosis greater than 70%
Adult seizure - medication at 5 imnutes
Rectal diazepam
Weakened dorsiflexion, inversion and eversion of the ankle
L5 nerve lesion
Which nerves are affected in vestibular schwannoma
Cranial nerves V, VII, VIII
Clinical picture if parkinsons drugs are withheld
Stiffness, tachycardia, pyrexia, elevated creatinine kinase
4 features of vestibular schwannoma
vertigo, hearing loss, tinnitus and an absent corneal reflex
Fasciculations in older man
Motor neurone
Treatment of low phosphate in adults
IV infusion
Vessel damaged in a subdural haematoma
Bridging veins between cortex and venous sinus
TIA secondary prevention
Clopidogrel only
Aspirin is used as first line treatment and if clopidogrel or other antiplatelets are contraindicated
Main feature of syringomyelia
Spinothalamic sensory loss (pain and temeprature)
Which nerve is most often affected in raised ICP
Abducens due to its long course
Vessel damaged in an extra dural haematoma
Middle meningeal artery
Vessel injured in a subarachnoid
berry aneurysm
RF for subdural haemorrhage
Elderly and alcoholics
Visual field defects (good luck lol)
left homonymous hemianopia means visual field defect to the left, i.e. lesion of right optic tract
homonymous quadrantanopias: PITS (Parietal-Inferior, Temporal-Superior)
incongruous defects = optic tract lesion; congruous defects= optic radiation lesion or occipital cortex
When assessing GCS take the best response
e.g. left flexes, right extends, take the felxion
What does refractory to treatment mean
Does not respond to treatment
What dementia is associated with MND
Frontotemporal
Treatment of bells palsy
Prescribe prednisolone
Forehead spared in….
STROKE
Parkinsons drugs at increased risk of gambling
Dopamine agonists e.g. bromocriptine
Xray for assessing degenerative cervical myelopathy?
No
DVLA guidelines on seizures
6 month break after first seizure
5 year ban if bus or lorry driver
Management of status epilepticus if patient has a cannula
IV lorazepam
Brain abscess on CT
collection of pus encapsulated by a pyogenic membrane
Shingles first line for nerve pain
Amitriptyline (or duloxetine, gabapentin or pregabalin)
Investigation for myasthenia gravis
Antibody screen
Extradural haemorrhage shape on CT
Biconvex
What gait is this?
Wide based gait with loss of heel to toe walking
Ataxic gait
Isolated rise in protein level in CSF
Indicative of GBS
Lambert eaton or myasthenia gravis
Lambert improves after exercise
Myasthenia worsens
Migraine in children
Avoid prokinetic agents e.g. metoclopramide
What is the typical aura in migraine
Spreading scintillating scotoa (jagged crescent)
Essential tremor
On intention
often in the hands
affects the vocal cords
Progressively worsening headache with higher cognitive dysfunction
Urgent imaging
TIA - specialist review within?
24 hours
fall soon after a parkinsons diagnosis
Assess cranial nerves for other diangosisi e.g. Parkinsons +
Medication for chemotherapy induced nausea and vomiting
Ondansetron (serotonin receptor antagonist)
Treatment of benign essential tremor
Propanolol (also alcohol lol)
How many drugs for neuropathic pain
Monotherapy
Assessment tool for stroke v stroke mimic
ROSIER