Neurology Flashcards
1
Q
CN3 lesion
A
Eye movement ‘down and out’
Ptosis and fixed dilated pupil with absent light reflex
2
Q
Left homonymous hemianopia
A
Visual field defect to the left
Lesion of the right optic tract
3
Q
Homonymous quadrantanopias
A
PITS
parietal inferior, temporal superior
4
Q
Incongruous defects
A
Optic tract lesion
5
Q
Congruous defects
A
Optic radiation lesion or occipital cortex
6
Q
CN4 lesion
A
Defective downward gaze and vertical diplopia
7
Q
CN6 palsy
A
Defective eye abduction and horizontal diplopia
8
Q
Lorazepam TWICE?
A
9
Q
Investigation for progressively worsening headache with impaired higher cognitive function
A
Urgent imaging required
10
Q
Imaging to view demyelinating lesions
A
MRI with contrast
11
Q
Management of brain abcess
A
IV 3rd generation cephalosporin + metronidazole
12
Q
CN5 lesion
A
Loss of corneal reflex
13
Q
What is hoover’s sign
A
Differentiates between organic and non-organic lower leg weakness (a sign of leg paresis)
14
Q
What is Romberg’s test
A
Investigates the cause of ataxia (+ve = sensory)
15
Q
What must you do before giving aspirin
A
Exclude a haemorrhagic stroke
16
Q
Bitemporal hemianopia
A
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
17
Q
What movements are spared in motor neurone disease
A
Eye movebments
18
Q
Tetrad of neuroleptic malignant syndrome
A
Hyperthermia, muscle rigidity, autonomic instability, altered mental status
(often when started on anti-psychotic medication)
19
Q
Describe the tremor seen in Parkinsons
A
Unilateral tremor that improves with voluntary movement
20
Q
First step in the management of obese patients with idiopathic intracranial hypertension
A
Weight loss
21
Q
Management of autonomic dysreflexia
A
Removal/control of the stimulus and treatment of any life-threatening hypertension and/or bradycardia
22
Q
What anaesthetic agent is contraindicated in myasthenia gravia
A
Suxamethonium
23
Q
Give 2 localising features of a temporal lobe seizure
A
Lip smacking
Post ictal dysphasia
(plucking of clothes)
24
Q
Treatment of patients with raised ICP
A
IV mannitol
25
What nerve is affected if there is weakness of foot dorsiflexion and foot eversion
Common peroneal nerve
26
3 features of normal pressure hydrocephalus
Urinary incontinence
Gait abnormality
Dementia
27
Obese young female with headaches and blurred vision
Think idiopathic intracranial hypertension
28
Most common hereditary sensorimotor neuropathy
Charcot-Marie-Tooth Disease
29
Treatment of acute migraine
| Treatment of migraine prophylaxis
Acute: Triptan + NSAID + paracetamol
Prophylaxis: Topiramate or propanolol
(propanolol preferred in women of childbearing age)
30
Investigation of choice for narcolepsy
Multiple sleep latency EEG
31
3 features of normal pressure hydrocephalus
Urinary incontinence + gait abnormality + dementia
32
1st line drug in the management of ocular myasthenia gravis
Pyridostigmine
33
3 drugs which exacerbate Parkinson's
Cyclizine
Prochlorperazine (antihistamines)
Metoclopramide
34
Anti-emetic used in parkinsons
Domperidone
35
MOA of sodium valproate
Inhibition of the P450 system
36
What does myaesthenia gravis show on an EEG
A diminished response to repetitive stimulation
37
How would you treat a patient with an acute ischaemic stroke who present within 4.5 hours
A combination of thrombolysis and thrombectomy
38
What scale measures disability or dependence in ADL in stroke patients
The Barthel index
39
5 most common places for brain tumours to metastasise
```
Lung
Breast
Kidney
Melanoma
Colorectal cancers
```
40
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
41
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)
42
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
43
Difficulty swallowing is a feature of what neurological condition
Myaesthenia Gravis
44
Myaesthenia Gravis VS Lambert Eaton
Same but lambert eaton with LUNG CANCER
45
GCS
Eye Very Much (want to die)
Eye = 4
Verbal = 5
Motor = 6
46
Head CT showing temporal lobe changes
Herpes simplex encephalitis
47
CT scan in meningitis
Often unremarkable
48
CT scan in HIV encephalitis
Changes to white matter and basal ganglia
49
Presentation of Creutzfeldt-Jakob disease
4 months of general neuro dysfunction
50
Time target for thrombolysis and thrombectomy
Thrombolysis: 4 hrs
Thrombectomy: 6 hrs
51
Management if a patient was not suitable for thrombolysis or thrombectomy
Aspirin
52
Painful third nerve palsy
Posterior communicating artery aneurysm
53
What medications are associated with idiopathic intracranial hypertension
```
tetracycline antibiotics
isotretinoin
contraceptives
steroids
levothyroxine
lithium
cimetidine
```
54
Diagnostic test for Guillain-Barre
Lumbar Puncture
55
Young person presenting with a stroke, what investigations must be done to rule out the cause
Thrombophilia and autoimmune screening
56
What is a holter analysis
Records the hearts rhythm
57
Most common complication following meningitis
Sensioneural hearing loss
58
First line treatment for parkinsons (newly diagnosed)
Levodopoa
59
4 features of progressive supranuclear palsy
Postural instability
Impairment of vertical gaze
Parkinsonism
Frontal lobe dysfunction
60
Hallmark of myasthenia gravis
Fatiguable painless muscle weakness that improves with rest
61
Tuberous sclerosis skin presentation
Roughened patches of skin over lumbar spine (shagreen patches)
62
Laughter followed by fall/collapse
Cataplexy
63
MRC scale
5: normal
4: against gravity and resistance
3: against gravity
2: gravity eliminated
1: flicker
0: nothing
64
Management of a medication overuse headache
Simple analgesia: stop
| Opioid: withdraw gradually
65
Classic organism for guillian-barre
Campylobacter
66
5 features of wernicke's encephalopathy
```
nystagmus (the most common ocular sign)
ophthalmoplegia
ataxia
confusion, altered GCS
peripheral sensory neuropathy
```
67
Wernicke vs Korsakoff
Amnesia and confabulation develop in korsakoff
68
What is Brown Sequard syndrome the result of
Lateral hemisection of the spinal cord
69
Frontal lobe seizure
Motor symptoms such as jerking of the limb
70
Parietal lobe seizure
Paraesthesia
71
Temporal lobe seizures
Automatisms and hallucinations
| De-ja-vu and aura
72
Occipital lobe seizure
Visual disturbance
73
Brainstem seizure
Very rare and not well researched
74
Fracture with wrist in a flexed position with weakness to extension noted on examination
Left mid shaft humeral fracture
75
Cause of postural hypotension in a patient with parkinsons
The parkinsons
76
Characteristic of pseudoseizures
Gradual onset
77
Patient with Bell's Palsy
| No sign of improvement after 3 weeks
Refer urgently to ENT
78
How long can Bell's palsy take to recover
12 months
79
3 features of broca's dysphagia
speech no fluent, comprehension normal, repetition impaired
80
Smiths fracture with loss of thumb opposition
Median nerve
81
Armpit sensation lost during axillary node dissection
Intercostobrachial
82
Supracondylar fracture gives a weak radial pulse and loss of pronation
Median
83
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
84
Diet in epilepsy
Ketogenic
85
Which parkinson medication increases inhibition disorders e.g. gambling
Dopamine receptor agonists e.g. Ropinirole
86
Vertical diplopia - nerve lesion
Trochlear
87
Aspirin prescription after stroke
```
high dose (300mg) for 14 days
then switch to clopidogrel
```
88
Medication that worsens myasthenia
Bisoprolol
89
Nail bed of the index finger - nerve sensation
Median
90
First step in managing raised ICP
Elevating the head of the bed to 30 degrees
91
Acoustic neuromas
- presentation
- management
hearing loss and ringing in the ear
| MRI of cerebellopontine angle
92
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
93
Conduction aphasia
Speech fluent but repetition poor
| Comprehension is relatively intact
94
Parkinsons with automonomc disturbance (atonic bladder, postural hypotension, erectile dysfunction)
Multiple system atrophy
95
Medications that can cause a megaloblastic anaemia
hydroxyurea, methotrexate, zidovudine, azathioprine, antiretroviral agents, valproic acid, and phenytoin
96
Mid-shaft humeral fracture
| Test the nerve
Extend the wrist (radial nerve injury)
97
NICE HEAD CT
98
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
```
99
GCS below 8 - management
Intubate and ventilate
100
Most common type of MS
Relapsing remitting
101
Carotid bruit investigation
Duplex ultrasound (diagnosis of stenosis)
102
Gold standard investigation for cervical myelopathy
MRI cervical spine
103
STROKE CLASSIFICATION
104
What nerve is damaged in a colles fracture
Median
105
First line treatment of wernickes
Pabrinex IV
106
Parkinsons symptoms with a symmetrical tremor
NOT idiopathic parkinsons
| Drug induced or other cause
107
Malignancy associated with myasthenia
Thymoma
108
Most common trigger for cluster headaches
Alcohol
109
Ptosis and dilated pupil
| Ptosis and constricted pupil
Dilated: CN3 palsy
Constricted: Horners
110
Post RTA patient with extremely high blood pressure, flushing and sweating
Autonomic dysreflexia
111
Side effect of carbemazapine
Steven Johnson syndrome
| Painful erythematous macules evolving to target lesions with mucosal ulceration
112
First line treatment for trigemninal neuralgia
Carbamazepine
113
Electric shock pains across the face that worsen when touching the skin
Trigeminal neuralgia
114
Investigation for vestibular schwannoma
Audiogram and MRI head (gadolinium enhanced)
115
What is mononeuritis multiplex
painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas
116
Treatment of guillian-barre
IV immunoglobulin
117
Biceps reflex nerve root
| Triceps reflex nerve root
Biceps: C5-C6
Triceps: C7-C8
118
Fine tremor in middle aged woman losing weight
Thyrotoxicosis
119
28 year old with a fine tremor with FHx
Essential tremor
120
Lateral medullary syndrome signs
PICA lesion
Cerebellar signs
Contralateral sensory loss
Ipsilateral Horners
121
Side effects of phenytoin
Teratogenic
CYP450 interactions
Loads of adverse effects - if in doubt put phenytoin
122
Parkinsons drug with reduced effectiveness over time
Levodopa
123
Parkinsons drug associated with pulmonary fibrosis
Cebergoline
124
Parkinsons drug useful for managing tremor in drug-induced parkinsons
Procyclidine
125
Treatment of paroxysmal hemicrania
Indomethacin
| Completely responsive
126
What is paroxysmal hemicrani
Severe attacks of unilateral headaches in the orbital or temporal region
127
Investigation for optic neuritis
MRI head with contrast as gold standard for MS
128
Where is the chemoreceptor trigger zone
Medulla
129
Stroke - CT with or without contrast
WITHOUT
130
What is the cushing reflex
Physiological nervous system response to ICP that results in hypertension and bradycardia
Bad sign
131
Autonomic dysreflexia
Faecal impaction and urinary retention are the most common triggers
Hypertension, bradycardia and sympathetic overdrive
Often after a spinal cord injury
132
Bedside test for CSF
Glucose
133
Third nerve palsy same or opposite side
Same side
134
Arnold-Chiari malformation - 2 associations
Cause of congenital hydrocephalus
| Syringomyelia
135
Contraindication for triptans
Ischaemic heart disease
136
CSF of patients with MS
Oligoclonal bands
137
First line for spasticity in MS
Baclofen and gabapentin
138
Syringiomyelia is associated with RA
139
Management of MS acute relapse
Oral steroids e.g. methylprednisolone
140
CT aneurysm that does and does not cross suture lines
Does cross suture lines: subdural
| Doesn't cross suture lines: extradural
141
Chronic subdural on CT
Hypodense (dark)
142
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
143
Which type of neurofibromatosis has vestibular schwannomas
Type 2
144
What is controlled hyperventilation and when is it used
In patients with raised ICP
| Reduced blood CO2 to induce cerebral vasoconstriction
145
Where is broca's area
Frontal lobe
146
Only opioid appropriate to consider in neuropathic pain
Tramadol
147
Pituitary apoplexy management (from pituitary adenoma)
Urgent steroids
148
Blood test to differentiate true seizures and pseudoseizure
Prolactin
149
Prophylaxis of cluster headaches
Verapamil
150
Cause of gait ataxia
Lesion in cerebellar vermis
151
Condition associated with subungual fibromatoma
Tuberus sclerosis
152
Inheritance of charcot marie tooth
autosomal dominant
153
Side effect of triptans
Tightness of the throat and chest
154
RTA need to intubate - with what
Cuffed endotracheal tube
155
Eye defect in primary open angle glaucoma
Unilateral peripheral visual field loss
156
Stroke with right sided hemiplegia, where is the eye defect
Right
157
Unilateral deafness or tinnitus
Acoustic neuroma
158
What is hyperacusis and what condition is it found in
Noises sound louder than usual
| Bell's Palsy
159
Bell's palsy - is there a sensory deficit
NO!
160
When would you perform carotid endardectomy
If stenosis greater than 70%
161
Adult seizure - medication at 5 imnutes
Rectal diazepam
162
Weakened dorsiflexion, inversion and eversion of the ankle
L5 nerve lesion
163
Which nerves are affected in vestibular schwannoma
Cranial nerves V, VII, VIII
164
Clinical picture if parkinsons drugs are withheld
Stiffness, tachycardia, pyrexia, elevated creatinine kinase
165
4 features of vestibular schwannoma
vertigo, hearing loss, tinnitus and an absent corneal reflex
166
Fasciculations in older man
Motor neurone
167
Treatment of low phosphate in adults
IV infusion
168
Vessel damaged in a subdural haematoma
Bridging veins between cortex and venous sinus
169
TIA secondary prevention
Clopidogrel only
| Aspirin is used as first line treatment and if clopidogrel or other antiplatelets are contraindicated
170
Main feature of syringomyelia
Spinothalamic sensory loss (pain and temeprature)
171
Which nerve is most often affected in raised ICP
Abducens due to its long course
172
Vessel damaged in an extra dural haematoma
Middle meningeal artery
173
Vessel injured in a subarachnoid
berry aneurysm
174
RF for subdural haemorrhage
Elderly and alcoholics
175
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
176
When assessing GCS take the best response
e.g. left flexes, right extends, take the felxion
177
What does refractory to treatment mean
Does not respond to treatment
178
What dementia is associated with MND
Frontotemporal
179
Treatment of bells palsy
Prescribe prednisolone
180
Forehead spared in....
STROKE
181
Parkinsons drugs at increased risk of gambling
Dopamine agonists e.g. bromocriptine
182
Xray for assessing degenerative cervical myelopathy?
No
183
DVLA guidelines on seizures
6 month break after first seizure
| 5 year ban if bus or lorry driver
184
Management of status epilepticus if patient has a cannula
IV lorazepam
185
Brain abscess on CT
collection of pus encapsulated by a pyogenic membrane
186
Shingles first line for nerve pain
Amitriptyline (or duloxetine, gabapentin or pregabalin)
187
Investigation for myasthenia gravis
Antibody screen
188
Extradural haemorrhage shape on CT
Biconvex
189
What gait is this?
| Wide based gait with loss of heel to toe walking
Ataxic gait
190
Isolated rise in protein level in CSF
Indicative of GBS
191
Lambert eaton or myasthenia gravis
Lambert improves after exercise
| Myasthenia worsens
192
Migraine in children
Avoid prokinetic agents e.g. metoclopramide
193
What is the typical aura in migraine
Spreading scintillating scotoa (jagged crescent)
194
Essential tremor
On intention
often in the hands
affects the vocal cords
195
Progressively worsening headache with higher cognitive dysfunction
Urgent imaging
196
TIA - specialist review within?
24 hours
197
fall soon after a parkinsons diagnosis
Assess cranial nerves for other diangosisi e.g. Parkinsons +
198
Medication for chemotherapy induced nausea and vomiting
Ondansetron (serotonin receptor antagonist)
199
Treatment of benign essential tremor
Propanolol (also alcohol lol)
200
How many drugs for neuropathic pain
Monotherapy
201
Assessment tool for stroke v stroke mimic
ROSIER
