Neurology Flashcards
Describe the pattern of weakness in GBS?
symmetrical ascending weakness
Describe the reflexes in someone with GBS
reduced
What investigations can be done in someone with suspected GBS?
nerve conduction studies and lumbar puncture
What is the time frame between the preceding infection and onset of symptoms in GBS?
within 4 weeks
How can we treat GBS?
intravenous immunoglobulins
plasmapheresis
What is the first line diagnostic investigation in SAH?
CT head
What should you do at least 12 hours after onset of symptoms in a patient with suspected SAH?
lumbar puncture
What is the most common thing to present with in SAH?
thunderclap headache- sudden onset and severe
What is xanthochromia ?
yellow discolouration indicating presence of bilirubin in the CSF
What are the things are looked at in the Glasgow coma scale?
eye opening
motor response
verbal response
Which nerve palsy can you get in SAH?
third cranial nerve palsy
A patient has two seizures and does not regain consciousness between them. What is the diagnosis?
status epilepticus
A patient has a tonic-clonic seizure that lasts more than 5 minutes- what is the diagnosis ?
status epilepticus
Which group of inherited conditions damage the peripheral nerves, with symptoms usually appearing between the ages of 5 and 15?
Charcot-Marie-Tooth disease
What does CIDP stand for?
chronic inflammatory demyelinating polyneuropathy
In which disease are there antibodies against nicotinic acetylcholine receptors?
myasthenia gravis
What is the most common type of mononeuropathy?
carpal tunnel syndrome
Which part of the nervous system does MS affect?
the CNS
What is the most common presentation of MS?
optic neuritis
What is the most common pattern of MS at initial diagnosis?
relapsing remitting
How should MS relapses be treated?
methyprednisolone
What kind of imaging could you do on someone with suspected MS?
MRI
What is the most common type of motor neurone disease?
amylotrophic lateral sclerosis
What is the second most common MND?
progressive bulbar palsy
Which disease involves the progressive degeneration of both upper and lower motor neurones?
MND
In parkinsons disease there is a progressive reduction of what chemical in the basal ganglia?
dopamine
What is the classic triad of features in parkinsons disease
resting tremor
rigidity
bradykinesia
What may happen to a persons handwriting in parkinsons disease
may get smaller
What is the typical gait of a person with parkinsons ?
shuffling
How does rest affect tremor in someone with parkinsons?
tremor is worse at rest
What medication is given in parkinsons disease to mimic dopamine ?
levodopa
What type of drug does levodopa have to be combined with to prevent it from being broken down?
peripheral decarboxylase inhibitors
What affect does alcohol have on a benign essential tremor?
improves tremor
What can make a benign essential tremor worse?
coffee, stress, fatigue and voluntary movement
What might you see if you perform fundoscopy on a patient with raised ICP?
papillodema
What is papilloedema?
swelling of the optic disc secondary to raised ICP
What type of cancer may result in the development of lambert-eaton myasthenic syndrome ?
small-cell lung cancer
What type of migraine may mimic a stroke ?
hemiplegic migraine
What is the name for a headache caused by long term analgesic use ?
analgesic headache
What does a headache that is worse when coughing indicate?
raised ICP
What does a postural headache suggest?
raised ICP
What may a headache during pregnancy indicate ?
pre-eclampsia
In what type of seizure is there a muscle tensing then muscle jerking epidode?
tonic-clonic
What is the period after a seizure called where the person may be drowsy and confused?
post-ictal
What is the first line management of tonic-clonic seizures in men?
sodium valproate
In which part of the brain do focal seizures start?
temporal lobes
What is the first line treatment for focal seizures ?
carbamazapine or lamotrigine
How long do absence seizures typically last?
10-20 seconds
If a patient has had a stroke and they now have aphasia- which artery was most likely to be the one blocked?
Middle cerebral artery- supplies both wenickes and brocas areas
A young overweight female presents with headache and blurred vision and sixth nerve palsy. On fundoscopy there is papilloedema. What is the most likely diagnosis?
Idiopathic intracranial hypertension
Describe the inheritance pattern of tuberous sclerosis
Autosomal dominant
A patient presents with depigmented ‘ash leaf spots’, fibromata beneath their nails and epilepsy. What is the most likely diagnosis?
Tuberous sclerosis
A neurologist places the base of a struck tuning fork on a patient’s forehead. What test is this?
Weber’s test
A neurologist performs Rinne’s test by placing a struck tuning fork onto the mastoid process and then moving the tuning fork next to the ear when the patient says they can no longer hear the sound. The patient reports that now the tuning fork has been moved they can hear it vibrating. Is this a normal result?
This is normal as in healthy individuals air conduction should be better than bone.
What is a rinnes positive result?
A rinnes positive result is when air conduction is louder than bone- this is a normal result
What is a normal Weber’s test result?
Sound heard equally in both ears
Webers test is performed on a patient with conductive hearing loss. Which ear will hear the sound loudest?
The affected ear
Vestibular schwannomas are also sometimes referred to as……?
Acoustic Neuromas
Where would you find a vestibular schwannoma?
The cerebellopontine angle
A tumour is found at the cerebellopontine angle. What type of tumour is this most likely to be?
Vestibular schwannoma AKA acoustic neuroma
A patient presents with vertigo, hearing loss and tinitis. O/E patient has absent corneal reflex. What tumour would you want to investigate for?
vestibular schwannoma (acoustic neuroma)
Which nerve is affected in cubital tunnel syndrome?
Ulnar
Which nerve gives sensation to the little finger on both the front and back of the hand?
Ulnar
What should be given to a patient presenting who is presenting with Bell’s palsy?
Prednisolone and lubricating eye drops
Apart from prednisolone, what should be given to a patient with Bell’s palsy?
lubricating eye drops
How can you tell stroke apart from Bell’s palsy?
In stroke the lesion is an upper motor neurone lesion thus the forehead will be spared
Which nerve palsy results in ptosis and down and out deviation of the eye?
third nerve palsy
what does mydriasis mean?
dilation of the pupil
What does miosis of the pupil mean?
constriction
In a third nerve palsy, how may the pupil be affected?
pupil may be dilated (mydriasis)
Which class of drugs have the strongest evidence base for reducing the number of relapses in MS? Clue: Natalizumab
Monoclonal antibodies
Which two drugs are first-line for MS spasticity?
baclofen and gabapentin
A 75 year old man presents with gait abnormality, urinary incontinence and dementia- what is the diagnosis?
Normal pressure hydrocephalus
In males, what is the first line treatment for focal seizures?
lamotrigine or levetiracetam
A patient is diagnosed with a disorder where the brachial plexus is compressed at the site of the thoracic outlet. They have generalised numbness and some hand weakness. What is the diagnosis?
Thoracic outlet syndrome
What is the most likely cause of a painful third nerve palsy?
posterior communicating artery aneurysm
A patient presents with double vision. O/E their right eye is deviated upwards and outwards. The doctor diagnoses a fourth nerve palsy. Which muscle is innervated by CN IV?
superior oblique
Which nerve innervates the skin on the palmar aspect of the thumb?
median nerve
