Neurology Flashcards
1
Q
5-HT3 antagonists:
Used in what type of nausea
A
Ondansetron
Chemotherapy induced
2
Q
Adverse effects 5-HT3 antagonists:
A
Constipation
QT prolongation
3
Q
Absence seizure tx:
A
ETHOSUXIMIDE
Sodium valproate
4
Q
Wernicke’s aphasia:
Where is lesion
A
Superior temporal gyrus
5
Q
Wernicke’s aphasia: what is impaired:
A
Comprehension - ‘word salad’
6
Q
Broca’s: lesion where is it?
A
Inferior frontal gyrus
7
Q
Conduction aphasia:
Classically due to:
Deficit:
A
Stroke affecting the arcuate fasiculus
Speech FLUENT but poor repetition
Comprehension normal
8
Q
Cerebellar hemisphere lesions cause __ ataxia
A
Peripheral
9
Q
Cerebellar vermis lesions cause ___ ataxia
A
Gait
10
Q
Autonomic dysreflexia trigger:
A
Faecal impaction or urinary retention
11
Q
Autonomic dysreflexia symptoms:
A
Extreme hypertension, flushing, sweating above the level of cord lesion
due to prevention of parasympathetic counter response by lesion
12
Q
Bell’s palsy tx.
A
Oral prednisolone w/in 72 hours of on-set
If no improvement in 3 weeks - urgent referral to ENT
13
Q
Symptom may precede facial palsy in Bell’s palsy:
A
Post-auricular pain
14
Q
Erb’s palsy:
Damage to:
Result:
A
Damage to C5,6
Winged scapula
15
Q
Klumpke’s palsy:
A
Damage to T1
loss of intrinsic hand muscles
16
Q
Brain abscess antibiotics:
A
3rd generation cephalosporin + metronidazole
17
Q
Tumours which most commonly metastasise to the brain:
A
Lung Breast Bowel Skin Kidney
18
Q
Glioblastoma on histology:
A
Pleomorphic tumour cells border necrotic areas
19
Q
Meningioma on histology:
A
Spindle cells in concentric whirls and calcified psammoma bodies
20
Q
Pilocytic astrocytoma:
M/c brain tumour in ->
Histology:
A
Children
Rosenthal fibres, corkscrew eosinophillic bundle
21
Q
Medulloblastoma histology
A
small, blue cells, rosette pattern of cells w/ many mitotic figures
22
Q
Brain tumour with ‘fried-egg appearance’
A
Oligodendroma
23
Q
Brown-Sequard syndrome deficits
Lateral hemisection of cord
A
Contralateral loss of pain and temperature sensation
Ipsilateral weakness below lesion
Ipsilateral loss of proprioception and vibration sensation
24
Q
Carbamazepine binds to _ channels to increase their refractory period
A
Sodium
25
Carbamazepine adverse effects:
Dizziness, drowsiness
Steven-Johnson syndrome
leucopenia and agranulocytosis
hyponatraemia 2ry to SIADH
26
DANISH
D - dysdiadochokinesia, dysmetria (past-pointing), may appear drunk
A - ataxia (truncal)
N - Nystagmus
I - Intention tremor
S - slurred staccato speech, scanning dysarthria
H - hypotonia
27
Most common hereditary peripheral neuropathy:
| Predominantly __ loss
Charcot-Marie-Tooth disease
| Motor
28
Cluster headache mx.
Acute: 100% oxygen w/ SC TRIPTAN
Prophylaxis = VERAPAMIL
29
Paroxysmal hemicrania mx.
INDOMETHACIN
30
CNS tumours ix. of choice:
MRI
31
Tibial and common fibular nerves come from which nerve:
Sciatic
32
Sensory loss in common fibular nerve palsy:
Dorsum of foot and lower lateral part of the leg
33
Creutzfeldt Jacob Disease fx.
Dementia + Myoclonus
34
CJD MRI:
Hyperintense signals from basal ganglia and thalamus
35
Degenerative cervical myelopathy symptoms:
Pain - affecting the neck, upper or lower limbs
Loss of motor function (loss of digital dexterity)
Loss of sensory function causing numbness
Loss of autonomic function - urinary or faecal incontinence/impotence)
36
What is Hoffman's sign:
Reflex test to assess for cervical myelopathy - flicking a finger on the pts. hand. A positive test results in reflex twitching of other fingers
37
Mx. for DCM
Urgent referral for assessment due to importance of early treatment.
Decompressive surgery is the only treatment thereafter
38
Dermatomes: L5
Big toe - Largest of the 5 toes
39
Dermatomes: S1
Lateral foot: small toe -> the smallest 1
40
Dermatomes: C2
Posterior half of the skull (cap)
41
Dermatomes: C3
Turtle neck
42
Dermatomes: C4
Low collar shirt
43
Dermatomes L1
Inguinal ligament
44
Drugs causing peripheral neuropathy
MINAV
```
Metronidazole
Isoniazid
Nitrofurantoin
Amiodarone
Vincristine
```
45
Focal seizures mx.
Carbamazepine
or Lamotrigine
46
Essential tremor
Affects:
Worse if:
Both upper limbs
| Arms outstretched: Postural tremor
47
Essential tremor tx.:
Propranolol
| Primidone sometimes used
48
Extradural haematoma: bleeding limited by which anatomical structure
Limited by the suture lines of the skull
49
Causes of bilateral facial nerve palsy:
Sarcoidosis
Guillain-Barre syndrome
Lyme disease
Bilateral acoustic neuromas (NF2)
50
Fourth nerve palsy:
Vertical diplopia - when reading a or when going downstairs
Head tilt
'Up and out' eye
51
Other features of Guillane-Barre:
Respiratory muscle weakness
Cranial nerve involvement - diplopia, b/l facial nerve palsy
Autonomic involvement: urinary retention, diarrhoea
52
Guillane-Barre: Investigations
Lumbar puncture -> rise in protein w/ normal WCC
| Nerve conduction studies: decreased motor nerve conduction velocity
53
Medication overuse headache:
present for _ days/month
Patients taking which medications for pain are more at risk:
Mx:
Present for 15 days or more/month
triptans and opioids
W/draw triptans and simple analgesics abruptly
W/draw opioids gradually
54
Meningitis protein in bacterial/viral CSF
Raised in bacterial
| Normal in viral
55
Most common complication of Meningitis:
Sensorineural hearing loss.
Others include:
seizures, focal neurological deficit
infective - sepsis, intracerebral abscess
56
Waterhouse-Friderichsen syndrome ->
adrenal insufficiency secondary to adrenal haemorrhage
57
Migraine prophylaxis:
Propranolol or topiramate
58
Migraine acute treatment:
First line = oral TRIPTAN AND NSAID or paracetamol
59
Migraine acute management if 12-17 yrs:
nasal rather than oral TRIPTAN
60
Migraine if prophylaxis fails ->
5-8 weeks of ACUPUNCTURE
61
Topiramate is contraindicated in ->
Pregnant women
62
Common but niche feature of MND:
Wasting of small muscles of the hand/tibialis anterior
63
MND diagnosis
CLINICAL but nerve conduction studies will show normal motor conduction and can help exclude neuropathy
EMG shows reduced number of action potentials with increased amplitude.
64
MND types:
| ALS signs
LMN in arms and UMN signs in legs
opposite of what would be logical i.e upper and lower
65
PLS signs:
UMN signs only
66
Progressive muscular atrophy:
LMN signs only
67
Progressive bulbar palsy:
Palsy of tongue, muscles of chewing, swallowing.
carries worst prognosis
68
Uhtoff's phenomenon:
Worsening of vision during rise in body temperature (showering etc)
69
Lhermitte's sign:
Paraesthesia of limbs on neck flexion
70
MS MRI:
WITH CONTRAST
High signal T2 lesions
Periventricular plaques
Dawson fingers
71
MS acute relapse mx.
High dose steroids (oral or IV methylprednisolone) for 5 days
shorten duration of relapse but do not improve degree of recovery
72
Disease modifying drugs: MS
Natalizumab - strongest evidence for preventing relapse of disease. Given IV
Fingolimod
b-interferon
Glatirmaer acetate - immune decoy. Given SC
73
MS fatigue tx.
Amantadine
74
MS spasticity:
Baclofen or Gabapentin
75
MS bladder dysfunction:
Get US first
If significant residual volume: ISC
If no significant residual volume: anti-cholinergics improve urinary frequency
76
MS oscillopsia (when visual fields appear to oscillate) tx.
Gabapentin
77
Myasthenia Gravis assoc w/ which tumour
| and other AI disorders?
Thymomas (15%)
| AI disorders: pernicious anaemia, thyroid disorders, RA, SLE.
78
MG Ix.
Single fibre EMG: High sensitivity
| CT thorax to exclude thymoma
79
MG mx.
Pyridostigmine
80
Mx. Myasthenic crisis:
Plasmapharesis
| IV immunoglobulins
81
Drugs which exacerbate MG:
```
Penicillamine
Quinidine, procainamide
B-blockers
Lithium
Phenytoin
Antibiotics: Gentamicin, macrolides, quinolones, tetracyclines
```
82
Mx. Narcolepsy
Modafinil
| Night-time sodium oxybate
83
NF1 fx.
```
Iris hamartomas (>90%)
Cafe au lait spots
Axillary or groin freckles
Peripheral neurofibromas
Phaechromocytomas
```
84
NF2 fx.
Bilateral vestibular schwannomas
| multiple intracranial schwannomas, meningiomas and ependyomas
85
As well as atypical antipsychotics which neuro drug may also cause neuroleptic malignant syndrome
Levodopa
86
Onset of neuroleptic malignant syndrome after starting antipsychotic
hours to days
87
NMS other fx.
Raised CK in most cases
AKI (2ry to rhabdomyolysis)
Leukocytosis
88
Mx. Neuroleptic malignant syndrome
Dantrolene
| Bromocriptine may be used
89
Neuropathic pain which is resistant to medication ->
referral to pain clinics
90
NP hydrocephalus triad
| Mx.
Gait abnormality
urinary incontinence
Dementia and bradyphrenia (slowed thinking and processing of information)
VP shunting
91
Refeeding syndrome metabolic consequences:
Hypophosphataemia
Hypokalaemia
Hypomagnesaemia
PKM -
please kill me
92
if pt. has not eaten for >5 days what percentage of energy and protein levels should be re-fed:
prescription of feed:
50%
start up to 10 calories/kg/day increasing to full needs over 4-7 days
93
Differentiating drug-induced Parkinson's from idiopathic Parkinson's
Motor symptoms are generally rapid on-set and bilateral
| Rigidity and rest tremor are less common
94
Parkinson's tx. if symptoms NOT affecting QoL:
```
Dopamine agonist (non-ergot derived)
MAO-B inhibitor
Levodopa
```
95
If pt. still has symptoms despite optimal levodopa tx. or has developed dyskinesia what should be started:
Dopamine agonist or
MAO-B or
COMT
96
Dopamine agonist therapy may result in:
impulse control disorders
97
Levodopa side effects:
Postural hypotension
Psychosis
dry mouth
anorexia
98
If pts. cannot take levodopa orally for a time, what should they be given:
Dopamine agonist PATCH
99
What are ergot derived dopamine agonists and what are they known to cause:
Bromocriptine, cabergoline
pulmonary, retroperitoneal and cardiac FIBROSIS
100
Drug induced Parkinson's causes:
Antipsychotics
| Metoclopramide
101
Pituitary apoplexy treatment.
Urgent steroids replacement due to loss of ACTH
Careful fluid balance
Surgery
102
Post-LP headache mx.
Supportive initially:
If pain continues past 3 days: Blood patch, epidural saline, IV CAFFEINE
103
Post-LP headache exacerbating factors
Worsens with upright position
| Improves on lying down
104
Progressive supranuclear palsy fx.
VERTICAL GAZE palsy - down gaze worse than up gaze -pts. complain of difficulty reading or descending stairs
Parkinsonism
Cognitive impairment
Postural instability
105
PSP response to levodopa
POOR
106
Factors which favour a true epileptic seizure over psychogenic
Raised PROLACTIN
| tongue biting
107
Weakened supination of prone hand and elbow flexion nerve palsy:
Radial nerve
108
Nerve supplying triceps:
Radial nerve
109
Normal ICP:
7-15 mmHg
110
Mx. Increased ICP:
Ix. and treat underlying cause
Head elevation to 30*
IV mannitol
controlled hyperventilation - reduce CO2 to cause cerebral vasoconstriction
111
Restless leg syndrome tx.
```
Simple measures - walking, stretching
treat iron deficiency
First line is DOPAMINE AGONISTS (ropinirole, pramipexole)
BZPs
Gabapentin
```
112
Dose of rectal diazepam for seizures in adults:
10-20 mg
113
Sodium valproate MoA:
Increases GABA activity
114
Which spinal cord disease does Friedrich's ataxia present similarly to:
Subacute degeneration of the cord
115
Anterior spinal artery occlusion spinal tracts affected:
Lateral CST - b/l spastic paresis
| Lateral STT - b/l loss of pain and temperature
116
Where is the lesion in internuclear ophthalmoplegia:
Medial longitudinal fasciculus
117
Features of internuclear ophthalmoplegia:
impaired adduction of the eye on the SAME side of lesion
| Horizontal nystagmus of the abducting eye on the contralateral side
118
Intracranial venous thrombosis gold standard investigation:
MRI venography
119
Management: intracranial venous thrombosis:
Anticoagulation w/ LMWH
120
Lambert-Eaton syndrome tx. drug:
3.4-diaminopyridine
121
Lateral medullary syndrome artery infarcted:
Posterior inferior cerebellar artery
122
Lateral medullary syndrome (Wallenburg syndrome) fx.:
Ataxia, Nystagmus
Dysphagia, facial numbness, cranial nerve palsy
Contralateral: limb sensory loss
123
Motor innervation of median nerve:
```
LOAF muscles:
Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor policis brevis
```
124
Spontaneous intracranial hypotension - CTD assoc.
Worse when:
Marfan's syndrome
Upright (like post-LP headache)
125
Status epilepticus: seizure termination:
Pre-hospital: PR diazepam or buccal midazolam
| Hospital: IV lorazepam (may be repeated ONCE after 10-20 minutes)
126
If on-going status what second agent may be started:
Phenytoin
127
Weber's syndrome:
Ipsilateral CN III palsy
| contralateral weakness of upper and lower extremity
128
Middle cerebral artery stroke:
Contralateral hemiparesis and sensory loss (Upper > Lower)
Contralateral homonymous hemianopia
Aphasia
129
Basilar artery stroke:
Locked in syndrome
130
Lacunar strokes:
Strong assoc. w/
px.
Hypertension
Px. w/ isolated hemiparesis, hemi-sensory loss or hemiparesis w. limb ataxia
131
Stroke - issues to manage:
```
Fluid management
Glycaemic control
Blood pressure management
Feeding assessment and management
Disability scales
```
132
Features of stroke more common w/ HAEMORRHAGIC causes:
Decreased level of consciousness
Headache
Nausea and vomiting
Seizures
133
TIA mx.
Immediate aspirin 300mg
Unless bleeding disorder, already on low dose (75mg) Aspirin
134
TIA assessment if:
Suspected in the last 7 days
Suspected more than a week previously:
Assessment w/in 24 hours
Assessment w/in 1 week
135
Stroke mx.
```
Offer THROMBECTOMY (if available) w/in 6 hours of symptoms on-set
If > 24 hours thrombectomy may still be indicated if there is potential to salvage brain tissue as shown in MRI
```
136
Consider thrombectomy w/ thrombolysis if:
W/in 4.5 hours
| posterior circulation stroke and there is potential to salvage brain tissue
137
Stroke 2ry prevention:
CLOPIDOGREL (aspirin plus dipyridamole if CI)
138
Subacute combined degeneration of spinal cord deficits:
Dorsal columns and lateral CST affected so
Joint position and vibration sense loss first then distal paraesthesia
UMN signs develop in the legs
139
IF chronic subdural haemorrhage found on CT and pt. px. w/ confusion what is mx.
Surgical decompression w/ burr holes
140
What syndrome may present alongside syringomyelia
Horner's syndrome - due to compression of sympathetic chain.
141
Tension headache mx.
Acute: Aspirin, paracetamol or NSAID = 1st line
Prophylaxis = 10 sessions of acupuncture of 5-8 weeks
low-dose amitriptyline NOT supported by NICE
142
TIA ix. if indicated
| Carotid imaging?
CT not done unless clinical suspicion of alternative diagnosis
MRI is preferred to determine the territory of ischaemia or detect haemorrhage.
Urgent carotid artery doppler if emboli suspected
143
What are triptan sensations:
tingling, heat tightness (chest, throat), heaviness and pressure
144
Contraindications of triptans:
Ischaemic heart disease or cerebrovascular disease
145
Damage of ulnar nerve:
wasting of intrinsic hand msucles
wasting of hypothenar muscles
Damage at elbow may result in radial deviation of the wrist
Remember ulnar paradox theory
146
Incongruous defects (defect is not the same in both eyes) =>
optic tract lesion
At face-value as per the visual tracts, visual loss will be symmetrical (congruous) more in depth, perhaps due to extent of compression, the defect may be incongruous between the two eyes
147
Congruous defect => (defect same in both eyes)
Optic radiation lesion or occipital cortex
148
Ix. for Degenerative cervical myelopathy:
MRI spine
| plain radiographs will not be sufficient
149
Condition which:
Can complicated facial infection, orbital cellulitis, pharyngitis, and other conditions
Presents w/ fever, ophthalmoplegia, and other eye findings such as peri-orbital swelling over an acute/subacute timeframe
Cavernous sinus thrombosis
150
Which syndrome may cause waddling gait due to pelvic girdle weakness:
Lambert Eaton Syndrome
*May precede a cancer diagnosis by a number of years
151
Well-defined tumour between brain parenchyma and tumour
Meningioma
152
Where does Ondansetron work:
CTZ - Medulla oblongata
153
Saturday night palsy causes compression of which nerve:
Radial nerve
154
Scale that measures disability or dependence in activities of daily living in STROKE patients
Barthel index
155
Absent corneal reflex + PROPTOSIS in a pt. w/ pre-existing nasopharyngeal carcinoma
Cavernous sinus syndrome
156
What is located in:
| inferior FRONTAL gyrus
Broca's area
157
What is located in:
| superior temporal gyrus
Wernicke's
