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MRCPI 2 Adult Med > Neurology > Flashcards

Neurology Flashcards

1
Q

A Jacksonian seizure is also known as a temporal lobe seizure T/F

A

F - AKA focal (partial) motor seizure

Note: consciousness preserved; often Todds paralysis afterwards

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2
Q

Carbamazepine is the first line tx for juvenile myoclonic epilepsy T/F

A

F - it can actually WORSEN seizures.

Note: usually use valproate or topiramate
Patients have excellent prognosis but often require lifelong AED to avoid relapses

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3
Q

Pt with preE coming in post seizure what is the initial mgmt of choice

A

Mg bolus

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4
Q

Pt with an intracranial bleed at what BP are anti HTNs indicated

A

> 170 systolic

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5
Q

When is NSGY opinion indicated in intracranial haemorrhage?

A

If intermediate or reducing GCS
OR cerebellar haemorrhage

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6
Q

Non neurological feature of Friedrich’s ataxia

A

It is associated with cardiomyopathy, scoliosis, pes cavus and diabetes

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7
Q

1st line treatment of Parkinson’s disease

A

Levodopa, dopamine agonists, or MAO-B inhibitors (eg selegiline) are the first choice options as there is evidence behind their use in providing symptoms control

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8
Q

Mnemonic for cavernous sinus thrombosis structures involved?

A

O TOM CAT
O: Oculomotor nerve
T: Trochlear nerve
O: Ophthalmic branch of trigeminal nerve
M: Maxillary branch of trigeminal nerve
C: Internal carotid artery
A: Abducens nerve
T: Trochlear nerve

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9
Q

Typical presentation of neurological AV malformations

A

seizures and a background of headaches.

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10
Q

Intermittent headaches with neurology affecting multiple cranial nerves is suggestive of ___

A

Cavernous Sinus Thrombosis

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11
Q

Frontotemporal dementia most commonly presents with memory problems T/F

A

F - more commonly presents with loss of insight and behavioural changes than memory problems

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12
Q

Presentation of neuralgic amyotrophy

A

Sudden onset of extreme pain in the upper extremity
followed by rapid multifocal motor weakness and atrophy and a slow recovery in months to years.
Usually proceeded by an upper respiratory tract infection.
Note: NA includes both an idiopathic (also known as Parsonage-Turner syndrome) and hereditary form.

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13
Q

Sporadic vs variant CJD

A

Sporadic: onset 45 -75 yrs old
- myoclonus
- dementia
-ataxia
-psychiatric/behavioural changes

Variant: average onset 26 yrs old
-Psychiatric prodrome
-Painful sensory symptoms

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14
Q

Investigations for CJD

A

Sporadic: EEG, LP (abnormal high levels of proteins 14-3-3 and S100B) and MRI brain

Variant : MRI is investigation of choice as EEG and LP are less sensitive

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15
Q

Use of memantine vs donepezil in Alzheimers dementia

A

Donepezil (or galantamine, or rivastigmine) usually first line

Memantine is for severe dementia or if unable to tolerate anti cholinesterase inhibitors

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16
Q

In the setting of trauma amnesia for greater than 30 minutes of events before impact is an indication for CT brain T/F

A

T

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17
Q

Acute total (painful) third nerve palsy with a dilated unreactive pupil is caused by_____

A

Compression of CN III, for example by tumour, posterior communicating or posterior cerebral artery aneurysms.

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18
Q

Features of multi system atrophy

A

-parkinsonian features
-autonomic insufficiency (leading to postural hypotension, anhidrosis, disturbance of sphincter control, impotence)
-signs of a cerebellar deficit.

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19
Q

Chronic inflammatory demyelinating polyneuropathy is clinically similar to which disease

A

GBS except follows a more chronic progressive course

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20
Q

18 yr old male presents with painless loss of vision in one eye a few weeks after losing vision in other eye. Most likely dx

A

Leber’s optic atrophy

Note: typical patient is a young male, LOV is painless but severe.

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21
Q

On MRI brain lesions enhance with gadolinium contrast - which is more likely MS or ADEM

A

ADEM

Note: MS lesions can sometimes enhance though less likely.
Think ADEM if encephalopathy, fever and focal neurology. May have had a preceding flu like illness or recent vaccinations

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22
Q

Optic neuropathy, proptosis, chemosis, Horner’s syndrome, ophthalmoplegia (sixth nerve palsy) and decreased corneal reflex is typical of ___

A

Orbital apex syndrome

Note: decreased corneal reflex is due to involvement of V1

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23
Q

What is the most common cause of limbic encephalitis

A

In 60% of cases it is paraneoplastic. Most commonly malignancy is small cell lung Ca

24
Q

Benign paroxysmal positional vertigo (BPPV) is associated with hearing loss T/F

A

F - it is not associated with hearing loss

Note:characterised by brief episodes of severe vertigo accompanied by nausea and vomiting. Vertigo can last for weeks and then self resolves.
Meniere’s disease is associated with hearing loss

25
Q

Thrombolysis timeframe in ischaemic stroke

A

4.5 hrs from onset of symptoms

26
Q

What is the annual % risk of stroke in pt with CHADSVasc of 3

A

3.2%

27
Q

target for cerebral perfusion pressure in setting for brain haemorrhage

A

61-80 mmHg

28
Q

A patient presents with hemiballism where is the lesion?

A

Contralateral subthalamic nucleus

Note: commonest cause is infarct. Tx is tetrabenazine.

29
Q

Hunt and Hess scale grades SAH:

A
  1. Asymptomatic or minimal headache & slight neck stiffness
  2. Moderate or severe headache with neck stiffness, but no neurological deficit other than cranial nerve palsy
  3. Drowsiness with confusion or mild focal neurology
  4. Stupor with moderate to severe hemiparesis or mild decerebrate rigidity
  5. Deeply comatose with severe decerebrate rigidity.
30
Q

MS flare are typically treated with bolus methylprednisolone T/F

A

F - only function- or life-threatening relapses should be treated by high doses of bolus methylprednisolone. For example a mild optic neuritis does not require any specific treatment

31
Q

A pt on beta interferon 1a injections and has been fully compliant with the medication for one and half years. She has presented with five relapses during the past one year. She presents with mild optic neuritis what is mgmt?

A

D/C interferon - if three or more attacks in a year consider re-evaluation of interferon or glatiramer acetate as they aim is to decrease relapse frequency

32
Q

1st line treatment of excessive daytime sleepiness in narcolepsy?

A

Modafinil

Note: Clomipramine, fluoxetine and sertraline are used in the management of cataplexy.

33
Q

Features of chronic paroxysmal hemicrania?

A

Similiar features to cluster headaches but shorter duration of headache with increased frequency. Headache can last between 3-45 minutes and occur 20-40 times per day.

Tx is with indomethacin

Note: cluster headache episodic cluster headache, lasts 15-180 minutes, occurs one to three times daily for four to eight weeks, with each cluster occurring several times yearly

34
Q

Features of myotonic dystrophy?

A

Frontal baldness in men
Atrophy of temporalis, masseters, facial muscle, and
Bilateral ptosis.

Also:
first degree heart block and complete heart block
Intellectual impairment
Gonadal atrophy
Insulin resistance

Note: most common muscular dystrophy in adults. Diagnosis is with EMG and muscle biopsy

35
Q

PSEN1 mutations are associated with___

A

Familial early onset Alzheimers

Note: presenilin 1 gene

36
Q

Juvenile myoclonic epilepsy is associated with a change on what chr

A

chr 6

37
Q

Differential diagnosis of autonomic neuropathy

A
  1. Diabetes
  2. Chronic renal failure
  3. AIDS
  4. Primary amyloidosis
  5. Porphyria
38
Q

Irregular low frequency tremor which is a combination of a rest, postural and action tremor is most likely?

A

Holmes’ tremor or rubral tremor

Note: also described as a ‘wing-beating’ type of tremor and is most prominent when the affected person is active or is maintaining a particular posture. Signs of ataxia and weakness can occur. It is secondary to a lesion in the red nucleus and can occur following a stroke in this area

39
Q

Corneal reflex, response to supraorbital pressure which CN

A

CN V and VII

40
Q

Gag reflex which CN

A

CN IX and X

41
Q

Cough reflex which CN

A

CN X

42
Q

_____ is the commonest cause of down beating nystagmus

A

Arnold-Chiari malformation

43
Q

______ is effective in treating cognitive decline in dementia with Lewy bodies.

A

Rivastigmine

44
Q

Max dose donezipil?

A

10mg daily

45
Q

NICE guidelines recommend discontinuation of cholinesterase inhibitors once the mini mental state examination has fallen below ___

A

12

Note: could consider starting memantine

46
Q

Symmetrical stiffness and bradykinesia associated with poor postural reflexes and impaired down-gaze. Likely dx?

A

Progressive supra nuclear palsy

Note: Idiopathic Parkinson’s disease presents with tremor and asymmetrical hemi-parkinsonism.
Vascular parkinsonism presents as lower limb parkinsonism.

47
Q

Tearing of the middle meningeal artery results in ___

A

Extradural haematoma (aka epidural)

48
Q

Rupture of the anterior and posterior communicating arteries results in _____

A

Subarachnoid haemorrhage

49
Q

Oculomasticatory myorhythmia is pathognomonic of ?

A

Whipples disease

50
Q

Increased reflexes tetanus vs botulism?

A

Tetanus

Note: botulism depressed or absent reflexes

51
Q

Ischaemic stroke, only BP of >___mmHg merits acute intervention.

A

220/120

52
Q

A CT scan of the brain showed dilated lateral ventricles with normal-sized third and fourth ventricle. Where is the lesion?

A

Foramen of Monro (eg a tumor)

53
Q

Which presents with abnormal lower limb exam discitits or epidural abscess?

A

Epidural abscess

54
Q

Most common cause of an isolated deep intracerebral haemorrhage in the basal ganglia is ____

A

Hypertension

55
Q

Monitoring for respiratory system is GBS?

A

Via Vital Capacity

Note: not peak flow

MRCPI 2 Adult Med (15 decks)

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