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Clinical Medicine > Neurology 🧠 > Flashcards

Neurology 🧠 Flashcards

1
Q

what is myasthenia gravis

A

autoimmune neuromuscular disease charactered by generalised muscle weakness
more common in females

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2
Q

pathophysiology of myasthenia gravis

A

autoantibodies against postsynaptic acetylcholine receptors

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3
Q

clinical features of myasthenia gravis

A

muscle fatiguability - muscles become progressively weaker during periods of activity - at end of day
diplopia
ptosis
dysphagia

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4
Q

associated conditions with myasthenia gravis

A

Thyomomas
autoimmune disorders
thyme hyperplasia

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5
Q

ix to perform for myasthenia gravis

A
  1. blood test for serum acetylcholine receptor antibody
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6
Q

mx myasthenia gravis

A

long acting acetylcholinesterase inhibitor
pyridostigmine

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7
Q

which drugs may exacerbate myasthenia gravis

A

beta blockers
penicillamine
lithium

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8
Q

what is multiple sclerosis

A

chronic degenerative autoimmune disease chacterised by demyelination in CNS
more common in women and those further away from equator

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9
Q

visual features of MS

A

optic neuritis - most common

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10
Q

sensory features of MS

A

pins/needles, numbness
Lhermitte’s sign : shooting electric sensation down the spine after flexion of neck
bilateral trigeminal neuralgia

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11
Q

motor features of MS

A

spastic weakness most commonly in legs

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12
Q

dx of MS

A

MRI brain + spine - FLAIR sequence

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13
Q

mx of MS

A

no cure but focuses on reducing frequency and duration of relapses
in acute relapse - high dose steroids
beta-interferon

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14
Q

what is uhtoff’s phenomenon

A

transient worsening of neurological symptoms in MS when the body becomes overheated

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15
Q

what is huntingtons disease

A

autosomal dominant disorder caused by >38 repeats of CAG
usually presents between 35-45 years

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16
Q

clinical features

A

demential, behavioural changes, hallucinations
CHOREA
dystonia
ataxia
usually results in death 20 years after initial symptoms develop

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17
Q

MRI and CT scans will show what in huntingtons

A

atrophy of caudate nucleus

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18
Q

features of Parkinson’s

A

bradykinesia - short shuffling gait, reduced arm swing
tremor at rest
rigidity

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19
Q

First line treatment of atomic seizures

A

Sodium valproate - not used in women of childbearing age
Lamotrigine

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20
Q

First line treatment of absence seizures

A

Sodium valproate
Ethosuximide

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21
Q

First line treatment of tonic clonic seizures

A

Sodium valproate or lamotrigine

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22
Q

First line treatment of myoclonic seizures

A

Sodium valproate unless the patient is a female of childbearing age
Then levetiracetam or tropiramate should be used

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23
Q

Symptoms of Ramsay hunt syndrome

A

Vesicular rash ipsilateral ear
Vesicular rash on ipsilateral hard palate and anterior two thirds of the tongue
Hearing loss
Ipsilateral facial weakness
Post-auricular/ear pain
Difficulty chewing
Incomplete eye closure
Drooling
Tingling

24
Q

Signs of Ramsay hunt syndrome

A

Vesicular rash on ear
Loss of nasolabial fold
Drooping of eyebrow
Drooping of corner of mouth
Asymmetrical smile

25
Management of Ramsay hunt syndrome
Anti-virals typically oral acyclovir Corticosteroids typically oral prednisolone Good eye care
26
Acute management of MS
An acute attack of MS should be treated with glucocorticoids 1g of IV methylprednisolone every 24 hours for 3 days
27
What is a TIA
Sudden onset focal neurological deficit of vascular aetiology with symptoms usually lasting less than an hour and no evidence of acute infarct on imaging
28
Risk factors for TIA
Diabetes mellitus High cholesterol Hypertension Smoking Family history AF
29
Presentation of TIA
Focal neurological deficit such as speech difficulty or arm/leg weakness/sensory changes Most symptoms resolve within 1 hour
30
First line treatment of patient with status epilepticus in a hospital setting
IV lorazepam
31
Classical presentation of spinal stenosis
Back pain with associated leg or buttock pain often relieved with flexion and worsened with extension Leg pain brought on by exercise
32
How do you investigate for a subarachnoid haemorrhage
Non contrast CT brain scan ASAP A lumbar puncture is indicated where a CT head does not confirm the diagnosis should be done 12 hours after symptom onset
33
Management of SAH
Can be split into medical, radiological and surgical management Medical Nimodipine has been used to prevent vasospasm Radiological & surgical Endovascular techniques exist for coiling or stenting Surgical techniques include clipping
34
what are Parkinson-plus syndromes
4 main ones they present as Parkinsonism (triad of resting tumour, hypertonia and bradykinesia) with additional clinical features
35
describe progressive supranuclear palsy
Parkinsonism and vertical gaze palsy
36
presentation multiple system atrophy
Parkinsonism and early autonomic clinical features such as postural hypotension, incontinence and impotence
37
cortico-basal degeneration presentation
Parkinsonism and fluctuations in cognitive impairment and visual hallucinations
38
acute management of suspected acute bacterial meningitis in a community based scenario e.g in a GP waiting for hospital transfer
IM benzylpenicillin if there is a non-blanching rash
39
acute management of suspected acute bacterial meningitis
2g of IV ceftriaxone twice daily with the addition of IV amoxicillin in young/old patients to better cover listeria IV acyclovir if viral encephalitis is suspected
40
how does vestibular neuritis present
commonly occurs after an URTI and presents with short bursts of dizziness
41
DANISH
cerebellar dysfunction Dysdiadochokinesia Ataxia Nystagmus Intention tremor Slurred speech Hypotonia
42
if a patient has a posterior circulation stroke what you thinking
cerebellar dysfunction symptoms DANISH
43
factors that are associated with worse prognosis in MS
older male motor signs at onset early relapses many MRI lesions axonal loss
44
features of extradural haemorrhage
haemorrhage between the skull and dura mater of the meninges tend to have a preceding history of head trauma and are rarely spontaneous bi-convex shape
45
features of subdural haemorrhage
haemorrhage between the dura mater and arachnoid mater tend to present more gradually than extradural haemorrhages with gradually increasing headache and confusion tend to occur in older patients and alcoholics on CT they have a crescent-shape
46
features of subarachnoid haemorrhage
a haemorrhage underneath the arachnoid mater presents as acute severe headaches often described as a blow to the back of the head
47
what is Lambert-eaton myasthenia syndrome
auto-immune disorder characterised by antibodies against the pre-synaptic voltage-gated calcium channels
48
what does Lambert-eaton myasthenia syndrome cause
progressive muscle weakness with increased use as a result of damage to the neuromuscular junction symptoms tend to be more insidious and less pronounced than in myasthenia gravis
49
who does Lambert-eaton typically occur in
patients with small-cell lung cancer result of antibodies produced by the immune system against voltage-gated calcium channels in small cell lung cancer
50
presentation of Lambert-eaton
ascending pattern of weakness that improves upon repetition/usage
51
Small cell lung cancer paraneoplastic syndrome
can be remembered by the SCLC mnemonic SIADH CUSHINGS LEMS CEREBELLAR DEGENERATION
52
Treatment for cluster headaches
Prophylaxis with verapamil Nasal Triptan
53
Presentation of cluster headaches
Recurrent attacks of sudden onset unilateral periorbital pain associated with a watery and bloodshot eye Nocturnal headaches Last 15 mins to 3 hours once or twice a day for a period of time
54
Bedside tests for myasthenia gravis
Ice pack test Application of an ice pack to to the eyes for 2-5 minutes If positive for myasthenia gravis, the patient no longer has characteristic ptosis
55
A 34-year-old obese female presents with a severe headache across both sides of her head and blurring of the vision in her right eye. you note that in her right eye she has papilloedema and a CNVI palsy. Her blood pressure is 160/100mmHg. She is currently on the combined oral contraceptive pill (COCP) what is the most likely diagnosis
idiopathic intracranial hypertension classically seen in young overweight females
56
mx idiopathic intracranial hypertension
weight loss diuretics

Clinical Medicine (26 decks)

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