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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
Q

Management of Ramsay hunt syndrome

A

Anti-virals typically oral acyclovir
Corticosteroids typically oral prednisolone
Good eye care

26
Q

Acute management of MS

A

An acute attack of MS should be treated with glucocorticoids
1g of IV methylprednisolone every 24 hours for 3 days

27
Q

What is a TIA

A

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
Q

Risk factors for TIA

A

Diabetes mellitus
High cholesterol
Hypertension
Smoking
Family history
AF

29
Q

Presentation of TIA

A

Focal neurological deficit such as speech difficulty or arm/leg weakness/sensory changes

Most symptoms resolve within 1 hour

30
Q

First line treatment of patient with status epilepticus in a hospital setting

A

IV lorazepam

31
Q

Classical presentation of spinal stenosis

A

Back pain with associated leg or buttock pain often relieved with flexion and worsened with extension

Leg pain brought on by exercise

32
Q

How do you investigate for a subarachnoid haemorrhage

A

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
Q

Management of SAH

A

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
Q

what are Parkinson-plus syndromes

A

4 main ones
they present as Parkinsonism (triad of resting tumour, hypertonia and bradykinesia) with additional clinical features

35
Q

describe progressive supranuclear palsy

A

Parkinsonism and vertical gaze palsy

36
Q

presentation multiple system atrophy

A

Parkinsonism and early autonomic clinical features such as postural hypotension, incontinence and impotence

37
Q

cortico-basal degeneration presentation

A

Parkinsonism and fluctuations in cognitive impairment and visual hallucinations

38
Q

acute management of suspected acute bacterial meningitis in a community based scenario e.g in a GP waiting for hospital transfer

A

IM benzylpenicillin if there is a non-blanching rash

39
Q

acute management of suspected acute bacterial meningitis

A

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
Q

how does vestibular neuritis present

A

commonly occurs after an URTI and presents with short bursts of dizziness

41
Q

DANISH

A

cerebellar dysfunction
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia

42
Q

if a patient has a posterior circulation stroke what you thinking

A

cerebellar dysfunction symptoms DANISH

43
Q

factors that are associated with worse prognosis in MS

A

older
male
motor signs at onset
early relapses
many MRI lesions
axonal loss

44
Q

features of extradural haemorrhage

A

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
Q

features of subdural haemorrhage

A

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
Q

features of subarachnoid haemorrhage

A

a haemorrhage underneath the arachnoid mater

presents as acute severe headaches often described as a blow to the back of the head

47
Q

what is Lambert-eaton myasthenia syndrome

A

auto-immune disorder characterised by antibodies against the pre-synaptic voltage-gated calcium channels

48
Q

what does Lambert-eaton myasthenia syndrome cause

A

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
Q

who does Lambert-eaton typically occur in

A

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
Q

presentation of Lambert-eaton

A

ascending pattern of weakness that improves upon repetition/usage

51
Q

Small cell lung cancer paraneoplastic syndrome

A

can be remembered by the SCLC mnemonic
SIADH
CUSHINGS
LEMS
CEREBELLAR DEGENERATION

52
Q

Treatment for cluster headaches

A

Prophylaxis with verapamil
Nasal Triptan

53
Q

Presentation of cluster headaches

A

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
Q

Bedside tests for myasthenia gravis

A

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
Q

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

A

idiopathic intracranial hypertension

classically seen in young overweight females

56
Q

mx idiopathic intracranial hypertension

A

weight loss
diuretics

Clinical Medicine (26 decks)

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