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RACP Exam Prep > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the diagnostic criteria for Parkinson’s disease?

A

Presence of bradykinesia with either rest tremor, rigidity or both

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2
Q

What are the three research criteria for PD?

A

Preclinical - Neurodegeneration without symptoms/signs
Prodromal - Symptoms/signs present but insufficient for diagnosis
Clinical - Diagnostic criteria met

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3
Q

What are the early symptoms/signs of PD?

A

REM behaviour disorder
Hyposmia
Constipation
Early motor impairment
Depression/anxiety
Executive dysfunction

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4
Q

What is the biggest risk factor for PD development?

A

Sibling with PD <50yo at diagnosis (LR+ 7.5)

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5
Q

What is the most protective factor against PD development?

A

Smoking (LR- 0.45)

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6
Q

What are the key histopathological findings of PD?

A

Lewy bodies (intracytoplasmic inclusions) and Lewy neurites (intra-axonal neurites) comprised of ubiquitin and alpha-synuclein

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7
Q

What is the biggest prodromal risk factor for PD?

A

RBD (LR+ 130)

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8
Q

What are the two most important genetic variations contributing to PD?

A

Glucocerebrodase (GBA) 10%
LRRK2 1-2%

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9
Q

What is the primary/concerning adverse effect of ergot-based dopamine agonists?

A

Cardiac, pulmonary and retroperitoneal fibrosis

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10
Q

Quetiapine is often used for confusion/hallucinations in PD. What important interaction needs to be considered when using quetiapine?

A

Long QT with used with domperidone (for nausea)

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11
Q

What adverse effect is more commonly seen with dopamine agonists than with levodopa?

A

Impulse control disorder

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12
Q

What adverse effect is more commonly seen with levodopa when compared to other PD treatments?

A

Dyskinesia

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13
Q

What are the features of peak-dose dyskinesia?

A

Onset 30-60 minutes post-dose, upper body chorea, patient often unaware

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14
Q

What are the features of end-dose dyskinesia?

A

Onset 3-4 hours post-dose, dystonic reactions of feet (most often), painful

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15
Q

What is the average time to onset of dementia in PD patients?

A

10 years

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16
Q

What red flags in a PD patient warrant review of the diagnosis?

A

Absence of tremor
Symmetrical signs
Falls within the first year of diagnosis
Marked speech/dysphagia
Early urinary incontinence
Early dementia within first two years

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17
Q

What are the four classic signs of PSP (Richardson’s syndrome)?

A

Early falls
Supranuclear down gaze palsy
Postural instability
Frontal dementia

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18
Q

What are the classic features of PSP-Parkinson’s?

A

Asymmetric onset
Tremor
Response to levodopa
Better prognosis

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19
Q

What is the most common presentation of corticobasal syndrome?

A

Useless, rigid, jerking arm

20
Q

What causes are there of corticobasal syndrome?

A

Corticobasal degeneration
PSP
Pick disease
Alzheimers
DLB
CJD

21
Q

What feature distinguishes the bradykinesia of PD from other causes?

A

Fatiguing

22
Q

King Penguin sign on MRI is indicative of what?

A

PSP

23
Q

Normal midbrain with pons atrophy is indicative of what on MRI?

A

MSA

24
Q

What age and gender are predominantly affected by MS?

A

Females aged 20-40

25
Q

Which five characteristic signs of MS are there?

A

Internuclear ophthalmoplegia
Optic neuritis
Acute partial myelopathy
Lhermitte’s symptoms
Uhtoff’s symptoms

26
Q

What is the difference between relapsing remitting MS and progressive MS?

A

RRMS - Complete resolution of symptoms between attacks
PPMS - Progressive deterioration without resolution from time of disease onset
SPMS - Progressive deterioration without resolution after previous post-attack resolution

27
Q

What level of the spinal cord are MS lesions most commonly seen?

A

Cervical

28
Q

What proportion of patients with CIS and an abnormal MRI will develop MS?

A

70-90%

29
Q

What CSF findings are seen with MS?

A

Normal CSF profile +/- mildly elevated lymphocytes
Oligoclonal bands + IgG levels
Normal serum oligoclonal bands

30
Q

What relapse rates are seen with pregnant women with MS?

A

Increased relapse rates in first and second trimester (2-3 fold), decreased risk in third trimester

31
Q

What are the three most important risk factors for ischaemic strokes?

A

Age, hypertension, atrial fibrilation

32
Q

What are the two most important risk factors for haemorrhagic strokes?

A

Hypertension, cerebral amyloid angiopathy

33
Q

What is the most common foetal abnormality seen with anti-epileptics?

A

Cardiac malformations

34
Q

What is the typical age of onset for myasthenia gravis?

A

75 years

35
Q

What is the test diagnostic of MG in 80% of cases?

A

Acetylcholinesterase antibodies

36
Q

What is the secondary receptor to which antibodies are formed in MG?

A

Muscle Specific Kinase

37
Q

Which HLA is MUSK MG associated with?

A

HLA DR14-DQ5

38
Q

What is the primary treatment for MG?

A

Acetylcholinesterase inhibitors

39
Q

What secondary means of treatment are there for MG?

A

Steroids, steroid-sparing (AZA, MTX), rituximab/eculizumab

40
Q

What is the life-threatening complication of myasthenic crisis?

A

Diaphragmatic/intercostal involvement

41
Q

What proportion of LEMS is paraneoplastic?

A

50% (usually SCLC)

42
Q

What HLA class is associated with LEMS?

A

HLA B8-DR3

43
Q

What antibodies are the cause of LEMS?

A

Anti-voltage gated calcium channel antibodies

44
Q

What is the primary treatment of LEMS?

A

3-4 diaminopyridine (potassium channel blocker)

45
Q

What is the most sensitive test for MG?

A

EMG

46
Q

What is the most common pattern of peripheral neuropathy?

A

Distal symmetrical neuropathy

RACP Exam Prep (9 decks)

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