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Medicine > Neurology > Flashcards

Neurology Flashcards

1
Q

What is the treatment of Ramsay Hunt syndrome?

A

oral aciclovir and oral corticosteroids are usually given if patient is systemically well

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2
Q

Where is the lesion in Bells palsy?

A

lower motor neuron - do not cause forehead sparing

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3
Q

What are the features of Horner’s syndrome?

A

miosis - small/constricted pupil
ptosis - drooping of upper eyelid
endophthlamos (sunken eye)
anhidrosis (loss of sweating one side)

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4
Q

What is the first-line treatment for absence seizures?

A

ethosuximide

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5
Q

What is the first-line treatment for focal seizures?

A

lamotrigine or levetiracetam

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6
Q

What is the gold standard test for diagnosing venous sinus thrombosis?

A

MR venogram

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7
Q

what is the first line treatment for tonic or atonic seizures?

A

males: sodium valproate
females: lamotrigine

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8
Q

At what GCS level should a patient be intubated?

A

Less than 8

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9
Q

What is the ROSIER tool used for?

A

used to differentiate stroke from stroke mimics

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10
Q

What is the ROSIER tool used for?

A

used to differentiate stroke from stroke mimics

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11
Q

What is the treatment of Bell’s Palsy?

A

prednisolone + eye care

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12
Q

What should be given if you suspect meningitis in children?

A

< 3 months: IV amoxicillin + IV cefotaxime
> 3 months: IV cefotaxime or ceftriaxone
NICE advise against corticosteroids in children younger than 3 months

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13
Q

What are the features of Bell’s Palsy?

A

lower motor neuron facial nerve palsy - forehead affected
post-auricular pain, altered taste, dry eyes, hyperacusis

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14
Q

How can you differentiate between Parkinsons disease dementia and dementia with lewby bodies?

A

PDD = parkinsonian symptoms for at least a year then dementia symptoms
DLB = neuropsychiatric + dementia symptoms for a year then parkinsonism

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15
Q

Which nerve/nerve root is tested with triceps reflex?

A

radial nerve - c7

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16
Q

How does lacunar stroke present?

A

one of the following:
- unilateral weakness and/or sensory deficit of face and arm, arm and leg or all three
- pure sensory stroke
- ataxic hemiparesis

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17
Q

What are the effects of Levodopa in patients with Parkinsons?

A
  • more improvement in motor symptoms
  • more improvement in activities of daily living
  • more motor complications
  • fewer specified adverse effects
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18
Q

What are the features of L5 Nerve root decompression?

A

Sensory loss over the dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

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19
Q

What is the NICE guidance on performing a CT scan within 8 hours of injury?

A

Age 65+
Any history of bleeding or clotting disorders including anticoagulants
Dangerous mechanism of injury
More than 30 mins retrograde amnesia of events immediately before the head injury (?)

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20
Q

What invstigation should be done if you suspect takayusu’s arteritis?

A

ct angiography of the large vesels

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21
Q

What anaesthetic agent would people with myasthenia gravis most likely be resistant to?

A

suxamethonium

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22
Q

what are the features of delirium tremens?

A

symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety
peak incidence of seizures at 36 hours
peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

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23
Q

What is the management of spinal cord compression?

A

high dose oral dexamethasone
urgent oncological assessment for consideration of radiotherapy or surgery - radiotherapy may be indicated in older frail patients

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24
Q

what is the most common medical cause of a third nerve palsy?

A

diabetes

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25
Q

What are the features of Broca’s aphasia and what causes it?

A

Expressive aphasia
caused by a lesion in the inferior frontal gyrus - typically supplied by the superior division of the left MCA
speech is non-fluent, laboured and halting.
Repetition is impaired
Comprehension is normal

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26
Q

What are the features of Wernicke’s aphasia and what causes it?

A

Due to a lesion in the superior temporal gyrus
Typically supplied by the interior division of the left MCA
This area ‘forms’ the speech before ‘sending it’ to Brocas area
The lesion results in sentences that make no sense, word substitution and neologisms but speech remains fluent - ‘word salad’

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27
Q

What are features of a common peroneal nerve lesion?

A

characteristic feature is foot drop
other features include:
- weakness of foot dorsiflexion
- weakness of foot eversion
- weakness of extensor hallucis longus
- sensory loss over dorsum of foot and lower lateral part of leg
- wasting of anterior tibial and peroneal muscles

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28
Q

what are the features of cubital tunnel syndrome and what nerve is affected?

A

compression of the ulnar nerve as it passes through the cubital tunnel:
- tingling and numbness of the 4th and 5th finger which starts off intermittent and then becomes constant
- over time patients may also develop weakness and muscle wasting
pain worse on leaning on the affected elbow
- over a history of osteoarthritis or prior trauma to the area

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29
Q

What is the triad of Wernicke’s encephalopathy?

A

confusion
ataxia
ophthalmoplegia (weakness or paralysis of eye muscles)

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30
Q

What are the features of specific focal seizures?

A

temporal - automatisms (lip-smacking) - deja vu or jamais vu, emotional disturbance (sudden terror), olfactory, gustatory or auditory hallucinations
frontal - motor features such as Jacksonian features, dysphasia or Todd’s palsy
parietal - sensory symptoms such as tingling and numbness, motor symptoms
occipital - visual symptoms such as spots and lines in the visual field

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31
Q

what are the signs of motor neuron disease?

A

fasciculations
absence of sensory signs/symptoms
mixture of lower motor neuron and upper motor neuron signs
wasting of the small hand muscles/tibialis anterior is common

32
Q

what is the typical presentation of vascular dementia?

A

progressive stepwise deterioration in cognition which usually occurs over a period of several months to years

33
Q

What is Weber’s syndrome and how does it present?

A

infarct in branches of posterior cerebral artery that supply the midbrain
presents with ipsilateral CN III palsy - diplopia, ptosis, RAPD, and contralateral weakness of the upper and lower extremity

34
Q

What are the pathological changes seen in Alzheimer’s Disease?

A

macroscopic: widened cerebral atrophy, particularly involving the cortex and hippocampus
microscopic: cortical plaques due to deposition of type A bets amyloid protein and neurofibrillary tangles caused by abnormal aggregation of the tau protein
biochemical: defecit of acetylcholine

35
Q

what is transient global amnesia?

A

neurological condition characterised by a temporary but total disruption of both short and long term memory. Episodes typically last a matter of hours before resolving, after which patients usually make a full recovery

36
Q

What is the classic Parkinson’s triad?

A

bradykinesia
resting tremor
rigidity

37
Q

what are other features of parkinson’s?

A

stooped posture
mask-like face
depression
anosmia
sleep distrubances
autonomic dysfunction

38
Q

what is the management of parkinson’s?

A
  • co-careldopa - dopamine with carbidopa or
  • co-beneldopa - dopamine with benserazide
    comt inhibitors e.g. entacapone
    dopamine agonists e.g. carbegoline
    moa-inhibs e.g. rasegeline
39
Q

what are the features of MSA?

A

Parkinsonism
Autonomic dysfunction - postural hypotension, constipation, abnormal sweating , sexual dysfunction - erectile dysfunction is early sign
cerebellar dysfunction - ataxia

40
Q

what are the features of PSP?

A

parkinsonism
postural instability and falls -> broad-based gait
impairment of vertical gaze
cognitive impairment - frontal lobe dysfunction

41
Q

what can be given for acute attacks of menieres?

A

prochlorperazine

42
Q

What is pituitary apoplexy and what can precipitate it?

A

sudden enlargement of a pituitary tumour secondary to haemorrhage or infarction
precipitating factors: hypertension, pregnancy, trauma, anticoagulation

43
Q

What are the features of pituitary apoplexy?

A

Sudden onset headache similar to that seen in subarachnoid haemorrhage
vomiting
Neck stiffness
Visual field defects: classically bitemporal superior quadrantic defect
extraocular nerve palsies
features of pituitary insufficiency: hypotension/hyponatraemia secondary to hypoadrenalism

44
Q

when can stopping anti-epileptic medication be considered in someone with epilepsy?

A

can be considered if seizure free for > 2 years with AEDs being stopped over 2-3 months

45
Q

What are the possible features of a posterior circulation stroke?

A

involves vertebrobasilar arteries and presents with 1 of the following:
- cerebellar or brainstem syndromes
- loss of consciousness
- isolated homonymous hemianopia

46
Q

what is lateral medullary syndrome?

A

occlusion of posterior inferior cerebellar artery
a.k.a wallenberg’s syndrome
ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral;=: limb sensory loss

47
Q

What antibodies can you test for if you suspect myasthenia gravis?

A

acetylcholine receptor antibodies - 85% of patients
muscle-specific kinase antibodies - 10% of patients
LRP4 antibodies - less than 5%

48
Q

what test can be performed to aid diagnosis of myasthenia gravis?

A

edrophonium test/tensilon test - not used commonly due to risk of cardiac arrhythmias
single fibre electromyography - high sensitivity - 92-100%
ct thorax to exclude thymoma

49
Q

what drugs can exacerbate myasthenia gravis?

A

penicillamine
quinidine, procainamide
beta blockers
lithium
phenytoinn
abx - gent, macrolides, quinolones, tetracyclines

50
Q

What are the features of hereditary sensorimotor neuropathy type I (Charcot-Marie-Tooth)?

A

autosomal dominant
due to defect in PMP-22 gene - codes for myelin
features often start at puberty
motor symptoms predominate
distal muscle wasting, pes cavus, clawed toes
foot drop, leg weakness are often the first features

51
Q

How is motor neuron disease diagnosed?

A

it is a clinical diagnosis, but nerve conduction studies will show normal motor conduction and can help exclude a neuropathy
Electromyography shows a reduced number of action potentials with increased amplitude
MRI is usually performed to exclude the differential diagnosis of cervical cord compression and myelopathy

52
Q

What are the triggers for migraine?

A

remember the mnemonic “CHOCOLATE”
Chocolate
Hangovers
Orgasms
Cheese, caffeine
Oral contraceptive pill
Lie ins
Alcohol
Travel
Exercise

53
Q

what is the window for thrombolysis in acute stroke?

A

within 4.5 hrs of onset of stroke symptoms when haemorrhage has been definitively excluded

54
Q

what are absolute contraindications to thrombolysis?

A

previous intracranial haemorrhage
seizure at onset of stroke
intracranial neoplasm
stroke or traumatic brain injury in preceding 3 months
lumbar puncture in preceding 7 days
GI haemorrhage in preceding 3 weeks
active bleeding
pregnancy
oesophageal varices
uncontrolled hypertension > 200/120

55
Q

what are relative contraindications to thrombolysis in acute stroke?

A

concurrent anticoagulation (INR > 7.1)
haemorrhagic diathesis - susceptibility to bleed
active diabetic haemorrhagic retinopathy
suspected intracardiac thrombus
major surgery/trauma in preceding 2 weeks

56
Q

what cranial nerves can be affected by an acoustic neuroma and what are the associated features?

A

VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
V: absent corneal reflex
VII: facial palsy

57
Q

what is a pontine haemorrhage?

A

form of intracerebral haemorrhage which can be caused by long standing hypertension

58
Q

how does a pontine haemorrhage present?

A

reduced GCS
paralysis
bilateral small or “Pin point” pupils

59
Q

how are cluster headaches treated acutely?

A

100% oxygen
subcutaneous triptan

60
Q

what is the prophylaxis for cluster headaches

A

verapamil is the drug of choice

61
Q

obstruction of which vessel causes amaurosis fugax?

A

retinal artery

62
Q

what is the treatment of myasthenic crisis?

A

plasmapharesis
iv immunoglobulins

63
Q

what is lambert eaton syndrome associated with?

A

small cell lung cancer and to a lesser extent breast and ovarian cancer

64
Q

what is pathophysiology of lambert eaton and how does this compare to myasthenia gravis?

A

antibodies directed against presynaptic voltage gated calcium channels in the peripheral nervous system
myasthenia is antibodies against post-synaptic terminal

65
Q

what are the features of lambert eaton syndrome?

A

repeated muscle contractions lead to increased muscle strength - in contrast to myasthenia gravis
limb girdle weakness - affects lower limbs first
hyporeflexia
autonomic symptoms - dry mouth, impotence, difficulty micturating
ophthalmoplegia and ptosis not commonly a feature (unlike in myasthenia gravis)

66
Q

what drugs are used for spasticity in MS?

A

baclofen and gabapentin

67
Q

which artery can be affected in temporal arteritis?

A

posterior ciliary artery - branch of ophthalmic artery - fundoscopy shows a swollen pale disc and blurred margins - anterior ischaemic optic neuropathy

68
Q

what is the investigation of choice for acoustic neuroma?

A

MRI of cerebellopontine angle

69
Q

what is the treatment of tonic/atonic seizures?

A

males: sodium valproate
females: lamotrigine

70
Q

what medications can worsen myasthenia gravis?

A

penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibitoics: gent, macrolides, quinolones, tetracyclines

71
Q

what is normal pressure hydrocephalus?

A

reversible cause of dementia seen in elderly patients - thought to be secondary to reduced CSF absorption at the arachnoid villi - may be 2ndary to head injury, subarachnoid haemorrhage or meningitis

72
Q

what is the triad of normal pressure hydrocephalus?

A

urinary incontinence
dementia and bradyphrenia
gait abnormality

73
Q

what are the features of anterior inferior cerebellar artery stroke/lateral pontine syndrome?

A

symptoms are similar to wallenberg -
ipsilateral facial pain and temperature loss
contralateral limb/torso pain and temperature loss
ataxia, nystagmus
and
ipsilateral facial paralysis and deafness

74
Q

what does hypoglossal nerve injury cause?

A

deviation of tongue towards side of lesion

75
Q

what blood test can be used to differentiate a true seizure and a psuedoseizure?

A

prolactin - raised following true epileptiform seizures

76
Q

what is benign rolandic epilepsy?

A

childhood epilepsy that typically occurs between age of 4 and 12
seizures characteristically occur at night
seizures are typically partial e.g. paraesthesia affecting the face but 2ndary generalisation may occur i.e. parents may report tonic clonic movements
eeg characteristically shows centrotemporal spokes
prognosis is excellent, with seizures stopping by adolescence

Medicine (20 decks)

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