Neurology Flashcards
1
Q
Differentiate carpal tunnely syndrome from pronatory syndrome
A
Palmar cutaneous branch. Splits off before carpal tunnel and goes above flexor retinaculum
In CTS, lateral pal spared
In pronator syndrome, lateral palm involved
2
Q
Rapidly progressive dementia associate with myoclonus
A
CJD
3
Q
Adies pupil
A
Loss of parasympathetic consrictors of pupil
Different from CN III lesion where opthalmoplegia occur
4
Q
Management of IIH
A
1st line weight loss
2nd - medical (acezetolamide, topiramate)
3rd - surgery
5
Q
CSF changes in Alzheimer’s
Earliest signs of pre-clinical Alzheimer’s disease
A
Early - Low CSF AB peptide 42
Next - High CSF Tau
High PET amyloid tracer retention
6
Q
Imaging changes for Alzheimers
- MRI
A
- MRI - hippocampal atrophy
7
Q
Which primary headache type can you use botulinum toxin in?
A
Chronic migraine (16-30 days of headache per month)
Use 2nd line
8
Q
Most common ongoing outcome of Wernicke’s
A
Amnestic memory loss i.e Korsakoff’s syndrome
9
Q
DDx of bilateral temporal lobe MRI changes
A
Infection
Inflammation - Limbic encephalitis (paraneoplastic or autoimmune)
10
Q
Rx of serotonin syndrome
A
Cyproheptadine
11
Q
Rx of NMS
A
Bromocriptine
12
Q
Signs and Rx of malignant hyperthermia
A
Fever, hypcarbia, rigidity after volatile induction anaesthetic
Rx - dantrolene (direct muscle relaxant)
13
Q
Which side of brain are speech centres?
A
Usually L - Left dominance
14
Q
Another name for essential tremor
A
Benign familial tremor
15
Q
Management of psychosis in Parkinson’s
A
Withdraw Parkinson’s meds in order of least effective (anticholinergics first)
Rx - quetiapine, clozapine
16
Q
Treatment of CVST
A
LWMH/heparin
Aim for therapeutic anticoagulation for 3-6 months
17
Q
Main risk factors for CVST
A
Pregnancy/puepuerium
COCP use
Malignancy
18
Q
Treatment of eclampsia - features of hypermagnesiaemia
A
Loss of deep tendon refexes –> hypermagnesaemia
19
Q
Episodic vertigo/ataxia
Interstitial keratitis
Oscilopsia (sensation of unstable vision
A
Cogan syndrome
Treat with pred and DMARDs - MTX
20
Q
Hemiballismus. Lesion where?
A
Subthalamic nucleus
21
Q
Components of basal ganglia
A
Striatum - caudata/putamen
Globus pallidus
Subthalamic nucleus
Substantia nigra - pars compact (Da) and parts reticulata (GABA)
22
Q
Trauma, neck pain, headache, horner’s syndrome
A
Carotid artery dissection
23
Q
Rhomberg test -positive and negative results intepretation
A
Positive - ataxia due to sensory loss (proprioception)
Negative - ataxia due to cerebellar cause
24
Q
Endolymphatic hydrops
A
Menierre disease
25
Rinne and Weber
Rinne - tunin fork on mastoid and next to ear. Normal is air > bone
Weber - if Rinne abnormal, can distinguish conductive vs sensironeural. cOnductive localises bad ear, sensironeural localises good ear
26
Parkinsonism
Postural instability/frequent falls
PSP
27
Parkinsonism
Asymmetric
Alien limb phenomenon
Athetosis, chorea
Corticobasal degeneration
28
Parkinsonism
Predominant autonomic symptoms
MSA
29
Features of prodromal PD
RBD
Hyposmia
Anxiety
30
Significance of RBD
50% will develop synucleopathy - iPD, MSA
31
GBA1 gene
- heterozygous - increased risk?
- homozygous - increased risk?
Heterozygous - 10% Parkinsons'
Homozygous - Gaucher disease
32
A/e of ergot Da agonists (hence not used)
Valvulopathy
Raynaud's
Erythromelalgia
Pulmonary fibrosis
Retroperitoneal fibrosis
33
COM-T - what is it and benefit of blocking
Degrades dopamine
Entacapone blocks COM-T, so reduces rate of breakdown of Da (and therefore L-dopa), potentiating effect (increasing half-life. Good for wearing off periods
34
Treatment of REM sleep behaviour disorder
Clonazepam
35
Risk of starting Da agonists
Impulse control disorders
- Pathological gambling
- Hypersexuality
- Compulsive shopping, bing eating
36
Repetitive sterotype movements in patient with Parkinson's on treatment
Name?
Cause?
Punding
Feature of dopamine dysregulation syndrome, due to Da agonists
37
Management of off periods
Add entacapone
Add amandatadine
Add Da agonist
Increase L-dopa dose or frequency
38
Which Parkinson medication has anticholinergic activity
Amantadine
39
Gene for Wilson's
ATP7B
- homozygote - confirms diagnosis
- heterozygote - confirms, most patients are compound heterozygotes
40
Neurological manifestations in Wilson's in terms of frequency
Dysarthria - most common
Dystonia
Tremor
Parkinsonism
41
Diagnostic approach to Wilson's
Caeroplasmin low, 24 urinary copper excretion high, Kayser fleischer rings confirm diagnosis
Any one of above not present - obtain liver biopsy or ATP7B gene testing to confirm
42
Oral disease modifying therapy for MS
Fingolimod
Teriflunomide
Dimethyl fumarate
43
MoA fingolimod
Decreases ability of lymphocytes to enter CNS by preventing lymphocytes leaving lymphatic tissue
44
A/E of fingolimod
Bradycardia and heart block
Overwhelming hsv
Downregulates spingosine 1 phosphate receptor subtypes
45
MoA of teriflunomide
Inhibits pyrimidine synthesis
46
NMOSD
- Name
- Cell involved
Neuromyelitis optica spectrum disorder
Astrocytes
47
APQ4 antibody
NMOSD
48
NMOSD mimicker:
- Classic clinical presentations
Bilateral/rapidly sequential optic neuritis
Tranverse myelitis (often > 3 segments)
Area postrema syndrome -Intractabile hiccups, nausea
49
NMOSD diagnosis
Clinical features (3)
APQ4 antibody
50
MOGAD disease presentation
ADEM in children
- Confusion
- Demyelination - weaness, numbness, bladder/bowel changes
51
MOGAD Ab
Myelin oligodendrocyte gylcoprotein associated Ab (MOGAD)
52
MS in pregnancy
Can use GIN
- glatiramer, inteferon, nataluzimab.
Aim for quiscient disease. Pregnancy is protective for MS relapse so can w/h altogether
53
Oftatumumab
Anti-CD20 for MS
54
Dominant lobe
- Side
- Symptoms
Left usually (for R hand people)
Aphasia - Broca's and Wernicke's
55
Non-dominant lobe
- Side
- Symptoms
R usually
Neglect, homonomous heminopia
56
Gerstman syndrome
- Location
Inferior angular gyrus parietal lobe dominant side
57
L PCA syndrome
- Normal
- Gerstmand
Normal - Alexia (reading issue), but no agraphia
Gerstman - Agraphia, (issue with writing), acaculia, Agnosia, L-R disorientation
58
L vs R PCA syndrome
- Similar
- Different
Both can have homonomous heminopia with macular sparing
L - Alexia without agraphia, Gerstman
R - more likely to have neglect
59
Blind but denies blindness
- Name?
- Cause
Anton syndrome
Bilateral PCA artery
60
Decreased conscious state
Gaze palsy
Dilated pupils
Top of the basilar stroke
61
Locked in syndrome - site of lesion?
Pons infarction - proximal basilar artery
62
Basilar artery
- Proximal pathology
- Distal pathology
Proximal = pons/medullar junction. Get bulbar dysfunction, locked in syndrome, herald weakness
Distal = midbrain pons. Get LoC and gaze palsies. ("top of basilar)
63
Most common residual effect of Wernicke's encephalopathy
Amneistic memory loss - Korsakoff syndrome, memory loss can persist in 80% of patients after recocery
64
Preventative stroke therapy for non-cardioembolic stroke
- Acute stroke NIHSS > 5
- TIA or NIHSS < 5 stroke
- Low ris TIA
Acute stroke NIHS > 5 or low risk TIA - aspirin
High RISK TIA or small stroke NIHSS < 5 - DAPT 21 days, clopi monotherapy
65
Pyrodoxine deficiency
- Deficiency causes?
- Common cause
Required for GABA synthesis
Deficiency can cause seizures, peripheral neuropathy
Common cause isoniazid use - Give concomittant B6
66
1st line for generalised seizures
Valproate
If child-bearing - lamotrigine
67
First line for focal seizures
CBZ
68
First line for absence seizures (generalised)
Ethosuximide
69
ANti-epileptics acting on GABA
PTV B to GABA
Phenobarbitol
Tigabine
Vigabitrin
BZD
70
Ca Channel anti-epileptics
Ca Channels - Ethosuximide
Alpha 2 delta subunit - pregabalin, gabapentin
71
Synaptic vesicle 2A
leviteracetam
72
NMDA receptor antagonist
Perampanel
73
A/E leviteracetam
Psychiatric - mood, irritability, suicidality
74
A/E of perampenl
Weight gain
Hostility
75
Antiepileptic causing weight loss
Topiramte
76
Options for pregnant women epilepsy
Lamotrigine, leviteracetam
77
Phenytoin decreased absoprtion with?
Enteral feeds
78
Anti-epileptic most likely to cause weight gain
Valproate
79
Seizures with CTB showing calcified cysts
Neurcysterocosis
- Calcified cysts - late stage, AED only
- Non-calcified cysts - albendazole and praziquantel
80
4 principles of MG therapy
Symptomatic - acetylcholinesterase inhibitor (pyridostigmine)
Immunomdulator therapy
Thymemectomy
Rescue for crisis - IVIG, PLEX
81
MusK Ab positive MG - Rx?
Rituximab
82
Indications for thymemectomy
MG + thymoma
MG + ACHr Ab positive + inadequate response to immunotherapy
83
Pathophys of LEMS
VGc Ab
84
EMG difference of LEMS and MG
LEMS - repeat high frequency stimulation causes high amplitude
MG - low amplitude with repeated stimulation
85
Management of LEMS
3.4 DAP (diaminopyrmidine) - K channel blocker
86
Severe shouder pain, with subsequent weaness/wasting around shoulder girlde
Brachial neuritis
Often post inefction/vaccination
87
Pain, numbness, weakness in arm on raising arm above head or repeated exertion
- ?cause
- Common aetiology
Neurogenic thoracic outlet syndrome - compression of NV bundle between 1st rib and clavicle.
Common cause - cervical rib
88
Deep tendon reflex - where is sensory receptor
Muscle spindle - stretch receptor in muscle that is stimulated with stretching of tendon
89
Pre-ganglionic autonomic nerve fibre type
B
90
Post-ganglionic autonomic nerve fibre type
C
91
Nerve fibre for warm temperature
C - opposite of cold
92
Nerve fibres for motor, proprioception/vibration
Aa - large fibre,large myelin
- Motor, vibration/proprioception
93
Ad fibres?
Small, minimally myelinated
- Cold temperature, pain
94
What are positive sensory symptoms?
- more common in acquired or hereditary
Prickling, paresthesias
More common in acquired peripheral neuropathy
95
CIDP
- Ab's indicating nodal/paranodopathy
- Rx?
Neurofascin AB's
Contactin 1
Both IgG4
Treat with rituximab
96
Charcot Marie tooth inheritance and gene
Autosomal dominant
Type 1 is PMP22
97
Sensory and Motor symptoms
Foot deformities - Pes planus (flat), pes cavus (high arch)
Foot drop, pseudohypertrophy calves
Charcot Marie Tooth
= Herediatry and Sensory Motor neuropathy
98
Episodes of isolated peripheral nerve palsy. Usually nerves susceptible to compression
- Cause?
- Genetics
Hereditary neuropathy with liability to pressure palsy (HNLPP)
Allele of PMP22 (Charcot Marie Tooth form)
99
Sensory symptoms
- Worsen with closing eyes (sensory ataxia)
- Associatd with pseudoathetoid movements (moving fingers like playing piano)
Cause?
Location of lesion
Paraneoplastic sensory neuropathy
Involving DRG
99
Sensory symptoms
- Worsen with closing eyes (sensory ataxia)
- Associatd with pseudoathetoid movements (moving fingers like playing piano)
Cause?
Location of lesion
Paraneoplastic sensory neuropathy
Involving DRG
99
Sensory symptoms, usually level
Motor symptoms - paraparesis
Autonomic symptoms - bladder, bowel dysfunction
Acute or Subacute
Transverse myelitis
Need MRI-spine to exclude compressive cause
100
Corticospinal tract which part of internal capsule?
Posterior limb
101
Where do following pathways decussate?
- Corticospinal
- DCMLN
- ST
Corticospinal (pyramid) - medulla
DCMLN - medulla
ST - 1-2 levels above spinal cord exit
102
Differentiate central cord syndrome and anterior cord
Simalarities
Anterior cord - has autonomic dysfunction, and preference of upper and lower limb weakness
Central Cord - rarely autonomic dysfunction. UL >LL for weakness. Hyperreflexia below lesion early
Both have preserveation of vibration/proprioception (dorsal columns)
103
Brown Sequard
- Patter of neurological loss - ipsilateral and contralteral?
Ipsilateral motor and vibration/proprioception
Contralteral pain/temperature (ST decussates 1-2 levels above)
104
Posterior cord features
Intermittent Shooting pains
Tabes Dorsalis - Neurosyphilis
105
LMN findings at spinal level only, no sensory
- type of disease
- cause
Anterior horn cell disease
Cause - Polio
106
Complete spinal cord lesion
Spasticity and paresis below level of lesion
Loss of all sensory modalities
Loss of autonomic function - bowel, bladder, erectile dysfunction
(similar to transverse myelitis)
107
Radial nerve palsies features
- Arm
- deep forearm (below elbow)
- Superficial forearm
Arm = spiral groove. Sensory loss and wrist drop
Splits below elbow:
- Posterior interosseus (deep forearm) - weakness extensors of hand, wrist spared a extensor carpi radialis get inmrvaton at elbow
Superficial radial - sensory only, no motor weakness
108
Weakness of extensors of hands
No sensory changes
Posterior interosseus palsy
- Fracture/dislocation radius
- Entrapment arcade of Frohse
109
Loss of sensation dorsum of hand, no wrist extensor weakness
Superficial radial nerve injury
- laceration to forearm
110
Median nerve injury at elbow (pronator teres syndrome) vs in forearm (AIN palsy)
Elbow - supracondylar fracture. = loss of LOAF muscles, forearm pronation, finger extension, Sensory deficit lateral 3 1/2 digits
AIN - can't pinch finger/thumb together. No senssory loss.
111
Carpal Tunnel vs laceration above palmar branch division
Carpal tunnel - sensory thenareminence spare
Above palmar branch division (wrist) - involves thenar eminence
112
Ulnar paradox
Ulnar lesion at elbow - long flexors also affected, so claw is more mild (DIP's can't flex due to loss of FDP)
Ulnar at wrist - long flexors preserved, so more pronounced DIP flexion from FDP
113
Cranial nerve 3 palsy
- Pupillary sparing (normal miosis (parasympathetics)
Diabetic mononeuritis multiplex
114
Function of trochlear nerve
SO
- Downward movement when adducted
- Intorsion when abducted
115
Isolated CN VI palsy - what case to be mindful of?
Elevated ICP - can be false localising sign
116
Structures cerebellopontine angle
CN V, VI, VII, VIII
CN V in more extensive lesions
117
Cranial nerves cavernous sinus
III, IV, V1, V2, VI and sympathetics
118
Cranial nerves foramen magnum
CN 9,10,11,12
119
Pons gaze centres
- sequence
Contralateral Eye field --> PPRF --> 6 --> crossover via MLF to 3 --> eye
120
Can't recognise faces
Propasognosia
R PCA
121
Apraxia
- What is it
- Which hemisphere
Difficulty performing tasks that require some complex planning - e.g constructional, dressing aprexia
Non-dominant
122
Operculum - consists of
Frontal, temporal and parietal lobe junction
Covers the insula
123
Prompting to get out of bed, eat:
- Sign?
- Cause?
Abulia
Frontal cortical stroke (ACA)
124
Pyramidal weakness
Extensors UL
Flexors LL
Think back of body
125
What detects and initaites deep tendon reflex
Muscle spindles
126
Treatment options for essential tremor
Propanolol
Primidone (antiseizure medication metabolised to phenobarbitol, beware CYP interactions
127
Ab for Miller Fisher syndrome
GQ1b
128
GQ1B syndromes - simialr features
Variants and separating features
Opthalmoplegia, Ataxia
MFS - areflexia
Bickerstaff encephalitis - encephalopathy
Pharyngeal/cervical - bulbar dysfunction
129
When to treated GQ1b syndromes
Lower limb weakness
Bulbar or respiratory involvement
130
Rapid onset vertigo
Nausea/vomitting
Gait instability but can still ambulate
Vestibular neuritis
131
Midline cerebellar features
Think middle
- Truncal ataxia - swaying of head/trunk when sitting
- Titubation - involuntary nodding of head/neck/trunk
- Gait ataxia with tendency to fall
132
Hemipshere cerebellar features
Think peripheral
- Dysdiadochonesis
- Dysmetria UL
- Intention tremor
- Limb ataxia
133
Diagnostic approach to GBS
Typical symptoms?
- LP --> high protein, normal WCC --> confirms diagnosis
Atypical symptoms or non-diagnostic LP --> NCS/EMG
134
Cause of lateral medulalry syndrome
Vertebral artery infarct
135
Cause of medial medullary syndrome
Vertebral artery or basilar artery infarct
136
Headache, vomitting, cerebellar signs
Decreased LoC
Stupor
Which vessel?
PICA
causing cerebellar infarction and mass effect
137
PML treatment for natazilumab
Stop natazilumab
Steroids if develop IRIS after withdrawal
138
Hummingbird sign MRI
PSP
139
A/E of amantadine
antichoinergic like activity
140
Moa of triptan release
Inhibits CRGP release (associated with migraine)
141
Type 1 muscle fibres
Slow, aerobic, fatigue resistance
High mitochondria, capillaries, myoglobin (for O2)
Low gylcogen
142
Type 2 muscle fibres - features
Fast
High glyocgen --> anaerobic
143
Dissemination in space for MS
2 MRI lesions
144
Dissemination in time for MS
MRI
- new lesion
- x2 lesions, one enhancing other note
- Further clinical attack
- Oligoclonal bands
145
Inferior qunadrantopia only
Occiptal lobe - cuneus
146
Important mimicker for meningitis involving VZV
Herpes opthalmicus - V1 (opthalmic branch of trigeminal)
147
Which radiculopathy are reflexes usually preserved?
L5
Most others have hyporeflexia
148
Anti-psychotic with highest risk of seizure
Clozapine
149
Findings that a NCS can demonstrate
Axonal degeneration
Demyelination
Conduction block
