Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCP PACES > Neurology > Flashcards

Neurology Flashcards

1
Q

Median nerve power

A

Thumb abduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Radial nerve power

A

Wrist extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Ulnar nerve power

A

Finger abduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ulnar nerve lesion findings
(FOUR)

A

Weakness of finger abduction
Hypothenar wasting
Weakness of 4th and 5th fingers
Altered sensation medial hand 4th and 5th fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatments for neuropathic pain
(THREE)

A

Tricyclic (amitriptyline)
SNRI (duloxetine)
Pregabalin or gabapentin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Investigations for isolated peripheral nerve neuropathy (eg radial/ulnar)
(THREE)

A

Neurophysiological testing
Nerve conduction studies
Consideration of EMG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Posterior interosseous nerve power

A

Finger extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of peripheral neuropathy (sensory)
(TWELVE)

A

Metabolic:
- Diabetes
- Hypothyroid
- Vitamin B12 deficiency
Toxic:
- Alcohol
- Vincristine
- Isoniazid
Immune:
- Rheumatoid arthritis
- Granulomatosis with polyangiitis
- Guillain-Barre
- Chronic inflammatory demyelinating polyneuropathy
Genetic:
- Charcot-Marie-Tooth
Infection:
- HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is mononeuritis multiplex?

A

Group of peripheral nerve disorders
Progressive peripheral motor and sensory neuropathies
Frequently associated with pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes of mononeuritis multiplex
(SEVEN)

A

Diabetes
Connective tissue diseases:
- Rheumatoid arthritis
- SLE
Vasculitides:
- Polyarteritis nodosa
- Churg-Strauss
Infection:
- HIV
Paraneoplastic conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bedside tests for peripheral neuropathy
(THREE)

A

Ophthalmoscopy - diabetic retinopathy
Urinalysis - glucose in urine
Blood glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Investigations for peripheral neuropathy
(TWELVE)

A

Bloods:
- Glucose and HbA1c
- FBC - macrocytic anaemia B12
- U+E - urea
- LFTs - alcohol
- TFTs
- B12 level
- ESR
- Connective tissue disease screen
- Immunoglobulins
- Serum protein electrophoresis
Nerve conduction studies - demyelinating vs axonal
EMG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of peripheral neuropathy - motor predominant
(FIVE)

A

Guillain-Barre (acute)
Botulism (acute)
Lead toxicity
Porphyria
Hereditary sensory motor neuropathy (Charcot-marie-tooth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Inheritance of charcot-marie-tooth

A

Autosomal dominant
Type I - demyelinating
Type II - axonal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Investigations for charcot-marie-tooth
(THREE)

A

Nerve conduction studies - demyelinating vs axonal
Blood genetic testing
Family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Management of charcot-marie-tooth
(FIVE)

A

No disease modifying treatments
Genetic counselling
Multidisciplinary team
Physiotherapy for mobility
Orthotics
Occupational therapy team - adaptations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Visual field defects and lesion location

A

Bitemporal hemianopia - optic chiasm
Unilateral whole field loss - that optic nerve after chiasm
Homonymous hemianopia - Optic nerve before chiasm, opposite side
Superior quadrantopia - temporal lesion
Inferior quadrantopia - parietal lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Limb signs of stroke
(FOUR)

A

Hypertonia
Reduced power
Hyperreflexia
Sensory loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Non-neurological examination for stroke
(FOUR)

A

Pulse for AF
Auscultate carotids for bruit
Auscultate heart - valvular heart disease
Blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Acute investigations and management for stroke
(THREE)

A

Baseline blood glucose - check for hypoglycaemia
Urgent CT head
If no haemorrhage consideration thrombolysis/thrombectomy
If outside window and no haemorrhage antiplatelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Non-acute investigations for stroke
(EIGHT)

A

MRI head
ECG
BP
Carotid doppler
3-5 day holter
Echo
HbA1c and lipid profile
Bedside swallow assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Cranial nerve signs for MS
(THREE)

A

Optic neuropathy:
- relative afferent pupiliary defect
- Pale optic disc
Intranuclear ophthalmoplegia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Investigations for multiple sclerosis
(FOUR)

A

MRI brain
MRI spine
LP - oligoclonal bands
Visual evoked potentials - reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Treatment of MS relapse

A

High dose steroids - methylpred (rule out infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Side effects of steroids
(FIVE)

A

Sleep disturbance
Mood disturbance
GI ulceration
Avascular necrosis hip
Long term use osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Spastic paraparesis differentials
(EIGHT)

A

Vascular - spinal infarct - sudden onset
Trauma - disc prolapse/cord compression
Multiple sclerosis - demyelinating
Anterior horn cell disease - motor neurone disease
Cerebral palsy
Friedrich’s ataxia
Subacute combined degeneration of the cord
Syringomyelia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Cerebellar signs
(SEVEN)

A

Dysdiadochokinesis
Ataxia
Nystagmus
Intention tremor
Scanning dysarthria
Hypotonia/hyporeflexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Differentials for cerebellar syndrome
(SEVEN)

A

Acute:
- Stroke
- Multiple sclerosis (relapse/remitting)
Alcohol
Malignant:
- Space occupying
- Paraneoplastic
Genetic:
- Friedrich’s ataxia
- Ataxia telangiecasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Management of cerebellar ataxia
(FOUR)

A

Identify and treat underlying cause
MDT
Physiotherapy for mobility
Occupational therapy - adaptations

30
Q

Cerebellar vs sensory ataxia

A

Cerebellar:
- Nystagmus
- Dysarthria
- Broad based stance and gait
Sensory:
- Impaired sensation (particularly proprioception and vibration)
- Pseudoathetosis - involuntary hand and arm movements
- Struggle finger nose with eyes closed
- Romberg’s sign positive

31
Q

Sensory ataxia - causes of central vs peripheral

A

Central:
- Dorsal column damage
Peripheral:
- Neuropathy
Both:
- B12 deficiency

32
Q

Investigations for cerebellar syndrome

A

MRI head

33
Q

Lifestyle advice for cerebellar syndrome
(THREE)

A

Alcohol cessation - worsens symptoms even if not cause
Occupation:
- Risks associated
- Occupational health for adaptations
Medications:
- Anything that may exacerbate dizziness or unsteadiness

34
Q

Investigations of MND

A

EMG - fasciculations and fibrillations without sensory signs
MRI scan - exclude other pathologies

35
Q

Differentials for MND
(FOUR)

A

Cervical cord compression
Spinal muscular atrophy
Syringomyelia
Multifocal motor neuropathy with conduction block

36
Q

Management of MND
(TWELVE)

A

Specialist neurology referral
Riluzole - small increase in survival (months)
MDT approach:
- MND specialist nurses
- Physiotherapy
- Occupational therapy
- Monitor swallowing with SALT
Consider non-oral feeding - PEG/NG
Monitor resp function:
- FVC
- Early morning blood gas
Consider NIV
Cough assist device
Palliative care

37
Q

What is myelopathy?

A

Disease or lesion of the spinal cord

38
Q

Differentials for myelopathy
(TEN)

A

Compressive:
- Herniation
- Tumours
- Spinal stenosis
Autoimmune:
- MS
- Lupus
Infective:
- HIV
- Varicella
Vascular:
- Infarct
Nutritional:
- B12 deficiency
Genetic:
- Hereditary spastic paraparesis

39
Q

Differentials for motor neurone disease
(TWO)

A

Kennedy’s disease
Spinal muscular atrophy

40
Q

MND vs Kennedy’s

A

Kennedy’s:
- Perioral fasciculations
- Gradual onset
- Hereditary (X linked recessive)

41
Q

Pes cavus causes
(THREE)

A

Charcot-Marie-Tooth
Post Polio syndrome
Friedrich’s ataxia

42
Q

Management of Guillain-Barre syndrome
(FIVE)

A

ABCDE approach
Often self limiting
Monitor FVC
If decreased FVC consider ABG and ICU support
IV Ig or plasma exchange

43
Q

Management of CIDP
(SEVEN)

A

MDT:
- Neurology
- Physiotherapy
- Occupational therapy
- Orthotics
Medication:
- Neuropathic pain agents
- Plasma exchange
- IV Ig

44
Q

Atypical signs in peripheral neuropathy (and causes)

A

Proximal weakness
Asymmetry
Prominent sensory ataxia
Guillain-Barre
CIDP

45
Q

Signs of Parkinsonism
(EIGHT)

A

Bradykinesia
Rigidity
Tremor
Micrographia
Hypophonic voice
Shuffling gait
Reduced arm swing
Reduced facial expression

46
Q

Parkinsons plus signs
(THREE)

A

Multi-system atrophy:
- Postural hypotension
- Cerebellar signs
Progressive supranuclear palsy:
- Vertical supranuclear gaze palsy

47
Q

Causes of Parkinsonism
(SIX)

A

Idiopathic Parkinson’s disease
Lewy body dementia
Vascular Parkinsonism
Drug induced Parkinsonism:
- Atypical antipsychotics
- Prochlorperazine
- Metoclopramide

48
Q

Non-motor symptoms of Parkinsonism
(FIVE)

A

Anosmia
Mood disorders
Cognitive impairment
Sleep disorders
Constipation

49
Q

Medical treatment for idiopathic Parkinson’s
(THREE)

A

Levodopa:
- co-beneldopa/co-carildopa
- Prevent breakdown before crosses blood-brain barrier
Dopamine agonists:
- Ropinirole
RISK OF IMPULSE CONTROL DISORDER
MAO-B inhibitor:
- Selegiline
- Reduced breakdown of dopamine

50
Q

Management of Parkinson’s
(SIX)

A

MDT approach:
- OT
- PT
- Neurology and geriatric medicine
- SALT
Medical therapy
Surgical therapy:
- Deep brain stimulator

51
Q

Stroke classification

A

TACS:
- Hemiplegia/sensory loss
- Homonymous hemianopia
- Higher cerebral dysfunction - dysphasia, visuospatial neglect
PACS:
- Two of three
LACS:
- Pure hemimotor/sensory loss

52
Q

Stroke artery territories

A

ACA:
- Contralateral hemiplegia (lower limb predominant)
- Contralateral sensory loss (lower limb predominant)
- Prefrontal cortex - altered executive function
MCA:
- Contralateral hemiplegia (face and upper limb predominant)
- Contralateral sensory loss (face and upper limb predominant)
- Speech disturbance (if left sided on right handed, either side left handed)
Posterior circulation:
- Hemianopia
- Horner’s syndrome
- Cerebellar symptoms

53
Q

Peripheral neuropathy feature suggest not length dependent

A

Weakness proximally more than distally

54
Q

Non-length dependent peripheral neuropathy causes
(FIVE)

A

Guillain-Barre
CIDP
Rheumatoid arthritis
GPA
SLE

55
Q

Causes of chorea
(FIVE)

A

Hyperglycaemia
Vascular - hemiballism secondary to subthalamic nucleus
Immune:
- SLE
- Sydenham’s - (secondary to group A beta haemolytic strep)
Genetic:
- Huntington’s

56
Q

Investigations for chorea
(SIX)

A

Blood glucose
If acute CT head/MRI head
History for SLE:
- Dry eyes
- Rashes
- Photosensitivity
Bloods for SLE:
- ANA, anti dsDNA
Family history
Genetic testing

57
Q

Management of Huntington’s
(SIX)

A

No disease modifiying therapy
MDT:
- Neurology
- Neuropsychiatry/psychology
- Dietician (increase basal metabolic rate)
- Occupational therapy
- Physiotherapy
- Palliative care

58
Q

Causes of weakness with normal sensation and reflexes

A

Neuromuscular junction pathology:
- Myasthenia gravis
- Lambert-Eaton
Muscular pathology:
- Myopathy

59
Q

Findings on neurophysiology in myasthenia gravis

A

Reduced action potential with repetitive stimulation

60
Q

Investigations for myasthenia gravis
(FIVE)

A

Nerve conduction studies
EMG
Bloods:
- Anti-acetylcholine receptor antibodies
- Anti-Musk antibodies
CT thorax - thymoma

61
Q

Distinguishing between MG and myopathy
(FOUR)

A

Ptosis - fatiguable
Ophthalmoplegia not cranial nerve specific
Fatiguable limb weakness - weakness worse with repetitive movements
Resolution of ptosis with ice

62
Q

Symptoms of myasthenia gravis
(FIVE)

A

Worse towards end of day
Worse with sustained exercise
Diplopia
Change in voice
Change in swallowing

63
Q

Management of myasthenia gravis
(EIGHT)

A

Acutely:
- ABCDE
- Monitor FVC
- Consider ITU escalation
- IV Ig
- Plasma exchange
Medical:
- Pyridostigmine
- Steroids
- Steroid sparing agents
Surgical:
- Thymectomy

64
Q

Friedrich’s ataxia signs
(FOUR)

A

Young patient
Absent reflexes
Upgoing plantars
Loss of proprioception and vibration sensation

65
Q

Causes of upgoing plantars but absent knee reflexes
(THREE)

A

Friedrich’s ataxia
Subacute combined degeneration of the cord
Motor neurone disease

66
Q

Friedrich’s ataxia investigations
(FIVE)

A

Bloods:
- B12
MRI brain and spine - exclude other pathologies (compressive)
Nerve conduction studies
EMG
Genetic testing

67
Q

Friedrich’s ataxia management
(SIX)

A

Regular echo and ECG:
- complications of cardiomyopathy and arrythmias
MDT:
- Neurology
- Physiotherapy
- Occupation therapy
- SALT
- Orthotics

67
Q

Friedrich’s ataxia management
(SIX)

A

Regular echo and ECG:
- complications of cardiomyopathy and arrythmias
MDT:
- Neurology
- Physiotherapy
- Occupation therapy
- SALT
- Orthotics

68
Q

Friedrich’s ataxia genetics

A

Autosomal recessive

69
Q

Young TIA differentials
(TEN)

A

Hypercoagulable states (antiphospholipid)
Paradoxical embolism in PFO
Sickle cell disease
Cardiac:
- Endocarditis
- Atrial myxoma
- Valvular disorders
Vascular:
- Takayasu’s arteritis
- Cerebral vasculitis
Demyelinating conditions (MS)
Space occupying lesion (glioma)

MRCP PACES (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions