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MRCP PACES > Neurology > Flashcards

Neurology Flashcards

1
Q

Median nerve power

A

Thumb abduction

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2
Q

Radial nerve power

A

Wrist extension

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3
Q

Ulnar nerve power

A

Finger abduction

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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

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5
Q

Treatments for neuropathic pain
(THREE)

A

Tricyclic (amitriptyline)
SNRI (duloxetine)
Pregabalin or gabapentin

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6
Q

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

A

Neurophysiological testing
Nerve conduction studies
Consideration of EMG

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7
Q

Posterior interosseous nerve power

A

Finger extension

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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

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9
Q

What is mononeuritis multiplex?

A

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

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10
Q

Causes of mononeuritis multiplex
(SEVEN)

A

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

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11
Q

Bedside tests for peripheral neuropathy
(THREE)

A

Ophthalmoscopy - diabetic retinopathy
Urinalysis - glucose in urine
Blood glucose

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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

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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)

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14
Q

Inheritance of charcot-marie-tooth

A

Autosomal dominant
Type I - demyelinating
Type II - axonal

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15
Q

Investigations for charcot-marie-tooth
(THREE)

A

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

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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

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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

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18
Q

Limb signs of stroke
(FOUR)

A

Hypertonia
Reduced power
Hyperreflexia
Sensory loss

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19
Q

Non-neurological examination for stroke
(FOUR)

A

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

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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

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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

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22
Q

Cranial nerve signs for MS
(THREE)

A

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

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23
Q

Investigations for multiple sclerosis
(FOUR)

A

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

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24
Q

Treatment of MS relapse

A

High dose steroids - methylpred (rule out infection)

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25
Side effects of steroids (FIVE)
Sleep disturbance Mood disturbance GI ulceration Avascular necrosis hip Long term use osteoporosis
26
Spastic paraparesis differentials (EIGHT)
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
27
Cerebellar signs (SEVEN)
Dysdiadochokinesis Ataxia Nystagmus Intention tremor Scanning dysarthria Hypotonia/hyporeflexia
28
Differentials for cerebellar syndrome (SEVEN)
Acute: - Stroke - Multiple sclerosis (relapse/remitting) Alcohol Malignant: - Space occupying - Paraneoplastic Genetic: - Friedrich's ataxia - Ataxia telangiecasia
29
Management of cerebellar ataxia (FOUR)
Identify and treat underlying cause MDT Physiotherapy for mobility Occupational therapy - adaptations
30
Cerebellar vs sensory ataxia
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
Sensory ataxia - causes of central vs peripheral
Central: - Dorsal column damage Peripheral: - Neuropathy Both: - B12 deficiency
32
Investigations for cerebellar syndrome
MRI head
33
Lifestyle advice for cerebellar syndrome (THREE)
Alcohol cessation - worsens symptoms even if not cause Occupation: - Risks associated - Occupational health for adaptations Medications: - Anything that may exacerbate dizziness or unsteadiness
34
Investigations of MND
EMG - fasciculations and fibrillations without sensory signs MRI scan - exclude other pathologies
35
Differentials for MND (FOUR)
Cervical cord compression Spinal muscular atrophy Syringomyelia Multifocal motor neuropathy with conduction block
36
Management of MND (TWELVE)
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
What is myelopathy?
Disease or lesion of the spinal cord
38
Differentials for myelopathy (TEN)
Compressive: - Herniation - Tumours - Spinal stenosis Autoimmune: - MS - Lupus Infective: - HIV - Varicella Vascular: - Infarct Nutritional: - B12 deficiency Genetic: - Hereditary spastic paraparesis
39
Differentials for motor neurone disease (TWO)
Kennedy's disease Spinal muscular atrophy
40
MND vs Kennedy's
Kennedy's: - Perioral fasciculations - Gradual onset - Hereditary (X linked recessive)
41
Pes cavus causes (THREE)
Charcot-Marie-Tooth Post Polio syndrome Friedrich's ataxia
42
Management of Guillain-Barre syndrome (FIVE)
ABCDE approach Often self limiting Monitor FVC If decreased FVC consider ABG and ICU support IV Ig or plasma exchange
43
Management of CIDP (SEVEN)
MDT: - Neurology - Physiotherapy - Occupational therapy - Orthotics Medication: - Neuropathic pain agents - Plasma exchange - IV Ig
44
Atypical signs in peripheral neuropathy (and causes)
Proximal weakness Asymmetry Prominent sensory ataxia Guillain-Barre CIDP
45
Signs of Parkinsonism (EIGHT)
Bradykinesia Rigidity Tremor Micrographia Hypophonic voice Shuffling gait Reduced arm swing Reduced facial expression
46
Parkinsons plus signs (THREE)
Multi-system atrophy: - Postural hypotension - Cerebellar signs Progressive supranuclear palsy: - Vertical supranuclear gaze palsy
47
Causes of Parkinsonism (SIX)
Idiopathic Parkinson's disease Lewy body dementia Vascular Parkinsonism Drug induced Parkinsonism: - Atypical antipsychotics - Prochlorperazine - Metoclopramide
48
Non-motor symptoms of Parkinsonism (FIVE)
Anosmia Mood disorders Cognitive impairment Sleep disorders Constipation
49
Medical treatment for idiopathic Parkinson's (THREE)
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
Management of Parkinson's (SIX)
MDT approach: - OT - PT - Neurology and geriatric medicine - SALT Medical therapy Surgical therapy: - Deep brain stimulator
51
Stroke classification
TACS: - Hemiplegia/sensory loss - Homonymous hemianopia - Higher cerebral dysfunction - dysphasia, visuospatial neglect PACS: - Two of three LACS: - Pure hemimotor/sensory loss
52
Stroke artery territories
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
Peripheral neuropathy feature suggest not length dependent
Weakness proximally more than distally
54
Non-length dependent peripheral neuropathy causes (FIVE)
Guillain-Barre CIDP Rheumatoid arthritis GPA SLE
55
Causes of chorea (FIVE)
Hyperglycaemia Vascular - hemiballism secondary to subthalamic nucleus Immune: - SLE - Sydenham's - (secondary to group A beta haemolytic strep) Genetic: - Huntington's
56
Investigations for chorea (SIX)
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
Management of Huntington's (SIX)
No disease modifiying therapy MDT: - Neurology - Neuropsychiatry/psychology - Dietician (increase basal metabolic rate) - Occupational therapy - Physiotherapy - Palliative care
58
Causes of weakness with normal sensation and reflexes
Neuromuscular junction pathology: - Myasthenia gravis - Lambert-Eaton Muscular pathology: - Myopathy
59
Findings on neurophysiology in myasthenia gravis
Reduced action potential with repetitive stimulation
60
Investigations for myasthenia gravis (FIVE)
Nerve conduction studies EMG Bloods: - Anti-acetylcholine receptor antibodies - Anti-Musk antibodies CT thorax - thymoma
61
Distinguishing between MG and myopathy (FOUR)
Ptosis - fatiguable Ophthalmoplegia not cranial nerve specific Fatiguable limb weakness - weakness worse with repetitive movements Resolution of ptosis with ice
62
Symptoms of myasthenia gravis (FIVE)
Worse towards end of day Worse with sustained exercise Diplopia Change in voice Change in swallowing
63
Management of myasthenia gravis (EIGHT)
Acutely: - ABCDE - Monitor FVC - Consider ITU escalation - IV Ig - Plasma exchange Medical: - Pyridostigmine - Steroids - Steroid sparing agents Surgical: - Thymectomy
64
Friedrich's ataxia signs (FOUR)
Young patient Absent reflexes Upgoing plantars Loss of proprioception and vibration sensation
65
Causes of upgoing plantars but absent knee reflexes (THREE)
Friedrich's ataxia Subacute combined degeneration of the cord Motor neurone disease
66
Friedrich's ataxia investigations (FIVE)
Bloods: - B12 MRI brain and spine - exclude other pathologies (compressive) Nerve conduction studies EMG Genetic testing
67
Friedrich's ataxia management (SIX)
Regular echo and ECG: - complications of cardiomyopathy and arrythmias MDT: - Neurology - Physiotherapy - Occupation therapy - SALT - Orthotics
67
Friedrich's ataxia management (SIX)
Regular echo and ECG: - complications of cardiomyopathy and arrythmias MDT: - Neurology - Physiotherapy - Occupation therapy - SALT - Orthotics
68
Friedrich's ataxia genetics
Autosomal recessive
69
Young TIA differentials (TEN)
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)

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