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3rd Year > Neurology > Flashcards

Neurology Flashcards

1
Q

What is Brown-Sequard syndrome?

A

Injury to one side of the spinal cord where the cord is damaged but not severed.

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2
Q

How does Brown-Sequard syndrome present?

A

Weakness or paralysis and proprioceptive deficits on the side of the body ipsilateral to the lesion and loss of pain and temperature sensation on the contralateral side.

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3
Q

What is the basic route of UMNs?

A

They originate in the cerebral cortex and travel down to the brain steam and spinal cord.

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4
Q

What is the basic route of LMNs?

A

They begin in the spinal cord and innervate muscles and glands in the body.

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5
Q

What type of drug is rotigotine and what are common side effects?

A

Dopamine agonist. Common side effects are pathological gambling, hyper sexuality, binge eating and compulsive shopping.

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6
Q

What kind of drug is levodopa and what is it used for?

A

Dopamine agonist - parkinsons’ disease

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7
Q

What condition can alter the effects of the COCP?

A

epilepsy (sometimes have to double the dose)

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8
Q

What is a contradiction for cholinesterase inhibitors (e.g. donepezil, rivastigmine, galantamine)?

A

COPD/asthma

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9
Q

What drug helps with opioid withdrawl?

A

Methadone

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10
Q

How do you treat bell’s palsy?

A

prednisolone

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11
Q

Why is the forehead spared in a stroke?

A

Receives motor innervation from both hemispheres of the brain.

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12
Q

What presents with prolonged movements worse at night?

A

Myasthenia gravis

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13
Q

What can be used for a benzodiazepine overdose?

A

flumazenil (GABA receptor)

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14
Q

What kind of stroke is pure motor?

A

Lacunar

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15
Q

What structure is likely to be damaged from kroskoff’s syndrome?

A

mammillary bodies - anterior thalamic nucleus

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16
Q

Where is Broca’s area located?

A

left inferior frontal gyrus

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17
Q

What are the signs of an UMN lesions?

A

spastic tone, no fasciculations, minimal wasting, hyperreflexia, decreased speed

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18
Q

What are the signs of a LMN lesion?

A

flaccid tone, fasciculations present, significant wasting, hyporeflexia, no speed

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19
Q

What is the triad for meningitis?

A

Headache, neck stiffness and vomiting

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20
Q

What kind of brain bleeds causes a berry aneurysms?

A

Subarachnoid haemorrhage

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21
Q

What is the spinothalamic tract responsible for? (sensory)

A

anterior = crude touch and pressure
lateral = temperature and pain

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22
Q

What does the dorsal column and medial leminiscus tract (sensory) do?

A

Fine touch and conscious proprioception

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23
Q

What does the spinocerebellar tract (sensory) do?

A

Carries unconscious proprioception information to the cerebellum. ( does not decussate)

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24
Q

How do you treat delirium in patients with PD or Lewy body dementia?

A

Lorazepam (benzodiazepine)

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25
Q

What does the corticospinal tract do and what is it controlled by? (motor)

A

Voluntary control by the cerebral cortex

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26
Q

What is the difference between the lateral CST and ventral CST decussation?

A

lateral = pyramidal decussation
ventral = fibres stay ipsilateral and decussate more caudally

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27
Q

After what is an extradural haemorrhage likely to occur?

A

Trauma, linear skull fracture

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28
Q

What types of epilepsy does carbamazepine worsen?

A

absence and myoclonic seizures

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29
Q

Which type of intercranial bleed present with a crescent shape on head CT?

A

subdural haematoma

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30
Q

What is the triad for normal pressure hydrocephalus?

A

gait disturbances, cognitive impairment, impaired bladder control

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31
Q

How soon does thrombolysis need to be performed?

A

<4.5hrs

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32
Q

When there is a weakness in the SCN which side does the head turn to?

A

turns to the opposite side

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33
Q

For BPPV which is the diagnostic test and the treatment?

A

dix-hallpike = diagnostic
epley manoeuvre = treatment

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34
Q

What does PITS stand for?

A

parietal inferior, temporal superior

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35
Q

What is a risk factor for mononeuritis multiplex?

A

diabetes, foot drop (peroneal palsy)

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36
Q

What is the treatment for MND?

A

riluzole (sodium channel blocker)

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37
Q

What is specific for a lacunar stroke?

A

No visual field deficits, higher cerebellar dysfunction, brainstem dysfunction

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38
Q

What does a lumbar puncture in a SAH look for?

A

xanthochromia

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39
Q

What is Broca’s area function?

A

Language production (anterior):
expressive aphasia

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40
Q

What is wernicke’s area function?

A

Language comprehension (posterior):
receptive aphasia

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41
Q

What investigations should be done in MG?

A

blood tests, chest CT (thymoma), nerve conduction studies

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42
Q

What is the medical treatment for MG?

A

anti-cholinesterase inhibitors (e.g. pyridostigmine or neostigmine).

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43
Q

What are the layers of the brain from the outermost?

A

Skull, dura mater, arachnoid mater, subarachnoid space, pia mater, brain parenchyma

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44
Q

When CN XII is affected which side will the tongue go towards?

A

To the affected side.

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45
Q

When does guillain-barre syndrome present?

A

1-3 weeks after infection

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46
Q

What is commonly associated with lambert-eaton myasthenic syndrome (LEMS)?

A

small cell lung cancer

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47
Q

What is the pathophysiology of LEMS?

A

Impaired influx of calcium at the presynaptic nerve terminal which reduces the release of Ach into the synaptic cleft.

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48
Q

What tests would you do for LEMS?

A

bloods - to check calcium
nerve conduction studies - double of muscle action potential

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49
Q

How is a diagnosis of MS made and what does it show?

A

MRI = periventricular white matter lesions

CSF = oligoclonal bands

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50
Q

How is acute MS treated?

A

glucocorticoids:

1g of intravenous methylprednisolone every 24 hours for 3 days

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51
Q

How is chronic MS treated?

A

beta-interferon injections

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52
Q

What is the pathophysiology for MG?

A

An autoimmune disease characterised by antibodies against the nicotinic acetylcholine receptors on muscle fibres. This limits the ability of acetylcholine to cause muscle contraction.

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53
Q

Which characteristics are specific to a parietal lobe focal seizure?

A

sensory symptoms - tingling, numbness

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54
Q

If there is a brain bleed and the patient regularly takes warfarin what should be done?

A

stop warfarin and start IV vit k and prothrombin complex concentrate

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55
Q

What is seen on an MRI for MS?

A

periventricular white matter lesions

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56
Q

What is the first line treatment for a migraine?

A

sumatriptan

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57
Q

What medication is used for migraine prophylaxis?

A

propranolol (CI = asthma), topiramate (if cannot tolerate bb)

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58
Q

What vitamin deficiency leads to wernicke’s encephalopathy?

A

B1 - thiamine

59
Q

What medication is started for an extradural haematoma and why?

A

mannitol to decrease the raised ICP

60
Q

What kind of headache presents at night?

A

cluster headache

61
Q

What organism causes encephalitis?

A

HSV 1

62
Q

Which is quicker heparin or warfarin?

A

heparin

63
Q

How is AD treated?

A

anticholinesterase inhibitors (e.g. galantamine, rivastigmine, donapezil)

64
Q

What is a common unilateral throbbing headache?

A

a migraine

65
Q

What drug worsens absence seizures?

A

carbamazepine

66
Q

Which kind of dementia presents with hallucinations?

A

lewy body dementia

67
Q

Which type of cell are the CNS and PNS nerves myelinated by?

A

CNS = oligodendrocytes
PNS = Schwann cells

68
Q

What does a broad based gait imply?

A

cerebellar ataxia

69
Q

How can encephalitis be differentiated from meningitis?

A

It presents with personality/behavioural changes, altered levels of consciousness, seizures

70
Q

What are the types of MND?

A

Spinal ALS - classic
Bulbar ALS - early tongue and bulbar involvement
Progressive muscular atrophy - with only lower motor neuron features
Primary lateral sclerosis - with only upper motor neuron features

71
Q

What is a bulbar palsy?

A

Lower motor neuron lesion which affects CN XI, X, XII.

72
Q

What are the features of cerebellar syndrome?

A

DANISH:
Dysdiadochokinesia an inability to perform rapid alternating hand movements, Ataxia,
Nystagmus, Intention tremor,
Slurred speech, Hypotonia

73
Q

Myoclonic seizures vs tonic-clonic seizures?

A

In myoclonic there is jerking but there is no loss of consciousness.

74
Q

How does a subdural haematoma present on CT?

A

hypodense, crescent shape

75
Q

Which lobe is responsible for personality changes?

A

frontal

76
Q

Which part of the brain shows widespread cerebral atrophy in AD?

A

hippocampus

77
Q

What 2 management options should be done for a patient presenting with stroke <4.5hrs?

A
  1. thrombolysis
  2. aspirin 300mg in 24hrs
78
Q

What is the MOA of benzodiazepines?

A

They facilitate the binding of the inhibitory neurotransmitter GABA at various GABA receptors throughout the CNS.

79
Q

What is the first line treatment for status epilepticus?

A

IV lorazepam (benzodiazepine)

80
Q

What are the features of PICA (lateral medullary)?

A

Ipsilateral: facial pain and temp. loss
Contralateral: limb/torso pain and temp. loss
Ataxia, nystagmus

81
Q

What are the features of basilar artery stroke?

A

“locked in syndrome”

82
Q

What are the features of anterior inferior cerebellar artery (lateral pontine)?

A

Ipsilateral: facial paralysis and deafness and PICA symptoms

83
Q

Which antibodies are directed against in MG?

A

Postsynaptic acetylcholine receptors.

84
Q

What type of headache presents after a head injury with a brief duration of unconsciousness, followed by improvement (lucid interval)?

A

extradural haemorrhage

85
Q

What is the treatment for MND?

A

riluzole

86
Q

What headache presents with lacrimation, rhinorrhoea, miosis, ptosis, lid swelling, and facial flushing?

A

cluster headache

87
Q

What is the treatment for a TIA?

A

aspirin 300mg

88
Q

Which condition is associated with small cell lung cancer?

A

Lambert-eaton

89
Q

What brain bleed shows a crescent shape on CT?

A

subdural haematoma

90
Q

How is the respiratory system monitored in Guillian-barre?

A

FVC

91
Q

What is the first line treatment for trigeminal neuralgia?

A

carbamazepine

92
Q

What headache is more likely in a patient with PCKD?

A

subarachnoid haemorrhage

93
Q

What is modafinil used for?

A

To treat fatigue in MS.

94
Q

What neurotransmitter is decreased in AD and Huntington’s?

A

acetylcholine

95
Q

What neurotransmitter is decreased in PD?

A

dopamine

96
Q

What cells make up the BBB?

A

astrocytes - specialised glial cells

97
Q

What cells are destroyed in MS?

A

oligodendrocytes - which leads to demyelination

98
Q

Where are schwann cells derived from?

A

neural crest

99
Q

Where is your circadian rhythm regulated?

A

suprachiasmatic nucleus part of the hypothalamus

100
Q

What is the difference between the medial and lateral geniculate nucleus?

A

medial - auditory
lateral - visual

101
Q

What part of the brain if affected in PD?

A

substantia nigra

102
Q

What is the mode of inheritance for huntington’s?

A

autosomal dominant - on chromosome 4

103
Q

What is seen on a CT for huntington’s?

A

Enlarged lateral ventricles, atrophy of putamen, defined sulci.

104
Q

What part of the brain is responsible for jerky, sudden movements?

A

basal ganglia

105
Q

What is dysarthria?

A

Motor inability to speak.

106
Q

What are the 4 types of glial cells and what do they do?

A
  1. oligodendrocytes - produces the myelin sheath in the cns
  2. microglial - phagocytic cells
  3. astrocytes - support, maintains homeostasis and BBB
  4. ependymal - lines the ventricles
107
Q

How is normal pressure hydrocephalus treated?

A

If suitable for surgery shunting.

108
Q

What is the treatment for encephalitis?

A

ceftriaxone and acyclovir for 2 weeks

109
Q

How is MG treated?

A

Anticholinesterase inhibitors (e.g. pyridostigmine or neostigmine).

110
Q

What is the treatment for trigeminal neuralgia?

A

carbamazepine (first line)
phenytoin
lamotrigine
gabapentin

111
Q

What nerves are responsible for pupillary reflex to light?

A

CN II - afferent
CN III - efferent

112
Q

What space and level is a lumbar puncture done?

A

subarachnoid space
Between L3 and L4 / L4 and L5 - to avoid the conus medullaris

113
Q

What do amyloid plaques present in?

A

AD

114
Q

What is the treatment for cluster headaches (acute and long term)?

A

acute = high flow 100% oxygen in a non-rebreather mask, subcutaneous sumatriptan can help

chronic = verapamil, topiramate

115
Q

Which artery is torn in an extradural haemorrhage and what layers does the blood pool between?

A

middle meningeal artery - between dura and pterion bone

116
Q

What are the 3 clinical features of TACS?

A
  1. hemiparesis / hemisensory loss
  2. homonymous hemianopia
  3. high cognitive dysfunction (e.g. dysphagia)
117
Q

What is the ROSIER scoring system used for?

A

stroke in A&E

118
Q

What are the 4 types of posterior strokes?

A
  1. Basilar artery occlusion - present with locked in syndrome
  2. Anterior inferior cerebellar artery - lateral pontine syndrome (similar to the lateral medullary syndrome) but with addition of pontine cranial nerve nuclei.
  3. Wallenberg’s syndrome (lateral medullary syndrome) - ipsilateral Horner’s syndrome, ipsilateral loss of pain and temperature sensation on the face, contralateral loss of pain and temperature sensation over the contralateral body.
  4. Weber’s syndrome/medial midbrain syndrome (paramedian branches of the upper basilar and proximal posterior cerebral arteries) - ipsilateral oculomotor nerve palsy and contralateral hemiparesis.
119
Q

Which structures are ruptured and where does the blood pool in a subdural haemorrhage?

A

Bridging veins - dura and arachnoid

120
Q

Which structure is ruptured and where does the blood pool for a subarachnoid haemorrhage?

A

aneurysms - between arachnoid and pia mater

121
Q

What are the 6 types of brain herniations?

A
  1. uncal transtentorial - CN III palsy
  2. central transtentorial - coma
  3. subfalcine - ACA infarct
  4. transcalvarial - trauma, surgery
  5. ascending transtentorial - coma
  6. tonsillar - cardio issues
122
Q

What is the tentorium of the brain?

A

It is in the cerebellum and a line in the posterior cranial fossa.

123
Q

If a tumour is causing an usual change in personality and behaviour where is it?

A

frontal lobe

124
Q

What are type of glial cancers?

A
  1. astrocytoma - over half (posterior cranial fossa)
  2. oligodendroglioma (frontal)
  3. ependymoma - rare
125
Q

What is the most common type of brain cancer in children and where in the brain?

A

medulloblastoma - near the cerebellum

126
Q

What is a cancer of the meninges called and which lobe is it most likely to be in?

A

meningiomas (25% of brain cancers and usually low grade) - parietal lobe

127
Q

What are the main risk factors for brain cancer?

A

females, previous radiotherapy, weakened immune system (HIV), VHL, neurofibromatosis, tubal sclerosis

128
Q

How are astrocytomas graded?

A

Grade 1 - pilocytic astroma
Grade 2 - low-grade diffuse astrocytoma
Grade 3 - anaplastic astrocytoma
Grade 4 - glioblastoma multiforme (GBM)

129
Q

Which nerve is a space occupying lesion most likely to affect and why?

A

Abducens - exits the ventral pons and travels upwards before protruding forward through the cavernous sinus and compressed against the sphenoid bone.

130
Q

What is the vestibulospinal tract responsible for?

A

It controls balance and posture by innervating the anti-gravity muscles (extensors for legs and flexors for arms).

131
Q

What does the limbic system do and where is it?

A

Medial hemisphere surface surface that encircles the corpus callosum.
The limbic system serves for higher emotional functions and contains a major component of the memory system.

132
Q

What system does the basal ganglia control and what structures make up the BG?

A

Motor system - caudate nucleus, putamen and globus pallidus.

133
Q

“Butterfly” appearance on MRI indicates what?

A

glioblastoma multiforme

134
Q

How do cerebellar symptoms present?

A

ipsilateral

135
Q

What changes is present on scan for AD?

A

Widespread cerebral atrophy mainly involving the cortex and hippocampus

136
Q

What is a serious side effect of lamotrigine?

A

Steven Johnson syndrome

137
Q

When is IV acyclovir used for HZV?

A

orbital involvement

138
Q

Who is topiramate contraindicated in?

A

women of childbearing age

139
Q

What deficiency causes spinal cord degeneration?

A

vitamin B12

140
Q

What is a prophylactic medicine for cluster headaches and what is used for relief?

A

prophylaxis - verapamil (CCB)
relief - sumatriptan

141
Q

What drugs worsen MG?

A

beta blockers, lithium, antimalarials

142
Q

What is the function of GABA receptors?

A

To reduce neuronal excitability by inhibiting nerve transmission.

143
Q

What condition increases the chance of third nerve palsy?

A

diabetes

144
Q

What is a clinically relevant aspect of the cavernous sinus?

A

They have no valves so the spread of sepsis is potent.

3rd Year (7 decks)

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