Neurology Flashcards
1
Q
What is crescendo TIA?
A
2+ TIAs in a week
2
Q
What is the clinical scoring tool for stroke?
A
ROSIER. Anything above 0= likely
3
Q
What dose is the stat dose of aspirin in stroke?
A
300mg
4
Q
What is the treatment window for thrombolysis in stroke?
A
4.5 hours
5
Q
What is the secondary prevention of stroke?
A
Clopidogrel 75mg OD and Atorvastatin 80mg
6
Q
How is GCS calculated
A
E4V5M6
Eyes:
Spontaneous=4
Speech=3
Pain=2
None=1
Verbal:
Orientated=5
Confused=4
Inappropriate words=3
Incomprehensible=2
None=1
Motor:
Obeys commands=6
Localises pain=5
Withdraws from pain=4
Abnormal flexion=3
Extends=2
None=1
7
Q
What is the lowest possible GCS?
A
3/15
8
Q
What are the features of a subdural haemorrhage?
A
Caused by bridging veins
CT scan shows crescent shape
Not limited by cranial sutures
9
Q
What are the features of a extradural haemorrhage?
A
Usually caused by rupture of the middle meningeal artery
Bi-convex shape
Limited by cranial sutures
10
Q
What causes are subarachnoid haemorrhages particularly associated with?
A
Cocaine and sickle cell anaemia
(also strenuous activity such as weight lifting and sex)
11
Q
What causes MS?
A
Inflammatory process activating the immune cells against myelin - results in demylination
12
Q
Which cells are attacked in MS?
A
Oligodendrocytes
13
Q
What is the diganostic criteria for MS
A
Disseminated in SPACE and TIME
14
Q
What is the most common presentation of MS?
A
Optic neuritis
15
Q
What are the features of a 6th cranial nerve palsy?
A
Palsy results in defective abduction → horizontal diplopia
16
Q
What is Lhermitte’s sign?
A
Electric shock sensation that travels down the spine and into limbs when flexing the neck
17
Q
what are the two types of ataxia which can be seen in MS?
A
Sensory and cerebellar
18
Q
What are the 3 patterns of progression in MS?
A
Relapsing-Remitting
Primary Progressive
Secondary progressive
19
Q
How is MS diagnosed?
A
MRI
Lumbar puncture- oligoclonal bands
20
Q
What are the key features of optic neuritis
A
Central scotoma (central blind spot)
Pain
Impaired colour vision
Relative afferent pupillary defect
21
Q
How can MS be managed?
A
DMARDs and biologic therapy (natalizumab or ocrelizumab)
Methylprednisolone for relapses (500mg orally daily)
Symptomatic treatment
22
Q
What is progressive bulbar palsy?
A
Second most common form of motor neurone disease which affects the muscles of talking and swallowing
23
Q
What is affected in MND?
A
There is progressive upper and lower motor neurone degeneration. Sensory neurones are spared
24
Q
What are the signs of lower motor neurone disease?
A
Muscle wasting
Reduced tone
Fasciculations
Reduced reflexes
25
What are the signs of upper motor neurone disease?
Increased tone or spasticity
Brisk reflexes
Upgoing plantar responses
26
What is the management of MND?
Riluzole can slow the progression (prevents stimulation of glutamate receptors)
Non-invasive ventilation
End of life care planning
27
What is the triad of parkinson's disease?
Resting tremor
Rigidity
Bradykinesia
28
What type of tremor is found in parkinson's?
"pill-rolling tremor"
29
Name 4 parkinson's plus syndromes?
multisystem atrophy
Dementia with Lewy Bodies
Progressive supranuclear palsy
Corticobasal degeneration
30
What is the management of parkinsons?
Levodopa +carbidopa (can be given as combination drugs co-benyldopa/ co-careldopa)
COMT inhibitors (entacapone)
Dopamine agonists (Cabergoline/Ropinirole)
MAO-B inhibitors (selegiline)
31
What is the main side effect of levodopa?
Dyskinesias (excessive motor activity)
32
What is a notable side effect of dopamine agonists? give an example of this drug.
Cabergoline
Pulmonary fibrosis
33
What is the pathopysiology of Parkinson's
Reduced dopamine in the basal ganglia
34
What are the features of a benign tremor?
Fine
Symmetrical
More prominent on voluntary movement
Worse when tired, stress, caffeine
35
What is the management of benign tremor?
Propanolol
36
What investigations should be done in epilepsy?
EEG
MRI brain
ECG
37
Whats the first line and second line management of tonic-clonic seizures?
1st= sodium valporate
2nd lamotrigine or cabamazipine
38
Where do focal seizures start?
temporal lobes
39
Whats the first line and second line management of focal seizures?
1st= cabamazipine or lamotrigine
2nd= sodium valporate
40
Whats the management of juvenile myoclonic epilepsy?
Sodium valporate
41
What is West syndrome?
Infantile spasms. Starts at around 6 months and is characterised by full body spasms
42
How is West syndrome managed?
Prednisolone
43
What are the notable side effects of sodium valporate?
Teratogenic
Liver damage
Hair loss
Tremor
44
What are the notable side effects of carbamazapine?
Agranulocytosis
Aplastic anaemia
45
What are the notable side effects of phenytoin?
Folate and vitamin D deficiency
Megablastic anaemia
Osteomalacia
gum bleeding
46
What are the notable side effects of lamotrigine?
Stevens- johnson syndrome
Leukopenia
47
How is status epilepticus defined?
seizures lasting more than 5 mins or more than 3 seizures in an hour
48
How should status epilepticus be managed?
ABCDE
After 10 mins, 4mg IV lorazepam, 10mg diazepam PR
IV phenytoin 20mg/kg if not working after 2 repeats
49
What are the 4 first line treatments for neuropathic pain?
Amitriptyline
Duloxetine (SNRI)
Gabapentin
Pregabalin (both anticonvulsants)
50
What are the features of complex regional pain syndrome?
Neuropathic pain
Skin flushing
Colour change
Temperature change
Abnormal sweating
Abnormal hair growth
Swelling
51
How does facial nerve palsy usually present?
Unilateral facial weakness
52
What is the cause of an upper motor neurone facial palsy?
Stroke or tumour
53
How do you differentiate between an upper and lower motor neurone facial nerve palsy?
Upper= can move forehead. It is spared
Lower= cannot move forehead, cant blink
54
How long can recovery from Bell's palsy take?
12 months
55
How is bell's palsy managed?
Prednisolone (50mg for 10 days, 60mg for 5 days, 5 days of reducing)
Lubricating eyedrops
56
Which virus causes Ramsey Hunt sydrome, and what is it?
Varicella zoster virus - causes facial nerve palsy
57
How does Ramsey Hunt syndrome present?
Unilater lower motor neurone facial palsy with painful vesicles behind the ear
58
What is the key finding on fundoscopy in brain tumours?
Papilloedema
59
What are headache red flags?
Constant
Nocturnal
Worse on wakening
Worse on coughing, straining or bending forward
Vomiting
60
Name 4 cancers which commonly metastasise to the brain
Lung
Breast
Renal cell carcinoma
Melanoma
61
What visual field defect do pituitary tumours cause and why?
Bitemporal hemianopia because they press on the optic chiasm
62
Where do acoustic neuromas usually occur?
Cerebellopontine angle
63
Which condition are bilateral acoustic neuromas associated with?
Neurofibromatosis type 2
64
Which drug can be used to block prolactin secreting tumors?
Bromocriptine (dopamine agonist)
65
What is the genetic mutations which causes huntington's chorea?
Tricnucleotide repeat (repeated expansion of CAG) in the HTT gene on chromosome 4
66
What is genetic anticipation?
This is diplayed in Huntington's. Successive generations have more repeats in the gene which results in earlier age of onset and increased severity of disease
67
What are the features of Huntington's?
Chorea (sudden, unintended jerky movements)
Eye movement disorders
Intellectual impairment
Dysarthria
Dysphagia
68
Which medications can be used to suppress the disordered movement in Huntington's?
Anti-psychotics
Benzodiazepines
Dopamine-depleting agents (tetrabenazine)
69
Which condition has a strong link to myasthenia gravis?
Thymoma
70
Which antibodies cause the problem in myasthenia gravis?
Acetylcholine receptor antibodies
71
How does myasthenia gravis present?
Weakness gets worse with use and better with rest
Most affects the proximal muscles - face, neck and shoulders
Dipolopia
Ptosis
Dysphagia
fatigue in jaw when chewing
72
How can the fatiguability of muscles be assessed in myasthenia gravis?
Repeated blinking will exacerbate ptosis
Prolonged upward gazing will exacerbate diplopia
Repeated abduction of one arm 20 times will cause profound unilateral weakness
73
What investigations should be done for myasthenia gravis?
Acetyl choline receptor antibodies
CT or MRI of thymus
Edrophonium test
74
What is the edrophonium test?
Give an IV dose of edrophonium chloride (or neostigmine). This blocks the cholinesterase enzymes, increases the concentration of ACh and briefly relieves the symptoms of myasthenia gravis
75
What is the management of myasthenia gravis?
Reversible acetylcholinesterase inhibitors (pyridostigmine or neostigmine)
Immunosupression
Thymectomy
Rituximab
76
Whats is myasthenic crisis?
Acute worsening of symptoms, sometimes triggered by another illness such as URTI
77
What is the management of myasthenic crisis?
BiPAP/ intubation
IV immunogloblins and plasma exchange
78
Which condition is lambert-eaton myasthenic syndrome often associated with?
Small cell lung cancer
79
What is the presentation of lambert-eaton?
Affects proximal muscles
slow onset
Diplopia
Ptosis
Dysphagia
Post-tetanic potentiation (tense muscles and reflexes are improved after)
80
What is the management of lambert eaton?
Sort the small cell lung cancer
Amifampridine allows more acetylcholine to be released
81
What is the inheritance pattern of charcot-marie-tooth disease?
Autosomal dominant
Affects the peripheral motor and sensory nerves
82
When do symptoms of charcot-marie-tooth disease appear?
Either <10 years or after 40 years of age
83
What are the features of charcot-marie-tooth?
High foot arches (pes cavus)
Distal muscle wasting causing inverted champagne bottle legs
Distal weakness in lower legs (particularly ankle dorsiflexion)
Weakness in hands
84
What are the causes of peripheral neuropathy?
ABCDE
A-alcohol
B-B12 deficiency
C-Cancer and CKD
D-diabetes and drugs
E-Every vasculitis
85
What is the management of charcot-marie-tooth disease?
Supportive
86
What viruses is Guillain Barré associated with?
Campylobacter jejuni (commenest cause)
Cytomegalovirus
Epstein-Barr
87
What is the presentation of Guillian Barre?
Symmetrical ascending weakness (glove and stocking)
Reduced reflexes
Peripheral loss of sensation or neuropathic pain
88
When do symptoms of guillain barre occur after the preceding infections?
4 weeks after
89
What are the diagnostic criteria for guillian barre?
the brighton criteria
90
What investigations should be done for guillian barre syndrome?
Nerve conduction studies
Lumbar puncture (shows raised protein, normal WCC and glucose)
91
What is the management of guillian barre?
IV immunoglobulins or plasma exchange
Supportive care
VTE prophylaxis
92
What is neurofibromatosis?
Genetic condition that causes neuromas to develop throughout the nervous system
93
Which is the more common type of neurofibromatosis?
Type 1
94
What is the inheritance pattern of neurofibromatosis?
Autosomal dominant
95
What are the diagnostic criteria for neurofibromatosis?
2 of the 7. Remember by the mnemonic CRABBING
C- cafe-au-lait spots (6 or more)
R-relative is affected
A-Axillary or inguinal freckles
BB- Bony dysplasia such as Bowing of a long bone
I- Iris haemotomas
N-Neurofibromas
G-Gliomas
96
What are the investigations for neurofibromatosis?
Genetic testing
X-rays
CT and MRI
97
What is the characteristic feature of Tuberous Sclerosis?
The development of hamartomas
98
What are the skin signs of tuberous sclerosis?
Ash leaf spots
Shagreen patches
Angiofibromas
Subungal fibromatoma
Cafe-au-lait spots
Poliosis
99
What are the neurological features of tuberous sclerosis?
Epilepsy
Learning difficulties
100
Which type of migraine can mimic stroke?
Hemiplegic
101
What are triptans?
5HT receptor agonists (serotonin receptor agonists)
102
Which medications can be used as migraine prophylaxis?
Propanolol
Topiramate
Amitriptyline
103
What is the acute management of a cluster headache?
Triptans
100% oxygen for 15-20 mins
104
What is used for cluster headache prophylaxis
Verapamil
