Neurology Flashcards
1
Q
what are the four strokes in the bamford classification
A
total anterior circulation
partial anterior circulation
lacunar
posterior circulation
2
Q
3 criteria for the classification of a total or partial anterior circulation stroke
A
- unilateral weakness/sensory loss of the face, arms and leg
- homogenous hemianopia
- higher cerebral dysfunction (dysphagia, visuospatial disorder)
(2 or 3 of above)
3
Q
which artery is compromised in an anterior circulation stroke
A
middle and anterior cerebral artery
4
Q
4 criteria in a lacunar stroke
A
- pure sensory
- pure motor
- sensorimotor
- ataxic hemiparesis
(1 of above)
5
Q
which arteries are compromised in a lacunar stroke
A
arteries in the thalamus, basal ganglia or internal capsule
6
Q
5 criteria for posterior circulation stroke
A
- CN palsy + contralateral motor/sensory deficit
- bilateral motor/sensory deficit
- conjugate eye movement disorder
- cerebellar dysfunction
- isolated HH/cortical blindness
7
Q
which artery is compromised in a posterior circulation stroke
A
vertebrobasilar arteries
8
Q
contralateral limb sensory loss
ipsilateral ataxia, nystagmus, dysphagia, facial numbness and horners
A
lateral medullary syndrome
9
Q
which artery is compromised in lateral medullary syndrome
A
posterior inferior cerebellar artery
10
Q
features of lateral medullary syndrome with added ipsilateral facial paralysis and deafness
A
lateral pontine syndrome
11
Q
which artery is compromised in lateral pontine syndrome
A
anterior inferior cerebellar artery
12
Q
ipsilateral CN3 palsy and contralateral weakness
A
weber’s syndrome
13
Q
which artery is compromised in webers syndrome
A
midbrain branch of the posterior cerebral artery
14
Q
locked in syndrome
A
lesion to basilar artery
15
Q
reduced GCS, paralysis, bilateral pinpoint pupils
A
pontine haemorrhage
16
Q
dominant hemisphere middle cerebral artery haemorrhage causes what
A
aphasia
17
Q
imaging for stroke
A
non-contrast CT
18
Q
hyperdense CT
A
haemorrhage
19
Q
when do you give aspirin
A
after the CT
20
Q
how do you assess carotid artery stenosis
A
USS
21
Q
when would you perform a carotid endardectomy
A
more than 70% occlusion and symptomatic
22
Q
management of a large stroke
A
thrombolysis and thrombectomy
23
Q
management of TIA
A
300mg aspirin
24
Q
driving rules after TIA
A
do not drive for 1 month
no need to inform DVLA
25
what medication combination would you give if clopidogrel was not tolerated for secondary prevention of stroke
aspirin and modified release dipyramidole
26
assessment score for stroke in ED
ROSIER
27
assessment score for ADL after stroke
barthel index
28
lesion in superior v inferior temporal gyrus
superior: wernicke
inferior: broca
29
fluent speech, poor repetition but comprehension intact
conduction aphasia
30
extradural v subdural haematoma on CT
extradural: biconvex does not cross suture lines
subdural: cresent and crosses suture lines
31
3 causes of a chronic subdural haematoma
alcoholic, elderly, shaken baby
32
cause of an acute subdural haematoma
high impact injury - risk of herniation
33
how do you differentiate between an acute and chronic subdural haematoma
chronic is hypodense (dark)
acute is hyperdense
34
what veins are damaged in a subdural haematoma
bridging veins
35
ipsilateral down and out eye
dilated pupil (mydriasis) and ptosis
third nerve palsy
36
cause of a painful third nerve palsy
posterior communicating artery aneurysm
37
decreased abduction and horizontal diplopia
sixth nerve palsy
38
cause of a sixth nerve palsy
raised ICP (long course of nerve) from tumour
39
unilateral throbbing and recurrent headache with aura, nausea and photosensitivity which impacts ADL and is associated with menstruation
migraine
40
prophylaxis and treatment for migraine
prophylaxis: propranolol or topiramate
treatment: triptan
41
side effect and contraindication for triptans
throat/chest tightness
CVD
42
recurrent bilateral headache like a band which does not impact ADL
tension headache
43
15-20 minute severe headache occurring 1-2x daily for 4-12 weeks associated with lacrimation and red painful eyes
cluster headache
44
3 RF for cluster headache
male, alcohol, smoking
45
treatment and prophylaxis for cluster headaches
treatment: oxygen and SC sumatriptan
prophylaxis: verapamil
46
rapid onset unilateral headache in a 60y/o associated with temporal tenderness and jaw claudication
temporal arteritis
47
marker for temporal arteritis
ESR
48
sharp unilateral facial pain triggered by chewing or touching the face
trigeminal neuralgia
49
how do you manage a medication overuse headache
stop simple analgesia and triptans immediately
withdraw opioids slowly
50
how many days of headache is needed for the diagnosis of a medication overuse headache
15 days a month
51
sudden onset headache with nausea, vomiting and LOC
venous sinus thrombus
52
investigation and treatment for venous sinus thrombosis
MRI venography and LMWH
53
headache worse on standing, associated with marfans and LP and treated with caffeine and fluids
spontaneous intracranial hypertension from CSF leak
54
obese young female with headache and blurred vision
perhaps taking COCP, tetracyclines, steroids, lithium, vitamin A or who is pregnant
idiopathic intracranial hypertension
55
treatment of idiopathic intracranial hypertension
weight loss, diuretics, LP, surgery, topiramate, acetylzolamide
56
iatrogenic cause of a low pressure headache
LP
57
sudden onset headache and visual field defect with signs of pituitary deficiency such as low blood pressure
pituitary apoplexy
58
treatment of pituitary apoplexy
urgent steroids
59
benign tumour from the meninges with well defined borders
meningioma
60
vertigo, hearing loss, tinnitus, loss of corneal reflex
acoustic neuroma
vestibular schwannoma
61
investigations for acoustic neuroma
MRI of cerebellopontine angle and audiogram
62
pus covered by pyogenic membrane in brain
brain abscess
63
treatment of brain abscess
IV cef and metro
64
confusion, gait ataxia, nystagmus and opthalmoplegia
wernickes encephalopathy
65
amnesia and confabulation
korsakoff syndrome
66
?CSF from nose or ears
check glucose level
67
urinary incontinence, gait abnormality and dementia
normal pressure hydrocephalus
68
ventricle size in normal pressure hydrocephalus
increased
69
most common complication of meningitis
sensorineural hearing loss
70
most common primary for brain mets
lung
71
no improvement in facial paralysis from bells palsy in 3w
urgent referral to ENT
72
facial nerve palsy and increased size of parotid gland
sarcoidosis
73
at what GCS should you intubate
8
74
GCS
E = 4
V = 5
M = 6
take the best response
75
role of controlled hyperventilation
reduces carbon dioxide which causes vasoconstriction and reduced ICP
76
physiological response to raised ICP
cushings reflex
77
blood pressure, heart rate and pulse pressure in the cushings reflex
bp raised
HR reduced
wide pulse pressure
78
seizure in which lobe lasts for 1 minute, associated with automatisms (lip smacking), aura, dejavu, hallucinations and LOC
temporal lobe
79
seizure in which lobe causes motor symptoms
e.g. head/leg movements, posturing, post-ictal weakness, jacksonian march (clonic movements)
frontal lobe
80
seizure in which lobe causes sensory loss
e.g. paraesthesia
parietal lobe
81
seizure in which lobe causes visual changes
e.g. flashers/floaters
occipital lobe
82
driving after an uprovoked/1st seizure with normal imaging and EEG
do not drive for 6 months
83
seizures in the morning or after sleep deprivation
juvenile myoclonic epilepsy
84
woman falls to the ground and is motionless
atonic seizure
85
laughter causing collapse
cataplexy
86
what provokes absence seizures
hyperventillation
87
widespread convulsions with no LOC
pseudoseizure
88
differentiating between a true and pseudoseizure
prolactin
89
medical management of generalised tonic clonic seizures in males and females
male: sodium valproate
female: lamotrigine/levetricetam
90
1st and 2nd line management of focal seizures
1st: lamotrigine/levetricetam
2nd: carbemazepine
91
medical management of absence seizures
ethosuximide
92
medical management of tonic/atonic seizures in males and females
male: sodium valproate
female: lamotrigine
93
which medication worsens absence seizures
carbemazepine
94
which 2 epilepsy medications cause steven johnson syndrome
carbamazepine and tamotrigine
95
management of steven johnson syndrome
IV fluids
96
which medication alters folate metabolism causing megaloblastic anaemia
phenytoin
97
which epilepsy drug causes weight gain
sodium valproate
98
when can you stop antiepileptics
withdraw slowly over 2-3m if seizure free for 2 years
99
4 lines of management of status epilepticus
1. Buccal midazolam/PR diazepam (10mg adult, 0.5mg child)
2. IV lorazepam (max 2)
3. IV phenytoin/phenobarbitol
4. Rapid sequence induction (after 45 mins)
100
Explain the difference between tuberus sclerosis and neurofibromatoma
neuro: axillary/groin freckles
tub: ash leaf spots, adenoma sebaceum, shagreem, subungal fibromatoma, epilepsy
101
which neurofibromatoma has an association with acoustic neuroma
2
102
inheritance of tuberus sclerosis and neurofibromatoma
autosomal dominant
103
most common type of MND associated with LMNL in arms and UMNL in legs
Amyotrophic lateral sclerosis
104
chromosome affected in ALS
21
105
MND with UMN loss
primary lateral sclerosis
106
MND with the best prognosis, LMN affected distal to proximal
progressive muscular atrophy
107
MND with the worst prognosis associated with palsy of the tongue, muscles of mastication and facial muscles
progressive bulbar palsy
108
which movements are spared in MND
eye
109
most common method of feeding in MND
PEG
110
which medication increases survival in MND
riluzole
111
which dementia is associated with MND
frontotemporal
112
which is the most common type of MS
relapsing remitting
113
tingling in hands when neck flexed in MS is called
Lhermeittes sign
114
2 investigations for MS
MRI with contrast
LP showing oligoclonal bands
115
management of an acute relapse of MS
high dose steroids
116
management of spasticity in MS
baclofen or gabapentin
117
inducing remission in MS
monoclonal antibodies e.g. natalizumab
118
pathophysiology of myasthenia gravis
antibodies to Ach receptors cause progressive weakening of muscles (esp limb girdle, neck and eyes)
119
cancer associated with myaesthenia gravia
thymoma
120
investigations for myasthenia gravis
antibodies
CT scan
121
creatinine kinase in myasthenia gravis
normal
122
treatment of myasthenia gravis
AchE inhibitors e.g. pyridostigmine
123
treatment of myasthenia gravis crisis
IV immunoglobulin and plasmapheresis
124
which medication worsens myasthenia gravis
bisoprolol
125
people with myasthenia gravis are resistant to which medication
suxamethonium
126
pathophysiology of lambert eaton syndrome
antibodies to calcium channels causes weakness which improves after exercise (different to myasthenia gravis)
127
association with lambert eaton
lung cancer
128
treatment of lambert eaton
treat the cancer
immunosupressants (azathioprine, prednisoline)
IV immunoglobulin
Plasma exchange
129
worsening lower limb weakness after gastroenteritis
guillian-barree
130
most common organism causing guillian-barre
campylobacter
131
investigations for guillian baree
LP increased protein
nerve conduction studies
132
treatment of guillian barre
IV immunoglobulin
133
most common hereditary sensorimotor neuropathy
charcot marie tooth
134
inheritance of charcot marie tooth
autosomal dominant
135
which type of gait to cerebellar injuries cause
ataxic (wide base with reduced heel-toe walking)
136
8 most common causes of cerebellar injury
Posterior fossa tumour
Alcohol
multiple Sclerosis
Trauma
Rare causes
Inherited
Epilepsy treatment
Stroke
137
Parkinsonism with autonomic disturbance and cerebellar sign
multiple system atrophy
138
autosomal dominant condition which causes tremor worse when arms are outstretched and better with alcohol/propanolol
benign essential tremor
139
unilateral tremor which improves with voluntary movement
parkinsons
140
give an example of a decarboxylase inhibitor
carbidopa
141
which drug causes dry mouth, anorexia, palpitations, psychosis, postural hypotension and an on-off phenomenon
levodopa
142
what happens if you abruptly stop parkinsons medication
acute dystonia
143
3 side effects at peak dose of levodopa
dystonia, chorea, involuntary movements
144
which class are brompcriptine, ropinerole and carbegoline
dopamine receptor agonists
145
why do you need an ECHO, EST, CK and CXR before starting dopamine receptor agonists
fibrosis
146
side effects of dopamine receptor agonists
IMPULSE CONTROL DISORDERS
LOSS OF INHIBITION
HALLUCINATIONS
POSTURAL HYPOTENSION
147
which class is selegiline
MAO-B inhibitors
148
side effects of MAO-B inhibitors
very few
149
which drug causes ataxia, slurred speech, confusion, dizziness, livedo reticularis
amantidine
150
what class are drugs which end in -CAPONE
COMT inhibitors
(enzyme which breaks down dopamine)
151
how do antimuscarinics e.g. procyclidine work in parkinsons
block cholinergic receptors in drug induced parkinsons or to help with tremor
152
how do you treat nausea in parkinsons
domperidone
antihistamines worsen
153
2 types of bitemporal hemianopia caused by lesions to the optic chiasm
upper quadrant defect: pituitary tumour
lower quadrant defect: craniophayngioma
154
2 causes of homonymous quadrantanopia
Parietal Inferior Temporal Superior
155
Brown-Sequard
lateral hemisection of the spinal cord
156
cause and presentation of subacute combined degeneration of the cord
reduced vitamin B
reduced proprioception and vibration sense, increased reflexes
157
cause of a high stepping gait
peripheral neuropathy
158
muscle wasting of the hands, numbness, tingling and autonomic symptoms
neurogenic thoracic outlet syndrome
159
cause of autonomic dysreflexia
injury to T6 or above
160
management of autonomic dysreflexia
remove stimulus and treat HTN or bradycardia
161
treatment of paradoxial hemicrania
indomethacin
162
pain in neck/limbs causing sensory, motor or autonomic symptoms and reduced fine motor use in the hands with positive hoffmans sign
degenerative cervical myelopathy
163
imaging for degenerative cervical myelopathy
MRI
164
tetrad in neuroleptic malignant syndrome
hyperthermia
muscle rigidity
autonomic instability
altered mental state
165
cause of neuroleptic malignant syndrome
antipsychotis e.g. clozapine
166
treatment of neuroleptic malignant syndrome
bromocriptine
167
collection of CSF in the spinal cord causedby trauma, tumour or the chiari malformation
syringiomyelia
168
sensory loss in syringiomelia
spinothalamic (pain and temp) in a cape like distribution
169
imaging for syringiomelia
spinal and brain MRI
170
less severe form of muscular dystrophy which presents later
beckers
171
treatment of restless leg
dopamine agonists
172
4 drugs to trial for neuropathic pain
amitriptyline
duloxetine
gabapentin
pregabalin
173
what part of the brain does ondansetron act on
medulla
174
6 grades of muscle movement
0: nothing
1: trace
2: gravity eliminated
3: against gravity
4: against resistance
5: normal
175
nerve roots for the following reflexes:
ankle
knee
biceps
triceps
ankle: S1 S2
knee: L3 L4
biceps: C5 C6
triceps: C7 C8
176
T1 lesion
weak finger abduction
177
what should you monitor if CT shows evidence of cerebral contusion
ICP
178
binocular vision
zygoma fracture
179
GCS below 8
urgent neurosurgery review before CT head
180
neck pain and unable to rotate c-spine
needs CT C-spine
181
RBC in CSF
traumatic tap
182
evidence of RBC breakdown products 12 hours after injury
subarachnoid haemorrhage
183
diffuse axonal injury (acceleration-deceleration injury)
MRI brain
184
increased head circumference, bulging fontanelle, subsetting eyes in a baby with known intraventricular haemorrhage
hydrocephalus
185
imaging in hydrocephalus
CT scan
186
6 criteria for brainstem death
1. pupillary reflex
2. corneal reflex
3. oculo-vestibular reflex
4. cough reflex
5. no respiratory effort
6. no response to supraorbital pressure
187
criteria for the doctors performing brainstem death tests
2 separate doctors
1 must be a consultant
both must have at least 5 years of postgrad experience
188
bleed between the dura and skull in the temporal region with raised ICP and a lucid interval
extradural haematoma
189
vessel commonly ruptured in extradural haematoma
middle meningeal artery
190
bleeding into the outer meningeal layer in the frontal/parietal region common in elderly, alcoholics or people on anticoagulation with fluctuating consciousness for weeks
subdural haematoma
191
vessel commonly ruptured in subdural haematoma
bridging veins
192
sudden occipital headache caused by a ruptured aneurysm or traumatic brain injury
subarachnoid haemorrhage
193
management of subaracnhoid haemorrhage
nimodipine to reduce vasospasm
coil (over clip)
194
why must you check the U+E after a subarachnoid haemorrhage
SIADH can cause hyponatremia
195
blood within the brain presenting like a stroke
intracerebral haemorrhage
196
nagement of intracerebral haemorrhage
conservative management with the stroke team
clot evacuation
197
RF for intracerebral haemorrhage
HTN, aneurysm, AV malformation, trauma, tumour (stroke)
198
LEARN THE NICE CT HEAD GUIDELINES
199
LEARN THE DIFFERENT EYE LESIONS HEHE
