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Medicine Year 5 > Neurology > Flashcards

Neurology Flashcards

1
Q

what are the four strokes in the bamford classification

A

total anterior circulation
partial anterior circulation
lacunar
posterior circulation

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2
Q

3 criteria for the classification of a total or partial anterior circulation stroke

A
  1. unilateral weakness/sensory loss of the face, arms and leg
  2. homogenous hemianopia
  3. higher cerebral dysfunction (dysphagia, visuospatial disorder)
    (2 or 3 of above)
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3
Q

which artery is compromised in an anterior circulation stroke

A

middle and anterior cerebral artery

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4
Q

4 criteria in a lacunar stroke

A
  1. pure sensory
  2. pure motor
  3. sensorimotor
  4. ataxic hemiparesis
    (1 of above)
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5
Q

which arteries are compromised in a lacunar stroke

A

arteries in the thalamus, basal ganglia or internal capsule

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6
Q

5 criteria for posterior circulation stroke

A
  1. CN palsy + contralateral motor/sensory deficit
  2. bilateral motor/sensory deficit
  3. conjugate eye movement disorder
  4. cerebellar dysfunction
  5. isolated HH/cortical blindness
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7
Q

which artery is compromised in a posterior circulation stroke

A

vertebrobasilar arteries

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8
Q

contralateral limb sensory loss
ipsilateral ataxia, nystagmus, dysphagia, facial numbness and horners

A

lateral medullary syndrome

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9
Q

which artery is compromised in lateral medullary syndrome

A

posterior inferior cerebellar artery

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10
Q

features of lateral medullary syndrome with added ipsilateral facial paralysis and deafness

A

lateral pontine syndrome

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11
Q

which artery is compromised in lateral pontine syndrome

A

anterior inferior cerebellar artery

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12
Q

ipsilateral CN3 palsy and contralateral weakness

A

weber’s syndrome

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13
Q

which artery is compromised in webers syndrome

A

midbrain branch of the posterior cerebral artery

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14
Q

locked in syndrome

A

lesion to basilar artery

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15
Q

reduced GCS, paralysis, bilateral pinpoint pupils

A

pontine haemorrhage

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16
Q

dominant hemisphere middle cerebral artery haemorrhage causes what

A

aphasia

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17
Q

imaging for stroke

A

non-contrast CT

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18
Q

hyperdense CT

A

haemorrhage

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19
Q

when do you give aspirin

A

after the CT

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20
Q

how do you assess carotid artery stenosis

A

USS

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21
Q

when would you perform a carotid endardectomy

A

more than 70% occlusion and symptomatic

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22
Q

management of a large stroke

A

thrombolysis and thrombectomy

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23
Q

management of TIA

A

300mg aspirin

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24
Q

driving rules after TIA

A

do not drive for 1 month
no need to inform DVLA

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25
Q

what medication combination would you give if clopidogrel was not tolerated for secondary prevention of stroke

A

aspirin and modified release dipyramidole

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26
Q

assessment score for stroke in ED

A

ROSIER

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27
Q

assessment score for ADL after stroke

A

barthel index

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28
Q

lesion in superior v inferior temporal gyrus

A

superior: wernicke
inferior: broca

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29
Q

fluent speech, poor repetition but comprehension intact

A

conduction aphasia

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30
Q

extradural v subdural haematoma on CT

A

extradural: biconvex does not cross suture lines
subdural: cresent and crosses suture lines

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31
Q

3 causes of a chronic subdural haematoma

A

alcoholic, elderly, shaken baby

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32
Q

cause of an acute subdural haematoma

A

high impact injury - risk of herniation

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33
Q

how do you differentiate between an acute and chronic subdural haematoma

A

chronic is hypodense (dark)
acute is hyperdense

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34
Q

what veins are damaged in a subdural haematoma

A

bridging veins

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35
Q

ipsilateral down and out eye
dilated pupil (mydriasis) and ptosis

A

third nerve palsy

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36
Q

cause of a painful third nerve palsy

A

posterior communicating artery aneurysm

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37
Q

decreased abduction and horizontal diplopia

A

sixth nerve palsy

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38
Q

cause of a sixth nerve palsy

A

raised ICP (long course of nerve) from tumour

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39
Q

unilateral throbbing and recurrent headache with aura, nausea and photosensitivity which impacts ADL and is associated with menstruation

A

migraine

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40
Q

prophylaxis and treatment for migraine

A

prophylaxis: propranolol or topiramate
treatment: triptan

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41
Q

side effect and contraindication for triptans

A

throat/chest tightness

CVD

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42
Q

recurrent bilateral headache like a band which does not impact ADL

A

tension headache

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43
Q

15-20 minute severe headache occurring 1-2x daily for 4-12 weeks associated with lacrimation and red painful eyes

A

cluster headache

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44
Q

3 RF for cluster headache

A

male, alcohol, smoking

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45
Q

treatment and prophylaxis for cluster headaches

A

treatment: oxygen and SC sumatriptan
prophylaxis: verapamil

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46
Q

rapid onset unilateral headache in a 60y/o associated with temporal tenderness and jaw claudication

A

temporal arteritis

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47
Q

marker for temporal arteritis

A

ESR

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48
Q

sharp unilateral facial pain triggered by chewing or touching the face

A

trigeminal neuralgia

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49
Q

how do you manage a medication overuse headache

A

stop simple analgesia and triptans immediately
withdraw opioids slowly

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50
Q

how many days of headache is needed for the diagnosis of a medication overuse headache

A

15 days a month

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51
Q

sudden onset headache with nausea, vomiting and LOC

A

venous sinus thrombus

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52
Q

investigation and treatment for venous sinus thrombosis

A

MRI venography and LMWH

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53
Q

headache worse on standing, associated with marfans and LP and treated with caffeine and fluids

A

spontaneous intracranial hypertension from CSF leak

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54
Q

obese young female with headache and blurred vision
perhaps taking COCP, tetracyclines, steroids, lithium, vitamin A or who is pregnant

A

idiopathic intracranial hypertension

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55
Q

treatment of idiopathic intracranial hypertension

A

weight loss, diuretics, LP, surgery, topiramate, acetylzolamide

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56
Q

iatrogenic cause of a low pressure headache

A

LP

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57
Q

sudden onset headache and visual field defect with signs of pituitary deficiency such as low blood pressure

A

pituitary apoplexy

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58
Q

treatment of pituitary apoplexy

A

urgent steroids

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59
Q

benign tumour from the meninges with well defined borders

A

meningioma

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60
Q

vertigo, hearing loss, tinnitus, loss of corneal reflex

A

acoustic neuroma
vestibular schwannoma

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61
Q

investigations for acoustic neuroma

A

MRI of cerebellopontine angle and audiogram

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62
Q

pus covered by pyogenic membrane in brain

A

brain abscess

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63
Q

treatment of brain abscess

A

IV cef and metro

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64
Q

confusion, gait ataxia, nystagmus and opthalmoplegia

A

wernickes encephalopathy

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65
Q

amnesia and confabulation

A

korsakoff syndrome

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66
Q

?CSF from nose or ears

A

check glucose level

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67
Q

urinary incontinence, gait abnormality and dementia

A

normal pressure hydrocephalus

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68
Q

ventricle size in normal pressure hydrocephalus

A

increased

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69
Q

most common complication of meningitis

A

sensorineural hearing loss

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70
Q

most common primary for brain mets

A

lung

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71
Q

no improvement in facial paralysis from bells palsy in 3w

A

urgent referral to ENT

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72
Q

facial nerve palsy and increased size of parotid gland

A

sarcoidosis

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73
Q

at what GCS should you intubate

A

8

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74
Q

GCS

A

E = 4
V = 5
M = 6

take the best response

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75
Q

role of controlled hyperventilation

A

reduces carbon dioxide which causes vasoconstriction and reduced ICP

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76
Q

physiological response to raised ICP

A

cushings reflex

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77
Q

blood pressure, heart rate and pulse pressure in the cushings reflex

A

bp raised
HR reduced
wide pulse pressure

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78
Q

seizure in which lobe lasts for 1 minute, associated with automatisms (lip smacking), aura, dejavu, hallucinations and LOC

A

temporal lobe

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79
Q

seizure in which lobe causes motor symptoms
e.g. head/leg movements, posturing, post-ictal weakness, jacksonian march (clonic movements)

A

frontal lobe

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80
Q

seizure in which lobe causes sensory loss
e.g. paraesthesia

A

parietal lobe

81
Q

seizure in which lobe causes visual changes
e.g. flashers/floaters

A

occipital lobe

82
Q

driving after an uprovoked/1st seizure with normal imaging and EEG

A

do not drive for 6 months

83
Q

seizures in the morning or after sleep deprivation

A

juvenile myoclonic epilepsy

84
Q

woman falls to the ground and is motionless

A

atonic seizure

85
Q

laughter causing collapse

86
Q

what provokes absence seizures

A

hyperventillation

87
Q

widespread convulsions with no LOC

A

pseudoseizure

88
Q

differentiating between a true and pseudoseizure

89
Q

medical management of generalised tonic clonic seizures in males and females

A

male: sodium valproate
female: lamotrigine/levetricetam

90
Q

1st and 2nd line management of focal seizures

A

1st: lamotrigine/levetricetam
2nd: carbemazepine

91
Q

medical management of absence seizures

A

ethosuximide

92
Q

medical management of tonic/atonic seizures in males and females

A

male: sodium valproate
female: lamotrigine

93
Q

which medication worsens absence seizures

A

carbemazepine

94
Q

which 2 epilepsy medications cause steven johnson syndrome

A

carbamazepine and tamotrigine

95
Q

management of steven johnson syndrome

96
Q

which medication alters folate metabolism causing megaloblastic anaemia

97
Q

which epilepsy drug causes weight gain

A

sodium valproate

98
Q

when can you stop antiepileptics

A

withdraw slowly over 2-3m if seizure free for 2 years

99
Q

4 lines of management of status epilepticus

A
  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
Q

Explain the difference between tuberus sclerosis and neurofibromatoma

A

neuro: axillary/groin freckles
tub: ash leaf spots, adenoma sebaceum, shagreem, subungal fibromatoma, epilepsy

101
Q

which neurofibromatoma has an association with acoustic neuroma

102
Q

inheritance of tuberus sclerosis and neurofibromatoma

A

autosomal dominant

103
Q

most common type of MND associated with LMNL in arms and UMNL in legs

A

Amyotrophic lateral sclerosis

104
Q

chromosome affected in ALS

105
Q

MND with UMN loss

A

primary lateral sclerosis

106
Q

MND with the best prognosis, LMN affected distal to proximal

A

progressive muscular atrophy

107
Q

MND with the worst prognosis associated with palsy of the tongue, muscles of mastication and facial muscles

A

progressive bulbar palsy

108
Q

which movements are spared in MND

109
Q

most common method of feeding in MND

110
Q

which medication increases survival in MND

111
Q

which dementia is associated with MND

A

frontotemporal

112
Q

which is the most common type of MS

A

relapsing remitting

113
Q

tingling in hands when neck flexed in MS is called

A

Lhermeittes sign

114
Q

2 investigations for MS

A

MRI with contrast
LP showing oligoclonal bands

115
Q

management of an acute relapse of MS

A

high dose steroids

116
Q

management of spasticity in MS

A

baclofen or gabapentin

117
Q

inducing remission in MS

A

monoclonal antibodies e.g. natalizumab

118
Q

pathophysiology of myasthenia gravis

A

antibodies to Ach receptors cause progressive weakening of muscles (esp limb girdle, neck and eyes)

119
Q

cancer associated with myaesthenia gravia

120
Q

investigations for myasthenia gravis

A

antibodies
CT scan

121
Q

creatinine kinase in myasthenia gravis

122
Q

treatment of myasthenia gravis

A

AchE inhibitors e.g. pyridostigmine

123
Q

treatment of myasthenia gravis crisis

A

IV immunoglobulin and plasmapheresis

124
Q

which medication worsens myasthenia gravis

A

bisoprolol

125
Q

people with myasthenia gravis are resistant to which medication

A

suxamethonium

126
Q

pathophysiology of lambert eaton syndrome

A

antibodies to calcium channels causes weakness which improves after exercise (different to myasthenia gravis)

127
Q

association with lambert eaton

A

lung cancer

128
Q

treatment of lambert eaton

A

treat the cancer
immunosupressants (azathioprine, prednisoline)
IV immunoglobulin
Plasma exchange

129
Q

worsening lower limb weakness after gastroenteritis

A

guillian-barree

130
Q

most common organism causing guillian-barre

A

campylobacter

131
Q

investigations for guillian baree

A

LP increased protein
nerve conduction studies

132
Q

treatment of guillian barre

A

IV immunoglobulin

133
Q

most common hereditary sensorimotor neuropathy

A

charcot marie tooth

134
Q

inheritance of charcot marie tooth

A

autosomal dominant

135
Q

which type of gait to cerebellar injuries cause

A

ataxic (wide base with reduced heel-toe walking)

136
Q

8 most common causes of cerebellar injury

A

Posterior fossa tumour
Alcohol
multiple Sclerosis
Trauma
Rare causes
Inherited
Epilepsy treatment
Stroke

137
Q

Parkinsonism with autonomic disturbance and cerebellar sign

A

multiple system atrophy

138
Q

autosomal dominant condition which causes tremor worse when arms are outstretched and better with alcohol/propanolol

A

benign essential tremor

139
Q

unilateral tremor which improves with voluntary movement

A

parkinsons

140
Q

give an example of a decarboxylase inhibitor

141
Q

which drug causes dry mouth, anorexia, palpitations, psychosis, postural hypotension and an on-off phenomenon

142
Q

what happens if you abruptly stop parkinsons medication

A

acute dystonia

143
Q

3 side effects at peak dose of levodopa

A

dystonia, chorea, involuntary movements

144
Q

which class are brompcriptine, ropinerole and carbegoline

A

dopamine receptor agonists

145
Q

why do you need an ECHO, EST, CK and CXR before starting dopamine receptor agonists

146
Q

side effects of dopamine receptor agonists

A

IMPULSE CONTROL DISORDERS
LOSS OF INHIBITION
HALLUCINATIONS
POSTURAL HYPOTENSION

147
Q

which class is selegiline

A

MAO-B inhibitors

148
Q

side effects of MAO-B inhibitors

149
Q

which drug causes ataxia, slurred speech, confusion, dizziness, livedo reticularis

A

amantidine

150
Q

what class are drugs which end in -CAPONE

A

COMT inhibitors
(enzyme which breaks down dopamine)

151
Q

how do antimuscarinics e.g. procyclidine work in parkinsons

A

block cholinergic receptors in drug induced parkinsons or to help with tremor

152
Q

how do you treat nausea in parkinsons

A

domperidone
antihistamines worsen

153
Q

2 types of bitemporal hemianopia caused by lesions to the optic chiasm

A

upper quadrant defect: pituitary tumour
lower quadrant defect: craniophayngioma

154
Q

2 causes of homonymous quadrantanopia

A

Parietal Inferior Temporal Superior

155
Q

Brown-Sequard

A

lateral hemisection of the spinal cord

156
Q

cause and presentation of subacute combined degeneration of the cord

A

reduced vitamin B
reduced proprioception and vibration sense, increased reflexes

157
Q

cause of a high stepping gait

A

peripheral neuropathy

158
Q

muscle wasting of the hands, numbness, tingling and autonomic symptoms

A

neurogenic thoracic outlet syndrome

159
Q

cause of autonomic dysreflexia

A

injury to T6 or above

160
Q

management of autonomic dysreflexia

A

remove stimulus and treat HTN or bradycardia

161
Q

treatment of paradoxial hemicrania

A

indomethacin

162
Q

pain in neck/limbs causing sensory, motor or autonomic symptoms and reduced fine motor use in the hands with positive hoffmans sign

A

degenerative cervical myelopathy

163
Q

imaging for degenerative cervical myelopathy

164
Q

tetrad in neuroleptic malignant syndrome

A

hyperthermia
muscle rigidity
autonomic instability
altered mental state

165
Q

cause of neuroleptic malignant syndrome

A

antipsychotis e.g. clozapine

166
Q

treatment of neuroleptic malignant syndrome

A

bromocriptine

167
Q

collection of CSF in the spinal cord causedby trauma, tumour or the chiari malformation

A

syringiomyelia

168
Q

sensory loss in syringiomelia

A

spinothalamic (pain and temp) in a cape like distribution

169
Q

imaging for syringiomelia

A

spinal and brain MRI

170
Q

less severe form of muscular dystrophy which presents later

171
Q

treatment of restless leg

A

dopamine agonists

172
Q

4 drugs to trial for neuropathic pain

A

amitriptyline
duloxetine
gabapentin
pregabalin

173
Q

what part of the brain does ondansetron act on

174
Q

6 grades of muscle movement

A

0: nothing
1: trace
2: gravity eliminated
3: against gravity
4: against resistance
5: normal

175
Q

nerve roots for the following reflexes:
ankle
knee
biceps
triceps

A

ankle: S1 S2
knee: L3 L4
biceps: C5 C6
triceps: C7 C8

176
Q

T1 lesion

A

weak finger abduction

177
Q

what should you monitor if CT shows evidence of cerebral contusion

178
Q

binocular vision

A

zygoma fracture

179
Q

GCS below 8

A

urgent neurosurgery review before CT head

180
Q

neck pain and unable to rotate c-spine

A

needs CT C-spine

181
Q

RBC in CSF

A

traumatic tap

182
Q

evidence of RBC breakdown products 12 hours after injury

A

subarachnoid haemorrhage

183
Q

diffuse axonal injury (acceleration-deceleration injury)

184
Q

increased head circumference, bulging fontanelle, subsetting eyes in a baby with known intraventricular haemorrhage

A

hydrocephalus

185
Q

imaging in hydrocephalus

186
Q

6 criteria for brainstem death

A
  1. pupillary reflex
  2. corneal reflex
  3. oculo-vestibular reflex
  4. cough reflex
  5. no respiratory effort
  6. no response to supraorbital pressure
187
Q

criteria for the doctors performing brainstem death tests

A

2 separate doctors
1 must be a consultant
both must have at least 5 years of postgrad experience

188
Q

bleed between the dura and skull in the temporal region with raised ICP and a lucid interval

A

extradural haematoma

189
Q

vessel commonly ruptured in extradural haematoma

A

middle meningeal artery

190
Q

bleeding into the outer meningeal layer in the frontal/parietal region common in elderly, alcoholics or people on anticoagulation with fluctuating consciousness for weeks

A

subdural haematoma

191
Q

vessel commonly ruptured in subdural haematoma

A

bridging veins

192
Q

sudden occipital headache caused by a ruptured aneurysm or traumatic brain injury

A

subarachnoid haemorrhage

193
Q

management of subaracnhoid haemorrhage

A

nimodipine to reduce vasospasm
coil (over clip)

194
Q

why must you check the U+E after a subarachnoid haemorrhage

A

SIADH can cause hyponatremia

195
Q

blood within the brain presenting like a stroke

A

intracerebral haemorrhage

196
Q

nagement of intracerebral haemorrhage

A

conservative management with the stroke team
clot evacuation

197
Q

RF for intracerebral haemorrhage

A

HTN, aneurysm, AV malformation, trauma, tumour (stroke)

198
Q

LEARN THE NICE CT HEAD GUIDELINES

199
Q

LEARN THE DIFFERENT EYE LESIONS HEHE

Medicine Year 5 (27 decks)

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