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BPT Sadness πŸ˜” > Neurology > Flashcards

Neurology Flashcards

1
Q

What sort of tremor is described?
β€’ Usually affects upper limbs
β€’ Autosomal dominant
β€’ Postural/worse when outstretched
β€’ Improved by EtOH and rest
β€’ Most common cause of titubation (head tremor)

A

Essential tremor

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2
Q

What are key features of Lambert-Eaton syndrome?

A

β€’ Muscle weakness improves with repetitive contraction
β€’ hyporeflexia and autonomic disruption such as dry mouth, impotence and difficulty micturating antibodies against the voltage-gated Ca2+ channels

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3
Q

What is found on EMG in Lambert-Eaton syndrome?

A

Incremental response to repetitive electrical stimulation

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4
Q

What is the pathophysiology in myasthenia gravis?

A

Blockage of the nicotinic acetylcholine receptors

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5
Q

Anti-GQ1b antibodies are present in 90% of which diagnosis?

A

Miller-Fisher syndrome

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6
Q

Which cranial nerve is most commonly affected in IIH?

A

CN 6, abducens nerve

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7
Q

What is the most common complication following meningitis?

A

Sensorineural hearing loss - up to 34% of cases
- Complications more common in pneumococcal meningitis (than meningococcal meningitis)

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8
Q

What is a serious but rare complication of meningococcal meningitis?

A

Waterhouse-Friderichsen syndrome
- Adrenal insufficiency secondary to bilateral adrenal haemorrhage secondary to fulminant meningococcal

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9
Q

What is diagnosis and what is the treatment?

32M BIBA post seizure in setting of fevers and vomiting. Incomplete course of ABx for bacterial sinusitis. CTB with contrast shows ring-enhancing lesion with inflammation of sinuses.

A

Brain abscess; spread from sinus infection
- IV ceftriaxone and metronidazole

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10
Q

Which 3 cranial nerves are most commonly affected in IIH?

A

CN VI > IV > III

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11
Q

Which drugs can exacerbate myasthenia gravis?

A

The following drugs may exacerbate myasthenia:
- Penicillamine
- Quinidine, procainamide
- Beta-blockers
- Lithium
- Phenytoin
- Antibiotics: gentamicin, macrolides, quinolones, tetracyclines
- Steroids

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12
Q

What is the name of this finding on MRIB, and what condition does this suggest?

A

Dawson’s fingers in MS
- FLAIR images - hyperintense lesions peripendicular to the corpus callosum

McDonald criteria

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13
Q

A subacute progressive weakness with a mixture of lower and upper motor neurone signs without sensory involvement points to which diagnosis (B12 and folate replete)

A

MND
β€’ Fasciculations
β€’ Absence of sensory signs/symptoms
β€’ Mixture of lower motor neuron and upper motor neuron signs
β€’ Wasting of the small hand muscles/tibialis anterior is common

Key DDx is subacute combined degeneration of the spinal cord (due to vitamin B12 deficiency)

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14
Q

What is the diagnosis?

Sudden and transient loss of muscular tonecaused bystrong emotion (e.g. laughter, being frightened).

A

Cataplexy
- Associated with narcolepsy

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15
Q

Visual field defect

A

The main points for the exam are:
β€’ Left homonymous hemianopia = visual field defect to the left, i.e. lesion of right optic tract
β€’ Homonymous quadrantanopias
- PITS (Parietal-Inferior, Temporal-Superior)
β€’ Incongruous defects = optic tract lesion; congruous defects = optic radiation lesion or occipital cortex

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16
Q

Which area is affected?

A lesion of the inferior frontal gyrus. It is typically supplied by the superior division of the left MCA

Speech is non-fluent, laboured, and halting. Repetition is impaired

Comprehension is normal

A

Broca’s area

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17
Q

Wernicke’s area is located where?

A

Superior temporal gyrus

This area β€˜forms’ the speech before β€˜sending it’ to Broca’s area. Lesions result in sentences that make no sense, word substitution and neologisms but speech remains fluent - β€˜word salad’

Comprehension is impaired

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18
Q

What is the eponymous name of lateral medullary syndrome, what are key features and which artery is implicated?

A

Wallenberg’s syndrome; occlusion of posterior inferior cerebellar artery (PICA)

Cerebellar features
- Ataxia
- Nystagmus

Brainstem features:
- Ipsilateral dysphagia, facial numbness, CN palsy e.g. Horner’s
- Contralateral: limb sensory loss

PICA-Chew (dysphagia)

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19
Q

Target LDL, TC and trig post stroke?

A

LDL <1.8 mmol/L
TC <5.5 mmol/L
Trig <1.7 mmol/L

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20
Q

Difference between CIDP and AIDP

A

CIDP is 8 weeks onwards

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21
Q

Bladder control?

A

Derisory and internal sphincter = Parasympathetic
External sphincter
= Voluntary

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22
Q

Anti-GQ1b are associated with which condition?

A
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23
Q

Which disorders are Ξ± synucleinopathies?

A
  1. Dementia with Lewy bodies
  2. Parkinson’s disease
  3. MSA
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24
Q

NCS findings in GBS?

A

β€’ Decreased motor nerve conduction velocity (due to demyelination)
β€’ Prolonged distal motor latency
β€’ Increased F wave latency

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25
Q

Causes of visual loss and where lesion is

A

How to remember upper vs. lower

Temporal
Parietal

TOILET PAPER

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26
Q

Severe encephalopathy (amnesia, confusion, psychosis, dysphasia) with autonomic instability, choreoathetoid movements +/- seizure makes you think?

A

NMDA receptor Ab-associated encephalitis

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27
Q

Can flumazenil precipitate seizures?

A

Yes

28
Q

Skin rash and AEDs - which drug requires slow uptitration to reduce SJS/TEN risk?

A

Lamotrigine
- 10% risk skin rash

Carbemazepine-associated rash is not dose-related
- If Asian, check HLA B1502 gene

29
Q

ABCD2 score?

A

A - age >60 +1
B - BP >140/90 +1
C - clinical features; speech disturbance +1, unilateral weakness +2
D - duration, 10-59 minutes +1, >60 minutes +2
D - diabetes +1

30
Q

Cardinal features of PD?

A

Need 2 out of 3
- Rest tremor
- Bradykinedia (slowness + decrement)
- Rigidity

31
Q

Treatment of PD-associated psychosis?

A

Quetiapine > clozapine
- Donepezil if dementia/confusion (cholinesterase inhibitor)

Quetiapine works on lots of things - dopamine, serotonin 5HT1A, histamine H1, muscarinic

32
Q

SE of DuoDopa gel?

A

Peripheral neuropathy
- B12
- B6
- Homocystein

33
Q

What proportion of CIS will develop MS?

A

Abnormal MRI - 70-90% will develop

Normal MRI
- 10% will develop MS

34
Q

AED associated with visual field constriction?

A

Vigabatrin

35
Q

Ptosis, dilated pupils, somnolence, eye shit but normal motor function makes you think which type of stroke?

A

Top of the basilar syndrome

36
Q

Agraphia, acalculia, finger agnosia, left-right disorientation makes you think?

A

Gerstman syndrome
- Usually left inferior parietal lobe or angular gyrus

37
Q

Bilirubin in CSF makes you think?

A

SAH
- Xanthochromia

38
Q

What drug is used to assist with mobility in MS?

A

Fampridine
- Potassium channel blocker; likely improves neuronal conduction
- Improves gait speed and endurance

39
Q

Most sensitive test for ocular myaesthenia gravis?

A

Single fibre EMG

40
Q

Contraindications to deep brain stimulation / DBS?

A

Dementia
Major psychotic disorder
Alcoholism
(Age >70 years)

41
Q

In internuclear opthalmoplegia, where is the lesion?

A

Medial longitudinal fasiculus (MLF) on same side as the eye which can’t ADduct
- Right INO: right eye unable to adduct, left eye has nystagmus

42
Q

Fingolimod mechanism of action?

A

S1P (sphingosine-1-phosphate) receptor modulator
- Sequesters B and T cells into LN > less migration into CNS
- Can cause bradyarrhythmia PML, cryptococcas meningitis
- Immunise beforehand

43
Q

Dimethyl fumarate MOA in MS?

A

Activates NF KB > dampens down inflammation
- Flushing and GI side effects
- Causes lymphopaenia

Also used to Tx psoriasis

44
Q

Mechanism of action terfluonamide?

A

Inhibits dihydroorotate dehydrogenase > inhibits pyrimidine synthesis
- Test TB beforehand

SE: HTN and LFT derangement, diarrhoea, alopecia

Metabolite of leflunomide

45
Q

Clinically isolated syndrome (CIS) conversion to MS?

A

If abnormal MRI: 70-90% progression to MS

If normal MRI: 10% progression

46
Q

More specific finding for ischaemic core

A

Severely reduced cerebral blood flow
- Also decreased blood volume

47
Q

How long to delay surgery after stroke?

A

3 months, up to 9 months if possible

48
Q

Epilepsy rules

A
  • Epilepsy in males = sodium valproate in males (except for focal and absence seizures)
  • Absence seizures = ethosuximide (carbemazepine may exacerbate)
  • Focal seizures = lamotrigine or levetirecetam
  • Females (esp. child bearing age) - either levetirecetam or lamotrigine (think pregnancy is heLL)
49
Q

Most specific finding denervation for ALS AKA MND on EMG

A

Sharp waves
Fasiculation potentials

50
Q

Which area of the brain is spared in HSV encephalitis?

A

Basal ganglia

51
Q

Immunomodulation summary in MS

A

Glatiromer:
- Co-polymer 1; mimics myelin > Ab decoy > dampens inflammation
- Doesn’t cross BBB; converts TH1 to TH2 (IL4, IL10) > thus induces TH2 to cross BBB and dampen inflammation

Interferon beta
- Suppresses T cell activation; acts on both T and B cells
- Induces neural cell conversion into oligodenodrocytes > repair of damaged nerve cells

Dimethyl fumarate/DMF
- Activates NrF2 > dampens down inflammation

Terfluonamide (metabolite of leflunamide)
- Inhibits DHODH > thus inhibits pyrimidine synthesis > decrease proliferation of B cells
- Thus slows down MS progression

52
Q

Immunosuppression in MS

A

Anti-CD20: rituximab, ocrelizumab, ofatimumab, ubilitixumab
- Possibly depletes both B and T cells

Anti-CF52 i.e. alemtuzumab
- Induction > maintenance
- Can also Tx CLL

Anti-alpha 4 integrin: natalizumab
- Prevents leucocyte trafficking into CNS
- β€œImmunosuppresses brain” > risk for JC virus > PML

S1P1 receptor modulator e.g. fingolimod
- Works on both B and T cells; sequestration lymphocytes into LN > thus less migration into CNS
- Monitor for 1st dose bradyarrythmia
- RF for PML, cryptococcus meningitis

53
Q

How common is hyperdense MCA sign on non-contrast CTB

A

30-40%

54
Q

What is recurrence risk after first seizure?

A

> 50%
- Usually within 6 months
- Acute metabolic derangement in 25-30%
- Abnormal MRI in 15%

55
Q

What is the definition of epilepsy?

A

2 unprovoked seizures that occur more than 24 hours apart, OR
after single event that occurs in a person who is at high risk of recurrence

56
Q

Definition of drug-resistant epilepsy?

A
57
Q

Treatment of early onset dystonia with diurnal variation

A

Levodopa

58
Q

Clozapine mechanism of action?

A

Blocks 5HT2 serotonin and D1 receptors (esp. D4)
- Both ondansetron and clozapine cause concentration

59
Q

Which genes are associated with hemi-plegic migraines?

A

CAS
- CACNA1A
- ATP1A2
- SCN1A

Autosomal dominant

60
Q

Central HINTS exam

A

Positive skew
Negative head impulse

61
Q

Cherry red spot and pale retina + painless makes you think?

A

Central retinal artery occlusion

62
Q

Young person with stroke-like symptoms with hearing loss makes you think?

A

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS)
- The characteristic features of MELAS include stroke-like episodes, seizures, recurrent migraine-like headaches, vomiting, short stature, hearing loss, muscle weakness, lactic acidosis, diabetes, cardiac disease, and gastrointestinal dysmotility

63
Q

B fibres in nerves are responsible for?

A

Autonomic nerve fibres
- Small, lightly myelinated

64
Q

The only unmyelinated fibres are which types of nerves?

A

Type C fibres

65
Q

Alexia without agraphia (can’t read but can still write) affects which vessel?

A

Posterior cerebral artery

66
Q

Startle myoclonus, nocturnal myoclonus and cerebellar syndrome make you think?

A

Creutzfeldt-Jakob disease CJD

BPT Sadness πŸ˜” (20 decks)

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