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Year 6 > Neurology > Flashcards

Neurology Flashcards

1
Q

How far apart do cluster headaches occur?

A

4-12 weeks

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2
Q

What eye changes occur in cluster headache?

A

Miosis
Ptosis

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3
Q

Diagnosis of cluster headache?

A

MRI with contrast (clinical but sometimes brain lesions found)

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4
Q

Cluster headache acute management and prophylaxis

A

Acute
- 100% oxygen
- SC triptan

Prophylaxis
- Verapamil

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5
Q

Which lobes are affected by encephalitis?

A

Temporal
Inferior frontal

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6
Q

Encephalitis CSF and imaging findings

A

CSF
- High lymphocytes
- High protein
- PCR: HSV-1

Imaging
- MRI e.g. petechial haemorrhages

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7
Q

Management for encephalitis

A

IV acyclovir

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8
Q

Condition with immune-mediated demyelination of PNS, and its causes

A

GBS

Resp illness or diarrhoea e.g. C. jejuni
Vaccination

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9
Q

Does GBS have sensory symptoms?

A

Yes, mild (paraesthesia)

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10
Q

Cranial nerve and autonomic symptoms of GBS

A

Cranial nerve - diplopia, facial nerve palsy, oropharyngeal weakness

Autonomic - urinary retenion, diarrhoea

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11
Q

GBS main investigations

A

LP - high protein
Nerve conduction - decreased velocity

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12
Q

GBS management

A

IVIG
Plasma exchange
Supportive e.g. DVT prophylaxis, ventilation

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13
Q

Patient with personality change, chorea, loss of coordination. How do you diagnose?

A

Huntington’s disease

Clinical
40+ CAG repeats
MRI: caudate or striatal atrophy

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14
Q

When is hydrocephalus headache worse?

A

Morning
Lying down
Valsalva manoeuvre

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15
Q

Difference between obstructive and non-obstructive hydrocephalus and their causes

A

Obstructive: non-communicating
- blocked flow of CSF
- dilatation of ventricles
e.g. tumour

Non-obstructive: communicating
- increased CSF: choroid plexus tumour
- decreased reabsorption: meningitis

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16
Q

What type of hydrocephalus has:
Memory impairment
Urinary frequency
Balance problems

A

Normal pressure hydrocephalus (CSF pressure appears normal but it isn’t)

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17
Q

When can LP be done in hydrocephalus?

A

Only non-obstructive

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18
Q

Acute management of hydrocephalus

A

External ventricular drain

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19
Q

Long-term management of n.o. hydrocephalus

A

Ventriculoperitoneal shunt

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20
Q

Obstructive hydrocephalus management

A

Surgery

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21
Q

Palsy in intracranial hypertension

A

Abducens

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22
Q

Idiopathic intracranial hypertension management

A

Weight loss
Diuretics
Therapeutic LP

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23
Q

Motor neuron disease signs

A

UMN and LMN
No sensory
Sphincter muscle dysfunction late

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24
Q

Main 2 types of MND

A

Amyotrophic lateral sclerosis: corticospinal tracts
Primary lateral - loss of Betz cells, mainly UMN

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25
MND diagnosis
Clinical Normal motor conduction MRI to exclude structural causes LP to exclude inflammatory
26
MND management
Supportive Drooling - amitriptyline Resp failure - NIV Spasticity - baclofen Dysphagia - PEG Pain - analgesic ladder Riluzole - extends life by 3 months
27
Which conditions involves cell-mediated autoimmune demyelination of the CNS?
Multiple sclerosis
28
Types of MS
Relapsing-remitting - 1-2 month acute attacks Secondary progressive - neurological signs between relapses Primary progressive - progressive deterioration from onset
29
MS features (motor, sensory, visual)
Motor - spastic weakness Sensory - Lhermitte's: paraesthesia in limbs on neck flexion Visual - optic neuritis, Uhthoff's (worse with increased temp), INO
30
MS investigations
Bloods: antibodies (anti-maltose binding protein) CSF - oligoclonal bands, not in serum MRI with contrast - periventricular plaques, dawson fingers
31
MS management (acute, and relapse risk reduction)
Acute - high-dose steroids (oral or IV) Risk - IV natalizumab
32
What happen to reflexes at level and below lesion (spinal cord compression)
Absent at level Reduced below
33
Investigation for spinal cord compression
MRI spine within 24 hours
34
Management of cauda equina
emergency decompression
35
Management of malignant spinal cord compression
IV corticosteroids Radiotherapy or surgery
36
How to know if spinal cord injury is partial
Perianal sensation spared
37
What types of signs are seen in spinal cord injury
UMN LMN Sensory Autonomic
38
Spinal cord injury imaging
Acute - urgent CT Chronic - MRI
39
Spinal cord injury management
Surgical decompression Physiotherapy Mobility Bladder management (self-catheterisation, pharmacological)
40
Trigeminal neuralgia management
Carbamazepine Some data for baclofen Refer to neurology
41
Wernicke's encephalopathy vitamin affected
B1 (thiamine)
42
Wernicke's encephalopathy features
Ophthalmoplegia/nystagmus Ataxia Encephalopathy Peripheral sensory neuropathy
43
Wernicke's encephalopathy investigations
Decreased red cell transketolase MRI
44
Korsakoff presentation
Untreated Wernicke's Antero/retrograde amnesia Confabulation
45
Stroke in which artery more likely to affect upper limbs?
Middle cerebral artery
46
Stroke in which artery more likely to affect lower limbs?
Anterior cerebral artery
47
Stroke management pathway
A-E CT head: excluded haemorrhagic - aspirin 300mg - alteplase within 4.5 hours - consider thrombectomy within 6 hours If haemorrhagic, generally supportive care / surgical resection of haematomas.
48
Stroke secondary prevention
Aspirin Clopidogrel MR dipyridamole
49
TIA management
Immediate aspirin 300mg or continue current aspirin if taking Don't give aspirin if taking anticoagulant or has bleeding disorder Admit if 1+ TIA Refer <24 hours if 1 within 7 days
50
TIA investigations
MRI: locate ischaemia and rule out haemorrhage Carotid doppler
51
TIA secondary prevention
Clopidogrel Statin
52
When is carotid endarterectomy considered?
Stroke / TIA in carotid territory Carotid stenosis >70%
53
Parkinson's features
Bradykinesia (shuffling, difficulty initiating mvoement) Resting tremor (improves with movement) Lead pipe and cogwheel rigidity Mask-like facies Depression Postural hypotension
54
How does drug-induced parkinsonism present differently
- rapid onset - bilateral rigidity
55
Parkinson's investigations
Clinical diagnosis Levodopa trial Single-photon emission CT
56
Parkinson's management
Motor symptoms affecting life: levodopa Motor symptoms not affecting life: dopamine agonist, levodopa, MAO-B inhibitor
57
Levodopa side effects
Dry mouth Palpitations Psychosis
58
What is levodopa usually combined with?
Decarboxylase inhibitor e.g. carbidopa to prevent peripheral metabolism to dopamine
59
Which spinal tract carries pain and thermal sensation, and where does it cross over?
Lateral spinothalamic tract Cross upon entering spinal cord
60
Which spinal tract carries crude sensation, and where does it cross over?
Anterior spinothalamic tract Cross upon entering spinal cord
61
Which spinal tracts carry motor neurons and where do they cross over?
Corticospinal tracts Medulla
62
Nerve supplying sensation to dorsum of hand (thumb edge to half of ring finger, not tips)
Radial
63
Nerve supplying sensation palmar hand (thumb half to half of ring finger, including tips)
Median
64
Nerve supplying sensation from pinky to half of ring finger (palmar and dorsal)
Ulnar
65
Nerve controlling upper limb extension
Radial nerve
66
Nerve controlling wrist flexion
Median nerve
67
Nerve controlling finger abduction
Ulnar nerve
68
Nerve controlling thumb flexion, opposition, abduction, and extension?
Median nerve
69
Hand of benediction nerve damage
Median nerve
70
Claw hand nerve damage
Ulnar nerve
71
Hip flexion nerve
Femoral
72
Hip extension nerve
Inferior gluteal
73
Knee flextion nerve
Sciatic
74
Knee extension nerve
Femoral
75
Ankle dorsiflexion nerve
Deep peroneal
76
Ankle plantarflextion nerve
Tibial
77
Big toe flexion nerve
Deep peroneal
78
Dermatome medial calf
L4
79
Dermatome lateral calf and middle of dorsum of foot
L5
80
Dermatome lateral edge of foot and just above ankle
S1
81
Dermatome going from heel up posterior of leg
S2
82
Ankle reflex nerves
S1-S2
83
Knee reflex nerves
L3-L4
84
Bicep reflex nerves
C5-C6
85
Tricep reflex nerves
C7-C8
86
Pathophysiology of myasthenia gravis
Antibodies against acetylcholine receptors
87
Which cancer is myasthenia gravis associated with?
Thymoma
88
Myasthenia gravis investigations
Single fibre electromyography CT thorax - thymoma Antibodies to ACh-r (less common if only eye muscle involved)
89
Myasthenia gravis management
Pyridostigmine Immunosuppression e.g. prednisolone
90
Myasthenic crisis management
Plasmapheresis IVIG
91
Erb's paralysis nerves and presentation
C5, C6 Waiter's tip
92
Klumpke's paralysis nerves and presentation
T1 Claw hand

Year 6 (19 decks)

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