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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
Q

MND diagnosis

A

Clinical

Normal motor conduction
MRI to exclude structural causes
LP to exclude inflammatory

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26
Q

MND management

A

Supportive
Drooling - amitriptyline
Resp failure - NIV
Spasticity - baclofen
Dysphagia - PEG
Pain - analgesic ladder

Riluzole - extends life by 3 months

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27
Q

Which conditions involves cell-mediated autoimmune demyelination of the CNS?

A

Multiple sclerosis

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28
Q

Types of MS

A

Relapsing-remitting
- 1-2 month acute attacks

Secondary progressive
- neurological signs between relapses

Primary progressive
- progressive deterioration from onset

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29
Q

MS features (motor, sensory, visual)

A

Motor - spastic weakness
Sensory - Lhermitte’s: paraesthesia in limbs on neck flexion
Visual - optic neuritis, Uhthoff’s (worse with increased temp), INO

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30
Q

MS investigations

A

Bloods: antibodies (anti-maltose binding protein)
CSF - oligoclonal bands, not in serum
MRI with contrast - periventricular plaques, dawson fingers

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31
Q

MS management (acute, and relapse risk reduction)

A

Acute - high-dose steroids (oral or IV)

Risk - IV natalizumab

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32
Q

What happen to reflexes at level and below lesion (spinal cord compression)

A

Absent at level
Reduced below

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33
Q

Investigation for spinal cord compression

A

MRI spine within 24 hours

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34
Q

Management of cauda equina

A

emergency decompression

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35
Q

Management of malignant spinal cord compression

A

IV corticosteroids
Radiotherapy or surgery

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36
Q

How to know if spinal cord injury is partial

A

Perianal sensation spared

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37
Q

What types of signs are seen in spinal cord injury

A

UMN
LMN
Sensory
Autonomic

38
Q

Spinal cord injury imaging

A

Acute - urgent CT
Chronic - MRI

39
Q

Spinal cord injury management

A

Surgical decompression
Physiotherapy
Mobility
Bladder management (self-catheterisation, pharmacological)

40
Q

Trigeminal neuralgia management

A

Carbamazepine
Some data for baclofen
Refer to neurology

41
Q

Wernicke’s encephalopathy vitamin affected

A

B1 (thiamine)

42
Q

Wernicke’s encephalopathy features

A

Ophthalmoplegia/nystagmus
Ataxia
Encephalopathy
Peripheral sensory neuropathy

43
Q

Wernicke’s encephalopathy investigations

A

Decreased red cell transketolase
MRI

44
Q

Korsakoff presentation

A

Untreated Wernicke’s

Antero/retrograde amnesia
Confabulation

45
Q

Stroke in which artery more likely to affect upper limbs?

A

Middle cerebral artery

46
Q

Stroke in which artery more likely to affect lower limbs?

A

Anterior cerebral artery

47
Q

Stroke management pathway

A

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
Q

Stroke secondary prevention

A

Aspirin
Clopidogrel
MR dipyridamole

49
Q

TIA management

A

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
Q

TIA investigations

A

MRI: locate ischaemia and rule out haemorrhage

Carotid doppler

51
Q

TIA secondary prevention

A

Clopidogrel
Statin

52
Q

When is carotid endarterectomy considered?

A

Stroke / TIA in carotid territory

Carotid stenosis >70%

53
Q

Parkinson’s features

A

Bradykinesia (shuffling, difficulty initiating mvoement)
Resting tremor (improves with movement)
Lead pipe and cogwheel rigidity
Mask-like facies
Depression
Postural hypotension

54
Q

How does drug-induced parkinsonism present differently

A
  • rapid onset
  • bilateral rigidity
55
Q

Parkinson’s investigations

A

Clinical diagnosis
Levodopa trial
Single-photon emission CT

56
Q

Parkinson’s management

A

Motor symptoms affecting life: levodopa
Motor symptoms not affecting life: dopamine agonist, levodopa, MAO-B inhibitor

57
Q

Levodopa side effects

A

Dry mouth
Palpitations
Psychosis

58
Q

What is levodopa usually combined with?

A

Decarboxylase inhibitor e.g. carbidopa to prevent peripheral metabolism to dopamine

59
Q

Which spinal tract carries pain and thermal sensation, and where does it cross over?

A

Lateral spinothalamic tract
Cross upon entering spinal cord

60
Q

Which spinal tract carries crude sensation, and where does it cross over?

A

Anterior spinothalamic tract
Cross upon entering spinal cord

61
Q

Which spinal tracts carry motor neurons and where do they cross over?

A

Corticospinal tracts
Medulla

62
Q

Nerve supplying sensation to dorsum of hand (thumb edge to half of ring finger, not tips)

A

Radial

63
Q

Nerve supplying sensation palmar hand (thumb half to half of ring finger, including tips)

A

Median

64
Q

Nerve supplying sensation from pinky to half of ring finger (palmar and dorsal)

A

Ulnar

65
Q

Nerve controlling upper limb extension

A

Radial nerve

66
Q

Nerve controlling wrist flexion

A

Median nerve

67
Q

Nerve controlling finger abduction

A

Ulnar nerve

68
Q

Nerve controlling thumb flexion, opposition, abduction, and extension?

A

Median nerve

69
Q

Hand of benediction nerve damage

A

Median nerve

70
Q

Claw hand nerve damage

A

Ulnar nerve

71
Q

Hip flexion nerve

A

Femoral

72
Q

Hip extension nerve

A

Inferior gluteal

73
Q

Knee flextion nerve

A

Sciatic

74
Q

Knee extension nerve

A

Femoral

75
Q

Ankle dorsiflexion nerve

A

Deep peroneal

76
Q

Ankle plantarflextion nerve

A

Tibial

77
Q

Big toe flexion nerve

A

Deep peroneal

78
Q

Dermatome medial calf

A

L4

79
Q

Dermatome lateral calf and middle of dorsum of foot

A

L5

80
Q

Dermatome lateral edge of foot and just above ankle

A

S1

81
Q

Dermatome going from heel up posterior of leg

A

S2

82
Q

Ankle reflex nerves

A

S1-S2

83
Q

Knee reflex nerves

A

L3-L4

84
Q

Bicep reflex nerves

A

C5-C6

85
Q

Tricep reflex nerves

A

C7-C8

86
Q

Pathophysiology of myasthenia gravis

A

Antibodies against acetylcholine receptors

87
Q

Which cancer is myasthenia gravis associated with?

A

Thymoma

88
Q

Myasthenia gravis investigations

A

Single fibre electromyography
CT thorax - thymoma
Antibodies to ACh-r (less common if only eye muscle involved)

89
Q

Myasthenia gravis management

A

Pyridostigmine
Immunosuppression e.g. prednisolone

90
Q

Myasthenic crisis management

A

Plasmapheresis
IVIG

91
Q

Erb’s paralysis nerves and presentation

A

C5, C6
Waiter’s tip

92
Q

Klumpke’s paralysis nerves and presentation

A

T1
Claw hand

Year 6 (19 decks)

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