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MRCP Part 1 > Neurology > Flashcards

Neurology Flashcards

1
Q

what is Lateral medullary syndrome, also known as Wallenberg’s syndrome

A

Lateral medullary syndrome, also known as Wallenberg’s syndrome, occurs following occlusion of the posterior inferior cerebellar artery (PICA)

Cerebellar features:
ataxia
nystagmus

Brainstem features:
ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s (mitosis, ptosis, anhydrosis)
contralateral: limb sensory loss

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2
Q

diagnosis multiple sclerosis

A

diagnosis is dependent on proof of demyelinating lesions separated by space AND time

MRI - high signal T2 images – of brain and spine

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3
Q

What is syringomyelia and how does it present?

A

cyst (syringe) forms in the spinal cord
compresses spinothalamic tract (responsible for pain, temperature, and crude touch)
Usually patients first notice a cape like (neck, shoulders and arms) loss of sensation to temperature but the preservation of light touch, proprioception and vibration - they might burn their hands without realising…

Loss of subtypes of sensation depends on how much of the spinothalamic tract fibres are damaged.

They might also get neuropathic pain

causes: idiopathic, trauma, tumours, chiari malformation

ix: MRI brain and spine

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4
Q

what is myotonic dystrophy?

A

genetic disorder (autosomal dominant)
affecting cardiac, smoothe and skeletal muscle

2 subtypes: DM1 and DM2

DM1
- chromosome 19
- Distal weakness more prominent

DM2
- chromosome 3
- Proximal weakness more prominent

features: ptosis, dysarthria, dysphagia, long face, heart block (long PR interval), cardiomyopathy, testicular atrophy, weakness of muscles

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5
Q

Miller-Fisher syndrome

A

Miller-Fisher syndrome, a variant of Guillain-Barre syndrome. The condition is classically associated with ophthalmoplegia, which normally develops first, a descending paralysis with areflexia and ataxia

EYE signs & descending are distinguishing,

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6
Q

Hemiballism

A

stroke damage to the subthalamic nucleus in basal ganglia –> involuntary “ballistic” movements on opposite side

patient jerk/ flinging/ ballistic movements

sometimes improve when sleeping

mx. haloperidol

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7
Q

trigeminal neuralgia signs and management

A

unilateral severe shooting pains in face (trigeminal nerve)
triggers- brushing teeth, combing hair
last a few seconds

mx. carbamazepine

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8
Q

wernicke’s vs broca and blood supply and regions of the brain

A

wernicke’s - understand - located in superior temporal gyrus, supplied by inferior division of the left MCA

broca - speech - - located in inferior frontal gyrus, superior division of the left MCA

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9
Q

conduction aphasia

A

affects connection between wenicke’s and broca’s known as the arcuate fasiculus

normal understanding
Speech is fluent but repetition is poor. Aware of the errors they are making

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10
Q

global aphasia

A

wenicke + broca + conduction (arcuate fasciculus)

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11
Q

Intracranial venous thrombosis investigation

A

MRI venography is the gold standard

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12
Q

stenosis cut off for Carotid endarterectomy

A

greater than 70% stenosis of the internal carotid artery.

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13
Q

distinguishing feature of serotonin syndrome vs neuroleptic malignant sydrome

A

serotonin syndrome has Myoclonus

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14
Q

Klumpke’s paralysis

A

T1 nerve palsy

cause: traumatic birth injury, or acute traction of the arm upwards

–> reduced power of the intrinsic hand muscles and over time can result in a ‘claw-like’ appearance

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15
Q

patchy haemorrhagic changes in the temporal lobe on MRI

A

herpes simplex encephalitis (HSE)

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16
Q

Drug options for reducing the risk of relapse in MS

A

natalizumab
ocrelizumab

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17
Q

drug for fatigue in MS

A

amantadine

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18
Q

Ramsay Hunt syndrome

A

reactivation of the varicella zoster virus in CN 7

oral aciclovir and corticosteroids are usually given

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19
Q

what anti-epileptic drug can worsen absence seizures?

A

Carbamazepine

(along with phenytoin, vigabatrin and gabapentin).

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20
Q

Baclofen mechanism of action

A

spasm

GABA receptor agonist

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21
Q

what is used to prevent vasospasm in aneurysmal subarachnoid haemorrhages

A

Nimodipine

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22
Q

what scale is used to determine ADL requirements in stroke patients?

A

The Barthel index is a scale that measures disability or dependence in activities of daily living in stroke patients

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23
Q

CT head showing temporal lobe changes

A

herpes simplex encephalitis

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24
Q

Miller-Fisher syndrome

A

Miller-Fisher syndrome is a variant of Guillain-Barré syndrome characterised by the triad of ophthalmoplegia, ataxia, and areflexia.

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25
Q

Treatment options for motor neurone disease

A
  1. Non-invasive ventilation at night if resp symptoms *greatest improvement on survival
  2. PEG feeding if needed
  3. Riluzole - prevents simulation of glutamate receptors
    prolongs life by 3mo
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26
Q

drug treatment for idiopathic cranial hypertension?

A

carbonic anhydrase inhibitors
- acetazolomide
- topiramate (additional benefit of weight loss)

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27
Q

stroke secondary prevention antiplatelet choice

A

clopidogrel

(high dose aspirin is given first then stopped)

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28
Q

what typical feature of PD helps differentiate it from other causes of parkinsonism.

A

Asymmetrical tremor is unique to parkinsons disease

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29
Q

when to do lumbar puncture if suspecting Subarachnoid haemorrhage?

A

If subarachnoid haemorrhage is suspected but a CT head done within 6 hours of symptom onset is normal, do not do an LP as this is accurate, consider an alternative diagnosis instead

if CT head is done 6 hours after onset, could still have SAH so do lumbar puncture

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30
Q

Huntington’s disease
- inheritance pattern
- what trinucleotide repeat?

A

autosomal dominant condition,

chromosome 4

There is a repeat expansion of CAG trinucleotide in

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31
Q

Pathway of pupillary light reflex

A

afferent: retina → optic nerve → lateral geniculate body → midbrain

efferent: Edinger-Westphal nucleus (midbrain) → oculomotor nerve

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32
Q

eye is deviated ‘down and out’

A

Third nerve palsy

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33
Q

Brown-Sequard syndrome

A

caused by lateral hemisection of the spinal cord

Features
ipsilateral weakness below lesion
ipsilateral loss of proprioception and vibration sensation
contralateral loss of pain and temperature sensation

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34
Q

Urinary incontinence + gait abnormality + dementia

A

= normal pressure hydrocephalus

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35
Q

when to suspect multi-system atrophy

A

multi-system atrophy due to parkinsonism + classical history of poor response to levodopa, impotence, urinary retention and younger age group.

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36
Q

long-term prophylaxis of cluster headaches

A

Verapamil is used for long-term prophylaxis of cluster headaches

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37
Q

acute disseminated encephalomyelitis

A

Autoimmune neurological condition which occur typically a few weeks following a viral illness or vaccination . It can present with motor weakness, encephalopathy, seizures and coma. It is found on T2-weighted MRI imaging which reveals poorly-defined
hyperintensities in the subcortical white matter.

38
Q

acute disseminated encephalomyelitis Management

A

Steroids and IV IG

39
Q

down and in pupil

A

6th nerve palsy

40
Q

what is narcolepsy associated with?

A

associated with HLA-DR2
it is associated with low levels of orexin (hypocretin),

41
Q

what is horner’s syndrome?

A

ipsilateral ptosis, miosis, and anhidrosis (no sweat)

42
Q

how to determine site of lesion in Horner’s syndrome presentation

A

anhydrosis determines site of lesion:

head, arm, trunk = central lesion: stroke, syringomyelia, multiple sclerosis, tumour

just face = pre-ganglionic lesion: Pancoast’s, cervical rib, trauma, thoidectomy

absent = post-ganglionic lesion: carotid artery, Carotid aneurysm, cluster headache

43
Q

A slow-relaxing grip may be noticed on initial hand-shake with the patient

A

The slow-relaxing grip

typical of myotonic dystrophy

44
Q

Nerve conduction studies (NCS) interpretation between axonal and demyelinating pathology

A

Axonal:
normal conduction velocity
reduced amplitude

Demyelinating:
reduced conduction velocity (myelin facilitates skip conduction)
normal amplitude

45
Q

Tx. Meningeal tuberculosis

A

12 months RIPE
AND STEROIDS

46
Q

What receptor does sumatriptan on & work MOA

A

Sumatriptan is a 5-HT1 receptor agonist
It works by constricting the blood vessels in the brain to relieve

47
Q

Holmes ADIe

A

DIlated pupil, females, absent leg reflexes

48
Q

What is the most likely cause for the patient’s hyponatraemia after subarachnoid haemorrhage?

A

SIADH

49
Q

Subacute combined degeneration of the cord

A

impairment of the dorsal columns, lateral corticospinal tracts and spinocerebellar tracts..

SCD tracts

Features:
dorsal column involvement
- distal tingling/burning/sensory loss is symmetrical and tends to affect the legs more than the arms
- impaired proprioception and vibration sense

lateral corticospinal tract involvement
- muscle weakness, hyperreflexia, and spasticity
- upper motor neuron signs typically develop in the legs first
- brisk knee reflexes
- absent ankle jerks
- extensor plantars

spinocerebellar tract involvement
- sensory ataxia → gait abnormalities
- positive Romberg’s sign

50
Q

Which type viral meningitis may be characteristically associated with a low cerebrospinal fluid glucose level?

A

MUMPS

51
Q

Internuclear ophthalmoplegia

A

due to a lesion in the medial longitudinal fasciculus (MLF)

Features
impaired adduction of the eye on the same side as the lesion
horizontal nystagmus of the abducting eye on the contralateral side

causes: multiple sclerosis, vascular

52
Q

where is the medial longitudinal fasciculus located?

A

paramedian area of the midbrain and pons

53
Q

what medication is contraindicated in absence seizures?

A

carbmazepine

54
Q

treatments for essential tremor.

A

Propranolol

55
Q

if standard treatment options have failed which opioid is it most appropriate to consider starting for neuropathic pain?

A

Tramadol has a dual mechanism of action, acting as both a weak opioid agonist and a reuptake inhibitor of serotonin and norepinephrine.

56
Q

What is Cushing reflex

A

The Cushing reflex is a physiological nervous system response to increased intracranial pressure (ICP) that results in hypertension and bradycardia

57
Q

The classical history of vestibular schwannoma

A

The classical history of vestibular schwannoma includes a combination of vertigo, hearing loss, tinnitus and an absent corneal reflex. Features can be predicted by the affected cranial nerves:
cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy

58
Q

post-herpetic neuralgia treatment

A

NICE recommend using amitriptyline, duloxetine, gabapentin or pregabalin first-line.

59
Q

Wilson management

A

Penicillamine

60
Q

which alzheimers drug can cause insomnia?

A

donepezil

61
Q

Which antibiotic lowers the seizure threshold

A

cipro

62
Q

Anti-GQ1b antibodies

A

Miller-Fisher syndrome is a variant of Guillain-Barre syndrome

Ataxia, areflexia and ophthalmoplegia are characteristic

63
Q

Contradinidcations to triptans

A

ischaemic vascular disease

64
Q

Causes of oculogyric crisis

A

antipsychotics
metoclopramide
postencephalitic Parkinson’s disease

65
Q

The first-line treatment for spasticity in MS is

A

either gabapentin or baclofen.

66
Q

Amiloride mecganism

A

selectively blocks the epithelial sodium transport channels in DCT

67
Q

Creutzfeldt-Jakob disease is characterised by

A

rapid onset dementia and myoclonus

68
Q

The MRI finding for Wernicke’s encephalopathy

A

The MRI finding of enhancement of the mamillary bodies due to petechial haemorrhages is specific for Wernicke’s encephalopathy,

69
Q

What is the mechanism of post-LP headaches?

A

Leaking of cerebrospinal fluid from the dura

It is thought that ongoing leak of cerebrospinal fluid (CSF) through the puncture site causes ongoing CSF loss, leading to low pressure.

A post-LP headache is typically frontal or occipital and occurs within three days.

70
Q

where is the medial longitudinal fasciculus located?

A

in the paramedian area of the midbrain and pons

71
Q

Migraine acute vs prophylaxis mx

A

acute: triptan + NSAID or triptan + paracetamol
prophylaxis: topiramate or propranolol

72
Q

vestibular neuronitis vs viral labyrinthitis.

A

vertigo that often develops following a viral infection.

no hearing loss = vestibular neuronitis

hearing loss/ tinnitis = viral labyrinthitis.

73
Q

extorsion (outward rotation) and elevation of the affected eye.

A

4th nerve palsy
superior oblique muscle

74
Q

ptosis (drooping eyelid), a dilated pupil, and an eye that is deviated downwards and outwards

A

3rd nerve palsy
unopposed action of lateral rectus and superior oblique muscles. Third cranial nerve palsy affects multiple extraocular muscles (medial rectus, inferior rectus, superior rectus, and inferior oblique), as well as levator palpebrae superioris which raises the upper eyelid.

75
Q

which palsy would result in an inability to abduct the affected eye properly.

A

6th nerve palsy
lateral rectus muscle, which abducts the eye

76
Q

horizontal diplopia that worsens when looking to the right side.

A

6th nerve palsy
lateral rectus muscle, which abducts the eye

77
Q

what drug can cause functional B12 deficiency?

What confirms this?

A

nitrous oxide

check for a HIGH methylmalonic acid (MMA) level.

78
Q

Parkinsons + ataxic vs shuffling gait

A

ataxic - multiple system atrophy (type Parkinsons vs type Cerebellum)

shuffling - parkinsons

79
Q

distinguishing parkinsons and multiple system atrophy

A

look at the gait

both including parkinsons features, autonomic instability and cerebellar signs

80
Q

which columns are affected in subacute combined degeneration of the spinal cord?

A

the dorsal columns and lateral corticospinal tracts and spinocerebellar tract are affected

81
Q

which type of head injury presents with lucid interval before decline?

A

extradural (epidural) haematoma

82
Q

which anti epileptic causes peripheral neuropathy?

A

phenytoin

83
Q

why when patients start carbamazepine they may see a return of seizures after 3-4 weeks of treatment

A

Carbamazepine is known to exhibit autoinduction, increasing its metabolising

so dose needs to be increased

84
Q

myasthenia gravis.

Which receptor is involved in the pathophysiology?

A

Skeletal muscle contraction is dependent on acetylcholine which activates NICOTINIC acetylcholine receptors

NOT Muscarinic annoyingly

85
Q

what should be given given prior to or with the first dose of antibiotic in bacterial meningitis

A

Intravenous dexamethasone to reduce the risk of neurological sequelae by reducing cerebrospinal inflammation.

If pneumococcal meningitis is suspected or confirmed from clinical features, cerebrospinal fluid parameters or culture results, then dexamethasone should be continued for 4 days.

avoid dexamethasone in septic shock, meningococcal septicaemia, or if immunocompromised, or in meningitis following surgery’

It should be stopped if another causative organism is strongly suspected or confirmed.

86
Q

Mx

Medication overuse headache

A

simple analgesia + triptans: stop abruptly
opioid analgesia: withdraw gradually

87
Q

Dipyridamole MOA

A

Dipyridamole is a non-specific phosphodiesterase inhibitor and decreases cellular uptake of adenosine

88
Q

which migraine drug can precipitate extra pyramidal side effects

A

metoclopramide (dopamine antagonist) to young patients as acute dystonic reactions may develop

89
Q

RAPD finding and causes

A

A relative afferent pupillary defect is when the affected and normal eye appears to dilate when light is shone on the affected eye

causes:
retina: detachment
optic nerve: optic neuritis e.g. multiple sclerosis

90
Q

Drug-induced parkinsonism vs Parkinson’s disease

A

in drug induced parkinsonism:
rigidity and rest tremor are uncommon
motor symptoms are generally rapid onset and bilateral

91
Q

recurrent sense of dejà vu associated with episodes of lip-smacking and postictal dysphasia suggest a seizure in which part of the brain?

A

a temporal lobe seizure.

92
Q

cluster headache triggers

management

A

triggers - alcohol

acute
1. 100% oxygen (80% response rate within 15 minutes)
2. subcutaneous triptan (75% response rate within 15 minutes)

prophylaxis
1. verapamil
2. tapering dose of prednisolone

MRCP Part 1 (21 decks)

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