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Difficult Passmed- MLA > Neurology > Flashcards

Neurology Flashcards

1
Q

How urgent do people with suspected TIAs need reviewing and does it change depending on presentation?

A

Specialist review:
More than 1 TIA or suspected cardioembolic source (might need urgent admission).
If had suspected TIA in last 7d then within 24hrs.
If suspected >7d ago then refer assessment within 7days

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2
Q

secondly prevention of TIA

A

Clopidogrel. Aspirin/dipyridamole is CI

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3
Q

Immediate management of TIA

A

Aspirin 300mg unless contraindicated

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4
Q

When to do a carotid artery endarterectomy in TIA

A

if stroke or TIA in coronary territory and not severely disabled. If carotid stenosis >70% in the side affected (remember if right symptoms, its left side affected)

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5
Q

Mx stroke

A

Exclude hemorrhagic with CT then aspirin 300mg ASAP
Thrombolysis within 4.5 hours (haemorrhagic excluded)
Thrombectomy <6hrs with iV thrombolysis with confirmed proximal anterior circulation
Thrombectomy 6-24hrs if confirmed proximal anterior circulation + potential to salvage brain tissue

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6
Q

Secondary prevention stroke

A

Secondary prevention = Clopidogrel (ischaemia) and if not tolerated then aspirin + Dipyrdamole

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7
Q

Which artery:

Contralateral hemiparesis + sensory loss, Lower>upper extremity

A

Anterior cerebral artery

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8
Q

Which artery:

A

Contralateral hemiparesis + sensory loss, upp>lower extremity. Contralateral homonymous hemianopia, aphasia

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9
Q

Which artery:

Contralateral homonymous hemianopia with macular sparing, visual agnosia

A

Posterior cerebral artery

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10
Q

What stroke by anatomy: / name

Ipsilateral CNIII palsy, contralateral weakness of upper + lower extremity

A

Webers syndrome
(ventral midbrain syndrome)

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10
Q

What stroke by anatomy: / name

Ipsilateral CNIII palsy, contralateral weakness of upper + lower extremity

A

Webers syndrome
(ventral midbrain syndrome)

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11
Q

Which artery:

Ipsilateral facial pain + temp loss, contralateral limb/torso pain + temp loss, ataxia, nystagmus

A

(Lateral medullary syndrome - Wallenbergs)
Posterior inferior cerebellar artery

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12
Q

Which artery/type stroke:

Ipsilateral facial paralysis + deafness, contralateral limb/torso pain + temp loss, ataxia, nystagmus

A

Anterior inferior cerebellar artery

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13
Q

On CT how does An acute ischaemic stroke present

A

Hyperdense artery signs may be seen
Usually visible immediately

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14
Q

All 3 =
(1) Unilateral hemiparesis +/- hemisensory loss,
(2)Homonymous hemianopia
(3) Higher cognitive dysfunction (dysphasia)

What stroke

A

Total anterior circulation infarct (TACI)
Middle + anterior cerebral artery

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15
Q

What stroke

2 of these present
(1) Unilateral hemiparesis +/- hemisensory loss,
(2)Homonymous hemianopia
(3) Higher cognitive dysfunction (dysphasia) :

A

PACI - partial anterior circulation infarct
Similar arteries of ant circulation eg, upp/lower division middle cerebral artery

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16
Q

Presents with ONE of following =
Unilat weakness (and/or sensory deficit) of face + arm, arm + leg or all three
Pure sensory stroke
Ataxic hemiparesis

Type of stroke

A

Lacunar infarct

Perforating arteries around internal capsule, thalamus and basal ganglia. Stronglya ss with HTN

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17
Q

Presents with ONE of following:
Cerebellar or brainstem syndromes
Loss of consciousness
Isolated homonymous hemianopia

what stroke

A

Posterior ciruclaiton infarct
Vertebrobasilar arteries

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17
Q

Presents with ONE of following:
Cerebellar or brainstem syndromes
Loss of consciousness
Isolated homonymous hemianopia

what stroke

A

Posterior ciruclaiton infarct
Vertebrobasilar arteries

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18
Q

SUperior temporal gyrus lesion. Sentences don’t make sense (word salad), but speech is fluent. COmprehension is imapired

A

Wernicke’s (Relative) aphasia

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19
Q

Inferior frontal gyrus. Non fluent speech, repetition impaired, comprehension is normal

A

Brocas (expressive) aphasia

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20
Q

Stroke affecting arcuate fasciculus - speech fluent, repetition poor, aware of errors making. COmprehension normal

A

conduction aphasia

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21
Q

where is the lesion

Sensory inattention, apraxia, asterognosis, inferior homonymous quadrantanopia, Gerstmann’s syndrome

A

Parietal lobe

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22
Q

Where is the lesion:

Homonymous hemianopia (macular sparing), cortical blindness, visual agnosia

A

occipital lobe

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23
Q

where is lesion

Wernicke’s aphasia, superior homonymous quadrantopia, auditory agnosia, prosopagnosia (difficulty recognising faces)

A

Temporal

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24
Q

WHERE IS LESION

Expressive broca’s aphasia, disinhibition, preservation, anosmia, inability to generate list.

A

frontla lobe

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25
Q

Which lobe lesion causes inferior homonymous quadrantanopia vs superior homonymous quadrantopia

A

Superior = lesion inferior optic radiations in temporal lobe (Meyers loop)
Inferior = lesion of superior optic radiations in parietal lobe

26
Q

Bitemporal hemianopia

Upper quadrant defect > lower

where is compression and likely cause

A

Upper quadrant defect > lower = inferior chiasm compression, commonly pituitary tumour

27
Q

Bitmeporal hemianopia with lower quadrant defect> upper

Where is compression nd likely cause

A

Lower quadrant defect > upper = superior chiasmal compression, commonly craniopharyngioma

28
Q

Men, smoker, intense stabbing pain around one eye 15mins-2hrs
Clusters typically 4-12 weeks
Lacrimation, lid swelling, nasal stuffiness.

dx and mx

A

cluster headache
MRI with gadolinium contrast
Acute - O2/Triptans
Proph - verapamil

29
Q

Migraine acute vs prophylaxis treatment

A

Acute = triptan + NSAID/triptan + paracetamol
Proph = Topiramate or propranolol. AMitriptyiline is 2nd line

30
Q

> 60, rapid onset unilateral, jaw claudication, tender/palpable temporal artery, raised ESR

A

temporal arteritis

31
Q

Eye movements (except SO/LR)
Down and out eye/ptosis, dilated fixed pupil

which CN

A

oculomotor nerve- SOF

32
Q

Eye movement - SO
Defective downward gaze, vertical diplopia

which cranial nerve

A

trochlear - SOF

33
Q

Facial sensation, chewing

which CN

A

Trigemnial - V1 SOF, V2 FR, V3 FO

34
Q

Which CN

Eye movement - LR
Defective abduction
Horizontal diplopia

A

abducens - SOF

35
Q

Movement of face, taste (ant ⅔)
Loss of taste, hyperacusis

which CN

A

Facial - IAM

36
Q

Taste (post ⅓ tongue)
Loss of gag reflex

which CN

A

Glosohparyngeal-JF

37
Q

Which cn
Phonation, swallowing, viscera
Uvula deviates away from site of lesion

A

vagus - JF

38
Q

Head + shoulder movements

which cranial nerve

A

accessory -JF

39
Q

Tongue movement, tongue deviation towards the site of lesion

which cn

A

Hypoglossa;

40
Q

Progressive, chorea/personality change/ dystonia. Saccadic eye movements

A

Huntington’s - autosomal dominant

41
Q

ix/mx of:

Optic neuritis, eye moement abnormalities, focal weakness/ sensory symptoms (Lhermittes sign), ataxia

A

MRI scans (brain + spine with contrast) + LP (oligoclonal bands)
Methyprednisolone

42
Q

UMN + LMN. Male 60s
Clumsiness + fatigue

Dx, Mx, aTypes

A

MND

Amyotrophic lateral sclerosis (most common type) - LMN arms, UMN legs.
Primary lateral sclerosis - UM only
Progressive muscular atrophy - LMN only
Progressive bulbar palsy - palsy of tingue, chewing/swallowing muscles, facial muscles etc. Worst progrnosis

Riluzide might help slow
NIV

43
Q

triggers myasthenia graves crisis

A

BBlockers can trigger crisis. Also lithium penicillamine, phenytoin, Abx.,

44
Q

Test and mx myasthenia gravis

A

Edrophonium test if doubt
Reversible AchE inhibitors (pyridostigmine, neostigmine) + immunosuppressants.
Monoclonal Abs - rituximab (B cells), Eculexumb (c5)

In crisis - Iv igG + plasma exchange

45
Q

Hoffmans sign positive: gently flick one finger on their hand. Positive is reflex stitching o other fingers on same hand in response to flick.

Dx?

A

Degenerative cervical myelopathy
MRI cervical spine
Decompressive surgery

46
Q

GCS - motor response

A

(6) Obeys common (5) localises to pain (4) withdraw from pain (3) abnormal flexion to pain (2) extending to pain (1) none

47
Q

GCS Verbal response

A

(5) orientated (4) confused (3) words (2) sounds (1) none

48
Q

GCS eye opening response

A

(4) Spontaneous (3) to speech (2) to pain (1) none

49
Q

Tremor - essential vs Parkinson’s

A

Essential
Autosomal D, usually bilateral, worse on intentional movements

Parkinsonism
Pill rolling, resting

50
Q

Middle meningeal artery. Low impact trauma. Lucid interval

A

extradural

51
Q

Old/alcohol. Crescent shape

A

subdural

52
Q

Thunderclap headache in strenuous activity . Ass with cocaine.

dx/ix

A

Subarachnoid
Thunderclap headache in strenuous activity . Ass with cocaine.
Xanthochromaia (yellow CSF)
CT then MRI

53
Q

Fever, headache, psych symptom, focal features

Dx/Ix/mx

A

CSF, Neuroimaging, EEG. IV acyclovir

54
Q

Headache, N&V, reduced consciousness.
Rf- COCP, FH VTE

dx and mx

A

MRI venography is gold standard
Need anticoag, generally LMWH

55
Q

Young overweight females, headaches, blurred vision, papilloedema.

dxmx

A

Idiopathic Intracranial HTN
Need to loose weight, diuretics, topiramate, LP possible, surgery

56
Q

Urinary incontinence, dementia + bradyphrenia, gait abnormality

Diagnosis, Ix, mx

A

Normal pressure hydrocephalus
Urinary incontinence, dementia + bradyphrenia, gait abnormality
Ventriculomegaly in absence of, or out of proportion to,sulcal enlargement
Ventriculoperitoneal shunting

57
Q

Ascending muscle weakness triggered by infection

A

GBS

58
Q

Headache, fever, neurology, raised intracranial pressure.

dx, mx

A

Brian abscess

CT scan, surg + Abx IV (3rd gen cephalosporin metronidazole)

59
Q

SCLC + muscle weakness

A

Lambert eaton syndrome

60
Q

. Cape like loss sensation to temp but preserve light touch. Proprioception/vibration ( burn hands without realising) etc. Pain, spastic weakness, autonomic, horner’s syndrome.

Dx, ix

A

Syringomyelia - collection CSF in spinal cord
MRI

61
Q

Hyperthermia, muscle rigidity, autonomic instability, altered mental status when taking antipsychotics

A

Neuroleptic malignant syndrome

62
Q

Vertigo, HL (SN), tinnitus, absent corneal reflex.

ix, dx

A

Acoustic neuromas
Vertigo, HL (SN), tinnitus, absent corneal reflex.
MRI of cerebellopontine angle

63
Q

Seizure and driving rules

A

Isolated seizure = 6M
If epilepsy, or unprovoked 12m seizure free.
If after meds withdrawal = at least 6m after last dose
Single episode of syncope, explained, treated = 4 weeks of
Single unexplained = 6m off
2 episodes = 12m off
Stroke/TIA 1m, multiple TIAS 3m

64
Q

Most common seizure in childhood, paraesthesia usually on waking up

A

Benign Rolandic epilepsy

65
Q

spasms first few months life, hypsarrhythmia on ECG

dx

A

Infantile spasm - west syndrome
(need steroid etc)

Difficult Passmed- MLA (26 decks)

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