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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
where is lesion Wernicke’s aphasia, superior homonymous quadrantopia, auditory agnosia, prosopagnosia (difficulty recognising faces)
Temporal
24
WHERE IS LESION Expressive broca’s aphasia, disinhibition, preservation, anosmia, inability to generate list.
frontla lobe
25
Which lobe lesion causes inferior homonymous quadrantanopia vs superior homonymous quadrantopia
Superior = lesion inferior optic radiations in temporal lobe (Meyers loop) Inferior = lesion of superior optic radiations in parietal lobe
26
Bitemporal hemianopia Upper quadrant defect > lower where is compression and likely cause
Upper quadrant defect > lower = inferior chiasm compression, commonly pituitary tumour
27
Bitmeporal hemianopia with lower quadrant defect> upper Where is compression nd likely cause
Lower quadrant defect > upper = superior chiasmal compression, commonly craniopharyngioma
28
Men, smoker, intense stabbing pain around one eye 15mins-2hrs Clusters typically 4-12 weeks Lacrimation, lid swelling, nasal stuffiness. dx and mx
cluster headache MRI with gadolinium contrast Acute - O2/Triptans Proph - verapamil
29
Migraine acute vs prophylaxis treatment
Acute = triptan + NSAID/triptan + paracetamol Proph = Topiramate or propranolol. AMitriptyiline is 2nd line
30
>60, rapid onset unilateral, jaw claudication, tender/palpable temporal artery, raised ESR
temporal arteritis
31
Eye movements (except SO/LR) Down and out eye/ptosis, dilated fixed pupil which CN
oculomotor nerve- SOF
32
Eye movement - SO Defective downward gaze, vertical diplopia which cranial nerve
trochlear - SOF
33
Facial sensation, chewing which CN
Trigemnial - V1 SOF, V2 FR, V3 FO
34
Which CN Eye movement - LR Defective abduction Horizontal diplopia
abducens - SOF
35
Movement of face, taste (ant ⅔) Loss of taste, hyperacusis which CN
Facial - IAM
36
Taste (post ⅓ tongue) Loss of gag reflex which CN
Glosohparyngeal-JF
37
Which cn Phonation, swallowing, viscera Uvula deviates away from site of lesion
vagus - JF
38
Head + shoulder movements which cranial nerve
accessory -JF
39
Tongue movement, tongue deviation towards the site of lesion which cn
Hypoglossa;
40
Progressive, chorea/personality change/ dystonia. Saccadic eye movements
Huntington's - autosomal dominant
41
ix/mx of: Optic neuritis, eye moement abnormalities, focal weakness/ sensory symptoms (Lhermittes sign), ataxia
MRI scans (brain + spine with contrast) + LP (oligoclonal bands) Methyprednisolone
42
UMN + LMN. Male 60s Clumsiness + fatigue Dx, Mx, aTypes
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
triggers myasthenia graves crisis
BBlockers can trigger crisis. Also lithium penicillamine, phenytoin, Abx.,
44
Test and mx myasthenia gravis
Edrophonium test if doubt Reversible AchE inhibitors (pyridostigmine, neostigmine) + immunosuppressants. Monoclonal Abs - rituximab (B cells), Eculexumb (c5) In crisis - Iv igG + plasma exchange
45
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?
Degenerative cervical myelopathy MRI cervical spine Decompressive surgery
46
GCS - motor response
(6) Obeys common (5) localises to pain (4) withdraw from pain (3) abnormal flexion to pain (2) extending to pain (1) none
47
GCS Verbal response
(5) orientated (4) confused (3) words (2) sounds (1) none
48
GCS eye opening response
(4) Spontaneous (3) to speech (2) to pain (1) none
49
Tremor - essential vs Parkinson's
Essential Autosomal D, usually bilateral, worse on intentional movements Parkinsonism Pill rolling, resting
50
Middle meningeal artery. Low impact trauma. Lucid interval
extradural
51
Old/alcohol. Crescent shape
subdural
52
Thunderclap headache in strenuous activity . Ass with cocaine. dx/ix
Subarachnoid Thunderclap headache in strenuous activity . Ass with cocaine. Xanthochromaia (yellow CSF) CT then MRI
53
Fever, headache, psych symptom, focal features Dx/Ix/mx
CSF, Neuroimaging, EEG. IV acyclovir
54
Headache, N&V, reduced consciousness. Rf- COCP, FH VTE dx and mx
MRI venography is gold standard Need anticoag, generally LMWH
55
Young overweight females, headaches, blurred vision, papilloedema. dxmx
Idiopathic Intracranial HTN Need to loose weight, diuretics, topiramate, LP possible, surgery
56
Urinary incontinence, dementia + bradyphrenia, gait abnormality Diagnosis, Ix, mx
Normal pressure hydrocephalus Urinary incontinence, dementia + bradyphrenia, gait abnormality Ventriculomegaly in absence of, or out of proportion to,sulcal enlargement Ventriculoperitoneal shunting
57
Ascending muscle weakness triggered by infection
GBS
58
Headache, fever, neurology, raised intracranial pressure. dx, mx
Brian abscess CT scan, surg + Abx IV (3rd gen cephalosporin metronidazole)
59
SCLC + muscle weakness
Lambert eaton syndrome
60
. 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
Syringomyelia - collection CSF in spinal cord MRI
61
Hyperthermia, muscle rigidity, autonomic instability, altered mental status when taking antipsychotics
Neuroleptic malignant syndrome
62
Vertigo, HL (SN), tinnitus, absent corneal reflex. ix, dx
Acoustic neuromas Vertigo, HL (SN), tinnitus, absent corneal reflex. MRI of cerebellopontine angle
63
Seizure and driving rules
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
Most common seizure in childhood, paraesthesia usually on waking up
Benign Rolandic epilepsy
65
spasms first few months life, hypsarrhythmia on ECG dx
Infantile spasm - west syndrome (need steroid etc)

Difficult Passmed- MLA (26 decks)

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