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Phase 3A (HV) > Neurology > Flashcards

Neurology Flashcards

1
Q

What triad of symptoms is associated with normal pressure hydrocephalus?

A

Urinary incontinence
Dementia
Gait abnormality

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2
Q

What is the result of a third nerve palsy?

A

Down and out eye
Diplopia
Ptosis
Fixed dilated pupil

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3
Q

What is the result of a fourth nerve palsy?

A

Defective downward gaze —>vertical diplopia

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4
Q

What is the result of a sixth nerve palsy?

A

Defective abduction—> horizontal diplopia

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5
Q

What is the management of neuropathic pain?

A

Monotheraphy with Amitryptiline, pregabalin, gabapentin, or duloxetine

If doesn’t work then switch medication

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6
Q

Triad for wernickes encephalopathy?

A

Gait ataxia
Ophthalmoplegia/Nystagmus
Confusion

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7
Q

What is the result of a common peroneal nerve palsy?

A

Weakness of foot Doris flexion and foot eversion

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8
Q

What marker can be used to differentiate a seizure form a pseudo seizure?

A

Prolactin

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9
Q

What is the mainstay treatment for a TIA?

A

Aspirin 300mg for 2 weeks followed by long term use of clopidogrel 75mg

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10
Q

What is the acute management of a cluster headache?

A

High flow oxygen + SC/intra nasal triptan

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11
Q

Prophylaxis mix of cluster headache?

A

Verapamil

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12
Q

What is the management of an acute relapse of ms?

A

High dose steroids

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13
Q

What medication/s reduce risk of relapse in MS

A

Natalizumab
Fingolimod
Beta interferon

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14
Q

What is the medical management of myasthenia gravis

A

Acetylycholinesterase inhibitors- Pyradistigmine

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15
Q

What is the 1st line Ix for MG?

A

Acetylcholine receptor antibodies

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16
Q

What is syringomeylia?

A

Collection of CSF in spinal cord

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17
Q

What are the key features of syringomyelia/

A

Cape like distribution
— loss of sensation to temperature but preservation of light touch, proprioception and vibration
—classic- burn hands and don’t notice
Upgoing plantars
Autonomic features e.g. horners
Spastic weakness (predominantly Lower limbs)

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18
Q

What does syringomyelia have a strong association with?

A

Chiari malformations

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19
Q

What is the ix and management for syringomyelia?

A

Ix- full spine and brain MRI

Ms- dependent on cause - possibly a shunt

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20
Q

What is a fixed dilated pupil and indication of?

A

Cn 3

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21
Q

What would be the result of Neuro imaging in NPH?

A

Ventriculomegaly w/o sulcal enlargement

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22
Q

What is the inheritance pattern of neurofibromatosis?

A

Autosomal dominance

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23
Q

What chr is affected in NF1 and list 3 features?

A

Chr 17

> =6, 15mm cafe au lair spots
Axillary/groin freckles
Iris hamatomas
Scoliosis
Phaechromocytoma

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24
Q

What chr is affected in NF2 and list prominent feature?

A

Chr 22

Bilateral vestibular schwannomas

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25
Q

List 3 Sx of. An acoustic neuroma?

A

Unilateral hearing loss
Reduced facial sensation
Balance problems

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26
Q

What is the 1st line and GS Ix for acoustic neuromas? Also what sign will be present on GS to be diagnostic?

A

1st line- Audio gram

GS- gondolinium enhanced MRI scan- will show ‘absence of dural tail’

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27
Q

What is the Rx for prophylaxis of migraines?

A

Propranolol
Topiramate- avoid in girls of bearing age
Amitryptiline

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28
Q

What nerve is affected in a mid shaft humeus fracture and what happens?

A

Radial nerve –> Wrist drop

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29
Q

What is the mode of inheritance of charcot marie tooth syndrome?

A

autosomal dominant

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30
Q

What nerve is affected in amurosis fugax?

A

retinal/opthalmic artery (branch of ICA)

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31
Q

What is the key diagnostic test in GBS and what does it show?

A

Lumbar puncture (raised protein, with normal wcc)

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32
Q

How long can a person who suffered from their first unprovoked/isolated seizure with no evidence in imaging/EEG not drive for?

A

6 months

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33
Q

What is the associated effects of an anterior cerebral artery infarct?

A

Contralateral hemiparesis
sesnoryt loss lower extremity > upper

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34
Q

What are the associated effects of a middle cerebral artery infarct?

A

Contralateral hemiparesis
sensory loss greater in upper extremity
contralateral homonymous heminanopia
aphasia

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35
Q

What are the associated effects of a posterior cerebral artery infarct?

A

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

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36
Q

What is werbers syndrome?

A

Weber’s syndrome is a form of midbrain stroke (posterior cerebral artery) characterised by the an ipsilateral CN III palsy and contralateral hemiparesis

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37
Q

Wha are the characteristics of Progressive supranuclear palsy (PSP)?

A

postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction

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38
Q

What is the tx of choice for an essential tremor?

A

Propranolol

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39
Q

What are sx and features of an acoustic neuroma?

A

vertigo
sensorineural hearing loss
unilateral tinnitus
absent corneal reflex
facial palsy

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40
Q

What classification can be used for an acute ischaemic stroke?

A

The Oxford stroke (Bamford) classification.

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41
Q

What medication should you give to someone within 4.5 hours of having an ischaemic stroke?

A

Thrombolysis - Alteplase (IV).

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42
Q

What are the contraindications for alteplase?

A

Haemorrhage.
Suspected SAH.
Active bleeding.
Recent GI infection or UTI.
Recent surgery.
Malignancy.

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43
Q

List the signs of a ACA infarct?

A

LL weakness and loss of sensation
Gait apraxia
Incontinence
Drowsiness
Decrease in spintaneous speech

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44
Q

List the signs of a MCA infarct?

A

UL and LL weakness
Contralteral homonymous hemianopia
Aphasia
Dysphasia
Facial droop

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45
Q

List the signs of PCA infarct?

A

Speech impairment + dysphagaia
Cerebellar dysfunction
Visual disturbances (contralateral homonymous hemianopia with macular sparing)
visual agnosia
prospagnosia

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46
Q

What are the signs of Werber’s syndrome and what artery is affected?

A

Branches of posterior cerebral artery that supply midbrian

Ipsilaterla CN3 Palsy
contralkaterla weakness of UL and LL

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47
Q

What is the signs of Wallenberg syndrome/lateral medulalry syndrome and what aretry is affected?

A

Posterior inferior cerebellar artery

ipsialteral facial pain and temp loss
Contralateral limb/torso pain and temp loss
Ataxia, Nystagmus

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48
Q

Give 4 signs of UMN weakness.

A

Increased muscle tone.
Hyperreflexia.
Spasticity.
Minimal muscle atrophy.

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49
Q

Give 5 signs of LMN weakness.

A

Decreased muscle tone.
Hyporeflexia.
Flaccid.
Muscle atrophy.
Fasciculations.

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50
Q

Give 3 signs of Myasthenia Gravis.

A

Generalised fatiguability:

Proximal limbs.
Neck/face - head drop, ptosis.
Extra-occular - diplopia.
Speech and swallowing problems.
Risk of other auto-immune disorders.

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51
Q

Peripheral Neuropathy: describe mononeuritis multiplex.

A

A patchy process where individual nerves are picked off randomly. Often it has an inflammatory or immune mediated cause. Chronic, slow progression.

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52
Q

What are the 3 main components of the Glasgow Coma scale?

A

Best motor response.
Best vocal response.
Best eye-opening response.

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53
Q

What spinal tract is responsible for motor response?

A

Corticospianl tract

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54
Q

What signals does the spinothalamic tract carry?

A

Anterior- Crude touch, light touch, vibration.
Lateral- pain, temperature,

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55
Q

Give 2 population groups who may be at increased risk of a subdural haematoma.

A

Elderly and alcoholics - due to cerebral atrophy.

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56
Q

Give 3 symptoms of a subarachnoid haemorrhage.

A

‘Thunderclap’, maximum severity headache within seconds.
Photophobia.
Neck stiffness.
Nausea and vomiting.

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57
Q

What investigations might you do in someone who you suspect has a subarachnoid haemorrhage?

A

CT head (star shaped).
Cerebral angiography.
Lumbar puncture - xanthochromia.

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58
Q

How do you manage and treat a patient who has had a subarachnoid haemorrhage?

A

Nimodipine (CCB).
Early intervention, support and close monitoring is essential.

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59
Q

Give 3 symptoms of Cauda Equina syndrome.

A

Bilateral sciatica - pain radiates down leg to foot.
Saddle anaesthesia.
Bladder/bowel dysfunction.
Erectile dysfunction.
Leg weakness.

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60
Q

Define frailty.

A

A state of increased vulnerability resulting from an ageing associated decline in reserve and function across multiple physiologic systems; the ability to cope with everyday stressors is therefore compromised.

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61
Q

What is relative afferent pupillary defect (RAPD)?

A

It is observed during the swinging light test. The patient’s pupils dilate when the light is swung from the unaffected to the affected eye. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced.

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62
Q

What is another name for RAPD?

A

Marcus Gunn pupil.

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63
Q

In what conditions might you see RAPD?

A

MS.
Glaucoma.
Severe retinal disease.
Optic nerve lesion.

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64
Q

List 5 RF for stroke?

A

Smoking
Alcohol
HTN
Hyperlipidaemia
obeisty
DM
AF

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65
Q

What is syncope?

A

A transient loss of conciousness, loss of postural tone

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66
Q

List 5 differentials for blackouts?

A

Vasovagal syncope
cardiac syncope
migraine w/ aura
Hypoglycaemia
TIAs
non-epileptic seizures
Intermittent hydrocephalus

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67
Q

What ix couold be done for blackouts

A

12 lead ECG
Brain imaging
EEG
Video telemtery
Tilt Table Test

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68
Q

List 3 features of Multi System Atrophy?

A

parkinsonism
autonomic disturbance
- erectile dysfunction: often an early feature
- postural hypotension
- atonic bladder
cerebellar signs

classical history of poor response to levodopa, impotence, urinary retention and age group.

69
Q

List features of PSP?

A

impaired balance and therefore being prone to many falls.
vertical gaze palsy.
symmetrical onset and is poorly responsive to levodopa

70
Q

what should be suspected with a Painful third nerve palsy

A

Posterior communictaion artery aneurysm

71
Q

What diagnosis should be suspected in a Obese, young female with headaches / blurred vision

A

Idiopathic intracranial hypertension

72
Q

which of the muscles are typically spared in MND

A

Ocular muscles

73
Q

What is Brown-Sequard syndrome a result of and list the main feature

A

BSS is a result of lateral hemisection of the spinal cord

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

74
Q

What is the GS ix for suspected stroke?

A

Non contrast CT head

75
Q

List 5 triggers for a migraine?

A

Chocolate
Hangovers
Orgasms
Cheese
Oral contraceptives
Lie ins
Alcohol
Tumult
Exercise

76
Q

List the triad associated with Horners syndrome

A

Ptosis, Miosis and Anhidrosis

77
Q

What is GCA and list 3 fetaures?

A

GCA is agrnaulamatous vasuclitis of medium sized arteries

Temporal headaches
Jaw claudication
Sclap tenderness
Amurosis fugax
Aching and stiffness

78
Q

What is the firts line and GS Ix of GCA?

A

1st line- Infammmatory markers- Raised ESR

GS- Temporal artery biopsy- granulamatous inflammation

79
Q

What is the 1st line medication for focal seizures

A

Lamotrigine or Leviteracetam

80
Q

What is Charcots Neurological triad and list the 3 features?

A

Charcot’s neurological triad refers to a set of three classic clinical features associated with the progression of multiple sclerosis (MS)
1) Nystagmus
2) Dysarthria
3) Intention tremor

81
Q

What is MS?

A

A chronic cell mediated autoimmune disorder charcterised by demyelination of the CNS (a type 4 hsr)

82
Q

What cells are reponsible for myelination in
a) CNS
B) PNS

A

A) Oligodendrocytes
B) Schwann cells

83
Q

What criteria is used to make a diagnosis of MS

A

McDonalds criteria

84
Q

List 2 signs/phenemenoms found in MS?

A

Lhermittes phenemenom- Parsatehesia in limbs following neck flexion

Uhertoffs phenemenom- Increase in temp causes worsening of sx

85
Q

List 2 findings in someone with MS

A

White matter plaques disseminaated in space and time
CSF- oligoclonal bands

86
Q

What type of lesion if bells palsy

A

LMN lesion

87
Q

list the clincial features in Parkinson’s disease

A

Bradykinesia
Pill rolling resting tremor
Postural insatbility
Rigidity

88
Q

What is Parkinson’s disease?

A

A neurodegenerative disorder characterised by the loss of dopiminergic neurons in the substantia nigra

89
Q

Give 2 histopathological signs of Parkinson’s disease.

A

Lewy bodies.
Loss of dopaminergic neurones in the substantia nigra.

90
Q

What class of medications are used to treat PD?

A

Levodopa
Dopmaine agonist e.g. Bromocriptine, ropinerole, Cabergoline
MAO-B Inhibitors- seleglline
COMT inhibitors- entacapone

91
Q

What lobe of the brain is affected in Alzheimer’s disease?

A

Temporal lobe

92
Q

Give histopathological signs of Alzheimer’s disease

A

Excess intraneuronal Amyloid plaques
Aggregates of TAU proteins– neurofibliray tangles

93
Q

What medication can be used to manage the sx of alzheimers dementia

A

Acetylcholinesterase inhibitors e.g Rivastigmine or memnatine

94
Q

Frontotemporal dementia is characterised by what?

A

Pick bodies

95
Q

What is the tx for GBS?

A

IVIG 5 days and plasma exchange

96
Q

What is MG?

A

(T2 Hypersensitivity reaction)
Automimmune disorder resulting in insufficient functioning acetylcholine receptors

97
Q

What antibodies are associated with MG?

A

Acetylchloline receptor antibodies
MUSK antibodies

98
Q

What is the mx of a myasthenic crisis?

A

Plasmapharesis and IVIG

99
Q

What other conditions is LEMS asscoaited with?

A

Small cell lung cancer **
breast and ovarian cancer to a lesser extent

100
Q

What is LEMS?

A

Lambert-Eaton myasthenic syndrome is caused by an antibody directed against presynaptic voltage-gated calcium channel in the peripheral nervous system.

101
Q

What antibody is associated with LEMS

A

Anti P/Q voltage gated calcium channel

102
Q

What si the mx of LEMS?

A
  • treat underlyimg cancer if indicated
    -sx management- AMIFAMPRIDINE
103
Q

What are the subtypes of MND and list their key sx?

A

1) Amyotrophic Lateral Sclerosis
UMN and LMN affected
Babinski +ve, Fasiculations on tongue, Dysphagia, Dysarthria

2) Progressive Bulbar plasy
(Bulbar)-> Medulla so CN 9,10,11,12 affected
Carries the WORST PROGNOSIS

3) Progressive Muscle atrophy

4) Primar lateral Sclerosis

104
Q

What is the 1st line tx for MND?

A

Riluzole

105
Q

List the RF for carpal tunnel syndrome and what nerve is repsonsible?

A

OPRAH
Obesity
Pregnancy
RA
Acromegaly
Hypothyroidism

Median nerve

106
Q

What is the mx of carpal tunnel?

A

moderate
1st line- wrist splint
2nd line- corticosteroid injection

severe
1st line- surgical release

107
Q

What is the GS ix for carpal tunnel?

A

EMG

108
Q

List the causes of Cauda equina syndrome

A

Lumbar disc hernaition (L4/5 AND L5/S1)- Most common cause
Neoplasm
Abscess
Iatrogenic causes

109
Q

List 5 sx of Cauda equina?

A

Back pain
Saddle anaesthesia
Loss of senstaion in bladder and rectum
Bilateral sciatica
Bilateral LMN weakness
Sexual dysfunction
Reduced anal tone on PR exam
Absent ankle reflex

110
Q

GS ix of cauda equina

A

urgent MRI of spine

111
Q

WHat is the mx of cauda equina syndrome

A

Surgical decompression ideally witthin 48 hours
if malignancy- give dexamethasone

112
Q

What tracts are repsonsible for
a) Temp and pain
b) crude touch
c) sensory info of lower limbs
d) Sensory info of upper limbs

A

a) Lateral spinothalamic tract
b) Anterior spinothalamic tract
c) DCML- Fasiculus Gracillis (Medial)
d) DCML- Fasiculus Cuneatus (Lateral)

113
Q

What is Subacute combined degenertaion of the spinal cord

A

A neurological complication associated with vit b12 deficiency

114
Q

List the causes of vit b12 deficiency that can cause SCDC

A

prenicious anemia
malabsorbtion syndromes
Dietary deficiencies
Misuse of nitrous oxide (functional rather than true)

115
Q

list the importance of vit b12 and how a deficiency of b12 may lead to sx of SCDC?

A
  • B12 is essential to the syntheisis of myelin therefore in b12 deificiency the synthesis is compromised and leading to demyelination of nerve fibres
  • in the absence of b12, the metabolism of certain amino acids and fatty acids is disrupted thus leading to an acucmulation of HOMOCYSTEINE and METHYLYMALONIC ACID –> toxic metabolites lead to neuro sx of SCDC
116
Q

What ix can be done for a diagnosis of SCDC?

A

Folate and B12 levels
Homocysteine levels- rasied level despite normal B12 levels may indicated functional deficiency
MRI of spine to exclude cervical myelopahy
EMG

117
Q

What is the managemnt of a brain abscess

A

surgery- abscess cavity is debrided
Abx- 3rd gen cephalosporin + metronidazole
Intracranial pressure mx- dexamethasone

118
Q

What may be seen on imaging for brain abscess?

A

Ring enhancing lesion on CT

119
Q

When should a refferal for Bells Palsy be made to ENT?

A

If no signs of improvement in 3 weeks

120
Q

List sx of idiopathic intracranial htn

A

Blurred vision
Headaches
Papillooedema
Enlarged blind spots
may ahve 6th nerve palsy

121
Q

What is the tx for trigeminal neuralgia?

A

1st line- Carbamazepine
other include- Phenytoin Lamotrigine, Gabapentin

122
Q

What is pituitary apoplexy?

A

Sudden enlargement of a pituitary tumour (usually non-functioning macroadenoma) secondary to haemorrhage or infarction.

123
Q

What is the ix and mx of choice for pituitary apoplexy?

A

ix- MRI is diagnostic

mx- urgent steroid replacement due to loss of ACTH
surgery

124
Q

What is wernickes aphasia and what lobe is compromised?

A

receptive aphasia- speech fluent, comprehension abnormal, repetition impaired

Temporal lobe

125
Q

What is Brocas aphasia and what lope in compromised?

A

Expressive aphasia- difficulty speaking fluently, and their speech may be limited to a few words at a time. Speech is halting or effortful.

126
Q

What is the most common complication of meningitis?

A

Sensorineural Hearing loss

127
Q

What are the signs of pontine haemorrhage?

A

Low GCS
Paralysis
Bilateral pinpoint pupils

128
Q

What class of medication should be avoided in myasthenia gravis

A

Beta blockers

129
Q

Where do secondary brain tumours arise from?

A

Lung
Colorectal
Melanoma
Breast
Kidney

130
Q

If clopidogrel is CI in the secondary managemnt of an ischaemic stroke what is the mx?

A

Aspirin 75mg + Dipyramidole

131
Q

What is the mx of cervical myelopathy?

A

Surgery

132
Q

If brain imaging is required in a TIA, what is the bets modality to use?

A

MRI Brain w/ diffuse weighted imaging

133
Q

List 3 sx of Bells Plasy

A

Facial nerve palsy –> FOREHEAD AFFECTED
Hyperacuisis
Aletred taste
Dry eyes
Post-auricular pain (may precede paralysis)

134
Q

What is the management of Bells Palsy

A

Oral prednisalone + eyecare

135
Q

What is the inheritance pattern of Friedreich’s ataxia

A

Autosomal recessive- trinucleotide repeat of GAA

136
Q

From which cancers do secondary brain tumours arise from

A

Lung
Breast
Kidney
Melanoma
Colorectal

137
Q

What medication can be used to treat Idiopathic Intracranial Hypertension (IIH)

A

Acetazolamide- a carbonic anhydrase inhibitor

138
Q

What is the most common complication following meningitis infection

A

Sensorineural hearing loss

139
Q

List 3 CI for a lumbar puncture?

A

Coagulopathy/bleeding disoreder
Signs of raised ICP
Sings of brain hernaition
Skin infection of puncture site
Focal neurology

140
Q

What is the mos common caustive agent of encephalitis?

A

HSV1

141
Q

List the rf for alzheimers

A

Downs syndrome
Lonliness
Depression

142
Q

What is the ABCD2 score and list the contents?

A

Stratifes the risk ofstroke following a TIA
Age >60
BP- >140/90
Clinical features-
- unilateral wekaness- 2
- Speech, no wekaness- 1
Duration
->60 mins- 2
-10-59 mins- 1
Diabetes- 1

143
Q

List 3 factors that favour pseduseizures compared to true epileptic seizures?

A

Gradual onset
Doesnt occur when alone
Pelvic thrusting
More common in females
Crying after seizures
Family member with epeilepsy

144
Q

List 5 RF of isachaemic stroke

A

Smoking
HTN
Obesity
Diabetes
Afib
hypercholestraemia

Male, Age

145
Q

What is the difference between strokes and epileptical events?

A

Strokes present with negative sx and obey the vascular territory whereas epileptic events present with positive sx and do not obey vascualr territory

146
Q

What ix can be done post acutely following an ischaemic stroke?

A

Carotid USS
Echocardiogram
CT/MRI angiogrpahy

147
Q

What is the chronic mx of a ischaemic stroke?

A

HALTSS
HTN
Antiplatelet- clopidogrel 75mg
Lipid lowering theraphy
Tobacco cessation
Sugar- get diabets under control
Surgery- carotid endarectomy if stenosis >70% (can be 50%- varies according to orgs)

148
Q

What is the main risk associated with thrombolysis

A

bleeding

149
Q

List 4 causes of painelss monocular vision loss

A

Amurosis fugax
retinal dettachemnt
vitreous haemorrhage
Anterior ischaemic optic neuritis

150
Q

List 2 complications of epilepsy?

A

Status epilepticus
depression
suicide
Sudden unexpected death in Epilepsy (SUDEP)

151
Q

WHat is the GS Ix for carotid sinus thrombosis?

A

MR venogram

152
Q

List 3 triggers of epilepsy?

A

Poor sleep
drugs and alcohol
stroke
Intracranial haemorrhage

153
Q

List 2 differential sof essential tremors

A

Parkinsons
Hyperthyroidism
Drug induced tremor

154
Q

What is the rules of driving following a TIA

A

do not drive for a month- no need to inform DVLA

155
Q

What is the MOA of triptans and list its CI for usage?

A

5HT Agonist

CI- In ischaemic heart disease and cerebrovascular disease

156
Q

What are the side effects associated with triptans?

A

Flushing, Tingling, Chest and throat tightness (may mimic angina)

157
Q

What is Brudzinkis sign?

A

passive neck flexion elicits hip and knee flexion

158
Q

What is kernigs sign?

A

Knee and hip flexed at 90. Extension of the knee is painful or limited in extension.

159
Q

Definition of seizures?

A

Transient occurunces of symptoms due to abnormal excessive neuronal activiy in the brain

160
Q

What is the definition of epilepsy?

A

Neurological disorder characterised by the recurrence of seizures

161
Q

What is cushings triad for raised ICP?

A

HTN/wide pulse pressure
Bradycardia
Irregular breathing

162
Q

List the 3 tracts that are affected in SCDC?

A
  1. Dorsal Columns- distal tingling/numbness. Impaired propioception and vibration
  2. Lateral corticospinal tracts- Muscle weakness, hypereflexia, UMN sigsn
  3. Spinocerebellar tract- ataxia and romberg +ve
163
Q

‘hot potato’ speech is indicative of what?

A

Pseudobulbar palsy

164
Q

List sx of anterior inferior cerebellar artery leison?

A

SImilar to wallenburh but ipsilateral facial paralysis and deafness

165
Q

List the sx of thoracic outlet syndrome?

A

Painless muscle wasting of hand–> weakness in grasping
Numbness and tingling
Cold hands
Swelling

166
Q

In cn 3 palsy, what isn the sataus of the light and consensual reflex?

A

Absent light reflex
Intact consensual reflex

167
Q

What EEG findings are present in infantile spasms?

A

Hypsarrythmia - Poor prognosis

Infantile spasms/west syndrome- characterised by salam attacks

168
Q

What EEG findings are concurrent with Benign rolandic epilepsy?

A

Centerotemporal spikes

Phase 3A (HV) (10 decks)

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