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Year 4 > Neurology > Flashcards

Neurology Flashcards

1
Q

What is syncope?

A

= term used to describe the event of temporarily losing consciousness due to a disruption of blood flow to the brain, often leading to a fall

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2
Q

What a prodrome?

A

= early signs or symptoms of an illness or health problem that appear before the major signs of symptoms start

(e.g., how a patient feels prior to fainting)

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3
Q

Primary vs secondary syncope

A

Primary syncope: no apparent cause, aka simple fainting

Secondary syncope: underlying cause, not including vasovagal syncope

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4
Q

Microscopic features associated with Alzheimer’s disease (2)

(the brain)

A
  • beta-amyloid plaques
  • intraneuronal neurofibrillary tangles
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5
Q

Macroscopic features associated with Alzheimer’s disease

+ particularly which areas of the brain affected?

A

= widespread cerebral atrophy

Particularly cortex + hippocampus

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6
Q

What is nominal dysphasia?

A

= inability to recall names of people or objects that are correctly perceived

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7
Q

Donepezil, Galantamine + Rivastigmine are all types of?

What are they used to manage?

A

= acetylcholinesterase inhibitors

Used for managing mild to moderate Alzheimer’s disease

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8
Q

First-line pharmacological treatment for Alzheimer’s disease

A

= acetylcholinesterase (AChE) inhibitors

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9
Q

Second-line pharmacological treatment in Alzheimer’s?

A

= Memantine

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10
Q

First-line sedative used in delirium?

A

= Haloperidol

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11
Q

Most common type of dementia?

A

= Alzheimer’s disease

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12
Q

Contraindications in Parkinson’s disease (2)

A
  • typical antipsychotics
  • anti-dopaminergic antiemetic e.g., Metoclopramide + Domperidone
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13
Q

What is the 2nd most common form of dementia?

A

= vascular dementia

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14
Q

What is vascular dementia?

A

= group of syndromes of cognitive impairment caused by different mechanisms causing ischaemia, or haemorrhage secondary to cardiovascular disease

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15
Q

What is CADASIL?

A

= rare, inherited type of vascular disease (a disease of the blood vessels such as arteries and veins) that can cause dementia

(cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)

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16
Q

3 subtypes of vascular dementia

A
  • stroke-related VD (multi/single-infarct dementia)
  • subcortical VD (caused by small vessel disease)
  • mixed dementia (presence of both VD + Alzheimer’s disease)
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17
Q

Which type of dementia is associated with a stepwise deterioration?

A

= vascular dementia

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18
Q

What is NINDS-AIREN criteria used for?

A

= diagnostic criteria for vascular dementia

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19
Q

Management for vascular dementia?

A
  • mainly symptomatic treatment
  • detect + address CV risk
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20
Q

When may AChE inhibitors, or Memantine be used for treatment of vascular dementia? (3)

A

If they have suspected co-morbid:
- Alzheimer’s disease
- Parkinson’s disease
- Lewy body dementia

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21
Q

What are alpha-synuclein cytoplasmic inclusions also known as, and what are they associated with?

A

= Lewy bodies

Associated with Lewy body dementia

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22
Q

True or false: early impairments in attention and executive function can be seen in those with Lewy body dementia rather than just memory loss (as seen in Alzheimer’s)

A

= true

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23
Q

What is used to diagnose Lewy body dementia?

A

= SPECT (single-photon emission computed tomography)

I‑FP‑CIT SPECT

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24
Q

Which type of dementia is associated with visual hallucinations?

A

= Lewy body dementia

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25
Q

Clinical features associated with Lewy body dementia? (3)

A
  • progressive cognitive impairment
  • Parkinsonism
  • visual hallucinations (other features such as delusions + non-visual hallucinations may also be seen)
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26
Q

What should be avoided in patients with Lewy body dementia?

A

= neuroleptics (anti-psychotics)

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27
Q

What is Parkinson’d disease?

A

= a condition where there is a progressive reduction of dopamine in the basal ganglia of the brain, leading to disorders of movement

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28
Q

Symptoms seen in Parkinson’s are typically:

  • symmetrical
  • asymmetrical
A
  • asymmetrical
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29
Q

Classic triad of symptoms seen in Parkinson’s disease?

A
  • resting tremor
  • rigidity
  • bradykinesia
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30
Q

Which part of the brain is affected in Parkinson’s disease?

A

= substantia nigra (part of the basal ganglia)

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31
Q

Where is dopamine produced?

A

= substantia nigra

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32
Q

Clinical features associated with Parkinson’s disease (8)

A
  • unilateral tremor, ‘pill-rolling tremor’
  • cogwheel rigidity
  • bradykinesia (movements get slower and smaller)

Other features:
- depression
- sleep disturbance + insomnia
- loss of sense of smell
- cognitive impairment
- memory problems

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33
Q

Tremor associated Parkinson’s disease is

  • symmetrical
  • asymmetrical
A
  • asymmetrical
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34
Q

Tremor associated with Parkinson’s disease is

  • 4-6 hertz
  • 5-8 hertz
A
  • 4-6 hertz
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35
Q

Tremor associated with Parkinson’s disease is

  • worse at rest
  • improves at rest
A
  • worse at rest
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36
Q

Tremor associated with Parkinson’s disease

  • worsens with intentional movement
  • improves with intentional movement
A
  • improves with intentional movement
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37
Q

Tremor associated with Parkinson’s disease

  • improves with alcohol
  • does not change with alcohol
A
  • does not change with alcohol
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38
Q

How is Parkinson’s disease diagnosed?

A

= by a specialist, based on symptoms + examination

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39
Q

What is Levodopa?

A

= synthetic dopamine (given orally), to boost levels

(used in Parkinson’s disease)

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40
Q

Levodopa is usually combined with peripheral decarboxylase inhibitors. Why?

A

= stops it being broken down in the body before it gets the chance to reach the brain

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41
Q

Cardbidopa, Benserazide - are examples of:

  • peripheral decarboxylase inhibitors
  • COMT inhibitors
  • Dopamine agonists
  • Monoamine Oxidase-B inhibitors
A
  • peripheral decarboxylase inhibitors
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42
Q

Most effective treatment for managing symptoms in Parkinson’s disease?

A

= Levodopa

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43
Q

Main side-effect associated with Levodopa

A

= dyskinesias (abnormal movements associated with excessive motor activity)

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44
Q

What is dystonia?

A

= excessive muscle contraction which leads to abnormal postures or exaggerated movements

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45
Q

What is chorea?

A

= abnormal involuntary movements that can be jerking and random

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46
Q

What is athetosis?

A

= involuntary twisting or writhing movements usually in the fingers, hands, and feet

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47
Q

Entacapone is an example of,

  • peripheral decarboxylase inhibitor
  • COMT inhibitor
  • Dopamine agonist
  • Monoamine Oxidase-B inhibitor
A
  • COMT inhibitor
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48
Q

Bromocryptine, Peroglide, Carbergoline - are examples of,

  • peripheral decarboxylase inhibitors
  • COMT inhibitors
  • Dopamine agonists
  • Monoamine Oxidase-B inhibitors
A
  • Dopamine agonists
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49
Q

Selegiline, Rasagiline - are examples of,

  • peripheral decarboxylase inhibitors
  • COMT inhibitors
  • Dopamine agonists
  • Monoamine Oxidase-B inhibitors
A
  • Monoamine Oxidase-B inhibitors
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50
Q

COMT inhibitors effect on Levodopa?

A

= inhibits an enzyme which metabolises Levodopa therefore, extending it’s effective duration

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51
Q

Side-effect associated with prolonged use of dopamine agonists?

A

= pulmonary fibrosis

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52
Q

Which of the following enzyme is specific to dopamine, and does not act on serotonin or adrenaline?

  • monoamine oxidase-A enzyme
  • monoamine oxidase-B enzyme
  • monoamine oxidase-C enzyme
A
  • monoamine oxidase-B enzyme
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53
Q

What is Huntington’s Chorea?

A

= autosomal dominant genetic condition that causes a progressive deterioration in the nervous system

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54
Q

A ‘trinucleotide repeat disorder’ the involves a genetic mutation in the HTT gene on chromosome 4 is associated with which condition?

A

= Huntington’s chorea

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55
Q

What is genetic anticipation?

A

= a phenomenon in which the signs and symptoms of genetic conditions become more severe and/or appear at an earlier age, as they are passed from one generation to the next

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56
Q

What are the consequences of Huntington’s chorea displaying genetic anticipation? (2)

A
  • earlier age of onset
  • increased severity of disease
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57
Q

Which kind of ‘movement disorder’ is strongly associated with Huntington’s?

A

= chorea

(involuntary, abnormal movements)

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58
Q

How is Huntington’s chorea diagnosed?

A

= genetic testing for faulty gene

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59
Q

Life expectancy in Huntington’s disease?

A

= 15-20 years

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60
Q

In Huntington’s disease, what is death most often caused by?

A

= respiratory disease

(suicide more common cause than in the general population)

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61
Q

What is Guillain-Barré syndrome?

A

= ‘acute paralytic polyneuropathy’ which affects peripheral nervous system

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62
Q

What is Guillain-Barré syndrome typically caused by?

A

= usually triggered by an infection

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63
Q

Which types of organisms are particularly associated with the development of Guillain-Barre Syndrome? (3)

HINT: CJ, CMV, EBV

A
  • campylobacter jejuni
  • cytomegalovirus
  • epstein-barr virus
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64
Q

Describe the pathophysiology of Guillain-Barre syndrome

A

Thought to occur due to a process called molecular mimicry. B-cells create antibodies which match proteins on the nerve cells. This causes nerve damage

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65
Q

What kind of weakness is seen in Guillain-Barré syndrome?

A

= symmetrical ascending weakness (starting at feet + moving up the body)

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66
Q

Guillain-Barré syndrome: symptoms usually start within

  • 1 week preceding infection
  • 2-3 weeks preceding infection
  • 4 weeks preceding infection
  • 1 year preceding infection
A
  • 4 weeks preceding infection
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67
Q

Guillain-Barré syndrome: symptoms PEAK within

  • 1 week
  • 2-4 weeks
  • 1 year
A
  • 2-4 weeks
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68
Q

Guillain-Barré syndrome: recovery period can last

  • days to weeks
  • weeks to months
  • months to years
A
  • months to years
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69
Q

Which of the following criteria can be used for diagnosing Guillain-Barré syndrome?

  • Blatchford score
  • Brighton criteria
  • Eddington criteria
  • Love heart criteria
A
  • Brighton criteria
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70
Q

Leading cause of death in Guillain-Barre syndrome?

A

= PE

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71
Q

Management for Guillain-Barré syndrome (3)

A
  • IV immunoglobulins
  • supportive care
  • VTE prophylaxis
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72
Q

What can be used as an alternative to IV immunoglobulins to treat Guillain-Barré syndrome?

A

= plasma exchange

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73
Q

Guillain-Barré syndrome: What % of patients fully recover?

  • 80%
  • 50%
  • 15%
  • 5%
A
  • 80%
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74
Q

What is dementia?

A

= syndrome associated with a decline in 2 or more cognitive domains, severe enough to disrupt ADLs, occupation or lifestyle

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75
Q

What is pseudo dementia?

A

= cognitive and functional impairment imitating neurodegenerative disorders caused secondary to neuropsychiatric symptoms

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76
Q

Description of a tension headache

A

= classically produces a mild ache across the forehead and in a band-like pattern around the head

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77
Q

Treatment of a tension headache (4)

A
  • reassurance
  • basic analgesia
  • relaxation techniques
  • hot towels to local area
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78
Q

What is a secondary headache?

A

= headache caused by another condition

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79
Q

What causes hormonal headaches?

A

= related to oestrogen. Tends to be related to low oestrogen

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80
Q

What can be used to help improve hormone headaches?

A

= oral contraceptive pill

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81
Q

Does trigeminal neuralgia most commonly present with unilateral or bilateral pain?

A

= unilateral (in 90% of cases)

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82
Q

What condition is associated with trigeminal neuralgia?

A

= multiple sclerosis

(around 5-10% of people with MS have trigeminal neuralgia)

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83
Q

What is the pain associated with trigeminal neuralgia usually described as?

A

= electricity-like shooting pain

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84
Q

First-line pharmacological treatment for trigeminal neuralgia?

A

= carbamazepine

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85
Q

What is multiple sclerosis (MS)?

A

= a chronic progressive condition that involves demyelination of myelinated neurons in the CNS

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86
Q

Which of the following cells wrap around axons in the CNS:

  • Schwann cells
  • oligodendrocytes
A
  • oligodendrocytes
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87
Q

Which of the following cells wrap around axons in the peripheral nervous system:

  • Schwann cells
  • oligodendrocytes
A
  • Schwann cells
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88
Q

How are the lesions in MS described as?

A

= disseminated in time and space

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89
Q

Most common presentation of MS?

A

= optic neuritis (demyelination of optic nerve + loss of vision in 1 eye)

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90
Q

What is conjugate lateral gaze disorder?

A

= when looking laterally in direction of affected eye, affected eye won’t be able to abduct

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91
Q

What is internuclear ophthalmoplegia internuclear + conjugate lateral gaze disorder associated with?

A

= multiple sclerosis (MS)

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92
Q

What is ‘ophthalmoplegia’?

A

= means problem with muscles around the eye

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93
Q

What is Lhermitte’s sign?

A

= electric shock sensation that travels down the spine into limbs when flexing the neck

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94
Q

What is Lhermitte’s sign associated with?

A

= Multiple sclerosis (MS)

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95
Q

What is ‘ataxia’?

A

= problem with coordinated movement

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96
Q

MS disease patterns: what is clinically isolated syndrome?

A

= describes the first episode of demyelination, and neurological signs + symptoms

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97
Q

MS disease patterns: what is relapsing-remitting pattern described as?

A

= characterised by episodes of disease + neurological symptoms followed by recovery

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98
Q

MS: what is the most common pattern at initial diagnosis?

  • clinically isolated syndrome
  • relapsing-remitting
  • secondary progressive
  • primary progressive
A
  • relapsing-remitting
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99
Q

MS disease patterns: what is secondary progressive pattern described as?

A

= there was relapsing-remitting disease at first, but now there is progressive worsening of symptoms with incomplete remissions

100
Q

MS disease patterns: what is primary progressive pattern described as?

A

= worsening of disease + neurological symptoms from point of diagnosis without initial relapses + remissions

101
Q

Investigations used to support diagnosis of multiple sclerosis (MS)? (2)

A
  • MRI (to demonstrate lesions)
  • lumbar puncture (to detect oligoclonal bands in CSF)
102
Q

What is motor neurone disease?

A

= progressive, ultimately fatal condition where the motor neurones stop functioning

103
Q

Most common and well-known specific motor neurone disease?

A

= ALS (amyotrophic lateral sclerosis)

104
Q

Second most common form of motor neurone disease?

A

= progressive bulbar palsy

105
Q

Signs of lower motor neurone disease (4)

A
  • Muscle wasting
  • Reduced tone
  • Fasciculations (twitches in the muscles)
  • Reduced reflexes
106
Q

Signs of upper motor neurone disease (3)

A
  • Increased tone or spasticity
  • Brisk reflexes
  • Upgoing plantar responses
107
Q

What is Riluzole used in?

A

= used in motor neurone disease, can slow the progression of disease and extend survival by a few months in ALS

108
Q

What non-pharmacological management can be used to support breathing at night in those with motor neurone disease?

A

= non-invasive ventilation (NIV)

109
Q

What is myasthenia gravis?

A

= autoimmune condition that causes muscle weakness that gets progressively worse with activity and improves with rest

110
Q

Myasthenia gravis has a strong link with what other condition?

A

= thymoma (tumours of the thymus gland)

111
Q

Pathophysiology of myasthenia gravis

A

= in 85% of patients, acetylcholine receptor antibodies are produced. Preventing ACh from being able to stimulate receptor + trigger muscle contraction

Antibodies also trigger complement system within NMJ, leading to damage of cells in postsynaptic membrane

In the other 15% - there are antibodies against MuSK + LRP4

112
Q

Do symptoms in myasthenia gravis typically get worse or better at the end of the day?

A

= worse

As weakness gets worse with muscle use + improves with test

113
Q

What is does the Edrophonium test involve? and what is it used for?

A

= give IV dose of edrophonium chloride (or neostigmine)

Normally, cholinesterase enzymes in neuromuscular junction breakdown Ach. Edrophonium block these enzymes and stop the breakdown of Ach

As a result, Ach at neuromuscular junction increases. Briefly and temporarily relieves the weakness

This helps establishes a diagnosis of myasthenia gravis

114
Q

Treatment options for myasthenia gravis? (2)

A
  • reversible acetylcholinesterase inhibitors (e.g., Pyridostigmine or Neostigmine)
  • monoclonal antibodies (e.g., Rituximab)
115
Q

What is Lambert-Eaton Myasthenia Syndrome?

A

= rare autoimmune disorder of the neuromuscular junction

Causes progressive muscle weakness with increased use as a result of damage to the NMJ

116
Q

Which condition is Lambert-Eaton Myasthenia Syndrome closely associated with?

A

= small-cell lung cancer

117
Q

Differences between Myasthenia Gravis and Lambert-Eaton Myasthenia Syndrome (LEMS)?

A

In LEMS - defect of transmission is in the presynaptic terminals (damage to

118
Q

What is a transient ischaemic attack (TIA)?

A

= transient neurological dysfunction secondary to ischaemia without infarction

119
Q

What is a crescendo TIA?

A

= where there is 2 or more TIAs within a week

(carries high risk of developing into a stroke)

120
Q

What is the FAST Tool used for? And what does it stand for?

A

= used for identifying stroke in the community

F - face
A - arm
S - speech
T - time (act fast, call 999)

121
Q

What is the ROSIER Tool used for?

A

= recognising stroke in the ED

122
Q

What imaging is used first-line to diagnose a stroke?

A

= CT head

123
Q

Gold standard imaging technique in stroke?

A

= diffusion-weighted MRI

124
Q

What is used in secondary prevention of stroke (2)?

A

= Clopidogrel 75mg once daily + Atorvastatin 80mg should be started but NOT immediately

125
Q

Key feature in presentation of intracranial bleed?

A

= headache

126
Q

Which of the following are more frequently seen in elderly or alcoholic patients?

  • subdural haemorrhage
  • extradural haemorrhage
  • intracerebral haemorrhage
  • subarachnoid haemorrhage
A
  • subdural haemorrhage
127
Q

Which of the following is typically seen as a cresent shape on CT scan?

  • subdural haemorrhage
  • extradural haemorrhage
  • intracerebral haemorrhage
  • subarachnoid haemorrhage
A
  • subdural haemorrhage
128
Q

Which of the following is associated with fracture of the temporal bone?

  • subdural haemorrhage
  • extradural haemorrhage
  • intracerebral haemorrhage
  • subarachnoid haemorrhage
A
  • extradural haemorrhage
129
Q

Which of the following is typically bi-convex (or lentiform) in shape on CT scan?

  • subdural haemorrhage
  • extradural haemorrhage
  • intracerebral haemorrhage
  • subarachnoid haemorrhage
A
  • extradural haemorrhage
130
Q

Which of the following is more commonly associated with young patient who has had a traumatic head injury and has an ongoing headache?

  • subdural haemorrhage
  • extradural haemorrhage
A
  • extradural haemorrhage
131
Q

Which of the following is associated with a sudden onset occipital headache that occurs during strenuous activity such as weight-lifting or sex?

  • subdural haemorrhage
  • extradural haemorrhage
  • intracerebral haemorrhage
  • subarachnoid haemorrhage
A
  • subarachnoid haemorrhage
132
Q

Which of the following is particularly associated with cocaine + sickle cell anaemia?

  • subdural haemorrhage
  • extradural haemorrhage
  • intracerebral haemorrhage
  • subarachnoid haemorrhage
A
  • subarachnoid haemorrhage
133
Q

What is a sudden onset occipital headache also called? And what is it a sign of?

A

= known as a thunderclap headache, seen in subarachnoid haemorrhage

134
Q

First-line investigation for subarachnoid haemorrhage?

A

= CT head

135
Q

What is xanthochromia?

A

= presence of bilirubin in the cerebrospinal fluid (appears yellow in colour)

136
Q

What is Nimodipine? And what is it used for?

A

= calcium channel blocker, used to prevent vasospasm - common complication that can result in brain ischaemia following a subarachnoid haemorrhage

137
Q

What is xanthochromia a sign of?

A

= may be a sign of subarachnoid haemorrhage

138
Q

What is a breakthrough seizure?

A

= happens when you have a seizure after not having one for 12 months - often due to not taking your medication, but other things can also trigger it

139
Q

What is a seizure?

A

= transient episode of abnormal electrical activity in the brain

140
Q

Investigations in suspected epilepsy (2)

A

Electroencephalogram (EEG) - can show typical patterns in different forms of epilepsy to support diagnosis

MRI brain - used to visualise structural problems which may be associated with seizures

Others: ECG (exclude heart problems)

141
Q

Describe a ‘generalised tonic-clonic seizure’

A

There is a loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) episodes

There may be associated tongue biting, incontinence, groaning and irregular breathing

After seizure there is a prolonged post-ictal period where the person is confused, drowsy and feels irritable or depressed

142
Q

First-line pharmacological management for a generalised tonic-clonic seizure?

A

= Sodium Valproate

143
Q

Where do focal seizures start?

A

= temporal lobe

144
Q

Describe a focal seizure

A

There are various ways that focal seizures can present:

  • Hallucinations
  • Memory flashbacks
  • Déjà vu
  • Doing strange things on autopilot
145
Q

First-line pharmacological treatment for a focal seizure

A

= Carbamazepine or Lamotrigine

146
Q

Describe an absent seizure

A

Patient becomes blank, stares into space and then abruptly returns to normal

During episode they are unaware of their surroundings + won’t respond

147
Q

How long do absent seizures typically last?

A

= 10-20 seconds

148
Q

First-line pharmacological treatment for absent seizures?

A

= Sodium Valproate or Ethosuximide

149
Q

Describe an atonic seizure

A

Also known as ‘drop attacks’. Characterised by brief lapses in muscle tone

150
Q

Describe myoclonic seizures

A

Present as sudden brief muscle contractions, like a sudden ‘jump’. Patient usually remains awake during the episode

151
Q

First-line pharmacological treatment for atonic OR, myoclonic seizures?

A

= Sodium Valproate

152
Q

Which of the following epilepsy maintenance medications SEs include Stevens-Johnson syndrome (a life threatening skin rash)?

  • Sodium Valproate
  • Carbamazepine
  • Phenytoin
  • Ethosuzimide
  • Lamotrigine
A
  • Lamotrigine
153
Q

Which of the following epilepsy maintenance medications SEs include agranulocytosis?

  • Sodium Valproate
  • Carbamazepine
  • Phenytoin
  • Ethosuzimide
  • Lamotrigine
A
  • Carbamazepine
154
Q

What is status epilepticus?

A

= defined as seizures lasting more than 5 minutes or more than 3 seizures in 1 hour

(MEDICAL EMERGENCY)

155
Q

What is given to treat status epilepticus in hospital?

A

= IV Lorazepam 4mg

156
Q

If IV Lorazepam 4mg does not stop seizure in patient with status epilepticus - what is the next step?

A

= repeat after 10 minutes

157
Q

Medical option for status epilepticus in the community?

A

= buccal Midazolam OR, rectal Diazepam

158
Q

What diagnosis would you suspect if a patient presents with the following clinical features:

  • high foot arches
  • distal muscle wasting (‘inverted champagne bottle legs’)
  • weakness in lower legs
  • weakness in hands
  • peripheral sensory loss
A

= Charcot-Marie-Tooth Disease

159
Q

What is Charcot-Marie-Tooth Disease?

A

= an inherited disease that affects peripheral motor and sensory nerves

Causes dysfunction in the myelin or axons

160
Q

Causes of peripheral neuropathy (5)

HINT: ABCDE

A

A - alcohol
B - B12 deficiency
C - cancer + CKD
D - diabetes + drugs (e.g., Isoniazid, Amiodarone + Cisplatin)
E - every vasculitis

161
Q

Management of Charcot-Marie-Tooth Disease

A

= no treatment to alter underlying disease or prevent progression

Management purely supportive involving input from various members of MDT

162
Q

How can you tell if a facial nerve palsy if due to a UMN or, LMN lesion?

A

UMN lesion - forehead spared, patient can move forehead on suspected side

LMN - forehead will NOT be spared

163
Q

Classical presentation of patient with a facial nerve palsy?

A

= unilateral facial weakness

164
Q

What is Bell’s palsy?

A

= unilateral LMN facial nerve palsy. Relatively common

165
Q

Cause of Bell’s palsy?

A

= idiopathic (unknown)

166
Q

Treatment of Bell’s palsy?

A

= Prednisolone

  • 50mg for 10 days OR,
  • 60mg for 5 days, followed by 5-day reducing regime of 10mg a day

+ lubricating eye drops

167
Q

What is Ramsay-Hunt Syndrome caused by?

A

= varicella zoster virus (VZV)

168
Q

Apart from unilateral facial weakness, what other clinical feature may suggest this is Ramsay-Hunt syndrome?

A

= painful, tender vesicular rash in ear canal, pinna + around ear of affected side

(rash can extend to anterior 2/3 of tongue + hard palate)

169
Q

Treatment for Ramsay-Hunt Syndrome (2)

A

= Prednisolone + Acyclovir

(recommended to be initiated within 72 hours)

May require lubricating eye drops too

170
Q

What is neurofibromatosis?

A

= genetic condition that causes nerve tumours (neuromas) to develop throughout the nervous system

171
Q

Is neurofibromatosis type 1 or type 2 more common?

A

= neurofibromatosis type 1

172
Q

Diagnosis criteria for neurofibromatosis type 1

HINT: CRABBING

A

C - cafe-au-lait spots
R - relative with NF1
A - axillary or inguinal frexkles
BB - bony dysphasia
I - iris hamartomas (Lisch nodules)
N - neurofibromas
G - glioma of optic nerve

173
Q

What are Lisch nodules (Irish hamartomas) associated with?

A

= neurofibromatosis type 1

174
Q

Which of the following is most associated with acoustic neuromas

  • neurofibromatosis type 1
  • neurofibromatosis type 2
A
  • neurofibromatosis type 2
175
Q

Is patient presents with bilateral acoustic neuromas, what does this almost certainly indicate?

A

= neurofibromatosis type 2

176
Q

Most common cancers that metastasise to the brain (4)

A
  • lung
  • breast
  • renal cell carcinoma (RCC)
  • melanoma
177
Q

Pharmacological management of idiopathic intracranial hypertension?

A

= Acetazolamide

(carbonic anhydrase inhibitors)

178
Q

Clinically how can you differentiate myasthenia gravis from, Lambert-Eaton myasthenic syndrome?

A

= Lambert-Eaton myasthenic syndrome is classically associated with fatigue that improves with repeated use, while patients with myasthenia gravis experience greater fatigue with continuous use

179
Q

What is cataplexy?

A

= describes the sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened

180
Q

She has not been able to read the newspaper recently, despite wearing her usual glasses and has trouble walking down the stairs. She has a past medical history of poorly controlled type two diabetes and hypertension.

An eye examination shows visual acuity 6/6 in both eyes with her glasses on, normal colour vision, intact central and peripheral fields, defective downward gaze and vertical diplopia.

Lesion to what cranial nerve is most likely to be causing her symptoms?

A

= 4th nerve palsy (Trochlear)

181
Q

What is sarcopenia?

A

= age-related progressive loss of muscle mass and strength

182
Q

What is ‘long lie’?

A

= term for when a person has fallen and spends a long time on the floor, waiting for assistanc

183
Q
A
183
Q

What is Todd paresis?

A

= a syndrome associated with weakness or paralysis of part or all of the body as soon as the ictal discharge (seizure) has ended

184
Q

What is a secondary cause of dementia seen in elderly patients which is thought to be secondary to reduced CSF absorption at the arachnoid villi known as?

A

= normal pressure hydrocephalus

185
Q

Classical triad of features seen in normal pressure hydrocephalus?

A
  • urinary incontinence
  • dementia + bradyphrenia (‘slow mind’)
  • gait abnormality (similar to Parkinson’s)
186
Q

Management of normal pressure hydrocephalus?

A

= ventriculoperitoneal shunting

187
Q

Hydrocephalus with enlarged fourth ventricle and, ventriculomegaly is indicative of?

A

= normal pressure hydrocephalus

188
Q

Which of the following is the strongest risk factor for developing Bell’s palsy?

  • smoking
  • combined oral contraceptive pill
  • asthma
  • sarcoidosis
  • pregnancy
A
  • pregnancy
189
Q

What is a quick and easy bedside test to perform to confirm that fluid coming out a patient’s nose is CSF?

A

= check for glucose

190
Q

What is uhthoff phenomenon?

A

= transient worsening of neurological function lasting less than 24 hours that can occur in multiple sclerosis patients due to increases in core body temperature

191
Q

In which condition is uhthoff phenomenon seen in?

A

= MS

192
Q

What is Ihermitte sign, and what disease is it seen in?

A

= a sudden brief pain or electrical buzzing sensation. It runs down your neck into your spine and might then spread into your arms or legs. It can be triggered when you bend your neck forward, or after a cough or sneeze

Seen in MS

193
Q

Which kind of ischaemic stroke commonly occurs due to a variety of factors including damage to the aorta?

A

= anterior spinal artery infarct

194
Q

Imaging of choice in diagnosing anterior spinal artery infarct?

A

= MRI scanning

(hyperintense signals on T2-weighted images in the anterior 2/3rds of the spinal cord)

195
Q

Is dorsal column function preserved in patients with anterior spinal artery infarct?

A

= yes

196
Q

Which nerve roots make up the brachial plexus? (5)

A

= C5-C8 + T1

197
Q

2 types of brachial plexus injuries?

A
  • Erb’s palsy
  • Klumpke’s palsy
198
Q

Which type of brachial plexus injury involves damage to C5-C6 nerve roots?

  • Erb’s palsy
  • Klumpke’s palsy
A
  • Erb’s palsy
199
Q

Which type of brachial plexus injury involves damage to C8-T1 nerve roots?

  • Erb’s palsy
  • Klumpke’s palsy
A
  • Klumpke’s palsy
200
Q

Which type of brachial plexus injury is more commonly assocaited with traumatic childbirth?

  • Erb’s palsy
  • Klumpke’s palsy
A
  • Erb’s palsy
201
Q

Major causes of brachial plexus injuries (3)

A
  • trauma (childbirth)
  • high-impact accidents
  • axillary radiotherapy (for breast cancer)
202
Q

‘Waiter’s tip’ sign: characterised by shoulder adduction, elbow extension, forearm pronation, and wrist flexion - is associated with which type of brachial plexus injury?

  • Erb’s palsy
  • Klumpke’s palsy
A
  • Erb’s palsy
203
Q

What investigation can be used to help confirm diagnosis of brachial plexus injury?

A

= electrodiagnostic studies (EMG + nerve conduction studies)

204
Q

Medication which can be used to manage pain associated with brachial plexus injury?

A

= NSAIDs

205
Q

Surgery options in brachial plexus injury if no improvement, or injury is severe?

A

= nerve grafts or transfers

206
Q

Which type of brachial plexus injury involves weakness of intrinsic muscles of the hand?

  • Erb’s palsy
  • Klumpke’s palsy
A
  • Klumpke’s palsy
207
Q

What is Brown-Sequard Syndrome?

A

= characterised by anatomical disruption of nerve fibre tracts in one half of the spinal cord

208
Q

Clinical features of brown-sequard syndrome? (3)

(inc. proprioception, pain + temp sensation, paralysis)

A
  • ipsilateral hemiplegia
  • ipsilateral loss of proprioception + vibration
  • contralateral loss of pain + temperature sensation
209
Q

Does bulbar palsy refer to a LMN or UMN lesion subtype?

A

= LMN lesion

210
Q

Which cranial nerves are affected in bulbar palsy? (3)

A
  • CN 9 (glossopharyngeal)
  • CN 10 (Vagus)
  • CN 12 (hypoglossal)
211
Q

Main resultant impairments associated with bulbar palsy? (2)

A
  • dysarthria (speech problems)
  • dysphagia (swallowing problems)
212
Q

Clinical manifestations of bulbar palsy (4)

A
  • absent or normal jaw jerk reflex
  • absent gag reflex
  • flaccid, fasiculating tongue
  • nasal speech, described as ‘quiet’
213
Q

What is encephalitis?

A

= pathological condition characterised by inflammation of the brain parenchyma, aka the ‘encephalon’

214
Q

Most common pathogen in encephalitis?

A

= herpes simplex virus type 1 (HSV-1)

215
Q

Primary clinical feature of encephliatis?

A

= altered mental status

216
Q

In encephalitis, which lobes does HSV typically affect?

A

= temporal lobes

(and bilateral multifocal haemorrhage is typical)

217
Q

Management of encephalitis (2)

A

Involves broad-spectrum antimicrobial cover with:
- 2g IV Ceftriaxone BD
- 10mg/kg Acyclovir TDS for 2 weeks

218
Q

What is cerebellar syndrome?

A

= refers to a cluster of clinical manifestations resulting from impaired function of the cerebellum, which is responsible for maintaining balance and coordination of movements

219
Q

Signs and symptoms of cerebellar syndrome?

Mneumonic ‘DANISH’

A

D - dysdiadochokinesia (=inability to perform rapid alternating hand movements)
A - ataxia (=broad-based, unsteady gait)
N - nystagmus
I - intention tremor (observed during ‘finger to nose test’)
S - slurred speech
H - hypotonia

220
Q

Cerebellar syndrome: Lesions in the cerebellar vermis leads to

  • ipsilateral limb symptoms
  • truncal ataxia and gait instability
A
  • truncal ataxia and gait instability
221
Q

Cerebellar syndrome: Lesions in the cerebellar hemisphere leads to

  • ipsilateral limb symptoms
  • truncal ataxia and gait instability
A
  • ipsilateral limb symptoms
222
Q

Cranial nerve affected in Bell’s palsy?

A

= facial nerve (7th CN)

223
Q

What is diplopia?

A

= refers to the perception of 2 images from a single object

224
Q

Common causes of diplopia? (3)

A
  • 3rd nerve palsy
  • 4th nerve palsy
  • 6th nerve palsy
225
Q

Resting eye position in a 3rd nerve palsy is?

  • down and in
  • down and out
  • upward and inwards
  • upward and outwards
  • medially deviated
A
  • down and out
226
Q

Resting eye position in a 4th nerve palsy is?

  • down and in
  • down and out
  • upward and inwards
  • upward and outwards
  • medially deviated
A
  • upward and inwards
227
Q

Resting eye position in a 6th nerve palsy is?

  • down and in
  • down and out
  • upward and inwards
  • upward and outwards
  • medially deviated
A
  • medially deviated
228
Q

In a patient with a 4th nerve palsy, the double vision is usually worse in

  • the vertical plane
  • the horizontal plane
  • the diagonal plane
A
  • the vertical plane
229
Q

In a patient with a 6th nerve palsy, the double vision is usually worse in

  • the vertical plane
  • the horizontal plane
  • the diagonal plane
A
  • the horizontal plane
230
Q

What is horner’s syndrome?

A

= a condition characterised by a set of signs and symptoms that occur due to a disruption in the sympathetic nerve supply to the eye

231
Q

3 common features associated with Horner’s syndrome

A
  • ptosis (=drooping of eyelid)
  • miosis (=constriction of pupil)
  • anhidrosis (=absence of sweating on affected side of face)
232
Q

Causes of horner’s syndrome (4)

A
  • pancoast tumour
  • stroke
  • carotid artery dissection

Additional causes: neck trauma, surgeries or trauma affecting the sympathetic chain

233
Q

Horner’s syndrome: heterochromia is suggestive of?

A

= congenital Horner’s syndrome

234
Q

What is neuromyelitis optica (Devic’s disease)?

A

= neurological disorder that primarily affects the optic nerves and the spinal cord

235
Q

Is neuromyelitis optica (Devic’s disease) more common in males of females?

A

= has a clear female preponderance

236
Q

Classic triad of Devic’s disease (neuromyelitis optica)

A
  • optic neuritis
  • transverse myelitis
  • antibodies to Aquaporin 4 (AQA4) found in serum of patient
237
Q

MRI head & spine reveals demyelinating lesions which, unlike in MS, affect both peripheral white matter tracts and central components of the spinal cord

What is the likely diagnosis?

A

= neuromyelitis optica (Devic’s disease)

238
Q

What is meningitis?

A

= inflammation of the meninges, which are composed of 3 layers: dura mater, arachnoid mater, and pia mater

This inflammation may arise from both infective and non-infective aetiologies

239
Q

Most common type of meningitis

  • viral
  • bacterial
  • fungal
A
  • viral

(however, usually least severe)

240
Q

Cardinal features of meningitis (8)

A
  • headache
  • fever
  • neck stiffness
  • photophobia
  • nausea & vomiting
  • focal neurology
  • seizures
  • reduced conscious level
241
Q

Meningitis: What is Kernig’s sign?

A

= patient lying on back with hip and knee flexed at 90 degrees. Examiner attempts to extend the patient’s knee. If patient experiences pain & resistance, especially when straightening the leg – positive Kernig’s sign

This is suggestive of meningeal irritation or inflammation

242
Q

Meningitis: What is Brudzinski’s sign?

A

= passive neck flexion, where examiner gently flexes the patient’s neck forward towards the chest while the patient is lying on their back. If patient involuntary flexes their hips and knees in response to neck flexion – considered positive

243
Q

Management of meningitis (2)

[bacteria & viral]

A

Bacterial:
- 2g of IV ceftriaxone twice daily
- with IV amoxicillin added in patients at age extremes for listeria coverage

Viral:
- IV acyclovir

244
Q

What is Cushings reflex?

A

= physiological nervous system response to acute elevations of intracranial pressure (ICP)

245
Q

Cushing triad (3)

A
  • widening pulse pressure (high systolic, low diastolic)
  • bradycardia
  • irregular respirations (Cheyne-Stokes respiration)

Year 4 (11 decks)

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