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MRCP PART 1 > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the features of Von Hippel Lindau Syndrome?

A
  1. Cerebellar haemangiomas: these can cause subarachnoid haemorrhages.
  2. Retinal haemangiomas: vitreous haemorrhage.
  3. Renal cysts (premalignant)
  4. Phaeochromocytoma
  5. Extra-renal cysts: epididymal, pancreatic, hepatic
  6. Endolymphatic sac tumours
  7. Clear-cell renal cell carcinoma
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2
Q

Mode of inheritance for Tuberous sclerosis?

A

Tuberous sclerosis (TS) is a genetic condition of autosomal dominant inheritance.

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3
Q

First line pharmacological management for trigeminal neuralgia?

A

Carbamazepine is first line.

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4
Q

What are the causes of spontaneous SAH?

A
  1. Intracranial aneurysm (saccular ‘berry’ aneurysms)
    accounts for around 85% of cases
    conditions associated with berry aneurysms include hypertension, adult polycystic kidney disease, Ehlers-Danlos syndrome and coarctation of the aorta.
  2. Arteriovenous malformation
  3. Pituitary apoplexy
  4. Mycotic (infective) aneurysm
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5
Q

What is the investigation of choice for SAH?

A
  1. Non-contrast CT head is the first-line investigation of choice:
    acute blood (hyperdense/bright on CT) is typically distributed in the basal cisterns, sulci and in severe cases the ventricular system.
  2. If CT head is done within 6 hours of symptom onset and is normal
    new guidelines suggest NOT doing a lumbar puncture.
  3. If CT head is done more than 6 hours after symptom onset and is normal:
    - Do a lumber puncture (LP)
    timing wise the LP should be performed at least 12 hours following the onset of symptoms to allow the development of xanthochromia (the result of red blood cell breakdown).
    xanthochromia helps to distinguish true SAH from a ‘traumatic tap’.
    - CSF findings consistent with subarachnoid haemorrhage include a normal or raised opening pressure.
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6
Q

Acute treatment for migraine?

A

First-line: Oral Triptan and NSAID, or
an Oral Triptan and Paracetamol.

  • for young people aged 12-17 years consider a nasal triptan in preference to an oral triptan.
  • If the above measures are not effective or not tolerated offer a non-oral preparation of metoclopramide or prochlorperazine and consider adding a non-oral NSAID or triptan.
    (caution should be exercised when prescribing metoclopramide to young patients as acute dystonic reactions may develop).
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7
Q

Prophylaxis for migraine?

A

One of the following:

  1. Propranolol
  2. Topiramate: should be avoided in women of childbearing age as it may be teratogenic and it can reduce the effectiveness of hormonal contraceptives.
  3. Amitriptyline
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8
Q

In subacute combined degeneration of the spinal cord, impairment of which tracts are seen?

A

Subacute combined degeneration of the spinal cord is due to vitamin B12 deficiency resulting in impairment of the dorsal columns, lateral corticospinal tracts and spinocerebellar tracts.

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9
Q

Features of Klumpke’s paralysis?

A
  • Damage to C8 and T1 in the brachial plexus
  • Claw Hand
  • It classically occurs as a birth injury, or when falling from a tree and grabbing onto a branch whilst falling
  • Weakness of intrinsic muscles of the hand
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10
Q

First line for essential tremor?

A

Essential tremor is an autosomal dominant condition which usually affects both upper limbs.

  • Postural tremor: worse if arms outstretched
  • Improved by alcohol and rest
  • Most common cause of titubation (head tremor)

Management:
- Propranolol is first-line
- Primidone is sometimes used

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11
Q

Broca’s aphasia is due to an infarct at which area?

A

Due to a lesion of the inferior frontal gyrus (lateral part of frontal lobe). It is typically supplied by the superior division of the left MCA

Speech is non-fluent, laboured, and halting. Repetition is impaired. Comprehension is normal

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12
Q

Hoffman’s sign is used for which condition?

A

Degenerative Cervical Myelopathy.

It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.

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13
Q

Causes of gingival hyperplasia?

A
  • Phenytoin
  • Calcium channel blockers
  • Ciclosporin
  • Acute Myeloid Leukemia
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14
Q

Bilateral vestibular schwanommas are seen in which condition?

A

Neurofibromatosis Type 2.

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15
Q

Which lobe does HSV encephalitis commonly affect?

A

Herpes simplex (HSV) encephalitis is a common topic in the exam. The virus characteristically affects the temporal lobes - questions may give the result of imaging or describe temporal lobe signs e.g. aphasia.

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16
Q

Anti Yo antibodies are associated with which condition?

A
  • Breast and ovarian cancer.
  • Causes Cerebellar Syndrome (nystagmus, past pointing).
17
Q

Anti GAD antibody is associated with which condition?

A
  • Associated with Breast, Colorectal and Small cell lung carcinoma.
  • Stiff person’s syndrome or diffuse hypertonia
18
Q

Acute management for cluster headache?

A
  • 100% oxygen (80% response rate within 15 minutes)
  • Subcutaneous Triptan (75% response rate within 15 minutes)
19
Q

Prophylaxis for cluster headache?

A

Verapamil.

there is also some evidence to support a tapering dose of prednisolone

20
Q

Management of myasthenic crisis?

A
  • Plasmapheresis
  • Intravenous immunoglobulins
21
Q

Long term management for myasthenia gravis?

A
  1. Long-acting acetylcholinesterase inhibitors: Pyridostigmine is first-line.

Immunosuppression is usually not started at diagnosis, but the majority of patients eventually require it in addition to long-acting acetylcholinesterase inhibitors:
- Prednisolone initially.
Azathioprine, Cyclosporine, Mycophenolate mofetil may also be used.

  1. Thymectomy
22
Q

Symptoms of cerebellar disease?

A

D - Dysdiadochokinesia, Dysmetria (past-pointing), patients may appear ‘Drunk’
A - Ataxia (limb, truncal)
N - Nystamus (horizontal = ipsilateral hemisphere)
I - Intention tremour
S - Slurred staccato speech, Scanning dysarthria
H - Hypotonia

23
Q

Which anti-epileptic is associated with Steven johnson syndrome?

A

Lamotrigine.

24
Q

Symptoms seen in accoustic neuroma (vestibular schwanomma)?

A

The classical history of vestibular schwannoma includes a combination of vertigo, hearing loss, tinnitus and an absent corneal reflex.

Features can be predicted by the affected cranial nerves:
- cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
- cranial nerve V: absent corneal reflex
- cranial nerve VII: facial palsy

25
Q

Gold standard investigation for Accoustic Neuroma?

A

MRI of the cerebellopontine angle is the investigation of choice.

26
Q

Lateral medullary syndrome is caused by occlusion of which blood vessel?

A

Posterior Inferior Cerebellar Artery.

27
Q

Classic triad of normal pressure hydrocephalus?

A
  • Urinary incontinence
  • Gait abnormality
  • Dementia
28
Q

Which spinal pathways are affected in subacute degeneration of the spinal cord?

A

Subacute combined degeneration of the spinal cord is due to vitamin B12 deficiency resulting in impairment of the dorsal columns, lateral corticospinal tracts and spinocerebellar tracts.

Dorsal Column - Proprioception and vibration sense

Corticospinal tract - voluntary motor

Spinocerebellar - sensory ataxia, positive Romberg’s

29
Q

Pharmacological management for restless leg syndrome?

A

Dopamine agonists are first-line treatment:
- Pramipexole
- Ropinirole

30
Q

Symptoms of Menieres disease?

A
  1. Recurrent Vertigo
  2. Tinnitus
  3. Hearing Loss (sensorineural)
  4. Aural fullness/pressure
  5. Nystagmus
  6. Positive Romberg test
  • Episodes last minutes to hours
  • Typically symptoms are unilateral but bilateral symptoms may develop after a number of years
31
Q

Prevention of attacks in Meniere’s disease?

A

Betahistine and vestibular rehabilitation.

32
Q

How to differentiate viral labyrinthitis and vestibular neuronitis?

A

Absence of hearing loss suggests a diagnosis of vestibular neuronitis rather than viral labyrinthitis.

Neuronitis - No loss of hearing
Labyrinthitis - Loss of hearing

33
Q

Time criteria for thrombectomy in stroke?

A

Thrombectomy - 6 hours
Thromblysis - 4.5 hours

34
Q

Axonal causes of peripheral neuropathy?

A

Axonal pathology:
- alcohol
- diabetes mellitus*
- vasculitis
- vitamin B12 deficiency*
- hereditary sensorimotor
- neuropathies (HSMN) type II

Nerve conduction studies shows reduced amplitude > suspect axonal cause.

NCS showing reduced velocity > suspect demyelinating cause > GBS, CIDP, amiodarone, hsmn

35
Q

Example of dopamine receptor agonist in PD?

A

Bromocriptine, Ropinirole, Cabergoline, Apomorphine

Patients should be warned about the potential for dopamine receptor agonists to cause impulse control disorders and excessive daytime somnolence.

36
Q

MAO-B (Monoamine Oxidase-B) inhibitor example in PD?

A
  • Selegiline

inhibits the breakdown of dopamine secreted by the dopaminergic neurons

37
Q

Example of COMT (Catechol-O-Methyl Transferase) inhibitors in PD?

A

e.g. Entacapone, Tolcapone
COMT is an enzyme involved in the breakdown of dopamine, and hence may be used as an adjunct to levodopa therapy.

38
Q

MOA of Carbidopa or Benserazide used in Parkinson’s disease?

A

DOPA-decarboxylase inhibitor.

Nearly always combined with a decarboxylase inhibitor (e.g. carbidopa or benserazide)
this prevents the peripheral metabolism of levodopa to dopamine outside of the brain and hence can reduce side effects.

MRCP PART 1 (20 decks)

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