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Daisy Finals Revision > Neurology > Flashcards

Neurology Flashcards

1
Q

What tumour is most associated with myasthenia gravis?

A

Thymoma

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2
Q

How does an anterior inferior cerebellar artery stroke present? (Lateral pontine syndrome)

A

Ipsilateral: facial pain and paralysis, temperature loss, deafness

Contralateral: facial pain and temp loss

Ataxia, nystagmus

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3
Q

What do GBS nerve conduction studies show?

A

Decreased motor nerve conduction velocity

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4
Q

What is the management for idiopathic intracranial hypertension?

A

Weight loss (if overweight)
(Specialist): Carbonic anhydrase inhibitors
Topiramate

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5
Q

How does MCA stroke present?

A

Contralateral hemiparesis and sensory loss
Upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

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6
Q

What is used for spasticity in MS?

A

Baclofen and gabapentin 1st line
PT important

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7
Q

How to test if a fluid is CSF in trauma?

A

Check for glucose at bedside

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8
Q

Blood tests in neuroleptic malignant syndrome?

A

Raised CK and leukocytosis

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9
Q

How does neuroleptic malignant syndrome present?

A

FEVER
Fever
Encephalopathy
Vitals (SNS activity inc)
Elevated CK
Rigidity

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10
Q

Initial treatment for PD?

A

Levodopa

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11
Q

What is the most common complication of meningitis?

A

Sensorineural hearing loss

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12
Q

Which nerve is affected in ‘Saturday night palsy’?

A

Radial nerve

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13
Q

What is the management for myasthenia gravis?

A

Long acting acetylcholinesterase inhibitors eg pyridostigmine

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14
Q

Medical management in paediatric status epilepticus?

A
  1. Buccal midazolam
  2. IV lorazepam
  3. IV phenytoin, keppra or sodium valproate
  4. Rapid sequence induction of anaesthesia using thiopental sodium
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15
Q

what are the 4 1st line medications for neuropathic pain?

A

duloxetine, amitriptyline, gapapentin and pregabalin
if one doesn’t work, try the others

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16
Q

what is the management for an acute myasthenic crisis?

A

IVIg, plasmapheresis

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17
Q

what type of brain bleed does fluctuating consciousness suggest?

A

subdural haemorrhage

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18
Q

trigger for cluster headaches?

A

alcohol

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19
Q

what is the test for carotid stenosis?

A

carotid USS

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20
Q

what is the management for carotid stenosis?

A

endarterectomy

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21
Q

which blood vessel causes extradural haemorrhage?

A

middle meningeal artery

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22
Q

which bone injury is associated with extradural haemorrhage?

A

fracture of temporal bone

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23
Q

which vessels cause subdural haemorrhage?

A

bridging veins

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24
Q

what is the shape of a subdural haemorrhage on CT?

A

crescent

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25
Q

at what GCS should securing the airway be considered?

A

> /8

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26
Q

what illicit drug is associated with SAH?

A

cocaine

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27
Q

what blood condition is associated with SAH?

A

sickle cell anaemia

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28
Q

what kidney condition is associated with SAH?

A

PKD

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29
Q

first line ix for SAH?

A

CT head

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30
Q

next test in SAH if CT head is negative? findings?

A

LP
- raised red cell count
- xanthochromia

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31
Q

medication to prevent vasospasm in SAH?

A

nimodipine

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32
Q

what is the abnormal pupil response in optic neuritis?

A

relative afferent pupillary defect

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33
Q

visual field defect in optic neuritis?

A

central scotoma

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34
Q

what is a single episode of MS called?

A

clinically isolated syndrome

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35
Q

pathophysiology of MS?

A

demyelination in the CNS

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36
Q

3 disease patterns in MS?

A

relapsing-remitting
secondary progressive
primary progressive

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37
Q

ix for MS?

A

MRI
LP

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38
Q

finding in the CSF in MS?

A

oligoclonal bands

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39
Q

tx of relapses in MS?

A

methylprednisolone

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40
Q

most common type of MND?

A

amylotropic lateral sclerosis

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41
Q

how is MND diagnosed?

A

clinically

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42
Q

licensed medication to slow progression of MND?

A

riluzole

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43
Q

tx to support breathing at night in MND?

A

NIV

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44
Q

LMN signs in MND?

A

fasciculations
muscle wasting

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45
Q

UMN signs in MND?

A

brisk reflexes
spasticity
upgoing plantars

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46
Q

classic triad of parkinsons features?

A

rigidity
bradykinesia
resting tremor

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47
Q

name for facial masking in PD?

A

hypomimia

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48
Q

PD plus syndrome with autonomic dysfunction?

A

multiple system atrophy

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49
Q

PD plus syndrome with varying alertness?

A

lewy body dementia

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50
Q

what is levodopa usually combined with in PD tx?

A

peripheral decarboxylase inhibitor
eg carbidopa and benserazide

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51
Q

3 examples of dyskinesias in PD?

A

dystonia, chorea and athetosis

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52
Q

what type of drug is entacapone?

A

COMT inhibitor

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53
Q

what type of drug is bromocriptine?

A

dopamine agonist

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54
Q

what type of drugs are selegiline and rasagiline?

A

MAO-B inhibitors

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55
Q

what type of tremor is 4-6Hz?

A

PD tremor

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56
Q

what type of tremor is worse at rest?

A

PD

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57
Q

what type of tremor improves with alcohol?

A

essential tremor

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58
Q

what type of tremor is asymmetrical?

A

PD

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59
Q

what type of tremor worsens on intentional movements?

A

essential tremor

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60
Q

mgt options for essential tremor?

A

propranolol
primidone

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61
Q

diagnostic tests for epilepsy?

A

EEG and MRI

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62
Q

additional features of tonic-clonic seizures?

A

tongue biting
incontinence
post ictal period
groaning

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63
Q

first line to prevent tonic-clonic seizures?

A

sodium valproate

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64
Q

type of seizure associated with memory flashbacks?

A

focal seizures

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65
Q

type of seizure associated with unresponsive staring?

A

absence seizures

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66
Q

type of seizure associated with ‘drop attacks’?

A

atonic seizure

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67
Q

type of seizure associated with muscle jerks?

A

myoclonic seizure

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68
Q

highly teratogenic epilepsy drug?

A

sodium valproate

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69
Q

first line generalised epilepsy medication for women of childbearing potential?

A

lamotrigine or levetiracetam

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70
Q

first line for focal seizures?

A

lamotrigine or keppra

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71
Q

first line for absence seizures?

A

ethosuximide

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72
Q

first line for myoclonic seizures?

A

sodium valproate (men)
levetiracetam (FCP)

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73
Q

drug for status epilepticus in community?

A

buccal midazolam or rectal diazepam

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74
Q

first line for tonic or atonic seizures?

A

sodium valproate
lamotrigine

75
Q

drug for status epilepticus in hospital?

A

IV lorazepam

76
Q

treatment options for neuropathic pain?

A

amitriptyline
duloxetine
gabapentin
pregabalin

77
Q

when would you use carbamazepine for neuropathic pain?

A

trigeminal neuralgia

78
Q

dx: 59 year old fractured wrist in fall. Noticed pain, skin flushing, swelling and unusual hair growth in area during recovery

A

complex regional pain syndrome

79
Q

name for experiencing pain from stimuli that are not normally painful?

80
Q

is facial nerve palsy an upper or lower MN pathology?

A

lower
-> forehead is affected

81
Q

idiopathic cause of facial nerve palsy?

A

bells palsy

82
Q

tx of bells palsy?

A

prednisolone if within 72h

83
Q

facial nerve palsy with vesicular rash around ear?

A

ramsay hunt syndrome

84
Q

treatment for ramsay hunt syndrome?

A

prednisolone
aciclovir

85
Q

key causes of UMN pathology?

A

stroke
tumour

86
Q

why are lubricating eye drops required in facial nerve palsy?

A

prevent the eye drying out and exposure keratopathy

87
Q

sign of raised ICP on fundoscopy?

A

papilloedema

88
Q

location of a brain tumour causing personality changes?

A

frontal lobe

89
Q

most malignant type of brain tumour?

A

glioblastoma

90
Q

name for tumour of the membranes around the brain?

A

meningioma

91
Q

typical sx of acoustic neuroma?

A

unilateral hearing loss
tinnitus
balance problems

92
Q

which cancers most commonly metastasise to brain?

A

lung
breast
renal cell carcinoma
melanoma

93
Q

dx: 37 yo lady with uncontrolled movts, falls and difficulty speaking

A

huntington’s chorea

94
Q

inheritance pattern of huntington’s?

A

autosomal dominant

95
Q

what type of genetic disorder is huntingtons?

A

trinucleotide repeat disorder

96
Q

name for earlier age of onset and inc severity in later generations?

A

anticipation

97
Q

pathophysiology of myasthenia gravis?

A

autoantibodies attack ach receptors on postsynaptic membrane

98
Q

most affected muscle groups in MG?

A

proximal muscles and small muscles of the head and neck

99
Q

most common antibodies in MG?

A

acetylcholine receptor antibodies

100
Q

tumour associated with myasthenia gravis?

101
Q

specific test for myasthenia gravis?

A

edrophonium test

102
Q

examples of reversible acetylcholinesterase inhibitors (for MG)?

A

pyridostigmine
neostigmine

103
Q

surgical tx for myasthenia gravis?

A

thymectomy

104
Q

moab tx for MG?

105
Q

pathophysiology of lambert eaton myasthenic syndrome?

A

autoantibodies attack calcium channels in presynaptic NMJ

106
Q

notable cause of lambert eaton syndrome?

A

small cell lung cancer

107
Q

key symptom of LAMS?

A

muscle weakness

108
Q

most affected skeletal muscles in LAMS?

A

proximal muscles (notably in legs)

109
Q

commonly affected muscle groups in LAMS?

A

intraocular muscles (diplopia)
levator muscles (ptosis)
oropharyngeal muscles (dysarthria + dysphagia)

110
Q

tendon reflexes in LAMS?

111
Q

what is post-tetanic potentiation (LAMS)?

A

reflexes improve after strong contraction of associated muscles

112
Q

medication for LAMS?

A

amifampridine (cholinergic receptor stimulator)

113
Q

dx: 35 year old with weakness in lower legs and peripheral sensory loss

A

charcot-marie-tooth disease

114
Q

pattern of inheritance of CMT?

A

autosomal dominant

115
Q

lower leg/foot signs in CMT?

A

pes cavus (high foot arches)
distal muscle wasting

116
Q

reflexes in CMT?

117
Q

7 causes of peripheral neuropathy?

A

ABCDE
Alcohol
B12 deficiency
Cancer, CKD
Diabetes, drugs (eg isoniazid)
Every vasculitis

118
Q

dx:26 year old presents with weakness and loss of sensation spreading up from her feet. she had an episode of gastroenteritis 3 weeks ago

A

guillain-barre syndrome

119
Q

type of cell that produces antibodies in GBS?

120
Q

key triggering pathogens in GBS?

A

campylobacter jejuni
CMV
EBV

121
Q

investigations to support GBS diagnosis?

A

nerve conduction studies
LP

122
Q

finding on CSF in GBS?

A

raised protein

123
Q

main tx for GBS?

124
Q

skin signs in neurofibromatosis type 1?

A

neurofibroma
cafe-au-lait spots
axillary freckling

125
Q

eye sign in neurofibromatosis type 1?

A

iris hamartomas (lisch nodules)

126
Q

what chromosome is the gene for NFT1 on?

127
Q

what protein does the gene for NFT1 code for?

A

neurofibromin (tumour suppressor gene)

128
Q

inheritance pattern of neurofibromatosis type 1?

A

autosomal dominant

129
Q

diagnosis associated with schwannomas?

A

neurofibromatosis type 2

130
Q

bilateral tumours with neurofibromatosis type 2?

A

bilateral acoustic neuromas

131
Q

skin signs associated with tuberous sclerosis?

A

poliosis
ash leaf spots
angiofibromas
(shagreen patches, subungual fibromata, cafe-au-lait spots)

132
Q

affected genes in tuberous sclerosis?

A

TSC1 gene - hamartin
TSC2 gene - tuberin

133
Q

tuberous sclerosis pathology in the heart?

A

rhabdomyomas

134
Q

tuberous sclerosis pathology in the brain?

135
Q

tuberous sclerosis pathology in the kidneys?

A

polycystic kidneys

136
Q

tuberous sclerosis pathology in the retina?

A

hamartomas

137
Q

tuberous sclerosis pathology in the lungs?

A

lymphangioleiomyomatosis

138
Q

key symptom of tuberous sclerosis requiring tx?

139
Q

first line management for trigeminal neuralgia?

A

carbamazepine

140
Q

stages of migraine with aura?

A

prodrome/premonitory
aura
headache
resolution
postdrome/recovery

141
Q

name for migraine with limb weakness?

A

hemiplegic migraine

142
Q

mechanism of triptans?

A

5ht receptor agonist

143
Q

options for migraine prophylaxis?

A

propranolol
topiramate
amitriptyline

144
Q

symptoms associated with cluster headaches?

A

red swollen watery eye
miosis
ptosis
nasal discharge
facial sweating

145
Q

triggers for cluster headaches?

A

alcohol, strong smells, exercise

146
Q

acute management for cluster headaches?

A

triptans
high flow oxygen

147
Q

prophylaxis options for cluster headaches?

A

verapamil
lithium
prednisolone

148
Q

which drugs worsen myasthenia gravis?

A

beta blockers
several antibiotics
antimalarials
lithium

149
Q

Patients with a thrombus in which location are more likely to benefit from thrombectomy?

A

proximal middle cerebral artery
or internal carotid artery

150
Q

what type of speech is associated with myasthenia gravis?

A

nasal speech

151
Q

features of subacute combined degeneration of the spinal cord?

A

dorsal column - distal tingling/burning/sensory loss, impaired proprioception and vibration sense
lateral corticospinal - muscle weakness, hyperreflexia, spasticity. UMN signs etc
spinocerebellar - sensory ataxia - gait abnormalities, positive romberg’s sign

152
Q

what does 4th nerve palsy cause?

A

defective downward gaze
vertical diplopia

153
Q

what does 3rd nerve palsy cause?

A

down and out

154
Q

what does 6th nerve palsy cause?

A

defective abduction
-> horizontal diplopia

155
Q

what is the major risk with withholding levodopa?

A

can precipitate neuroleptic malignant syndrome

156
Q

homonymous quadrantanopias mnemonic?

A

PITS
parietal - inferior
temporal - superior

157
Q

if a patient has a homonymous quadrantanopia, is it ipsilateral or contralateral?

A

contralateral
eg right parietal = left inferior HQ

158
Q

pathophysiology of huntingtons?

A

trinucleotide repeat disorder
degeneration of the cholinergic and GABAergic neurones in the striatum of the basal ganglia
defect in huntingtin gene on chromosome 4

159
Q

what type of organism is n. meningitidis?

A

gram negative diplococci

160
Q

signs of 3rd nerve palsy?

A

ptosis
down and out eye
dilated, fixed pupil
(unable to adduct)

161
Q

IV nerve palsy?

A

defective downward gaze
-> vertical diplopia

162
Q

VI nerve palsy?

A

defective abduction
-» horizontal diplopia

163
Q

dx: patient presents post head injury, is okay then rapidly deteriorates

A

extradural haematoma

164
Q

MS investigations?

A

MRI brain with contrast - look for demyelinating lesions
CSF- oligoclonal bands

165
Q

if recent blood levels of normal epilepsy medication is normal for a patient in status who hasn’t responded to 2 doses of lorazepam, what do you do?

A

give a diff 2nd line drug like keppra or phenytoin

166
Q

bitemporal hemianopia with predominantly upper quadrant defect?

A

pituitary tumour

167
Q

bitemporal hemianopia with predominantly lower quadrant defect?

A

craniopharyngioma

168
Q

tx for wernicke’s encephalopathy????

169
Q

tx for alcohol withdrawal???

A

chlordiazepoxide

170
Q

where in the brain should MRI be focussed for acoustic neuroma?

A

cerebellopontine angle

171
Q

appearance of chronic subdural haematoma on CT?

A

hypodense (dark)
crescentic collection
around convexity of the brain

172
Q

patient with blood results showing macrocytic anaemia with low b12, next test you do?

A

intrinsic factor antibodies for pernicious anaemia

173
Q

serious dermatological s/e of lamotrigine?

A

stevens johnson syndrome

174
Q

medication for IIH?

A

acetozolamide

175
Q

mgt for brain abscess?

A

IV ceftriaxone and metronidazole

176
Q

neurological features of GBS?

A

hyporeflexia
progressive symmetrical weakness of all limbs
mild sensory sx eg distal paraesthesia

177
Q

GBS causative organism?

A

campylobacter jejuni

178
Q

mgt of acute relapse in MS?

A

high dose steroids - IV or oral methyprednisolone

179
Q

score that measures disability or dependence in activities of daily living in stroke patients

A

barthel index

180
Q

damage of what nerve in mid shaft humeral fracture?

A

radial nerve -> wrist drop

181
Q

is the tremor asymmetrical or symmetrical in parkinsons?

A

asymmetrical

182
Q

symptoms of autonomic dysreflexia?

A

severe hypertension and flushing and sweating above the level of injury

Daisy Finals Revision (25 decks)

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