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MRCP > Neurology > Flashcards

Neurology Flashcards

1
Q

Multiple sclerosis cells affected

A

Oligodendrocytes

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2
Q

3 types of MS

A
  1. relapsing remitting (95%)
  2. primary progressive
  3. secondary progressive
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3
Q

Genetic mutation for MS

A

HLA DRB1

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4
Q

Pathophysiology

A

Astrocytic and macrocytic activation
Causes demyelination

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5
Q

Investigations for MS

A
  1. MRI - demyelination in time and place
  2. CSF oligocloncal bands
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6
Q

Scoring system for MS

A

Kurtzke Expanded disability score

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7
Q

Management of MS

A
  1. DMARD: interferon or glatiramer
    (second line dimethyl fumarate)
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8
Q

Management of primary progressive MS

A

Ocrelizumab in primary progressive

Given IV
Anti CD-20 antibody

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9
Q

Management of secondary progressive MS

A

spionmod

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10
Q

Management of relapse of MS

A

IV Methylprednisolone for 5 days

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11
Q

NPH management

A

Shunt if not suitable for surgery will require frequent CSF taps

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12
Q

Acoustic neuroma symptoms

A
  • unilateral tinnitus
  • hearing loss
  • loss of corneal reflex
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13
Q

Sub acute degeneration of the spinal cord cause

A

Vitamin B12 deficiency

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14
Q

Temporal lobe epilepsy

A

Lip smacking

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15
Q

Frontal lobe epilepsy

A

Jacksonian march

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16
Q

Indications to start DMARDs in MS

A

Relapsing-remitting disease + 2 relapses in past 2 years + able to walk 100m unaided

OR

Secondary progressive disease + 2 relapses in past 2 years + able to walk 10m (aided or unaided)

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17
Q

First line DMARD for MS

A

Natalizumab

(Given IV, recombinant monoclonal antibody against alpha-4 beta-1-integrin found on leucocytes, has the strongest evidence base)

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18
Q

Management of tiredness in MS

A

Amantadine once other causes ruled out

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19
Q

Management of spasticity in MS

A

Baclofen and gabapentin

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20
Q

Management of bladder dysfunction in MS

A

Significant residual volume: self-catheterisation

No significant residual volume: anti-cholinergics

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21
Q

Management of oscillopsia (visual fields oscillating) in MS

A

Gabapentin

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22
Q

Brocas dysphagia (able to comprehend but cannot speak coherently) where in the brain?

A

Inferior frontal gyrus

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23
Q

Imaging for urinary incontinence in MS

A

USS MUST DO BEFORE STARTING MANAGEMENT (anticholinergics may make it worse in some cases)

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24
Q

Good prognostic indicators for MS

A
  • female
  • young age of onset (i.e. 20s or 30s)
  • relapsing-remitting disease
  • sensory symptoms only
  • long interval between first two relapses
  • complete recovery between relapses
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25
Q

MND drug management

A

Riluzole

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26
Q

Riluzole MOA

A

Prevents stimulation of glutamate receptors

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27
Q

Other treatments for MND

A

Non-invasive ventilation, normally BiPAP (can increase life by 7 months)

PEG for feeding

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28
Q

GBS pattern of weakness

A

Ascending

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29
Q

Most common cause of GBS

A

Campylobacter

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30
Q

GBS investigations

A
  1. LP - rise in protein but normal WCC
  2. Nerve conduction studies
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31
Q

GBS nerve conduction findings

A
  1. Decreased motor nerve conduction velocity (due to demyelination)
  2. Prolonged distal motor latency
  3. Increased F wave latency
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32
Q

GBS management

A

Immunoglobulins, also require regular FVC monitoring

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33
Q

anterior cerebral artery presentation

A

contralateral hemiparesis and sensory loss (legs >arms)

34
Q

middle cerebral artery presentation

A

contralateral hemiparesis and sensory loss (arms > legs), contralateral homonymous hemianopia and aphasia

35
Q

posterior cerebral artery presentation

A

contralateral homonymous hemianopia with macular sparing, visual agnosia

36
Q

Webers syndrome

A

(Posterior cerebral artery that supplies the midbrain): ipsilateral CN III palsy, contralateral weakness of upper and lower extremity

37
Q

Wallenburg syndrome

A

Lateral medullary syndrome (posterior inferior cerebellar artery) ipsilateral facial pain and temperature loss, contralateral limb/torso pain, ataxia and nystagmus

38
Q

Lateral pontine syndrome

A

(anterior inferior cerebellar artery): similar to Wallenbergs but also have ipsilateral facial paralysis and deafness

39
Q

Stroke management

A
  1. Rule out haemorrhagic, once ruled out for aspirin 300mg
  2. Thrombolysis if within 4.5 hours
  3. May have thrombectomy if within 6 hours
40
Q

Indications for a thrombectomy

A

Confirmed occlusion of the proximal anterior circulation demonstrated by CTA or MRA if within 6 hours of symptoms and if thrombolysis (if within 4.5 hours)

As soon as possible to people who were last known to be well between 6 and 24 hours if confirmed occlusion of the proximal anterior circulation demonstrated by CTA or MRA AND if there is the potential to salvage brain tissue as shown by imaging such as CT perfusion or diffusion weighted MRI sequences showing limited infarct core volume

41
Q

Long term management of stroke

A

Aspirin 75mg and clopidogrel 75mg

If cannot tolerate clopidogrel for dipyradimole

42
Q

When to offer carotid artery endarectomy

A

If carotid stenosis >70% unilaterally or >50% bilaterally

43
Q

Management of a TIA

A

Aspirin 300mg

44
Q

Long term management of TIA

A

Clopi (unless AF then for DOAC)

45
Q

Further investigation post TIA

A

If more than one TIA or suspected cardioembolic source → need for discussion
If patient has had a suspected TIA in the last 7 days → seen within 24 hours
If has had a suspected TIA more than a week ago → see within 7 days

46
Q

Why is levodopa given with co-careldopa

A

Prevents the peripheral break down and therefore reduces the risk of side effects

47
Q

Parkinsons, consequences of meds

A

End of dose weaning off (decline of motor activity)

On-off phenomenon

Dyskinesia when having the maximum dose

48
Q

Management of restless legs

A

Ensure treated for iron deficiency

Ropinirole/pramipexole

49
Q

First line management for motor symptoms in Parkinsons

A

levodopa and co-careldopa

50
Q

Neurofibromatosis cause of hypertension

A

Phaeochromocytoma

51
Q

SAH investigation

A

CT head, if done <6 hours and normal need to think of other pathology

if >6 hours for LP (needs to be done >12 hours)

then need to work out why a spontaneous SAH –> CT angiogram

52
Q

SAH management

A

Oral nimodipine
Neurovascular coiling

53
Q

Brain abscess management

A

IV ceftriaxone and metronidazole

54
Q

Right incongronous homonymous hemianopeia

A

Incongronous - optic tract
Congronous - optic radiation lesion
Macula sparing: lesion of occipital cortex

55
Q

Superior bitemporal hemianopeia common cause

A

Pituitary tumour

56
Q

Inferior bitermoral hemianopeia common cause

A

Craniopharyngioma

57
Q

Side effect of phenytoin

A

Folate deficiency
Cerebellar symptoms

58
Q

How to distinguish neuromyelitis optica and MS

A

Neuromyelitis optica is NMO IgG positive

59
Q

Palatal myoclonus lesion

A

Olivary nucleus

60
Q

Food bourne botulism mx

A

Heptavelent antitoxin

61
Q

Status epilepticus management

A

IV/IM loraz 4mg or PR diazepam 10mg

62
Q

Forehead sparing where is the lesion

A

UMN

63
Q

Forehead not spared where is the lesion

A

LMN

64
Q

Benign essential tremor management

A

Propranolol or topimarate
(primidone is second line as can cause tiredness)

65
Q

Pontine haemorrhage

A

Pinpoint pupils, severe headache, reduced GCS, no movement of eyes on turning

66
Q

Transient global amnesia

A

Amnesia but is aware of who they are. It is a benign condition, no increased risk of vascular events.

67
Q

Warfarin and antiepileptic

A

Lamotrigine is safe

68
Q

Most common inherited polyneuropathy

A

Charcot-Marie

69
Q

Largest risk factor for stroke

A

AF (rheumatic)

70
Q

Drug management of TIC

A

risperidone

71
Q

Management of a stroke, how long should you take aspirin for

A

aspirin 75mg for 2 weeks then switch to clopidogrel 75mg. If clopi not tolerated then can switch to aspirin and dipyradimole

72
Q

Miller Fisher syndrome

A

Descending paralysis
Eyes normally affected first

73
Q

HSV encephalitis

A

Affects the temporal lobes, petechial haemorrhages can be seen on CT

74
Q

Paraneoplastic cerebellar degeneration

A

Rapidly progressive cerebellar signs + evidence of ovarian carcinoma

75
Q

When to use amantadine in Parkinsons

A

Used to treat dyskinesia in later stages of the disease

76
Q

When to use COMT in Parkinsons

A

Can help with motor fluctuations later in the disease course

77
Q

Best diagnostic test for CJD

A

LP

78
Q

Cavernius sinus thrombosis

A

CN III, IV, V, VII affected

79
Q

Sagittal sinus thrombosis

A

Seizures and bilateral motor deficits

80
Q

Dose of pyridostigmine bromide

A

30mg QDS for 2-4 days if not effective can increase to 60mg qds and if this is ineffective may require oral pred

MRCP (28 decks)

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