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Neurology Flashcards

1
Q

Differentiate between essential tremor and Parkinson’s tremor.

A

Essential tremor is worse with arms outstretched, Parkinson’s tremor at rest.

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2
Q

What is the management for a confirmed ischemic stroke within 4.5 hours?

A

Thrombolysis with alteplase + thrombectomy

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3
Q

Describe the classic features of Bell’s palsy.

A

Forehead and lip droop, post-auricular pain, hyperacusis, altered taste

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4
Q

Which type of head bleed has a lucid interval

A

Extradural haematoma

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5
Q

What is seen on brain CT in subdural haematoma

A

crescent-shaped

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6
Q

What are the cardinal signs of meningitis?

A

Neck stiffness, photophobia, headache, fever.

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7
Q

Describe the appearance of CSF in bacterial meningitis

A

Cloudy, turbid with high protein and low glucose

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7
Q

What does a CN III palsy indicate in the context of head injury

A

Eye down, out, and dilated; suspect extradural/epidural hematoma.

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8
Q

Name the components of the classic triad in Cavernous Sinus Syndrome.

A

Vision loss, pain, ophthalmoplegia.

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9
Q

What is the most common type of multiple sclerosis?

A

Relapsing-Remitting Multiple Sclerosis (RRMS).

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10
Q

Identify the triad in Guillain-Barre Syndrome.

A

Rapid muscle weakness, sensory changes, after infection.

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11
Q

What is the characteristic finding in Lambert-Eaton myasthenic syndrome?

A

Weakness that improves with exercise, particularly in lower limbs

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12
Q

What are the common features of Progressive Supranuclear Palsy?

A

Backward falls, problems with vision, speech, and swallowing.

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13
Q

What is the classic presentation of Amyotrophic Lateral Sclerosis (ALS)?

A

Muscle weakness, atrophy, stiffness, spastic ataxic gait.

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14
Q

Describe the classic triad in Tuberous Sclerosis.

A

Ash-leaf spots, shagreen patches, facial angiofibromas.

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15
Q

Differentiate between NF1 and NF2 in Neurofibromatosis.

A

NF1 - café-au-lait spots, NF2 - bilateral vestibular schwannomas.

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16
Q

What is the first-line treatment for trigeminal neuralgia?

A

Carbamazepine

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17
Q

Name the medication used for prophylaxis in cluster headaches.

A

Verapamil

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18
Q

Define the classic triad of symptoms in trigeminal neuralgia.

A

Sudden severe, stabbing pain along V2/V3, triggered by touch.

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19
Q

Name the common cause of bacterial meningitis in adults.

A

Neisseria meningitidis.

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20
Q

Differentiate between acute and normal-pressure hydrocephalus.

A

Acute - raised ICP symptoms, normal-pressure - dementia, ataxia, incontinence.

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21
Q

What is the management for myasthenia gravis?

A

Pyridostigmine.

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22
Q

Identify the typical symptoms of Lewy body dementia.

A

Hallucinations and Parkinsonism.

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23
Q

What is the mainstay treatment for Parkinson’s disease?

A

Levodopa + domperidone for nausea and vomiting.

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24
Q

Define Todd’s paresis in the context of epilepsy.

A

Postictal weakness following a seizure.

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25
Q

What are the distinctive features of multiple sclerosis?

A

Gradual visual disturbances, peculiar sensory changes, relapses and remissions.

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25
Q

Differentiate between tonic-clonic seizures and pseudoseizures.

A

Tonic-clonic: loss of consciousness, pseudoseizures: no loss of consciousness.

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26
Q

Define Degenerative Cervical Myelopathy.

A

Smoking-related spinal cord compression; pain, motor deficits, sensory deficits.

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27
Q

Describe the classic presentation of Syringomyelia.

A

Shawl-like sensation loss, particularly pain and temperature.

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28
Q

What are the cardinal symptoms of vestibular schwannoma?

A

Vertigo, sensorineural hearing loss, tinnitus.

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29
Q

How does hydrocephalus present with raised pressure?

A

Headache, nausea, blurred vision, papilloedema.

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30
Q

What is the primary pharmacological treatment for Alzheimer’s disease?

A

Acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine).

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31
Q

Describe the key features of vascular dementia.

A

Abrupt onset, stepwise decline, focal neurological signs.

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32
Q

Identify the most common subtype of frontotemporal dementia.

A

Pick’s Disease, characterized by personality change, impaired social conduct, and weight gain.

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32
Q

Differentiate between frontal, parietal, temporal, and occipital seizures.

A

Frontal - motor symptoms; Parietal - sensory symptoms; Temporal - ‘HEAD’ (Hallucinations, Epigastric rising/Emotional, Automatisms, Deja vu); Occipital - affects eyes.

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32
Q

What is the primary treatment for migraines?

A

Acute: sumatriptan; Prophylaxis: topiramate or propranolol.

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33
Q

Describe the typical presentation of myasthenia gravis.

A

Gradual muscle weakness, often starting with extraocular and facial muscles, worsens with exercise.

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34
Q

Differentiate between Parkinson’s disease and Parkinson-plus syndromes.

A

Parkinson’s disease - bradykinesia, tremor, rigidity; Parkinson-plus syndromes - additional features like backward falls (MSA), vision problems (PSP).

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35
Q

What is the primary pathology in Guillain-Barre Syndrome?

A

Acute autoimmune demyelination of peripheral nerves.

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36
Q

What is the first-line treatment for Bell’s palsy?

A

Prednisolone + artificial tears.

37
Q

Define Cauda Equina syndrome.

A

Lower back pain, bladder and bowel disturbance, saddle anesthesia; requires urgent MRI.

38
Q

Which patients need urgent CT head and review in TIA-like symptoms (relieved within 24 hours)?

A

Patients on anticoagulant medication as there is most likely a haemorrhagic root cause

39
Q

dentify the characteristic features of a TACS (Total Anterior Circulation Stroke).

A

unilateral weakness, homonymous hemianopia, higher cerebral dysfunction.

40
Q

What are the common features of vasovagal syncope?

A

Stress-triggered, twitching or jerking of limbs, rapid recovery, short postictal period.

41
Q

What is seen on CT head in extradural haematoma

A

lens-shaped biconvex disc

42
Q

What are the primary symptoms of subarachnoid hemorrhage?

A

Thunderclap headache, meningeal irritation, often associated with aneurysm

43
Q

Differentiate between Alzheimer’s disease and vascular dementia in terms of onset.

A

Alzheimer’s - gradual onset; Vascular - abrupt onset.

44
Q

Differentiate between extradural and subdural hematomas.

A

Extradural - arterial bleed, lucid interval; Subdural - venous bleed, crescent-shaped.

45
Q

What is the primary antibiotic for bacterial meningitis in the community?

A

Benzylpenicillin.

46
Q

Which exam can be used to distinguish vestibular neuronitis from posterior circulation stroke

A

HiNTs exam

47
Q

What is the TIA management of a patient presenting to their GP within 7 days of symptomology?

A

300 mg aspirin + specialist review within 7 days

48
Q

Which type of stroke leads to lower limb symptomology, but no face or speech impairment?

A

Anterior cerebral artery stroke

49
Q

Which antibiotic should you be careful of prescribing in epileptics?

A

Ciprofloxacin lowers the seizure threshold

50
Q

Which drug is used palliatively in Headache caused by raised intracranial pressure due to brain cancer

A

Dexamethasone

51
Q

Which type of stroke causes Weber’s syndrome (CNIII palsy + contralateral limb weakness)

A

Posterior cerebral

52
Q

Which anti-emetic should be used in Parkinsons

A

Domperidone

53
Q

What may be seen on U&Es in SAH?

A

Hyponatraemia

54
Q

Which co-prescribed medication can lead to lithium toxicity

A

Thiazides

55
Q

Symptoms seen in lithium toxicity

A

Coarse tremor, diarrhoea, vomiting, muscle twitching and ataxia

56
Q

Which type of dementia presents with fluctuating cognition

A

Lewy body dementia

57
Q

CT head aside, what should be a 1st line blood test in TIA to rule out a key differential?

A

Blood glucose - hypoglycaemia can cause focal neurological symptoms

58
Q

Which lung condition is associated with dermatomyositis?

A

Lung fibrosis

59
Q

Which blood marker is raised in dermatomyositis?

A

Anti-Jo1

60
Q

How do we define dermatomyositis by findings?

A

Myositis (inflamed muscles, causing weakness) + Anti-Jo1 + Raynaud’s / mechanic’s hand (thickened and cracked skin on hands)

61
Q

In MS and optic neuritis, do you use contrast or non-contrast enhanced MRI?

A

Contrast

62
Q

Which classification of medications is associated with mortality in dementia?

A

Antipsychotics

63
Q

Antibiotics used in meningitis

A

Benzylpenicillin (community), IV ceftriaxone (hospital)

64
Q

Which cranial nerve is most likely to be affected in a middle cerebral infarct?

A

Facial nerve

65
Q

Which visual defect is seen in left MCA infarct?

A

Right homonomous hemianopia

66
Q

What happens to reflexes in MCA infarct and why?

A

Hyperreflexia (ie brisk) - ↓ descending central nervous system input into the reflex arc, leading to an uninhibited reflex response

67
Q

What happens to the plantar reflex in MCA infarct?

A

Upwards facing/Babinski’s sign

68
Q

Common side effects of Levodopa?

A

GI upset, nausea, on-off phenomenon, end of dose dyskinesia, hallucination, postural hypotension, palpitations

69
Q

How do we minimise SE of L-dopa?

A

Co-prescribe a Peripheral DOPA Decarboxylase Inhibitor (e.g. Carbidopa)

70
Q

Other than L-Dopa, which drugs are used in Parkinsons

A

Dopamine Receptor Agonists e.g. Ropinirole

MAO-B Inhibitor e.g. Selegiline

Anticholinergics e.g. Amantadine

Domperidone for N+V

71
Q

Non-neurological complications of stroke

A

Aspiration pneumonia
DVT/PE due to immobility
Communication difficulties due to dysphasia and dysarthria
Depression
Bed sores due to immobility

72
Q

Complications of menigococcal septicaemia

A

Septic shock / hearing loss / seizures/ intellectual impairment

73
Q

Appearance of CSF in TB meningitis and white cell present in tests

A

Cloudy and viscous - lymphocytes

74
Q

What is the pathological basis of Parkinson’s disease?

A

Progressive degeneration of dopaminergic neurons in the substantia nigra

75
Q

What is the main sign on U&Es of anorexia nervosa?

A

Hypokalaemia

76
Q

Risk factors for refeeding syndrome

A

BMI less than 16 kg/m2
Excessive exercise
Rapid weight loss
Compensatory behaviours (laxative misuse, vomiting) Dehydration
Use of diet pills
Water loading
Fasting for 5+ days

77
Q

U&Es seen in refeeding syndrome

A

This leads to hypophosphatemia, hypokalaemia, and hypomagnesemia

78
Q

Mechanism of action of refeeding syndrome

A

Caused by the sudden introduction of glucose after prolonged starvation.

When blood glucose is low, cell metabolism slows down; when glucose is introduced, it causes insulin to be released, which pushes glucose into cells.

This causes a demand for phosphate, potassium, and magnesium - hypophosphataemia, hypokalaemia, hypomagnesia

79
Q

What type of dysphasia is seen in Broca’s and Wernicke’s

A

Broca’s = expressive dysphasia; Wernicke’s = Receptive dysphasia

80
Q

Define a stroke

A

A rapidly developing focal neurological deficit of vascular origin lasting over 24 hours or resulting in death.

81
Q

RF for stroke

A
  • Increasing age
  • Hypertension
  • Atherosclerosis
  • AF
  • DM
  • Smoking
  • Previous TIA/stroke
  • Hypercholesterolaemia
  • Cocaine use
  • Male
  • Asian descent
  • Carotid artery stenosis
82
Q

Symptom pattern seen in Brown Sequard Syndrome

A

Unilateral spastic paresis and loss of proprioception/vibration sensation with loss of pain and temperature sensation on the opposite side

83
Q

Define a seizure (3)

A

Transient episodes of abnormal electrical activity in the brain

84
Q

What should patients with epilepsy avoid?

A

Baths, swimming, heights

85
Q

Management of elderly patient after a fall

A

Strength and Balance training / Home Hazard Assessment / Med Review / Vision Assessment

86
Q

Where does the bleed come from in an extradural bleed?

A

Middle meningeal artery

87
Q

Criteria used in MS diagnosis

A

McDonald’s criteria

88
Q

What is seen in CSF in MS?

A

Oligoclonal bands

89
Q

Which cells are affected in MS?

A

Oligodendrocytes

90
Q

Median nerve root

A

C6-T1

91
Q

Describe the pain pattern in carpal tunnel syndrome

A
  • Worse at night
  • Gradually worsening
  • Intermittent
  • Relived by shaking hand
92
Q

Risk factors for carpal tunnel syndrome

A
  • Pregnancy
  • Menopause
  • Obesity
  • Repetitive strain injury / vibrational power tools / tendinopathy
  • Inflammatory arthropathy / rheumatoid arthritis
  • Osteoarthritis (osteophytes)
  • Ganglion cysts
  • Previous wrist fractures / trauma
  • Diabetes mellitus
  • Hypothyroidism
  • Acromegaly
  • Smoking
93
Q

Why is palmar sensation unaffected in carpal tunnel syndrome?

A

The palmar cutaneous branch of the median nerve does not pass through the carpal tunnel

94
Q

What is “coning” in extradural haematoma

A

(Raised intracranial pressure causes)
Herniation of the cerebellar tonsils through the foramen magnum Leads to compression to the brainstem
(and respiratory arrest)

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