Neurology Flashcards
Differentiate between essential tremor and Parkinson’s tremor.
Essential tremor is worse with arms outstretched, Parkinson’s tremor at rest.
What is the management for a confirmed ischemic stroke within 4.5 hours?
Thrombolysis with alteplase + thrombectomy
Describe the classic features of Bell’s palsy.
Forehead and lip droop, post-auricular pain, hyperacusis, altered taste
Which type of head bleed has a lucid interval
Extradural haematoma
What is seen on brain CT in subdural haematoma
crescent-shaped
What are the cardinal signs of meningitis?
Neck stiffness, photophobia, headache, fever.
Describe the appearance of CSF in bacterial meningitis
Cloudy, turbid with high protein and low glucose
What does a CN III palsy indicate in the context of head injury
Eye down, out, and dilated; suspect extradural/epidural hematoma.
Name the components of the classic triad in Cavernous Sinus Syndrome.
Vision loss, pain, ophthalmoplegia.
What is the most common type of multiple sclerosis?
Relapsing-Remitting Multiple Sclerosis (RRMS).
Identify the triad in Guillain-Barre Syndrome.
Rapid muscle weakness, sensory changes, after infection.
What is the characteristic finding in Lambert-Eaton myasthenic syndrome?
Weakness that improves with exercise, particularly in lower limbs
What are the common features of Progressive Supranuclear Palsy?
Backward falls, problems with vision, speech, and swallowing.
What is the classic presentation of Amyotrophic Lateral Sclerosis (ALS)?
Muscle weakness, atrophy, stiffness, spastic ataxic gait.
Describe the classic triad in Tuberous Sclerosis.
Ash-leaf spots, shagreen patches, facial angiofibromas.
Differentiate between NF1 and NF2 in Neurofibromatosis.
NF1 - café-au-lait spots, NF2 - bilateral vestibular schwannomas.
What is the first-line treatment for trigeminal neuralgia?
Carbamazepine
Name the medication used for prophylaxis in cluster headaches.
Verapamil
Define the classic triad of symptoms in trigeminal neuralgia.
Sudden severe, stabbing pain along V2/V3, triggered by touch.
Name the common cause of bacterial meningitis in adults.
Neisseria meningitidis.
Differentiate between acute and normal-pressure hydrocephalus.
Acute - raised ICP symptoms, normal-pressure - dementia, ataxia, incontinence.
What is the management for myasthenia gravis?
Pyridostigmine.
Identify the typical symptoms of Lewy body dementia.
Hallucinations and Parkinsonism.
What is the mainstay treatment for Parkinson’s disease?
Levodopa + domperidone for nausea and vomiting.
Define Todd’s paresis in the context of epilepsy.
Postictal weakness following a seizure.
What are the distinctive features of multiple sclerosis?
Gradual visual disturbances, peculiar sensory changes, relapses and remissions.
Differentiate between tonic-clonic seizures and pseudoseizures.
Tonic-clonic: loss of consciousness, pseudoseizures: no loss of consciousness.
Define Degenerative Cervical Myelopathy.
Smoking-related spinal cord compression; pain, motor deficits, sensory deficits.
Describe the classic presentation of Syringomyelia.
Shawl-like sensation loss, particularly pain and temperature.
What are the cardinal symptoms of vestibular schwannoma?
Vertigo, sensorineural hearing loss, tinnitus.
How does hydrocephalus present with raised pressure?
Headache, nausea, blurred vision, papilloedema.
What is the primary pharmacological treatment for Alzheimer’s disease?
Acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine).
Describe the key features of vascular dementia.
Abrupt onset, stepwise decline, focal neurological signs.
Identify the most common subtype of frontotemporal dementia.
Pick’s Disease, characterized by personality change, impaired social conduct, and weight gain.
Differentiate between frontal, parietal, temporal, and occipital seizures.
Frontal - motor symptoms; Parietal - sensory symptoms; Temporal - ‘HEAD’ (Hallucinations, Epigastric rising/Emotional, Automatisms, Deja vu); Occipital - affects eyes.
What is the primary treatment for migraines?
Acute: sumatriptan; Prophylaxis: topiramate or propranolol.
Describe the typical presentation of myasthenia gravis.
Gradual muscle weakness, often starting with extraocular and facial muscles, worsens with exercise.
Differentiate between Parkinson’s disease and Parkinson-plus syndromes.
Parkinson’s disease - bradykinesia, tremor, rigidity; Parkinson-plus syndromes - additional features like backward falls (MSA), vision problems (PSP).
What is the primary pathology in Guillain-Barre Syndrome?
Acute autoimmune demyelination of peripheral nerves.
What is the first-line treatment for Bell’s palsy?
Prednisolone + artificial tears.
Define Cauda Equina syndrome.
Lower back pain, bladder and bowel disturbance, saddle anesthesia; requires urgent MRI.
Which patients need urgent CT head and review in TIA-like symptoms (relieved within 24 hours)?
Patients on anticoagulant medication as there is most likely a haemorrhagic root cause
dentify the characteristic features of a TACS (Total Anterior Circulation Stroke).
unilateral weakness, homonymous hemianopia, higher cerebral dysfunction.
What are the common features of vasovagal syncope?
Stress-triggered, twitching or jerking of limbs, rapid recovery, short postictal period.
What is seen on CT head in extradural haematoma
lens-shaped biconvex disc
What are the primary symptoms of subarachnoid hemorrhage?
Thunderclap headache, meningeal irritation, often associated with aneurysm
Differentiate between Alzheimer’s disease and vascular dementia in terms of onset.
Alzheimer’s - gradual onset; Vascular - abrupt onset.
Differentiate between extradural and subdural hematomas.
Extradural - arterial bleed, lucid interval; Subdural - venous bleed, crescent-shaped.
What is the primary antibiotic for bacterial meningitis in the community?
Benzylpenicillin.
Which exam can be used to distinguish vestibular neuronitis from posterior circulation stroke
HiNTs exam
What is the TIA management of a patient presenting to their GP within 7 days of symptomology?
300 mg aspirin + specialist review within 7 days
Which type of stroke leads to lower limb symptomology, but no face or speech impairment?
Anterior cerebral artery stroke
Which antibiotic should you be careful of prescribing in epileptics?
Ciprofloxacin lowers the seizure threshold
Which drug is used palliatively in Headache caused by raised intracranial pressure due to brain cancer
Dexamethasone
Which type of stroke causes Weber’s syndrome (CNIII palsy + contralateral limb weakness)
Posterior cerebral
Which anti-emetic should be used in Parkinsons
Domperidone
What may be seen on U&Es in SAH?
Hyponatraemia
Which co-prescribed medication can lead to lithium toxicity
Thiazides
Symptoms seen in lithium toxicity
Coarse tremor, diarrhoea, vomiting, muscle twitching and ataxia
Which type of dementia presents with fluctuating cognition
Lewy body dementia
CT head aside, what should be a 1st line blood test in TIA to rule out a key differential?
Blood glucose - hypoglycaemia can cause focal neurological symptoms
Which lung condition is associated with dermatomyositis?
Lung fibrosis
Which blood marker is raised in dermatomyositis?
Anti-Jo1
How do we define dermatomyositis by findings?
Myositis (inflamed muscles, causing weakness) + Anti-Jo1 + Raynaud’s / mechanic’s hand (thickened and cracked skin on hands)
In MS and optic neuritis, do you use contrast or non-contrast enhanced MRI?
Contrast
Which classification of medications is associated with mortality in dementia?
Antipsychotics
Antibiotics used in meningitis
Benzylpenicillin (community), IV ceftriaxone (hospital)
Which cranial nerve is most likely to be affected in a middle cerebral infarct?
Facial nerve
Which visual defect is seen in left MCA infarct?
Right homonomous hemianopia
What happens to reflexes in MCA infarct and why?
Hyperreflexia (ie brisk) - ↓ descending central nervous system input into the reflex arc, leading to an uninhibited reflex response
What happens to the plantar reflex in MCA infarct?
Upwards facing/Babinski’s sign
Common side effects of Levodopa?
GI upset, nausea, on-off phenomenon, end of dose dyskinesia, hallucination, postural hypotension, palpitations
How do we minimise SE of L-dopa?
Co-prescribe a Peripheral DOPA Decarboxylase Inhibitor (e.g. Carbidopa)
Other than L-Dopa, which drugs are used in Parkinsons
Dopamine Receptor Agonists e.g. Ropinirole
MAO-B Inhibitor e.g. Selegiline
Anticholinergics e.g. Amantadine
Domperidone for N+V
Non-neurological complications of stroke
Aspiration pneumonia
DVT/PE due to immobility
Communication difficulties due to dysphasia and dysarthria
Depression
Bed sores due to immobility
Complications of menigococcal septicaemia
Septic shock / hearing loss / seizures/ intellectual impairment
Appearance of CSF in TB meningitis and white cell present in tests
Cloudy and viscous - lymphocytes
What is the pathological basis of Parkinson’s disease?
Progressive degeneration of dopaminergic neurons in the substantia nigra
What is the main sign on U&Es of anorexia nervosa?
Hypokalaemia
Risk factors for refeeding syndrome
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
U&Es seen in refeeding syndrome
This leads to hypophosphatemia, hypokalaemia, and hypomagnesemia
Mechanism of action of refeeding syndrome
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
What type of dysphasia is seen in Broca’s and Wernicke’s
Broca’s = expressive dysphasia; Wernicke’s = Receptive dysphasia
Define a stroke
A rapidly developing focal neurological deficit of vascular origin lasting over 24 hours or resulting in death.
RF for stroke
- Increasing age
- Hypertension
- Atherosclerosis
- AF
- DM
- Smoking
- Previous TIA/stroke
- Hypercholesterolaemia
- Cocaine use
- Male
- Asian descent
- Carotid artery stenosis
Symptom pattern seen in Brown Sequard Syndrome
Unilateral spastic paresis and loss of proprioception/vibration sensation with loss of pain and temperature sensation on the opposite side
Define a seizure (3)
Transient episodes of abnormal electrical activity in the brain
What should patients with epilepsy avoid?
Baths, swimming, heights
Management of elderly patient after a fall
Strength and Balance training / Home Hazard Assessment / Med Review / Vision Assessment
Where does the bleed come from in an extradural bleed?
Middle meningeal artery
Criteria used in MS diagnosis
McDonald’s criteria
What is seen in CSF in MS?
Oligoclonal bands
Which cells are affected in MS?
Oligodendrocytes
Median nerve root
C6-T1
Describe the pain pattern in carpal tunnel syndrome
- Worse at night
- Gradually worsening
- Intermittent
- Relived by shaking hand
Risk factors for carpal tunnel syndrome
- 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
Why is palmar sensation unaffected in carpal tunnel syndrome?
The palmar cutaneous branch of the median nerve does not pass through the carpal tunnel
What is “coning” in extradural haematoma
(Raised intracranial pressure causes)
Herniation of the cerebellar tonsils through the foramen magnum Leads to compression to the brainstem
(and respiratory arrest)
