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year 3 conditions > neurology > Flashcards

neurology Flashcards

1
Q

how can you differentiate surgical and medical 3rd nerve palsy

A

surgical = painful and causes fixed dilated pupil, can be caused by posterior communicating artery aneurysm
medical = pupil sparing, common cause is diabetes

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2
Q

describe symptoms of midbrain infarct (weber’s syndrome)

A

n ipsilateral third nerve palsy (due to involvement of oculomotor nerve fibres originating in the midbrain)
and contralateral hemiparesis (due to involvement of corticospinal fibres as they pass through the midbrain)

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3
Q

what is chemosis

A

swelling of the tissue that lines the eyelids and surface of the eye

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4
Q

describe symptoms of cavernous sinus thrombosis

A

unilateral ptosis and chemosis
oedema
headache
photophobia

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5
Q

what does the triad of urinary incontinence, dementia and gait abnormality indicate

A

normal pressure hydrocephalus

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6
Q

what is the definitive management for normal pressure hydrocephalus

A

Ventriculo-peritoneal shunting

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7
Q

what does bilateral medial temporal lobe involvement on an MRI indicate

A

encephalitis

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8
Q

what mediation is given to reduce the long term neurological symptoms of meningitis

A

IV dexamethasone

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9
Q

what mediation is given to relatives/close contacts to a pt with meningitis

A

oral ciprofloxacin or rifampicin

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10
Q

what bacteria does an India ink stain show

A

Cryptococcal meningitis

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11
Q

likely cause of meningitis in an immunocompromised pt eg with HIV, who has fibrin web CSF, high protein, normal glucose ad high lymphocytes, but normal CXR and no haemoptysis

A

Cryptococcal meningoencephalitis
(normal CXR and no haemoptysis indicate that its not TB)

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12
Q

Tx for meningitis in a pt with penicillin allergy

A

IV Chloramphenicol
(cefriaxoen is C/I due to cross-reactivity between cephalosporins and penicillin)

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13
Q

what is the common gram positive rod shaped bacteria that causes meningitis

A

listeria monocytogenes

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14
Q

what type of encephalitis do IgM or IgG antibodies in the CSF suggest

A

tick-borne encephalitis

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15
Q

what can be given for status epileptics in the community if IV route can’t be established

A

PR diazepam or Bucal midazolam

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16
Q

pt had stomach upset 2 weeks ago and now has rapidly progressing ascending weakness
diagnosis?

A

guillain barre syndrome

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17
Q

what is used to monitor respiratory muscle involvement in Guillain barre syndrome

A

FVC

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18
Q

which anti epileptic causes gingival hypertrophy, hirsutism and coarsening facial features

A

phenytoin

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19
Q

side effects of levetiracetam

A

drowsiness
headaches
irritation
nausea and vomiting

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20
Q

side effects of carbamazepine

A

drowsiness
ataxia
headache
hyponatraemia
rarely, Stevens-Johnson syndrome

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21
Q

how can temporal lobe epilepsy cause long term memory loss

A

can cause damage to medial temporal lobe structures eg hippocampus - causes long term memory loss

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22
Q

what is west syndrome

A

infantile spasms, which usually start between 4-8 months of age and involve myoclonic jerking (or ‘jack-knife’ spasms) that occur in clusters

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23
Q

preceded by an aura followed by automatisms, including fidgeting of the hands, chewing, lip smacking or swallowing
These episodes would usually be accompanied with altered awareness and subsequent amnesia.
which type of focal epilepsy is this

A

temporal lobe epilepsy

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24
Q

which juvenile epilepsy occurs exclusively in sleep

A

benign Rolandic seizures

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25
Q

cause of tremor on movement but nothing at rest

A

essential tremor

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26
Q

facial weakness, unilateral ear pain and vesicles seen in the ear canal
diagnosis?

A

Ramsay hunt syndrome due to VZV infection (causes inflammation of the geniculate ganglion of the facial nerve)

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27
Q

Tx for Ramsay hunt syndrome due to VZV infection

A

oral antiviral and steroids

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28
Q

first line tx for GBS

A

Iv immunoglobulin and supportive treatment

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29
Q

what is the most important thing to monitor regarding pt prognosis in a pt with GBS

A

FVC

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30
Q

what does an isolated rise in CSF protein indicate

A

GBS

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31
Q

name 5 drugs which cause idiopathic inter cranial HTN

A

Oral contraceptive pill
Steroids
Tetracycline
Vitamin A
Lithium

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32
Q

first line Tx for atonic seizures in women of reproductive age

A

lamotrigine (or levetiracetam)
(sodium valproate is first line for generalised seizures but not for women of reproductive age)

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33
Q

what type of hydrocephalus is caused by problems in the subarachnoid space, often stemming from complications like subarachnoid haemorrhage and infective meningitis.

A

communicating hydrocephalus

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34
Q

where are the common causes of obstruction in obstructive hydrocephalus

A

foramen of Monro (e.g. due to colloid cysts), cerebral aqueduct (e.g. due to aqueduct stenosis), or fourth ventricle (e.g. due to posterior fossa tumour).

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35
Q

dilated lateral ventricles and third ventricle
normal fourth ventricles
headache, no other history
diagnosis?

A

obstructive hydrocephalus due to lesion/obstruction in cerebral aqueduct (aqueduct stenosis)

(obstructive hydrocephalus can affect all the ventricles)
but communicating hydrocephalus would be after meningitis or subarachnoid haemorrhage

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36
Q

what is a secondary generalised seizure

A

secondary to preceding focal seizure

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37
Q

tx for Ramsey hunt syndrome

A

prednisolone and oral acyclovir

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38
Q

LMN facial nerve palsy
ringing noise
vesicles in ear
diagnosis?

A

ramsay hunt syndrome

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39
Q

what is scintillating scotoma

A

visual phenomenon described in patients suffering from migrainous headache
visual hallucination of zigzags starting in centre and moving out to peripheries of vision

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40
Q

what type of lesion does babinskis sign suggest

A

UMN lesion

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41
Q

what is the difference between the movements of the foot that are impaired in peroneal/common fibular nerve palsy and L5 root lesion

A

peroneal/common fibular nerve palsy
= loss of
ankle eversion
ankle dorsiflexion

L5 root lesion
= loss of
ankle eversion
ankle dorsiflexion
ankle inversion
(also causes weakness of hip abduction)

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42
Q

which disorder causes an ascending pattern of weakness that improves on exertion/repetition

A

LEMS (Lambert-eaton syndrome)

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43
Q

which disorder causes descending weakness that fatigues on repletion/sustained action

A

myasthenia gravis

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44
Q

effects of autonomic neuropathy

A

postural hypotension
gastroparesis

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45
Q

effects of spinothalamic tract damage

A

contralateral loss of coarse touch/pain and temperature sensation

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46
Q

effects of peripheral sensory neuropathy

A

glove-and-stocking distribution of sensory loss or paraesthesiae

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47
Q

effects of dorsal column damage

A

ipsilateral loss of fine touch, vibration sense, and proprioception

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48
Q

effects of corticospinal tract damage

A

ipsilateral weakness below the level of the medulla
contralateral weakness above the level of the medulla

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49
Q

what is raised on bloods in an epileptic seizure

A

prolactin

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50
Q

what is the difference between a true epileptic seizure and non epileptic attack disorder

A

true epileptic seizure
- caused by abnormal brain activity
- head remains fixed
- eyes remain open
- post octal confusion / tongue biting / incontinence
- raised prolactin

non epileptic attack disorder
- caused by psychological stress
- pelvic thrusting
- head movements
- eyes closed
- Postictal crying
- normal prolactin

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51
Q

pelvic thrusting, head movements, eyes closed, postictal crying
what kind of seizure/disorder is this

A

non epileptic attack disorder

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52
Q

what is Todds paresis/palsy

A

when there is persistent weakness or paralysis in a part of the body following a seizure

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53
Q

what medication can be given through a cannula for a patient who is in status epilepticus

A

lorazepam
(lorazepam given IV, diazepam given PR)

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54
Q

which nerve is often damaged in fractures of head of fibula

A

common fibular/peroneal nerve

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55
Q

which seizure involves crazy movements and jerking of limbs but no loss consciousness

A

myoclonic

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56
Q

what does reflex anoxic seizure involve

A

faint, causing a brief twitching episode

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57
Q

tx for GBS

A

IV Ig
or plasma exhcnage if they have vit A deficiciency or renal failure

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58
Q

which epilepsy is seen in children 1-2 hours after waking up, triggered by lack of sleep, and which is seen in children during sleep

A

juvenile myoclonic epilepsy
- after waking up
- triggered by lack of sleep
- myoclonic

benign Rolandic seizures
- during sleep
- tonic clonic

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59
Q

what is the cause of a fine bilateral tremor associated with anxiety, hair loss, palpitations and breathlessness

A

thyrotoxicosis

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60
Q

cause of intention tremor, reduced coordination and dysarthria

A

cerebellar ataxia

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61
Q

which tremor starts following a stressful life event

A

psychogenic tremor

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62
Q

what is vital to monitor in GBS and why

A

FVC, the ascending muscle weakness could affect diaphragm which could then cause resp arrest

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63
Q

what is a coryzal illness

A

inflammation of mucous membranes of nasal cavities

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64
Q

what is the triad for normal pressure hydrocephalus

A

urinary incontinence
dementia
gait abnormality

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65
Q

what medication can be given through cannula for status epilepticus

A

IV lorazepam
(diazepam given PR)

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66
Q

which nerve is damaged in a neck of fibula fracture

A

Common fibular nerve (common peroneal nerve)

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67
Q

which seizure is a faint followed by twitching

A

reflex anoxic seizure

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68
Q

describe consciousness in a myoclonic seizure

A

not affected

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69
Q

which child epilepsy occurs after waking up, and which one occurs during sleep

A

juvenile myoclonic epilepsy
- after waking up
- triggered by lack of sleep
- myoclonic

benign Rolandic seizures
- during sleep
- tonic clonic

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70
Q

what is the cause of a bine bilateral tremor associated with anxiety, hair loss, palpitations, breathlessness

A

thyrotoxicosis

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71
Q

what is the cause of an intention tremor, associated with reduced coordination and dysarthria

A

cerebellar ataxia

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72
Q

which tremor starts after stressful life event

A

psychogenic tremor

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73
Q

why should FVC be monitored in GBS

A

the weakness may spread to diaphragm which causes resp arrest

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74
Q

first line manager t for idiopathic inter cranial hypertension

A

weight loss and close monitoring

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75
Q

how do LMN and UMN lessons affect forehead

A

UMN - forehead sparing
LMN - non forehead sparing

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76
Q

is bells palsy UMN or LMN lesion

A

LMN

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77
Q

give a cause of acute onset unilateral facial drooping with forehead sparing

A

acute stroke

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78
Q

cause of unilateral facial weakness with hypersensitivity to loud sounds

A

Ramsay hunt syndrome

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79
Q

what is the cause of foot drop that involves loss of foot inversion as well as eversion

A

L5 radiculopathy

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80
Q

what is the cause of foot drop that involves loss of sensation over the big toe

A

L5 radiculopathy

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81
Q

what is the cause of foot drop that involves loss of sensation over the lateral calf

A

common perineal nerve palsy

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82
Q

LMN facial palsy with ear pain, hearing loss and vertigo
diagnosis?

A

Ramsay hunt syndrome

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83
Q

what is the likely diagnosis of a hiker that had illness (fever, fatigue muscle/joint pain) and later developed monoarthiritis or facial nerve palsy or neuropathic pain or palpitations

A

Lyme disease

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84
Q

what is the diagnostic sign for GBS

A

albumin-cytologic dissociation
ie raised protein, normal white cell count
(raised WCC would indicate infection, but GBS is usually para-infectious)

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85
Q

pt has urinary incontinence, dementia and gait abnormality
diagnosis?

A

normal pressure hydrocephalus

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86
Q

tx for normal pressure hydrocephalus

A

ventriculo-peritoneal shunting

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87
Q

ix for cauda equina due to metatstases

A

spine MRI (cauda equina due to all causes)
do whole spine MRI rather than just lumbar spine MRI if you think the cause is metastases as you can check the whole spine and pick up multiple lesions if there are some

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88
Q

which seizure involves
Swearing / screaming / laughing
Urinary incontinence
Weakness after the seizure

A

frontal lobe seizure

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89
Q

pt has a seizure which involves repetitively pulling at his shirt
what kind of seizure is this

A

temporal lobe

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90
Q

what is this feature and what type of seizure does it present in
twitching in one area of body, that progresses to involve another area of the body as well

A

Jacksonian march
frontal lobe seizure

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91
Q

CSF: very high proton. normal WCC, normal glucose, normal appearance
diagnosis

A

GBS

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92
Q

pt was complaining of numbness in his fingers and arm, before he lost consciousness and his arms and legs starting jerking.
type of seizure ?

A

Generalised seizure secondary to parietal lobe seizure

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92
Q

tx for Ramsay hunt syndrome

A

acyclovir

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93
Q

what is todds paresis

A

focal unilateral weakness after a seizure - usually frontal lobe seizure

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94
Q

which antiepileptic can cause hepatic dysfunction

A

sodium valproate

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95
Q

which condition can the Tensilon Test diagnose

A

myasthenia gravis

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96
Q

which test confirms Idiopathic inter cranial hypertsenion

A

lumbar puncture - will have high opening pressure
(do imaging of brain first to rule out a space occupying lesion ads that would contraindicate lumbar puncture)

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97
Q

management of pt with IIH that has new onset visual loss

A

optic nerve fenestrations - try to relieve the pressure and improve sight

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98
Q

which type of hydrocephalus is after subarachnoid haemorrhage

A

communicating hydrocephalus

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99
Q

which type of hydrocephalus results from problems with the arachnoid granulations

A

communicating hydrocephalus
(CSF can exit the ventricular system but there is a problem with CSF absorption at the arachnoid granulations)

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100
Q

what is opthalmoplegia

A

paralysis of eye muscles

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101
Q

which condition has a prodrome pf gastroenteritis and presents with a triad of ataxia, areflexia and opthalmoplegia

A

miller fisher syndrome

(Remember that Guillain-Barre starts distally (polyneuropathy) and makes it way up. Miller-Fisher starts proximally i.e. with the eyes)

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102
Q

which antiepileptic can cause renal stones

A

topiramate

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103
Q

which anti epileptic can cause skin rash, ataxia, dysarthria and nystagmus

A

carbamezapine

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104
Q

which anti epileptic can cause Acne, anorexia, constipation, dizziness, gingival hypertrophy, hirsutism, insomnia, rash, tremor.

A

phenytoin

105
Q

proteinuria
oedema
enlarged kidneys
palpitations
cardiomegaly
carpal tunnel syndrome
likely diagnosis?

A

Amyloidosis

106
Q

what is the cause of “violet wide-amplitude flinging movements of the proximal limb” after a stroke

A

Hemiballismus due to stroke in the contralateral side of the brain

107
Q

which lobe is affected in receptive aphasia

A

left temporal lobe
- wernickes area is in the the left temporal lobe

108
Q

which lobe is affected in expressive aphasia

A

left frontal lobe
- broca’s area is in the left frontal lobe

109
Q

pt has stroke and CT head is normal
what does that mean

A

it is a thrombotic stroke not hemorrhagic

110
Q

which syndrome presents with
hoarse voice
difficulty swallowing
changes in taste
ipsilateral constructed pupil and drooping eyelid
ipsilateral loss of pain and temp sensation on face
contralateral loss of pain and temp sensation on limbs

A

Wallenbergs syndrome - infarct/ischaemia of the posterior inferior cerebellar artery (PICA)

111
Q

which 3 features constitute a TACI (Total Anterior Circulation Infarct

A

Contralateral hemiparesis and / or sensory loss
Contralateral homonymous hemianopia that is non-macular sparing
Higher cerebral dysfunction (eg aphasia, neglect)

( If only 2 of these features are present (or there is higher cortical dysfunction alone) the stroke is called a PACI-)

112
Q

aphasia vs dysarthria

A

Aphasia occurs due to brain damage that affects the ability to express and understand speech.
Dysarthria, on the other hand, is a condition that affects the muscles necessary for speech

113
Q

is the basilar artery anterior or posterior circulation

A

posterior

114
Q

symptoms of basillar artery stroke

A

prodromal symptoms 2 weeks before: vertigo, nausea, headaches

115
Q

what is hypocusis

A

partial or total loss of hearing acuity (clarity/clearness)

116
Q

symptoms of basilar artery stroke

A

hemiparesis or quadriparesis, and facial palsies, dizziness, headache, and speech abnormalities
locked in syndrome

117
Q

what is bruising over the mastoid process known as, and what does it indicate

A

Battle sign
suggestive of a skull fracture

118
Q

what is a hemotympanum and what does it indicate

A

presence of blood in the middle ear
clinical feature of a skull fracture

118
Q

what is CSF otorrhea and what does it indicate

A

leakage of CSF from the ear (seen as clear fluid)
clinical feature of a skull fracture.

119
Q

head injury causing an initial loss of consciousness, followed by a lucid interval where the patient appears to have recovered which is then followed by a deterioration in GCS
what type of stroke is this

A

extradural

120
Q

which vessel is the most common cause of an extradural haemorrhage

A

middle meningeal artery

121
Q

what scoring system can be used in someone with AF to assess their risk of a stroke

A

CHA2DS2VASc

122
Q

what scoring system can be used in someone who had a TIA to assess their risk of stroke

A

ABCD2

123
Q

what hereditary condition causes recurrent sprains and joint dislocations and which stroke does it increase the risk of

A

Ehlers dances syndrome
increases risk of Subarachnoid haemorrhage

124
Q

what type of visual loss does a left parietal lobe lesion cause

A

right sided inferior homonymous quadrantanopia

125
Q

what type of visual loss does a left occipital lobe lesion cause

A

right sided homonymous hemianopia with macular sparing

126
Q

what type of visual loss does a left temporal lobe lesion cause

A

right sided superior homonymous hemianopia

127
Q

what should be given to a pt on warfarin after a hemorrhagic stroke

A

stop warfarin
give
IV vitamin K
and
Prothrombin complex concentrate

128
Q

what type of stroke causes
ipsilateral cranial nerve three palsy
and contralateral weakness

A

webers syndrome - midbrain stroke syndrome

129
Q

what are the symptoms of Wallenberg syndrome (lateral medullary syndrome)

A

“DANVAH”
Dysphagia,
ipsilateral Ataxia,
ipsilateral Nystagmus,
Vertigo,
Anaesthesia (Ipsilateral facial numbness and contralateral pain loss on the body)
ipsilateral Horner’s syndrome

130
Q

pt had severe headache and CT head was normal, had LP 12 hours later which showed xanthochromia. what’s the next step

A

CT angiogram

131
Q

what is the difference in symptoms between anterior inferior cerebellar artery stroke and posterior inferior cerebellar artery stroke

A

posterior inferior cerebellar artery stroke (Wallenberg’s ie lateral medullary syndrome)
-“DANVAH”
Dysphagia,
ipsilateral Ataxia,
ipsilateral Nystagmus,
Vertigo,
Anaesthesia (Ipsilateral facial numbness and contralateral pain loss on the body)
ipsilateral Horner’s syndrome

anterior inferior cerebellar artery syndrome
- same as Wallenbergs with the addition of
- ipsilateral facial paralysis
- hearing loss

132
Q

which stroke is almost always due to trauma

A

extradural haemorrhage

133
Q

what is the characteristic clinical course of an extradural haemorrhage

A

Initial brief loss of consciousness following the trauma
A period of regained consciousness and apparent recovery (the lucid interval)
Subsequent deterioration of consciousness and the onset of a headache

134
Q

are extradural haematomas arterial or venous

A

arterial

135
Q

are subdural haematomas arterial or venous

A

venous

136
Q

which vessel is the typical source of bleeding for an extradural haematoma

A

middle meningeal artery

137
Q

are extradural haematomas infratentorial or supratentorial

A

supratentorial

138
Q

typical presentation of subarachnoid haemorrhage on CT scan

A

white area in the centre of the brain that expands bilaterally

139
Q

typical presentation of subdural haemorrhage on CT scan

A

crescent shaped haematoma - not limited by sutures of the skull

140
Q

typical presentation of subarachnoid haemorrhage on CT scan

A

biconvex haematoma which is limited to the skull sutures where the dura adheres to the skull.

141
Q

contrast subarachnoid haemorrhage and intracerebral haemorrhage symptoms

A

Subarachnoid haemorrhage: Characterised by a sudden, severe headache (often described as a ‘thunderclap’ headache), nausea, vomiting, and neck stiffness
(severe headache + meningism)

Intracerebral haemorrhage: Presents with sudden onset severe headache, vomiting, high blood pressure, and signs of increased intracranial pressure
(severe headaches + raised ICP)

142
Q

which surgical procedure can be done for extradural haemorrhage

A

ligation of the bleeding artery

143
Q

what is a lentiform shape and which type of haemtaoma is shaped like this

A

like a lens - convex
extradural haematoma

144
Q

what level do you want co2 to be at during raised ICP

A

normal, so if try to get pt to hyperventilate
bc high Co2 causes vasodilation in the cerebral vessels which increases blood flow to the brain and therefore further increases ICP, you don’t want that

145
Q

what colour is CSf from LP 12 hours after a confirm subarachnoid haemorrhage

A

yellow (or sometime pink)

146
Q

what is a Amaurosis fugax

A

temporary painless loss if vision in eye which returns to normal after - its like a TIA in the eye

147
Q

ipsilateral cranial nerve 3 palsy
and contralateral weakness
diagnosis

A

webers syndrome

148
Q

which scoring system is used to recognise stroke in the acute setting of the emergency department

A

ROSIER

149
Q

what is conductive aphasia

A

there is an isolated inability to repeat
different from Broca or wernicke aphasia

150
Q

what is nominal aphasia

A

inability to correctly name objects

151
Q

what is mannitol used for

A

raised ICP

152
Q

what is contrast vs non contrast Ct head scans used for

A

contrast enhanced CT head
- intracerebral infections
- tumours

non-contrast CT scan
- haemorrhage (stroke)

153
Q

what does tetraplegic mean

A

paralysed in the upper and lower body

154
Q

lesion in which artery can cause tetraplegia with preserved consciousness and only preserved vertical eye movements

A

basillar artery (locked in syndrome)

155
Q

mechanical thrombectomy id most beneficial in thrombi in which 2 arteries

A

proximal middle cerebral artery thrombus
or
internal carotid artery thrombus

156
Q

what is enoxaparin

A

anticoagulant

157
Q

what should the target bp be in a haemorrhagic stroke

A

<140 mmHg

158
Q

when do you start aspirin 300mg in a pt who has been thrombolysed with Iv atleplase

A

24 hrs after thrombolysis

159
Q

when do you start aspirin 300mg in a pt who has presented >4.5 hrs from stroke onset

A

immediately

160
Q

what type os stroke is cerebral amyloid antipathy associated with

A

hemorrhagic stroke

161
Q

what scoring system can be used to assess functional independence of patients after a stroke

A

Barthel Index

162
Q

what is the modified SOAR score used for

A

looks at the short-term mortality of patients after an ischaemic stroke and is measured on a scale of 0–9

162
Q

what is the NIH stroke scale used for

A

to measure the severity of neurology after a stroke. It can be used when patients first present to establish the extent and severity of focal neurology with higher scores indicating higher levels of neurological impairment. It is often used to help clinicians decide whether the severity of the stroke outweighs the risks of giving a patient thrombolysis.

163
Q

what is the DRAGON score used for

A

is used for patients with ischaemic stroke to predict their 3-month prognosis if they are to be thrombolysed with alteplase

164
Q

pt is unable to abduct their right eye
where is the lesion

A

unable to abduct right eye –> lateral rectus muscle doesn’t work –> damage to the abducens nerve which innervates it –> abducens nucleus come out of pons –> lesion in right pons

(Cranial nerve lesions are ipsilateral, except trochlear)

165
Q

which CN come out of midbrain, pons and medulla

A

mid brain: CN 3, 4
pons: CN 5, 6, 7, 8
medulla: CN 9, 10, 11, 12

166
Q

what does loss of grey-white matter differentiation on a CT scan indicate

A

‘loss of grey-white matter differentiation’ = cytotoxic oedema = ischaemia –> ischaemeic stroke

167
Q

best ix for MS

A

MRI brain and spine

168
Q

what phenomena of MS can checking visual evoked potentials reveal

A

optic neuritis

169
Q

which Parkinson’s meds are c/I in pts with impulse control disorders eg gambling addiction

A

dopmine agonists eg ropinerole, pramipexole, apomorphine

170
Q

weakness in legs, patches of sensory loss that come and go, middle aged female pt
likely diagnosis

A

MS

171
Q

progressive weakness with mixed UMN and LMN signs
diagnosis

A

MND

172
Q

what is the parkinsonian triad of symptoms

A

tremor
hypertonia
bradykinesia

173
Q

tremor
hypertonia
bradykinesia
vertical gaze palsy

A

progressive supra nuclear palsy

174
Q

tremor
hypertonia
bradykinesia
fluctuating cognitive impairment and hallucinations

A

Lewy body dementia

175
Q

describe the gait in parkinsons

A

festinating and shuffling gait

176
Q

causes of unilateral and bilateral high stepping gait

A

LMN lesions

Bilateral
- cauda equina
- peripheral neuropathy
- Guillain barre / charocot-maire-tooth

Unilateral
- radiculopathy of L5 root
- neuropathy of the sciatic nerve or common peroneal nerve
- polio at the anterior horn

177
Q

causes of Spastic and circumducting gait

A

MS
space occupying lesions
tumours

178
Q

causes of Spastic and scissoring gait

A

Cord lesions
- due to trauma, compression, syringomyelia or transverse myelitis

Bihemispheric brain lesions
- due to cerebral palsy or multiple sclerosis

179
Q

what type of tremor is worse of resting, and reduced on action, can be assymetrical

A

parksions tremor
(essential tremor is usually bilateral/symmetrical, worse on resting, associated with family history, received by alcohol consumption)

180
Q

which medication for MS can reduce duration and severity of attacks

A

IV methylprednisolone

181
Q

what medication for MS can reduce relapse rate in the long term

A

IV beta interferon

182
Q

what do periventricular lesions on MRI indicate

A

MS

183
Q

factors associated with worse prognosis in MS

A

Older, male, motor signs at onset, early relapses, many MRI lesions and axonal loss

184
Q

which condition is micrographia (abnormally small cramped handwriting) associated with

A

parkinsons

185
Q

tremor
hypertonia
bradykinesia
spontaneous activity or akinetic rigidity of a limb
diagnosis

A

Parkinson plus syndrome –> cortico-basal degeneration

186
Q

what is sporadic MND

A

occurs with no family history

187
Q

what do SOD1mutations cause

A

familial ALS –> MND

188
Q

what is hyperemesis gravidarum

A

persistent severe vomiting leading to weight loss and dehydration, as a condition occurring during pregnancy

189
Q

what could be the cause of wernickes encephalopathy in a pregnant woman

A

hyperemesis gravidarum

190
Q

what should be prescribed to a parksinons pt on levodopa who is experiencing on-off symptoms (motor fluctuations)

A

MAO-B inhibitor eg rasagiline
or OCMT inhibitor
or dopamine agonist eg ropinerole, pramipexole, apomorphine

191
Q

classic cause of raised CSF protein

A

GBS

192
Q

worsening unilateral neck pain
constricted pupil
ptosis
diagnosis?

A

internal carotid dissection, causing horners syndrome

193
Q

which medications can cause acute dystonic reactions

A

dopamine antagonists eg metoclopramide

194
Q

how does lesion in the primary visual cortex affect vision

A

contralateral homonymous hemianopia with macular sparing

195
Q

how does lesion in the lateral geniculate nucleus affect vision

A

contralateral homonymous hemianopia

196
Q

how does lesion in the optic tract affect vision

A

incongruous homonymous hemianopia
eg lesion in left optic tract causes right homonymous hemianopia

197
Q

where is the lesion in optic neuritis

A

optic nerve

198
Q

what is the gene and inheritance pattern of Huntingtons

A

autosomal dominant, defect in HTT gene

199
Q

triad of Huntingtons

A

movement disorder
psychiatric features
depression

200
Q

what is an oculogyric crisis (OGC), common causes and treatment

A

acute dystonic reaction - upward deviation of eyes, sometimes neck extended backwards and mouth fixed in open wide position

commonly caused by use of metoclopramide or haloperidol

tx = procyclidine, benzatropine

201
Q

what is malingering

A

the deliberate faking of symptoms in order to obtain secondary gain

202
Q

pt has difficulty hearing for 6 months, vertigo, reduced sensation of the opthalmic, maxillary, and mandibular divisions of the left trigeminal nerve, reduced taste sensation of the posterior left side of the tongue; and deviation of the uvula to the right
diagnosis?

A

acoustic neuroma

203
Q

back pain associated with leg or buttock pain
relieved by flexion and worse with extension
may have weakness or reduced sensation in certain areas
diagnosis

A

spinal stenosis (which causes spinal claudication)

204
Q

describe onset fo cluster headache vs migraine

A

cluster - sudden onset
migraine - gradual onset

205
Q

where is the lesion in left upper quadrantinopia

A

right temporal lobe

206
Q

where is the lesion in left homonymous hemianopia with macular sparing

A

right occipital lobe

207
Q

sudden intense headache pain when shaving / brushing teeth / touching face / eating ice cream
diagnosis?

A

trigeminal neuralgia

208
Q

unilateral sudden headache pain around eye
profuse eye watering and nasal secretions
diagnosis?

A

cluster headache

209
Q

which conditions is sumatriptan (migraine med) C/I in

A

ischaemic heart disease, hypertension, peripheral vascular disease, previous strokes, and previous myocardial infarctions
(bc sumatriptan causes vasoconstriction)

210
Q

which medications are used first line for neuropathic pain

A

Gabapentin, Pregabalin, Amitriptyline and Duloxetine

211
Q

most common cause of LEMS

A

Small cell lung cancer

212
Q

what is LEMS

A

autoimmune, usually due to underlying malignancy eg SCLC
limb weakness
worse in mornings
dry mouth / impotence / orthostatic hypotension
reduced / absent reflexes

213
Q

what med can be used as symptoms management for LEMS

A

amifampridine

214
Q

LEMS investigations

A

serology for anti-voltage-gated calcium channel antibodies
nerve condition studies - show a doubling of muscle action potential amplitude following exercise
imaging for SCLC

215
Q

LEMS vs myasthenia gravis

A

LEMS
- weakness worse in mornings
- limb weakness
- absent or reduced reflexes
- small response to edrophonium

myasthenia gravis
- fatiguable mucles weakness
- starts with ocular muscle weakness
- persevered reflexes
- proper repose to edrophonium (improves in repose to acetylecholinsterase inhibitors)

216
Q

when exactly should sumatriptan be taken for a migraine

A

should be taken once the headache starts, but not during the aura phase

217
Q

pt presents with severe sudden onset headache and has history of recurrent sprains and shoulder dislocations like her father
diagnosis and explain what’s going on

A

she has Ehlers danlos syndrome
and is experiencing a subarachnoid haemorrhage due to rupture of a berry aneuryrsm (Ehlers danlos causes aneurysms)

218
Q

diminished vibration sensation and proprioception
symmetrical sensory symptoms
some exaggerated and some diminished reflexes
diagnosis

A

subacute combined degeneration of the spinal cord

219
Q

cause of subacute combined degeneration of the spinal cord

A

vit B12 deficiency

220
Q

which tracts are degenerated in subacute combined degeneration of the spinal cord

A

degeneration of the dorsal column and the corticospinal tract

221
Q

tx for subacute combined degeneration of the spinal cord

A

vt b12 replacement

222
Q

function of spinothalamic tract

A

only sensory
- Pain
- Temp
sPinoThalamic

223
Q

function of corticospinal tracts

A

sensory
- proprioception
light touch
vibration

motor
- lateral corticocpinal tract
voluntary movement of contralateral limbs

  • anterior corticospinal tract
    voluntary movement of the trunk
224
Q

function of the dorsal column

A

only sensory
- fine touch
- 2 point discrimination
- proprioception
- vibration

225
Q

what do Kayser-Fleischer rings in eye suggest

A

Wilsons disease

226
Q

which condition is the ATP7B gene linked to

A

Wilsons disease

227
Q

what is Wilsons disease, what are the signs an symptoms, investigations and treatments

A

defective copper metabolism
leads to copper accumulation esp in liver and brain
ATP7B gene mutation

signs/symptoms
- psychiatric / neurological symptoms
- hepatic dysfunction
- kayser-fleischer rings in the eye

investigations
- serum ceruloplasmin (low)
- serum copper levels (low)
- 24hr urinary copper collection (high)
- genetic testing

treatment
- chelators
–> D-penicillamine
–> Trientine
–> Zinc salts

228
Q

crampy leg pain that radiates down the back of legs, is brought on by exercise but improves on bending over our walking uphill
diagnosis

A

spinal claudication

229
Q

what are the antibodies against in LEMS

A

Autoantibodies against presynaptic voltage-gated calcium channel

230
Q

in which condition are Anti-acetylcholine receptor antibodies found

A

myasthenia gravis

231
Q

first line prophylaxis in migraine

A

propanolol
(if asthmatic give topiramate - but don’t give to pregnant or child brawling age)

232
Q

first line prophylaxis for cluster headaches

A

verapamil

233
Q

tx for cluster headaches

A

high flow oxygen or sumatriptan (subcut or intranasal)

234
Q

tx for migraine

A

sumatriptan (oral) + NSAIDs

235
Q

tiredness
weakness in limbs
numbness
increased tone and spasticity in legs
absent angle jerks
macrocytic megaloblastic anaemia
diagnosis

A

subacute combine degeneration of the spinal cord

236
Q

what is a classic cause of surgical third nerve palsy

A

posterior communicating artery aneurysm

237
Q

pt: suddenly feeling very dizzy, losing her sense of balance and has been choking on her food. On examination there is reduced left facial sensation, absent pain sensation throughout the right arms and legs, a droopy left eyelid and a constricted left pupil
diagnosis

A

Lateral medullary syndrome aka Wallenberg syndrome
(“DANVAH” - Dysphagia, ipsilateral Ataxia, ipsilateral Nystagmus, Vertigo, Anaesthesia, ipsilateral Horners syndrome)

238
Q

sudden onset of vertigo
recent viral illness
vertigo not triggered by head movements
no hearing loss or tinnitus
diagnosis

A

vestibular neuritis

239
Q

what are the paraneoplastic syndromes of small cell lung cancer

A

can be remembered by the “SCLC” mnemonic which stands for
SIADH,
Cushing’s,
LEMS
Cerebellar degeneration.

240
Q

contrast horners syndrome caused by pan coats tumour vs carotid artery dissection

A

pancoast tumour
- miosis, ptosis, anhidrosis
- also shoulder pain, cough etc

carotid artery dissection
- miosis, ptosis
- no anhidrosis
- neck pain

241
Q

patient is unable to adduct her left eye and nystagmus is noted in the right eye on abduction
diagnosis

A

left intranuclear opthalmoplegia (caused by lesion affecting left medial longitdinal fasciculus)

242
Q

features of cerebellar dysfunction

A

DANISH:

Dysdiadochokinesia (inability to perform rapid alternating movements)

Ataxia

Nystagmus (typically multidirectional)

Intention tremor (tremor during voluntary movement illustrated by the finger-nose test)

Slurred speech

Hypotonia

243
Q

which can best visualises spinal claudication

A

non contrast spine MRI

244
Q

when can you use dexamethasone for raised ICP

A

only used for raised ICP resulting from malignancy
if have raised ICP due to cerebral oedema give mannitol

245
Q

which medication can be used for raised ICP due to cerebral oedema

A

mannitol

246
Q

which headache is COCP C/I in

A

migraine with aura

247
Q

right-sided inferior quandrantanopia
where is the lesion

A

left parietal lobe

248
Q

which medication can be used to manage choreoathetosis

A

tetrabenazine

249
Q

what is sensory ataxia

A

ataxia due to impairment of sensory feedback signals eg when vision is removed -> rombergs test

250
Q

what type of visual loss is most common due to optic neuritis

A

central scotoma

251
Q

instability
night time falls
jeans no longer fit
pmh of diabetes
diagnosis

A

diabetic amyotrophy (symmetric wasting of the thighs in diabetes)

252
Q

pt has infectious signs, siezure, and lateralising signs eg right sided increases tone and hypereflexia
diagnosis?

A

cerebral abscess - meningitis would not present with focal neurological signs

253
Q

what does a ring enhancing lesion indicate on CT

A

abscess

254
Q

which medication can be given for migraine prophylaxis to an asthmatic young woman

A

amytriptyline

255
Q

MRI shows atrophy of the caudate nucleus and putamen
which condition has this

A

huntigntons

256
Q

which genetic condition causes choreoathetosis and dementia

A

Huntingtons

257
Q

confused, nausea, headache, non contrast CT shows hyper density in a sinus
diagnosis and first lien tx

A

intracranial venous thrombosis
LMWH

258
Q

medical vs surgical 3rd nerve palsy, and causes

A

medical
- doesn’t affect pupil
- problem from inside of nerve: ischaemia of the nerve

surgical
- does affect pupil: dilation
- problem from outside of nerve compressing on it and the parasympathetic fibres which runs along its surface (parasympathetic constructs the pupil): PCA aneurysm - in circle of willis

year 3 conditions (17 decks)

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