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Neurology Flashcards

1
Q

Examples of neuropathic pain

A

1) Post-hermetic neuralgia.
2) Trigeminal neuralgia.
3) Prolapsed intervertebral disc.
4) Diabetic neuropathy.

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2
Q

Next step if the patient did not improve on one agent (patient with neuropathic pain?)

A

Switch to another agent. Don’t add

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3
Q

What agent can be used as a rescue therapy for neurpathic pain?

A

Tramadol

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4
Q

Examples of agents used in neuropathic pain?

A
  • Gabapentin, Doluxetin, pregabalin, Amitryptylin.
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5
Q

First line agent for trigeminal neuralgia?

A

Carbamezapine

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6
Q

Topical capsaicin can be used in?

A

Post-herpetic neuralgia

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7
Q

associated with chromosome 9 GAA mutation?

A

Friedrich ataxia

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8
Q

Affect cerebellum and spinal cord, causing wide gait + absent reflex

A

Friedrich ataxia

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9
Q

Shortness of breath, lower limb weakness improve with activity, dryness and impotence. Antibody?

A

Antibody against presynaptic Voltage gated calcium channel (VGCC)
Lambert eaton syndrome

Other features: hyporeflexia, difficulty micturation

VS MG:
- Improve with activity.
- No ophthalmoplagia.

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10
Q

Association of lambert eaton and cancer?

A

SCC

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11
Q

Lambert eaton management?

A

1) Treat underlying cause (malignancy).
2) Steroid and azathioprine.
3) K channel efflux blockers 3,4-diaminopyridine on trials now

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12
Q

Pathophysiology of Lambert eaton

A

1) Antibody blocks Pre-synaptic calcium channel. (VGCC)
2) Lead to decrease calcium influx
3) Impair Ach release in NMJ

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13
Q

Featuers of autonomic neuropathy

A

1) Failure to decrease HR After deep breath
2) Postural hypotension
3) Inability to sweat and impotence
4) Pupils: dilate following adrenaline installation.

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14
Q

Diseases associated with autonomic neuropathy

A

1) Parkinson. 2) DM 3) GBS 4) Multisystem atrophy
5) Drugs: TCA, anti hypertensive agents.
6) Infections: HIV, neurosyphilis and chagas disease
7) Cranipharyngoma

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14
Q

rise in protein with a normal white blood cell count (albuminocytologic dissociation) - found in 66% suggest?

A

GBS

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15
Q

Clinical features of GBS

A

1) Sensation:
- Stock and glove appearance.
- Back and limb pain.

2) Motor dysfunctions: 
- Facial nerve palsy. 
- Areflexia. 
- Ascending symmetric paralysis. 

3) Autonomic dysfunction: 
- Respiratory failure. 
- Cardiac arrest Fluctuation in BP.
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15
Q

Types of subdural hemorrhage?

A

1) Acute
2) Sub-acute
3) Chronic

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15
Q

Etiology of subdural hemorrhage?

A

Rupture of the bridging veins

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15
Q

Mention 5 risk factors for SAH

A

1) Aneurysmal rupture (berry aneurysm).
2) Mycotic aneurysm.
3) Pituitary apoplexy.
4) Coarctation of aorta.
5) APCKD

3 CAUSED BY Aneurysm: APCKD, Berry, mycotic

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16
Q

How to differ between the types of subdural hemorrhage?

A

1) Onset 3 days, 3 to 20. More than 20 days.
2) CT:
Acute: hyperdense bright
Chronic: hypodense dars
3) Clinically:
- Acute: coma.
- Chronic: memory loss

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16
Q

CT findings of Subdural hemorrhage?

A

Cross suture lines.

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16
Q

Role of LP in SAH?

A

Negative CT after 6 hours of symptoms.
Shows Xanthochromia.

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17
Q

Next step if you suscpect re-bleeding in SAH

A
  • Usually occur within 12 hours.
  • Do head CT STAT
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18
Q

Next step after confirming SAH by CT?

A

Digital substraction angiogram (looking for aneurysmal rupture as it is the most common cause)

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18
4 complications of SAH
1) Re-bleeding. 2) Hydrocephalus. 3) SIADH 4) Delayed cerebral ischemia (vasospasm)
19
Next step if you suscpect vasospsm?
- It occur usually after 1 to 2 weeks. - Ensure euvolemia. - Use of vasopressor if needed.
20
Poor prognostic factors of GBS? 5
* age > 40 years * poor upper extremity muscle strength * previous history of a diarrhoeal illness (specifically Campylobacter jejuni) * high anti-GM1 antibody titre * need for ventilatory support
21
Chromosome p3 mutation.
Von-hipped lindau disease (mutation in chromosome p3 short arm)
22
VHL predispose the patient to?
1) Cerebellar and retinal hemangioma. 2) Clear renal cell cancer. 3) Renal cyst. 4) Extra-renal cyst (pancreas and liver) 5) Pheochromocytoma
23
trinucleutide repeat disorder causes mutation in chromosome 4
Huntington disease
24
In huntington disease there is repeat expansion of? which lead to degeneration of GABAnergic and cholinergic neurons in?
CAG Basal ganglia
25
Mention 5 causes of chorea
1) Ataxic talengactesia. 2) Wilson disease 3) HD 4) Thyroitoxicosis. 5) Chorea gravidarum. 6) Autoimmune: APS and SLE 7) Med's: anti-pshycotic and levodopa. 8) PCV 9) CO Poisining.
26
Mutation in ATM gene?
Ataxic talengacteisa AR condition While HD is AD
27
Trinucleutide repeat disorder mutation in GAA
Fredrich ataxia whild HD mutation in CAG
28
This area 'forms' the speech before 'sending it' to Broca's area. Lesions result in sentences that make no sense, word substitution and neologisms but speech remains fluent - 'word salad' Comprehension is impaired
Wernikie
29
It is typically supplied by the superior division of the left MCA. Lesion lead to which type of aphasia?
Broca
30
Speech is non-fluent, laboured, and halting. Repetition is impaired Comprehension is normal. Which type of aphasia?
Broca
31
Speech is fluent but repetition is poor. Aware of the errors they are making Comprehension is normal. Type of aphasia?
Speech is fluent but repetition is poor. Aware of the errors they are making Comprehension is normal
32
What can effect dorsal columns, lateral corticospinal tracts and spinocerebellar tracts..
Subacute combined degeneration of the spinal cord secondary to B12 defiecency
33
What can cause functional low B12?
NO inhalation. Here measure MMA will be high
34
Syndrome consist of inability to count + impairment in reading comprehension
Grestmann syndrome, acalculia + alexia Lesion in parietal lobe
35
Chorea occur due to a lesion in which part of the brain?
Basal ganglia (C)audate nucleus
36
Hemibalism occur after a lesion in which part of the brain?
Subthalamic nucleus of basal ganglia
37
Patient with hyper-sexuality, put everything in mouth
Kluver-Buncy syndrome (lesion in amygdala)
38
Visual agnosia occur after damage in which part of the temporal lobe?
Ventral: visual
39
39
Orexin is associated with which condition?
Narcolepsy. Hormone associated with destruction of neurons lead to sleepfulness during daytime
40
EEG findings of narcolepsy?
Multiple sleep cycle in EEG
41
Two diseases affect the anterior horn of the spinal cord?
ALS And polio
42
What is the major effect of uremia? Motor or sensory?
Causes polyneuropathy, mainly sensory loss secondary to uremia. Causes loss of proprioception, temprature.
43
4 causes of predominantly sensory loss?
DM, uremia, alcoholism, B12
44
For how long the patient should stop driving after his first episode of seizure?
A) Unprovoked, normal CT, MRI And EEG: - 6 MONTHS B) Evidence in EEG, CT or MRI: - 12 months. _____ Others: 1) one syncope episode, explained: 4 weeks. 2) One episode of syncope, not explained: 6 months.
45
Mention 3 drugs causes peripheral neuropathy
Amiodarone, metronidazole, nitrofurantoin, vincristine.
46
Clinical features of neuroleptic malignant syndrome
(FEVER): F: Fever. E: Encephalopathy. V: Vital signs (high HR, BP, T + Autonomic symptoms like sweating and urinary incontinence). E: Enzymes (high CK) R: Lead pipe rigidity.
47
What is the effect of levodopa on prolactin production?
Increase dopamine inhibit prolactin in pituitary
48
one example of MAO- inhibitor
Selegiline
49
example of COMT inhibitor
Entacapone
50
What pulmonary test is used to monitor patient with GBS?
FVC
51
features of UMN Lesion?
UMN effect the cortex, brain or white matter of spinal cord. Hyper-reflexia, hypertonia, positive plantar reflex, no or little muscle atrophy
52
Indication of amantadine?
1) Parkinson. 2) MS For fatigue. 3) Influenza. | dopamin reuptake inhibitor is the MOA
53
54
Relationship of migraine with aura + Use of OCP?
OCP increases the risk of stroke in patient with migraine with Aura Other notes: - HRT might increase the frequency of migraines but it is safe
55
First line for migraine during pregnancy?
Paracetamol Second line: NSAID’s in T1 AND T2 Avoid aspirin
56
Clinical features of medications overuse headache?
- more than 15 days per month - Worsening with taking analgesia
57
Ophtalmoplagia, areflexia, ataxia and ascending paralysis
Miller- Fischer syndrome, variant of GBS. - Present with ascending paralysis. - Eyes effected first - GQ1B antibodies seen in 90 % of cases
58
Mention three skin findings of tuberous sclerosis
1) Angiomfibroma (under the nails and skin of the hand) 2) Angioma 3) Ashleaf spots 4) Shagreen patches.
59
Renal masses caused by Tuberous sclerosis?
Angiomyolipoma (increase risk of bleeding)
60
Effect of phenytoin on the fetus?
Cleft palate, low vitamin k (Risk of bleeding), congenital heart disease
61
Lymphadenopathy, gum bleeding and glove and stock numbness: after taking anti-epileptic medication
Phenytoin
62
Hair loss and tremor after taking anti-epileptic
Na Valproate
63
Kidney stones after taking anti-epileptic
Topiramate
64
Ataxia and diplopia after taking anti-epileptic medication
Carbamezapine
65
Indications of thrombectomy?
1) Proximal anterior circulation within 6 hours or within 24 hours if there is evidence of salvage brain tissue on CT-diffusion image or MRI. 2) Proximal posterior circulation within 24 hours if there is salvage brain tissue.
66
Indications for endarictomy in stroke
1) Patient not disabled. 2) Occlusion less than 70 %
67
Contraindications for thrombolysis?
Brain: 1) History of stroke or TIA within 3 months. 2) Intracranial neoplasm. 3) Suspicion of SAH 4) LP within 7 days. 5) Seizure at onset of stroke. Others: 6) Esophageal varices. 7) GI bleeding within 3 weeks. 8) Pregnancy. Uncontrolled hypertension.
68
What is astereognosis. What brain part effected?
Parietal lobe Inability to identify objects.
69
Break : )
70
What is prosopagnosia ? what brain part effected?
- Difficulty in recognizing faces. - Temporal area
71
conductive deafness, tinnutis + positive family history of deafness
Otosclerosis where the normal bone replaced by spongy bone. AD condition
72
Bleeding from .. artery occur in epidural hematoma
Middle meningeal artery Other notes: - Does not cross suture lines. - Lucid vivid interval
73
EEG: bilateral, symmetrical 3Hz spike and wave pattern Diagnosis?
Absece seizure. There is 90-95 % chance that the patient will be seizure free at 16 years old.
74
First line management for absence seizure?
Na Valproate or ethosuximide
75
Pregnant lady on phenytoin. What to give her in the last month of pregnancy?
Vitamin K Phenytoin causes bleeding + cleft palate
76
Hyperacusis results from which cranial nerve damage?
Facial nerve. As it supplies the Stapedius muscle
77
High arch feet, weakness in LL and UL with sensory impairment + LL muscle atrophy
Charcot marie tooth disease It is one of the heriditary sensory motor neuropathy. Type I is AD With predominant motor features Type II: Mainly axonal
78
Medication contraindicated in absence seizure?
Carbamezapine Three things about carbamezapine: 1- Ataxia. 2- Blurred vision. 3- CI in absence seizure
79
80
Which medication used for parkinsonism causes ataxia and levido reticularis?
Amantadine
81
Which anti-parkinson medication causes postural hypotension, dry mouth and palpitation?
Levodopa
82
Stroke causes ataxia, dysphagia, horner, vertigo + contralateral impaired temprature and proprioception sensation
Lateral medullary syndrome (PICA syndrome) Caused by damage in: PICA or vertebral artery
83
Stroke with weakness on the left side + occulomotor occlusion
Weber syndrome (midbrain) Vessel: PCA
84
What anti-epileptic contraindicated in absence seizure?
Carbaezapine
85
What feature of parkinson suggest Idiopathic parkinsonism rather than secondary parkinsonism?
Assymetrical tremor
86
What feature suggest drug induced parkinson?
Bilateral rapid motor symptoms. Tremor is less common
87
Where is the location of medial longitudinal faciculus?
Paramedian area of pons and midbrain
88
Multiple strokes, TIA and dementia. MRI shows multiple infarction in cebellum and pons.
CADASIL

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