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MRCP Part 1 > Neurology > Flashcards

Neurology Flashcards

1
Q

decreased red cell transketolase

Seen In …?

A

Wernicke’s encephalopathy

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2
Q

Features of Von Hippel-Lindau (VHL) syndrome

A

cerebellar haemangiomas: these can causesubarachnoid haemorrhages

retinal haemangiomas: vitreous haemorrhage

renal cysts (premalignant)

phaeochromocytoma

extra-renal cysts: epididymal, pancreatic, hepatic

endolymphatic sac tumours

clear-cell renal cell carcinoma

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3
Q

VHL gene located on short arm of chromosome

A

chromosome 3

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4
Q

If no response refractory status epilepticush witin 45 minutes from onset, then the best way to achieve rapid control of seizure activity is induction of ……

A

general anaesthesia or phenobarbital

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5
Q

Risk factors of Idiopathic intracranial hypertension

A

Obesity
Female
Pregnancy
Drugs
- OCP
- Steroids
- tetracyclines
- retinoids (isotretinoin, tretinoin) / vitamin A
- lithium

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6
Q

Management of Idiopathic intracranial hypertension

A
  1. Weight loss
  2. carbonic anhydrase inhibitors: acetazolamide
  3. repeated lumbar puncture may be used as a temporary measure but is not suitable for longer-term management
  4. optic nerve sheath decompression and fenestration may be needed to prevent damage to the optic nerve
  5. lumboperitoneal or ventriculoperitoneal shunt may also be performed to reduce intracranial pressure
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7
Q

Miller Fisher syndrome is variant of Guillain-Barre syndrome, associated with

A
  1. ophthalmoplegia, areflexia and ataxia. The eye muscles are typically affected first
  2. usually presents as a descending paralysis rather than ascending as seen in other forms of Guillain-Barre syndrome
  3. anti-GQ1b antibodies are present in 90% of cases
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8
Q

lumbar puncture in GBS

A

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

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9
Q

treatment of Lennox-Gastaut syndrome

A

ketogenic diet may help

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10
Q

treatment of Typical (petit mal) absence seizures

A

valproate, ethosuximide

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11
Q

Breast feeding is generally considered ………. for mothers taking antiepileptics

A

safe

the possible exception of the barbiturates

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12
Q

It is advised that pregnant women taking phenytoin are given …………. in the last month of pregnancy to prevent clotting disorders in the newborn

A

vitamin K

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13
Q

in pregnancy
1. sodium valproate: associated with …………….

  1. phenytoin: associated with ……………..
A
  1. sodium valproate: associated with neural tube defects
  2. phenytoin: associated with cleft palate
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14
Q

Focal seizures
first line: ………………………..
second line: ……………………..

A

Focal seizures
first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide

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15
Q

Absence seizures (Petit mal)
first line: ……………………………………..
second line: …………………………

which drug may exacerbate absence seizures?

A

Absence seizures (Petit mal)
first line: ethosuximide
second line:
male: sodium valproate
female: lamotrigine or levetiracetam
carbamazepine may exacerbate absence seizures

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16
Q

Myoclonic seizures
first line: …………………

A

males: sodium valproate
females: levetiracetam

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17
Q

Tonic or atonic seizures
first line: …………………

A

Tonic or atonic seizures
males: sodium valproate
females: lamotrigine

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18
Q

Generalised tonic-clonic seizures

first line: …………………

A

Generalised tonic-clonic seizures
males: sodium valproate
females: lamotrigine or levetiracetam

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19
Q

Ramsay Hunt syndrome (herpes zoster oticus) is caused by the reactivation of the varicella zoster virus in ……………….. cranial nerve.

A

the geniculate ganglion of the seventh cranial nerve.

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20
Q

Reye’s syndrome is a severe, progressive encephalopathy affecting children that is accompanied by fatty infiltration of ………………..

A

the liver, kidneys and pancreas.

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21
Q

Causes of transverse myelitis

A

viral infections: VZV, HSV, CMV, EBV, influenza, echovirus, HIV

bacterial infections: syphilis, Lyme disease

post-infectious (immune mediated)

first symptom of multiple sclerosis (MS) or neuromyelitis optica (NMO)

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22
Q

Narcolepsy is associated with low levels of …..1….., a protein which is responsible for controlling ……….2…..

A
  1. orexin (hypocretin)
  2. appetite and sleep patterns
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23
Q

management of Narcolepsy

A

daytime stimulants (e.g. modafinil) and nighttime sodium oxybate

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24
Q

investigations of Narcolepsy

A

multiple sleep latency EEG

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25
Q

Hemiballism occurs following damage to ……………

A

the subthalamic nucleus.

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26
Q

Ballisic movements are involuntary, sudden, jerking movements which occur …….to the side of the lesion

A

contralateral

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27
Q

Hemiballism vs chorea

A

hemiballism : unilateral, proximal limb musculature

chorea: bilateral, distal muscles

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28
Q

management of Hemiballism

A

Antidopaminergic agents (e.g. Haloperidol) are the mainstay of treatment

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29
Q

HSV encephalitis characteristically affects the …………. lobes

A

temporal and inferior frontal lobes

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30
Q

features of HSV encephalitis

A

fever, headache, psychiatric symptoms, seizures, vomiting

focal features: aphasia

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31
Q

CSF in HSV encephalitis

A

CSF: lymphocytosis, elevated protein

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32
Q

Meningitis: complications

A

sensorineural hearing loss (most common)
seizures
focal neurological deficit
sepsis
intracerebral abscess
brain herniation
hydrocephalus

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33
Q

Patients with meningococcal meningitis are at risk of ……………..

A

Waterhouse-Friderichsen syndrome (adrenal insufficiency secondary to adrenal haemorrhage).

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34
Q

conditions are associated with raised protein levels in CSF

A
  1. Guillain-Barre syndrome
  2. tuberculous, fungal and bacterial meningitis
  3. Froin’s syndrome*
  4. viral encephalitis
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35
Q

conditions are associated with raised lymphocytes in CSF

A
  1. viral meningitis/encephalitis
  2. TB meningitis
  3. partially treated bacterial meningitis
  4. Lyme disease
  5. Behcet’s, SLE
  6. lymphoma, leukaemia
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36
Q

normal CSF glucose = …..

A

glucose = > 2/3 blood glucose

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37
Q

management of Acute disseminated encephalomyelitis

A

iv glucocorticoids and the consideration of IVIG where this fails.

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38
Q

Anti-NMDA receptor encephalitis is a paraneoplastic syndrome, presenting as prominent …………… features

A

psychiatric features

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39
Q

Ovarian teratomas is associated with

A

Anti-NMDA receptor encephalitis

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40
Q

Treatment of anti-NMDA encephalitis

A

immunosuppression with iv steroids, ivIG, rituximab, cyclophosphamide or plasma exchange, alone or in combination.

Resection of teratoma is also therapeutic.

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41
Q

seizures characteristically occur at night
seizures are typically partial

features of ….?

A

Benign rolandic epilepsy

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42
Q

EEG in Benign rolandic epilepsy

A

EEG characteristically shows centrotemporal spikes

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43
Q

seizure with Floaters/flashes

localising features of ………. seizures

A

Occipital lobe (visual)

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44
Q

seizure with Paraesthesia

localising features of ………. seizures

A

Parietal lobe (sensory)

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45
Q

seizure with Head/leg movements, posturing, post-ictal weakness, Jacksonian march

localising features of ………. seizures

A

Frontal lobe (motor)

46
Q

Seizures typically last around one minute
automatisms (e.g. lip smacking/grabbing/plucking) are common
and An aura occurs in most patients

localising features of ………. seizures

A

Temporal lobe

47
Q

what is the most common form of MS

A

Relapsing-remitting disease

48
Q

what is Primary progressive disease (MS)?

A

progressive deterioration from onset

49
Q

what is Secondary progressive disease (MS) ?

A

describes relapsing-remitting patients who have deteriorated and have developed neurological signs and symptoms between relapses

50
Q

what is Relapsing-remitting disease (MS)?

A

acute attacks (e.g. last 1-2 months) followed by periods of remission.

51
Q

Patient’s with MS may present with non-specific features, for example around 75% of patients have ……….

A

significant lethargy.

52
Q

WHAT IS Uhthoff’s phenomenon?

A

worsening of vision following rise in body temperature

53
Q

WHAT’S Lhermitte’s syndrome?

A

paraesthesiae in limbs on neck flexion

54
Q

CSF IN MS

A

oligoclonal bands (and not in serum)
increased intrathecal synthesis of IgG

55
Q

Good prognosis features OF MS

A
  1. female sex
  2. age: young age of onset (i.e. 20s or 30s)
  3. relapsing-remitting disease
  4. sensory symptoms only
  5. long interval between first two relapses
  6. complete recovery between relapses
    • the typical patient carries a better prognosis than an atypical presentation**
56
Q

TREATMENT OF Acute relapse

A

oral or IV methylprednisolone may be given for 5 days to shorten the length of an acute relapse.

57
Q

Typical indications for disease-modifying drugs to reduce the risk of relapse in patients with MS

A
  1. relapsing-remitting disease + 2 relapses in past 2 years + able to walk 100m unaided
  2. secondary progressive disease + 2 relapses in past 2 years + able to walk 10m (aided or unaided)
58
Q

Drug options for reducing the risk of relapse in MS

A
  1. natalizumab
  2. ocrelizumab
  3. fingolimod
  4. beta-interferon
  5. glatiramer acetate
59
Q

TREATMENT OF FATIGUE IN MS

A

once other problems (e.g. anaemia, thyroid or depression) have been excluded NICE recommend a trial of amantadine

other options include mindfulness training and CBT

60
Q

TREATMENT OF Spasticity IN MS

A

baclofen and gabapentin are first-line. Other options include diazepam, dantrolene and tizanidine

physiotherapy is important

61
Q

TREATMENT OF Bladder dysfunction IN MS

A

guidelines stress the importance of getting an ultrasound first to assess bladder emptying - anticholinergics may worsen symptoms in some patients

if significant residual volume → intermittent self-catheterisation

if no significant residual volume → anticholinergics may improve urinary frequency

62
Q

TREATMENT OF Oscillopsia IN MS

A

gabapentin is first-line

63
Q

Neuromyelitis optica Diagnosis requires

A

Diagnosis requires bilateral optic neuritis, myelitis and 2 of the following 3 criteria:
1. Spinal cord lesion involving 3 or more spinal levels

  1. Initially normal MRI brain
  2. Aquaporin 4 positive serum antibody
64
Q

Management OF Neuromyelitis optica

A

immunosuppressant e.g. with anti-CD20 agent rituximab

65
Q

Poor prognostic features OF GBS

A
  1. age > 40 years
  2. poor upper extremity muscle strength
  3. previous history of a diarrhoeal illness (specifically Campylobacter jejuni)
  4. high anti-GM1 antibody titre
  5. need for ventilatory support
66
Q

Miller Fisher syndrome

A

variant of GBS
associated with ophthalmoplegia, areflexia and ataxia.

usually presents as a descending paralysis rather than ascending as seen in other forms of GBS

anti-GQ1b antibodies are present in 90% of cases

67
Q

nerve conduction studies IN GBS

A
  1. decreased motor nerve conduction velocity (due to demyelination)
  2. prolonged distal motor latency
  3. increased F wave latency
68
Q

…………… IS USED to monitor respiratory function

A

FVC

69
Q

steroids and immunosuppressants IN GBS

A

not been shown to be beneficial

70
Q

IN Myasthenia gravis, Antibodies to ……… are seen in 85-90% of cases*

A

Antibodies to acetylcholine receptors are seen in 85-90% of cases*

71
Q

Myasthenia gravis IS ASSOCIATED WITH

A
  1. thymomas in 15%
  2. autoimmune disorders: pernicious anaemia, autoimmune thyroid disorders, rheumatoid, SLE
  3. thymic hyperplasia in 50-70%
72
Q

INVESTIGATIONS OF Myasthenia gravis

A
  1. single fibre electromyography: high sensitivity (92-100%)
  2. CT thorax to exclude thymoma
  3. CK normal
  4. antibodies to acetylcholine receptors
73
Q

Management of myasthenic crisis

A

plasmapheresis
IVIG

74
Q

Management OF Myasthenia gravis

A

pyridostigmine is first-line

prednisolone, azathioprine, cyclosporine, mycophenolate mofetil may also be used

thymectomy

75
Q

drugs may exacerbate myasthenia:

A

antibiotics: gentamicin, macrolides, quinolones, tetracyclines
beta-blockers
lithium
phenytoin
penicillamine
quinidine, procainamide

76
Q

Lambert-Eaton myasthenic syndrome is seen in association with

A

small cell lung cancer and to a lesser extent breast and ovarian cancer

77
Q

Lambert-Eaton myasthenic syndrome is caused by an antibody ……………………………. in the peripheral nervous system.

A

directed against presynaptic voltage-gated calcium channel

78
Q

IN Lambert-Eaton myasthenic syndrome, affects ……………. limbs first)

A

affects lower limbs first)

79
Q

MANAGMENT OF Lambert-Eaton myasthenic syndrome

A

treatment of underlying cancer

immunosuppression, for example with prednisolone and/or azathioprine

ivig and plasma exchange may be beneficial

80
Q

PATIENT TAKES Vigabatrin, visual fields should be checked every …….

DUE TO ……………

A

6 months

visual field defects, which may be irreversible

81
Q

risk factors of Idiopathic intracranial hypertension
(drugs)

A

combined OCP
steroids
tetracyclines
retinoids (isotretinoin, tretinoin) / vitamin A
lithium

82
Q

management of Idiopathic intracranial hypertension

A
  1. weight loss
    (diet and exercise are important, medications such as semaglitide and topiramate)
    *Topiramate is particularly beneficial as it also inhibits carbonic anhydrase
  2. acetazolamide
  3. repeated lumbar puncture
  4. surgery:
    optic nerve sheath decompression and fenestration may be needed to prevent damage to the optic nerve.

A lumboperitoneal or ventriculoperitoneal shunt may also be performed to reduce intracranial pressure

83
Q

investigations of Intracranial venous thrombosis

A

MRI venography is the gold standard
CT venography is an alternative

84
Q

features of Sagittal sinus thrombosis

A
  1. may present with seizures and hemiplegia
  2. parasagittal biparietal or bifrontal haemorrhagic infarctions
  3. ‘empty delta sign’ seen on venography
85
Q

features of Lateral sinus thrombosis

A

Lateral sinus thrombosis

86
Q

features of Cavernous sinus thrombosis

A

periorbital erythema and oedema

ophthalmoplegia: 6th nerve damage typically occurs before 3rd & 4th

87
Q

causes of Internuclear ophthalmoplegia

A

MS
vascular disease

88
Q

Internuclear ophthalmoplegia is due to a lesion in ……… that is located in ……………………………………

A

the medial longitudinal fasciculus (MLF)

located in the paramedian area of the midbrain and pons

89
Q

features of Internuclear ophthalmoplegia

A

impaired (3ed) adduction of the eye on the same side as the lesion

horizontal nystagmus of the (6th) abducting eye on the contralateral side

90
Q

management of Medication overuse headache

A

simple analgesics and triptans should be withdrawn abruptly (may initially worsen headaches)

opioid analgesics should be gradually withdrawn

91
Q

what is the most common trigger of cluster headache

A

alcohol

92
Q

management of cluster headache

A

acute
1. 100% oxygen (80% response rate within 15 minutes)
2. triptan s.c (75% response rate within 15 minutes)

prophylaxis
1. verapamil is the drug of choice
2. tapering dose of prednisolone

93
Q

A classical triad of features of Normal pressure hydrocephalus

A

urinary incontinence
dementia and bradyphrenia
gait abnormality (may be similar to Parkinson’s disease)

94
Q

features of Arnold-Chiari malformation

A
  1. non-communicating hydrocephalus may develop as a result of obstruction of cerebrospinal fluid (CSF) outflow
  2. headache
  3. syringomyelia
95
Q

Management of Neuroleptic malignant syndrome

A
  1. stop antipsychotic
  2. Iv fluids
  3. Dantrolene
  4. bromocriptine, dopamine agonist, may also be used
96
Q

Migraine: management

A

Acute treatment
1. NSAIDs and oral triptan ( if age < 17 nasal triptans)

  1. If not effective then metoclopramide or prochlorperazine and consider adding a non-oral NSAID or triptan

Prophylaxis treatment
1. Propranolol

  1. Topiramate
  2. amitriptyline
97
Q

for women with predictablemenstrual migrainetreatment

A

frovatriptan (2.5 mg twice a day) or

zolmitriptan (2.5 mg twice or three times a day) as a type of ‘mini-prophylaxis’

98
Q

patients have migraine with aura then the combined OCP is absolutely contraindicated due to an increased risk of …..

A

stroke

99
Q

Management of Migraine during pregnancy

A

paracetamol 1g is first-line

NSAIDs can be used second-line in the first and second trimester

avoid aspirin and opioids such as codeine during pregnancy

100
Q

Treatment of Migraine during menstruation

A
  1. mefanamic acid or
  2. combination of aspirin, paracetamol and caffeine.
  3. Triptans are also recommended in the acute situation
101
Q

Recent viral infection
Sudden onset of vertigo
Nausea and vomiting
Hearing may be affected

A

Viral labyrinthitis

102
Q

Management of Vestibular neuronitis

A

buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases

short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases

vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms

103
Q

Vertigo
Hearing loss
Tinnitus
Absent corneal reflex

Features of ?

A

Vestibular schwannomas

104
Q

Bilateral vestibular schwannomas are seen in …….

A

neurofibromatosis type 2.

105
Q

What is the investigation of choice in vestibular schwannomas

A

MRI of the cerebellopontine angle

106
Q

conductive deafness

tinnitus

positive family history

Normal tympanic membrane ( but 10 % of patients have flamingo tinge)

Features of…..

A

Otosclerosis

107
Q

Management of Otosclerosis

A

hearing aid

stapedectomy

108
Q

Otosclerosis describes thereplacement of normal bone by …..1……..

It causes a progressive conductive deafness due to fixation of the stapes at ….2…

A
  1. vascular spongy bone
  2. the oval window.
109
Q

……… nystagmus - foramen magnum lesions

Arnold-Chiari malformation

A

Downbeat nystagmus

110
Q

Management of Meniere’s disease

Acute :

Prevention:

A

acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required

prevention: betahistine and vestibular rehabilitation exercises may be of benefit

111
Q

Drugs causing tinnitus

A

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

MRCP Part 1 (17 decks)

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