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PLAB 1 August 2024 > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the symptoms of absence seizures / petit mal seizures?

A
  • Seen in children < 10 years;
  • Stares blanky into space;
  • Loss of awareness (seems like it’s daydreaming);
  • Eyelids may flutter
  • Eyes may turn up
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2
Q

What is the investigation in absence seizure?

A

EEG

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3
Q

What is the difference between acute withdrawal symptoms and delirium tremens?

A

► Delirium tremens
- Acute withdrawal symptoms
- Altered mental status
- Hallucinations indistinguishable from reality.

► Acute withdrawal symptoms
- Mental status NOT ALTERED (hallucinations are mild).
- Tremor
- Anxiety
- Nausea
- Sweating

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4
Q

What is the pathophysiology of alzheimer's disease?

A

There is a ⬇︎ in acetylcholine production caused by:
- Amyloid plaques
- Neurofibriliary tangles.

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5
Q

What are the risk factors for alzheimer's disease?

A
  • Down syndrome
  • Apolipoprotein E4 inheritance
  • Family history
  • Ageing

First 2 high yield.

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6
Q

What are the symptoms for alzheimer's disease?

A
  • Poor memory
  • Forgetting names and places
  • Easily gets lost
  • Difficulty with language
  • Urinary incontinence
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7
Q

What is the investigation done in alzheimer's disease?

A

Goldstandard: MRI

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8
Q

What is the Rx of alzheimer's disease?

A

◉ First line:
➜ Acetycholinesterase inhibitors
- Donepezil
- Rivastigmine
- Galantamine
- Dr G. (memorise it)

◉ Second line:
➜ NMDA
- Memantine

Acetycholinesterase inhibitors: are contraindicated in:
- Bradycardia
- Heart block

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9
Q

Describe the cause of Amaurosis Fugax?

A

➜ It is caused by retinal ischemia due to:
- Platelet emboli passing through retinal circulation.
- OR
- Stenosis of the ispilateral carotid artery.

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10
Q

Describe the symptoms of Amaurosis Fugax?

A
  • Painless
  • Sudden unilateral vision loss (black curtain coming down)
  • Lasts for 5-15 min
  • Resolves within 24h
  • Associated with giant cell arteritis
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11
Q

What is the investigation done in Amaurosis Fugax?

A

◆ Carotid ultrasound: assessment of carotid artery stenosis
◆ Echocardiogram: If a cardiac source of emboli is suspected

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12
Q

Describe the treatment of Amaurosis Fugax?

A
  • AAS
  • Statins
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13
Q

Describe what is amyotrophic lateral scerosis?

A

➜ It is a degenerative condition affecting the motor neurons of the spinal cord and the motor cranial nuclei.

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14
Q

Describe the symptoms of amyotrophic lateral sclerosis ?

A
  • Limb weakness (upper limb usually)
  • Foot drop
  • Slurring of speech
  • Dysphagia
  • Fasciculations
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15
Q

Describe the treatment of amyotrophic lateral sclerosis?

A
  • Riluzole
  • Non-invasive pressure ventilation
  • Nutrional support (percutaneous endoscopic gastrostomy)
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16
Q

What is the cause of Bell's palsy?

A

Lower motor neuron facial nerve palsy.

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17
Q

What are the symptoms of Bell's palsy?

A
  • Unilateral (ipsilateral) facial weakness
  • Difficulty in eye closure

Associated with pregnancy and DM.

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18
Q

What is the treatment of Bell's palsy?

A

Within 72h of symptoms:
- Prednisolone
- Eye patch

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19
Q

What is the cause of benign paroxysomal positional vertigo?

Bening paroxysomal positional vertigo is the most common cause of vertigo.

A

It is due to otoliths.

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20
Q

What are the symptoms of benign paroxysomal positional vertigo?

A
  • Sudden onset of vertigo triggered by a change of head position.
  • Lasts 20-30 sec.
  • Nausea
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21
Q

How is the diagnosis of benign paroxysomal positional vertigo?

A

Dix-Hallpike’s test will be positive.

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22
Q

What is the treatment of benign paroxysomal positional vertigo?

A
  • Epley’s manouevre.

Repositions the otoliths.

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23
Q

In brocal aphasia, where is the lesion located?

A

Inferior frontal gyrus of dominant hemisphere.

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24
Q

Symptoms of brocal aphasia?

A

➜ Patient understands but cannot express it
- Patient can understand
- Broken speech

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25
Q

In wernick aphasia, where is the lesion located?

A

Superior temporal gyrus of dominant hemisphere.

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26
Q

Symptoms of wernick aphasia?

A

➜ Patient DOES NOT understand but CAN express himself well
- Fluent but nonsense speech
- Patient does not understand

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27
Q

Describe what is cauda equina syndrome.

A

Compression of the cauda equina due to:
- Disk herniation
- Tumour
- Trauma

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28
Q

Symptoms of cauda equina syndrome.

A
  • Back pain that radiates to the legs
  • Weakness of the legs
  • Saddle and perineal paresthesia
  • Faecal incontinence
  • Urinary retention / incontinence
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29
Q

What is the Rx of cauda equina syndrome?

A

SURGICAL EMERGENCY
- Urgent surgical decompression
- Corticosteroids

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30
Q

What is the investigation done in cauda equina syndrome?

A

Urgent MRI.

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31
Q

What is the cause of cavernous sinus thrombosis?

A

Sinuses infection caused by:
- S. Aureus
- Streptococcus

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32
Q

What are the symptoms of cavernous sinus thrombosis?

A
  • Headache
  • Unilateral periorbital oedema
  • Photophobia
  • Proptosis
  • Diplopia (paralysis of cranial nerve VI)
  • Mydriasis, ptosis, eye muscle weakness (paralysis of CN III)

Symptoms start unilateraly but progress to become bilateral.

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33
Q

Investigation done in cavernous sinus thrombosis?

A
  • CT scan
  • MRI venography
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34
Q

What is the Rx of cavernous sinus thrombosis

A
  • Anticoagulation
  • Antibiotics
  • Referral to neurosurgery
  • Corticosteroids
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35
Q

What is the step by step IMMEDIATE management of TIA?

A

If patient is taking anticoagulation FIRST CT scan to rule out haemorrhagic stroke
- AAS 300 mg (for 2 weeks)
- Statins
- Referral to specialist to be seen in 24h

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36
Q

What is the LONG TERM management of Stroke?

A

CT scan within 1h.

Ischaemic stroke & AF
- DOAC & statins

Ischaemic stroke without AF
- Clopidogrel & statins

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37
Q

What is the IMMEDIATE management of ischaemic stroke?

A

Alteplase
- Within 4.5 h of stroke symptoms.

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38
Q

When do you pick MRI over CT scan for stroke investigation?

A
  • If location of stroke in brain is not clear on the CT.
  • Suspicion of posterior stroke
  • Suspicion on posterior circulation stroke (CT is normal)
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39
Q

What is the step by step IMMEDIATE management of ischaemic stroke?

A
  • CT scan
  • Thrombolysis within 4.5h of onset
  • Avoid antiplatelets for first 24h post thrombolysis
  • Repeat CT scan after 24h (if normal then next step)
  • AAS 300 mg for 2 weeks (if thrombolysis not done)
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40
Q

What is the step by step management of haemorrhagic stroke?

A
  • CT scan
  • If on anticoagulation: reversal of anticoagulants
  • BP control
  • Evacuation of haemotoma surgically
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41
Q

What is the step by step LONG TERM management of ischaemic stroke?

A

CT scan within 1h.

Ischaemic stroke & AF
- DOAC/warfarin & statins

Ischaemic stroke without AF
- Clopidogrel & statins

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42
Q

What is the step by step LONG TERM management of TIA?

A
  • Clopidogrel 75mg
  • Statins

Clopidogrel after 2 weeks of AAS.

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43
Q

Describe the anatomy of the middle cerebral artery.

A
  • Originates from the internal carotid artery
  • Part of the anterior cerebral circulation
  • Supplies the lateral surfaces of the hemispheres and temporal pole of the brain.
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44
Q

Describe the symptoms of the middle cerebral artery stroke.

A

Occlusion of MCA & branches
- Contralateral hemiplegia (paralysis)
- Hemianaesthesia (loss of sensation on one side of the body)
- Dysarthria (due to facial weakness

MCA Stroke
- Speech is affected

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45
Q

Describe the anatomy of the anterior cerebral artery.

A
  • Originates from the internal carotid artery.
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46
Q

Describe the symptoms of the anterior cerebral artery occlusion.

Stroke of ACA are very rare.

A
  • Motor deficits of the contralateral lower limb
  • Paresis of the contralateral arm
  • Urinary incontinence
  • Altered mental status
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47
Q

Describe the anatomy of the posterior cerebral artery.

A
  • Originates from the basilar artery
  • It supplies mainly the occipital lobe.
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48
Q

Describe the symptoms of the posterior cerebral artery occlusion.

A

Homonymous hemianopia

  • Visual field loss in the same halves of the visual field of each eye.
  • For example, in right HH, the visual field loss is on the right side in the right eye and on the right side in the left eye.
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49
Q

What are the CSF findings in meningites?

A

Bacterial
➜ Glucose: low
➜ Protein: high
➜ White cells: mainly neutrophils
➜ Appearance: purulent, turbid, cloudy

Viral
➜ Glucose: normal
➜ Protein: normal to high
➜ White cells: mainly lymphocytes
➜ Appearance: clear

“Bacterias eat glucose, viruses don’t.”

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50
Q

What are the symptoms of meningitis?

A
  • Headache
  • Fever
  • Photophobia
  • Neck stiffness
  • Non-blanching rash (Meningococcal)
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51
Q

Describe the Kernig’s sign and the Brudzinski’s sign seen in meningitis.

A

Kernig’s sign
- Pain and resistance on passive knee extension with hips fully flexed

Brudzinski’s sign
- Hips flex on bending the head forward.

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52
Q

What is the treatment for bacterial meningitis?

A
  • < 60 years: Ceftriaxone IV
  • > 60 years: Ceftriaxone IV + Ampicillin
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53
Q

What is the treatment for viral meningitis?

A
  • Supportive Rx
  • No antivirals given.
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54
Q

What is the treatment for TB meningitis?

A

Anti-tuberculosis medication.

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55
Q

What is the prophylaxis treatment of closed contacts of a patient with meningococcal meningitis?

A
  • Ciprofloxacin

or

  • Rifampicin
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56
Q

What are the symptoms of cluster headache?

A
  • Unilateral
  • Near the ispilateral eye
  • Ipsilateral: lacrimation, conjuctival injection, nasal congestion and rhinorrhea;
  • Agitation, restless
  • Happens 1-2x/day for 6-12 weeks;
  • Lasts 15min - 3h;
  • It occurs every 1-2 years
  • Common in males.
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57
Q

What is the Rx of cluster headache?

A

Acute attack:
- Sumatriptan SC or nasal
- O₂

Prophylaxis:
- Verapamil

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58
Q

What are the tests done when suspecting dementia?

Cognitive assessment tool

A
  • Mini-Mental State examination (MMSE)
  • Addenbrooke’s cognitive examination (ACE)
  • Montreal cognitive assessment (MoCA)
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59
Q

What is the most common cause of dementia?

A

Alzheimer’s disease.

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60
Q

What are the different types of dementia?

A
  • Alzheimer’s disease
  • Parkinson’s disease
  • Frontotemporal dementia (Pick’s disease)
  • Vascular dementia
  • Lewy body dementia
  • Normal-pressure hydrocephalus
  • Pseudodementia
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61
Q

What is the pathophysiology of frontotemporal dementia (Pick’s disease)?

A

Degeneration of the frontal and temporal regions of the brain.

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62
Q

What is the pathophysiology of vascular dementia?

A

Dementia secondary to cerebrovascular insults.

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63
Q

What is the pathophysiology of Lewy body dementia?

A

Deposit of proteins known as Lewy bodies.

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64
Q

What is the pathophysiology of Parkinson’s disease?

A

Degeneration of the dopaminergic pathways of the substantia nigra.

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65
Q

What is the pathophysiology of normal pressure hydrocephalus?

A

Ventricular dilation without a raise in CSF pressure.

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66
Q

What is the pathophysiology of pseudodementia?

A

Severe depression masquerading as dementia.

67
Q

What is the difference between delirium and dementia?

A

Delirium
- Acute onset: hours to days
- Symptoms fluctuate thorough the day (on and off)
- Hallucinations
- Reversible

Dementia
- Gradual onset: over months;
- Symptoms have a progressive course;
- Hallucinations are not common;
- Irreversible

68
Q

DDX between:
- Guillain-Barré syndrome
- Myasthenia gravis
- Motor neuron disease

• Weakness
• Fatigue
• Reflexes
• Pain
• Fasciculations

A

Guillain-Barré
- Weakness: Yes
- Fatigue: No
- Reflexes: absent or decreased
- Pain: often
- Fasciculations: No

Myasthenia gravis
- Weakness: Yes
- Fatigue: Yes
- Reflexes: Present
- Pain: No
- Fasciculations: No

Motor neuron disease
- Weakness: Yes
- Fatigue: No
- Reflexes: Increased
- Pain: No
- Fasciculations: Yes

69
Q

What disease is cryptococcal meningitis associated with?

A
  • HIV
  • Usually with CD4 < 200
70
Q

What are the symptoms of cryptococcal meningitis?

A
  • Headache
  • Altered mental state
  • Signs of meningitis
  • Coma
71
Q

Investigation done in cryptococcal meningitis?

A

Lumbar puncture
- CSF: cryptococcal antigen positive.

72
Q

What is the treatment for cryptococcal meningitis?

A

Acute Rx
- Amphotericin + Flucytosine

Maintenance
- Fluconazole

73
Q

What are the symptoms of delirium?

A
  • Often in elderly patients
  • Acute onset (hours to days)
  • Fluctuating level os consciousness
  • Disorientation
  • Mood changes
  • Memory impairment
74
Q

What are the precipitating factors of delirium?

A
  • Metabolic disorders
  • Hypoxia
  • Infection
  • Dehydration
  • Constipation
  • Urinary retention
  • Medications (benzodiazepines)
75
Q

Rx of delirium?

A
  • Treat the underlying cause;
  • Consider antipsychotics.
76
Q

What is the cause of diabetic amyotrophy (proximal diabetic neuropathy)?

A

Poorly controlled diabetes.

77
Q

Symptoms of diabetic amyotrophy (proximal diabetic neuropathy)?

A
  • Muscle pain (unilateral)
  • Wasting
  • Weakness
  • Sensory loss (proximal leg or pelvic griddle)
78
Q

DDX of traumatic brain injury.

A

Extradural/Epidural haematoma
- Lucid intervals (becomes lucid carries on with tasks before becoming unconscious)
- (Usually) unilateral pupil dilation
- Injury to the middle meningeal artery

Subdural haematoma
Chronic subdural haematoma
- Elderly on anticoagulation or alcoholic
- Slow onset
- After a minor fall

Acute subdural haematoma
- Onset faster than chronic subdural but slower than epidural
- Trauma
- Lucid intervals

Subarachnoid haemorrhage
- Thunderclap headache / “Worse headache of my life”
- Meningeal irritation (neck stiffness, photophobia)
- Due to aneurysm formation (usually)
- Associated with polycystic kidney disease and Ehlers danlos syndrome

79
Q

What are the recommendations for DVLA (for cars)?

A

First epileptic seizure
- Patient must inform DVLA
- Cease driving for 6 months (from the date of the seizure) if normal investigations
- Cease driving for 12 months if abnormal investigations

Epilepsy
Can drive if
- Seizure free for 1 year
- If medication changed recently: seizure free for the past 6 months.

Dementia + Alzheimer’s
- Patient must inform DVLA
- Usually can keep on driving unless told not to.
- If continues to drive when told not to drive then Doctor must inform DVLA.

OSA syndrome
Suspicion
- Advise to stop driving.

Confirmed with sleep studies (moderate to severe)
- Patient must inform DVLA.

If patient refuses to inform:
- Dr. must inform DVLA

TIA
- Stop driving for 1 month
- No need to inform DVLA
- If severe neurological injury, inform DVLA after 1 month.

DVT and PE
- No need to inform DVLA

80
Q

In a pregnant woman, which antiepileptic drug is most commonly associated with increased risk of teratogenicity?

A

Sodium valproate.
- Should be changed to another medication (if not pregnant yet)
- If already pregnant leave it as it is.

81
Q

What anti epileptic medications are recommended in pregnancy?

A
  1. Lamotrigine
  2. Carbamazepine
82
Q

Symptoms of essential tremors?

A
  • Improve after alcohol consumption (in 50% of patients);
  • Do not happen at rest
  • Do not improve with distractions
  • Bilateral
  • Distal symmetric on the upper limbs
  • Family history
83
Q

Treatment of essential tremors?

A
  • Propranolol
84
Q

What is the cause of Epidural / Extradural haematoma?

A
  • Skull fracture
  • Middle meningeal artery injury
  • Involves arterial blood.
85
Q

What are the symptoms of Epidural / Extradural haematoma?

A
  • Raised ICP
  • Lucid interval
86
Q

Investigation in epidural (extradural) haematoma?

A

CT scan.

87
Q

Treatment of epidural (extradural) haematoma?

A

Initial
- Burr hole

Definitive
- Craniotomy and evacuation of the haematoma

88
Q

How to different epidural and subdural haematoma on CT scan?

A

Epidural haematoma
- Lemon

Subdural haematoma
- Banana

89
Q

What is fibromyalgia?

A

It is a chronic pain disorder condition that affects mainly women with the following characteristics:
- Pain exacerbated by pressure on muscles and joints

90
Q

Symptoms of fibromyalgia

A
  • Pain on muscles and joints
  • Fatigue
  • Morning stiffness
  • Sleep disturbances
  • Anxiety
91
Q

Investigation done in fibromyalgia?

A
  • ESR
  • C-reactive protein
  • Thyroid function test
92
Q

DDX between:
- Fibromyalgia
- Myalgic enchephalomyelitis

A

Fibromyalgia
- Pain
- Tenderness

Myalgic enchephalomyelitis
- Fatigue after recent URTI.

93
Q

What is the epidemiology of frontal temporal dementia?

A
  • Usually 50 - 65 yo
  • If < 35 yo DEFINITELY FRONTAL TEMPORAL DEMENTIA.
94
Q

Symptoms of frontotemporal dementia?

A
  • Behavioural changes (social withdrawal)
  • Sexual disinhibition
  • ## Difficulty initiating gait (frontal lobe)
95
Q

Investigation done in frontotemporal dementia?

A

MRI
Atrophy of the:
- Orbitofrontal cortex (high yield)
- Frontal lobe
- Inferior or anterior.

96
Q

Treatment of frontotemporal dementia?

A
  • No treatment.
  • If sexual disinhibition: cimetidine or spironolactone.
97
Q

What is the cause of subdural haematoma?

A

Rupture of bridging veins.

98
Q

What is the cause of intraparenchymal bleeding and Subarachnoid haemorrhage?

A

Middle cerebral artery injury.

99
Q

DDX of dizziness.

A

Benign paroxysmal positional vertigo
- Dizzy when rolling over bed.

Orthostastic hypotension
- Dizzy when getting up from bed

Migraine
- Light sensitivity during dizzy spells

Vestibular neuritis
- Severe vertigo
- Lasts for hours
- Vomiting

Meniere’s disease
- One ear feels full before or during dizzying attack

100
Q

What is the physiology of Guillain-Barré syndrome?

A

Due to demyelination of neurons.

101
Q

What is the cause of Guillain-Barré syndrome?

A
  • Infection (2/3 of cases)
  • Antibodies of the organism attack the neurons.
102
Q

What are the symptoms of Guillain-Barré syndrome?

A

SAM’S LOSS
Symmetrical ascending motor and sensory loss

1. Infection
- History of URTI or gastroenteritis

2. Weakness
- Starts in the lower limbs
- Symmetrical ascending pattern
- Onset symptoms peak after 2 weeks
- Respiratory failure (due to respiratory muscle weakness on severe cases).
- Dysphagia and dysarthria (severe cases).

3. Pain
- Neuropathic pain (legs mainly)

4. Reflexes
- Reduced or absent

5. Sensory
- Paresthesia and sensory loss (starts from legs)

103
Q

What is the investigation in Guillain-Barré syndrome?

A

Gold standard
- Nerve conduction studies

Initial
- Lumbar puncture (rise in CSF protein, cell count normal)
- Spirometry

104
Q

What is the treatment of Guillain-Barré syndrome?

A
  • Plasma exchange
  • IV immunoglobulins
  • Respiratory support
105
Q

DDx between:
- Guillain-Barré syndrome
- Myasthenia gravis
- Multiple sclerosis

A

Deep tendon reflexes
- Guillain-Barré: Decreased or absent
- Myasthenia gravis: Normal
- Multiple sclerosis: Increased

106
Q

Describe how is the vision affected in Guillain-Barré syndrome?

A
  • Vision is not affected
  • Muscles that control eye movement are affected causing double vision Miller Fisher syndrome(variant of GBS with ophtalmoplegia)
107
Q

Describe the physiology of Myasthenia gravis.

A

Autoantibodies attack acetylcholine receptors.

108
Q

What are the symptoms of Myasthenia gravis?

A
  • Weakness that increases with exercise:
    • Tired by the end of the day;
    • Fatigue on voice after counting to 50
  • Diploplia (often the first sign)
  • Ocular muscles fatigue:
    • Drooping eyelids at the end of the day
  • Dysphagia
  • Dysarthria
  • Normal reflexes
  • Associated with hyperthyroidism
109
Q

What is the investigation done in Myasthenia gravis?

A

First line
- Serum anti-acetylcholine receptor antibodies.

110
Q

What condition is Myasthenia gravis associated with?

A

Thymoma.

111
Q

What is the treatment of Myasthenia gravis?

A

First line
- Pyridostigmine (acetylcholinesterase inhibitor)

2nd line to modify the disease
- Immunosuppression:
• Corticosteroids
• Azathioprine

Other
- Thymectomy

112
Q

What is the management of Myasthenia gravis with respiratory failure?

A
  • Intubation and ventilation
  • IV immunoglobulins
  • Plasma exchange
  • Steroids
113
Q

Describe the physiology of Lambert-Eaton Myasthenic syndrome

A

Autoantibodies towards the presynaptic voltage-gated calcium channels.

114
Q

What are the symptoms of Lambert-Eaton Myasthenic syndrome?

A
  • Limb weakness (proximal);
  • Facilitation: strength and reflexes improve with repeated testing;
  • Waddling gait;
  • Associated with small cell cancer of the lung.
115
Q

Investigation done in Lambert-Eaton Myasthenic syndrome?

A
  • Chest CT/MRI (malignancy)
  • Repetitive nerve stimulation test (improves strength momentarily)
  • Serum measurements of voltage-gated calcium channels antibodies
116
Q

What is the treatment of Lambert-Eaton Myasthenic syndrome?

A
  • Treating the underlying neoplasm
  • Diaminopyridine
117
Q

Describe Multiple Sclerosis.

A
  • Autoimmune disorder causing demyelination of the neurons in the brain and spinal cord.
  • Neurological dysfunction at multiple sites of the central nervous system.
118
Q

Symptoms of Multiple Sclerosis?

A
  • Optic neuritis: painful vision loss
  • Double vision
  • Facial weakness
  • Paresthesia and numbness of the extremities.
119
Q

Investigation done in Multiple Sclerosis?

A
  • MRI: Periventricular lesions
  • CSF: oligoclonal bands
120
Q

Treatment for Multiple Sclerosis?

A

Initial / 1st line
- Methylprednisolone IV/ oral

Long term
- Interferon beta
- Glatiramer
- Natalizumab

121
Q

Describe what is Papiloedema.

A

Swelling of the optic disk caused by increased ICP.

122
Q

What are the causes of papiloedema?

A
  • Brain tumor
  • Idiopathic ICP
  • Cerebral venous sinus thrombosis
  • Intracranial haemorrhage
123
Q

Symptoms of Idiopathic intracranial hypertension ?

A
  • Throbbing headache (worse in the morning)
  • Headaches worse on bending or straining
  • Bilateral papiloedema
  • Visual blurring
  • Visual loss (momentarily)
124
Q

What are the symptoms of Lewy body dementia?

A
  • Dementia (fluctuating levels of awareness)
  • Visual hallucinations
  • Mild parksonism:
    ◆ Tremor
    ◆ Rigidity

HIGH YIELD: Dementia preceeds the parksonism signs.

125
Q

What is the investigation of Lewy body dementia?

A

MRI: Parietal atrophy
SPECT (DATscan): ⬇︎ dopamine uptake in basal ganglia.

126
Q

Describe nerve root entrapments.

A

◉ L4:
- Motor weakness of knee extension

◉ L5:
- Motor weakness of big toe dorsiflexion

◉ S1:
- Motor weakness of foot plantarflexion

◉ S1 & S2:
- Ankle jerk reflex changes

◉ L3 & L4:
- Knee jerk reflex changes

127
Q

Symptoms of Meniere's disease?

A
  • Vertigo
  • Deafness: increased feeling of pressure in the ear
  • Dizziness
  • Tinnitus
128
Q

What is the investigations of Meniere's disease?

A
  • MRI is normal (to exclude acoustic neuroma)
129
Q

What is the treatment of Meniere's disease?

A
  • Prochlorprazine
  • Cyclizine
  • Promethazine
130
Q

What is the treatment for migraines?

A

First line:
- Paracetamol
- Ibuprofen

2nd line:
- Triptans (oral but if vomiting nasal or SC)

Prophylaxis:
- Beta blockers: Propranolol
- Amitriptyline
- Topiramate (contraindicated in pregnancy)

131
Q

What are the symptoms of ME: myalgic encephalomyelites / chronic fatigue syndrome?

A
  • Flu like symptoms
  • Fatigue that gets worse by activity and it is not relieved by rest;
  • Brain fog (memory problems)
  • Pain
132
Q

What is the classification of neurofibromatosis?

A

Type 1:
- Café-au-lait spots
- Scoliosis
- Associated with phaeochromocytomas

Type 2:
- Bilateral acoustic neuromas
- Multiple intracranial schwannomas

133
Q

What are the symptoms of normal pressure hydrocephalus?

A
  • Confusion & memory loss
  • Urinary incontinence
  • Gait disturbance

Wacky, Wet, Wobbly grandpa.

134
Q

What are the investigations done in normal pressure hydrocephalus?

A

CT/MRI:
- Enlarged ventricles without global athrophy

Lumbar puncture:
- CSF: normal or slightly elevated

135
Q

What is the treatment done in normal pressure hydrocephalus?

A

Definitive:
- CSF shunting

Others:
- Acetazolamide (decreases CSF)
- Serial lumbar puncture (if unfit for surgery)

136
Q

What is the investigation done in OSA?

A

Goldstandard:
- Polysomnography

Others:
- Overnight oximetry

137
Q

What is the treatment of OSA?

A
  • CPAP
  • Weight loss
  • ⬇︎ alcohol & smoking
138
Q

What are the symptoms of Parkison's disease?

A
  • Resting tremors
  • Rigidity
  • Bradykinesia
  • Abnormal gait
  • Mask like face
139
Q

What is the treatment of Parkison's disease?

A

First line:
- Levodopa
- Carbidopa

Others:
- MAO-B inhibitors: selegiline
- Dopamine antagonist: pramipexole and ropinirole
- Amantadine

140
Q

Describe the management of psychosis related to Parkinson's disease.

A

Rapid tranquility desired (aggressive patient):
- Benzodiazepine

Rapid tranquility NOT desired:
- ⬇︎ dose of levodopa
OR
- Antipsychotics: Quetiapine or clozapine

141
Q

What are the symptoms of Progressive Supranuclear Palsy (PSP)?

A
  • Eye movement restriction (downgaze more affected)
  • Falling backwards
  • Change in behaviour
142
Q

What is the cause of Ramsay Hunt syndrome?

A

Herpes Zoster oticus.

143
Q

What are the symptons of Ramsay Hunt syndrome?

A
  • Ipsilateral facial paralysis

Caused by lower motor neuron facial nerve paralysis

144
Q

DDX between Bell’s Palsy and Ramsay Hunt syndrome?

A

Ramsay Hunt syndrome
- Ipsilateral facial paralysis
- Vesicles in ear or palate
- Pain
- Antivirals + Prednisolone

Bell’s palsy:
- Ipsilateral facial paralysis
- Prednisolone

145
Q

What is the Rx of Ramsay Hunt syndrome?

A

- Antivirals: within 72h and 1 week from onset.
- Prednisolone: within 2 weeks of onset.

146
Q

What are the symptoms of REM sleep behaviour disorder?

A
  • Vivid dreams (might be violent or cause injuries)
  • May fall out of bed.
147
Q

What is the Rx of REM sleep behaviour disorder?

A

First line:
- Clonazepam

2nd line:
- Melatonin

148
Q

What drugs worsen Parkinson symptoms?

A

Nausea & vomit:
- Metaclopramide
- Cinnarizine
- Prochlorperazine

Delirium & confusion
- Haloperidol
- Risperidone
- Olanzapine

Cough & cold
- Ephedrine
- Pseudoephedrine

Avoid all of them.

149
Q

Parkinson patient

Presenting with new symptoms:
- Due to parkinson medication?
- Due to worsening of the disease?

A

Dyskinesia
➜ Extra movements
- Caused by medications (levodopa)

Bradykinesia
➜ ↑ rigidity, less movements
- Caused by worsening of Parkinson disease
- Insufficient medication.

150
Q

What diseases is SAH (subarachnoid haemorrhage) associated with?

A
  • HTA
  • Polycystic kidney disease (Berry aneurysm)
  • Ehler Danlos syndrome
151
Q

How the diagnosis of SAH done?

A
  • CT
    - Lumbar puncture:
    ◆ CSF bloody ➝ xanthochromic (bilirubin)
152
Q

What is the Rx of SAH?

A

Nimodipine.

153
Q

Describe what is syringomyelia.

A

Cyst in the spinal cord (usually cervical).

154
Q

What are the symptoms of syringomyelia?

A
  • Loss of pain and temperature sensation (arms and hands)
  • Progressive weakness of arms and hands
  • Headaches
  • Bladder disturbances
155
Q

What is the investigation in syringomyelia?

A

MRI

156
Q

What is syringobulbia?

A

When syrinx extends the brain stem.

157
Q

DDX of neuro infection associated with HIV?

A

Toxoplasmosis
- MRI / CT scans: enhanced rings
- Rx: pyrimethamine + sulfadiazine

Cryptococcal meningitis
- Meningism
- Rx: Amphotericin + Flucytosine

158
Q

Describe Neurocysticercosis.

A

► Caused by taenia solium (pork tapeworm)
- Seizures
- CT: calcified lesions
- Rx: Praziquantel & Niclosamide

159
Q

Describe what is Transverse myelitis.

A

Spinal cord inflammation (that might happen) after infection.

160
Q

What is the investigation done in Transverse myelitis?

A

MRI
- Spinal cord lesion that is enhaced by gadolinium.

161
Q

What are the symptoms of trigeminal neuralgia?

A
  • Electric shooting pain
  • Unilateral on the distribution of trigeminal nerve
  • Lasts < than 2 min.
162
Q

What is the management of trigeminal neuralgia?

A

1st line:
- Carbamazepine

2nd line:
- Gabapentin
- Lamotrigine
- Phenytoin

163
Q

DDx of tremors.

A

Essential tremors:
➔ Most common type
- Improves with alcohol
- Doesn’t dissapear with distraction

Parkisonian tremor:
- Occurs at rest
- Dissapears with voluntarily movements

Psychogenic tremor:
- Dissapears with distraction
- Appears and dissapears suddenly

Cerebellar tremor:
- Intentional tremors: gets worse with volutarily movements

PLAB 1 August 2024 (32 decks)

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