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YEAR 4 > Neurology > Flashcards

Neurology Flashcards

1
Q

Bradykinesia, unilateral pill-rolling tremor and rigidity are 3 of the core symptoms of parkinson’s disease, name 8 other characteristic features.

A

Micrographia
Hypersalivation
Mask-like facies
Impaired olfaction
Psychiatric features: depression, dementia and psychosis.
Sleep disorders.
Fatigue
Autonomic dysfunction

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2
Q

What are the features of drug-induced Parkinsonism?

A

Motor sx are usually rapid onset and bilateral.
Rigidity and rest tremor are uncommon.

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3
Q

Levodopa is one of the medications used to treat the motor sx of parkinson’s disease, name 2 other classes of medications used to treat Parkinson’s with three examples of each.

A

Dopamine agonists: Ropinirole, Rotigotine and Cabergoline.
Monoamine Oxidase B Inhibitors: Selegiline, Rasafiline and Safinamide.

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4
Q

Which medication can be used to treat the dyskinesia associated with treatment of Parkinsons?

A

Amantadine

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5
Q

What are two examples of COMT inhibitors used in the treatment of Parkinson’s?

A

Tolcapone
Entacapone

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6
Q

What can be prescribed to help prevent the hypersalivation that is associated with Parkinson’s?

A

Glycopyronium bromide

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7
Q

Dry mouth, anorexia and palpitations are 3 side effects assoicated with levodopa, name 2 more.

A

Postural hypotension
Psychosis

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8
Q

What are the ergot-derived dopamine agonists and what side effects are they associated with?

A

Cabergoline
Bromocriptine

Pulmonary, retroperitoneal and cardiac fibrosis.

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9
Q

Which drugs are used in the treatment of drug-induced Parkinsonism?

A

Anti-muscarinics which help with tremor.
Procyclidine

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10
Q

What are the features of progressive supranuclear palsy?

A

Postural instability and falls (stiff broad-based gait)
Impairment of vertical gaze.
Parkinsonism - prominent bradykinesia
Cognitive impairment (primarily frontal lobe dysfunction)

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11
Q

Unilateral upper and lower facial nerve palsy and dry eyes are two features of Bell’s palsy, name 3 more.

A

Post-auricular pain
Altered taste
Hyperacusis

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12
Q

When should people with Bell’s palsy be referred?

A

If the paralysis is persistent after 3 weeks with no signs of improvement.

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13
Q

Which class of drug can worsen the symptoms of myasthenia gravis?

A

Beta blockers
Lithium
Phenytoin
Antibiotics - macroldies, quinolones

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14
Q

What is the most common complication following meningitis?

A

Sensorineural Hearing loss

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15
Q

What is the most appropriate initial management if a cerebral infarction transforms into a cerebral haemorrhage?

A

Stop anticoagulation
Control BP

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16
Q

Which nerve is most likely to be damaged in a mid-shaft humeral fracture and how would this present?

A

Radial nerve
Wrist drop

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17
Q

What is the most common form of motor neuron disease?

A

Amyotrophic lateral sclerosis

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18
Q

What specific abnormalities can topiramate cause if taken during pregnancy?

A

Cleft lip and palate.

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19
Q

What are the three key features of normal pressure hydrocephalus?

A

Gait abnormalities (often similar to Parkinson’s)
Urinary incontinence
Dementia and bradyphenia (slowness of thought)

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20
Q

Guillain-Barre Syndrome causes progressive, symmetrical weakness of all the limbs, name 3 more features that may be found on examination of the limbs.

A

Ascending weakness (legs affected first)
Reflexes reduced or absent
Mild sensory sx (distal paraesthesia) - may not be present

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21
Q

Patients with Guillian-Barre syndrome may suffer from respiratory muscle weakness, name 5 more features that may be present.

A

Diplopia
Bilateral facail nerve palsy
Oropharyngeal weakness (common)
Urinary retention
Diarrhoea

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22
Q

What investigatons are carried out for a suspected case of Guillain-Barre syndrome and what would positive results show?

A

LP - rise in protein with normla WBC count (found in 66%)
Nerve conduction studies - decreased motor nerve conduction velocity (prolonged distal motor latency, increaded F wave latency).

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23
Q

Nasal discharge, red swollen watering eye and eyelid drooping are common features of a cluster headache, name 2 more features.

A

Pupil constriction
Facial sweating

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24
Q

What is the management for an acute cluster headache?

A

IM triptans
High flow oxygen

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25
Q

What is the firstline prophylaxis for cluster headaches? What other prophylactic options are there?

A

Verapamil

Occipital nerve block
Prednisolone - short course to break cycle
Lithium

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26
Q

What are the features of the diagnostic criteria for neurofibromatosis 1?

A

Cafe au lait spots (>15mm)
Relative with NF1
Axillary or iguinal freckling
Bony dysplasia (bowing of a long bone)
Iris hamartomas (yellow-brown spots on the iris)
Neurofibromas (2 or more are significant)
Glioma (optic pathway)

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27
Q

Migraines, epilepsy and learning disability are 3 complications of NF1, name 6 more.

A

Renal artery stenosis
Scoliosis of spine
Vision loss
Gastrointestinal stromal tumour
Brain tumours
Spinal cord tumours

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28
Q

What type of tumour is NF2 particularly associated with?

A

Acoustic Neuromas

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29
Q

What is the characteristic finding of normal pressure hydrocephalus on CT?

A

Ventriculomegaly with absence of/or out of proportion to sucal enlargement.

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30
Q

What is the pathophysiology behind normal pressure hydrocephalus?

A

Reduction in CSF reabsorption by arachnoid villi - secondary to head injury or SAH.

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31
Q

What are the 3 key features of Wernicke’s encephalopathy?

A

Ataxia
Confusion
Ophthalmoplegia

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32
Q

What are the 3 types of mutliple sclerosis?

A

Relapsing and remitting
Primary progressive
Secondary progressive

Progressive forms - worsening in between relapsing.

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33
Q

Optic neuritis is a common presenting feature of multiple sclerosis, name 10 more potential presenting features.

A

Optic atrophy
Pins/needles
Numbness
Trigeminal neuralgia
Spastic weakness
Ataxia
Tremors
Urinary incontinence
Intellectual deterioration
Sexual dysfunction

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34
Q

What are the features seen in the CSF for MS?

A

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

35
Q

What are the features seen on MRI for MS?

A

high signal T2 lesions
periventricular plaques

36
Q

What do you give for acute MS relapse?

A

High dose steroids (IV methylprednisolone)

37
Q

What do you give longterm for MS?

A

DMARDs

38
Q

What can be given for sx of spasticity?

A

Baclofen or gabapentin

39
Q

What can be the mx for urinary dysfunction?

A

Intermittent self-catheterisation
Anticholinergics

40
Q

Smoking is a risk factor for MS, name 3 more.

A

Vitamin D deficiency
EBV
Obesity

41
Q

What can be used to treat Oscillopsia? (visual fields appear to oscillate)

A

Gabapentin

42
Q

What is the definition of TIA?

A

A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.

43
Q

What are examples of TIA mimetics that need to be excluded?

A

hypoglycaemia
intracranial haemorrhage

44
Q

Firstline imaging for TIA if no risk factors for intracranial bleeding?

A

MRI

45
Q

What cranial nerves can be affected by acoustic neuromas?

A

V, VII, VIII

46
Q

What is the treatment of Ramsay Hunt?

A

High dose aciclovir, high dose oral steroids and eye protection

47
Q

Which antiepileptic is most associated with weight gain?

A

Sodium valproate

48
Q

How does pontine haemorrhage present?

A

Pinpoint pupils
Reduced GCS
Paralysis

49
Q

What medication can be administerd in a SAH to prevent cerebral vasospasm?

A

Nimodipine

50
Q

What drug class can precipitate idiopathic intracranial hypertension?

A

Tetracyclines

51
Q

Where is the defect in a left homonymous hemianopia?

A

Right optic tract

52
Q

What are the characteristic features of a posterior cerebral artery stroke?

A

Homonymous hemianopia with macular sparing and visual agnosia

53
Q

On examination, you note that he has a loss of vision in the right upper quadrant of the visual field in both eyes. Where is the lesion?

A

Left temporal lobe, inferior optic radiations

54
Q

What is the most important diagnostic investigation for degenerative cervical myelopathy?

A

MRI cervical spine

55
Q

What is the firstline treatment for myoclonic seizures in females?

A

Levetiracetam

56
Q

What is the firstline treatment for tonic or atonic seizures in females?

A

Lamotrigene

57
Q

Which score is used to measures disability or dependence in activities of daily living in stroke patients?

A

Barthel Score

58
Q

What type of tumour is an acoustic neuroma?

A

Cerebellopontine tumour

59
Q

What is the firstline treatment for myasthenia gravis and what is the mechanism of action?

A

Pyridostigmine
Acetylcholinesterase inhibitor

60
Q

What is the treatment for Bells Palsy?

A

Prednisolone (oral)
Within 72 hours of sx onset

61
Q

What does a rise in prolactin after an episode of collapse suggest?

A

Seizure rather than a pseudoseizure.

62
Q

What is the firstline treatment for myoclonic seizures in men?

A

Sodium valproate

63
Q

In a patient with status epilepticus what are the two most important things to initially rule out?

A

Hpoxia
Hypoglycaemia

64
Q

In a traumatic fracture what is the fasest way to check whether any draining fluid is CSF?

A

Check glucose = positive result = CSF
(not present in mucus)

65
Q

If a seizure begins in one limb and then travels around the body what is this called and where is the seizure most likely occurring in the brain?

A

Jacksonian march
Frontal lobe.

66
Q

What is the medication used to treat restless leg syndrome?

A

Dopamine agonists e.g. ropinirole

67
Q

Which nerve is at risk in a surgical neck of humerus fracture?

A

Axillary nerve

68
Q

A 32 year-old female presents with a 3 day history of altered sensation on her left foot and right forearm. On examination she has clonus in both legs and has hyperreflexia in all limbs. Diagnosis?

A

Multiple sclerosis

69
Q

What are the findings of myotonic dystrophy?

A

Bilateral weakness in the face.
Slow fist opening.

70
Q

What are the findings in facio-scapula-humeral dystrophy?

A

When asked to raise their arm, their scapula raises first.

71
Q

A 45-year-old female with multiple sclerosis complains of tingling in her hands which comes on when she flexes her neck. What is this an example of?

A

Lhermitte’s sign

72
Q

What is the most appropriate diagnostic investigation for suspected optic neuritis?

A

MRI brain and orbit with contrast (gadolinium).

73
Q

What is the most appropriate diagnostic investigation for suspected optic neuritis?

A

MRI brain and orbit with contrast (gadolinium).

74
Q

What age does Picks Disease present usually?

A

Under 65

75
Q

What drug can be used for treatment of tremor in Parkinson’s?

A

Procyclidine

76
Q

What dopamine agonist has the side effect of pulmonary fibrosis?

A

Cabergoline

77
Q

When does delirium tremens occur with alcohol withdrawal? When do seizures occur?

A

48-72 hours after last drink
36 hours

78
Q

What are the two characteristic features of Creutzfeldt-Jakob disease?

A

Rapid onset dementia
Myoclonus (although may not appear as quickly as dementia)

79
Q

What is the associated skin rash with juvenile idiopathic arthritis?

A

Salmon pink rash (legs)

80
Q

What are the stroke mimetics?

A

Hypoglycaemia
SOL
BPPV
Migraine
Epilepsy

81
Q

What is the most common cause of death post-stroke?

A

Aspiration

82
Q

What is the ischaemic pernumbra?

A

Part of stroke that is at risk of infarction but may be salvageable if reperfused.

83
Q

What are poor functional prognostic factors for stroke?

A

Dense hemipareis
Inattention
receptive dysphasia
cognitive dysfunction

84
Q
A

YEAR 4 (11 decks)

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