Neurology Flashcards
1
Q
2 types of stroke
A
ischaemic stroke
haemorrhagic stroke
2
Q
Tool for stroke in community
A
FAST Tool
F – Face
A – Arm
S – Speech
T – Time (act fast and call 999)
3
Q
PITS
2 parts of this are?
A
Parietal lobe damage causes Inferior (lower) quadrantanopia.
Temporal lobe damage causes Superior (upper) quadrantanopia.
4
Q
Middle Cerebral Artery (MCA) Stroke
3 buzzwords
A
“Face and arm” (weakness/sensory loss)
“Aphasia” (dominant hemisphere)
“Neglect” (non-dominant hemisphere)
Like old lady on ward.
5
Q
Anterior Cerebral Artery (ACA) Stroke
3 buzzwords
A
“Leg weakness” (contralateral)
“Personality changes” (frontal lobe)
“Incontinence” (frontal micturition center)
6
Q
Posterior Cerebral Artery (PCA) Stroke
H,T,M
3 buzzwords
A
“Homonymous hemianopia”
(contralateral)
“Thalamic pain” (syndrome)
“Memory loss” (temporal lobe)
7
Q
what part of brain is responsible for balance and walking?
A
Cerebellum
8
Q
Area in brain for difficulty understanding speech
A
Wernicke’s area in the left temporal lobe of the left cerebral hemisphere.
9
Q
Area in brain responsible for coordination of voluntary movements?
A
1° Motor cortex in frontal lobe initiates movement.
cerebellum is fine tuning centre
10
Q
Gross motor skills issue, which part of brain?
A
Subthalamic nucleus
11
Q
POCS – Posterior Circulation Stroke
3 buzzwords
A
Vertigo
Ataxia
diplopia
12
Q
Long term therapy for ischemic stroke (2)
A
(300mg aspirin 2 weeks)
- clopidogrel 75 mg once daily
- atorvastatin 80 mg once nightly
BUT
IF AF… DOAC+ STATIN (>3.5mm/l)
13
Q
Wallenberg’s syndrome:
5 buzzwords
PICA
A
Ipsilateral loss of pain and temperature on the face.
Contralateral loss of pain and temperature on the body.
dysphasia/voice issues
Ataxia
nystagmus
14
Q
basilar artery stroke
3 buzzwords
A
Locked-in syndrome
Dysarthria
Quadriplegia
15
Q
A lacunar stroke, 3 buzzwords
A
clumsy hand syndrome
(dysarthria) slurred speech.
pure motor / pure sensory only
16
Q
Weber’s Syndrome 3 Buzzwords:
A
Midbrain stroke
Oculomotor nerve palsy (“down and out” eye, ptosis)
Contralateral hemiparesis
(AND hypertension, diabetes, or hypercholesterolaemia)
17
Q
ischemic stroke, immediate treatment (2)?
A
Alteplase (if within 4.5 hours & eligible for thrombolysis).
Aspirin 300mg (if thrombolysis is not an option or after 24 hours post-thrombolysis).
18
Q
spinothalamic tract carries xxx and yyy sensation from the body to the brain
what are xxx and yyy
A
spinothalamic tract carries pain and temperature sensation from the body to the brain
and crude touch
19
Q
MCA Stroke - 3 Buzzwords:
A
✅ Face & Arm Weakness (Contralateral)
✅ Aphasia (If Left Hemisphere)
✅ LS Neglect (If Right Hemisphere)
20
Q
Posterior cerebral artery associated with what issue generally (2)
A
Visual issues
memory issues
21
Q
Ischemic stroke , initial= CT scan
to exclude what?
A
Exclude Haemorrhage
22
Q
Carotid stenosis test
A
Carotid doppler Ultrasound
23
Q
Q: When is carotid endarterectomy (CEA) recommended for carotid stenosis?
A
✅ 70–99% (Symptomatic) → Endarterectomy strongly recommended
✅ 50–69% (Symptomatic) → Consider Endarterectomy (case by case)
✅ <50% (Any Symptoms or Asymptomatic) → Medical therapy only
✅ 100% Occlusion → No surgery (Medical management only)
24
Q
Order of Brain out to in:
A
Skull
Dura
Archnoid mater
(Subarachnoid space)
Pia
25
Extradural (Epidural) Hemorrhage (EDH)
+
Tx
3 buzzwords
Middle meningeal artery
Lucid interval
Biconvex (lentiform) shape
Tx= Craniotomy+ hematoma evacuation
26
Subdural Hemorrhage (SDH)
3 buzzwords + Tx
Bridging veins
Crescent-shaped on CT
Elderly/Anticoagulation
Burr holes
27
Subarachnoid Hemorrhage (SAH)
3 buzzwords
Thunderclap headache
Berry aneurysm
Blood in basal cisterns
28
Intracerebral Hemorrhage (ICH)
3 buzzwords
Hypertension
Basal ganglia
Focal neurological deficits
29
Extra dural - treatment?
Craniotomy + artery ligation
30
Subdural - treatment?
Craniotomy + artery ligation + burr holes
31
Subarachnoid - treatment?
clipping or
coiling (better)
32
MINOR bleed: WWW
MAJOR bleed: XXX
NOT bleeding:
INR >8: YYY
INR 5-8: ZZZ
MINOR bleed: WWW IV vitamin K
MAJOR bleed: XXX IV vitamin K + prothrombin complex concentrate
NOT bleeding:
INR >8: YYY oral vitamin K
INR 5-8: ZZZ miss next dose of warfarin
33
Haemotoma Hyper-dense CT:
Acute or Chronic?
Fresh or Old Blood?
Haemotoma Hypo-dense CT:
Acute or Chronic?
Fresh or Old Blood?
Bright (hyperdense) = Fresh blood = Acute haematoma
Dark (hypodense) = Old blood = Chronic haematoma
34
What are the acute and prophylactic treatments for cluster headaches?
✅ Acute Treatment: Sumatriptan + High-flow Oxygen (100%)
✅ Prophylaxis: Verapamil
35
Good acronym for haemorrhagic stroke management
A -
B -
C -
Good acronym for haemorrhagic stroke management
A - anticoagulant reversal
B - BP control
C - Consider neurosurgery
36
Male/Female 40-60 age
stiffneck
Photophobia
Sudden severe occipital headache
Which disease?
subarachnoid hemorrhage
THUNDERCLAP HEADACHE
37
3 reasons why people get subarachnoid hemorrhage?
1. Illicit Drug use
2. Blood conditions (Sickle cell)
3. Kidney issues
38
1st line Ix Subarachnoid Hemorrhage
and 2nd line
Non-Contrast CT HEAD
then
12 hours after L.P ( ↑ RBC)
(Pink/ Yellow) Xanthochromia
39
Medication to prevent vasospasm after SAH
Nimodipine
40
Female
20-40 age
Epstein-Barr virus
↓ Vit D
Which disease?
**Lhermitte's sign**
Multiple Sclerosis
41
disease linked with M.S a lot
Optic Neuritis
42
3 types of Disease patterns for M.S
Relapsing Remitting (most common)
Secondary Progressive
Primary Progressive
43
MS Ix (2)
MRI
L.P (Oligoclonal bands)
44
Finding in CSF in MS
Oligoclonal bands
45
Multiple Scerlosis Tx
Methylprednisolone
46
Age 50-70
Male
gradual onset weakness (hands / shoulders)
No sensory symptoms
Which disease?
Motor Neurone Disease
47
Most common MND
AMYLOTROPIC LATERAL SCLEROSIS
48
Meds for ALS/MND
riluzole
49
UMN or LMN sign: LMN or UMN
fasciculations
Brisk Reflexes
Upgoing plantars
Muscle Wasting
Spasticity
fasciculations LMN
Brisk Reflexes UMN
Upgoing plantars UMN
Muscle Wasting LMN
Spasticity UMN
50
Primary lateral sclerosis (PLS): UMN or LMN?
progressive UMN degeneration,
spasticity
hyperreflexia
weakness
without muscle atrophy or fasciculations.
51
Spinal Muscular Atrophy (SMA)
UMN or LMN?
LMN
degeneration of LMNs
muscle atrophy
weakness
fasciculations without spasticity or hyperreflexia.
52
Progressive bulbar palsy - affects what?
primarily affects the muscles of talking and swallowing (the bulbar muscles).
53
Male, 60-65 years
Resting tremor
Rigidity
Bradykinesia
Which disease?
Why it happens?
Parkinson’s
↓ D2 in substantia nigra
54
Name of Facial masking in Parkinson's
Hypomimia
55
Multiple System Atrophy (MSA):
(Parkinson's)
3 buzzwords
A C P
Autonomic dysfunction – Postural **h**ypotension, urinary incontinence.
**C**erebellar ataxia – Coordination problems.
Parkinsonism – Tremor, rigidity, **b**radykinesia (poor response to levodopa).
Hot Cross Buns
56
Dementia with Lewy Bodies (DwLB):
(Parkinson's)
3 buzzwords
Visual hallucinations – Common early symptom.
Fluctuating cognition – Varying levels of alertness and attention.
REM sleep disorder – Acting out dreams (early feature).
57
3 examples of Dyskinesias (Parkinsons)
Dystonia: Sustained, abnormal postures or twisting movements.
Chorea: Sudden, unpredictable, jerky movements.
Athetosis: Slower, writhing, snake-like movements.
58
a COMPT inhibitor, link to Parkinsons? What name of drug
Entacopone
inhibits COMT enzyme, increasing dopamine availability
59
a Dopamine Agonist (parkinsons)
Bromocriptine
is a dopamine D2 receptor agonist, reducing prolactin secretion
60
Mao-B inhibitor (2)
After Levodopa (+ Carbidopa) and/or Dopamine Agonists (e.g. Ropinirole)
(Parkinsons)
Selegiline and rasagiline
selective MAO-B (monoamine oxidase-B) inhibitors.
61
3 key reasons to think Benign Essential Tremor (BET) over Parkinson's disease:
1. Tremor with action – BET occurs during movement, while Parkinson's tremor is usually at rest.
2. Symmetrical tremor – BET typically affects both sides equally, while Parkinson's often starts asymmetrically.
3. Lack of bradykinesia or rigidity – BET lacks the slowed movements and muscle stiffness seen in Parkinson’s disease.
62
Treatment for BET (2)
Propanolol (CI Asthma)
Primidone/ Topiramate
63
Tonic-Clonic seizure (Grand Mal) (3)
Loss of consciousness
Muscle tone stiffening and rigidity (1st)
Clonic phase, Rhythmic jerking or convulsions. (2nd)
bonus= post ictal period
64
Absence seizure (Petit Mal) (3)
Staring spells: Sudden, brief episodes of staring or blank expression.
No postictal confusion: The person resumes normal activity immediately after.
Children: More common in pediatric populations.
65
Myoclonic seizure (3)
Sudden jerks: Quick, involuntary muscle twitches. (no stiffness)
No loss of consciousness: The person remains aware during the jerks.
Morning onset: Often occurs shortly after waking.
66
Atonic seizure (3)
Drop attacks: Sudden loss of muscle tone causing falls.
Brief: The episode lasts only a few seconds.
Injury risk: High risk of injury due to sudden collapse.
67
Focal (Partial) seizure (3)
Starts in one area of the brain (localised onset)
Awareness can be preserved or impaired
💡 Simple = aware
💡 Complex = impaired awareness
May begin with an aura (déjà vu, unusual smells)
68
Tonic-Clonic / Myoclonic / Atonic / Tonic Seizures treatment 1st + 2nd line
1st Sodium valproate (teratogenic)
2nd Lamotrigine and levetiracetam (ladies)
💥 Myoclonic Tx= levetiracetaM
69
Focal Seizures 1st line Tx
(Temporal, frontal, occiptal, parietal)
Temporal = Hallucinations/ Epgastric rising, Automatisms, Dejavu (HEAD)
Frontal= Jacksonian march
Occiptal= Floaters / Flashers
Parietal= Paresthesia (pins/needles)
1st line Tx
Lamotrigine and levetiracetam
70
Absence Seizures 1st line
Ethosuximide
71
Non-Epileptic Attack Disorder (NEAD)
(4)
pelvic thrusting
head movements
stress related
Remembers everything
(raised prolactin)
72
Drugs for status in ''Community'' epileptic seizure
buccal midazolam or rectal diazepam
73
Drugs for status in ''hospital'' epileptic seizure
IV lorazepam
74
escalation steps in the treatment of status epilepticus
(4)
Lorry Lorry Funny Call ITU
- x2 doses IV Lorazepam,
- IV Phenytoin/ Levetiracetam
- Call ITU
75
Trigeminal neuralgia 1st line treatment?
carbamazepine
76
post-herpetic neuralgia (PHN), the first-line treatments are:
Amitriptyline or nortriptyline
Gabapentin or pregabalin
77
Damage to
Wernicke's and Broca's
What happens?
Wernicke's area damage= word salad
Broca's= broken speech
78
Bell's palsy, what type of damage UNM or LNM?
Entire face affected including forehead?
Tounge involvement?
Lower Motor Neuron (LMN) Damage
both the forehead and the lower face (on affected side)
loss of taste of the anterior 2/3 of the tongue (on the same side as the facial weakness)
79
stroke, UNM or LNM?
Forehead spared or not spared?
forehead is spared
Face droops
80
Idiopathic cause of FNP? and Tx
Bell's
Pred (within 72 hrs)
81
Vesicular rash around ear in FNP?
Ramsy Hunt Syndrome
82
Treatment for Ramsey Hunt Syndrome
Pred AND Acyclovir (PO)
83
4 Key symptom of Brain Tumours
vomiting
constant headache
worse on bending forward
raised ICP
84
Brain tumour sign on Fundoscopy
Papilloedema
85
Most maligiant type of brain tumour
Astrocytoma (the most common and aggressive form is glioblastoma)
86
tumour of membrane brain
meningiomas
87
Acoustic nueroma (3)
✅ Unilateral sensorineural hearing loss
→ Most common presenting symptom
✅ Tinnitus
→ Often in the affected ear
✅ Balance issues (imbalance, not true vertigo)
→ Due to involvement of the vestibular part of CN VIII
88
3 key buzzwords
Huntington's chorea
Treatment?
Chorea
Cognitive Decline
Psychiatric Symptoms
Tx
Tetrabenazine
89
Myasthenia Gravis most common antibodies
ACh receptor antibodies
90
Myasthenia Gravis Most affected muscle groups
Proximal+ small muscles head/neck
91
Associated tumour Myasthenia Gravis
Thymoma
92
Specific test Myasthenia Gravis
edrophonium test/ Tensilon test
93
In Myasthenia Gravis, 2 examples of reversible ACh enzyme inhibitors
Also
Tx for underlying MG
Pyridostigmine (helps eye issues/ SYMPTOMS)
Neostigmine
====
Tx immunosuppression
94
Myasthenia Gravis surgical treatment
Thymectomy
95
Monoclonal antibody treatment Myasthenia Gravis
Rituximab
96
LEMS associated with?
SCLC
97
Key symptom of LEMS
Muscle Weakness/ better after exercise
98
Most affected muscles in LEMS
Proximal muscles (legs)
99
other commonly affected muscle groups in LEMS (3)
Intraocular (diplopia)
Levator muscles (ptosis)
Oropharyngeal muscles (Dysarthria / dysphagia)
100
Meds for LEMS
Amifamprodine
101
more common, MG or LEMS?
MG
102
Type of cell that produce antibodies in GBS
B-Cells
103
Key triggering pathogens in GBS (3)
Campy
Cytomegalovirus
EBV
104
GBS 2 Ix?
Nerve conduction studies
L.P
105
Finding on GBS CSF
↑ protein
106
Main treatment for GBS
IV immunoglobulins
107
GBS starts proximally or distally?
distally
108
3 symptoms for Neurofibromatosis Type 1
Neurofibroma
Café au lait spots
Axillary freckles
109
Neurofibromatosis Type 1 eye sign
Iris Hamartomas (Lisch nodules)
110
Neurofibromatosis Type 1 , Chromosome gene is on?
Chromosome 17
111
Protein Gene codes for Neurofibromatosis Type 1
Neurofibromin (tumour suppressor gene)
112
Neurofibromatosis Type 1 pattern?
Autosomal dominant
113
Neurofibromatosis type 2- key buzzword
schwannomas
114
Neurofibromatosis Type 2 bilateral what?
bilateral acoustic neuromas
115
Tuberous Sclerosis- 5 buzzwords
who usually gets it?
children.
Autosomal dominant
Seizures
Angiofibromas (facial skin growths)
Cortical tubers (brain lesions)
Shagreen patches (thickened skin spots)
116
Jugular Foramen Syndrome
3 buzzwords
voice changes,
swallowing difficulty,
shoulder /neck weakness
117
DANISH
what does it stand for and which disease profile?
Cerebellar stroke
Mainly Posterior Inferior Cerebellar Artery (PICA) stroke
aka Lateral medullary syn
drome / Wallenberg syndrome
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
118
5 key buzzwords for Parkinson's Plus Syndromes (also known as atypical parkinsonism):
PSP: Vertical eye movement difficulty, postural instability.
MSA: Autonomic dysfunction (e.g., BP instability, bladder issues).
CBD: Asymmetric motor symptoms, limb apraxia.
LBD: Visual hallucinations, fluctuating cognition.
Poor levodopa response: Minimal improvement with Parkinson’s meds.
5 key buzzwords for Parkinson's Plus Syndromes (also known as atypical parkinsonism):
PSP: Vertical eye movement difficulty, postural instability.
MSA: Autonomic dysfunction (e.g., BP instability, bladder issues).
CBD: Asymmetric motor symptoms, limb apraxia.
LBD: Visual hallucinations, fluctuating cognition.
Poor levodopa response: Minimal improvement with Parkinson’s meds.
119
optic neuritis
CRAP
optic neuritis
CRAP
C- central scotoma
R- red desaturation/ relative afferent pupillary defect
A- acuity decreased
P- painful eye movement
120
Anti TB drugs, AEs
Rifampicin, Ethambutol, and Isoniazid
**R**ifampicin = r for red secretions
**E**thambutol = e for eyes
iso**N**iazid = the only one with n , for nerves
121
cerebellar hemisphere is responsible for 3 key things?
coordination, fine motor skills, and balance
122
Cerebral Amyloid Angiopathy (CAA), 3 buzzwords
Lobar Hemorrhage –
Amyloid Deposition –
Elderly –
123
Posterior Inferior Cerebellar Artery (PICA): Lateral Medullary (Wallenberg) Syndrome
DANVAH
D - dysphagia
A - ataxia
N - nystagmus
V - vertigo
A - anaesthesia
H - Horner's syndrome
124
AICA Syndrome: Lateral Pontine Syndrome
F'(ing) CHAV
F = Facial weakness (ipsi) (CN VII: LMN lesion causing ipsilateral facial paralysis).
C = Cochlear involvement (hearing loss, tinnitus) (CN VIII).
H = Horner’s syndrome (due to disruption of sympathetic fibers).
A = Ataxia (ipsi) (damage to cerebellar peduncles).
V = Vertigo and nystagmus (vestibular nucleus involvement).
125
Posterior Cerebral Artery (PCA) Stroke (3)
Homonymous Hemianopia:
Thalamic Pain Syndrome:
Memory Impairment
126
Hypodense area (dark on CT scan):
Indicates what? .
Hyperdense area (bright on CT scan):
Indicates what?
Hypodense area (dark on CT scan):
ischemic stroke, meaning there's a lack of blood supply to the brain, leading to tissue death.
Hyperdense area (bright on CT scan):
hemorrhagic stroke, where there's active bleeding in the brain tissue
127
TACI
Total Anterior Circulation Infarc (3)
Hemiparesis/Hemisensory loss
Hemianopia
Higher cortical dysfunction
128
✅ "CN VI palsy →
✅ "CN IV palsy →
✅ "CN III palsy →
✅ "CN VI palsy → Diplopia when looking laterally (failure to abduct the eye)"
✅ "CN IV palsy → Diplopia when looking down (difficulty reading & walking downstairs)"
✅ "CN III palsy → Diplopia with 'Down & Out' eye + ptosis"
129
Spinothalamic tract- what travels?
Pain and temperature
130
Vestibulospinal tract- what travels?
Motor neuronal signals relating to posture
131
Cuneate fasciculus- what travels?
Fine touch, pressure and proprioception
132
Posterior spinocerebellar tract- what travels?
Proprioceptive signals to cerebellum
133
Anterior corticospinal tract- what travels?
The anterior corticospinal tract transmits motor signals from the precentral gyrus to the motor neurons responsible for voluntary axial and proximal muscle movements, playing a key role in posture and gross motor control.
134
Posterior cerebral artery (PCA): Big buzzword?
Visual field defects (e.g., homonymous hemianopia, as the PCA supplies the occipital lobe, which is responsible for vision).
135
Basilar artery: Big buzzword
Locked-in syndrome
136
Spinothalamic tract - 2 buzzwords
Cuneate fasciculus (upper body , dorsal tract)- 3 buzzwords
Pain and temperature
Fine touch, pressure, and proprioception
137
Taste from the posterior 1/3rd of the tongue is mediated by the which nerve?
glossopharyngeal nerve
138
Lacunar pure motor stroke
4 buzzwords
Diabetes/hypertension
Pure motor or pure sensory stroke
Basal ganglia or internal capsule
139
encephalitis 5 buzzwords+
Tx
Fever
Altered mental status:
Seizures
HSV
↑ lymphocytes
⇔ glucose
↑ protein levels
Tx Aciclovir
140
5 high-yield buzzwords for Idiopathic Intracranial Hypertension (IIH):
Papilledema
Headache: (worsens with eye movements)
Visual disturbances
Young, obese female
lumbar puncture reveals elevated CSF pressure.
treatment
carbonic anhydrase inhibitors e.g. acetazolamide
141
For cervical spondylosis, here are 5 high-yield buzzwords:
✅ Neck pain + stiffness
→ Chronic, worsens with movement
✅ Radiculopathy
→ Shooting arm pain or weakness from nerve root compression
✅ Myelopathy (if severe)
→ Gait issues, clumsiness, or upper limb weakness from spinal cord compression
✅ Osteophytes / disc degeneration
→ Seen on imaging — bony spurs, narrowed disc space
✅ Age >50
→ Common in older adults due to degenerative wear and tear
EXAM TIP: elderly patient + neck stiffness + arm pain ± clumsy hands, always think cervical spondylosis and assess for cord compression (myelopathy).
142
Encephalitis treatment
IV ceftriaxone + IV aciclovir
143
subacute combined degeneration (SACD) of the spinal cord:
Vitamin B12 deficiency – The most common cause of SACD, often seen in pernicious anemia.
Dorsal columns affected – Loss of proprioception and vibration sensation.
Corticospinal tract involvement – Leads to spastic weakness and hyperreflexia.
Megaloblastic anemia – Common hematological manifestation, often coexists with neurological findings.
"Mixed upper and lower motor neuron signs" – Combination of spastic paresis (upper motor neuron) and paresthesia/numbness (lower motor neuron).
144
increased intracranial pressure
Cushing's triad...
bradycardia
hypertension
irregular/SLOW breathing
145
subacute combined degeneration of the spinal cord (SACD)
4 buzzwords
B12 deficiency
hyperreflexia
loss of proprioception
loss of vibration sense
(not pain or temperature sense).
146
Syringomyelia:
3 buzzwords
Cape-like distribution
Chiari malformation (often associated with this condition).
Cystic cavity (syrinx) in the spinal cord.
burn on arms (oven)
147
Neuroleptic Malignant Syndrome (NMS) presents with FEVER
Fever (Hyperthermia)
Encephalopathy (altered mental status)
Vitals unstable (tachycardia, hypotension)
Elevated enzymes (CK)
Rigidity of musles
148
PD tremor x-x Hz frequency (resting tremor).
Essential tremor is usually faster, around y-y Hz, and occurs during action or postural movements.
What is X-X and Y-Y
Parkinson's Disease (PD) tremor typically occurs at a 3-5 Hz frequency (resting tremor).
Essential tremor is usually faster, around 6-8 Hz, and occurs during action or postural movements.
149
Bacterial Meningitis, 3 things on biochem to show it?
↑ Neutrophils
↑ protein
↓ Glucose
150
Viral Encephalitis, 2 key biochem.
Normal Glucose
↑ Protein
151
Bacterial Encephalitis (low yield)
↑ Neutrophils
↑↑ PROTEIN
↓ Glucose (due to bacterial consumption)
152
migraine 4 buzzwords
unilateral
photo/phonophobia
Auras
Dark room
female
153
Migraine treatment
Treat Triptan
Prevent Propanolol (not for asthma)
(prophylaxis topiramate teratogenic)
154
5 buzzwords hydrocephalus
Increased intracranial pressure (due to excess CSF)
Ventricular enlargement (dilated ventricles)
Tx= Ventriculoperitoneal shunting
Cognitive decline (symptom in chronic cases)
Papilledema (optic disc swelling from pressure)
155
Cluster headache 3 buzzwords
Excruciating (intense pain)
Orbital (around the eye)
Autonomic symptoms (tearing, nasal congestion)
Cyclical (occurs in clusters or periods)
156
Bulbar Palsy, 1 buzzwords
tongue fasciculation
157
Test is used to diagnose myasthenia gravis
Diagnostic
Serum acetylcholine receptor antibodies is correct.
158
Brain Abscess imaging and 3 buzzwords
Ring-enhancing lesion on imaging (CT/MRI)
Headache
fever
focal neurology
159
time lengths for below:
Cluster headache
trigeminal neuralgia
migraine
Cluster headache = 15-180 mins
trigeminal neuralgia= Few seconds - 2 mins
migraine= 4- 72 hours
160
Normal pressure hydrocephalus triad
weird (dementia)
wet (incontinence)
wobbly (gait abnormality)
161
MOA of Bupropion
inhibit the reuptake of dopamine and norepinephrine
162
Dorsal Column (Posterior Column)
carries 3 things, what are they?
Carries fine touch, proprioception, and vibration sense.
Divided into:
Fasciculus gracilis (lower limb).
Fasciculus cuneatus (upper limb).
Decussates at the medulla.
163
Lateral Spinothalamic Tract
AND
Anterior spinothalamic
carries 2 things each, what are they?
Lateral spinothalamic: Pain and temperature.
Anterior spinothalamic: Crude touch and pressure.
Decussates in the spinal cord.
164
Brown-Séquard Syndrome (5)
Hemisection of the Spinal Cord / Stab
Ipsilateral Weakness (UMN Signs Below Lesion)
Ipsilateral Loss of Vibration/Proprioception
Contralateral Loss of Pain/Temperature
Asymmetrical Deficits
165
Internuclear Ophthalmoplegia (INO)
Pathway affected ???
Key feature ???
Internuclear Ophthalmoplegia (INO)
Pathway affected: medial longitudinal fasciculus (MLF)
Eye that can't move inward = side of the MLF lesion.
166
Wernicke's encephalopathy
triad of ataxia
confusion
ocular abnormality
167
Complex partial seizures
(3)
altered consciousness
Lip smacking
Sensory hallucinations
168
Management of myasthenic (g) crisis (2)
intravenous immunoglobulin
AND
plasmapheresis
169
3 Buzzwords for Autonomic Dysreflexia
Spinal cord injury above T6
Severe hypertension with bradycardia
full bladder
170
first-line drug for mild-moderate Alzheimer's
and second line
(2)
Donepezil acetylcholinesterase inhibitor
(Severe) Memantine is an NMDA receptor antagonist
171
Dementia + Parkinson’s together =
Parkinson’s first, then dementia years later =
Dementia + Parkinson’s together = LBD
Parkinson’s first, then dementia years later = PDD
172
Stop Amitriptyline with old people when?
due to the risk of worsening cognitive impairment.
173
TIPPED
Tibial inverts and plantar flexes
peroneal everts and dorsiflexes
174
Parkinson's Tx
Motor symptoms AFFECTING QoL (any age)
Motor symptoms NOT affecting QoL:
<65 years
≥65 years
Motor symptoms AFFECTING QoL (any age)
→ 💊 Levodopa + dopa-decarboxylase inhibitor
* **Co-careldopa **= Levodopa + Carbidopa
* Co-beneldopa = Levodopa + Benserazide
Motor symptoms NOT affecting QoL:
<65 years
→ 💊 Start with Dopamine agonist (e.g. **ropinirole**) OR MAO-B inhibitor (e.g. **selegiline**)
⛔ Watch for impulse control side effects
≥65 years
→ 💊 Start with **Levodopa** OR Dopamine agonist OR MAO-B inhibitor
✅ Levodopa generally preferred due to tolerability
⛔ Dopamine agonists poorly tolerated in elderly (falls, hallucinations)
175
>65 years or functionally impaired Parkinsons → Tx?
Start with Levodopa (+ Carbidopa/Benserazide).
176
cerebral venous sinus thrombosis (CVST) Tx
IV mannitol
177
Viral Encephalitis Tx
IV acyclovir
177
Tx for Multiple Sclerosis or Autoimmune encephalitis
IV methyprednisolone
178
Progressive supranuclear palsy
mnemonic
PSP - 'supra' think upper, so the one with vertical gaze palsy
PSP - problem seeing planes (looking vertically)
179
Temporal (HEAD):
Hallucinations
(auditory/gustatory/olfactory)
Epigastric rising sensational/Emotional
Automatisms
(lip smacking/grabbing/plucking), Deja vu/Dysphasia post-ictal)
179
neuropathic pain Tx
Don't (Duloxetine)
Get (Gabapentin)
Pain (Pregabalin)
Again (Amitriptyline)
180
4Hs of encephalitis:
Hot (high fever)
Hectic (seizures)
Hysterical (odd behaviour)
Herpes (HSV)
180
C5, C6, C7 reflexes → "BBC":
Biceps (C5)
Brachioradialis (C6)
Triceps (C7)
C5, C6, C7 reflexes → "BBC":
Biceps (C5)
Brachioradialis (C6)
Triceps (C7)
181
1️⃣ Numbness, tingling → A
2️⃣ Eye problems (colour vision loss, blurry vision) → B
3️⃣ Red/orange urine, tears → C
4️⃣ Liver problems → A B D
5️⃣ Gout → D
1️⃣ Numbness, tingling → Isoniazid
2️⃣ Eye problems (colour vision loss, blurry vision) → Ethambutol
3️⃣ Red/orange urine, tears → Rifampicin
4️⃣ Liver problems → Rifampicin, Isoniazid, Pyrazinamide
5️⃣ Gout → Pyrazinamide
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C6 = make a 6 with your hand (thumb and index)
C7 = middle finger to heaven (seven heaven)
C8 = ring + pinky (two fingers = two circles = 8)
T4 = T4 at the Teat Pore (nipples)
T10 = bellybuTEN
L1 = Ligament1nguinal
L4 = down on aLL fours (knees)
L5 = largest of toes
S1 = smallest of toes
S2/S3 = S3 for the pee (genitalia)
C6 = make a 6 with your hand (thumb and index)
C7 = middle finger to heaven (seven heaven)
C8 = ring + pinky (two fingers = two circles = 8)
T4 = T4 at the Teat Pore (nipples)
T10 = bellybuTEN
L1 = Ligament1nguinal
L4 = down on aLL fours (knees)
L5 = largest of toes
S1 = smallest of toes
S2/S3 = S3 for the pee (genitalia)
183
long-acting benzodiazepine frequently used to manage alcohol withdrawal
BUT
If exisiting liver damage, give what?
chlordiazepoxide
Liver damage= Lorazepam
184
Partial (Focal) seizure
Temporal
Parietal
Occipital
Frontal
Awareness can be preserved or impaired
💡 Simple = aware
💡 Complex = impaired awareness
Temporal: Déjà vu, jamais vu, unusual smells, taste
Parietal: Tingling/numbness, sensory distortions
Occipital lobe: Visual symptoms (flashing lights, colours)
Frontal lobe: Motor signs (e.g. head/eye turning), speech arrest
185
GCS "MoVE" mnemonic?
MoVE b**** , get outa the way
🧠 MoVE = Motor, Verbal, Eye
➡️ Score order: 6 – 5 – 4
✅ Total GCS = 15 (max)
🚑 GCS ≤ 8 = coma → consider intubation
186
xxx and yyy are first-line for spasticity in multiple sclerosis
Baclofen and gabapentin
187
UP LOC
UP Upper Quadrant loss → Think
LOC LOwer Quadrant loss → Think
UP LOC
UP Upper Quadrant loss → Think Pituitary tumour
LOC LOwer Quadrant loss → Think Craniopharyngioma
188
Anti emetic for Parkinsons
Domperidone
189
Bacterial meningitis treatment
IV Cefotaxime, IV dexamethasone,
+ LP
(↑ white blood cells (pleocytosis), ↑ protein, ↓ glucose)
189
PCA (1)
AICA (2)
PICA (3)
PCA= Dizziness
AICA= Dizziness , Deafness
PICA= Dizziness, Dysphagia, Dysphonia
190
POCI (3)
POCI= Hemianopia (especially homonymous)
Ataxia / cerebellar signs
↓ Consciousness or locked-in syndrome
191
resolved TIA Sx, Mg step within 24 hours?
300mg aspirin + urgent tia clinic referral within 24 hrs
192
TIA reviewed by specialist (high risk patient), give what?
Aspirin + Clopidogrel (anti platelet)
193
TIA Long term secondary prevention post 21 days?
Clopidogrel
194
If AF (TIA) give what?
DOAC ('bans)
195
Skull out to in layers
Some Strict Doctors Always Say Please concentrate
Skull
Dura
Arachnoid
Subarachnoid
Pia
Cerebral Cortex
196
🟪 "Pies in the sky" → Temporal lobe → Upper homonymous quadrantanopia
🟦 "Pies on the floor" → Parietal lobe → Lower homonymous quadrantanopia
🟥 Chiasm compressed (middle squished) → Bitemporal hemianopia (Pituitary tumour, Craniopharyngioma)
🟩 Whole same-side visual field gone → Homonymous hemianopia (optic tract or occipital cortex)
🟪 "Pies in the sky" → Temporal lobe → Upper homonymous quadrantanopia
🟦 "Pies on the floor" → Parietal lobe → Lower homonymous quadrantanopia
🟥 Chiasm compressed (middle squished) → Bitemporal hemianopia (Pituitary tumour, Craniopharyngioma)
🟩 Whole same-side visual field gone → Homonymous hemianopia (optic tract or occipital cortex)
197
Bacterial Meningitis = "P-H-L"
Viral Meningitis = "L-N-N"
→ Lymphocytes, Normal protein, Normal glucose
TB Meningitis= "L-H-L + spider web"
→ Lymphocytes, High protein, Low glucose + unique clot
Bacterial = "P-H-L"
→ Polymorphs, High protein, Low glucose
Viral = "L-N-N"
→ Lymphocytes, Normal protein, Normal glucose
TB = "L-H-L + spider web"
→ Lymphocytes, High protein, Low glucose + unique clot
198
" DISH vs WISH"
DISH =
Advanced Statement VS
WISH =
"WISH vs DISH"
WISH = Advance Statement = "I wish I could be at home" → Not enforceable
DISH = Advance Decision = "I don’t want a feeding tube" → Do not serve the dish = Enforceable refusal
199
RIPE ONGO
Rifampicin:
Isoniazid:
Pyrazinamide:
Ethambutol:
RIPE ONGO
**R**ifampicin: Red/Orange secretions
Iso**N**iazid: Neuropathy
Pyrazinamide: Gout
**E**thambutol: Optic Neuritis/ Eyes
200
🔤 All –
🔤 Diabetics –
🔤 Get –
🔤 Pain –
🔤 All – Amitriptyline
First-line for neuropathic pain unless contraindicated (e.g. in elderly or cardiac risk).
TCAs like amitriptyline are effective for nerve-related pain.
🔤 Diabetics – Duloxetine
An SNRI used if amitriptyline isn't suitable or not tolerated.
Also helps with coexisting depression or anxiety.
🔤 Get – Gabapentin (or Pregabalin)
Anticonvulsants used as alternatives if the above don't work.
Useful especially for patients with sleep disturbance due to pain.
🔤 Pain – Pain clinic referral or Combination
If no response → refer to pain clinic or consider combination therapy.
Example: low-dose amitriptyline + pregabalin.
