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PHASE 3A > Neurology > Flashcards

Neurology Flashcards

1
Q

What triad of symptoms is associated with normal pressure hydrocephalus?

A

Urinary incontinence
Dementia
Gait abnormality

KNOWN AS HAKIM TRIAD

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2
Q

What is the result of a third nerve palsy?

A

Down and out eye
Diplopia
Ptosis
Fixed dilated pupil (mydriasis)

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3
Q

What is the result of a fourth nerve palsy?

A

Defective downward gaze (vertical diplopia)

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4
Q

What is the result of a sixth nerve palsy?

A

Defective abduction (horizontal diplopia)

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5
Q

What is the management of neuropathic pain?

A

Monotheraphy with Amitryptiline, pregabalin, gabapentin, or duloxetine

If doesnt work then switch medication

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6
Q

Triad for wernickes encephalopathy?

A

Gait ataxia
Ophthalmoplegia/Nystagmus
Confusion

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7
Q

What is the result of a common peroneal nerve palsy?

A

Weakness of foot Doris flexion and foot eversion

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8
Q

What marker can be used to differentiate a seizure form a pseudo seizure?

A

Prolactin

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9
Q

What is the mainstay treatment for a TIA?

A

Aspirin 300mg for 2 weeks followed by long term use of clopidogrel 75mg

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10
Q

What is the acute management of a cluster headache?

A

High flow oxygen + SC/intra nasal triptan

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11
Q

Prophylaxis mix of cluster headache?

A

Verapamil

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12
Q

What is the management of an acute relapse of ms?

A

High dose steroids

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13
Q

What medication/s reduce risk of relapse in MS

A

Natalizumab
Fingolimod
Beta interferon

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14
Q

What is the medical management of myasthenia gravis

A

Acetylycholinesterase inhibitors- Pyradistigmine

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15
Q

What is the 1st line Ix for MG?

A

Acetylcholine receptor antibodies

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16
Q

What is syringomeylia?

A

Collection of CSF in spinal cord

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17
Q

What are the key features of syringomyelia/

A

Cape like distribution loss of sensation to temperature and pain but preservation of light touch, proprioception and vibration classic- burn hands and don’t notice
Upgoing plantars
Autonomic features e.g. Horner’s
Spastic weakness (predominantly Lower limbs)

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18
Q

What does syringomyelia have a strong association with?

A

Arnold-Chiari malformations

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19
Q

What is the ix and management for syringomyelia?

A

Ix- full spine and brain MRI

Ms- dependent on cause - possibly a shunt

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20
Q

What is a fixed dilated pupil and indication of?

A

Cn 3

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21
Q

What would be the result of Neuro imaging in NPH?

A

Ventriculomegaly w/o sulcal enlargement

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22
Q

What is the inheritance pattern of neurofibromatosis?

A

Autosomal dominance

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23
Q

What chr is affected in NF1 and list 3 features?

A

Chr 17

> =6, 15mm cafe au lair spots
Axillary/groin freckles
Iris hamatomas (Lisch Nodules)
Scoliosis
Phaechromocytoma

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24
Q

What chr is affected in NF2 and list prominent feature?

A

Chr 22

Bilateral vestibular schwannomas

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25
Q

List 3 Sx of. An acoustic neuroma?

A

Unilateral hearing loss
Reduced facial sensation
Balance problems

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26
Q

What is the 1st line and GS Ix for acoustic neuromas? Also what sign will be present on GS to be diagnostic?

A

1st line- Audio gram

GS- gadolinium enhanced MRI scan- will show ‘absence of dural tail’

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27
Q

What is the Rx for prophylaxis of migraines?

A

Propranolol
Topiramate- avoid in girls of bearing age
Amitryptiline

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28
Q

What nerve is affected in a mid shaft humerus fracture and what happens?

A

Radial nerve –> Wrist drop and loss of grip strength

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29
Q

What is the mode of inheritance of charcot marie tooth syndrome?

A

autosomal dominant

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30
Q

What nerve and blood vessel is affected in amurosis fugax?

A

Optic nerve

retinal/opthalmic artery (branch of ICA)

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31
Q

What is the key diagnostic test in GBS and what does it show?

A

Lumbar puncture (raised protein, with normal wcc)

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32
Q

How long can a person who suffered from their first unprovoked/isolated seizure with no evidence in imaging/EEG not drive for?

A

6 months

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33
Q

What is the associated effects of an anterior cerebral artery infarct?

A

Contralateral hemiparesis
sesnoryt loss lower extremity > upper

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34
Q

What are the associated effects of a middle cerebral artery infarct?

A

Contralateral hemiparesis
sensory loss greater in upper extremity
contralateral homonymous heminanopia
aphasia

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35
Q

What are the associated effects of a posterior cerebral artery infarct?

A

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

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36
Q

What is webers syndrome?

A

Weber’s syndrome is a form of midbrain stroke (posterior cerebral artery) characterised by the an ipsilateral CN III palsy and contralateral hemiparesis

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37
Q

Wha are the characteristics of Progressive supranuclear palsy (PSP)?

A

postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction

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38
Q

What is the tx of choice for an essential tremor?

A

Propranolol or Primidone

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39
Q

What are sx and features of an acoustic neuroma?

A

vertigo
sensorineural hearing loss
unilateral tinnitus
absent corneal reflex
facial palsy

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40
Q

What classification can be used for an acute ischaemic stroke?

A

The Oxford stroke (Bamford) classification.

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41
Q

What medication should you give to someone within 4.5 hours of having an ischaemic stroke?

A

Thrombolysis - Alteplase (IV).

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42
Q

What are the contraindications for alteplase?

A

Haemorrhage.
Suspected SAH.
Active bleeding.
Recent GI infection or UTI.
Recent surgery.
Malignancy.

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43
Q

List the signs of a ACA infarct?

A

LL weakness and loss of sensation
Gait apraxia
Incontinence
Drowsiness
Decrease in spontaneous speech

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44
Q

List the signs of a MCA infarct?

A

UL and LL weakness
Contralteral homonymous hemianopia
Aphasia
Dysphasia
Facial droop

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45
Q

List the signs of PCA infarct?

A

Speech impairment + dysphagaia
Cerebellar dysfunction
Visual disturbances (contralateral homonymous hemianopia with macular sparing)
visual agnosia
prospagnosia

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46
Q

What are the signs of Weber’s syndrome and what artery is affected?

A

Branches of posterior cerebral artery that supply midbrian

Ipsilaterla CN3 Palsy
contralkaterla weakness of UL and LL

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47
Q

What is the signs of Wallenberg syndrome/lateral medulalry syndrome and what aretry is affected?

A

Posterior inferior cerebellar artery

Ipsilateral facial pain and temp loss and Horner’s
Contralateral limb/torso pain and temp loss
Ataxia, Nystagmus

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48
Q

Give 4 signs of UMN weakness.

A

Increased muscle tone.
Hyperreflexia.
Spasticity.
Minimal muscle atrophy.

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49
Q

Give 5 signs of LMN weakness.

A

Decreased muscle tone.
Hyporeflexia.
Flaccid.
Muscle atrophy.
Fasciculations.

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50
Q

Give 3 signs of Myasthenia Gravis.

A

Generalised fatiguability:

Proximal limbs.
Neck/face - head drop, ptosis.
Extra-occular - diplopia.
Speech and swallowing problems.
Risk of other auto-immune disorders.

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51
Q

Peripheral Neuropathy: describe mononeuritis multiplex.

A

A patchy process where individual nerves are picked off randomly. Often it has an inflammatory or immune mediated cause. Chronic, slow progression.

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52
Q

What are the 3 main components of the Glasgow Coma scale?

A

Best motor response.
Best vocal response.
Best eye-opening response.

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53
Q

What spinal tract is responsible for motor response?

A

Corticospianl tract

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54
Q

What signals does the spinothalamic tract carry?

A

Anterior- Crude touch, light touch, vibration.
Lateral- pain, temperature,

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55
Q

Give 2 population groups who may be at increased risk of a subdural haematoma.

A

Elderly and alcoholics - due to cerebral atrophy.

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56
Q

Give 3 symptoms of a subarachnoid haemorrhage.

A

Thunderclap, maximum severity headache within seconds.
Photophobia.
Neck stiffness.
Nausea and vomiting.

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57
Q

What investigations might you do in someone who you suspect has a subarachnoid haemorrhage?

A

CT head (star shaped).
Cerebral angiography.
Lumbar puncture - xanthochromia.

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58
Q

How do you manage and treat a patient who has had a subarachnoid haemorrhage?

A

Nimodipine (CCB).
Early intervention, support and close monitoring is essential.

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59
Q

Give 3 symptoms of Cauda Equina syndrome.

A

Bilateral sciatica - pain radiates down leg to foot.
Saddle anaesthesia.
Bladder/bowel dysfunction.
Erectile dysfunction.
Leg weakness.

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60
Q

Define frailty.

A

A state of increased vulnerability resulting from an ageing associated decline in function across multiple physiologic systems; the ability to cope with everyday stressors is therefore compromised.

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61
Q

What is relative afferent pupillary defect (RAPD)?

A

It is observed during the swinging light test. The patient’s pupils constrict when the light is swung from the unaffected to the affected eye. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced.

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62
Q

What is another name for RAPD?

A

Marcus Gunn pupil.

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63
Q

In what conditions might you see RAPD?

A

MS.
Glaucoma.
Severe retinal disease.
Optic nerve lesion.

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64
Q

List 5 RF for stroke?

A

Smoking
Alcohol
HTN
Hyperlipidaemia
obeisty
DM
AF

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65
Q

What is syncope?

A

A transient loss of conciousness, loss of postural tone

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66
Q

List 5 differentials for blackouts?

A

Vasovagal syncope
cardiac syncope
migraine w/ aura
Hypoglycaemia
TIAs
non-epileptic seizures
Intermittent hydrocephalus

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67
Q

What ix couold be done for blackouts

A

12 lead ECG
Brain imaging
EEG
Video telemtery
Tilt Table Test

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68
Q

List 3 features of Multi System Atrophy?

A
  • parkinsonism
  • autonomic disturbance
  • cerebellar signs

classical history of poor response to levodopa, impotence, urinary retention and age group.

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69
Q

List features of PSP?

A

impaired balance and therefore being prone to many falls.
vertical gaze palsy.
symmetrical onset and is poorly responsive to levodopa

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70
Q

what should be suspected with a Painful third nerve palsy

A

Posterior communictaion artery aneurysm

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71
Q

What diagnosis should be suspected in a Obese, young female with headaches / blurred vision

A

Idiopathic intracranial hypertension

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72
Q

which of the muscles are typically spared in MND

A

Ocular muscles

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73
Q

What is Brown-Sequard syndrome a result of and list the main feature

A

BSS is a result of lateral hemisection of the spinal cord

ipsilateral weakness below lesion
ipsilateral loss of proprioception and vibration sensation
contralateral loss of pain and temperature sensation

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74
Q

What is the GS ix for suspected stroke?

A

Non contrast CT head

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75
Q

List 5 triggers for a migraine?

A

Chocolate
Hangovers
Orgasms
Cheese
Oral contraceptives
Lie ins
Alcohol
Tumult
Exercise

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76
Q

List the triad associated with Horners syndrome

A

Ptosis, Miosis and Anhidrosis

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77
Q

What is GCA and list 3 fetaures?

A

GCA is agrnaulamatous vasuclitis of medium sized arteries

Temporal headaches
Jaw claudication
Sclap tenderness
Amurosis fugax
Aching and stiffness

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78
Q

What is the firts line and GS Ix of GCA?

A

1st line- Infammmatory markers- Raised ESR

GS- Temporal artery biopsy- granulamatous inflammation

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79
Q

What is the 1st line medication for focal seizures

A

Lamotrigine or Leviteracetam

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80
Q

What is Charcots Neurological triad and list the 3 features?

A

Charcot’s neurological triad refers to a set of three classic clinical features associated with the progression of multiple sclerosis (MS)
1) Nystagmus
2) Dysarthria
3) Intention tremor

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81
Q

What is MS?

A

A chronic cell mediated autoimmune disorder charcterised by demyelination of the CNS (a type 4 hsr)

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82
Q

What cells are reponsible for myelination in
a) CNS
B) PNS

A

A) Oligodendrocytes
B) Schwann cells

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83
Q

What criteria is used to make a diagnosis of MS

A

McDonalds criteria of MRI imaging

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84
Q

List 2 signs/phenemenoms found in MS?

A

Lhermittes phenemenom- Parsatehesia in limbs following neck flexion

Uhertoffs phenemenom- Increase in temp causes worsening of sx (often visual)

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85
Q

List 2 findings in someone with MS

A

White matter plaques disseminaated in space and time
CSF- oligoclonal bands

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86
Q

What type of lesion if bells palsy

A

LMN lesion

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87
Q

list the clincial features in Parkinson’s disease

A

Bradykinesia
Pill rolling resting tremor
Postural instability
Rigidity
Reduced facial expression (hypomimia)

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88
Q

What is Parkinson’s disease?

A

A neurodegenerative disorder characterised by the loss of dopiminergic neurons in the substantia nigra

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89
Q

Give 2 histopathological signs of Parkinson’s disease.

A

Lewy bodies.
Loss of dopaminergic neurones in the substantia nigra.

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90
Q

What class of medications are used to treat PD?

A

Levodopa
Dopmaine agonist e.g. Bromocriptine, ropinerole, Cabergoline
MAO-B Inhibitors- seleglline
COMT inhibitors- entacapone

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91
Q

What lobe of the brain is affected in Alzheimer’s disease?

A

Temporal lobe

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92
Q

Give histopathological signs of Alzheimer’s disease

A

Excess intraneuronal Amyloid plaques
Aggregates of TAU proteins– neurofibliray tangles

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93
Q

What medication can be used to manage the sx of alzheimers dementia

A

Acetylcholinesterase inhibitors e.g Donepezil, Rivastigmine

or Memnatine (NMDA antagonist)

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94
Q

Frontotemporal dementia is characterised by what?

A

Pick bodies

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95
Q

What is the tx for GBS?

A

IV Immunoglobulins 5 days and plasma exchange

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96
Q

What is MG?

A

(T2 Hypersensitivity reaction)
Automimmune disorder resulting in insufficient functioning acetylcholine receptors

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97
Q

What antibodies are associated with MG?

A

Acetylchloline receptor antibodies
MUSK antibodies

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98
Q

What is the mx of a myasthenic crisis?

A

Plasmapharesis and IVIG

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99
Q

What other conditions is LEMS asscoaited with?

A

Small cell lung cancer **
breast and ovarian cancer to a lesser extent

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100
Q

What is LEMS?

A

Lambert-Eaton myasthenic syndrome is caused by an antibody directed against presynaptic voltage-gated calcium channel in the peripheral nervous system.

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101
Q

What antibody is associated with LEMS

A

Anti P/Q voltage gated calcium channel

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102
Q

What is the mx of LEMS?

A

3,4 Diaminopyridine (Amifampridine)

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103
Q

What are the subtypes of MND and list their key sx?

A

1) Amyotrophic Lateral Sclerosis
UMN and LMN affected
Babinski +ve, Fasiculations on tongue, Dysphagia, Dysarthria

2) Progressive Bulbar plasy
(Bulbar)-> Medulla so CN 9,10,11,12 affected
Carries the WORST PROGNOSIS

3) Progressive Muscle atrophy

4) Primary lateral Sclerosis

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104
Q

What is the 1st line tx for MND?

A

Riluzole

Then just symptom management: Respiratory care, Nutrition

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105
Q

List the RF for carpal tunnel syndrome and what nerve is repsonsible?

A

OPRAH
Obesity
Pregnancy
RA
Acromegaly
Hypothyroidism

Median nerve

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106
Q

What is the mx of carpal tunnel?

A

moderate
1st line- wrist splint
2nd line- corticosteroid injection

severe
1st line- surgical release

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107
Q

What is the GS ix for carpal tunnel?

A

EMG

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108
Q

List the causes of Cauda equina syndrome

A

Lumbar disc hernaition (L4/5 AND L5/S1)- Most common cause
Neoplasm
Abscess
Iatrogenic causes

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109
Q

List 5 sx of Cauda equina?

A

Back pain
Saddle anaesthesia
Loss of senstaion in bladder and rectum
Bilateral sciatica
Bilateral LMN weakness
Sexual dysfunction
Reduced anal tone on PR exam
Absent ankle reflex

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110
Q

GS ix of cauda equina

A

urgent MRI of spine

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111
Q

WHat is the mx of cauda equina syndrome

A

Surgical decompression ideally witthin 48 hours
if malignancy- give dexamethasone

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112
Q

What tracts are repsonsible for
a) Temp and pain
b) crude touch
c) sensory info of lower limbs
d) Sensory info of upper limbs

A

a) Lateral spinothalamic tract
b) Anterior spinothalamic tract
c) DCML- Fasiculus Gracillis (Medial)
d) DCML- Fasiculus Cuneatus (Lateral)

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113
Q

What is Subacute combined degeneration of the spinal cord

A

A neurological complication associated with vit b12 deficiency

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114
Q

List the causes of vit b12 deficiency that can cause SCDC

A

prenicious anemia
malabsorbtion syndromes
Dietary deficiencies
Misuse of nitrous oxide (functional rather than true)

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115
Q

list the importance of vit b12 and how a deficiency of b12 may lead to sx of SCDC?

A
  • B12 is essential to the syntheisis of myelin therefore in b12 deificiency the synthesis is compromised and leading to demyelination of nerve fibres
  • in the absence of b12, the metabolism of certain amino acids and fatty acids is disrupted thus leading to an acucmulation of HOMOCYSTEINE and METHYLYMALONIC ACID –> toxic metabolites lead to neuro sx of SCDC
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116
Q

What ix can be done for a diagnosis of SCDC?

A

Folate and B12 levels
Homocysteine levels- rasied level despite normal B12 levels may indicated functional deficiency
MRI of spine to exclude cervical myelopahy
EMG

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117
Q

What is the managemnt of a brain abscess

A

surgery- abscess cavity is debrided
Abx- 3rd gen cephalosporin + metronidazole
Intracranial pressure mx- dexamethasone

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118
Q

What may be seen on imaging for brain abscess?

A

Ring enhancing lesion on CT

119
Q

When should a refferal for Bells Palsy be made to ENT?

A

If no signs of improvement in 3 weeks

120
Q

List sx of idiopathic intracranial htn

A

Blurred vision
Headaches
Papillooedema
Enlarged blind spots
may ahve 6th nerve palsy

121
Q

What is the tx for trigeminal neuralgia?

A

1st line- Carbamazepine
other include- Phenytoin Lamotrigine, Gabapentin

122
Q

What is pituitary apoplexy?

A

Sudden enlargement of a pituitary tumour (usually non-functioning macroadenoma) secondary to haemorrhage or infarction.

123
Q

What is the ix and mx of choice for pituitary apoplexy?

A

ix- MRI is diagnostic

mx- urgent steroid replacement due to loss of ACTH
surgery

124
Q

What is wernickes aphasia and what lobe is compromised?

A

receptive aphasia- speech fluent, comprehension abnormal, repetition impaired

Temporal lobe

125
Q

What is Brocas aphasia and what lope in compromised?

A

Expressive aphasia- difficulty speaking fluently, and their speech may be limited to a few words at a time. Speech is halting or effortful.

126
Q

What is the most common complication of meningitis?

A

Sensorineural Hearing loss

127
Q

What are the signs of pontine haemorrhage?

A

Low GCS
Paralysis (quadriplegia)
Bilateral pinpoint pupils (small reactive pupils)

128
Q

What class of medication should be avoided in myasthenia gravis

A

Beta blockers

129
Q

Where do secondary brain tumours arise from?

A

Lung
Colorectal
Melanoma
Breast
Kidney

130
Q

If clopidogrel is CI in the secondary managemnt of an ischaemic stroke what is the mx?

A

Aspirin 75mg

131
Q

What is the mx of cervical myelopathy?

132
Q

If brain imaging is required in a TIA, what is the best modality to use?

A

MRI Brain w/ diffuse weighted imaging

133
Q

List 3 sx of Bells Plasy

A

Facial nerve palsy –> FOREHEAD AFFECTED
Hyperacuisis
Aletred taste
Dry eyes
Post-auricular pain (may precede paralysis)

134
Q

What is the management of Bells Palsy

A

Oral prednisalone + eyecare

135
Q

What is the inheritance pattern of Friedreich’s ataxia

A

Autosomal recessive- trinucleotide repeat of GAA

136
Q

From which cancers do secondary brain tumours arise from

A

Lung
Breast
Kidney
Melanoma
Colorectal

137
Q

What medication can be used to treat Idiopathic Intracranial Hypertension (IIH)

A

Acetazolamide- a carbonic anhydrase inhibitor

138
Q

What is the most common complication following meningitis infection

A

Sensorineural hearing loss

139
Q

List 3 CI for a lumbar puncture?

A

Coagulopathy/bleeding disoreder
Signs of raised ICP
Sings of brain hernaition
Skin infection of puncture site
Focal neurology

140
Q

What is the mos common caustive agent of encephalitis?

A

HSV1 - Herpes Simplex

141
Q

List the rf for alzheimers

A

Downs syndrome
Lonliness
Depression

142
Q

What is the ABCD2 score and list the contents?

A

Stratifes the risk ofstroke following a TIA
Age >60
BP- >140/90
Clinical features-
- unilateral wekaness- 2
- Speech, no wekaness- 1
Duration
->60 mins- 2
-10-59 mins- 1
Diabetes- 1

143
Q

List 3 factors that favour pseduseizures compared to true epileptic seizures?

A

Gradual onset
Doesnt occur when alone
Pelvic thrusting
More common in females
Crying after seizures
Family member with epeilepsy

144
Q

List 5 RF of isachaemic stroke

A

Smoking
HTN
Obesity
Diabetes
Afib
hypercholestraemia

Male, Age

145
Q

What is the difference between strokes and epileptical events?

A

Strokes present with negative sx and obey the vascular territory whereas epileptic events present with positive sx and do not obey vascualr territory

146
Q

What ix can be done post acutely following an ischaemic stroke?

A

Carotid USS
Echocardiogram
CT/MRI angiogrpahy

147
Q

What is the chronic mx of a ischaemic stroke?

A

HALTSS
HTN
Antiplatelet- clopidogrel 75mg
Lipid lowering theraphy
Tobacco cessation
Sugar- get diabets under control
Surgery- carotid endarectomy if stenosis >70% (can be 50%- varies according to orgs)

148
Q

What is the main risk associated with thrombolysis

149
Q

List 4 causes of painelss monocular vision loss

A

Amurosis fugax
retinal dettachemnt
vitreous haemorrhage
Anterior ischaemic optic neuritis

150
Q

List 2 complications of epilepsy?

A

Status epilepticus
depression
suicide
Sudden unexpected death in Epilepsy (SUDEP)

151
Q

WHat is the GS Ix for carotid sinus thrombosis?

A

MR venogram

152
Q

List 3 triggers of epilepsy?

A

Poor sleep
drugs and alcohol
stroke
Intracranial haemorrhage

153
Q

List 2 differential sof essential tremors

A

Parkinsons
Hyperthyroidism
Drug induced tremor

154
Q

What is the rules of driving following a TIA

A

do not drive for a month- no need to inform DVLA

155
Q

What is the MOA of triptans and list its CI for usage?

A

5HT Agonist

CI- In ischaemic heart disease and cerebrovascular disease

156
Q

What are the side effects associated with triptans?

A

Flushing, Tingling, Chest and throat tightness (may mimic angina)

157
Q

What is Brudzinkis sign?

A

passive neck flexion elicits hip and knee flexion

158
Q

What is kernigs sign?

A

Knee and hip flexed at 90. Extension of the knee is painful or limited in extension.

159
Q

Definition of seizures?

A

Transient occurunces of symptoms due to abnormal excessive neuronal activiy in the brain

160
Q

What is the definition of epilepsy?

A

Neurological disorder characterised by the recurrence of seizures

161
Q

What is cushings triad for raised ICP?

A

HTN/wide pulse pressure
Bradycardia
Irregular breathing

162
Q

List the 3 tracts that are affected in SCDC?

A
  1. Dorsal Columns- distal tingling/numbness. Impaired propioception and vibration
  2. Lateral corticospinal tracts- Muscle weakness, hypereflexia, UMN sigsn
  3. Spinocerebellar tract- ataxia and romberg +ve
163
Q

‘hot potato’ speech is indicative of what?

A

Pseudobulbar palsy

164
Q

List sx of anterior inferior cerebellar artery leison?

A

SImilar to wallenburh but ipsilateral facial paralysis and deafness

165
Q

List the sx of thoracic outlet syndrome?

A

Painless muscle wasting of hand–> weakness in grasping
Numbness and tingling
Cold hands
Swelling

166
Q

In cn 3 palsy, what isn the sataus of the light and consensual reflex?

A

Absent light reflex
Intact consensual reflex

167
Q

What EEG findings are present in infantile spasms?

A

Hypsarrythmia - Poor prognosis

Infantile spasms/west syndrome- characterised by salam attacks

168
Q

What EEG findings are concurrent with Benign rolandic epilepsy?

A

Centerotemporal spikes

169
Q

What nerve root correspond to the ankle reflex?

170
Q

What nerve root correspond to the knee reflex?

171
Q

What nerve root correspond to the biceps reflex?

172
Q

What nerve root correspond to the triceps reflex?

173
Q

What parts of the spinal cord is affected in subacute combined degeneration of the spinal cord?

A

Loss of myelin in dorsal and lateral columns of the spinal cord and the spinocerebellar tracts

JUST REMEMBER: SCD
Spinocerebellar, Corticospinal, Dorsal

174
Q

Describe features of subacute combined degeneration of the spinal cord?

A

Distal sensory loss, tingling (paraesthesia)

Babinski Sign - absent ankle jerks/extensor plantars

Gaits abnormalities
Romberg’s positive

175
Q

What is the NEW Definition of TIA?

A

Tissue based not time-based. A TIA is caused by focal brain, spinal cord or retinal ischaemia without acute infarction

176
Q

What tool is recommended by NICE to assess stroke symptoms?

A

ROSIER - Recognition of Stroke In The Emergency Room

177
Q

What clinical syndrome occurs in spinal injury at, or above T6 spinal level?

A

Autonomic dysreflexia

178
Q

What are the features of autonomic dysreflexia?

A
  • Unbalanced physiological response - Extreme hypertension
  • Flushing and sweating above level of lesion
  • Agitation
179
Q

What is the radiological feature of a subdural haemorrhage?

A

Isodense (hypodense) crescent-shaped collection

180
Q

What are features of cataplexy?

A

Sudden transient episode of muscle weakness after strong emotions such as laughter, anger or surprise

181
Q

What is first line treatment for males with Myoclonic seizures?

A

Sodium valproate

182
Q

What are the 6 options for motor response in GCS?

A
  1. Obeys commands
  2. Localises to pain
  3. Withdraws from pain
  4. Abnormal flexion to pain (decorticate posture)
  5. Extending to pain
  6. None
183
Q

What are the 5 options for verbal response in GCS?

A
  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None
184
Q

What are the 4 options for Eye response in GCS?

A
  1. Spontaneous
  2. To speech
  3. To pain
  4. None
185
Q

What are adverse effects of sodium valproate?

A

Teratogenic, Nausea, Weight gain, Alopecia

186
Q

What is the management of myasthenic crisis?

A

Supportive care and IV immunoglobulins or Plasma exchange

187
Q

Name some clinical features of raised ICP?

A

Headache
Vomiting
Reduced consciousness
Papilloedema
Cushing’s Triad

188
Q

What is the Mx of raised ICP?

A

Head elevation to 30 degrees

IV Mannitol
Controlled Hyperventilation
Removal of CSF

189
Q

When starting a phenytoin infusion what must be monitored?

A

Cardiac monitoring due to pro-arrhythmogenic effects

190
Q

Describe the Mx of an Acute Seizure episode?

A

ABCDE
Maintain airway
- Benzodiazepines e.g. Lorazepam IV. Repeat after 10-20 mins if seizure continues

  • Phenytoin infusion
191
Q

What are clinical features and Ix of Intracranial venous thrombosis?

A

Headache, Nausea, Vomiting, Reduced Consciousness

MRI Venography - GS
Non-contrast CT is normal in 70%

192
Q

What is the Mx of Encephalitis?

A

IV Aciclovir

193
Q

What is the Ix for encephalitis?

A

CSF Analysis - Lymphocytosis, Elevated protein

194
Q

What Ix must all TIA patients have?

A

Carotid doppler

195
Q

What is the duration of each cluster headache episodes?

A

15 minutes - 2 hours

196
Q

In terms of visual field defects, how does a parietal and temporal lobe lesion manifest?

A

Homonymous quadrantanopias

Parietal - Inferior
Temporal - Superior

197
Q

What is a Lacunar stroke?

A

Arteries to deep structures such as Thalamus or Basal Ganglia are affected

198
Q

What are the Sx of a Lacunar Stroke?

A
  • Unilateral weakness and/or
  • Sensory deficits of the face and arm, arm and leg
    or
  • All 3, a pure sensory stroke
    or
  • Ataxic hemiparesis.
199
Q

What is a total anterior circulation stroke?

A

Affects middle and anterior cerebral arteries

Presents with Unilateral hemiparesis and/or hemisensory loss, homonymous hemianopia and higher cognitive dysfunction

200
Q

What is the MOA and adverse effects of Lamotrigine?

A

MOA - Sodium channel blocker

Adverse effect - Stevens-Johnson Syndrome & Toxic epidermal necrolysis

201
Q

In terms of Bitemporal Hemianopia. What are the common lesion sites for a upper and lower quadrant defect?

A

Upper - Pituitary tumour

Lower - Craniopharyngioma

202
Q

What two causes of status epilepticus must be ruled out first?

A

Hypoxia
Hypoglycaemia

203
Q

Name and function of CN 1

A

Olfactory nerve
Function - Smell

204
Q

Name and function of CN 2

A

Optic Nerve
Function - Sight

205
Q

Name and function of CN 3

A

Oculomotor Nerve
Function - Eye Movement, Pupil constriction, Accommodation, Eyelid opening

206
Q

What does palsy of CN3 result in?

A

Ptosis
Down and Out eye
Dilated, Fixed Pupil

207
Q

Name and function of CN 4?

A

Trochlear Nerve
Function - Eye movement

208
Q

What does palsy of CN 4 result in?

A

Defective downward gaze aka Vertical diplopia

209
Q

Name and function of CN 5

A

Trigeminal nerve
Function - Facial sensation and Mastication

210
Q

What does lesion of CN 5 result in?

A

Trigeminal neuralgia
Loss of corneal reflex
Loss of facial sensation
Paralysis of mastication muscles
Deviation of jaw to weak side

211
Q

Name and function of CN 6

A

Abducens
Function - Eye movement

212
Q

What does palsy of CN 6 result in?

A

Defective abduction aka Horizontal diplopia

213
Q

Name and function of CN 7

A

Facial nerve
Function - Facial movement, Taste (2/3rd of tongue), Lacrimation, Salivation

214
Q

What does a lesion of CN 7 result in?

A

Flaccid paralysis of upper and lower face
Loss of corneal reflex
Loss of taste
Hyperacusis

215
Q

Name and function of CN 8

A

Vestibulocochlear Nerve
Function - Hearing and Balance

216
Q

What does lesion of CN 8 result in?

A

Hearing loss, Vertigo, Nystagmus

217
Q

Name and function of CN 9

A

Glossopharyngeal Nerve
Function - Taste (1/3rd of tongue), Salivation, Swallowing, Mediates input from carotid body and sinus

218
Q

What does lesion of CN 9 result in?

A

Hypersensitive carotid sinus reflex
Loss of gag reflex

219
Q

Name and function of CN 10

A

Vagus Nerve
Function - Phonation, Swallowing, Innervates viscera

220
Q

What does lesion of CN 10 result in?

A

Uvula deviates away from site of lesion
Loss of gag reflex

221
Q

Name and function of CN 11?

A

Accessory nerve
Function - Head and Shoulder Movement

222
Q

What does lesion of CN 11 result in?

A

Weakness turning head to contralateral side

223
Q

Name and function of CN 12

A

Hypoglossal nerve
Function - Tongue movement

224
Q

What does lesion of CN 12 result in

A

Tongue deviates towards side of lesion

225
Q

What do the lumbar puncture findings show for autoimmune encephalitis?

A

Lymphocytosis

226
Q

What is the first line treatment for autoimmune encephalitis?

A

Steroids and IV Immunoglobulins

227
Q

In refeeding syndrome, what electrolyte change is most likely?

A

Hypophosphataemia

228
Q

What type of drugs should be avoided in Lewy body dementia?

A

Antipsychotics

229
Q

How is Lewy body dementia differentiated from idiopathic Parkinson’s disease dementia?

A

Time of onset of dementia compared to motor symptoms

230
Q

What is the quick and easy bedside test to confirm a fluid is CSF?

A

Check for glucose

GS is test for Beta-2-transferrin

231
Q

What differential to cluster headaches, last minutes and can occur up to 20 times a day

A

Paroxysmal hemicrania

232
Q

What is the Mx for Acute subdural haemorrhage?

A

Decompressive craniectomy

233
Q

What is the Mx for Chronic subdural haemorrhage?

A

Burr hole evacuation

234
Q

What injuries or syndromes would impact the median nerve?

A

Supracondylar fracture of humerus
Carpel tunnel
Wrist laceration

235
Q

What would proximal damage to the median nerve manifest with?

A

Cant make a fist with thumb, index and middle finger

236
Q

What would distal damage to the median nerve manifest with?

A

Median claw
Can’t extend with thumb, index and middle finger
Atrophy of thenar eminence

237
Q

What nerve would a fracture of the medial epicondyle impact and manifest with?

A

Ulnar nerve

Can’t make fist with with ring and pinky

238
Q

What nerve would a fracture of the hook of hamate impact and manifest with?

A

Ulnar nerve

Can’t extend with ring and pinky
Atrophy of hypothenar eminence

239
Q

What is Uhthoff’s phenomenon?

A

Neurological symptoms exacerbated by increase in body temperature typically associated with MS

240
Q

How does weakness differ between Lambert-Eaton syndrome and Myasthenia gravis?

A

Weakness improves after exercise or repetitive movement in LE and not MG

241
Q

When is a carotid endarterectomy considered in a patient who had a TIA?

A

Carotid artery stenosis exceeding 50% on the side contralateral to the symptoms

NASCET CRITERIA

242
Q

How is Wernicke’s encephalopathy managed?

A

IV Pabrinex (B and C vitamins)

For thiamine replishing

243
Q

What is Juvenile myoclonic epilepsy and its Mx

A

Infrequency seziures often in morning after sleep deprivation
Daytime absensces
Sudden shock like myoclonic seizures

Treatment is Sodium valproate

244
Q

What would a CT head show for herpes simplex encephalitis?

A

temporal lobe hypodensities

MRI is better, CT can be normal

245
Q

Name 4 causes of Bilateral facial nerve palsy?

A

Sarcoidosis
GBS
Lyme disease
Bilateral acoustic neuromas
Bell’s palsy

246
Q

Name 4 causes of unilateral facial nerve palsy?

A

Bell’s palsy
Ramsay-Hunt Syndrome
Acoustic neuroma
Parotid tumours
HIV
MS
Diabetes

247
Q

What is the criteria assessed for the Oxford Stroke Classification?

A
  1. Unilateral hemiparesis and/or hemisensory loss of face, arm and leg
  2. Homonymous hemianopia
  3. Higher cognitive dysfunction e.g. Dysphasia
248
Q

What is a total anterior circulation infarct (TACI)

A

Involves middle and cerebral arteries

All 3 Oxford Stroke Criterion met

249
Q

What is a Partial anterior circulation infarct (PACI)?

A

Involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery

2 criterion of Oxford Stroke met

250
Q

What is a Lacunar infarct (LACI)?

A

Involves perforating arteries around internal capsule, thalamus and basal ganglia

Presents with 1 of:
- Unilateral weakness and/or sensory deficit of face, arm leg

  • Pure sensory stroke
  • Ataxic hemiparesis
251
Q

What is a Posterior circulation infarct (POCI)?

A

Involves vertebrobasilar arteries
Present with 1:
- Cerebellar or brainstem syndromes
- Loss of consciousness
- Isolated homonymous hemianopia

252
Q

Where would a lesion cause Wernicke’s aphasia?

A

Superior temporal gyrus

253
Q

Where would a lesion cause Broca’s aphasia?

A

Inferior frontal gyrus

254
Q

What is a conduction aphasia due to?

A

Stroke affecting the arcuate fasiculus

255
Q

What is Korsakoff’s syndrome?

A

Complication of Wernicke’s encephalopathy. Features: anterograde amnesia, retrograde amnesia and confabulation

256
Q

What anti-emetic is recommended for patients with Parkinson’s?

A

Domperidone because it doesnt cross blood brain barrier

257
Q

What drugs are associated with Steven-Johnson syndrome?

A

Carbamazepine
Lamotrigine
Allopurinol
Sulfonimine
Phenobarbital

258
Q

What muscle groups would be affected in myasthenia but not MND?

A

Eye muscles and Facial muscles

259
Q

In myasthenia gravis would you expect proximal or distal muscle weakness first?

260
Q

What investigations would you do for suspected MND?

A

Nerve conduction studies
MRI head and spine
EMG

261
Q

What is the preferred method to support nutrition for those with MND?

A

Percutaneous gastrotomy tube (PEG)

262
Q

What is the preferred method for respiratory support for those with MND?

A

Non-invasive ventilation usually BIPAP

263
Q

What is the most common cause of meningitis in pregnant women?

A

Listeria monocytogenes

264
Q

In the UK, what are the most common causative bacteria of meningitis in people over 3 years old?

A

Neisseria meningitidis
Strep pneumoniae (most common)
Haemophilus influenza type B

265
Q

What is the most common cause of meningitis in neonates (under 1 month old)?

A

Strep agalactiae
E. coli
Strep pneumoniae
Listeria monocytogenes

266
Q

What is the most common cause of meningitis in children 3 months or older?

A

N. meningitidis
S. pneumoniae
Haemophilus influenza type B

267
Q

Name contraindication to doing a lumbar puncture?

A

Signs of raised ICP
Coagulopathy
Focal neurological signs
Decreased GCS (<12)
Papilledema
Sepsis

268
Q

What is the management for close contacts of those with bacterial meningitis?

A

Oral Ciprofloxacin to all in close contact within past 7 days

269
Q

What is the management of bacterial meningitis caused by Listeria monocytogenes?

A

IV Amoxicillin + Gentamicin

270
Q

Describe a positive Kernig’s sign?

A

Patient is supine
Flex hip to 90 degree
Extension of knees elicit pain or there is resistance to extension

271
Q

Describe a positive Brudzinski’s sign?

A

When the neck is flexed, the hips and knees flex involuntarily

272
Q

Describe the gram stain and shape of S. pneumoniae?

A

Gram positive diplococci

273
Q

Describe the gram stain and shape of E. coli?

A

Gram negative bacilli

274
Q

Describe the gram stain and shape of H. influenzae?

A

Gram negative coccobacilli

275
Q

Describe the gram stain and shape of L. monocytogenes?

A

Gram positive rod

276
Q

What are the most common causes of viral meningitis?

A

Enteroviruses such as Coxsackie virus or Echovirus

277
Q

What is the Mx in primary care for suspected Meningococcal disease in children?

A

IM Benzylpenicillin

278
Q

What is the Mx of bacterial meningitis?

A

3 months - 50 years old - IV Cefotaxime (or Ceftriaxone)

Over 50 years old - IV Cefotaxime + Amoxicillin

279
Q

What are the complications following meningitis?

A

Sensorineural hearing loss (most common)
Seizures
Focal neurological deficiit

280
Q

What is the management of autoimmune encephalitis?

A

IV Methylprednisolone and IV Immunoglobulins

281
Q

What is the Mx of a migraine?

A

Sumatriptan oral
NSAID or Paracetamol

282
Q

In terms of Sumatriptan use for a migraine, When should it be used?

A

Taken once the headache starts but not during the aura phase

283
Q

Can you give Donepazil to someone with asthma

A

No. Its contraidicated

284
Q

What drug is useful for managing tremor in drug-induced parkinsonism?

A

Procyclidine

285
Q

Fracture of the surgical neck of the humerus, puts what nerve at risk?

A

Axillary nerve

286
Q

Damage to C8-T1 causes what?

A

This is the lower aspect of the Brachial plexus causing Klumpe’s paralysis it presents with Horner’s syndrome

287
Q

Damage to C5-C6 causes what?

A

Erbs Palsy

288
Q

What anaesthetic agent are those with Myasthenia gravis resistant to?

A

Suxamethonium

is a depolarising NMBD - it acts by binding to and activating the receptor, at first causing muscle contraction, then paralysis. Again, due to a decreased number of available receptors, MG patients are typically resistant to depolarising NMBDs and may require significantly higher doses.

289
Q

What is the management of post-lumbar puncture headache/

A

Analgesia, Rest, Caffeine, Blood patch, Epidural saline

290
Q

What is cubital tunnel syndrome?

A

Ulnar nerve neuropathy

291
Q

Describe Wernicke’s aphasia (receptive aphasia)? and common site of lesion

A

Lesion of superior temporal gyrus
- Typically inferior division of left MCA

Sentences make no sense, word substitution and neologisms but speech remains fluent ‘word salad’

292
Q

Describe Broca’s aphasia (expressive aphasia)? and common site of lesion

A

Lesion of inferior frontal gyrus
- Typically superior division of left MCA

Speech is non-fluent, laboured and halting, repetition is impaired
But Comprehension is normal

293
Q

Describe conduction aphasia? and common site of lesion

A

Due to stroke affecting arcuate fasciculus - Connection between Wernicke’s and Broca’s area

Speech is fluent but repetition is poor. Aware of the error they are making
Comprehension is normal

294
Q

Describe global aphasia? and common site of lesion

A

Large lesion affecting all 3 of the above areas resulting in severe expressive and receptive aphasia

May still be able to communicate using gestures

PHASE 3A (11 decks)

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