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MSRA > Neurology > Flashcards

Neurology Flashcards

1
Q

Which organism causes GBS?

A

Guillain-Barre syndrome is classically triggered by Campylobacter jejuni infection

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2
Q

What is Gower’s sign?

A

Gower’s sign: Seen in Duchenne muscular dystrophy, when a child used their arms to aid standing from a squat

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3
Q

What does the biceps reflex test?

A

C5-C6 nerve root

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4
Q

What do C7 and C8 do?

A

Although these cervical nerve roots do contribute to upper limb function - specifically wrist flexion (C7) and finger flexion (C8) - they are not primarily involved in eliciting the biceps reflex which tests mainly C5-C6 nerve root integrity.

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5
Q

Give three common sites of lacunar strokes

A

Common sites of lacunar strokes are the basal ganglia, thalamus and internal capsule

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6
Q

Which artery is affected in locked in syndrome?

A

Basilar

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7
Q

What is affected in Wallenburg syndrome?

A

Posterior inferior cerebellar artery

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8
Q

How do lacunar strokes present?

A

Either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

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9
Q

What is Saturday Night Palsy?

A

Saturday night palsy’ caused by compression of the radial nerve against the humeral shaft, possibly due to sleeping on a hard chair with his hand draped over the back. Means you are unable to extend your wrist.

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10
Q

What is adhesive capsulitis?

A

Frozen shoulder - stiffness and pain in her left shoulder, which started around a month ago. She had a similar episode that resolved by itself. Examination reveals limited external rotation.

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11
Q

How does degenerative cervical myelopathy present?

A

Degenerative cervical myelopathy leads to loss of fine motor function in both upper limbs. There is a delay in diagnosis of degenerative cervical myelopathy, which is estimated to be >2 years in some studies [1]. It is most commonly misdiagnosed as carpal tunnel syndrome and in one study, 43% of patients who underwent surgery for degenerative cervical myelopathy, had been initially diagnosed with carpal tunnel syndrome [1]

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12
Q

What is the tremor seen in cerebellar disease?

A

Intention tremor

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13
Q

What is Hoffmans sign? Where is it seen?

A

degenerative cervical myelopathy [DCM], which is associated with upper motor neuron signs. Hoffmans sign is elicited by flicking the distal phalaynx of the middle finger to cause momentary flexion. A positive result is exaggerated flexion of the terminal phalanyx of the thumb.

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14
Q

Why is topiramate avoided in women of child-bearing age?

A

Whilst topiramate is an agent used for migraine prophylaxis, it is not the first choice in a woman of childbearing age when there is another equally suitable agent such as propranolol. This is because topiramate is teratogenic and can also impair hormonal contraception.

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15
Q

How does neuroleptic malignant syndrome present?

A

It occurs within hours to days of starting an antipsychotic (antipsychotics are also known as neuroleptics, hence the name) and the typical features are:
pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion

A raised creatine kinase is present in most cases. Acute kidney injury (secondary to rhabdomyolysis) may develop in severe cases. A leukocytosis may also be seen

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16
Q

How does DCM present?

A

DCM symptoms can include any combination of [1]:
Pain (affecting the neck, upper or lower limbs)
Loss of motor function (loss of digital dexterity, preventing simple tasks such as holding a fork or doing up their shirt buttons, arm or leg weakness/stiffness leading to impaired gait and imbalance
Loss of sensory function causing numbness
Loss of autonomic function (urinary or faecal incontinence and/or impotence) - these can occur and do not necessarily suggest cauda equina syndrome in the absence of other hallmarks of that condition
Hoffman’s sign: is a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.

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17
Q

How do we manage DCM?

A

Urgent referral.
Currently, decompressive surgery is the only effective treatment. It has been shown to prevent disease progression. Close observation is an option for mild stable disease, but anything progressive or more severe requires surgery to prevent further deterioration. Physiotherapy should only be initiated by specialist services, as manipulation can cause more spinal cord damage.

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18
Q

What causes Parkinson’s disease?

A

Parkinson’s Disease is a neurodegenerative disorder involving death of neurones in the substantia nigra

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19
Q

What are first-line for spasticity in MS?

A

Baclofen and gabapentin are first-line for spasticity in multiple sclerosis

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20
Q

Which facial palsy is associated with parotid gland surgery?

A

Parotid pathology can cause a lower motor neurone facial palsy

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21
Q

Where do you see loss of corneal reflex?

A

Acoustic neuroma

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22
Q

What is an acoustic neuroma, and how does it present?

A

An acoustic neuroma (or vestibular schwannoma) is a benign tumour of the vestibulocochlear nerve. Symptoms include vertigo, tinnitus and unilateral sensorineural hearing loss.

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23
Q

How does Ramsay-Hunt syndrome present?

A

It typically presents with a triad of symptoms: ipsilateral facial paralysis, ear pain and vesicles in the auditory canal or on the tympanic membrane.

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24
Q

What is the pathognomonic feature of MND?

A

Specialist said pathognonomic feature is tongue fasciculations + jaw jerk - UMN and LMN together.

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25
Q

Which organism is associated with GBS?

A

Campylobacter jejuni

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26
Q

Give two treatments for cluster headaches

A

Oxygen and triptans

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27
Q

How does encephalitis present differently to meningitis on investigation findings?

A

This patient is presenting with symptoms (fever, headache, vomiting and seizures) and investigation findings (the most sensitive being prominent swelling and increased signal of the brain on MRI) suggestive of encephalitis.

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28
Q

How do we treat essential tremor?

A

Propranolol

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29
Q

First line tx for trigeminal neurlagia?

A

Carbamazepine

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30
Q

How do common peroneal nerve lesions present?

A

Common peroneal nerve lesion can cause weakness of foot dorsiflexion and foot eversion

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31
Q

What does an increased gamma GT show?

A

An increased gamma GT is suggestive of excessive alcohol consumption

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32
Q

What makes up the GCS?

A

GCS: Motor (6 points) Verbal (5 points) Eye opening (4 points). Can remember as ‘654…MoVE’

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33
Q

Where do you see anti-acetylcholine receptor antibodies?

A

Anti-acetylcholine receptor antibodies are present in myasthenia gravis.

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34
Q

What do we use for the long-term prophylaxis of cluster headaches

A

Verapamil

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35
Q

Name an anti-epileptic that can cause weight gain

A

Sodium valproate

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36
Q

What nerve is most likely to be damaged as a result of a mid-shaft humeral fracture?

A

Radial nerve - wrist drop

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37
Q

What is amaurosis fugax?

A

Amaurosis fugax is a form of stroke that affects the retinal/ophthalmic artery

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38
Q

How do we diagnose MS?

A

MRI with contrast

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39
Q

How does sciatic nerve damage present?

A

weakness to all muscles groups below the knee, intact knee jerk but weak ankle jerk

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40
Q

What supplies the sciatic nerve?

A

It is supplied by L4-5, S1-3

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41
Q

How do we manage acute ischaemic stroke in pts who present within 4.5 hours

A

A combination of thrombolysis AND thrombectomy is recommend for patients with an acute ischaemic stroke who present within 4.5 hours

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42
Q

Name three SEs of phenytoin

A

peripheral neuropathy, characterized by numbness and reduced sensation in a glove-and-stocking distribution. Additionally, phenytoin can cause gingival hyperplasia, which may lead to bleeding gums. Lymphadenopathy is another potential side effect of phenytoin.

Phenytoin - can’t PHEELY my TOEn

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43
Q

When does NMS usually occur?

A

Neuroleptic malignant syndrome is typically seen in patients who have just commenced treatment

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44
Q

A patient is noted to have an absent ankle reflex. Which nerve root does this correspond to?

A

S1-S2

45
Q

Name the reflex mneumonic

A

S1 S2 buckle my shoe (ankle)
L3 L4 kick the door (knee)
C5 C6 pick up sticks (biceps)
C7 C8 shut the gate (triceps)

46
Q

How do lacunar strokes present?

A

Lacunar strokes can present with
unilateral motor disturbance affecting the face, arm or leg or all 3.
complete one sided sensory loss.
ataxia hemiparesis.

47
Q

How does a total anterior circulation infarct present?

A
  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
48
Q

Describe essential tremor

A

Features
postural tremor: worse if arms outstretched
improved by alcohol and rest
most common cause of titubation (head tremor)

Management
propranolol is first-line
primidone is sometimes used

49
Q

What is Hoffman’s sign?

A

To elicit it, the examiner should flick the patients distal phalanx (usually of the middle finger) to cause momentary flexion. A positive sign is exaggerated flexion of the thumb.

50
Q

Where would you see Hoffman’s sign?

A

A positive Hoffmans sign is a sign of upper motor neuron dysfunction and points to a disease of the central nervous system - in this case from the history degenerative cervical myelopathy [DCM] affecting the cervical spinal cord is most likely.

51
Q

PEG vs NG?

A

Therefore, a definitive long-term management option for this patient would be a PEG tube.

NG is removed after 4-6/52

52
Q

How do you distinguish MND vs myasthenia gravis?

A

Myasthenia gravis is the second most likely differential, as facial weakness, hypophonic speech, and difficulty swallowing can be present. Ocular signs are usually present however and therefore MND is more likely.

53
Q

What is the difference between tibial nerve and peroneal nerve pathology?

A

TIPPED
Tibial nerve-Inversion-Plantarflexion
Peroneal nerve-Eversion-Dorsiflexion

54
Q

How does CN4 palsy present?

A

Vertical diplopia

55
Q

What is the most common SE of cabergoline?

A

Pulmonary fibrosis

56
Q

How do we distinguish C8/T1 radiculopathy from cubital tunnel syndrome?

A

C8/T1 radiculopathy can mimic ulnar nerve neuropathy. In this case, the preserved sensation of the forearm favours a diagnosis of cubital tunnel syndrome. The ulnar nerve does not provide sensation to the medial forearm, which is innervated by the medial antebrachial cutaneous nerve (C8 and T1).

57
Q

How does C6 radiculopathy present?

A

The patient’s symptoms of neck and arm pain, electric shock-like sensations, and exacerbation on head movement are suggestive of cervical radiculopathy. The decreased sensation on the dorsal aspect of the thumb and index finger corresponds to the dermatomal distribution of the C6 nerve root. Cervical radiculopathy occurs when a nerve root in the cervical spine becomes compressed or irritated, often due to degenerative changes such as disc herniation or osteophyte formation.

58
Q

Which nerve roots supply the hand?

A

C6 = thumb
C7 = middle
C8 = little finger

59
Q

How would an extensive L sided stroke present in terms of hemiplagia and ocular sx?

A

Right sided hemiplagia and R sided homonymous hemianopia

60
Q

Which visual defect would a primary open angle glaucoma in right eye present with?

A

Unilateral peripheral visual field loss

61
Q

What is second line in preventing further ischaemic stroke?

A

If clopi not tolerated:
Aspirin + dipyridamole lifelong. This combination has been shown to significantly reduce the risk of recurrent stroke in patients who have had an ischaemic stroke. Aspirin works by inhibiting platelet aggregation, thereby reducing the risk of clot formation. Dipyridamole works synergistically with aspirin by inhibiting platelet activation and adhesion, as well as having vasodilatory effects. The combination therapy should be continued indefinitely unless contraindicated or not tolerated.

62
Q

What is the pattern of inheritance for Huntington’s disease?

A

Autosomal dominant
Huntington’s is on Cr. 4: The letter ‘H’ has 4 arms

63
Q

What is Lhermitte’s sign?

A

Tingling in her hands which comes on when she flexes her neck. Seen in MS

64
Q

What is Uhthoff’s sign?

A

Uhthoff’s phenomenon occurs when you get “Uhthoff” the bath
worsening of vision following rise in body temperature
Seen in MS

65
Q

What is dantrolene used for, and when?

A

Dantrolene sodium is useful for spasticity it acts by decreasing muscle tone, clonus, and muscle spasm. However, it is not used as first-line in MS and can be considered if conventional treatments prove ineffective (gabapentin, baclofen)

66
Q

What is the most common complication following meningitis?

A

Sensorineural hearing loss is the most common complication following meningitis

67
Q

What is pathognomonic for Herpes simplex encephalitis?

A

Classically, HSE causes temporal lobe changes (hypodensities on CT, or hyperintensities on MRI) and bilateral temporal lobe changes are pathognomonic of HSE. (Note: although not required in this question, do be aware of the clinical features of temporal lobe changes e.g. aphasia, hemiparesis, memory loss etc since some questions may require you to infer temporal lobe involvement without imaging results).

68
Q

How do we manage tremor in drug-induced parkinsonism?

A

Procyclidine

69
Q

What is the motor section of GCS?

A

1 = no response ; worst possible ofc
2= extension ; nonsensical response to pain really
3= flexion ; bit better from a sort of pain response perspective (vaguely withdrawing from the pain)
4 = actually withdrawing from the pain; better still
5 = localising the pain; swatting away or whatever
6 = good response, obeying command

70
Q

What is the verbal section of GCS?

A
  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None
71
Q

A 60 year-old male presents with clumsy hands. He has been dropping cups around the house. His wife complains he doesnt answer his mobile as he struggles to use it. His symptoms have been gradually deteriorating over the preceding months. Dx?

A

This patient is likely to have degenerative cervical myelopathy [DCM], which is associated with upper motor neuron signs.

Hoffmans sign is elicited by flicking the distal phalaynx of the middle finger to cause momentary flexion.

72
Q

What does Hoffman’s sign show?

A

upper motor neuron signs

Seen in MS, DCM

73
Q

A 72-year-old man develops visual problems. He is noted to have a left homonymous hemianopia with some macula sparing. Where will the lesion be?

A

Occipital cortex

74
Q

What is Cushing’s triad?

A

Patients with raised ICP may exhibit Cushing’s triad:
widening pulse pressure
bradycardia
irregular breathing

75
Q

What are the SEs of sodium valproate?

A

V - vomiting
A - Alopecia
L - Liver toxicity
P - Pancreatitis / Pancytopaenia
R - Ravenous / round / retention of fat (increased appetite/weight gain)
O - Oedema
A - Ataxia
T - Teratogenic (neural tube defects)
E - Enzyme Inhibitor (Inhibites seizures)

76
Q

What is the most common symptom of posterior circulation stroke

A

Dizziness - not coordination difficulties!

77
Q

What would a left inferior homonymous quadrantanopia indicate?

A

A left inferior homonymous quadrantanopia indicates damage to the contralateral (opposite side) superior optic radiations, which are located in the right parietal lobe.

78
Q

What is Broca’s dysphasia?

A

Broca’s dysphasia: speech non-fluent, comprehension normal, repetition impaired

Broca’s area in frontal lobe

(expressive aphasia)

79
Q

What is Wernicke’s dysphasia?

A

Whilst a lesion in the temporal lobe could cause dysphasia, this would instead be a Wernicke’s dysphasia due to Wernicke’s area being affected. This Wernicke’s dysphasia would instead present with fluent speech but no comprehension. (receptive aphasia)

80
Q

What is a Jacksonian movement, and what type of seizure is ti associated with?

A

Jacksonian movement (clonic movements travelling proximally) indicates frontal lobe epilepsy

81
Q

How does Internuclear ophthalmoplegia present?

A

Internuclear ophthalmoplegia (INO) occurs due to a lesion of the medial longitudinal fasciculus (MLF), a tract that allows conjugate eye movement. This results in impairment of adduction of the ipsilateral eye. The contralateral eye abducts, however with nystagmus.

82
Q

Why do we need to start cardiac monitoring with IV phenytoin infusions?

A

When starting a phenytoin infusion cardiac monitoring is required due to the pro-arrhythmogenic effects it elicits.

83
Q

Which dyskinesias is levodopa assocaited with?

A

Patients taking levodopa may experience dyskinesias at peak dose: dystonia, chorea and athetosis (involuntary writhing movements)

Patients taking levodopa which is used to treat parkinson’s may conversely experience dyskinesias (erratic movements) at peak dose. This is usually a few hours after their dose and is more common after being on levodopa for a few years.

84
Q

Which anti-emetic do we use in Parkinson’s disease?

A

Domperidone. Domperidone works by blocking dopamine receptors in the chemoreceptor trigger zone (CTZ) of the brain, which provides anti-emetic effects. Importantly, it does not readily cross the blood-brain barrier and hence does not exacerbate Parkinson’s symptoms by blocking dopamine in areas of the brain involved in movement. It is a preferred choice for patients with Parkinson’s disease experiencing nausea or vomiting.

Can’t use metoclopramide or prochlorperazine for this reason

85
Q

Which artery does a posterior circulation infarct impact?

A

A POCI (posterior circulation infarct) involves the vertebrobasilar arteries

86
Q

What is the most common psychiatric presentation of Parkinson’s?

A

Depression

87
Q

What is 1st line for absence seizures?

A

ethosuxamide

88
Q

What is tuberous sclerosis?

A

Tuberous sclerosis is a genetic disorder that causes non-cancerous (benign) tumours to grow in different parts of the body. It often affects the brain and can lead to conditions such as epilepsy. The image shows characteristic adenoma sebaceum on the nose.

89
Q

A 45-year-old alcoholic patient starts to fit in the waiting room. You place him in the recovery position and apply oxygen. After 5 minutes he is still fitting. What is the most appropriate medication to administer?

A

Rectal diazepam 10mg or buccal midazolam 10mg

90
Q

What is mydriasis?

A

dilated pupil

91
Q

How would we manage a patient with neuropathic pain, who has not responded to amitryptiline?

A

Drugs for neuropathic pain are typically used as monotherapy, i.e. if not working then drugs should be switched, not added

92
Q

What is ropinirole, and which psychiatric side effect can it lead to?

A

Parkinson’s disease medications: dopamine agonists have a higher risk of hallucinations compared to the other classes of medications

93
Q

Neuropathic pain characteristically responds poorly to opioids. However, if standard treatment options have failed which opioid is it most appropriate to consider starting?

A

The correct answer is Tramadol. Tramadol has a dual mechanism of action, acting as both a weak opioid agonist and a reuptake inhibitor of serotonin and norepinephrine. This unique action profile gives it an edge in managing neuropathic pain compared to other opioids.

94
Q

What causes subdural haemorrhage?

A

Subdural haemorrhage results from bleeding of damaged bridging veins between the cortex and venous sinuses

95
Q

When is the standard target time for thrombectomy?

A

The standard target time for thrombectomy in acute ischaemic stroke is 6 hours

Offer thrombectomy as soon as possible to people who were last known to be well between 6 hours and 24 hours previously (including wake-up strokes):

Thrombolysis is 4.5 hours

96
Q

What is a C6 lesion?

A

‘Make a 6 with your left hand by touching the tip of the thumb & index finger together - C6’

97
Q

What hearing abnormality may you see in Bells Palsy?

A

Hyperacusis

98
Q

Which movements are spared in MND?

A

Eye movements are typically spared in motor neurone disease

99
Q

What is the inheritance pattern in essential tremor?

A

AD

100
Q

How does Wernicke’s dysphasia present?

A

Wernicke’s aphasia is correct. Associated with lesions in the posterior superior temporal gyrus, it is sometimes termed fluent aphasia or receptive aphasia. Speech remains fluent but makes little sense and commonly includes nonsense or irrelevant words. Interestingly, the person does not realise they are using incorrect words.

101
Q

When can drivers drive again after a TIA?

A

For group 1 drivers, following a single TIA they can start driving if symptom-free for 1 month and there is no need for them to inform the DVLA.

102
Q

Which medications can cause myasthenic crises?

A

The following drugs may exacerbate myasthenia:
penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines

103
Q

What is Weber’s syndrome?

A

This is a type of brainstem stroke, specifically in the midbrain. It occurs due to an occlusion in a branch of the posterior cerebral artery. The syndrome is characterised by an ipsilateral cranial nerve III palsy (oculomotor nerve) and contralateral hemiparesis (weakness).

104
Q

How does Weber’s syndrome present ophthalmogically?

A

Oculomotor nerve (III) lesion

Shown by enlarged pupil due to loss of parasympathetic innervation and ‘down and out’ pupil position

105
Q

How does Wallenburg syndrome present?

A

This presents with ipsilateral facial pain and temperature loss. Along with contralateral limb/ torso pain, ataxia and nystagmus.

106
Q

What is the Cushing reflex?

A

The Cushing reflex is a physiological nervous system response to increased intracranial pressure (ICP) that results in hypertension and bradycardia

107
Q

When do we use mannitol vs dex for brain oedema?

A

Dex seems to be recommended for cerebral oedema due to brain tumours, and mannitol seems to be used as a diuretic agent for cerebral oedema secondary to stroke/haemorrhage, as steroids arent recommended for those reasons

108
Q
A

MSRA (21 decks)

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