Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCP - Passmed > Neurology > Flashcards

Neurology Flashcards

1
Q

conductive hearing loss, tinnitus and positive family history - diagnosis?

A

Otosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

episodic vertigo, tinnitus, and hearing loss - diagnosis?

A

Meniere’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why can phenytoin cause bruising in newborn if mother takes it?

A

Phenytoin induces vitamin K metabolism, which can cause a relative vitamin K deficiency, creating the potential for heamorrhagic disease of the newborn

Mothers taking phenytoin advised to have Vit K in last month of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Caution for those using Natalizumab?

A

Natalizumab can cause reactivation of the JC virus causing progressive multifocal leukoencephalopathy (PML) - hx of MS with new neurological sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mx of focal seizures?

A

first line: lamotrigine or levetiracetam

second line: carbamazepine, oxcarbazepine or zonisamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Mx of absence seizures? What is CI and why?

A

first line: ethosuximide

second line:
male: sodium valproate
female: lamotrigine or levetiracetam

CI = carbamazepine may exacerbate absence seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Mx of myoclonic seizures

A

males: sodium valproate
females: levetiracetam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mx of tonic / atonic seizures?

A

males: sodium valproate
females: lamotrigine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mx of generalised tonic-clinc seizures?

A

males: sodium valproate
females: lamotrigine or levetiracetam

girls aged under 10 years and who are unlikely to need treatment when they are old enough to have children or women who are unable to have children may be offered sodium valproate first-line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Waterhouse-Friderichsen syndrome - who is at risk of this?

A

Waterhouse-Friderichsen syndrome (adrenal insufficiency secondary to adrenal haemorrhage)

Pts with meningococcal meningitis are at risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Anti-epileptics and breastfeeding?

A

Safe with most except barbiturates (-barbital suffix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Mx of cranial abscess?

A

surgery
a craniotomy is performed and the abscess cavity debrided
the abscess may reform because the head is closed following abscess drainage

IV antibiotics: IV 3rd-generation cephalosporin + metronidazole

intracranial pressure management: e.g. dexamethasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

cerebellar signs, contralateral sensory loss & ipsilateral Horner’s

Which stroke syndrome? Vessel affected?

A

Lateral medullary syndrome - PICA affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Adverse effects associated with 5HT3 antagonists?

Where do they act? examples?

A

Ondansetron - act on chemoreceptor trigger zone in medulla oblongata

Can cause constipation and prolonged QT -> increased risk of polymorphic VT or torsades de pointes (mx = IV MgSO4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Important blood test in restless legs syndrome?

A

Ferritin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is hemiballism?

A

Ballisic movements are involuntary, sudden, jerking movements which occur contralateral to the side of the lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cause of hemiballism? Mx?

A

Hemiballism occurs following damage to the subthalamic nucleus in the basal ganglia

Antidopaminergic agents (e.g. Haloperidol) are the mainstay of treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When to perform LP if suspecting SAH?

A

12 hours post headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Medication used in MND?

A

Riluzole - prolongs life by about 3 months (mostly used in ALS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which neuro medication can cause SJS?

A

Lamotrigine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Mx of idiopathic intracranial HTN?

A

Weight loss - 1st
Acetazolamide - carbonic anhydrase inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

1st line tx for parkinsons?

A

If motor sx affecting QoL - Levodopa

If motor sx not affecting QoL - Dopamine agonnist, levodopa or MAO-B inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How to manage drooling in Parkinsons?

A

Glycopyrronium bromide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

dementia (rapid onset)
myoclonus

Suggestive of what condition?

A

CJD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the most common causes of brain abscesses?

A

Extension of sepsis from middle ear / sinuses

Trauma / surgery to scalp

Penetrating head injuries

Embolic events from endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What scoring system can be used to quantify the disability in activities of daily living? - In stroke patients

A

Barthel index

i.e. feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, chair transfer, ambulation and stair climbing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

shock-like, irregular jerking movements, usually of the arms suggestive for which type of seizures

A

Myoclonic seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

MoA of Ramsay Hunt? mx?

A

reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.

mx - oral aciclovir and corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Mx of spasticity in MS?

A

Baclofen + Gabapentin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Best tx for survival benefits in MND?

A

Riluzole - prolongs life by 3 months

NIV - prolongs life by 7 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What do assymetric symptoms in Parkinsons suggest?

A

Idiopathic parkinsons instead of drug induced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

First line mx in Restless legs?

A

Dopamine agonists eg pramipexole and ropinirole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is impaired in subacute combined degeneration of spinal cord?

A

Dorsal column - impaired proprioception and vibration sense, distal parasthesia legs>arms

Lateral corticospinal tracts - muscle weakness, hyperreflexia and spasticity, UMN signs typically in legs first, brisk knee reflexes, absent ankle, extensor plantars

Spinocerebellar tracts - sensory ataxia and +ve Rombergs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

combination of falls, alcohol excess, fluctuating episodes of confusion and focal neurology

suggests which diagnosis?

A

Fluctuating consciousness = subdural haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Which CN palsy causes vertical diplopia? which causes horizontal diplopia?

A

Vertical - Trochlear

Horizontal - Abducens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What can percipitate subacute degeneration of spinal cord in B12 deficient patients?

A

Replacing folate before replacing B12

Always do B12 first as B is before F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is anti-NMDA receptor encephalitis?

How does it present and what is usually present?

A

Paraneoplastic syndrome - presents with prominent psychiatric features inc agitation, hallucinations, delusions and disordered thinking

Ovarian teratomas in 1/2 of female adults - particularly afro-carribeans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the features of internuclear ophthalmoplegia? what are some causes?

A

Impaired adduction of eye - ipsilateral side
Horizontal nystagmus of adducting eye - contralateral side

Causes - vascular disease and MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Where is the leison present in internuclear ophthalmoplegia?

A

Leison in medial longitudnal fasciculus (MLF) - paramedian area of midbrain / pons which controls horizontal eye movements by connecting CN III, IV and VI nuclei

It is located in paramedian area of midbrain and pons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

When can carbamazepine be used for neuropathic pain?

A

Only in trigeminal neuralgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Location of homonymous quadrantanopias and the mneumonic?

A

superior: lesion of the inferior optic radiations in the temporal lobe (Meyer’s loop)
inferior: lesion of the superior optic radiations in the parietal lobe

mnemonic = PITS (Parietal-Inferior, Temporal-Superior)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How can the different aphasias be classified?

A

Speech is NOT fluent: (laboured and halting)
- Comprehension relatively in tact - Brocas (expressive)
- Comprehension impaired - Global aphasia

Speech is fluent (sentences dont make sense, word substitution + neologisms but speech is fluent)
- Comprehension relatively intact - conduction aphasia (poor repetition)
- Comprehension impaired - wernickes (receptive) aphasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Common peroneal nerve - where is injury normally? characteristic feature?

A

Injury typically at neck of fibula - leads to foot drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Sciatic nerve divides into:

A

Common peroneal nerve

Tibial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Features of common peroneal nerve leison?

A

weakness of foot dorsiflexion
weakness of foot eversion
weakness of extensor hallucis longus

sensory loss over the dorsum of the foot and the lower lateral part of the leg

wasting of the anterior tibial and peroneal muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Which anti-epileptic can lead to increased appetite and weight gain?

A

Sodium Valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Prognosis absence seizures in adolescence?

A

90-95% seizure free

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Speech is fluent but repetition is poor

Comprehension normal

Which aphasia?

A

Conduction aphasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Which disease is associated with bilateral vestibular schwannomas?

A

NF2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

EEG - bilateral, symmetrical 3Hz spike and wave pattern

Suggestive of what disorder?

A

Absence seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

peripheral neuropathy, lymphadenopathy, and bleeding gums

Can occur with which anti-epileptic

A

Gingival hyperplasia and the other sx mentioned are most common with phenytoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Why to be careful giving metaclopramide in mx of migraines to young people and females?

A

At greater risk of EPSEs / acute dystonic reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Why do you get hyperaccusis in CN 7 palsy eg Bells palsy?

A

CN 7 damage affects stapedius muscle involved in dampening loud sounds -> paralysis of this means this doesn’t happen anymore

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Presentation of peripheral neuropathy in a personal treated with decompressive surgery for degenerative cervical myelopathy

Mx? why?

A

Urgent referral to spinal / neurosurg - pathology can ‘recurr’ at adjacent spinal levels and require urgent mx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What are the different types of MND?

A

ALS - UMN + LMN

Primary lateral sclerosis - UMN only

Progressive muscular atrophy - LMN only distal muscles > proximal

Progressive bulbar palsy - palsy of tongue, muscles of mastication and facial muscles due to loss of func of brainstem motor nuclei

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Best and worst prognosis MND?

A

Best - Progressive muscular atrophy

Worst - Progressive bulbar palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is Miller Fisher Variant? antibodies present?

A

Variant of GBS - associated with ophthalmoplegia, areflexia and ataxia - eye muscles typically affected first

Descending paralysis usually v ascending

Anti-GQ1b antibodies in 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Suspected post-LP headache - mechanism?

A

Leaking of CSF from dura via puncture site -> ongoing CSF loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Trigger for neuroleptic malignant syndrome? Features?

A

Antipsychotics (inc atypicals) + Dopaminergic drugs for Parkinsons (eg Levodopa) - often when drug is suddnely stopped

Pyrexia
Muscle rigidity
Autonomic lability - HTN, tachycardia + tachypnoea
Agitated delirium with confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Mx of neuroleptic malignant syndrome?

A

Stop antipsychotic

-> to medical ward (often ICU)

IV fluids - prevent renal failure
Dantrolene - decreases excitation-contraction in skeletal muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Ipsilateral:
Weakness (below leison)
Loss of proprioception + vibration

Contralateral:
Loss of pain and temperature sensation

Diagnosis and cause?

A

Brown-Sequard syndrome - caused by lateral hemisection of spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

How should paracetamol and triptans be stopped in medication overuse headaches?

A

Withdrawn abruptly - may initially worsen headaches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What does it tell us if there is a visual field defect that is congruous? what if the macula is spared alongside this and why?

A

Congruous suggests the leison is posterior to optic tract (optic radiation or occipital cortex)

Macula sparing tells us this leison is in the occipital cortex due to dual blood supply from MCA and PCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Where is the leison in Wenickes aphasia?

A

Due to leison in superior temporal gyrus - supplied my inferior division of L MCA

(Forms speech before sending to Brocas) -> Word salad

Remember by Wernickes is W so ‘we up’ hence superior temporal gyrus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Where is the leison in the Brocas aphasia?

A

Leison of inferior frontal gyrus supplied by superior division of L MCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Where is the leison in conduction aphasia?

A

Arcuate fasiculus - connection between Brocas and Wernicke’s area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Where is the leison in global aphasia?

A

Large leison affecting inferior, superior temporal gyrus and arcuate fasiculus (all 3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are the features of ataxia telangiectasia?

A

Cerebellar ataxia

Telangiectasias

IgA deficiency -> recurrent chest infection

10% risk of malignancy mostly leukaemia / lymphomaa but also non-lymphoid tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

age of onset in friedreichs ataxia and ataxia telangiectasia?

A

Ataxia telangiectasia = 1-5 years old

Friedrichs ataxia - 10-15 years old

Both autosomally recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is CADASIL and how does this present

A

cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

Genetic condition that presents with migraines in middle age -> recurrent TIAs + strokes -> neurocognitive decline, psychiatric problems and dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

MRI findings in CADASIL?

A

Multiple widespread hyper intense leisons in white matter, basal ganglia, thalamus and pons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What are some CIs for use of triptans? Triptan MoA?

A

Triptan MoA - 5HT1B / 5HT1D agonists

CI = hx of significant RFs for IHD / CVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Bitemporal hemianopias:
What are the different causes dependent on whether upper or lower quadrants are more greatly affected?

A

upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour

lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What are the features of parietal lobe lesions?

A

sensory inattention
apraxias
astereognosis (tactile agnosia)
inferior homonymous quadrantanopia
Gerstmann’s syndrome (lesion of dominant parietal): alexia, acalculia, finger agnosia and right-left disorientation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Features of occipital lobe leisons?

A

homonymous hemianopia (with macula sparing)
cortical blindness
visual agnosia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Features of temporal lobe leisons?

A

Wernicke’s aphasia: this area ‘forms’ the speech before ‘sending it’ to Brocas area. Lesions result in word substituion, neologisms but speech remains fluent
superior homonymous quadrantanopia
auditory agnosia
prosopagnosia (difficulty recognising faces)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Which CNs are affected in vestibular schwannomas (acoustic neuromas)

A

Classically vertigo, hearing loss, tinnitus and absent corneal reflex

CN VIII - Vertigo, unilateral sensorineural hearing loss, unilateral tinnitus

CN V - Absent corneal reflex

CN VII - Facial palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What condition do you see bilateral vestibular schwannomas in ?

A

NF 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Prophylactic management of cluster headaches?

A

Verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What can cause gingival hyperplasia?

A

Phenytoin

Ciclosporin

CCBs

AML

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What can happen after SAH -> excessive Na loss? How can you distinguish between these?

A

SIADH and cerebral salt wasting syndrome

Both lead to increased urinary sodium

Cerebral salt wasting syndrome has low / normal urine osmolality whereas in SIADH (everything urinary is high) hence high osmolality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What is spastic paraparesis? how can varicella / HIV cause this?

A

UMN patterns of weakness in lower limbs

Via transverse myelitis in HIV / Varicella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Which imaging should be used in MS, strokes / TIAs and which in thyroid eye disease?

A

MRI FLAIR - MS

MRI Diffusion-weighted - Stroke / TIA

MRI STIR - Thyroid eye disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What is brachial neuritis?

A

acute onset of unilateral (occasionally bilateral) severe pain, followed by shoulder and scapular weakness several days later

Usually minimal sensory changes

Can see muscle wasting depending the nerve involved

Good prognosis unless phrenic nerve involved -> significant breathlessness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What nerve palsy can be seen with raised ICP and why?

A

Third nerve palsy - pupillary dilatation due to herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Which opioid can be trialled in neuropathic pain if failure to respond to classical options and why?

A

Tramadol - dual MoA

Weak opioid agonist
Reuptake inhibitor of serotonin and norepinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Features of Friedreichs ataxia?

A

Neurological features
- absent ankle jerks/extensor plantars
- cerebellar ataxia
- optic atrophy
- spinocerebellar tract degeneration

Other features
- HOCM (90%, most common cause of death)
- DM (10-20%)
- high-arched palate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Which tumours are associated with VHL?

A

Hemangiomas

Clear cell renal cell carcinoma

Phaeochromocytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Features of Tuberous Sclerosis?

A

ASHLEAF
A- ash leaf spots
S- Shagreen patches
H- Heart Rhabdomyomas
L- lung lumphanfioleiomyomatosis
E- epilepsy
A- angiomylolipoma in kidney
F- Facial angiofibroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

NICE guidelines for starting AEDs after 1st seizure state:

A

To start AEDs if:
the patient has a neurological deficit
brain imaging shows a structural abnormality
the EEG shows unequivocal epileptic activity
the patient or their family or carers consider the risk of having a further seizure unacceptable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

NCS in axonal pathology?

A

Normal conduction velociy
Reduced amplitude

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

NCS in demyelinating disorders?

A

Reduced conduction velocity
Normal amplitude

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Where is the damage present in GBS?

A

Myelin sheath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is Brown Sequard syndrome caused by? What are the features?

A

Ipsilateral weakness below leison
Ipsilateral loss of proprioception and vibration sense

Contralateral loss of pain and temp sensation

Caused by lateral hemisection of spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What occurs when there is a rupture of MMA due to injury to pterion? what can be seen in some pts

A

Extradural haematoma

Can see lucid interval in some patients - usually after major head injury

96
Q

What are subdural haematomas usually associated with?

A

luctuating consciousness, often following trivial injury in the elderly or alcoholics

97
Q

How can you distinguish between carpal tunnel syndrome and degenerative cervical myelopathy?

A

Both can present similarly but DCM will also have +ve hoffmans (thumb and index finger coming together when you flick the middle finger down)

98
Q

Which AED can cause hypotension?

A

Phenytoin

99
Q

Medication overuse headache tx?

A

Simple analgesia - stop abruptly

Opioid analgesia - withdraw gradually

100
Q

CT showing temporal lobe changes eg petechial haemorrhages is suggestive of ….

A

HSV encephalitis

101
Q

Facioscapulohumeral muscular dystrophy - what is it? who does it affect? What other features can be present?

A

AD muscular dystrophy that affects face, scapula and upper arms 1st typically presents by 20y

Can also involve high frequency-hearing loss and abnormality of the retinal arteries

102
Q

Why to be careful using Natalizumab in certain patients for MS?

A

Can reactivate JC virus -> PML (Progressive multifocal leukoencephalopathy)

103
Q

What is HSMN? What are the main types and how are they distinguished?

A

Hereditary sensorimotor neuropathy (HSMN) is a relatively new term which encompasses Charcot-Marie-Tooth disease

7 but 2 main clinically:
HSMN type I: primarily due to demyelinating pathology
HSMN type II: primarily due to axonal pathology

104
Q

What can happen 3-4 weeks after starting Carbemazepine tx and why?

A

Can become less effective and more rapidly metabolised

This is due to autoinduction of the enzyme that metabolises it

105
Q

MoA of procyclidine

A

Anti-muscarinic

105
Q

MRI: hyperintense signals in the basal ganglia and thalamus

pulvinar region and dorsomedial thalamus are hyperintense on T2-weighted imaging

What is this sign called and when is it seen?

A

Seen in CJD known as hockey stick sign

105
Q

Mneumonic for cerebellar signs? what if its unilateral?

A

D - Dysdiadochokinesia, Dysmetria (past-pointing), patients may appear ‘Drunk’
A - Ataxia (limb, truncal)
N - Nystamus (horizontal = ipsilateral hemisphere)
I - Intention tremour
S - Slurred staccato speech, Scanning dysarthria
H - Hypotonia

Signs will occur in ipsilateral side

106
Q

What are the features of CJD?

A

rapid onset dementia

myoclonus

107
Q

What is PICA stroke called? What are the features?

A

Lateral medullary syndrome (Wallenbergs) due to occlusion of PICA

Cerebellar signs - ataxia, nystagmus

Brainstem signs - ipsilateral (dysphagia, facial numbness, CN palsy eg Horners) + contralateral (limb sensory loss)

108
Q

What is the mx of a myasthenic crisis?

A

IVIg or plasmapheresis

109
Q

What are the features of Wenickes encephalopathy and Korsakoffs syndrome?

A

Wernickes:
- Nystagmus
- Ophthalmoplegia inc nystagmus
- Ataxia

If untreated develops into Korsakoff’s which includes above and also:
- Amnesia (anterograde + retrograde)
- Confabulation

110
Q

What are the features of transient global amnesia?

A

clinical syndrome of uncertain aetiology, characterised by a discrete episode lasting for a few hours (always less than 24 hours) of anterograde amnesia, retrograde amnesia, repetitive questioning with an absence of other cognitive or neurological impairments

There has to be a reliable witness, absence of trauma / LOC, preserved personal identity and absence of epileptic features

111
Q

What is Gerstmanns syndrome?

A

Acalculia, right-left disorientation, finger agnosia and agraphia

Due to deficit in dominant parietal lobe (angular and supramarginal gyri)

112
Q

inability to generate a list

Where is the leison?

A

Frontal lobe

113
Q

anosmia

Where is the leison?

A

Frontal lobe

114
Q

Where is Brocas area?

A

Frontal lobe

115
Q

Where is Wernickes area?

A

Temporal lobe

116
Q

What are the features of midline cerebellar leisons?

A

gait and truncal ataxia

117
Q

What are the features of hemispheric cerebellar leisons?

A

intention tremor, past pointing, dysdiadokinesis, nystagmus

118
Q

Damage to the Medial thalamus and mammillary bodies of the hypothalamus leads to what disorder?

A

Wernicke and Korsakoff syndrome

119
Q

Damage to the subthalamic nucleus of the basal ganglia leads to what disorder?

A

Hemiballism

120
Q

Damage to the Striatum (caudate nucleus) of the basal ganglia leads to what disorder?

A

Huntington chorea

121
Q

Damage to the amygdala leads to what disorder and what are the features of this?

A

Kluver-Bucy syndrome (hypersexuality, hyperorality, hyperphagia, visual agnosia

122
Q

What is the pattern of muscle weakness in CMT?

A

Distal muscular weakness / atrophy

can get stork leg deformity

123
Q

What are the features of Juvenile myoclonic epilepsy (Jans syndrome)? tx?

A

infrequent generalized seizures, often in morning//following sleep deprivation
daytime absences
sudden, shock-like myoclonic seizure (these may develop before seizures)

treatment: usually good response to sodium valproate

124
Q

How can you distinguish NPH from MSA?

A

The presence of dementia and absence of cerebellar signs point away from a diagnosis of multiple system atrophy

125
Q

Which anti-epileptic is associated with SJS? How can this present?

A

Lamotrigine

SJS - several, global rash with blistering and peeling of the skin

126
Q

symptoms of progressive ataxia, dysarthria, cognitive impairment and generalised weakness

In someone with MS being treated - what is the likely diagnosis, organisms and implicated drug?

A

progressive multifocal leukoencephalopathy (PML) due to reactivation of JC virus

Med - Natalizumab

127
Q

How can you distinguish between Wernickes and Conduction aphasia?

A

Wernickes - impaired comprehension

Conduction - Comprehension in tact

128
Q

What may be seen in imaging for someone with hydrocephalus?

A

hydrocephalus with ventriculomegaly in the absence of, or out of proportion to, sulcal enlargement

129
Q

Distal sensory loss, tingling + absent ankle jerks/extensor plantars + gait abnormalities/Romberg’s positive

Is suggestive of what?

A

Subacute combined degeneration of the spinal cord

130
Q

Which neuropathic analgesic should be used less often if someone has reacted to pregabalin?

A

Gabapentin

131
Q

What type of hearing loss in otosclerosis?

A

Conductive

132
Q

Which side is the leison in PICA (Lateral medullary) strokes?

A

Ipsilateral to horners

Contralateral to sensory loss

133
Q

MRI finding shape in extradural v subdural - how to distinguish between acute / chronic?

A

Extradural = convex / limited by suture lines

Subdural = Concave / not limited by suture lines

Acute = Hyperintense
Chronic = Hypointense

134
Q

Progressive supranuclear palsy - features? (4)

A

postural instability,

supranuclear ophtalmoplegia - typcially impairment of vertical gaze (patients may complain of difficultly reading or descending stairs)

parkinsonism,
frontal lobe dysfunction

135
Q

delayed, but well preserved waveform in visual EVPs dx?

A

MS

136
Q

Bladder dysfunction in MS - ix and mx?

A

guidelines stress the importance of getting an ultrasound first to assess bladder emptying - anticholinergics may worsen symptoms in some patients

if significant residual volume → intermittent self-catheterisation

if no significant residual volume → anticholinergics may improve urinary frequency (eg oxybutinin and tolterodine)

137
Q

Features of dystonic myotonica ?

A

Dystrophia myotonica - DM1

Distal weakness initially
autosomal Dominant
Diabetes
Dysarthria

Cataract +- loss of red reflex
Hear conduction defects
Testicular atrophy - secondary to hormone issues

138
Q

What is a rare but important adverse effect of topiramate?

A

acute myopia and secondary angle-closure glaucoma

139
Q

What are the localising features of temporal lobe seizures?

A

May occur with or without impairment of consciousness or awareness

An aura occurs in most patients
typically a rising epigastric sensation
also psychic or experiential phenomena, such as dejà vu, jamais vu
less commonly hallucinations (auditory/gustatory/olfactory)

Seizures typically last around one minute
automatisms (e.g. lip smacking/grabbing/plucking) are common

140
Q

Features of frontal, parietal and occipital lobe focal seizures?

A

Frontal lobe (motor) Head/leg movements, posturing, post-ictal weakness, Jacksonian march

Parietal lobe (sensory) Paraesthesia

Occipital lobe (visual) Floaters/flashes

141
Q

Cause of upbeat nystagmus v downbeat?

A

Upbeat nystagmus
cerebellar vermis lesions (top of cerebellum)

Downbeat nystagmus - foramen magnum lesions -> Arnold-Chiari malformation (low cerebellar tonsils)

142
Q

Prognostic features of MS?

A

Good prognosis features
female sex
age: young age of onset (i.e. 20s or 30s)
relapsing-remitting disease
sensory symptoms only
long interval between first two relapses
complete recovery between relapses

Ways of remembering prognostic features
the typical patient carries a better prognosis than an atypical presentation

143
Q

Causes of Parkinsonianism?

A

Parkinson’s disease

drug-induced e.g. antipsychotics, metoclopramide*

progressive supranuclear palsy

multiple system atrophy

Wilson’s disease

post-encephalitis

dementia pugilistica (secondary to chronic head trauma e.g. boxing)

toxins: carbon monoxide, MPTP

144
Q

BP control in ischaemic strokes?

A

blood pressure should not be lowered in the acute phase of ischaemic stroke unless there are complications e.g. Hypertensive encephalopathy or they are being considered for thrombolysis (see below)

blood pressure control should be considered for patients who present with an acute ischaemic stroke, if they present within 6 hours and have a systolic blood pressure > 150 mmHg

145
Q

Features of ACA, MCA and PCA strokes?

A

ACA - Contralateral hemiparesis and sensory loss, lower extremity > upper

MCA - Contralateral hemiparesis and sensory loss, upper extremity > lower, Contralateral homonymous hemianopia, Aphasia

PCA - Contralateral homonymous hemianopia with macular sparing, Visual agnosia

146
Q

Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

Suggest what stroke?

A

Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)

147
Q

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

+ Ipsilateral: facial paralysis and deafness

Which type of stroke?

A

Anterior inferior cerebellar artery (lateral pontine syndrome)

148
Q

Retinal/ophthalmic artery stroke?

A

Amaurosis fugax

149
Q

Basilar artery stroke?

A

‘Locked-in’ syndrome

150
Q

Lacunar strokes features?

A

present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

strong association with hypertension

common sites include the basal ganglia, thalamus and internal capsule

151
Q

Mx of otitis externa?

A

Topical corticosteroid + aminoglycoside

152
Q

Craniopharyngioma - what part of the hypothalamus may be involved?

A

The ventromedial area of the hypothalamus is often involved.

153
Q

how to distinguish between TIA and Migraine?

A

Stroke and TIA are associated with sudden-onset ‘negative’ symptoms,

migraine is more commonly associated with ‘positive’ symptoms

Negative Symptoms: These refer to deficits or losses in neurological function. In strokes and TIAs, patients may experience:

Hemiparesis: Weakness on one side of the body.
Aphasia: Difficulty with speech or language comprehension.
Visual Field Deficits: Loss of vision in part of the visual field.
Positive Symptoms: These involve the presence of abnormal sensations or experiences. In migraines, particularly during the aura phase, patients may report:

Visual Disturbances: Such as scintillating scotomas or zigzag lines.
Sensory Changes: Including tingling or numbness, often unilateral.
Aura Symptoms: Can include auditory hallucinations or olfactory changes.
This differentiation is essential for timely intervention; while migraines are typically self-limiting, strokes require immediate medical attention to prevent long-term disability.

154
Q

Movement disorders in order of least speed to fastest?

A

Dystonia - fixated position
Athetosis - Snake-like writhing (slow)
Choreiform - Like a dance choreographer
Ballistic/Ballismus/Hemiballismus - Fast flinging movements, can injure themselves or others ‘like a ballistic missile’ (memorisation method)

DACB

155
Q

The following conditions are associated with raised lymphocytes in CSF?

A

viral meningitis/encephalitis
TB meningitis
partially treated bacterial meningitis
Lyme disease
Behcet’s, SLE
lymphoma, leukaemia

156
Q

Which side is optic tract leison in comparison to incongruous homonymous hemianopia?

A

Contralateral side

157
Q

Mutation in CADASIL?

A

NOTCH3

158
Q

Painful third nerve palsy suggests what disorder?

A

posterior communicating artery aneurysm

159
Q

Causes of demyelinating v axonal peripheral neuropathy?

A

Demyelinating pathology
Guillain-Barre syndrome
chronic inflammatory demyelinating polyneuropathy (CIDP)
amiodarone
hereditary sensorimotor neuropathies (HSMN) type I
paraprotein neuropathy

Axonal pathology
alcohol
diabetes mellitus* - can also be demyelinating
vasculitis
vitamin B12 deficiency* - can also be demyelinating
hereditary sensorimotor neuropathies (HSMN) type II

160
Q

Typical presentation of syringiomyelia?

A

cape-like loss of pain and temperature sensation due to compression of the spinothalamic tract fibres decussating in the anterior white commissure of the spine

161
Q

NF chromosome?

A

NF1: chromosome 17 - as neurofibromatosis has 17 characters
NF2: chromosome 22 - all the 2’s

162
Q

What causes loss of corneal reflex?

A

Seen due to CN V palsy in acoustic neuroma (vest schwannoma)

163
Q

Which NF is associated w Phaeo? what else can you see

A

NF1

can also see:
Cafe-au-lait spots (>= 6, 15 mm in diameter)
Axillary/groin freckles
Peripheral neurofibromas
Iris hamatomas (Lisch nodules) in > 90%
Scoliosis
Pheochromocytomas

Nb NF2 has other CNS tumours present

164
Q

Essential tremor mx when BB CI?

A

Primidone

165
Q

cause of narcolepsy?

A

Orexin levels being low (hypocretin)

166
Q

Which patients should be offered thrombectomy?

A

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):
- confirmed occlusion of the proximal anterior circulation demonstrated by CTA or MRA and
- if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume

Offer thrombectomy as soon as possible and within 6 hours of symptom onset, together with intravenous thrombolysis (if within 4.5 hours), to people who have:
acute ischaemic stroke and
- confirmed occlusion of the proximal anterior circulation demonstrated by computed tomographic angiography (CTA) or magnetic resonance angiography (MRA)

167
Q

areflexia, ataxia, ophthalmoplegia

Is the triad of what disorder?

A

Miller fisher GBS

168
Q

What are some trinucleotide repeat disorders and their nucleotides?

A

CAG: Huntingtons - like hunting animals in a cage

GAA: Friedrich Ataxia - Friedrich is a baby, goo
goo gaa gaa

CTG: Myotonic dystrophy - if youre in myotonic dystrophy you need a CT, G

CGG: Fragile X syndrome - Comme Garcos gay, if you have this you have a fragile X

169
Q

trigger for cluster headache?

A

alcohol

maybe nocturnal sleep

170
Q

Causes of miosis (small pupil)

A

Horner’s syndrome
Argyll-Robertson pupil
senile miosis
pontine haemorrhage
congenital

171
Q

Poor prognostic features of GBS?

A

age > 40 years
poor upper extremity muscle strength
previous history of a diarrhoeal illness (specifically Campylobacter jejuni)
high anti-GM1 antibody titre
need for ventilatory support

172
Q

SPASTIC PARAPARESIS causes ?

A

S=syringiomyelia
p=parasagittal meningioma
a=arthritis of the cervical spine
s=spastic paraplegia hereditary
t=tropical spastic paraparesis
t=transverse myelitis
i=infection..HIV / VZV
C=cord compression trauma, tumour

173
Q

Essential tremor inheritance pattern?

A

Autosomally dominant

174
Q

HSMN - what type of disease is this?

A

Lower Motor neuron hence hyporeflexia

175
Q

Why is COCP CI in migraine w aura?

A

Significant risk of ischaemic stroke

176
Q

Can you get diplopia in parkinsons?

A

No - think of a parkinson plus condition like progressive supranuclear palsy

177
Q

Which interferon can be used for reducing relapse risk in MS?

A

b-inteferon

178
Q

Drug causes of IIH?

A

combined oral contraceptive pill

steroids

tetracyclines

retinoids (isotretinoin, tretinoin) / vitamin A

lithium

179
Q

Mx of migraines in pregnancy? and menstruation?

A

Pregnancy:
> paracetamol 1g is first-line
> NSAIDs can be used second-line in the first and second trimester
> avoid aspirin and opioids such as codeine during pregnancy

Menstruation related:
> mefanamic acid or a combination of aspirin, paracetamol and caffeine.
> Triptans are also recommended in the acute situation

180
Q

Which parkinsonian sx are uncommon in drug induced parkinsons?

A

rigidity and rest tremor

181
Q

Causes of predominantly sensory peripheral neuropathy?

A

diabetes
uraemia - eg ckd
leprosy
alcoholism
vitamin B12 deficiency
amyloidosis

182
Q

Causes of predominantly motor peripheral neuropathy?

A

Guillain-Barre syndrome

porphyria

lead poisoning

hereditary sensorimotor neuropathies (HSMN) - Charcot-Marie-Tooth

chronic inflammatory demyelinating polyneuropathy (CIDP)

diphtheria

183
Q

Stroke / TIA driving advice?

A

stroke or TIA: 1 month off driving, may not need to inform DVLA if no residual neurological deficit

multiple TIAs over short period of times: 3 months off driving and inform DVLA

184
Q

Seizures DVLA advice?

A

1st / isolated seizure:
> 6 months off if there are no relevant structural abnormalities on brain imaging and no definite epileptiform activity on EEG.
> If these conditions are not met then this is increased to 12 months

for patients with established epilepsy or those with multiple unprovoked seizures:
> Drive if seizure free for 12m
> If no seizures for 5y +- meds - til 70 licence restored

withdrawal of meds:
> should not drive whilst anti-epilepsy medication is being withdrawn and for 6 months after the last dose

185
Q

Vigabatrin - adverse effect?

A

Vigabatrin can cause visual field defects hence requires fields monitoring every 6m

Anti-epileptic

186
Q

Apomorphine moa?

A

Dopamine agonist

187
Q

Which anti epileptic can cause cerebellar syndrome?

A

Phenytoin

188
Q

What drugs can cause peripheral neuropathy?

A

amiodarone
isoniazid
vincristine
nitrofurantoin
metronidazole

189
Q

How can you distinguish between Parkinsons and MSA?

A

Presence of ataxia

190
Q

What is used for drug induced parkinsonianism?

A

Anti muscarinic drugs eg procyclidine, benzotropine and trihexyphenidyl (benzhexol)

191
Q

When can AEDs be withdrawn in epilepsy?

A

Seizure free>2 yr ,AED stop over 2-3 m

192
Q

presents with a combination of cranial nerve (CN) palsies involving the 3rd and 6th nerves, which are both involved in eye movement.

Additionally, there is hyperaesthesia of the upper face on the left side, suggesting involvement of the trigeminal nerve (CN V)

Location of Leison?

A

Cavernous sinus

193
Q

ECG finding in myotonic dystrophy?

A

Prolonged PR

194
Q

Presentation of vestibular neuronitis and viral labyrinthitis?

A

Vestibular neuronitis:
self-limiting condition characterised by acute onset vertigo with nausea and horizontal nystagmus, but crucially without auditory symptoms following a viral illness

Viral labyrinthitis:
Commonly follows viral infection, presents w vertigo + involves vestibular and cochlear part of inner ear -> hearing loss and / or tinnitus

195
Q

Paraneoplastic syndromes affecting nervous system - Anti-Hu?

A

associated with small cell lung carcinoma and neuroblastomas

sensory neuropathy - may be painful

cerebellar syndrome
encephalomyelitis

196
Q

Paraneoplastic syndromes affecting nervous system - Anti-Yo?

A

associated with ovarian and breast cancer

cerebellar syndrome

197
Q

Paraneoplastic syndromes affecting nervous system - Anti-GAD?

A

associated with breast, colorectal and small cell lung carcinoma

stiff person’s syndrome or diffuse hypertonia

198
Q

Paraneoplastic syndromes affecting nervous system - Anti-Ri?

A

associated with breast and small cell lung carcinoma

ocular opsoclonus-myoclonus

199
Q

Paraneoplastic syndromes affecting nervous system - Anti-purkinje ab?

A

peripheral neuropathy in breast cancer

200
Q

Ovarian teratoma ix?

A

Pelvic USS

201
Q

irregular, flowing, non-rhythmic involuntary movements that appear to move from one body part to another

Describes what neuro feature? where is the damage?

A

Chorea - caused by damage of the caudate nucleus of the basal ganglia

202
Q

Phaeochromocytoma, renal cell cancer are seen in which neuro condition?

A

VHL

203
Q

Which abx are CI in MG as they can percipitate an attack?

A

Aminoglycosides eg gentamicin

204
Q

Tachycardia, lower limb hyporeflexia and flaccid paralysis are seen in which condition? hyperreflexia is seen in which condition?

A

GBS - Absent or depressed deep tendon reflexes, paralysis is flaccid and autonomic sx are rare but most commonly tachycardia + urinary retention

hyperreflexia seen in GBS variant - Bickerstaffs encephalitis

205
Q

Effect of phenytoin on hair?

A

Hirsuitism

206
Q

Indications for specialist referral in a patient with foot drop?

A

Bilateral symptoms, fasiculations or other abnormal neurological findings (e.g. hyperreflexia) are indications for specialist referral.

207
Q

Peroneal neuropathy mx?

A

Conservative - avoidance of leg crossing, squatting + kneeling and rv -> should improve in 2-3 months

208
Q

What are the different types of MSA?

A

1) MSA-P - Predominant Parkinsonian features
2) MSA-C - Predominant Cerebellar features

209
Q

Poor response to L-Dopa may be seen in which condition?

A

MSA

210
Q

What is neuromyelitis optica?

A

Neuromyelitis optica (NMO) is a monophasic or relapsing-remitting demyelinating CNS disorder

More common in asians

ypically involves the optic nerves and cervical spine, with imaging of the brain frequently normal. Vomiting is also a common presenting complaint.

211
Q

Criteria for dx of neuromyelitis optica?

A

Diagnosis requires bilateral optic neuritis, myelitis and 2 of the following 3 criteria:
1. Spinal cord lesion involving 3 or more spinal levels
2. Initially normal MRI brain
3. Aquaporin 4 positive serum antibody - NMO-IgG seropositive status (The NMO-IgG test checks the existence of antibodies against the aquaporin 4 antigen.)

212
Q

Motor weakness, encephalopathy, seizures and coma

Is a neurological condition which occurs typically a few weeks following a viral illness or vaccination

ix? and mx?

A

Ix
T2-weighted MRI imaging which reveals poorly-defined hyperintensities in the subcortical white matter. These lesions can develop throughout the course of the illness and hence serial MRIs may be required.

Dx:Acute disseminated encephalomyelitis

213
Q

Mx of Post-lumbar puncture headache?

A

supportive initially (analgesia, rest)
if pain continues for more than 72 hours then specific treatment is indicated, to prevent subdural haematoma
treatment options include: blood patch, epidural saline and intravenous caffeine

214
Q

Which dopamine agonists in parkinsons are associated w pulmonary retroperitoneal and pericardial fibrosis?

A

Ergot derived ones eg pergolide, bromocriptine, cabergoline, Pergolide

215
Q

Why can phenytoin cause anaemia?

A

Can cause megaloblastic anaemia secondary to altered folate metabolism

216
Q

Mx and prevention of menieres?

A

acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required

prevention: betahistine and vestibular rehabilitation exercises may be of benefit

217
Q

What condition is characterised by episodic vertigo, tinnitus (often described as a ‘roaring’ sensation), and sensorineural hearing loss?

A

Menieres

218
Q

L Dopa advereese effects?

A

D - Drowsiness, Dry Mouth, Dry mouth
O - On/off effect
P - Postural hypotension, Palpitations, Psychosis
A - Anorexia, Arrythmias

219
Q

Which drugs can percipitate MG crises?

A

penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines

220
Q

Vertical v Horizontal gaze palsy leison location?

A

Dorsal Midbrain: vertical gaze palsy

Pons: horizontal gaze palsy

221
Q

MRI finding in Wenickes encephalopathy?

A

enhancement of the mamillary bodies due to petechial haemorrhages

222
Q

What is Foster kennedy syndrome?

A

which is an anterior intracranial mass directly compresses the ipsilateral optic nerve —–> causing atrophy and Increases intracranial pressure —–> causing contralateral papilledema.

Leison is in frontal lobe

223
Q

Why are analgesics often given with prokinetic agents in migraine?

A

Patients with migraine experience delayed gastric emptying during acute attacks

Hence prokinetic agents can help

224
Q

Alexia (cant read ) without agraphia (cant write) - where is the leison?

A

Corpus callosum

225
Q

Palatal myoclonus - leison location?

A

Olivary nucleus

226
Q

Laughter → fall/collapse is what sign? when may this be seen?

A

Cataplexy and may be seen with narcolepsy

227
Q

What is a gelastic seizure?

A

Laughing outburst is the seizure - caused by brain neoplasms

228
Q

What to do when focal seizures dont respond to lamotrigine / levetiracetam?

A

Use the other drug ie lamotrigine / levetiracetam

229
Q

Ataxic telangiectasia gene?

A

ATM gene

230
Q

When for carotid endartectomy?

A

> 70% stenosis

231
Q

Entacapone MoA?

A

Sounds like mascapone, and COMT is also a cheese.

232
Q

Selegiline MoA?

A

MAO-B inhibitor

233
Q

In subacute combined degeneration of the spinal cord

What is affecgted?

A

Dorsal columns - Loss of proprioception + vibration sense

Lateral corticospinal tracts - Leads to UMN signs

234
Q

When to avoid amitripytilline and why in mx of neuropathic pain?

A

If pt has hx of glaucoma - anticholinergic effects can exacerbate this

MRCP - Passmed (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions