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MRCP - Passmed > Neurology > Flashcards

Neurology Flashcards

1
Q

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

A

Otosclerosis

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2
Q

episodic vertigo, tinnitus, and hearing loss - diagnosis?

A

Meniere’s disease

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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

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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

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5
Q

Mx of focal seizures?

A

first line: lamotrigine or levetiracetam

second line: carbamazepine, oxcarbazepine or zonisamide

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6
Q

Mx of absence seizures?

A

first line: ethosuximide

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

carbamazepine may exacerbate absence seizures

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7
Q

Mx of myoclonic seizures

A

males: sodium valproate
females: levetiracetam

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8
Q

Mx of tonic / atonic seizures?

A

males: sodium valproate
females: lamotrigine

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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

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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

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11
Q

Anti-epileptics and breastfeeding?

A

Safe with most except barbiturates (-barbital suffix)

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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

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13
Q

cerebellar signs, contralateral sensory loss & ipsilateral Horner’s

Which stroke syndrome? Vessel affected?

A

Lateral medullary syndrome - PICA affected

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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

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15
Q

Important blood test in restless legs syndrome?

A

Ferritin

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16
Q

What is hemiballism?

A

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

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17
Q

Cause of hemiballism? Mx?

A

Hemiballism occurs following damage to the subthalamic nucleus

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

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18
Q

When to perform LP if suspecting SAH?

A

12 hours post headache

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19
Q

Medication used in MND?

A

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

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20
Q

Which neuro medication can cause SJS?

A

Lamotrigine

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21
Q

Mx of idiopathic intracranial HTN?

A

Weight loss - 1st
Acetazolamide - carbonic anhydrase inhibitor

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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

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23
Q

How to manage drooling in Parkinsons?

A

Glycopyrronium bromide

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24
Q

dementia (rapid onset)
myoclonus

Suggestive of what condition?

A

CJD

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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

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.

27
Q

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

A

Myoclonic seizures

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

29
Q

Mx of spasticity in MS?

A

Baclofen + Gabapentin

30
Q

Best tx for survival benefits in MND?

A

Riluzole - prolongs life by 3 months

NIV - prolongs life by 7 months

31
Q

What do assymetric symptoms in Parkinsons suggest?

A

Idiopathic parkinsons instead of drug induced

32
Q

First line mx in Restless legs?

A

Dopamine agonists eg pramipexole and ropinirole

33
Q

What is impaired in subacute combined degeneration of spinal cord?

A

Dorsal column - impaired proprioception and vibration sense, distal parasthesia legs&raquo_space; 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

34
Q

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

suggests which diagnosis?

A

Fluctuating consciousness = subdural haemorrhage

35
Q

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

A

Vertical - Trochlear

Horizontal - Abducens

36
Q

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

A

Replacing folate before replacing B12

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

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

39
Q

Where is the leison present in internuclear ophthalmoplegia?

A

Leison in medial longitudnal fasciculus (MLF) which controls horizontal eye movements by connecting CN III, IV and VI nuclei

It is located in paramedian area of midbrain and pons

40
Q

When can carbamazepine be used for neuropathic pain?

A

Only in trigeminal neuralgia

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)

42
Q

How can the different aphasias be classified?

A

Speech is non-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
- Comprehension impaired - wernickes (receptive) aphasia

43
Q

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

A

Injury typically at neck of fibula - leads to foot drop

44
Q

Sciatic nerve divides into:

A

Common peroneal nerve

Tibial nerve

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

46
Q

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

A

Sodium Valproate

47
Q

Prognosis absence seizures in adolescence?

A

90-95% seizure free

48
Q

Speech is fluent but repetition is poor

Comprehension normal

Which aphasia?

A

Conduction aphasia

49
Q

Which disease is associated with bilateral vestibular schwannomas?

A

NF2

50
Q

EEG - bilateral, symmetrical 3Hz spike and wave pattern

Suggestive of what disorder?

A

Absence seizures

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

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

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

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

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&raquo_space; proximal

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

56
Q

Best and worst prognosis MND?

A

Best - Progressive muscular atrophy

Worst - Progressive bulbar palsy

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%

58
Q

Suspected post-LP headache - mechanism?

A

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

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

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

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

62
Q

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

A

Withdrawn abruptly - may initially worsen headaches

MRCP - Passmed (15 decks)

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