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Neurology Flashcards

1
Q

What is lateral medullary syndrome? and what causes it?

A

Wallenberg syndrome - acute ischaemic infarct of lateral medulla oblongata

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2
Q

What are the symptoms of a medulla oblongata infarct?

A

eople with conduction aphasia have good comprehension and coherent speech, but have difficulty repeating words or phrases

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3
Q

What is the pneumonic to remember features of cerebellar disease?

A

DANISH
Dysdiadochokinesis
Ataxia
Nystagmus
Intention tremor
Scanning dysarthria / slurred speech
Heel-shin test positivity/ hypotonia

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4
Q

If there is a pontine lesion how does it present?

A

Will affect the cranial nerves - v,v1 and v3 and v4 so ipsilateral weakness of abduction of eye and ipsilateral facial weakness and ipsilateral deafness

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5
Q

What is first line treatment for essential tremor?

A

Propranolol

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6
Q

If patient has asthma and essential tremor what is treatment?

A

Topiramate

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7
Q

What anti-platelet should be given after thrombolysis ensuring there is no haemorrhage?

A

\Aspirin 300mg after 24 hours

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8
Q

What is the most common hereditary peripheral neuropathy?

A

Charcot-marie-tooth disease

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9
Q

What is charcot marie tooth disease?

A

Distal muscle weakness
Foot drop
Decreased sensation

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10
Q

What is the inheritance pattern of caharcot marie tooth disease?

A

Autosomal dominant

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11
Q

If common fibular nerve (common peroneal nerves) was damaged what signs would you expect?

A

Foot drop

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12
Q

Which dementia is linked to amyotrophic lateral sclerosis?

A

Fronto-temporal dementia

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13
Q

Which gene is found in amyotrophic lateral sclerosis and fronto-temporal dementia?

A

C9orf72

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14
Q

What is driving advice for first seizures?

A

After a one off seizure you can’t drive for a minimum of 6 months

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15
Q

What is preferred treatment for a subarachnoid haemorrhage?

A

Endovascular coiling

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16
Q

If a CT head is negative for a subarachnoid haemorrhage but it’s still suspected what other test can be done?

A

Lumbar puncture - as it may reveal blood in CSF or xanthochromia - yellowed CSF from haemolysis - indicates an older bleed

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17
Q

What is brown-sequard syndrome?

A

Due to damage affecting one half of spinal cord - usually due to knife or gunshot wound. Can also be due to other trauma like falls or malignancy

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18
Q

What are the symptoms of posterior cord syndrome?

A

Loss of fine touch, proprioception and vibration

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19
Q

Which column tract does posterior cord syndrome affect?

A

Dorsal column

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20
Q

What symptoms appear with anterior cord syndrome?

A

Loss of pain and temperature sensation

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21
Q

Which vitamin deficiency is a risk factor for subacute combined degeneration of the spinal cord?

A

B12

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22
Q

What is first line for seizing patient?

A

2 doses of IV lorezapam

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23
Q

If after 2 doses of IV lorezapam there is not stopping the seizure what should be tried?

A

IV infusion of phenytoin

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24
Q

What is used in acute treatment of cluster headaches?

A

High flow oxygen also triptans can be used

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25
What is initial treatment for trigeminal neuralgia?
Carbamazepine
26
How does a cluster headache present?
Worst pain ever Usually temporal around eyes can last from 15 mins to three hours
27
Which region in brain is degenerated in parkison's?
Substantia nigra
28
What is the definition of status epilepticus ?
Seizure lasting 5 mins or more or multiple seizures occurring within a 5 min windows without regaining full consciousness
29
What is first line treatment for Myasthenia gravis?
Pyridostigmine
30
What's the mechanism of action of pyridostigmine?
Acetylcholinesterase inhibitor
31
Which nerve supplies sensation to the little finger?
Ulnar nerve
32
What is the gold standard treatment for symptomatic parkinson's?
Levodopa + carbidopa
33
What visual defect is seen with optic chiasm compression?
Bitemporal hemianopia
34
What is a major complication to be aware of with subarachnoid haemorrhage in the first 12 hours?
Anyeurysmal rebleed
35
What are the symptoms of an aneurysm rebleed?
Sudden worsening of neuro symptoms after presenting
36
What is an important side effect of levodopa?
Postural hypotension
37
In bell's vs stroke which one is forehead sparing?
Stroke spares forehead but bell's doesn't - meaning forehead can't wrinkle in bells bcos it's a lower motor neurone disease
38
What is the gold standard way to measure a patients with breathing difficulty respiratory effort?
FVC
39
What is myasthenia gravis?
Autoimmune disease - where antibodies that target the post synaptic nicotinic acetylcholine receptors at neuromuscular junction are targeted
40
What is pathophysiology of myasthenia gravis?
Ability of acetylcholine to trigger muscle contractions is reduced leading to muscle weakness
41
What is the main demographic of myasthenia gravis?
Women under 40 and men over 60
42
What's are the symptoms of myasthenia gravis?
They get worse by end of day or after prolonged movement: Fatigable limb muscle weakness Ptosis Diplopia Facial palsy Dysphagia Dysphonia
43
Which drugs can exacerbate MG?
Beta blockers Lithium Penicillamine Gent Quinolones Phenytoin
44
What are some investigations for MG?
Ice pack test - ice over eye for 2-5 mins to assess for improvement in ptosis - test is positive if there is an improvement by more than 2mm
45
Why does the ice pack test work?
Cooling the skeletal fibres decreases the activity of acetylcholinesterase's - allows more acetylcholine to collect in neuromuscular junctions - increasing muscle contraction
46
Which antibodies are seen in MG?
Anti-AChR Anti- muscle specific tyrosine kinase Anti-LRP4
47
When should an MG patient receive mechanical ventilation?
If FVC is 15ml/kg or less
48
What is medical management of MG?
Steroids and anticholinesterase inhibitors: pyridostigmine or neostigmine
49
In acute cases of MG what should be given?
IV immunoglobulin or plasmapharesis
50
How would an L3 radiculopathy present?
Hip and thigh pain Weakness of hip extension and abductions Reduction of knee jerk reflex
51
How would S1 radiculopathy present?
Pain in posterior aspect of leg Weakness of plantar flexion, leg extension and knee flexion
52
What is the presentation of GBS?
Ascending inflammatory demyelinating polyneuropathy affecting lower limbs first Ascending flaccid paralysis Can occur after infection
53
Which infection does GBC usually occur after?
Campylobacter gastroenteritis
54
What is first line treatment for GBS?
IV immunoglobulin and supportive therapies
55
Which area connects Wernicke's and Broca's area?
Left arcuate fasciculus
56
What type of aphasia presents with inability to repeat words and incorrect substitution?
Conduction aphasia
57
What brain area is affected in conduction aphasia?
Left arcuate fasciculus
58
What is diagnostic investigation for Idiopathic intracranial hypertension
Lumbar puncture: opening pressure over 20cmH2O
59
What is a common cause of obstructive hydrocephalus?
Aqueduct stenosis - so site of lesion would be in the cerebral aqueduct
60
What is first line management of lumbar spinal stenosis?
Analgesia and physio
61
Which part of brain do Jacksonian marches originate from?
Frontal lobe
62
What is presentation of amyloidosis?
Proteinuria and oedema of legs and abdomen Kidneys become small, pale and hard or large Heart failure
63
Which cervical root is most affected by cervical myelopathy?
C7
64
What's the management for diabetic peripheral neuropathy?
Gabapentin Pregabalin Amitriptyline BUT all monotherapy so must use one at a time
65
Which investigation is best for a carotidartery dissection?
CT head and neck angiogram
66
Which antibiotic is most likely to reduce seizure threshold in epileptics?
Ciprofloxacin
67
What are the two types of charcot marie tooth disease?
Type 1: demyelinating - more common - champagne bottle legs Type 2: Axonal
68
What is the only way to definitively confirm diagnosis of Creutzfeldt Jakob disease?
Brain biospy - often post mortem
69
What is first linetreatment for a cluster headache?
SC sumatriptan and 100% high flow oxygen
70
What's first line treatment for a tonic clonic seizure in non women - child bearing age vs child bearing age woman?
Sodium valproate vs Lamotrigine
71
What is first line medication for absence seizures?
Ethosuximide
72
What is first line medication for focal seizures?
Carbamezapine
73
What's the scoring scale used in assessing possible stroke in A&E?
ROSIER
74
What is first line medical management of MS relapse - e.g. optic neuritis?
Oral methylprednisolone
75
What is the pathology of MS?
CD4 mediated destruction of oligodendroglia cells and humoral response to myelin binding protein
76
What are the symptoms of MS?
Patchy parasthesia Red desaturation Painful eye movements Cerebellar ataxia Bowel and bladder disturbances
77
What would be seen in CSF with MS?
Oligoclonal bands
78
What criteria is used to diagnose MS?
Mcdonald's criteria
79
What is chronic management of MS?
Beta interferons and glatiramer Dimethyl fumarate Natalizumab - and alemtzumab
80
What type of medication is selegiline?
Monoamine oxidase type b inhibitor - parkinson's medication - don't dela administration
81
What is prophylaxis in migraines?
Propranolol first line unless asthmatic then amitriptyline, topiramate or candesartan
82
What is special about a lacunar stroke?
The symptoms are motor issues due to small vessel disease usually
83
What's the most common cause of subacute combined degeneration of the cord?
B12 deficiency
84
What is tabes dorsalis?
Late presentation of neurosyphilis
85
What is lhermitte's sign?
Pain on neck flexion
86
What are the symptoms of normal pressure hydrocephalus?
Wet Weird Wobbly - Urinary incontinence Gait instability Mild dementia
87
What is treatment of normal pressure hydrocephalus?
Ventriculoperitoneal shunt
88
How can creutzfeldt jakob disease present?
Swift cognitive decline Mood lability Involuntary muscle jerks (myoclonus)
89
What marker is used to detect creutzfeldt jakob disease?
CSF 14-3-3 protein
90
Why can straining in a patient with uncontrolled hypertension lead to acute cerebral haemorrhage?
Straining for pooing = Valsalva - exacerbates the hypertension
91
What is an oculogyric crisis?
Acute dystonic reaction characterised by upward deviation of eyes and sometimes neck and mouth involvement
92
Which medications can precipitate a oculogyric crisis?
Metroclopramide and anti-psychotics like haloperidol
93
What is management of oculgyric crisis?
Procyclidine
94
What's the most common cause of a surgical third nerve palsy?
Posterior communicating artery anyeurysm located in circle of willis
95
What's a side effect to look out for with lamotrigine use?
Steven johnson sydnrome - blistering rash
96
What's a side effect to look out for with phenytoin use?
Gingival hypertrophy
97
Which artery is affected in locked in syndrome?
Basilar artery
98

UKMLA (14 decks)

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