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
Q

What is initial treatment for trigeminal neuralgia?

A

Carbamazepine

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26
Q

How does a cluster headache present?

A

Worst pain ever
Usually temporal around eyes
can last from 15 mins to three hours

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27
Q

Which region in brain is degenerated in parkison’s?

A

Substantia nigra

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28
Q

What is the definition of status epilepticus ?

A

Seizure lasting 5 mins or more or multiple seizures occurring within a 5 min windows without regaining full consciousness

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29
Q

What is first line treatment for Myasthenia gravis?

A

Pyridostigmine

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30
Q

What’s the mechanism of action of pyridostigmine?

A

Acetylcholinesterase inhibitor

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31
Q

Which nerve supplies sensation to the little finger?

A

Ulnar nerve

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32
Q

What is the gold standard treatment for symptomatic parkinson’s?

A

Levodopa + carbidopa

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33
Q

What visual defect is seen with optic chiasm compression?

A

Bitemporal hemianopia

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34
Q

What is a major complication to be aware of with subarachnoid haemorrhage in the first 12 hours?

A

Anyeurysmal rebleed

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35
Q

What are the symptoms of an aneurysm rebleed?

A

Sudden worsening of neuro symptoms after presenting

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36
Q

What is an important side effect of levodopa?

A

Postural hypotension

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37
Q

In bell’s vs stroke which one is forehead sparing?

A

Stroke spares forehead but bell’s doesn’t - meaning forehead can’t wrinkle in bells bcos it’s a lower motor neurone disease

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38
Q

What is the gold standard way to measure a patients with breathing difficulty respiratory effort?

A

FVC

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39
Q

What is myasthenia gravis?

A

Autoimmune disease - where antibodies that target the post synaptic nicotinic acetylcholine receptors at neuromuscular junction are targeted

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40
Q

What is pathophysiology of myasthenia gravis?

A

Ability of acetylcholine to trigger muscle contractions is reduced leading to muscle weakness

41
Q

What is the main demographic of myasthenia gravis?

A

Women under 40 and men over 60

42
Q

What’s are the symptoms of myasthenia gravis?

A

They get worse by end of day or after prolonged movement:
Fatigable limb muscle weakness
Ptosis
Diplopia
Facial palsy
Dysphagia
Dysphonia

43
Q

Which drugs can exacerbate MG?

A

Beta blockers
Lithium
Penicillamine
Gent
Quinolones
Phenytoin

44
Q

What are some investigations for MG?

A

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
Q

Why does the ice pack test work?

A

Cooling the skeletal fibres decreases the activity of acetylcholinesterase’s - allows more acetylcholine to collect in neuromuscular junctions - increasing muscle contraction

46
Q

Which antibodies are seen in MG?

A

Anti-AChR
Anti- muscle specific tyrosine kinase
Anti-LRP4

47
Q

When should an MG patient receive mechanical ventilation?

A

If FVC is 15ml/kg or less

48
Q

What is medical management of MG?

A

Steroids and anticholinesterase inhibitors: pyridostigmine or neostigmine

49
Q

In acute cases of MG what should be given?

A

IV immunoglobulin or plasmapharesis

50
Q

How would an L3 radiculopathy present?

A

Hip and thigh pain
Weakness of hip extension and abductions
Reduction of knee jerk reflex

51
Q

How would S1 radiculopathy present?

A

Pain in posterior aspect of leg
Weakness of plantar flexion, leg extension and knee flexion

52
Q

What is the presentation of GBS?

A

Ascending inflammatory demyelinating polyneuropathy affecting lower limbs first
Ascending flaccid paralysis
Can occur after infection

53
Q

Which infection does GBC usually occur after?

A

Campylobacter gastroenteritis

54
Q

What is first line treatment for GBS?

A

IV immunoglobulin and supportive therapies

55
Q

Which area connects Wernicke’s and Broca’s area?

A

Left arcuate fasciculus

56
Q

What type of aphasia presents with inability to repeat words and incorrect substitution?

A

Conduction aphasia

57
Q

What brain area is affected in conduction aphasia?

A

Left arcuate fasciculus

58
Q

What is diagnostic investigation for Idiopathic intracranial hypertension

A

Lumbar puncture: opening pressure over 20cmH2O

59
Q

What is a common cause of obstructive hydrocephalus?

A

Aqueduct stenosis - so site of lesion would be in the cerebral aqueduct

60
Q

What is first line management of lumbar spinal stenosis?

A

Analgesia and physio

61
Q

Which part of brain do Jacksonian marches originate from?

A

Frontal lobe

62
Q

What is presentation of amyloidosis?

A

Proteinuria and oedema of legs and abdomen
Kidneys become small, pale and hard or large
Heart failure

63
Q

Which cervical root is most affected by cervical myelopathy?

A

C7

64
Q

What’s the management for diabetic peripheral neuropathy?

A

Gabapentin
Pregabalin
Amitriptyline
BUT all monotherapy so must use one at a time

65
Q

Which investigation is best for a carotidartery dissection?

A

CT head and neck angiogram

66
Q

Which antibiotic is most likely to reduce seizure threshold in epileptics?

A

Ciprofloxacin

67
Q

What are the two types of charcot marie tooth disease?

A

Type 1: demyelinating - more common - champagne bottle legs
Type 2: Axonal

68
Q

What is the only way to definitively confirm diagnosis of Creutzfeldt Jakob disease?

A

Brain biospy - often post mortem

69
Q

What is first linetreatment for a cluster headache?

A

SC sumatriptan and 100% high flow oxygen

70
Q

What’s first line treatment for a tonic clonic seizure in non women - child bearing age vs child bearing age woman?

A

Sodium valproate
vs
Lamotrigine

71
Q

What is first line medication for absence seizures?

A

Ethosuximide

72
Q

What is first line medication for focal seizures?

A

Carbamezapine

73
Q

What’s the scoring scale used in assessing possible stroke in A&E?

A

ROSIER

74
Q

What is first line medical management of MS relapse - e.g. optic neuritis?

A

Oral methylprednisolone

75
Q

What is the pathology of MS?

A

CD4 mediated destruction of oligodendroglia cells and humoral response to myelin binding protein

76
Q

What are the symptoms of MS?

A

Patchy parasthesia
Red desaturation
Painful eye movements
Cerebellar ataxia
Bowel and bladder disturbances

77
Q

What would be seen in CSF with MS?

A

Oligoclonal bands

78
Q

What criteria is used to diagnose MS?

A

Mcdonald’s criteria

79
Q

What is chronic management of MS?

A

Beta interferons and glatiramer
Dimethyl fumarate
Natalizumab - and alemtzumab

80
Q

What type of medication is selegiline?

A

Monoamine oxidase type b inhibitor - parkinson’s medication - don’t dela administration

81
Q

What is prophylaxis in migraines?

A

Propranolol first line unless asthmatic then amitriptyline, topiramate or candesartan

82
Q

What is special about a lacunar stroke?

A

The symptoms are motor issues due to small vessel disease usually

83
Q

What’s the most common cause of subacute combined degeneration of the cord?

A

B12 deficiency

84
Q

What is tabes dorsalis?

A

Late presentation of neurosyphilis

85
Q

What is lhermitte’s sign?

A

Pain on neck flexion

86
Q

What are the symptoms of normal pressure hydrocephalus?

A

Wet
Weird
Wobbly
- Urinary incontinence
Gait instability
Mild dementia

87
Q

What is treatment of normal pressure hydrocephalus?

A

Ventriculoperitoneal shunt

88
Q

How can creutzfeldt jakob disease present?

A

Swift cognitive decline
Mood lability
Involuntary muscle jerks (myoclonus)

89
Q

What marker is used to detect creutzfeldt jakob disease?

A

CSF 14-3-3 protein

90
Q

Why can straining in a patient with uncontrolled hypertension lead to acute cerebral haemorrhage?

A

Straining for pooing = Valsalva - exacerbates the hypertension

91
Q

What is an oculogyric crisis?

A

Acute dystonic reaction characterised by upward deviation of eyes and sometimes neck and mouth involvement

92
Q

Which medications can precipitate a oculogyric crisis?

A

Metroclopramide and anti-psychotics like haloperidol

93
Q

What is management of oculgyric crisis?

A

Procyclidine

94
Q

What’s the most common cause of a surgical third nerve palsy?

A

Posterior communicating artery anyeurysm located in circle of willis

95
Q

What’s a side effect to look out for with lamotrigine use?

A

Steven johnson sydnrome - blistering rash

96
Q

What’s a side effect to look out for with phenytoin use?

A

Gingival hypertrophy

97
Q

Which artery is affected in locked in syndrome?

A

Basilar artery

98
Q
A