Neurology Flashcards
1
Q
Colles fracture
A
distal radius
median nerve
thumb and lateral 2 fingers
2
Q
C8 radiculopathy
A
reduced sensation over the medial side of the hand over the little finger
reduced flexion of the distal interphalangeal and metacarpophalangeal joints
3
Q
Klumpke’s palsy
A
damage to T1
loss of intrinsic hand muscles (thumb adduction and finger abduction)
claw hand
loss of sensation over medial epicondyle of elbow
due to traction
4
Q
myoclonic vs tonic seizure female first line
A
myoclonic = levetiracetam
tonic= lamotrigine
5
Q
3rd nerve palsy vs Horners
A
3rd nerve= ptosis + mydriasis (dilated)
Horners= ptosis + miosis (constricted)
6
Q
Required before thrombolysis in acute ischaemic stroke
A
lower blood pressure if >185/110
7
Q
surgical third nerve palsy
A
ptosis, enlarged pupil and inability to adduct/supraduct.
8
Q
cubital tunnel syndrome
A
ulnar nerve neuropathy
sensory innervation to the palmar and dorsal aspects of 1.5 fingers medially (4th and 5th fingers)
wasting and paralysis of intrinsic hand muscles (except lateral two lumbricals) and the hypothenar muscles
9
Q
Focal seizures Tx
A
lamotrigine or levetiracetam are first-line
10
Q
Aphasia
A
Dominant hemisphere (left) middle cerebral artery
11
Q
hyperdense crescentic/concave collection
A
acute subdural
hypodense= chronic
12
Q
raised intracranial pressure (ICP) secondary to traumatic brain injury Tx
A
IV mannitol
13
Q
raised ICP secondary to vasogenic oedema from central nervous system infections or neoplasms Tx
A
IV dexamethasone
14
Q
GBS Ix
A
Nerve conduction studies
15
Q
Gait ataxia
A
cerebellar vermis
16
Q
finger-nose ataxia
A
cerebellar hemisphere
17
Q
phenytoin side effects
A
peripheral neuropathy
gingival hyperplasia
hirsutism
megaloblastic anaemia
18
Q
raised ICP -positioning
A
worse on lying flat as this raises ICP
therefore elevate bed to 30 degrees
19
Q
loss of corneal reflex
A
CN V1
20
Q
Narcolepsy Ix
A
multiple sleep latency EEG
21
Q
tonic seizure
A
muscles become stiff
22
Q
atonic seizure
A
muscles become floppy
23
Q
myoclonic seizure
A
short, jerking movements
24
Q
Brown-Sequard syndrome
A
same sided weakness and proprioception/vibration loss
loss of pain/temperature on the opposite side to the hemisection
(This is because the pathway for pain/temperature sensation decussates at the level of the nerve root)
25
most sensitive test for myasthenia gravis
vs most specific
single fibre EMG
antibody testing for antibodies against acetylcholine receptors in the neuromuscular junction
26
Ondansetron (5HT-3 antagonist) side effect
QT prolongation
27
Widespread convulsions without conscious impairment
psychogenic non-epileptic seizure (pseudoseizure)
28
MND associated with what dementia
frontotemporal
29
trigeminal neuralgia Red flag symptoms
Sensory changes
Deafness or other ear problems
History of skin or oral lesions that could spread perineurally
Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally
Optic neuritis
A family history of multiple sclerosis
Age of onset before 40 years
30
Pituitary apoplexy Tx
urgent IV hydrocortisone
31
supracondylar fracture injury- nerve
median nerve
32
axillary dissection nerve injury
intercostobrachial nerves
sensation to axilla
33
smiths fracture nerve injury
median nerve
34
erb's palsy
C5-6
arm pronated and medially rotated.
35
pontine haemorrhage
Cx secondary to chronic hypertension
reduces Glasgow coma score, quadriplegia, miosis, and absent horizontal eye movements.
36
Miller Fisher syndrome
areflexia, ataxia, ophthalmoplegia
37
Meningioma
arise from the arachnoid cap cells of the meninges and are typically located next to the dura and cause symptoms by compression rather than invasion.
38
cataplexy
a sudden and transient episode of muscle weakness, typically triggered by strong emotions such as laughter, anger or surprise
39
Aspirin CI
high risk of GI bleed--> clopidogrel +PPI
40
4th nerve palsy
up and out
41
Medication overuse headache Tx
simple analgesia + triptans: stop abruptly
opioid analgesia: withdraw gradually
42
anterior inferior cerebellar artery stroke vs posterior inferior cerebellar artery stroke
supplies medulla brainstem
both:
ataxia
nystagmus
contralateral pain and temperature loss
ipsilateral facial pain and temperature loss
Anterior:
ipsilateral facial paralysis
deafness
43
highest chance of inhibition disorders out of the antiparkinsonian medications
dopamine agonists
44
internuclear ophthalmoplegia:
features
seen in
impaired adduction of the ipsilateral eye
horizontal nystagmus of the abducting eye on the contralateral side
seen in MS, vascular disease
45
cervical radiculopathy causes
nerve root becomes pinched and inflamed:
cervical spondylosis
disc herniation
osteophyte formation
trauma
46
3rd nerve palsy + decreasing conscious level and an intracranial mass
trans-tentorial herniation
due to raised ICP
47
if GCS<8
intubate with endotracheal tube
48
Ataxic gait
wide based gait with loss of heel to toe walking
49
Controlled hyperventilation in raised ICP
hyperventilation --> reduce CO2--> vasoconstriction of cerebral arteries--> reduce ICP
50
Headache + muscle stiffness
Temporal arteritis (PMR)
51
bilateral vs unilateral foot drop
bilateral= peripheral neuropathy
unilateral= common peroneal nerve injury
52
mononeuritis multiplex
simultaneous or sequential involvement of individual non-contiguous nerve trunks.
It typically presents with acute or subacute loss of sensory and motor function of individual nerves.
asymmetric --> symmetric
53
wrist drop
fracture of shaft of humerus w associated radial nerve damage
54
myasthenia gravis patients resistant to what anaesthetic
Suxamethonium
55
bulbar-onset amyotrophic lateral sclerosis
Patients often have more difficulty swallowing liquids than solids in the early stages.
Facial weakness, hypophonic speech, fasciculations and reduced jaw jerk reflex (LMN sign) are all features.
Eye movements are typically spared.
56
significant risk factor for bells palsy
pregnancy
57
cavernous sinus thrombosis
pain, opthalmoplegia, proptosis, trigeminal nerve lesion (opthalmic branch) and Horner's syndrome.
58
venous sinus thrombosis Ix
MR venogram
59
Managing tremor in drug induced Parkinson's
procyclidine
60
saturday night palsy
radial nerve
wrist drop
61
where is the lesion:
left homonymous hemianopia with some macula sparing.
occipital cortex
62
Wernicke's dysphasia
speech fluent, comprehension abnormal, repetition impaired
63
Complications of SAH
rebleeding
hydrocephalus
hyponatraemia
vasospasm
seizures
64
Severe TBI (GCS ≤8) and abnormal CT findings-->
insertion of ICP monitoring device
65
CT head within 1 hour
GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting
66
signs of basal skull fracture
haemotympanum
'panda' eyes
cerebrospinal fluid leakage from the ear or nose
Battle's sign- bruising over mastoid
67
CT head within 8 hours
age 65 years or older
any history of bleeding or clotting disorders including anticogulants
dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
more than 30 minutes' retrograde amnesia of events immediately before the head injury
68
Binocular vision post-facial trauma
depressed fracture of the zygoma
69
Infants with hydrocephalus presentation
increased head circumferences
a bulging fontanelle
sunsetting of the eyes (impaired upward gaze)
70
confirmed occlusion of the proximal anterior circulation
thrombolysis and thrombectomy if <4.5 hours
71
Ipsilateral oculomotor palsy and contralateral weakness of the upper and lower extremity
Webers syndrome
branches of the posterior cerebral artery that supply the midbrain
72
Myasthenia gravis - antibodies against
against acetylcholine receptors
prevent acetylcholine from binding to receptors
73
degenerative cervical myelopathy Tx
referral for decompressive surgery
74
encephalitis key investigation
PCR of cerebrospinal fluid for HSV, VZV and enteroviruses
75
findings in SACD
corticospinal tract --> hyper-reflexia, muscle weakness and spasticity
dorsal columns --> impaired vibration and proprioception
spinocerebellar tract --> positive rombergs, gait abnormalities
76
drugs which increase risk of idiopathic intracranial hypertension
combined oral contraceptive pill
steroids
tetracyclines
retinoids (isotretinoin, tretinoin) / vitamin A
lithium
77
Lateral medullary syndrome
posterior inferior cerebellar artery
ipsilateral facial pain and temp loss
contralateral limb/torso pain and temp loss
ataxia, nystagmus
78
lateral pontine syndrome
anterior inferior cerebellar artery
ipsilateral facial pain and temp loss
ipsilateral facial paralysis and deafness
contralateral limb/torso pain and temp loss
ataxia and nystagmus
79
syringomyelia features
cape-like (neck, shoulders, arms) loss of pain and temperature
spastic weakness - LL>UL
80
loss of corneal reflex
acoustic neuroma (trigeminal nerve V1)
81
controlled hyperventilation
reduce blood CO2 --> induce cerebral vasoconstriction--> reduce ICP
82
An isolated result of high protein in the CSF is indicative of
GBS
83
Frontal lobe lesions may cause
disinhibition
84
MS and bladder dysfunction
US KUB
if significant residual volume --> intermittent self-catheterisation
if no significant residual volume --> anticholinergics
85
Weber syndrome
ipsilateral 3rd nerve palsy
contralateral hemiparesis
ventral midbrain stroke
86
Pontine haemorrhage commonly presents
with reduced GCS, paralysis and bilateral pin point pupils
87
headache worse on standing and improve when lying flat
low CSF headache
spontaneous intracranial hypotension, post LP, CSF leak
88
locked in syndrome
basilar artery infarct
89
If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, they should
be admitted immediately for imaging to exclude a haemorrhage
90
For thrombectomy in acute ischaemic stroke, an extended target time of 6-24 hours may be considered 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
91
Progressive peripheral polyneuropathy with hyporeflexia suggests
Guillain-Barre syndrome
92
Management of myasthenic crisis (respiratory involvement)
intravenous immunoglobulin, plasmapheresis
93
Headache linked to Valsalva manoeuvres =
raised ICP until proven otherwise so LP is contraindicated
94
'empty delta sign' seen on venography
Sagittal sinus thrombosis
95
headache improves on lying down
low pressure headache
96
venous sinus thrombosis
headache (may be sudden onset)
nausea & vomiting
reduced consciousness
with evidence of hyper coagulable state e.g. smoker
97
patients with suspected TIA who require brain imaging
MRI brain with diffusion-weighted imaging
98
amaurosis fugax - cause
atherosclerosis of ipsilateral internal carotid --> retinal/opthalmic artery
99
what type of weakness in GBS
flaccid weakness (LMN- progressive peripheral polyneuropathy)
