Neurology Flashcards
Tingling sensation + Poor balance + Impaired Propriopception + Brisk knee reflexes.
+ Vit B12 deficiency + Nitric oxide
Subacute Combined Degenaration of spinal cord.
Affected : Dorsal column + Lateral CST.
Dorsal coloumn lesion :
B/L Loss of propriopcetion & Joint poisition.
Sensory loss which commonly affects lower limbs.
B/L Loss of propriopcetion & Joint poisition.
Sensory loss which commonly affects lower limbs. Lesion ?
Dorsal coloumn lesion
Lateral CST lesion:
B/l Spastic Paraesis.
Brisk Knee reflexes.
Stressful event + Anterograde amnesia ( lasting for 3-4 Hours)+ anxious pt repeating same questions.+ Relieves in 24 hrs
Transient Global Amnesia.
Differentiating feature b/w Tranient Global Amnesia and Epilpesy.?
Epilepsy lasts for Less than One hour.
TGA duration is 3-4 hours.
Rx of Transient Global Amnesia :
Reassurance.
Asteognosis :
Inability to identify simple objects by touch when eye are closed.
Inability to identify simple objects by touch when eye are closed.
Asteognosis
B/L Asteognosis Dx:
Dominant Parietal Lesion.
In Bell’s palsy , does forehead get affected ?
Entire one half of face ( forehead included ) is affected.
While lowering the bell entire face on one side gets hit.
Bells palsy , does it affect motor or sensory part of facial nerve?
Only motor part of facial nerve gets affected.
Is hyperacusis a feature of Bell’s palsy ?
Yes.
In UMN facial palsy, forehead gets affected ?
Forehead is spared in UMN Facial palsy.
Miller Fisher syndrome, Descending or Ascending paralysis ?
Descending paralysis.
H/o Diarrhoe/Food Poisoning/Campylobacter jejuni+ Anti GQ1B—opthalmoplegia+Ataxia+Areflexia
Miller Fischer Syndrome.
Miller Fischer Syndrome antibodies ?
Anti GQ1B
Miller Fischer Syndrome bacteria ?
/Campylobacter jejuni
Miller Fischer Syndrome clinical feature ?
Ataxia+ opthalmoplegia+ Areflexia+ Descending paralysis .
Confabulation is a feature of ?
Korsakoff
Ipsilateral Loss of Pain & Temp of Face + C/L Loss of pain & Temp of arm + Dysphagia+Dysarthria+Nystagmus & Ataxia:
Wallenberg / Lateral Medullary Syndrome.
Wallenberg / Lateral Medullary Syndrome/PICA:
Ipsilateral Loss of Pain & Temp of Face + C/L Loss of pain & Temp of arm + Nystagmus & Ataxia.+ dysarthria
AICA & PICA differentiating features:
AICA: Facial par
lysis + Deafness + PICA features.
In PICA : only Ipsilateral Loss of Pain & Temp of Face
Gingival hyperplasia cause?
CCB
CCB adverse ?
Gingival Hyperplasia.
Common early symptom of multiple sclerosis:
Lethargy.
Lethargy + Visual Disturbances—unable to see red colour + symptom resolved spontaneously.
Multiple Sclerosis.
Breastfeeding is safe in which Anti epileptic drugs ?
All Anti epileptic drugs.
Which anti epileptic drug causes heamorrhagic disease of the newborn?
Phenytoin.
SAH + CT done within 6 hours = Normal. Next step ?
Do not do LP. Consider alternative Diagnosis.
SAH+ CT done after 6 hours= Normal. Next step ?
Do LP , after 12 hours of onset of headache.
SAH Headache onset 8 hours before. CT = Normal. Next step?
Do LP after 12 hours. Ie : after ( 8 + 4) hours.
Deafness(SNHL)+Vertigo +Tinnitus—+Aural fullness.
Minere’s disease.
Minere’s :
DVT + aural fullness.
Deafness(SNHL) + Vertigo + Tinnitus .
Myasthenic Crisis Rx:
Plasmapheresis or IV immunoglobulins.
Myasthenic Crisis features :
K/c/o Myasthenia Gravis + Dyspnoea + Cyanosis.
Seizure + Lip smacking + post-ictal dysphasia. Affected lesion?
Temporal lobe.
Unable to remember what happened during the seizure. Dx ?
Focal awareness impaired seizure.
Parkinson’s + Motor symptoms. Rx?
Levadopa.
stopping of anti-epileptic drugs
Seizure free for 2 years + with AED being stopped for 2-3 months.
Internuclear ophthalmoplegia is due to a lesion in :
If left eye adduction problem:
Medial Longitudinal Fasciculus( Paramedian area of Midbrain and pons)
Left MLF lesion.
Internuclear Opthalmoplegia, mnemonic :
INO
( Ipsilateral Adduction, Nystagmus opposite )
Stroke—arms affected + Homonymous Hemianopia:
MCA artery affected.
Motor neuron disease - which treatment is better NIV or Riluzole?
Non invasive ventilation.
Is Lisch Nodules a feature of Tuberous sclerosis ?
No.
Is Retinal Hamartomas a feature of Tuberous Sclerosis ?
Yes.( Hammer in the ground)
Is Renal angiomyolipomata a feature of Tuberous Sclerosis ?
Yes. ( Red wire around waist)
is Ash leaf spots a feature of Tuberous sclerosis ?
Yes ( ash of green cigar on ground)
Antibodies in Neuromyelitis Optica ?
NMO-igG.
Post hepatic Neuralgia Rx first line :
Amitryptilin.
Duloetine.
Gabapentin.
Post hepatic Neuralgia Rx Second line:
Tramadol.
RT Arm exaggerated flinging motion. Dx and Site of lesion:
Hemibalismus.
Site: Left sub thalamic nucleus of Basal Ganglia.
Wake up stroke + Confirmed confirmed occlusion of the proximal anterior circulation (anterior cerebral artery or middle cerebral artery). Rx?
Mechanical clot removal.
Auditory agnosia feature of which lobe ?
Temporal lobe lesions
Temporal lobe lesion Mnemonic ?
PAWS
P-prosopagnosia-difficulty recognising face.
A-Auditory agnosia
W-wernickes aphasia
S-Superior homonymous quadrantonopia.
Auditory agnosia:
Impairment in sound perception, despite intact hearing, cognitive function.
Ipsilateral weakness + Ipsilateral loss f propiopception + C/l loss of pain & temp. Dx?
Brown Sequard syndrome.
Restless leg syndrome. Rx?
Ropinirole ( dopamine agonist)
Shwartz sign in otosclerosis?
Redness of the promontory of cochlea.
B/L Conductive hearing loss + Tinnitus + Family history + Schwartz sign :
Otosclerosis.
most common complication following meningitis
SNHL.
gram-negative diplococci That causes meningitis ?
Neisseria Meningitis.
Autonomic symptoms common in GBS:
Tachycardia.
Urinary Retention.
Type of paralysis in GBS:
LMN weakness: Flaccid paralysis+ Decreased Reflexes.
loss of sensation in both of her arms and forearms, and on the back of her neck + can’t feel pain and temperature + Chiari 1 malformation
Syringomyelia.
Painful third nerve palsy( eye deviated down and out ) :
Posterior communicating artery aneurysm.
Posterior communicating artery aneurysm.
Painful third nerve palsy( eye deviated down and out ) :
Narcolepsy is associated with
low orexin
strong emotions such as fear or laughter+ collapse on the spot and immediately lose consciousness + sudden unavoidable urges to sleep
Narcolepsy
Relapsing Remitting symptoms is a feature of :
Multiple Sclerosis.
Anti-NMDA receptor encephalitis:
Psychiatric features + Ovarian Teratoma.
first-line for spasticity in multiple sclerosis:
Baclofen and gabapentin.
Hypodense collection around the convexity of the brain:
Subdural Hematoma.
B/L spastic paraparaesis + B/L loss of pain and temp:
Anterior Spinal Artery Occlusion.
Anterior Spinal Artery Occlusion
B/L spastic paraparaesis (cst)+ B/L loss of pain and temp(spinothalamic):
Raised ICP Ass with which eye problem?
Raised ICP features?
Raised IcP: head ache worse in morning and leaning forward.
Third nerve palsy (occuomotor)
Eye deviation: down and out.
DVLA advice post multiple TIAs
cannot drive for 3 months
(TIA-3 letters-3 Months)
DVLA advice post one episode of stroke ?
Can’t drive for one Month.
DVLA advice post first unprovoked or isolated seizure ?
Can’t drive for 6 Months.
Seizures =six-zures
Parkinson’s features + O/E: problem in vertical gaze :
Progressive supranuclear palsy.
Does GBS have sensory problems, loss of joint sense, temperature, fine touch?
NO.
GBS predominantly has motor problems.
K/c/o CKD+ Loss of sensation B/L, loss of of joint sense+ fine touch. Dx?
Uraemic Polyneuropathy.
Dx of MS:
MRI flair : To identify Demyelinating lesions.
trinucleotide in Huntington’s
CAG
( Hunt or be caged)
Family History + Recent aggressive behaviour+ Depression + Chorea:
Hungtintons chorea.
Facial palsy + spares forehead. Dx: stroke or Bell’s palsy ?
Stroke.
Spares forehead: UMN lesion: Stroke.
Involves Forehead : LMN: Bell’s Palsy.
Ataxic telangiectasia Gene ?
ATM gene.
Cerebellar Ataxia + Telangiectasia + IGA deficiency = Recurrent infection. Dx?
Ataxia telangiectasia.
Tried to climb a tree when he was drunk but fell, hitting a few branches on the way down+ fingers of the left hand are flexed into a claw position. There is a loss of sensation along the ulnar aspect of the whole hand and arm.
Klumpkey’s Paralysis.
Medication overuse headache: for analgesia and Opioids :
simple analgesia + triptans: stop abruptly
opioid analgesia: withdraw gradually
loss of temperature and pain sensation on the medial aspect of both hands and elbows. Proprioception and vibration sensation are preserved.Dx?
Syrinomyelia.
Multiple sclerosis patient with bladder dysfunction
Ultrasound to assess bladder emptying.
Absent Ankle Reflex.UMN or LMN ?
LMN lesion.
Extensor plantar is UMN or LMN ?
UMN lesion.
Extensor plantar+Absent ankle reflex + sensation intact. Dx?
UMN lesion +. LMN lesion + sensation intact= ALS.
Stevens-Johnson syndrome
Adverse of which anti epileptics?
Lamotrigine.
Klumpke’s paralysis, which nerve root damage ?
T1 nerve root damage.
Focal seizures, Rx?
Lamotrigine or Levetiracetam
Gingival hyperplasia ass with which leukemia ?
AML.
Distal weakness + red reflex in eyes + glycosuria :
Myotonic Dystrophy.
Anti-epileptic drugs is most likely to cause visual field defects?
Vigabatrin
sumatriptan: 5HT?
5HT 1 agonist.
No. 1 organ is Brain.
Agonist when you are in agony.
trigger for cluster headaches
Alcohol.
(Alcohol-relieving factor in essential tremors)
Neurofibromatosis type 1 Which chromosome ?
Chromosome 17.
Apomorphine acts on which receptor ?
Dopamine receptor agonist.
acute angle closure glaucoma, which anti epileptic ?
Topiramate.
Autosomal Dominant+ K/c/o Migraine with Auras + Low Mood + Stroke like symptoms + cognitive impairment + MRI= Multiple cerebral infarcts + Notch 3 gene mutation.
CADASIL.
Mutation in CADASIL :
NOTCH 3 gene.
MRI findings in CADASIL :
Multiple Cerebral Infarctions.
Migraine with aura+ Recurrent TIAs or stroke. Dx?
CADASIL.
Wernicke’s encephalopathy
Confusion, gait ataxia, nystagmus + ophthalmoplegia
Confusion, gait ataxia, nystagmus + ophthalmoplegia
Wernicke’s encephalopathy
5 year old + Ataxia + Recurrent chest infection :
Ataxia telangiectasia.
Age group affected in Ataxia Telangiectasia :
0-5 year old.
Age group affected in friericks ataxia :
10-14 year old.
Which anti epileptic causes cerebellar syndrome ? ( ataxia, nystagmus, slurred speech )?
Phenytoin.
Bilateral vestibular schwannomas+
Multiple intracranial schwannomas. Dx and chromosome ?
NF2 and chromosome 22.
mnemonic for peripheral neuropathy :
I am very numbed.
Isoniazid
Amiodarone.
Metronidazole.
Vincristine.
Nitrofurantoin.
Mnemonic for shy dagger/ Multi system Atrophy :
Wet wobbly wacky grandpa:
Parkinson’s + ED+Postural Hypotension+Urinary incontinence + Cerebellar sign( Ataxia)*
Drugs most useful in the management of tremor for Parkinson’s ?
Benzhexol ( trihexyphenidyl.)
Downbeat nystagmus is seen in :
Arnold chiari malformation.
Cerebellar tonsils LOWERING itself in brainstem—DOWNBEAT nystagmus.
Renal angiomyolipoma ass with which Neurocutaneous Condition?
Tuberous Sclerosis.
Myotonic dystrophy ECG feature:
Prolonged PR interval.
Which one of the following factors indicates a poor prognosis in patients with multiple sclerosis?
Male sex?
Miosis or Mydriasis in Holmes adie’s pupils ?
Mydriasis ( Huge pupil in Holmes adie’s pupils, Hesitant reaction to light( sluggish reaction )
no history of a diarrhoeal illness, good or bad prognosis in GBS ?
Good prognosis.
Is Wilson’s ass with Parkinson’s?
Yes.
Is dementia pugilistica Ass with Parkinson’s ?
Yes.
Is lead poisoning ass with Parkinson’s ?
No.
Notable feature in Creutzfeldt-Jakob disease Which differentiates it from others ?
Notable Jerk ( MYOCLONUS) + Rapid onset Dementia.
Creutzfeldt-Jakob disease MRI sign :
Hockey Stick Sign.
MS causes UMN or LMN ?
UMN only.
Age group of Motor neuron disease :
50-70 years.
ondansetron 5H ?
5HT3 antagonist.
Ondans(three)on
IV phenytoin S/E :
Hypotension.
Patient Started on carbamazepine— they may see a return of seizures after 3-4 weeks of treatment d/t:
D/t Autoinduction.
preferred way to support nutrition in patents with motor neuron disease
Percutaneous gastrostomy tube (PEG)
Natalizumab can cause reactivation of which Virus ? And leading to ?
JC virus.
Progressive multifocal leukoencephalopathy (PML).
Subarachnoid haemorrhage: if rebleeding is suspected (e.g. sudden worsening of neurological symptoms) →
Repeat CT.
Which neuropathic pain med to avoid in Open angle Glaucoma?
Amitryptiline.
speech non-fluent, comprehension normal, repetition impaired
Broca’s aphasia. ( Broken speech)
Inferior frontal gyrus-
seizures in the morning/following sleep deprivation—H/o Sleepover:
Juvenile Myoclonic Seizures.
Antiemetic causing prolonged QT interval and increased risk of polymorphic VT
Ondansetron.
Ondansetron cardiac S/E:
Antiemetic causing prolonged QT interval and increased risk of polymorphic VT
telangiectasias of the eyes Present as:
Bloodshot eyes.
Ataxia + Recurrent chest infection + Blood shot eyes.Dx:
Ataxia Telangiectasia.
idiopathic intracranial hypertension. Rx?
Acetazolamide.
Worsening Headache+ Intermittent loss of vision+ Pulse synchronous tinnitus +B/L blurring of optic disc. Dx;
Idiopathic Intracranial Hypertension.
Ipsilateral numbness of face+ Ipsilateral Horners (ptosis, miosis, anhydrosis, ) + Dysphagia + Ataxia + Nystagmus :
PICA.
Drug given in subarachnoid haemorrhages
Nimodipine.
Hallucination+Agitation + Anti NMDA positive. Dx and Firs line IX?
Anti-NMDA receptor encephalitis.
First Ix: Pelvic Ultrasound.
small area of erythema with central blistering on his right elbow + sensation is reduced in the C5-6 dermatomes bilaterally
Syringomyelia.
13 years old girl + sudden jerks in arms + Zone out episodes in school:
Juvenile Myocclonic seizures.
Restless legs syndrome - the single most important blood test
serum ferritin.
common cause of restless legs syndrome (RLS) is :
Iron deficiency.
H/o sinusitis/ear infection—Fever + Headache + Vomitting + CT: Ring enhancing lesion. Dx:
Brain abscess.
contraindicated in absence seizures
Carbamazepine.
Progressive weakness of Arm+Shoulder+ Hip + Facial ms weakness ( Difficulties in closing eyes, smiling, blowing) + Abnormal in retinal arteries.Dx:
Facioscapulohumeral muscular dystrophy
Tibial nerve function and supply :
PIT : Plantar flexion, inversion.
Supply : Medial aspect of Foot.
Common peroneal nerve function :
Common penis nerve: Towards Dick : Dorsiflexion.
Supply to lateral part of foot.
Feature to Parkinson’s disease and helps differentiate it from other causes of Parkinsonism :
Assymetrical tremors.
Eye symptoms in Acoustic Neuroma :
Absent corneal reflex.D/t CN 5
Parkinson’s disease - most common psychiatric problem is :
Depression
Chorea is caused by damage to T which part of brain?
basal ganglia, in particular the Caudate nucleus
severe headache+ pyrexia+ CT head = temporal lobe changes
Herpes simplex encephalitis
Epilepsy + pregnancy = ___ folic acid
5 MG.
Motor neuron disease medication RX?
Riluzole
common consequence of subarachnoid haemorrhage
SIADH.
Hyperintense T2 signal extending across the spinal cord, between the levels of T9 and T12.Dx?
Transere Myelitis.
Common cause of Transvere Myelitis ?
HIV
Varicella.
Blistering Rash +weakness of both legs + with upgoing plantars bilaterally, reflexes are brisk+ loss of fine touch sensation below the umbilicus.
Transverse Myelitis secondary to varicella.
Klumpke’s paralysis features :
Wasting of the thenar and hypothenar eminence + claw hand + reduced sensation in ulnar distribution.
Pancoast tumour + Wasting of the thenar and hypothenar eminence + claw hand + reduced sensation in ulnar distribution.
Klumpke’s paralysis.
Klumpke’s paralysis affects ulnar or radial distribution ?
Ulnar.
Recurrent falls at old age + Fluctuating consciousness. Which type of Haemorrhage ?
Sub Dural Haemorrhage.
sudden, brief (< 100 ms) and almost shock-like involuntary single jerks of his face and right upper limb. The movements are stimulus-sensitive and provoked by touching. Dx and Rx ?
Myoclonic Seizure.
Rx: Sodium Valproate.
Phaeochromocytoma, renal cell cancer → ?
Von Hippel-Lindau syndrome
Uraemic polyneuropathy is sensory or motor ?
Predominantly sensory loss
( Loss of sensation in lower limbs)
Acetazolamide MOA:
carbonic anhydrase inhibito
Drooling of saliva in people with Parkinson’s disease.Rx?
Glycopyrronium Bromide
neck pain
wide-based, ataxic or spastic gait
upper motor neuron weakness in the lower legs - increased reflexes, increased tone and upgoing plantars
bladder dysfunction e.g. urgency, retention
Cervical spondylitic myelopathy
Rx: Cervival Decompression Surgery.
2nd line in Status epilepticus :
Life Saving Power drugs in Status:
Levetiracetam or Sodium Valproate Phenytoin or
Bell’s palsy. Rx?
Oral Prednisolone within 72 hours of onset.
Clumsiness in walking + Foot Drop + Weakness + Sensory ( Numbness + tingling in foot. ) + Distal muscle wasting( Pes cavus + High arch foot) + High stepping gait :
Charcot marrie tooth disease.( Can’t move toes)
UMN or LMN in Charcot marrie Tooth ?
LMN
Acute onset U/L severe pain in shoulder—subsided—shoulder or scapular weakness for several days.s
Brachial neuritis.
Brachial neuritis.
Acute onset U/L severe pain in shoulder—subsided—shoulder or scapular weakness for several days.s
Small area of erythema in hand + cape like sensation loss in upper limbs + Spastic weakness in lower limbs + upgoing plantar :
Syringomyelia ( CST tract affected—UMN weakness below the lesion)
K/c/o Parkinson’s/scizophrenia + pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion
Neuroleptic Malignant syndrome.
Rx: Dantrolene.
Differentiating feature between Neuroleptic malignant syndrome and serotonin syndrome:
Myoclonus : only in serotonin.
ExtraDural haemorrhage which artery or veins are involved ?
Extradural = ExtraMural haemorrhage.
Middle meningeal artery involvement.
What kidney involvement in Tuberous sclerosis?
Renal angiomyolipomata.
Subarachnoid haemorrhage: if rebleeding is suspected:
Repeat CT
Does SLE caused raised protein in csf and facial nerve palsy?
No
Which type of motor neuron disease carries the worst prognosis?
Progressive bulbar palsy
otitis externa Rx :
Topical corticosteroid + aminoglycoside.
H/o Swim/Holiday—Itchy red ear+ Typanic membrane= Clear+
Otitis external.
Meds causing raised intracranial hypertension:
Steroid
Oc pills.
common peroneal neuropathy, what to avoid ?
Leg crossing, squatting or kneeling may cause a foot drop
Anti Hu antibodies
who kicked my chair (pain) and then fell over (ataxia)
Sensory neuropathy and ataxia
Small cell lung cancer.
antibodies are associated with painful sensory neuropathy in patients with small cell lung cancer?
Anti hu.
ovarian cancer. She presents due to ‘unsteadiness’. On examination there is evidence of nystagmus and past-pointing. Which one of the following antibodies is most likely to be present?
Anti yo
Yo-varian cancer.
antibodies is associated with ocular opsoclonus-myoclonus in patients with breast cancer?
Anti Ri
degenerative cervical myelopathy (DCM)? Gold standard test ?
MRI Spine
Myasthenia gravis pathophysiology
antibodies against acetylcholine receptors
What scoring system can be used to quantify the disability in activities of daily living? In stroke patient
The Barthel index
Treatment of Ramsay Hunt syndrome Rx
oral aciclovir and corticosteroids
Fever flu + auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus
Ramsay Hunt syndrome
Baclofen MOA
agonist of GABA receptors
speech fluent, but repetition poor. Comprehension is relatively intact
Conduction dysphasia:
Arcuate fasciculus
speech fluent, comprehension abnormal, repetition impaired
Wernicke’s aphasia( Wulta-Pulta speech)
Broadman area 22 in superior temporal Gyrus.
first-line for spasticity in multiple sclerosis
Baclofen.
What cancer is most commonly associated with Von hippel Lindau syndrome?
Renal cell carcinoma.
Tumour suppressor gene in Von hippel lindau syndrome in which chromosome ?
Chromosome 3.( Tree behind Von Hippo)
How to differentiate MSA and Normal pressure hydrocephalus ?
presence of dementia and abscense of cerebellar signs points towards Normal pressure hydrocephalus.
Uhthoff ‘s phenomenon:
where neurological symptoms are exacerbated by increases in body temperature is typically associated with multiple sclerosis
generalised weakness. Examination of her face reveals bilateral ptosis, dysarthric speech and a slow-relaxing grip. What is the most likely diagnosis?
Myotonic dystrophy.
Slow relaxing grip , think :
Myotonic Dystrophy.
Prophylaxis of migraine in asthamatic migraine :
Non asthamatic migraine :
Topiramate in asthamatic
Propranolol in non asthamatic
Cluster headache - acute treatment:
subcutaneous sumatriptan + 100% O
Contralateral hemiparesis and sensory loss with the lower extremity being more affected than the upper.
Anterior cerebral artery
A= two slanting lines of legs look like legs.
Frontal lobe lesion :
DP + broca’s aphasia+ inability to generate a list + anosmia.
Disinhibition.
Perseveration.
Perseveration is caused by which lobe lesion ?
Parietal lobe lesion.
Tonic clinic seizure Rx:
Sodium Valproate.
(ST)
Progressive supra nuclear palsy—Vertical or horizontal gaze palsy ?
Vertical gaze palsy.
He described three episodes of sudden, forceful contraction of both arms and legs, each lasting one-to-two seconds with no loss of consciousness
Myoclonic seizure.
H/o Diarrhoe. Weakness that improves after exercise:
Lambert Eaton Syndrome.
Difference between Myasthenia and Lambert Eaton :
Lambert Eaton improves after exercise
Myasthenia worsens after exercise.
First line in status epilepticus
IV lorazepam
Facioscapulohumeral muscular dystrophy, which type of inheritance ?
Autosomal Dominant.
Old man+ Dysmetria+Ataxia+ Horizonal nystagmus. Dx:
Cerebellar Stroke.
Pyrodostigmine MOA:
Long acting acetylcholinesterase inhibitors.
Sudden painless loss of vision in Von hippel Lindau Syndrome is due to :
Retinal hemangioma.
post-dural puncture headache Rx:
Blood patch.
Which anaemia and due to what deficiency in Phenytoin ?
Macrocytic anaemia due to folate deficiency.
Quinine S/e :
B/L tinnitus.
Tinnitus is caused by which antimalarial ?
Quinine.
Why cocp is contraindicated in migraine ?
Increased risk of Ischaemic stroke.
Which meds help in preventing attacks of Minere’s ?
Betahistine.
Anti GAD antibodies :
Stiff man syndrome
K/C/O colorectal cancer + C/o stiffness. Which antibodies ?
Anti GAD
Neuropathic pain, which opioids?
Tramadol.
Vertigo lasting for days. Dx?
Vestibulat neuritis.
vertigo lasting for 30-60 mins. Dx?
Minere’s
Vertigo lasting for seconds.Dx?
BPPV.
Deafness type in Minere’s:
SNHL
Ondansetron acts on which part of the brain ?
Medulla oblangata.
Common precipitator of Myasthenic crisis :
Bisoprolol.
Which drug is used in treatment of Multiple sclerosis ?
B interferon.
Does Carbon Monoxide lead to chorea?
Yes.
Which rheumatoid condition leads to chorea ?
SLE.
Ataxia Telangiectasia Mode of inheritance ?
Autosomal recessive
Taxi= small auto
Parinaud syndrome occurs due to :
Dorsal Midbrain lesion.
MRI finding of Wernickes :
Enhancement of mammillary bodies
Known space occupying mass+ Ipsilateral optic atrophy + contralateral papiloedema =
Foster Kennedy syndrome.
Optic atrophy D/t direct damage from space occupying lesion.
Left sided optic atrophy + Rt eye papilloedema + known mass in brain. Dx: and location of mass ?
Foster Kennedy syndrome.
Mass in left frontal side.
EEG of Myoclonic seizures And focal:
brief bursts of poly-spike and wave discharge during ictal episodes.
abnormal discharges in one specific area.
Comprehension in brocas?
Normal.
Essential tremors.
Rx in asthamatic and non asthmatic
In non asthma : Propranolol.
In Asthmatic : Primodine.
Parkinson’s—develops tremors( Motor symptoms which does not affect day to day life):
Dopamine receptor agonist ( Ropinirole )
Lambert Eaton affects which antibodies :
voltage gated calcium channel antibodies.
bilateral vestibular schwannomas feature of which neurocutaneous disorder ?
Neurofibromatosis 2.
Absence seizures - ____ become seizure free in adolescence
90-95%
Lambert Eaton is ass with which cancer ?
Small cell lung cancer
B/L vitreous haemorrhage + ataxia. Dx?
Von hippel Lindau Syndrome
Is impotence a feature of Lambert Eaton ?
yes.
Is renal failure a feature of neuroleptic malignant syndrome ?
Yes
Is Multiple sclerosis UMN or LMN?
UMN type of weakness.
Patient with migraine + taking PCM—failed to relieve symptoms. Reasons ?
Patient with migraine experience delayed gastric emptying.
Therefore PPI is added.
Seizures + fibromata under nail + hypopigmentation patches. Dx?
Tuberous sclerosis.
Peripheral Neuropahty is a feature of which Anti epileptic drug ?
Phenytoin.
Cabergoline S/e:
Pulmonary fibrosis.
Guillain-Barre syndrome Conduction studies finding :
Reduced conduction velocities.
Pergolide S/E:
Pulmonary Fibrosis.
Which Parkinson’s S/E is pulmonary fibrosis :
Cabergoline.
Pergolide.
Ondansetron S/E:
Constipation
QTc prolongation.
Migraine in pregnancy Rx:
1st line: Paracetamol
2nd line: NSAID( Ibuprofen)
Is phonophobia a feature of Migraine ?
Yes.
Antiemetic with extrapyramidal S/E:
Metclopramide
Ear related S/E in facial nerve paralysis :
Hyperacusis.
Herpes simplex encephalitis
Rx: IV acyclovir + supportive treatment.
Small cell lung cancer+ B/L leg weakness + hyporeflexia+ Dry mouth + erectile Dysfunction: Dx:
Lambert Eaton
degenerative cervical myelopathy.RX:
Urgent referral to spine or neurosurgery.
Seizure affecting a peripheral body part such as a toe, finger or section of the lip and then spreads quickly ‘marches’ over the respective foot, hand or face—marches to tonic clonic
Jacksonian march.
Jacksonian march.
Seizure affecting a peripheral body part such as a toe, finger or section of the lip and then spreads quickly ‘marches’ over the respective foot, hand or face—marches to tonic clonic
Lumber Puncture headache pathology:
Leaking of cerebrospinal fluid from the dura.
Isolated alexia. Lesion ?
Corpus callosum.
Palatal Myoclonus is caused by lesion in which part of brain ?
Olivary nucleus.
Gerstmann syndrome
is a constellation of acalculia, right-left disorientation, finger agnosia and agraphia.
Gerstmann syndrome Lesion :
C/L parietal lobe.
Right handed man—Rt left disorientation+ acalculia+ finger agnosia+ agraphia. Dx and site of lesion:
Gerstmann syndrome.
Lesion= left parietal lobe lesion.
Which examination is specific to degenerative cervical myelopathy [DCM?
Positive Hoffman sign.
worsening bilateral upper limb paraesthesias and leg stiffness+ H/o back pain+ Lumbar spondylitis.Dx and Ix:
Dx: Degenerative cervical Myopathy.
Ix: MRI cervical spine.
Features uncommon in drug-induced parkinsonism:
Tremors and rigidity.
1st and 2nd line in generalised tonic clonic seizure:
1st: Sodium Valproate.
2nd: lamotrigine.
Migraine on PCM. No relief in symptoms, Next step?
Start 2nd line : Tristan’s.
Does sodium valproate cause tremors ?
Yes
B/L paraesthesia over radial side of arm. Dx
Degenerative cervical myelopathy.
Hearing loss in vestibular neuritis ?
No
first line and most appropriate Rx for GBS
first line: Plasma exchange
Most appropriate : IV Immunoglobulins.
Should you treat hypertension in initial phase of management of stroke ?
NO.
Electric shock like pain lasting for 30-60 seconds + on side of the face.Dx:
Trigeminal neuralgia.
Rx for Trigeminal neuralgia :
Carbamazapine.
Stroke symptoms after 4.5 hours o onset. Rx
out of window period.
Rx: Aspirin.
(No thrombectomy in question)
left congruous homonymous hemianopia
Rt occipital cortex lesion.
C=Congrous=Cortex
Monitoring of respiratory function in Guillain-Barré syndrome:
Forced vital capacity.
Stroke symptoms withing 4.5 hours:
Thrombolysis and thrombectomy.
H/o carpal tunnel syndrome refractory to treatment+ new onset weakness of lower legs and imbalance. Rx:
Degenerative cervical myelopathy.
Vision worse going downstairs. Which nerve palsy ?
4th nerve palsy.—Trochlear nerve palsy.
LR6 SO4—Trochlear supplies superior oblique—function to look down.
which part of this child’s hypothalamus would be affected causing weight gain if there is a lesion ?
Venteromedial area of hypothalamus.
Sodium valproate causes inhibition or induction of the P450 system?
Inhibition.
H/o viral urti + headache+ confusion+ hearing voices
+ MRI: Assymetric and poorly marginated hyperintense T2 weighted and flair lesion :
Acute disseminated encephalomyelitis.
Unable to perceive stimuli in the superior temporal field of his left eye and the superior nasal field of his right eye:
Right Temporal Lobe.
PITS
subacute combined degeneration of the spinal cord, which vitamin deficiency ?
Vitamin B12.
bitemporal hemianopia with predominately the lower quadrants being affected.
Cranipharyngioma.
Lowe= superior chias all compression
PICS: parietal=inferior, craniopharyngioma=superior
Famliy history of ear issues+ B/L conductive hearing loss.
Otosclerosis.
Stroke symptoms, 5 hours of onset. Rx:
it’s between 4.5-5.5 : therefore = thrombectomy.
Examination reveals a right incongruous homonymous hemianopia:
Left optic tract lesion.
Stroke symptoms + 5 hours of onset. K/C/O Afib. Rx:
Outside window period.
Rx: Aspirin + Anticoagulation ( warfarin) after 2 weeks.
blind spots in the bottom left quarter in both eyes.
Right parietal
Examination reveals an inferior homonymous quadrantanopia.
PITS
Inferior= superior optic radiation in parietal lobe.
visual field changes would be most consistent with a left parietal lobe lesion?
Right homonyous quadrantonopias.
Ropinirole is :
Dopamine agonist
Anti epileptics most ass with weight gain:
Sodium valproate.
bitemporal hemianopia with predominately the upper quadrants being affected
PICS
Upper = lower affected.
Lower is pituitary.
operation to remove a meningioma in his left temporal lobe. What sort of visual field defect is he at risk of having following the procedure?
Rt superior homonymous quadrantonopia.
Internuclear ophthalmoplegia
Medial longitudinal fasisculus ( paramedical area of midbrain and pons)
How to diagnose BPPV?
Dix-Hallpike test:
Stroke patient outside window. K/C/O high cholesterol. Aspirin given. Next treatment:
Clopidogrel + statin after 14 days.
H/o fracture and cast + Fracture healed + Shooting pain + Swelling + Tenderness
Complex regional pain syndrome.
Tremors worse during stress+ worse on outstretched hand+ improved by alcohol.
Essential tremors.
point which is specific to essential tremors and differentiate it from Parkinson’s tremors :
Tremors get worse on outstretched hands.
Pt on warfarin had a fall. no sign of injury and no fall in GCS.Next step ?
patient on warfarin should have CT scan within 8 hours regardless of the injury
What are affected first in Miller Fisher syndrome ?
Eye symptoms are affected first—causing opthalmoplegia.
Rx for BPPV ?
Apply epply.
Epply’s manoeuvre.
Double vision + reduced reflexes + wide gait :
Miller fisher syndrome.
Additional features ass with Freidricks ataxia /
Optic Atophy
Dysarthria
Pes cavus.
Cause of vomitting and loss of consciousness in Sub arachnoid Haemorhage ?
Mass effect
