Neurology

Question 1

Gingival hyperplasia causes

Answer 1

phenytoin, ciclosporin, calcium channel blockers and AML

Question 2

Baclofen MoA

Answer 2

GABA agonist

Question 3

Autoantibody associated with Lambert-Eaton myasthenic syndrome

Answer 3

anti voltage gated calcium channel

Question 4

Two cardinal features of sporadic Creutzfeldt-Jakob disease

Answer 4

rapidly progressive mental deterioration and myoclonus (usually provoked by startle)

C cerebellar signs
J jerks (myoclonus)
D dementia

Question 5

Wernicke’s encephalopathy MRI findings

Answer 5

Enhancement of the mamillary bodies

Question 6

Wernickes apashia Sx?

Answer 6

Speech fluent, comprhension abnormal, repetition impaired

Wernicke=Wtf are you talking about? ( No sense)
Broca’s= Broken Words

W - wernicke
T - temporal
F - fluency present

Question 7

Idiopathic intracranial hypertension management and MoA

Answer 7

Acetazolamide is a carbonic anhydrase inhibitor that is used to treat idiopathic intracranial hypertension

Question 8

In subacute combined degeneration of the spinal cord which parts of the spinal cord aare effected?

Answer 8

dorsal columns and lateral corticospinal tracts are affected and spinocerebellar tracts..§

Question 9

antiepileptic drug most commonly associated with weight gain

Answer 9

Sodium Valprroate

Question 10

Antieplieptic that increases risk of heamorrhagic disease of the newborn if taken in pregnancy

Answer 10

Phenytoin induces vitamin K metabolism, which can cause a relative vitamin K deficiency, creating the potential for heamorrhagic disease of the newborn

Question 11

transient global amnesia diagnostic criteria

Answer 11

onset of retrograde amnesia with preserved orientation and consciousness

Transient global amnesia is characterized by the acute onset of anterograde amnesia (the inability to form new memories). The aetiology is unknown, thought to be due to transient ischaemia to the thalamus (in particular the amygdala and hippocampus).

Features
patients may appear anxious and repeatedly ask the same question
episodes are self-limited and resolve within 24 hours

Question 12

Motor neurone disease medication that improves prognosis

Answer 12

Riluzole

prevents stimulation of glutamate receptors
used mainly in amyotrophic lateral sclerosis
prolongs life by about 3 months

currently the only disease-modifying therapy approved for use in amyotrophic lateral sclerosis

Question 13

Broca’s dysphasia occurs due to a lesion of

Answer 13

the inferior frontal gyrus of dominant hemisphee

Question 14

Wernicke’s aphasia occurs due to a lesion of

Answer 14

superior temporal gyrus of dominant hemisphee

Question 15

What is the neuronal bundle that connects Broca’s and Wernickes

Answer 15

Arcuate fasiculus

Question 16

Conduction aphasia

Answer 16

Inability to repeat (damage to arcute fascilus which connects brocas and wernickes), recognise and try to correct

Question 17

Anomia

Answer 17

Word blindness/difficulty naming

Lesion in angluar gyrus

Question 18

Listeria monocytogenes meningitis ABx

Answer 18

AMPICILLIN

IV ceftriaxone and ampicillin i

Question 19

why might see a return of seizures after 3-4 weeks of treatment with carbemazepine

Answer 19

Auto-induction of CPY
Carbamazepine induces its own metabolism via the hepatic microsomal enzyme system CYP3A4 system. This process is known as auto-induction. The half-life of carbamazepine decreases considerably as auto-induction takes place. In practical terms, this means that carbamazepine levels fall significantly (by about 50%) after several weeks of treatment, which may result in seizure recurrence within this period of auto-induction. For this reason, the dose should be increased every 2 weeks.

Question 20

Progressive supranuclear palsy cardinal Sx

Answer 20

Progressive supranuclear palsy: postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction

Does not respond well to L-dopa

Question 21

Mutisystem atrophy cardical SX

Answer 21

Multiple system atrophy is a rare neurodegenerative disorder that shares some features with Parkinson’s disease such as parkinsonism; however, it also involves autonomic dysfunction (such as orthostatic hypotension) and cerebellar ataxia. While multiple system atrophy may cause gait disturbances similar to those seen in this patient, it does not typically present with cognitive impairment or vertical gaze palsy.

Question 22

Myotonic dystrophy characeteristics

Answer 22

Dystrophia myotonica - DM1
distal weakness initially
autosomal dominant
diabetes
dysarthria
frontal balding
Mild mental impairment

Myotonic dystrophy (also called dystrophia myotonica) is an inherited myopathy with features developing at around 20-30 years old. It affects skeletal, cardiac and smooth muscle. There are two main types of myotonic dystrophy, DM1 and DM2.

General features
myotonic facies (long, ‘haggard’ appearance)
frontal balding
bilateral ptosis
cataracts
dysarthria

Other features
myotonia (tonic spasm of muscle)
weakness of arms and legs (distal initially)
mild mental impairment
diabetes mellitus
testicular atrophy
cardiac involvement: heart block, cardiomyopathy
dysphagia

Sow-relaxing grip may be noticed on initial hand-shake with the patient and is typical of myotonic dystrophy.

Question 23

Hoffman’s sign

Answer 23

Hoffman’s sign: is a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick

Question 24

Dementia pugilistica,

Answer 24

Dementia pugilistica: think of Muhammad ali. He suffered from parkinsoniam.

Dementia pugilistica, also known as chronic traumatic encephalopathy (CTE), is a neurodegenerative condition associated with repeated head trauma, commonly seen in boxers and other contact sport athletes. It presents with a spectrum of symptoms that overlap with Parkinsonism.

Pathophysiology: Characterised by the accumulation of hyperphosphorylated tau protein, leading to neurofibrillary tangles and neuronal loss, particularly in the frontal and temporal lobes.
Clinical Features: Symptoms may include:
Cognitive decline (memory impairment, executive dysfunction)
Behavioural changes (aggression, impulsivity)
Motor symptoms resembling Parkinsonism (bradykinesia, rigidity, tremor)
Diagnosis: Primarily clinical; imaging may show atrophy in affected brain regions. Definitive diagnosis is post-mortem via histopathological examination.
Management: Currently symptomatic; no disease-modifying treatments exist. Supportive care and rehabilitation are essential.

Question 25

Lead poisioning neurrological effects

Answer 25

Predominantly motor peripheral neuropathy.

Question 26

n the treatment of migraine, sumatriptan is an example of a

Answer 26

5HT1agonist

They work by constricting blood vessels in the brain that are involved in causing migraine headaches

Think that all the good stuff (chocolate coffee etc) causes a migraine -> uses up th serotonin so this adds it back in

Question 27

CT head timing for SAH Dx

Answer 27

if CT H -ve and done within 6 hrs of Sx onset NO NEED FOR LP

If CT H -ve and done >6 hrs frrom Sx onset, consider LP

Question 28

hemiballismus

Answer 28

characterised by unilateral, repetitive, uncontrollable limb movements. These often decrease in intensity when the patient is relaxed or asleep.

lesion most commonly in basal ganglia

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

Question 29

Myasthenia Gravis antibodies

Answer 29

Anti-MuSK (anti muscule specific tyrosine kinase)

And

The anti-AChR antibody

Question 30

antibody is classically associated with guillan barre?

Answer 30

Anti-GM1 (anti - ganglioside-monosialic acid)

Question 31

Lateral medullary syndrome

Answer 31

PICA lesion - cerebellar signs, contralateral sensory loss & ipsilateral Horner’s

Question 32

cataplexy

Answer 32

So for Cataplexy laughter is NOT the best medicine,

The correct answer in this case is cataplexy. Cataplexy is a sudden and transient episode of muscle weakness typically triggered by strong emotions, such as laughter, anger, or surprise. It is often associated with narcolepsy, a chronic sleep disorder characterized by excessive daytime sleepiness and other symptoms like sleep paralysis and hypnagogic hallucinations. The patient’s history of leg weakness following bouts of laughing and brief collapse after a similar episode are classic presentations of cataplexy.

Question 33

It’s CRITical that you remember this.
C(ongruous) = Radiation lesion.
I(ncongruous) = Tract lesion.

in conext of hemianiopias

Question 34

The ‘2’ syndrome:
2 sides accustic neuroma—> NFM 2 –> 22 chromosome

Neurofibramoatosis T1 has 17 letters

Question 35

In subacute combined degeneration of the spinal cord, the dorsal columns and lateral corticospinal tracts are affected

Question 36

Waterhouse-Friderichsen syndrome

Answer 36

adrenal insufficiency secondary to adrenal haemorrhage

Question 37

Drug treatment according to the type of epilepsy

Answer 37

Generalised tonic-clonic seizures
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

Focal seizures
first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide

Absence seizures (Petit mal)
first line: ethosuximide
second line:
male: sodium valproate
female: lamotrigine or levetiracetam
carbamazepine may exacerbate absence seizures

Myoclonic seizures
males: sodium valproate
females: levetiracetam

Tonic or atonic seizures
males: sodium valproate
females: lamotrigine

Question 38

Neurofibromatosis type 1 is due to a mutation in chromosome 17, von-Hippel Lindau is inherited via chromosome 3 and tuberous sclerosis is often associated with a mutation in chromosome 16 (as is polycystic kidney disease type 1)

Question 39

localising features of a temporal lobe seizure

Answer 39

Lip smacking + post-ictal dysphasia

May occur with or without impairment of consciousness or awareness

An aura occurs in most patients
typically a rising epigastric sensation
also psychic or experiential phenomena, such as dejà vu, jamais vu
less commonly hallucinations (auditory/gustatory/olfactory)

Seizures typically last around one minute
automatisms (e.g. lip smacking/grabbing/plucking) are common

Question 40

Localising features of a frontal lobe seizure

Answer 40

Frontal lobe (motor) Head/leg movements, posturing, post-ictal weakness, Jacksonian march

Question 41

Localising features of a parietl seizure

Answer 41

Parietal lobe (sensory) Paraesthesia

Question 42

Loacalising features of an occipital lobe seizure

Answer 42

Occipital lobe (visual) Floaters/flashes

Question 43

Ovarian teratoma is associated with Anti-NMDA receptor encephalitis

Question 44

Essentail tremor pharmacological management

Answer 44

1. Propanolol
2. Primidone acts by modulating GABAergic neurotransmission, enhancing inhibitory effects in the central nervous system. This leads to decreased neuronal excitability, which may help alleviate tremors.

Question 45

SJS drugs

Answer 45

SJS happens in 3 PLACES
P-Phenytoin
P-Phenobarbitone
P-Penicillin
L-Lamotrigine
A-Allopurinol
C-Carbamazepine
E-Erythromycin
S-Sulfa Drugs

Question 46

Patients with von Hippel-Lindau syndrome may develop retinal haemangiomas which present as a vitreous haemorrhage

Question 47

Intraacrain HTN drug causes

Answer 47

LAST-C(See) Fat Pregnant Lady
- lithium
- Vitamin A
- Steroid
- Tetracyclin
- COCP

or spotty pregnant lady as lots of these drugs used to treat acne

Question 48

Wernicke and Korsakoff syndrome localises to the medial thalamus and mammillary bodies of the hypothalamus. Huntington chorea is localised to the striatum (caudate nucleus) of the basal ganglia. Parkinson’s disease is caused by disease of the substantia nigra of the basal ganglia. Kluver-Bucy syndrome is caused by damage both temporal lobes including the amygdala.

Question 49

Hypothalamic Functions (Simplified)

Ventromedial: Satiety center (controls feeling of fullness)
Anterior: Heat dissipation (cooling the body)
Posterior: Heat generation (warming the body)
Paraventricular + Supraoptic: Antidiuretic hormone (ADH) & oxytocin production

Question 50

Natalizumab can cause reactivation of the JC virus causing progressive multifocal leukoencephalopathy (PML)

Question 51

Paraneoplastic syndromes affecting nervous system

Lambert-Eaton myasthenic syndrome
associated with small cell lung cancer (also breast and ovarian)
antibody directed against pre-synaptic voltage gated calcium channel in the peripheral nervous system
can also occur independently as autoimmune disorder

Anti-Hu
associated with small cell lung carcinoma and neuroblastomas
sensory neuropathy - may be painful
cerebellar syndrome
encephalomyelitis

Anti-Yo
associated with ovarian and breast cancer
cerebellar syndrome

Anti-GAD antibody
associated with breast, colorectal and small cell lung carcinoma
stiff person’s syndrome or diffuse hypertonia

Anti-Ri
associated with breast and small cell lung carcinoma
ocular opsoclonus-myoclonus

Purkinje cell antibody
- peripheral neuropathy in breast cancer

Answer 51

Anti-Ri (Rieally blurry vision)Anti GAD GAAAAD he’s stiff (stiff man syndrome)Anti-Hu who kicked my chair (pain) and then fell over (ataxia)Anti yo- Yo lady give me back my danish (cerebellar syndrome, lady for breast + ovarian)

anti GAD in Arabic means a serious person:: so a serious person = stiffed
My way of remembering
anti Ri : conect it to RiO Ocular OpsOclOnus-myOclOnus
and ive read somewhere
anti H : imagine H sticks as 2 lungs or 2 brain hemispheres
anti Yo : imagine Y as lady’s private organ

Question 52

CADASIL

Answer 52

CADASIL (also known as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is the most common cause of hereditary cerebral small-vessel disease and vascular cognitive impairment in young adults. It is, as implied by the name, an autosomal dominant condition caused by a NOTCH3 mutation on chromosome 19.

Question 53

Klumpke’s paralysis:

Answer 53

T1 nerve root damage

Question 54

Myotonic Dystrophy
- Features can be remembered with 3T 3D
- 3T: Toupee (balding), ticker (cardiomyopathy), testicles (atrophy)
- 3D: diabetes, dysarthria, learning disability

• Also Both CTG and myotonic have T in the middle
• D for autosomal dominant (along with Facioscapulohumeral dystrophy) whereas Duchenne and Becker are X-linked recessive

Question 55

Carrbamazepine is contraindicated in what typ of seizue?

Answer 55

Abscense seizure

to remember this, absence seizures happen in children and adolescents mostly and we don’t give them cars

Question 56

Juvenile myoclonic epilepsy

Answer 56

Juvenile myoclonic epilepsy first presents in teens. Seizures typically occur upon waking in the morning, associated with sleep deprivation. Myoclonic jerks can occur, preceding generalised seizures. Absence seizures are also often observed, but not in every case. Juvenile myoclonic epilepsy often necessitates life-long anti-convulsant, but patients respond well; sodium valproate is first-line but should be avoided in girls of child-bearing age.

Question 57

benign rolandic epiliepsy

Answer 57

Benign rolandic epilepsy presents in children aged 5-12 on average, causing focal aware seizures or generalised tonic-clonic seizures occurring during the night. Seizures are infrequent, and the majority of children do not require treatment and become seizure-free in adulthood.

Question 58

Hyponogogic myoclonus

Answer 58

Hypnogogic myoclonus is a physiological phenomenon that causes sudden and involuntary jerking just as a person is falling asleep. They are often associated with a feeling of shock. These involuntary movements and not related to seizure activity and would not progress to a generalised seizure.

Question 59

Lennox-Gestault syndome

Answer 59

Lennox-Gastaut syndrome is an epileptic encephalopathy causing both tonic and atonic seizures. The condition presents in pre-school years and carries a poor prognosis.

Question 60

Rett syndrome

Answer 60

Rett syndrome is a genetic disorder causing developmental regression after 12-18 months of normal development. Seizures can occur, but not in every case; the first presentation is often around 1 year of age.

Question 61

Medication that precipitate acute angle closure glaucoma

Answer 61

Topiramate can precipitate acute angle closure glaucoma

Question 62

egot derived DA agonist complications

Answer 62

fibrosis - retroperitoneal, pulmonaay & peircardiala

ergot-derived dopamine agonists such as Pergolide, Lisuride, Bromocriptine and Cabergoline are associated with an increased risk of these fibrotic reactions due to their mechanism of action on serotonin 5-HT2B receptors which can cause fibrotic changes in tissues.