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MRCP PART 1 > Neurology > Flashcards

Neurology Flashcards

1
Q

Which neurological condition presents with areflaxia, ataxia and ophthalmoplegia?

A

Miller - Fisher Syndrome

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2
Q

Which antibody is associated with Miller Fisher syndrome?

A

Anti-GQ1b

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3
Q

What pattern of paralysis is seen in Miller Fisher syndrome?

A

Descending paralysis

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4
Q

Which occular muscle does the Trochlear nerve ( CN IV) supply?

A

Superior oblique (SO4)

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5
Q

What does the superior oblique muscle do to the eye?

A

Downward and outward rotation
(enables the eye to look downward on adduction)

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6
Q

What are the features of 4th nerve palsy?

A
  • Vertical diplopia (reading a book/going downstairs)
  • Tilting of objects (tortional diplopia)
  • Head tilt
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7
Q

How many hours within symptom onset should CT head be performed for SAH?

A

6 hours –> no LP if normal

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8
Q

What are the CT findings in spontaneous SAH?

A

hyperdense/bright

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9
Q

How many hours should LP be done post symptom onset for SAH?

A

12 hours

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10
Q

What are the presenting features of SAH?

A
  • Headache - ‘worse’, usually occipital
  • N + V
  • meningism
  • coma
  • seizures
  • ECG - long QT, ST elevation
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11
Q

What are the features of Supranuclear Palsy?

A
  • postural instability
  • impairment of vertical gaze
  • parkinsonism
  • frontal lobe dysfunction
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12
Q

What are the features of Parietal lobe lesions?

A

sensory inattention
apraxias
astereognosis (tactile agnosia)
inferior homonymous quadrantanopia
Gerstmann’s syndrome (lesion of dominant parietal): alexia, acalculia, finger agnosia and right-left disorientation

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13
Q

What are features of temporal lobe lesions?

A

Wernicke’s aphasia: this area ‘forms’ the speech before ‘sending it’ to Brocas area. Lesions result in word substituion, neologisms but speech remains fluent
superior homonymous quadrantanopia
auditory agnosia
prosopagnosia (difficulty recognising faces)

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14
Q

What are the features of occipital lobe lesions?

A

homonymous hemianopia (with macula sparing)
cortical blindness
visual agnosia

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15
Q

What are the features of frontal lobe lesions?

A
  • expressive (Broca’s) aphasia: located on the posterior aspect of the frontal lobe, in the inferior frontal gyrus.
  • Speech is non-fluent, laboured, and halting
  • disinhibition
  • perseveration
  • anosmia
  • inability to generate a list
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16
Q

What are the features of cerebellar lesions?

A

midline lesions: gait and truncal ataxia
hemisphere lesions: intention tremor, past pointing, dysdiadokinesis, nystagmus

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17
Q

What are the features of the anterior cerebral artery?

A

Contralateral hemiparesis and sensory loss with the lower extremity being more affected than the upper

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18
Q

Which chromosome is associated with NF1?

A

NF1: chromosome 17 - as neurofibromatosis has 17 characters

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19
Q

Which chromosome is associated with NF2?

A

NF2: chromosome 22 - all the 2’s

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20
Q

What are the poor prognostic factors for Guillian barre?

A
  • age > 40 years
  • poor upper extremity muscle strength
  • previous history of a diarrhoeal illness (specifically Campylobacter jejuni)
  • high anti-GM1 antibody titre
  • need for ventilatory support
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21
Q

What are the features of common peroneal nerve palsy?

A
  • weakness of foot dorsiflexion
  • weakness of foot eversion
  • weakness of extensor hallucis longus
  • sensory loss over the dorsum of the foot and the lower lateral part of the leg
  • wasting of the anterior tibial and peroneal muscles
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22
Q

Which drugs exacerbate MG?

A
  • penicillamine
  • quinidine, procainamide
  • beta-blockers
  • lithium
  • phenytoin
  • antibiotics: gentamicin, macrolides, quinolones, tetracyclines
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23
Q

Which structure is damaged in hemibalism?

A

Subthalamic nucleus

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24
Q

What structure is damaged in chorea?

A

Caudate nucleus (basal ganglia)

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25
What are the genetics of Ataxia telangiectasia?
Autosommal recessive Defect in the ATM gene --> codes DNA repair enzymes
26
What are the features of Ataxic telangiectesia?
* Onset 1-5 years * Telangiectesia * Recurrent chest infections - IgA deficiency * increased risk of lymphoma and leukemia
27
What are the features of conductive dysphasia?
* Fluent speech * Poor repetition * Comprehension intact
28
What are the features of Broca's dysphasia? (expressive aphasia)
Lesion in inferior frontal gyrus * Non fluent speech * Laboured and halting * Comprehension intact
29
Which artery supplies Broca's area?
Superior division of the left MCA
30
What are the features of Wernicke's aphasia?
* Lesion of superior frontal gyrus * Word salad * Neologisms * Comprehension is impaired
31
What causes conduction aphasia?
Lesion affecting the arcuate fasiculus
32
What are the features of CNIII palsy?
* Eye is deviated 'down' and 'out' * ptosis * dilated pupil
33
What are the causes of CNIII palsy?
* Diabetes * Posterior communicating aneurysm * Raised ICP * SLE * Cavernous sinus thrombosis
34
How long can patients not drive post 1st seizure with normal MRI and EEG?
6 months
35
How long can patients with provoked established seizures not drive for?
12 months
36
What time period do patients have to be seizure free for to have full licenses established?
5 years
37
What are the findings of extradural haematoma on CT?
biconvex or lens-shaped hyperdense collection
38
Which type of MND carries the worse prognosis?
Progressive bulbar palsy
39
What are the causes of peripheral neuropathy with motor loss?
(CLD Has Poor ProGnosis) * CIDP * Lead poisoning * Diptheria * HSMN * Porphyria * GBS
40
What are the causes of peripheral neuropathy with sensory loss?
VALUeD * Vit B12 * Alcohol, Amyloidosis * Leprosy * Uraemia * Diabetes
41
What is the cause of Lambert Eaton myasthenic syndrome?
Antibodies against voltaged gated calcium channels in the peripheral nervous system.
42
What are the features of Lambert Eaton myasthenic syndrome?
* Limb girdle weakness * Repeated muscle use = strength * Hyporeflexia * Autonomic features: dry mouth, impotence
43
Which artery is occluded in Wallenberg syndrome? (lateral medullary syndrome)
Posterior inferior cerebellar artery
44
What are the features of Wallenberg syndrome?
* Ataxia * Nystagmus * Dysphagia * Ipsilateral Horner's syndrome * contralateral limb sensory loss
45
Which trinucleotide repeat is seen in Huntington's?
CAG
46
Which trinucleotide repeat is seen in Freidreich's ataxia?
GAA
47
Which trinucleotide repeat is seen in myotonic dystrophy?
CTG
48
Which chromosome is the Huntington gene located on?
Chromosome 4
49
What are the causes of gingival hyperplasia?
* Ciclosporin * Phenytoin * Calcium channel blocker (nifedipine) * AML
50
Which chromosome is DMPK gene located?
Chromosome 19
51
Which chromosome is the ZFN9 gene located (DM2)
Chromosome 3
52
What are the features of Myotonic dystrophy?
* Autosommal dominant * dysarthria * Distal weakness * Diabetes * Frontal balding * Ptosis * Dysphagia
53
What are the features of NF2?
* Vestibular schwanomas * Intracranial schwanomas *
54
Which drugs cause peripheral neuropathy?
I AM Very Numbed I isoniazid A amiodarone M metronidazole V vincristine N nitrofurantoin
55
What are the features of Multi system atrophy?
* Parkinsonism * Autonomic dysfunction * Cerebellar symptoms
56
What are the cutaneous features of tuberous sclerosis?
* Ash leaf spots * Shagreen patches - roughened patches over the spine * Angiofibromas (over the nose * subungal fibromata * cafe - au - lait spots
57
What is the MoA of Phenytoin?
Binds to sodium channnels --> incresaes refractory period
58
What are the side effects of phenytoin?
* Gingival hyperplasia * Hirsutism * Megaloblastic anaemia * Peripheral neuropathy * Osteomalacia
59
What is the MoA of Sodium Valporate?
Increases GABA activity
60
What are the side effects of Sodium Valporate?
* Ataxia * Tremor * Weight gain * P450 inhibitor * Alopecia * Pancreatitis * Thrombocytopenia * Hyponatraemia
61
What is the treatment for excessive day time sleepiness in PD?
Modafinil
62
What is used to treat orthostatic hypotension in PD?
Midodrine (alpha adrenergic)
63
What is the MoA of Carbidopa + Benzirazide?
Decarboxylase inhibitor
64
What are the side effects of Levodopa?
* dry mouth * anorexia * palpitations * postural hypotension * psychosis * on-off effects * arrhythmias * N+V * reddish discolouration of urine on standing
65
What is the MoA of Ropinirole/Bromocriptine/Carbegoline/Apomorphine?
Dopamine receptor agonists
66
What drugs are ergot derived dopamine receptor agonists?
* Bromocriptine * Carbergoline
67
What are the side effects of ergot derived dopamine agonists (Carbergoline and Bromocriptine)?
* Pulmonary, retroperitoneal and cardiac fibrosis
68
What is the MoA of Selegiline?
MAO -B inhibitor --> inhibits breakdown of dopamine
69
What is the MoA of Entacapone?
COMT (Catechol - O- Methyl Transferase)- inhibitor
70
What drugs are used in the management of drug induced PD?
* Procyclidine * Benzotropine * Benzhexol Antimuscarinics
71
What is the MoA of Ondansetron?
5HT3 antagonists Works on CTZ in medulla oblongata
72
What is the mode of inheritance in Von-Hippel Lindau?
Autosommal dominant
73
Which chromosome is mutated in VHL syndrome?
Chromosome 3
74
What are the features of VHL?
* Cerebellar haemangiomas --> SAH * Retinal haemangiomas --> vitreous haemorrhage * Renal cysts * Extra renal cysts: Pancreas, hepatic * Risk of clear cell RCC
75
What are the features of neuroleptic malignant syndrome?
* pyrexia * autonomic lability * agitated confusion with delirium * muscle rigidity
76
What is the MoA of Dantrolene?
Decreases release of Ca from sarcoplasmic reticulum
77
What is the management of neuroleptic malignant syndrome?
Dantrolene
78
Where is the median fasiculus located?
Paramedian area of the midbrain and pons (CN III, IV + VI)
79
What are the features of Internuclear ophthalmoplegia?
* Horizontal disconjugate eye movement * Ipsilateral impaired eye adduction * Contralateral horizontal nystagmus on abduction
80
What is Grestsman syndrome?
Lesion of the dominant parietal lobe
81
What are the features of dominant parietal lobe lesions?
* Alexia * Acalculia * Finger agnosia * Right - left disorientation
82
What are the features of occipital lobe lesions?
* homonymous hemianopia with macula sparing * cortical blindness * visual agnosia
83
What are the features of temporal lobe lesions?
* Wernicke's aphasia - forms speech * superior homonymous quadrantopia * auditory agnosia * difficulty recognising faces
84
What are the features of frontal lobe lesions?
* Expressive (Brocas) aphasia * disinhibition * persevaration - inability to switch thoughts * anosmia * inability to generate lists
85
Which area of the brain is impaired in Korsakoff - wernickes encephalopathy?
Medial thalamus and mammillary bodies of the hypothalamus
86
What is the management of PD motor symptoms affecting QoL?
Levodopa
87
How long should a patient stop driving for following a TIA/Stroke?
1 month
88
How long should a patient stop driving for following multiple TIAs?
3 months
89
Where is Brocas area located?
Left inferior temporal gyrus (dominant side in right handed individuals)
90
What is the standard treatment time for thrombectomy?
6 hours
91
Which area of the spinal cord is affected in subacute degeneration of the spinal cord?
posterior and lateral columns (corticospinal tracts) of the spinal cord
92
Which nerve root is damaged in Klumpke's paralysis?
T1
93
Which nerve root is damaged in Erb-Duchenne paralysis?
C5/6
94
How to manage BPH with both storage and voiding symptoms despite initial management?
an antimuscarinic (anticholinergic) drug such as tolterodine or darifenacin may be tried
95

MRCP PART 1 (9 decks)

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