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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
Q

What are the genetics of Ataxia telangiectasia?

A

Autosommal recessive
Defect in the ATM gene –> codes DNA repair enzymes

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26
Q

What are the features of Ataxic telangiectesia?

A
  • Onset 1-5 years
  • Telangiectesia
  • Recurrent chest infections - IgA deficiency
  • increased risk of lymphoma and leukemia
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27
Q

What are the features of conductive dysphasia?

A
  • Fluent speech
  • Poor repetition
  • Comprehension intact
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28
Q

What are the features of Broca’s dysphasia? (expressive aphasia)

A

Lesion in inferior frontal gyrus

  • Non fluent speech
  • Laboured and halting
  • Comprehension intact
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29
Q

Which artery supplies Broca’s area?

A

Superior division of the left MCA

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30
Q

What are the features of Wernicke’s aphasia?

A
  • Lesion of superior frontal gyrus
  • Word salad
  • Neologisms
  • Comprehension is impaired
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31
Q

What causes conduction aphasia?

A

Lesion affecting the arcuate fasiculus

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32
Q

What are the features of CNIII palsy?

A
  • Eye is deviated ‘down’ and ‘out’
  • ptosis
  • dilated pupil
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33
Q

What are the causes of CNIII palsy?

A
  • Diabetes
  • Posterior communicating aneurysm
  • Raised ICP
  • SLE
  • Cavernous sinus thrombosis
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34
Q

How long can patients not drive post 1st seizure with normal MRI and EEG?

A

6 months

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35
Q

How long can patients with provoked established seizures not drive for?

A

12 months

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36
Q

What time period do patients have to be seizure free for to have full licenses established?

A

5 years

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37
Q

What are the findings of extradural haematoma on CT?

A

biconvex or lens-shaped hyperdense collection

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38
Q

Which type of MND carries the worse prognosis?

A

Progressive bulbar palsy

39
Q

What are the causes of peripheral neuropathy with motor loss?

A

(CLD Has Poor ProGnosis)
* CIDP
* Lead poisoning
* Diptheria
* HSMN
* Porphyria
* GBS

40
Q

What are the causes of peripheral neuropathy with sensory loss?

A

VALUeD
* Vit B12
* Alcohol, Amyloidosis
* Leprosy
* Uraemia
* Diabetes

41
Q

What is the cause of Lambert Eaton myasthenic syndrome?

A

Antibodies against voltaged gated calcium channels in the peripheral nervous system.

42
Q

What are the features of Lambert Eaton myasthenic syndrome?

A
  • Limb girdle weakness
  • Repeated muscle use = strength
  • Hyporeflexia
  • Autonomic features: dry mouth, impotence
43
Q

Which artery is occluded in Wallenberg syndrome? (lateral medullary syndrome)

A

Posterior inferior cerebellar artery

44
Q

What are the features of Wallenberg syndrome?

A
  • Ataxia
  • Nystagmus
  • Dysphagia
  • Ipsilateral Horner’s syndrome
  • contralateral limb sensory loss
45
Q

Which trinucleotide repeat is seen in Huntington’s?

46
Q

Which trinucleotide repeat is seen in Freidreich’s ataxia?

47
Q

Which trinucleotide repeat is seen in myotonic dystrophy?

48
Q

Which chromosome is the Huntington gene located on?

A

Chromosome 4

49
Q

What are the causes of gingival hyperplasia?

A
  • Ciclosporin
  • Phenytoin
  • Calcium channel blocker (nifedipine)
  • AML
50
Q

Which chromosome is DMPK gene located?

A

Chromosome 19

51
Q

Which chromosome is the ZFN9 gene located (DM2)

A

Chromosome 3

52
Q

What are the features of Myotonic dystrophy?

A
  • Autosommal dominant
  • dysarthria
  • Distal weakness
  • Diabetes
  • Frontal balding
  • Ptosis
  • Dysphagia
53
Q

What are the features of NF2?

A
  • Vestibular schwanomas
  • Intracranial schwanomas
    *
54
Q

Which drugs cause peripheral neuropathy?

A

I AM Very Numbed
I isoniazid
A amiodarone
M metronidazole
V vincristine
N nitrofurantoin

55
Q

What are the features of Multi system atrophy?

A
  • Parkinsonism
  • Autonomic dysfunction
  • Cerebellar symptoms
56
Q

What are the cutaneous features of tuberous sclerosis?

A
  • Ash leaf spots
  • Shagreen patches - roughened patches over the spine
  • Angiofibromas (over the nose
  • subungal fibromata
  • cafe - au - lait spots
57
Q

What is the MoA of Phenytoin?

A

Binds to sodium channnels –> incresaes refractory period

58
Q

What are the side effects of phenytoin?

A
  • Gingival hyperplasia
  • Hirsutism
  • Megaloblastic anaemia
  • Peripheral neuropathy
  • Osteomalacia
59
Q

What is the MoA of Sodium Valporate?

A

Increases GABA activity

60
Q

What are the side effects of Sodium Valporate?

A
  • Ataxia
  • Tremor
  • Weight gain
  • P450 inhibitor
  • Alopecia
  • Pancreatitis
  • Thrombocytopenia
  • Hyponatraemia
61
Q

What is the treatment for excessive day time sleepiness in PD?

62
Q

What is used to treat orthostatic hypotension in PD?

A

Midodrine (alpha adrenergic)

63
Q

What is the MoA of Carbidopa + Benzirazide?

A

Decarboxylase inhibitor

64
Q

What are the side effects of Levodopa?

A
  • dry mouth
  • anorexia
  • palpitations
  • postural hypotension
  • psychosis
  • on-off effects
  • arrhythmias
  • N+V
  • reddish discolouration of urine on standing
65
Q

What is the MoA of Ropinirole/Bromocriptine/Carbegoline/Apomorphine?

A

Dopamine receptor agonists

66
Q

What drugs are ergot derived dopamine receptor agonists?

A
  • Bromocriptine
  • Carbergoline
67
Q

What are the side effects of ergot derived dopamine agonists (Carbergoline and Bromocriptine)?

A
  • Pulmonary, retroperitoneal and cardiac fibrosis
68
Q

What is the MoA of Selegiline?

A

MAO -B inhibitor –> inhibits breakdown of dopamine

69
Q

What is the MoA of Entacapone?

A

COMT (Catechol - O- Methyl Transferase)- inhibitor

70
Q

What drugs are used in the management of drug induced PD?

A
  • Procyclidine
  • Benzotropine
  • Benzhexol
    Antimuscarinics
71
Q

What is the MoA of Ondansetron?

A

5HT3 antagonists
Works on CTZ in medulla oblongata

72
Q

What is the mode of inheritance in Von-Hippel Lindau?

A

Autosommal dominant

73
Q

Which chromosome is mutated in VHL syndrome?

A

Chromosome 3

74
Q

What are the features of VHL?

A
  • Cerebellar haemangiomas –> SAH
  • Retinal haemangiomas –> vitreous haemorrhage
  • Renal cysts
  • Extra renal cysts: Pancreas, hepatic
  • Risk of clear cell RCC
75
Q

What are the features of neuroleptic malignant syndrome?

A
  • pyrexia
  • autonomic lability
  • agitated confusion with delirium
  • muscle rigidity
76
Q

What is the MoA of Dantrolene?

A

Decreases release of Ca from sarcoplasmic reticulum

77
Q

What is the management of neuroleptic malignant syndrome?

A

Dantrolene

78
Q

Where is the median fasiculus located?

A

Paramedian area of the midbrain and pons (CN III, IV + VI)

79
Q

What are the features of Internuclear ophthalmoplegia?

A
  • Horizontal disconjugate eye movement
  • Ipsilateral impaired eye adduction
  • Contralateral horizontal nystagmus on abduction
80
Q

What is Grestsman syndrome?

A

Lesion of the dominant parietal lobe

81
Q

What are the features of dominant parietal lobe lesions?

A
  • Alexia
  • Acalculia
  • Finger agnosia
  • Right - left disorientation
82
Q

What are the features of occipital lobe lesions?

A
  • homonymous hemianopia with macula sparing
  • cortical blindness
  • visual agnosia
83
Q

What are the features of temporal lobe lesions?

A
  • Wernicke’s aphasia - forms speech
  • superior homonymous quadrantopia
  • auditory agnosia
  • difficulty recognising faces
84
Q

What are the features of frontal lobe lesions?

A
  • Expressive (Brocas) aphasia
  • disinhibition
  • persevaration - inability to switch thoughts
  • anosmia
  • inability to generate lists
85
Q

Which area of the brain is impaired in Korsakoff - wernickes encephalopathy?

A

Medial thalamus and mammillary bodies of the hypothalamus

86
Q

What is the management of PD motor symptoms affecting QoL?

87
Q

How long should a patient stop driving for following a TIA/Stroke?

88
Q

How long should a patient stop driving for following multiple TIAs?

89
Q

Where is Brocas area located?

A

Left inferior temporal gyrus (dominant side in right handed individuals)

90
Q

What is the standard treatment time for thrombectomy?

91
Q

Which area of the spinal cord is affected in subacute degeneration of the spinal cord?

A

posterior and lateral columns (corticospinal tracts) of the spinal cord

92
Q

Which nerve root is damaged in Klumpke’s paralysis?

93
Q

Which nerve root is damaged in Erb-Duchenne paralysis?

MRCP PART 1 (3 decks)

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