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AKT > Neurology 2 > Flashcards

Neurology 2 Flashcards

1
Q

Motor neuron disease
Upper/lower
Age of onset

Features (4)

A

Both upper and lower motor neuron signs
>40yo

Fasciculations
Absence of sensory signs
Mixture of upper and lower signs
Wasting of small hand muscles

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2
Q

Features NOT seen in motor neuron disease (3)

A

No cerebellar signs
Doesn’t impact external ocular muscles
No sensory signs

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3
Q

Examples of motor neuron disease (3)

A

Amyotrophic lateral sclerosis
Progressive muscular atrophy
Bulbar palsy

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4
Q

Diagnosis of MS

A

Two or more relapses
OR
Two or more lesions
OR
One lesion with reasonable historical evidence of prev relapse

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5
Q

What is Uhthoff’s phenomenon

A

Worsening of vision following a rise in body temperature

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5
Q

Acute relapse of MS mx

A

High dose steroids 5/7 (PO or IV methylpred)

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6
Q

Mx for reducing the risk of relapse in MS (1)
Give five examples

A

DMARDS
1. natalizumab
2. ocrelizumab
3. fingolimod
4. beta-interferon
5. glatiramer acetate

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7
Q

MS symptomatic management
Fatigue (2)

A
  1. Amantadine
  2. CBT/ mindfulness
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8
Q

MS symptomatic management
Spasticity
1st line (2)
2nd line (3)
3rd line (1)

A
  1. Baclofen/ gabapentin
  2. Diazepam/ dantrolene/ tizanidine
  3. PT
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9
Q

MS symptomatic management
Bladder dysfunction
Ix (1)
If sig residual volume (1)
If not (1)

A

US
If significant residual volume –> intermittent self catheterisation
If no significant residual volume –> anticholinergics

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10
Q

MS symptomatic management
Oscillopsia
Mx (1)

A

Gabapentin

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11
Q

Good prognosis features for MS (6)

A

Female
Young age of onset
Relapsing remitting
Sensory sx only
Long interval between first two relapses
Complete recovery between relapses

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12
Q

Multiple system atrophy
Features (3)

A

Parkinsonism
Autonomic dysfunction e.g erectile dysfunction, postural hypotension, atonic bladder
Cerebellar signs

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13
Q

Myasthenia gravis
What is it?

A

Autoimmune disorder resulting in antibodies to acetylcholine receptors

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14
Q

Myasthenia gravis features (4)

A
  1. Extraocular + proximal muscle weakness
  2. Ptosis
  3. Dysphagia
  4. Diplopia
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14
Q

Myasthenia gravis
Associations (3)

A

Thymomas
Pernicious anaemia
Autoimmune thyroid disorders

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15
Q

Myasthenia gravis
Ix (4)

A

EMG
CT thorax to exclude thymoma
CK normal
Autoantibodies

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16
Q

Myasthenia gravis mx (3)

A
  1. Pyridostigmine
  2. Prednisolone, AZT, cyclosporin
  3. Thymectomy
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17
Q

Myasthenia crisis mx (2)

A

Plasmapheresis
IV immunoglobulins

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18
Q

Drugs that can exacerbate myasthenia gravis (4)

A

BB
Lithium
Phenytoin
Gent, macrolides, tetracyclines, quinolones, penicillamine

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19
Q

Triad for Wernicke’s encephalopathy

A

Ataxia
Encephalopathy
Ophthalmoplegia/nystagmus

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20
Q

Korsakoff’s extra symptoms (2)

A

Antero+retrograde amnesia
Confabulation

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21
Q

What is Von Hippel Lindau syndrome?

A

AD condition characterised by cysts/ benign tumours with potential for malignant transformation

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22
Q

Cerebellar haemangiomas
Extra-renal cysts
Retinal haemorrhages
Renal cysts
Phaeo
= which condition?

A

Von Hippel Lindau

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23
Q

Restless legs
Associations (4)

A

IDA
Uraemia
DM
Pregnancy

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24
Q

Restless legs mx (4)

A
  1. Walking/stretching/massaging
  2. Pramipexole/ ropinirole (dopamine agonists)
  3. Benzos
  4. Gabapentin
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25
Q

What is Reye’s syndrome?
Age
Features (4)

A

Severe, progressive encephalopathy affecting children
2yo

Preceding viral illness
Encephalopathy
Fatty infiltration of liver, kidney, pancreas
Hypoglycaemia

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26
Q

Management of acute seizures
1 month-1year
2year-11year
12-17years
Adult
Elderly

When can you repeat?

A

Rectal diazepam

1 month-1year 5mg
2year-11year 5-10mg
12-17years 10mg
Adult 10-20mg
Elderly 10mg

Once more, after 10-15 minutes

IV benzo if in hospital

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27
Q

Adverse effects of sodium valproate (5)

A

Teratogenic
Alopecia
Hepatotoxicity
Pancreatitis
Hyponatraemia

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28
Q

Define status epilepticus

A

Seizure lasting >5 minutes
OR
>= 2 seizures within a 5 minute period without the person returning to normal in between

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29
Q

Acute subdural haematoma is most commonly caused by?
What will the CT show? (2)

A

High impact trauma
Crescentic collection, not limited by suture lines
Hyperdense +/- midline shift

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30
Q

Chronic subdural haematoma
Who is at risk? (2)

How will the patient present?
CT

A

Elderly and alcoholics

Several week to month progressive history of confusion and reduced consciousness or neurological deficit

Crescentic shape not limited by suture lines but appear hypodense

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31
Q

Syringomyelia what is it?

Features (5)

Ix

A

Collection of CSF within the spinal cord

  1. Cape like (neck, shoulder arms) loss of sensation to temperature e.g pt burns hands without realising
  2. Spastic weakness
  3. Neuropathic pain
  4. Upgoing plantars
  5. Horner’s syndrome

MRI spine + brain

32
Q

Causes of syringomyelia (3)

A

Trauma
Tumours
Chiari malformation (strong association)

33
Q

Tension type headache
First line mx (3)
Prophylaxis (1)

A

First line: aspirin, paracetamol, NSAID

Prophylaxis 10 sessions of acupuncture over 5-8 weeks

34
Q

Down and out, ptosis + dilated pupil

Causes (4)

A

Third nerve palsy

  1. DM
  2. Vasculitis
  3. Cavernous sinus thrombosis
  4. Weber’s syndrome
35
Q

What is Weber’s syndrome?

A

Ipsilateral third nerve palsy, contralateral hemiplegia (caused by midbrain strokes)

36
Q

Thoracic outlet syndrome what is it?
Typical patient
Age
Usually precipitated by?

A

Disorder involving compression of brachial plexus, subclavian artery or vein

Thin, young woman, long neck and drooping shoulders
30-40
Trauma

37
Q

Features of neurogenic thoracic outlet syndrome (3)

A
  1. Painless muscle wasting of hand
  2. Nubmness and tingling of arm
  3. Cold hands, blanching or swellling
38
Q

Features of vascular TOS (2)

A
  1. Diffuse arm swelling with distended veins
  2. Painful arm secondary to artery compression (claudication), ulceration, gangrene
39
Q

Thoracic outlet syndrome Ix (6)

A

XR cervical spine/ CXR
CT/MR
Venography/ angiography

40
Q

Neurofibromatosis
NF1 chrm?
NF2 chrm?

A

NF1 chrm 17
NF2 chrm 22

41
Q

NF1 features (5)

A

Cafe au lai spots
Axillary groin freckles
Iris haematomas (lisch nodules)
Scoliosis
Pheochromo

42
Q

NF2 features (2)

A

Bilateral vestibular schwannomas
Multiple intracranial schwannomas

43
Q

Ash leaf spots
Shagreen patches
Epilepsy
Developmental problems + intellectual impairment
Adenoma sebaceum (angiofibromas) butterfly distribution over nose

= which condition?

A

Tuberous sclerosis

44
Q

Myotonic dystrophy what is it?
Age
Distal or proximal weakness more prominent in each?
DM1 chrm?
DM2 chrm?

A

Inherited myopathy affecting skeletal, cardiac and smooth muscle
20-30yo
DM1 chrm 19 distal weakness more prominent
DM2 chrm 3 proximal weakness more prominent

45
Q

Myotonic dystrophy features (5)

A

Myotonic facies (long haggard appearance)
Frontal balding
Bilateral ptosis
Cataracts
Dysarthria

45
Q

Long haggard appearance
Frontal balding
Bilateral ptosis
Cataracts
Dysarthria
= which condition?

A

Myotonic dystrophy

46
Q

Mild mental impairment
DM
Testicular atrophy
Heart block/ cardiomyopathy
Dysphagia
= which condition

A

Myotonic dystrophy

47
Q

Neuroleptic malignant syndrome
Occurs when?
Features (4)

A

Hours to days of starting an antipsychotic

Pryexia
Muscle rigidity
Autonomic lability (HTN, tachycardia, tachypnoea)
Delirium

48
Q

Neuroleptic malignant syndrome
Ix (3) (all bloods findings)

A

Raised CK
AKI
Leukocytosis

49
Q

Neuroleptic malignant syndrome
Mx (2)

A

Stop antipsychotic
IVF

50
Q

Differences between neuroleptic malignant syndrome and serotonin syndrome

Reflexes
Pupils
Onset
Other feature

A

Serotonin syndrome
Increased reflexes
Clonus
Dilated pupils
Faster onset (hours)

Neuroleptic malignant syndrome
Reduced reflexes
Lead pipe rigidity
Normal pupils
Hours to days onset

51
Q

Neuropathic pain mx
1st line (4)

A
  1. Amitriptyline
  2. Duloxetine
  3. Gabapentin
  4. Pregabalin
52
Q

Neuropathic pain
Rescue therapy (1)
Localised neuropathic pain (1)

A

Tramadol
Topical capsaicin

53
Q

Normal pressure hydrocephalus
Triad of symptoms

Mx (1)

A

Urinary incontinence
Dementia
Gait abnormality

Mx shunting

54
Q

Parkinson’s disease classic triad of features

Drug induced parkinsonism features (2)
Which two of the triad are not usually present?

A

Bradykinesia
Tremor
Rigidity

Motor symptoms are generally rapid onset and bilateral
Rigidity and rest tremor are uncommon

55
Q

Parkinson’s mx
1st line management (2)

A

If motor sx are affecting the patient’s QOL = levodopa

Otherwise DA, levodopa or MAO-B inhib

56
Q

Levodopa should always be combined with?

SE (5)

A

Decarboxylase inhibitor

Dry mouth
Anorexia
Palpitations
Postural hypotension
Psychosis

57
Q

Dopamine agonists
Examples (2)

SE (4)

A

Bromocriptine
Cabergoline

SE
Pulmonary/ retroperitoneal/ cardiac fibrosis
Excessive daytime somnolence
Hallucinations
Nasal congestion

58
Q

MAO-B inhibitors
Example (1)

A

Selegiline

59
Q

Amantadine
SE (4)

A

Ataxia
Slurred speech
Confusion
Livedo reticularis

60
Q

COMT inhibitors
Examples (2)
When is it used?

A

Entacapone, tolcapone
In conjunction with levodopa

61
Q

Mx of drug induced Parkinsonism (2)

A

Anti-muscarinics e.g procyclidine & benzotropine

62
Q

Mx of drooling in PD?

A

Glycopyronium

63
Q

Orthostatic hypotension in PD mx (1)

A

Midodrine

64
Q

Causes of peripheral neuropathy sensory (4)

A

Alcoholism
B12 deficiency
DM
Uraemia

65
Q

Peripheral neuropathy motor loss causes (4)

A

Guillian Barre
Porphyria
Lead poisoning
Charcot Marie Tooth

66
Q

When to check trough levels of phenytoin?

ignore

A

Dose change
Suspected toxicity
Detection of non adherence

67
Q

Phenytoin SE (6)

A
  1. Teratogenic (cleft palate, congenital heart disease)
  2. Diplopia
  3. Nystagmus
  4. Gingival hyperplasia
  5. Megaloblastic anaemia
  6. Peripheral neuropathy
68
Q

Reflexes nerve roots
Ankle
Knee
Biceps
Triceps

A

S1-S2
L3-L4
C5-C6
C7-C8

68
Q

Reflexes nerve roots
Ankle
Knee
Biceps
Triceps

A

S1-S2
L3-L4
C5-C6
Ct-C8

69
Q

Topiramate
COCP UKMEC
Implant UKMEC
Depot
IUS

A

3
2
Depot + IUS not affected by topiramate

70
Q

Topiramate
SE (4)

A

Acute myopia/ secondary angle closure glaucoma
Reduced appetite and weight loss
Paraesthesia
Foetal malformations

71
Q

TIA
Who should get a specialist review?
When to admit (1)
When to get an assessment within 24 hours
When to get an assessment within 7 days

A

> 1 TIA (e.g crescendo TIA) - admit
If suspected TIA in the last 7 days - arrange urgent assessment within 24 hours
If >1 week ago for specialist assessment within 7 days

72
Q

TIA mx (2)

A
  1. Aspirin 300mg immediately + clopi
    OR
  2. Aspirin + dipyridamole (if clopi not tolerated)
73
Q

Trigeminal neuralgia mx (2)

A
  1. Carbamazepine
    If not effective - refer to neurology
74
Q

Features of acoustic neuromas (4)
Mx (2)

A

Vertigo
Tinnitus
Hearing loss
Absent corneal reflex

Urgent referral to ENT
Surgery/ RT

75
Q

Left hemianopia means visual field defect to the left which means a lesion where?

A

Right optic tract

76
Q

Homonymous quadrantanopias

A

PITS
Parietal - inferior
Temporal - superior

AKT (52 decks)

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