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3a > Neurology > Flashcards

Neurology Flashcards

1
Q

what might you give a patient with LOC?

A

ajmaline to look for Brugada, not necessarily brought on by exercise

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2
Q

what are the causes of syncope?

A

cardiogenic
vasovagal (stress, prolonged standing)
orthostatic hypotension
subclavian steal

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3
Q

what lobe is memory disturbance associated with?

A

temporal

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4
Q

what are all the possible features of a frontal focal seizure?

A

jacksonian march
dysphasia
posturing

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5
Q

SEs of sodium valproate

A

N&V, diarrhoea, weight gain, AED hypersensitivity syndrome

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6
Q

what are the features of antiepileptic hypersensitivity syndrome?

A

fever, rash, hepatitis

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7
Q

what can phenytoin be used for and what are its side effects?

A

for tonic clonic only, ataxia, hypersensitivity

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8
Q

what are the symptoms of encephalitis?

A

altered mental state, headache, fever, LOC, focal neuro signs

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9
Q

what is the triad of symptoms found in Huntington’s disease?

A

emotional/behavioural disturbance
movement disorder
cognitive difficulty

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10
Q

what are anterior horn cells?

A

somatic motor neuron that has its cell body in the grey matter of the spinal cord

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11
Q

what is entacapone?

A

catechol-O-methyltransferase inhibitor, stops peripheral (sympathetic) SEs of Parkinsons drugs

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12
Q

what are the side effects of Parkinson’s drugs?

A

think they become more psychotic and more sympathetic so: hypotension, dyskinesias, visual hallucinations

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13
Q

how is tourettes treated?

A

risperidone, haloperidol

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14
Q

what are the tics in tourettes

A

voluntary but unwanted tics: tonic clonic, dystonic or phonic

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15
Q

what is LEMS?

A

a paraneoplastic syndrome where there are antibodies to the pre synapse, this means that with exercise-responses get better and reflexes are decreased (they’re blocked)

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16
Q

why aren’t reflexes affected in MG?

A

there is not time for the max concentration to be reached and therefore for the response to be fatigued

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17
Q

what is the peek sign

A

in MG, where you pull against closed eyelids and they start to open

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18
Q

Riana is a 42 yo who has discovered herself and is travelling to Ghana in 2 weeks but her AChR and MUSK antibodies are positive, what are you worried about?

A

Quinine prophylaxis and pregnancy worsening myasthenic condition

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19
Q

what other than MG could cause fatiguable weakness?

A

SLE, Takayasu’s arteritis, botulism, polymyositis

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20
Q

what is the main differential in myasthenic crisis?

A

cholinergic crisis-an overtreatment

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21
Q

how do you treat myasthenic crisis?

A

monitor FVC-give ventilatory support
IVIg
plasmapheresis

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22
Q

group the symptoms of MS

A

motor: spastic weakness, gait problems, slurring of speech, hyperreflexia
sensory: tingling, numbness, trigemminal neuralgia, muscle cramps, pain
autonomic: ED, incontinence
cerebellar: ataxia, vertigo, dizziness
3: optic neuritis, odd sensory sx, fatigue

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23
Q

what might Ronald bear the bad news of?

A

MS-clinical diagnosis is through the McDonald criteria

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24
Q

what are the differentials for an MS presentation?

A

UMN pathologies: Sjogrens (autonomic), syphilis, AIDS

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25
Q

what might lead to an MS relapse?

A

exercise, stress, temperature

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26
Q

Sandra has MS attacks, her symptoms get worse between attacks, what clinical syndrome does she have?

A

relapsing progressive

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27
Q

Bob has secondary progressive MS, what does this mean?

A

initially he will have relapsing remitting attacks with steady states in between, after this period there will be an attack which is followed by steadily worsening symptoms

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28
Q

Cindy has been experiencing spastic weakness in her legs and has bilateral Babinski +ves, her MRI shows spinal lesions only, what should be attempted?

A

diagnosis of acute transverse myelitis, this has a good prognosis with plasmapheresis

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29
Q

what management could be used for spasticity in a patient with a UMN problem?

A

physio, baclofen, diazepam, phenol, botulinum toxin

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30
Q

if a patient has bowel incontinence, what is the best form of management?

A

proper history and MRI to rule out cauda equina, then loperamide if a result of underlying condition

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31
Q

what can carbemazepine be used for?

A

focal and generalised seizures (NOT abscence) and trimgeminal neuralgia

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32
Q

what medication would you give to 2 month old child with meningitis?

A

IV cefotaxime

dexamethosone if raised ICP signs

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33
Q

what should you give to the parents of a child with meningitis?

A

rifampicin or ciprofloxacin

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34
Q

what increases the risk of a cerebral abscess?

A

cyanotic heart disease (less oxygen to brain), HIV/AIDS, dental procedures, mastoiditis, otitis media, skull fracture, endocarditis, bronchiectasis.

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35
Q

what pathogens may be involved in cerebral abscess?

A

Staphylococcus aureus, strep, listeria
Aspergillis, candida, cryptococcus
Toxoplasmosis gondii

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36
Q

Jenna is hoping to have a child, unfortunately she has developed focal seizures, UMN signs, altered personality and infectious prodrome, what pathogen are you most worried about for her possible unborn child?

A

Toxoplasmosis gondii, patient should be treated with pyrimethamine and sulfadiazine

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37
Q

Martin, a known epileptic, has been seizing for over 30mins continuously, what are you going to do with him?

A

Stabalise using O2 and IV access, monitor regularly

Lorezepam (?status) or phenytoin; if this doesn’t work then GA

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38
Q

when Gill feels groggy, she sees misshapen monkey brains come out of her house plants, what is happening here?

A

GROG-hypnoGOGnic hallucinations, need to consider narcolepsy so ask:
(loss of tone) cataplexy; night time wakefulness; just body asleep with fear and hallucinations (sleep paralysis).
Mx: modafinil

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39
Q

Kate has cataplexy, Catherine has catalepsy, which will move slowly when her arms are placed above her head?

A

Catherine-waxy flexability

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40
Q

what drugs are good alternatives for benzodiazepines for insomnia?

A

z drugs-zopiclone or zolpidem-should also only be used short term though

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41
Q

John has had a stroke, he is weak in his right arm, what will happen in a few hours?

A

the weakness will become spastic, it is a UMN problem

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42
Q

Alex comes in with wide based ataxia, confusion and a headache, what are your differentials and what investigations would you do?

A 
Wernicke's encephalopahty-thiamine
cerebellar stroke-MRI (better for cerebellum), clotting profile, anaemia, polycythaemia, WBC (infection can>stroke)
bleed/trauma-CT
infection-blood cultures
hypoglycaemic attack-glucose
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43
Q

Brian is experiencing sudden onset weakness of his right leg, what could be happening?

A

ACA stroke (lower limbs), hemplegic migraine, focal seizure

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44
Q

what kind of stroke would give contralateral homonymous hemianopia?

A

MCA-through the optic radiation after the chiasm or PCA

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45
Q

differentials to cerebellar stroke?

A

gluten ataxia, hypoglycaemia, middle ear infection, thiamine deficiency, CO posioning

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46
Q

what artery is affected to give locked in syndrome?

A

basilar

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47
Q

what is the picture given in anterior cord blockage?

A

complete motor paralysis beneath the level but spinothalamic still intact

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48
Q

what supportive therapy does someone who has just had thrombolysis need?

A

no IMs and BP monitoring

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49
Q

list the syndromes that only affect the motor system

A 
polio
MG
Bell's
polymyositis
myopathy
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50
Q

what investigations should you do in someone with suspected Bell’s?

A

FBC, glucose, borrelia antibodies (Lyme), CT

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51
Q

name cardiac conditions that would predispose to an embolus forming

A 
patent foramen ovale
IE
AF
MI causing septal disease
valve disease
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52
Q

what worsens a Parkinson’s tremor?

A

rest, stress, tired

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53
Q

what should be started first in Parkinson’s treatment?

A

dopamine receptor agonist: ropinirole, pramipexole, bromocriptine, cabergoline

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54
Q

pattern given by cerebral hemisphere infarct?

A

dysphasia, contralateral hemiparesis, homonymous hemianopia

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55
Q

what is the most common cause of metabolic delirium?

A

low sodium, also hypoglycaemia, renal failure, liver failure.

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56
Q

what investigations should you do in someone presenting with delirium?

A 
ECG-for MI
infection screen
FBC, U&Es, clotting, LFT, TFT, glucose
CT
post void bladder scan
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57
Q

what commonly used drugs may lead to headache, drowsiness, fatigue, coma?

A

NSAIDs leading to water retention and so hyponatraemia

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58
Q

what is Luria’s 3 step test?

A

differentiating between AD and FTD

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59
Q

what test can be used to differentiate FTD, AD and LBD more accurately?

A

SPECT scan

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60
Q

what is the picture in Alz?

A

word finding difficulties and short term memory leading to mood changes, loss of insight and loss of reasoning

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61
Q

what is LBD?

A

alpha synuclein protein

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62
Q

what screening tool can be used for frontotemporal?

A

Lund-Manchester

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63
Q

what are the 5 features of korsakoffs?

A 
ophthalmoplegia
ataxia
confusion
anterograde amnesia
confabulation
this is chronic B1-thiamine
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64
Q

what is punch drunk syndrome also called?

A

chronic traumatic encephalopathy

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65
Q

define osteoporosis

A

imbalance between bone resorption and bone remodelling causing reduced bone density

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66
Q

what does it mean if ataxia is worse on closing eyes?

A

it is not a cerebellar lesion but DCML

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67
Q

what does DANISH stand for

A 
dysdiadochokinesis
ataxia
nystagmus
intention tremor
slurring of speech
hypotonia
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68
Q

what investigation will confirm your suspiscion of a patient being an alcoholic who is not currently intoxicated

A

raised MCV

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69
Q

tom and his wife are 62, who is more likely to have MG?

A

before 50-sue, after-tom

70
Q

after the glove and stocking distribution, what nerves will be affected in peripheral neuropathy

A

anterior thoracic nerves, anterior chest wall

71
Q

which peripheral neuropathy will not affect the feet first and why?

A

B12 deficiency affects the hands first bc it is more acute

72
Q

what does MUSK stand for?

A

muscle specific kinase

73
Q

what is PS1 and PS2 asso with?

A

along with APP-Alzheimer’s

74
Q

what anti-sickness medication can be used for the nausea caused by antiparkinsonian drugs?

A

domperidone, the rest are dopamine blockers

75
Q

what does it suggest if a parkinsonian patient presents early?

A

it could be DLB-a Parkinson’s plus syndrome

76
Q

what medications are used for tourette’s

A

risperidone

haloperidol

77
Q

what muscles typically waste in ALS?

A

thenar

tibialis anterior

78
Q

is bulbar UMN or LMN

A

LMN, that’s why PBP is LMN only, pseudobulbar is also called corticobulbar so it is UMN

79
Q

give the classic signs of myositis?

A

proximal weakness
myalgia and arthalgia
dysphagia and dysphonia

80
Q

what symptoms additional to myositis does dermatomyositis have?

A

shawl sign-a macular rash
heliotrope (lilac) rash on eyelids with oedema
Gottron’s papules (on knuckles)

81
Q

what types of cancer are most likely to have caused a paraneoplastic syndrome of myositis

A

ovarian
lung
pancreatic
bowel

82
Q

what is suggested if muscle pain gets worse on exercise?

A

ischaemia or a metabolic myopathy such as McArdle’s (genetic)

83
Q

where do LMN signs start?

A

anterior horn cells

84
Q

what is pyradimal weakness?

A 
no fasciulation
increased reflexes
no wasting
hypertonia
spastic
85
Q

what blood conditions could lead to an ischaemic stroke?

A

polycythaemia
sickle cell
myeloma

86
Q

what gender are more likely to get strokes

A

female

87
Q

where are Broca’s and Wernicke’s supplied by respectively?

A

both MCA!

88
Q

what kind of dysphagia will damage to Broca’s give?

A

expressive dysphasia-cannot express yourself but can understand

89
Q

what are the electrolyte causes of generalised muscle weakness?

A

hypercalcaemia, hyperkalaemia, hypocalaemia

90
Q

how do you treat hyperkalaemia

A

polystyrene sulfonate resin, insulin, salbutamol

91
Q

how do you treat hypokalaemia?

A

oral supplement or IV after normalising magnesium

92
Q

what autonomic symptoms do you get in GBS?

A

sweating, increased pulse, urinary retention, abnormal BP, arrythmia

93
Q

what conditions is bell’s associated with?

A

pregnancy, diabetes, infections, brainstem lesions

94
Q

pattern of weakness with myelopathy?

A

UMN below level LMN at level
bilat pain
gradual onset
spastic and hyperreflexic legs (unless shock)

95
Q

pattern of weakness with radiculopathy?

A

LMN signs

pain is below the lesion

96
Q

causes of spinal cord compression?

A 
bony mets
disc protrusion
myeloma
TB
abscess
97
Q

name of the drug used in SAH to prevent vasoaspasm

A

nimodipine

98
Q

what common medication is contraindicated in people with migraines?

A

COCP

99
Q

when will LOC happen in epilepsy

A

only if it is a generalised attack, loss of awareness can occur in partial seizures

100
Q

what 2 things can increase the frequency of epileptic attacks?

A

sleep depravation and alcohol

101
Q

what will happen if a seizure is temporal?

A

complex movements, aura, a rising sensation

102
Q

what has the opposite treatment to abscence seizures

A

don’t give carbemazepine in abscence seizures so trigemminal neuralgia because that is treated with cb

103
Q

common causes of coma

A

hypoxia
intoxication
bleeds>mass lesions

104
Q

what does the IV nerve control?

A

superior oblique, palsy will lead to vertical diplopia

105
Q

what condition is Charles Bonnet asso with?

A

macular degeneration

106
Q

what is amblyopia?

A

lazy eye, no signals from that eye are interpreted so don’t see double but some of visual cortex doesn’t develop

107
Q

what symptoms accompanying dizziness point to a non ear cause?

A

LOC-seizure
hearing loss-labyrinthine or VIII problem
lightheadedness-anaemia
palpitations-arrythmias

108
Q

what causes ototoxicity and what does it look like?

A

drugs-aminoglycosides, loop diuretics, cisplatin

causes deafness, sometimes also vertigo

109
Q

what can set off benign paroxysmal positional vertigo?

A

flights
infection
trauma

110
Q

what is an acoustic neuroma?

A

vestibular schwannoma

present with unilateral hearing loss and later-vertigo

111
Q

what is the triad seen in menieres disease?

A

tinnitus
sensorineural hearing loss (may be permanent or temporary)
vertigo

112
Q

what are the symptoms of ramsay hunt syndrome?

A 
tinnitus
painful vesicular rash across face
ipsilateral facial palsy
dry mouth and eyes
hearing loss
113
Q

what picture will central retinal vein occlusion give?

A

blurring which starts on waking, will not give full loss of vision as with artery

114
Q

what visual defect is associated with GCA

A

anterior ischaemic optic neuropathy, so seek out other symptoms with sudden onset reduced acuity that affects either upper or lower half of visual field

115
Q

what 2 pathologies should be ruled out with optic neuritis?

A

B12 deficiency

MS

116
Q

what is the clinical picture with optic neuritis

A 
sub-acute onset
pain behind the eye
reduced acuity
associated dull headache
reduced visual fields
117
Q

what is the clinical picture with acute angle glaucoma

A 
sudden onset excruciating pain around eye
N&V
blurring
pupil fixed and dilated
eye will appear red
118
Q

what measures the pressure in the eye

A

tonometry

119
Q

how would you go about reducing the pressure in the eye?

A

miosis (constriction) so pilocarpine

120
Q

what is glaucoma?

A

raised intraocular pressure with damage to the optic nerve

121
Q

what is the striatum?

A

caudate and putamen

122
Q

how is OSA categorised?

A

epworth sleepiness scale

123
Q

what cerebral artery is essential for speech?

A

the dominant side MCA

124
Q

what area of the brain does the inferior visual field go through?

A

parietal

PITS-parietal inferior; temporal superior

125
Q

what conditions is myasthenia associated with?

A

autoimmune conditions: pernicious anaemia, coeliac, SLE, sjogrens, thyroid, psoriasis

126
Q

what age does myasthenia gravis present?

A

before 40

127
Q

name a side effect of carbemazepine

A

hyponatraemia

128
Q

side effect of lamotrigine

A

hypersensitivity

129
Q

side effect of leviterceteram

A

suicidal thoughts (think of mothers and mental health)

130
Q

side effects of sodium valproate

A

hepatotoxicity, ataxia, encephalopathly, tereatogenecity

131
Q

what AEDs can be used for abscence seizures

A

sodium valproate and lamotrigine

132
Q

how can status epilepticus be managed?

A

1) rectal diazepam or buccal midazolam
2) repeat
3) IV lorazepam
4) 30min later>phenytoin

133
Q

what is internuclear opthalmoplgegia?

A

when one eye cannot abduct as quickly so while the other is waiting, it does nystagmus, this is associated with MS. damage to the medial longditudinal fasciculus

134
Q

what is Marcus Gunn pupil?

A

relative afferant pupillary defect- where shining light in the dysfunctioning eye doesn’t constrict the pupils as much as it should-cannot detect the light as much
asso with optic neuritis
will happen with lesions anterior to the optic chiasm (retinal detachment or optic neuritis)

135
Q

what is argyll robertson pupil?

A

prostitutes, small, they accomodate but don’t react-indicitive of neurosyphilis or diabetic retinopathy

136
Q

what muscle groups are affected in myasthenia gravis?

A

proximal

137
Q

what was the tensilon test associated with?

A

cardiac arrest

138
Q

what investigation must you undertake following the diagnosis of myasthenia gravis?

A

CT thorax for thymoma

139
Q

what could be the cause of an embolic stroke?

A

vascular: atheroma, cardiac mural, left atrial

140
Q

how much time off driving do you need to take for a cerebrovascular accident?

A

TIA/stroke-1month

multiple-3 months

141
Q

what should you do with someone scoring >4 on ABCD2?

A

high risk (also if multiple in 1 week) then must be seen by a specialist in 24hours

142
Q

what might be the cause of an afferant pupillary defect?

A

optic neuritis, optic atrophy, retinal disease, where there is no response at all (no constriction at all)

143
Q

what is the cause of cerebral palsy in term babies?

A

hypoxic ischaemic encephalopathy

alternatively: metabolic abnormalities or infection

144
Q

sodium valproate SEs

A

weight gain

hair loss

145
Q

carbemazepine SEs

A

rash
hyponatraemia
ataxia
PY450 inducer

146
Q

lamotrigine SEs

A

rash
insomnia
ataxia

147
Q

levetiracetam SEs

A

irratability

148
Q

what are the signs of niacin deficiency?

A

inflamed skin
diarrhoea
sores in the mouth

149
Q

what part of the spinal cord does b12 deficiency affect?

A

DCML

150
Q

sodium valproate SEs?

A 
increased appetite
weight gain
ataxia
hepatitis
thrombocytopenia
151
Q

what is bias?

A

an error that leads to distortion of the true value

152
Q

what is narcolepsy?

A

irresistable attacks of sleep may also have cataplexy which is loss of tone (with no loss of awareness)

153
Q

how can sleep narcolepsy be treated?

A

modafinil

154
Q

what is the treatment for insomnia?

A

CBT and sleep hygeine

155
Q

what is the most likely site of a mononeuropathy?

A

median nerve at flexor renitaculum

156
Q

how is mononeuritis multiplex diagnosed?

A

LP-it is usually sarcoidosis

ESR/CRP-a vasculitis-particularly GPA

157
Q

give causes of peripheral neuropathy other than DM

A

toxins (thyrotox, uraemia and alcoholism)

b12 and folate deficiency

158
Q

SEs of gabapentin

A

appetite disturbance

anxiety

159
Q

what are the features of optic neuritis

A

retrobulbar, worse on movement, loss of acuity, loss of colour vision, light flashes

160
Q

what do you need to monitor in MND patients on riluzole

A

LFTs

161
Q

what bloods would you do in someone who had just had a stroke?

A

FBC, U+E, LFT, TFT, glucose, clotting screen

162
Q

what are you looking for in the FBC of someone who had just had a stroke?

A

platelet count
polycythaemia and dehydration
increased white cells

163
Q

what won’t you get in MND

A

sensory disturbance
sphincter disturbance
cerebellar signs

164
Q

3 mainstays of treatment of haemorrhagic stroke

A

vit k if on warfarin
stabalise bp
surgery

165
Q

what are the contraindications to alteplase?

A

previous haemorrhagic stroke
pregnancy
aneurysm
recent surgery

166
Q

what are the causes of inflammatory myopathy

A

myositis

dermomyositis

167
Q

where is the huntingin gene?

A

ch4

168
Q

features of friedriech’s ataxia

A

hypertrophic cardiomyopathy
scoliosis
DM

169
Q

likely diagnosis in obese young woman with unilateral VI nerve palsy and headache?

A

idiopathic intracranial hypertension, can treat with repeated LPs

170
Q

what does it mean if the patient’s imbalance isn’t worsened by closing their eyes?

A

cerebellar
same cerebellar
different DCML

171
Q

what are the risk factors for SAH?

A

S. A. H.
smoking
a -haemophilia
htn

3a (11 decks)

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