Neurology Flashcards
1
Q
what might you give a patient with LOC?
A
ajmaline to look for Brugada, not necessarily brought on by exercise
2
Q
what are the causes of syncope?
A
cardiogenic
vasovagal (stress, prolonged standing)
orthostatic hypotension
subclavian steal
3
Q
what lobe is memory disturbance associated with?
A
temporal
4
Q
what are all the possible features of a frontal focal seizure?
A
jacksonian march
dysphasia
posturing
5
Q
SEs of sodium valproate
A
N&V, diarrhoea, weight gain, AED hypersensitivity syndrome
6
Q
what are the features of antiepileptic hypersensitivity syndrome?
A
fever, rash, hepatitis
7
Q
what can phenytoin be used for and what are its side effects?
A
for tonic clonic only, ataxia, hypersensitivity
8
Q
what are the symptoms of encephalitis?
A
altered mental state, headache, fever, LOC, focal neuro signs
9
Q
what is the triad of symptoms found in Huntington’s disease?
A
emotional/behavioural disturbance
movement disorder
cognitive difficulty
10
Q
what are anterior horn cells?
A
somatic motor neuron that has its cell body in the grey matter of the spinal cord
11
Q
what is entacapone?
A
catechol-O-methyltransferase inhibitor, stops peripheral (sympathetic) SEs of Parkinsons drugs
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
13
Q
how is tourettes treated?
A
risperidone, haloperidol
14
Q
what are the tics in tourettes
A
voluntary but unwanted tics: tonic clonic, dystonic or phonic
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)
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
17
Q
what is the peek sign
A
in MG, where you pull against closed eyelids and they start to open
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
19
Q
what other than MG could cause fatiguable weakness?
A
SLE, Takayasu’s arteritis, botulism, polymyositis
20
Q
what is the main differential in myasthenic crisis?
A
cholinergic crisis-an overtreatment
21
Q
how do you treat myasthenic crisis?
A
monitor FVC-give ventilatory support
IVIg
plasmapheresis
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
23
Q
what might Ronald bear the bad news of?
A
MS-clinical diagnosis is through the McDonald criteria
24
Q
what are the differentials for an MS presentation?
A
UMN pathologies: Sjogrens (autonomic), syphilis, AIDS
25
what might lead to an MS relapse?
exercise, stress, temperature
26
Sandra has MS attacks, her symptoms get worse between attacks, what clinical syndrome does she have?
relapsing progressive
27
Bob has secondary progressive MS, what does this mean?
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
28
Cindy has been experiencing spastic weakness in her legs and has bilateral Babinski +ves, her MRI shows spinal lesions only, what should be attempted?
diagnosis of acute transverse myelitis, this has a good prognosis with plasmapheresis
29
what management could be used for spasticity in a patient with a UMN problem?
physio, baclofen, diazepam, phenol, botulinum toxin
30
if a patient has bowel incontinence, what is the best form of management?
proper history and MRI to rule out cauda equina, then loperamide if a result of underlying condition
31
what can carbemazepine be used for?
focal and generalised seizures (NOT abscence) and trimgeminal neuralgia
32
what medication would you give to 2 month old child with meningitis?
IV cefotaxime
| dexamethosone if raised ICP signs
33
what should you give to the parents of a child with meningitis?
rifampicin or ciprofloxacin
34
what increases the risk of a cerebral abscess?
cyanotic heart disease (less oxygen to brain), HIV/AIDS, dental procedures, mastoiditis, otitis media, skull fracture, endocarditis, bronchiectasis.
35
what pathogens may be involved in cerebral abscess?
Staphylococcus aureus, strep, listeria
Aspergillis, candida, cryptococcus
Toxoplasmosis gondii
36
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?
Toxoplasmosis gondii, patient should be treated with pyrimethamine and sulfadiazine
37
Martin, a known epileptic, has been seizing for over 30mins continuously, what are you going to do with him?
Stabalise using O2 and IV access, monitor regularly
| Lorezepam (?status) or phenytoin; if this doesn't work then GA
38
when Gill feels groggy, she sees misshapen monkey brains come out of her house plants, what is happening here?
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
39
Kate has cataplexy, Catherine has catalepsy, which will move slowly when her arms are placed above her head?
Catherine-waxy flexability
40
what drugs are good alternatives for benzodiazepines for insomnia?
z drugs-zopiclone or zolpidem-should also only be used short term though
41
John has had a stroke, he is weak in his right arm, what will happen in a few hours?
the weakness will become spastic, it is a UMN problem
42
Alex comes in with wide based ataxia, confusion and a headache, what are your differentials and what investigations would you do?
```
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
```
43
Brian is experiencing sudden onset weakness of his right leg, what could be happening?
ACA stroke (lower limbs), hemplegic migraine, focal seizure
44
what kind of stroke would give contralateral homonymous hemianopia?
MCA-through the optic radiation after the chiasm or PCA
45
differentials to cerebellar stroke?
gluten ataxia, hypoglycaemia, middle ear infection, thiamine deficiency, CO posioning
46
what artery is affected to give locked in syndrome?
basilar
47
what is the picture given in anterior cord blockage?
complete motor paralysis beneath the level but spinothalamic still intact
48
what supportive therapy does someone who has just had thrombolysis need?
no IMs and BP monitoring
49
list the syndromes that only affect the motor system
```
polio
MG
Bell's
polymyositis
myopathy
```
50
what investigations should you do in someone with suspected Bell's?
FBC, glucose, borrelia antibodies (Lyme), CT
51
name cardiac conditions that would predispose to an embolus forming
```
patent foramen ovale
IE
AF
MI causing septal disease
valve disease
```
52
what worsens a Parkinson's tremor?
rest, stress, tired
53
what should be started first in Parkinson's treatment?
dopamine receptor agonist: ropinirole, pramipexole, bromocriptine, cabergoline
54
pattern given by cerebral hemisphere infarct?
dysphasia, contralateral hemiparesis, homonymous hemianopia
55
what is the most common cause of metabolic delirium?
low sodium, also hypoglycaemia, renal failure, liver failure.
56
what investigations should you do in someone presenting with delirium?
```
ECG-for MI
infection screen
FBC, U&Es, clotting, LFT, TFT, glucose
CT
post void bladder scan
```
57
what commonly used drugs may lead to headache, drowsiness, fatigue, coma?
NSAIDs leading to water retention and so hyponatraemia
58
what is Luria's 3 step test?
differentiating between AD and FTD
59
what test can be used to differentiate FTD, AD and LBD more accurately?
SPECT scan
60
what is the picture in Alz?
word finding difficulties and short term memory leading to mood changes, loss of insight and loss of reasoning
61
what is LBD?
alpha synuclein protein
62
what screening tool can be used for frontotemporal?
Lund-Manchester
63
what are the 5 features of korsakoffs?
```
ophthalmoplegia
ataxia
confusion
anterograde amnesia
confabulation
this is chronic B1-thiamine
```
64
what is punch drunk syndrome also called?
chronic traumatic encephalopathy
65
define osteoporosis
imbalance between bone resorption and bone remodelling causing reduced bone density
66
what does it mean if ataxia is worse on closing eyes?
it is not a cerebellar lesion but DCML
67
what does DANISH stand for
```
dysdiadochokinesis
ataxia
nystagmus
intention tremor
slurring of speech
hypotonia
```
68
what investigation will confirm your suspiscion of a patient being an alcoholic who is not currently intoxicated
raised MCV
69
tom and his wife are 62, who is more likely to have MG?
before 50-sue, after-tom
70
after the glove and stocking distribution, what nerves will be affected in peripheral neuropathy
anterior thoracic nerves, anterior chest wall
71
which peripheral neuropathy will not affect the feet first and why?
B12 deficiency affects the hands first bc it is more acute
72
what does MUSK stand for?
muscle specific kinase
73
what is PS1 and PS2 asso with?
along with APP-Alzheimer's
74
what anti-sickness medication can be used for the nausea caused by antiparkinsonian drugs?
domperidone, the rest are dopamine blockers
75
what does it suggest if a parkinsonian patient presents early?
it could be DLB-a Parkinson's plus syndrome
76
what medications are used for tourette's
risperidone
| haloperidol
77
what muscles typically waste in ALS?
thenar
| tibialis anterior
78
is bulbar UMN or LMN
LMN, that's why PBP is LMN only, pseudobulbar is also called corticobulbar so it is UMN
79
give the classic signs of myositis?
proximal weakness
myalgia and arthalgia
dysphagia and dysphonia
80
what symptoms additional to myositis does dermatomyositis have?
shawl sign-a macular rash
heliotrope (lilac) rash on eyelids with oedema
Gottron's papules (on knuckles)
81
what types of cancer are most likely to have caused a paraneoplastic syndrome of myositis
ovarian
lung
pancreatic
bowel
82
what is suggested if muscle pain gets worse on exercise?
ischaemia or a metabolic myopathy such as McArdle's (genetic)
83
where do LMN signs start?
anterior horn cells
84
what is pyradimal weakness?
```
no fasciulation
increased reflexes
no wasting
hypertonia
spastic
```
85
what blood conditions could lead to an ischaemic stroke?
polycythaemia
sickle cell
myeloma
86
what gender are more likely to get strokes
female
87
where are Broca's and Wernicke's supplied by respectively?
both MCA!
88
what kind of dysphagia will damage to Broca's give?
expressive dysphasia-cannot express yourself but can understand
89
what are the electrolyte causes of generalised muscle weakness?
hypercalcaemia, hyperkalaemia, hypocalaemia
90
how do you treat hyperkalaemia
polystyrene sulfonate resin, insulin, salbutamol
91
how do you treat hypokalaemia?
oral supplement or IV after normalising magnesium
92
what autonomic symptoms do you get in GBS?
sweating, increased pulse, urinary retention, abnormal BP, arrythmia
93
what conditions is bell's associated with?
pregnancy, diabetes, infections, brainstem lesions
94
pattern of weakness with myelopathy?
UMN below level LMN at level
bilat pain
gradual onset
spastic and hyperreflexic legs (unless shock)
95
pattern of weakness with radiculopathy?
LMN signs
| pain is below the lesion
96
causes of spinal cord compression?
```
bony mets
disc protrusion
myeloma
TB
abscess
```
97
name of the drug used in SAH to prevent vasoaspasm
nimodipine
98
what common medication is contraindicated in people with migraines?
COCP
99
when will LOC happen in epilepsy
only if it is a generalised attack, loss of awareness can occur in partial seizures
100
what 2 things can increase the frequency of epileptic attacks?
sleep depravation and alcohol
101
what will happen if a seizure is temporal?
complex movements, aura, a rising sensation
102
what has the opposite treatment to abscence seizures
don't give carbemazepine in abscence seizures so trigemminal neuralgia because that is treated with cb
103
common causes of coma
hypoxia
intoxication
bleeds>mass lesions
104
what does the IV nerve control?
superior oblique, palsy will lead to vertical diplopia
105
what condition is Charles Bonnet asso with?
macular degeneration
106
what is amblyopia?
lazy eye, no signals from that eye are interpreted so don't see double but some of visual cortex doesn't develop
107
what symptoms accompanying dizziness point to a non ear cause?
LOC-seizure
hearing loss-labyrinthine or VIII problem
lightheadedness-anaemia
palpitations-arrythmias
108
what causes ototoxicity and what does it look like?
drugs-aminoglycosides, loop diuretics, cisplatin
| causes deafness, sometimes also vertigo
109
what can set off benign paroxysmal positional vertigo?
flights
infection
trauma
110
what is an acoustic neuroma?
vestibular schwannoma
| present with unilateral hearing loss and later-vertigo
111
what is the triad seen in menieres disease?
tinnitus
sensorineural hearing loss (may be permanent or temporary)
vertigo
112
what are the symptoms of ramsay hunt syndrome?
```
tinnitus
painful vesicular rash across face
ipsilateral facial palsy
dry mouth and eyes
hearing loss
```
113
what picture will central retinal vein occlusion give?
blurring which starts on waking, will not give full loss of vision as with artery
114
what visual defect is associated with GCA
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
what 2 pathologies should be ruled out with optic neuritis?
B12 deficiency
| MS
116
what is the clinical picture with optic neuritis
```
sub-acute onset
pain behind the eye
reduced acuity
associated dull headache
reduced visual fields
```
117
what is the clinical picture with acute angle glaucoma
```
sudden onset excruciating pain around eye
N&V
blurring
pupil fixed and dilated
eye will appear red
```
118
what measures the pressure in the eye
tonometry
119
how would you go about reducing the pressure in the eye?
miosis (constriction) so pilocarpine
120
what is glaucoma?
raised intraocular pressure with damage to the optic nerve
121
what is the striatum?
caudate and putamen
122
how is OSA categorised?
epworth sleepiness scale
123
what cerebral artery is essential for speech?
the dominant side MCA
124
what area of the brain does the inferior visual field go through?
parietal
| PITS-parietal inferior; temporal superior
125
what conditions is myasthenia associated with?
autoimmune conditions: pernicious anaemia, coeliac, SLE, sjogrens, thyroid, psoriasis
126
what age does myasthenia gravis present?
before 40
127
name a side effect of carbemazepine
hyponatraemia
128
side effect of lamotrigine
hypersensitivity
129
side effect of leviterceteram
suicidal thoughts (think of mothers and mental health)
130
side effects of sodium valproate
hepatotoxicity, ataxia, encephalopathly, tereatogenecity
131
what AEDs can be used for abscence seizures
sodium valproate and lamotrigine
132
how can status epilepticus be managed?
1) rectal diazepam or buccal midazolam
2) repeat
3) IV lorazepam
4) 30min later>phenytoin
133
what is internuclear opthalmoplgegia?
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
what is Marcus Gunn pupil?
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
what is argyll robertson pupil?
prostitutes, small, they accomodate but don't react-indicitive of neurosyphilis or diabetic retinopathy
136
what muscle groups are affected in myasthenia gravis?
proximal
137
what was the tensilon test associated with?
cardiac arrest
138
what investigation must you undertake following the diagnosis of myasthenia gravis?
CT thorax for thymoma
139
what could be the cause of an embolic stroke?
vascular: atheroma, cardiac mural, left atrial
140
how much time off driving do you need to take for a cerebrovascular accident?
TIA/stroke-1month
| multiple-3 months
141
what should you do with someone scoring >4 on ABCD2?
high risk (also if multiple in 1 week) then must be seen by a specialist in 24hours
142
what might be the cause of an afferant pupillary defect?
optic neuritis, optic atrophy, retinal disease, where there is no response at all (no constriction at all)
143
what is the cause of cerebral palsy in term babies?
hypoxic ischaemic encephalopathy
| alternatively: metabolic abnormalities or infection
144
sodium valproate SEs
weight gain
| hair loss
145
carbemazepine SEs
rash
hyponatraemia
ataxia
PY450 inducer
146
lamotrigine SEs
rash
insomnia
ataxia
147
levetiracetam SEs
irratability
148
what are the signs of niacin deficiency?
inflamed skin
diarrhoea
sores in the mouth
149
what part of the spinal cord does b12 deficiency affect?
DCML
150
sodium valproate SEs?
```
increased appetite
weight gain
ataxia
hepatitis
thrombocytopenia
```
151
what is bias?
an error that leads to distortion of the true value
152
what is narcolepsy?
irresistable attacks of sleep may also have cataplexy which is loss of tone (with no loss of awareness)
153
how can sleep narcolepsy be treated?
modafinil
154
what is the treatment for insomnia?
CBT and sleep hygeine
155
what is the most likely site of a mononeuropathy?
median nerve at flexor renitaculum
156
how is mononeuritis multiplex diagnosed?
LP-it is usually sarcoidosis
| ESR/CRP-a vasculitis-particularly GPA
157
give causes of peripheral neuropathy other than DM
toxins (thyrotox, uraemia and alcoholism)
| b12 and folate deficiency
158
SEs of gabapentin
appetite disturbance
| anxiety
159
what are the features of optic neuritis
retrobulbar, worse on movement, loss of acuity, loss of colour vision, light flashes
160
what do you need to monitor in MND patients on riluzole
LFTs
161
what bloods would you do in someone who had just had a stroke?
FBC, U+E, LFT, TFT, glucose, clotting screen
162
what are you looking for in the FBC of someone who had just had a stroke?
platelet count
polycythaemia and dehydration
increased white cells
163
what won't you get in MND
sensory disturbance
sphincter disturbance
cerebellar signs
164
3 mainstays of treatment of haemorrhagic stroke
vit k if on warfarin
stabalise bp
surgery
165
what are the contraindications to alteplase?
previous haemorrhagic stroke
pregnancy
aneurysm
recent surgery
166
what are the causes of inflammatory myopathy
myositis
| dermomyositis
167
where is the huntingin gene?
ch4
168
features of friedriech's ataxia
hypertrophic cardiomyopathy
scoliosis
DM
169
likely diagnosis in obese young woman with unilateral VI nerve palsy and headache?
idiopathic intracranial hypertension, can treat with repeated LPs
170
what does it mean if the patient's imbalance isn't worsened by closing their eyes?
cerebellar
same cerebellar
different DCML
171
what are the risk factors for SAH?
S. A. H.
smoking
a -haemophilia
htn
