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FINALS > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the clinical features of internal capsule and corticospinal tract lesions?

A

UMN signs

Contralateral hemiparesis and sensory loss

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2
Q

What are the clinical features of spinal cord lesions?

A

LMN signs at the level of the lesion
UMN signs below the lesion
Sensory level

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3
Q

What do the internal carotid arteries supply?

A

Anterior 2/3 cerebral hemisphere

Basal ganglia

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4
Q

What do the anterior cerebral arteries supply?

A

Front and middle cerebrum

Occlusion - contralateral leg weakness

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5
Q

What do the middle cerebral arteries supply?

A

Lateral part of hemisphere
Occlusion - contralateral hemiparesis and sensory loss
Dominant - homonymous hemianopia
Non-dominant - visuospatial disturbance

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6
Q

What do the posterior cerebral arteries supply?

A

Occipital lobe

Occlusion - contralateral homonymous hemianopia

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7
Q

What are the red flags for headache?

A

Papilloedema, visual field loss
6th nerve palsy, tender temples
Focal neurology
Purpuric rash

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8
Q

What are the treatments for migraine?

A
  1. Triptan + NSAID + paracetamol, anti-emetic

2. Prophylactic topiramate propranolol

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9
Q

What are the treatments for cluster headaches?

A

O2 therapy + nasal triptan

Prophylactic verapamil

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10
Q

What are some contraindications to triptans?

A

IHD, TIA, CVA

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11
Q

What are the criteria for prophylactic migraine treatment?

A 
1 of:
Quality of life severely affected
More than 2 attacks per month 
Does not respond to acute drugs 
Frequent/long/uncomfortable auras
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12
Q

What are the clinical features of extradural haematomas?

A

Arterial bleed - often middle meningeal artery
Lucid interval after initial event
Crescent shaped opacity on scan

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13
Q

What are the clinical features of subdural haematomas?

A

Venous bleed - can occur after trivial injury
Increased risk in elderly and alcoholics
Fluctuating levels of consciousness

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14
Q

What are the clinical features of trigeminal neuralgia?

A

Paroxysms of stabbing pain in trigeminal distribution
Washing, shaving, eating, talking
MRI to exclude secondary cause

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15
Q

What are the clinical features of a subarachnoid haemorrhage?

A

Thunderclap headache
Vomiting, collapse, seizures
Usually due to rupture of berry aneurysm
Urgent CT, if negative do LP

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16
Q

What are the features of temporal lobe seizures?

A 
Automatisms - lip smaking/fiddling 
Dysphagia 
Deja-vu 
Emotional disturbance
Hallucinations
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17
Q

What are the features of frontal seizures?

A

Motor features e.g. posturing

Post-ictal Todd’s palsy

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18
Q

What is the treatment for absence seizures?

A

Sodium valproate

Ethosuximide

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19
Q

What is the treatment for tonic-clonic seizures?

A

Sodium valproate

Lamotrigine

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20
Q

What is the treatment for myoclonic seizures?

A

Sodium valproate

Levetriacetam

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21
Q

What are the clinical features and treatment of Bell’s palsy?

A

Abrupt onset, complete unilateral facial palsy
Prednisolone in within 72 hours onset
Artificial tears, tape eye closed at night

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22
Q

What are the clinical features and treatment of Ramsay Hunt syndrome?

A

Shingles of the geniculate ganglion of the facial nerve
Painful vesicular rash on auditory canal and eardrum
Ipsilateral facial palsy, loss of taste, tinnitus, dry eyes and mouth
Aciclovir and prednisolone

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23
Q

What are the clinical features of carpal tunnel syndrome?

A

Compression of median nerve
Aching pain in arm and hand
Paraesthesiae in thumb, index and middle finger
Wasting of thenar eminence

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24
Q

What are the clinical features of a radial nerve palsy?

A

Compression against mid-shaft of humerus

Wrist drop and finger drop

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25
Q

What are the features of an ulnar nerve palsy?

A

Vulnerable to elbow trauma
Hypothenar wasting
Weak 5th digit abduction

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26
Q

What are the features of a CPN palsy?

A

Prolonged knee flexion - winds round fibular head
Footdrop
Weak dorsiflexion and eversion
Sensory loss over dorsum

27
Q

What are the features of a sciatic nerve palsy?

A

Damaged by pelvic and femoral fractures
Footdrop
Reduced sensation below knee laterally

28
Q

What are the features of a tibial nerve palsy?

A

Inability to stand on tiptoes
Cannot invert foot or flex toes
Sensory loss over sole of foot

29
Q

What are some causes of polyneuropathies?

A 
Vascular - RA, GPA
Infective - HIV, syphilis, lyme
Metabolic - DM, renal failure, hypothyroidism 
Inflammatory - GBS, sarcoidosis 
Nutrition - B12, folate, B1 deficiency 
Drugs - cisplatin, phenytoin, isoniazid
30
Q

How does Guillain-barre present?

A

Acute motor demyelinating neuropathy
Follows d+v (campylobacter)
Symmetrical ascending muscle weakness
Autonomic dysfunction - sweating, tachycardia, arrhythmias

31
Q

What tests should be done for GBS?

A

LP - cytoalbuminologic dissociation
Nerve conduction
FVC 4 hourly - if <1.5L call ICU

32
Q

What is the treatment of GBS?

A

IV immunoglobulins - 0.4g/kg/24hrs for 5 days

33
Q

What causes myasthenia gravis?

A

Antibodies to nicotinic acetylcholine receptors
Check anti-ACLR antibodies
Can be due to thyoma - do CT

34
Q

What is the treatment of myasthenia gravis?

A

Anticholinesterase e.g. pyridostigmine
Prednisolone
Thymectomy

35
Q

What are the features of motor neurone disease?

A

Neurodegenerative diseases - selective loss of neurons in motor cortex, cranial nerve nuclei and anterior horn cells
Gives a mixture of UMN and LMN signs
Does not affect eye movements or sphincters

36
Q

What are the signs of motor neurone disease?

A

Under 40, stumbling spastic gait, foot drop, proximal myopathy, weak grip, aspiration pneumonia

37
Q

What are the fours types of motor neurone disease?

A
  1. Amyotrophic lateral sclerosis
  2. Progressive bulbar palsy
  3. Progressive muscular atrophy
  4. Primary lateral sclerosis
38
Q

What are myopathies?

A

Primary disorders of muscle with gradual onset symmetrical weakness
Preserved reflexes, no fasisculations

39
Q

What tests should be done for myopathy?

A

ESR, CK, AST and LDH
EMG, muscle biopsy
Genetic testing

40
Q

What are the features of Duchenne muscular dystrophy?

A 
Under 4
Clumsy walking, difficulty standing, respiratory failure
x-linked recessive 
Gower's sign 
Increased CK
41
Q

What are the features of Becker muscular dystrophy?

A

Milder symptoms

Later age

42
Q

What are the inflammatory myopathies?

A

Polymyositis and dermatomyositis
Spontaneous pain at rest
Local tenderness on palpation

43
Q

What is multiple sclerosis?

A

Inflammatory plaques of demyelination in the CNS disseminated in time and space

44
Q

How can MS present?

A

Optic neuritis
Gait ataxia
UMN signs and sensory disturbance
Cerebellar signs

45
Q

What tests should be done for suspected MS?

A

B12, CRP, ESR
HIV, syphilis, hep b and c
MR spine and brain
CSF - oligoclonal bands of IgG

46
Q

How are relapses of MS treated?

A

Check for infection

High dose methylprednisolone

47
Q

How are symptoms in MS treated?

A

Fatigue - TFTs, FBC, vit D, sleep hygiene, amantadine
Gait - physiology, fampridine
Sensory - gabapentin
Spasticity - physiology, baclofen

48
Q

What are some stroke mimics?

A

Hypo/hyperglycaemia
Subdural haemorrhage
Hemiplegic migraine
Post-ictal

49
Q

What are the criteria for TACS?

A
  1. Unilateral weakness of face, arm and leg
  2. Homonymous hemianopia
  3. Higher cerebral dysfunction
50
Q

What are the criteria for POCS?

A

1 of:

  1. Cerebellar or brainstem syndrome
  2. LOC
  3. Homonymous hemianopia
51
Q

What are the criteria for LACS?

A

1 of:

  1. Unilateral face, arm and leg weakness
  2. Pure sensory stroke
  3. Ataxic hemiparesis
52
Q

What is the acute management of stroke?

A
  1. ABCDE - glucose and MRI
  2. CT/MR head within 1 hour
  3. NIHSS
  4. Aspirin 300mg
  5. Thrombolysis if within 4.5 hours
  6. Consider thrombectomy
  7. Admit to stroke unit
53
Q

What tests should be done following a TIA?

A

FBC, ESR, UEs, glucose, lipids

ECG, echo, carotid doppler

54
Q

What predicts prognosis following a TIA?

A

Age over 60
Bp over 140/90
Clinical features - unilateral = 2, speech disturbance = 1
Duration - over 1 hour = 2, 10-59mins = 1
Diabetes

Over 4 - specialist review within 24 hours

55
Q

What are the side effects of levodopa?

A

Dyskinesia, dystonia
Hallucinations
Nausea and vomiting

56
Q

What are ropinorole and pramipexole?

A

Dopamine agonists
Can be used as monotherapy in early PD
SE: drowsiness, compulsive behaviour

57
Q

What are rasagiline and selegiline?

A

MAO-B inhibitors
Can be used as monotherapy in early PD
SE: postural hypotension, AF

58
Q

What are entacapone and tolcapone?

A

COMT inhibitors

Can help motor complications in late PD

59
Q

What are the features of dementia with lewy bodies?

A
  1. Dementia
  2. Parkinsonism
  3. Visual hallucinations
60
Q

What are the features of multi-system atrophy?

A

Autonomic features - hypotension, bladder instability

Symmetrical Parkinsonism

61
Q

What are the features of progressive nuclear palsy?

A

Early falls
Truncal rigidity
Vertical gaze palsy
Reduction in mid brain volume on MRI

62
Q

What are the features of normal pressure hydrocephalus?

A
  1. Dementia
  2. Gait disorder
  3. Bladder instability
63
Q

What are the features of portico-basal degeneration?

A

Asymmetrical Parkinsonism
Dyspraxia
Sensory deficit

FINALS (19 decks)

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