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RACP > Neurology > Flashcards

Neurology Flashcards

1
Q

Diagnostic criteria for encephalitis.

A

Major Criteria - acute onset of behavioural disturbance <24 hours

Minor Criteria

  • Documented fever
  • Seizures not related to pre-existing disorder
  • New onset focal neurology
  • CSF WBC >5
  • Brain imaging changes
  • EEG changes
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2
Q

What activates NMDA receptors?

A

Glutamate

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3
Q

Which part of the internal capsule does the corticospinal tract run through?

A

Posterior limb

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4
Q

When are electrophysiologic studies useful?

A

Peripheral neuropathy
Entrapment neuropathy
Radiculopathies
Muscle disorders

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5
Q

What are the expected EMG findings in neuropathy?

A

Denervation
Fibrillations
Fasciculations
Positive sharp waves

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6
Q

What are the expected EMG findings in myopathies?

A

Decreased amplitudes

Small polyphasic MUAPs

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7
Q

What is the most sensitive test for myasthenia gravis?

A

Single fibre EMG

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8
Q

What is the argyle Robertson pupil? And what is the differential diagnosis?

A

Bilateral small pupils that accomodate but do not react.

Neurosyphilis
Diabetic neuropathy

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9
Q

What is the diagnostic criteria for MELAS?

A
  1. Stroke like episodes before 40
  2. Encephalopathy (seizures or dementia)
  3. Lactic acidosis OR “ragged red fibres” on skeletal muscle biopsy
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10
Q

What is the treatment of MELAS patients with an acute stroke like episode?

A

Intravenous followed by oral arginine hydrochloride

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11
Q

What are the 2 core clinical criteria for MMN?

A
  1. Stepwise progressive asymmetric limb weakness for more than a month
  2. No objective sensory change (apart from mild vibration sense changes)
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12
Q

What are the exclusion criteria for MMN?

A

Upper motor neuron signs
Marked bulbar involvement
Sensory impairment
Diffuse symmetrical weakness at the start

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13
Q

What is the treatment of MMN?

A

IVIG

Not responsive to plasma exchange or steroids

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14
Q

What is the classical presentation of CJD? And what is the median survival?

A

Rapidly progressive dementia with myoclonus. Median survival 4-5 months.

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15
Q

What is variant CJD and what is the prognosis?

A

Bovine to human transmission of CJD resulting in similar clinical phenotype (dementia and myoclonus)

Median survival 11 months

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16
Q

Type 1 myotonic dystrophy results from an expansion of which trinucleotide repeat?

A

CTG

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17
Q

How does having a malignancy influence the prognosis of NMDA encephalitis?

A

Improved prognosis with malignancy.

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18
Q

What protein is associated with duchennes muscular dystrophy?

A

Dystrophin

19
Q

What is the ABCD2 score?

A 
Age - >60
BP - >140/90
Clinical - unilateral weak (2), speech (1) 
Duration - 10-59mins (1), >60 (2)
Diabetes - 1
20
Q

What are the common residual deficits after Wernickes?

A
  1. Horizontal nystagmus (60%)
  2. Ataxia (60%)
  3. Memory deficit (80%)
21
Q

What is the treatment of Ramsay Hunt Syndrome?

A

Valacyclovir 10 days

Prednisone 5 days

22
Q

What lesion causes Alexia without agraphia?

A

Dominant PCA infarction

23
Q

Describe fragile X syndrome.

A

X linked dominant condition from CGG trinucleotide repeats (>200) (FMR1) which results in intellectual disability, ataxia, tremor and Parkinsonism.

24
Q

Type 1 muscle fibres description.

A 
Red colour 
High mitochondria 
Slow twitch fibre 
Slow conduction velocity 
Fatigue resistant 
Aerobic metabolism
25
Q

Where is Broca’s area?

A

Inferior frontal gyrus

26
Q

What are the features of a 4th nerve palsy?

A

Vertical diplopia

Eyes that turn up and out

27
Q

Anti Hu antibody
Disease association?
Presentation?

A

Small cell lung cancer

Encephalomyelitis or cerebellar Syndrome

28
Q

Anti Yo antibodies
Disease association?
Presentation?

A

Ovarian and breast cancer

Cerebellar Syndrome

29
Q

Anti GAD antibodies
Disease association?
Presentation?

A

Small cell/ breast/ colorectal cancer

Stiff person syndrome

30
Q

Anti Ri antibodies
Disease association
Presentation?

A

Small cell and breast cancer

Ocular opsoclonus myoclonus

31
Q

Mechanism of riluzole?

A

Unknown really but
?sodium channel blockade
?Glutamate antagonist

32
Q

What features of Parkinson’s are uncommon in drug induced Parkinsonism?

A

Rigidity and rest tremor

33
Q

How does phenytoin cause anemia?

A

Folate deficiency

34
Q

What medication is first line in the prevention of cluster headaches?

A

Verapamil

35
Q

What percentage of children with absence seizures will be free of seizures by 15 years?

A

95%

36
Q 
Wernickes aphasia 
Type of aphasia?
Lesion location? 
Fluent or non fluent? 
Comprehension normal or abnormal? 
Repetition normal or impaired?
A 
Receptive aphasia 
Superior temporal gyrus 
Fluent speech 
Abnormal comprehension 
Normal repetition
37
Q 
Conduction aphasia
Type of aphasia?
Lesion location? 
Fluent or non fluent? 
Comprehension normal or abnormal? 
Repetition normal or impaired?
A 
Dissociative aphasia 
Actuate fasiculus 
Fluent aphasia 
Abnormal comprehension 
Poor repetition
38
Q 
Brocas aphasia 
Type of aphasia?
Lesion location? 
Fluent or non fluent? 
Comprehension normal or abnormal? 
Repetition normal or impaired?
A 
Expressive dysphasia 
Inferior frontal gyrus 
Non fluent speech 
Normal comprehension 
Poor repetition
39
Q

A lesion of which artery results in a lateral medullary syndrome?

A

PICA

40
Q

What is the Wallenberg Syndrome?

A

Lateral medullary syndrome from PICA stroke

Vertigo
Ipsilateral horners
Ipsilateral bulbar muscle weakness
Loss of pain and temperature on contralateral side

41
Q

What is Dejerine Syndrome?

A

Small perforating branch occlusion

Contralateral Hemiplegia
Contralateral sensory loss
Contralateral limb ataxia

42
Q

What are the features of a AICA infarct?

A

Vertigo
Ataxia
Facial palsy
Hypoacusis

43
Q

What are the features of myotonic dystrophy?

A

Distal weakness
Dominant (autosomal)
Diabetes
Dysarthria

RACP (16 decks)

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