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MRCP > Neurology > Flashcards

Neurology Flashcards

1
Q

Extraoccular muscles

A 
SR: move eye up - CN3
IR: move eye down - CN3
LR: abduct eye - CN6
MR: adduct eye - CN3
IO: up and out - CN3
SO: down and out - CN 4
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2
Q

Brown sequard

A

Hemisection of spinal cord

contralateral spintholamic loss - pain, temp, fine touch

ipsilateral loss of motor, vibration, deep touch, proprioception

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3
Q

M.G.

A

Px - known

Typicially nictonic acetylcholine receptor antibodies

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4
Q

M.S. symptoms

A

Diagnosis based on clinical signs, evidence of relapsing and evidence of a lesion (MRI dissemination in space and new lesion)

Visual sx:

  • optic neuritis
  • optic atrophy
  • uhtoffs phenomenon: worsening vision following rise in body temp

Sensory sx

  • puns and needles
  • numbness
  • trugeninal neuralfia
  • Llhermittes syndrome: parsthesia of limbs on neck flexion

Motor:
- spastic weakness - legs

Atxia
Urinary incontinence

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5
Q

Visual field defects

A

Homonyous hemianopia:

  • incongruous defects: optic tract
  • congruous defects: optic radiation or occipital cortex

Homonymous quadrantanopias:

  • superior- temporal lobe
  • inferior - parietal lobe

Bitemoral hemianopia:

  • optic chiasm
  • upper quad - inf chiasmal compression - pituitary
  • lower quad - superior chiasmal compression - craniopharyngioma
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6
Q

Phenytoin

A

Bunds to sodium channel and increases refractory period.

Adverse effects: PHENYTOIN

P-450 interaction 
Hirsuitism/Heamorrhagic dx of the new born 
Enlarged gums 
Nystagmus 
Yellow skin 
Teratogenic 
Osteomalacia 
Inteference with vitamin b12metabolism 
Neuropathies - vertigo, ataxia
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7
Q

Myasthenia crisis exacerbating factors

A 
Penicillamine 
Procainimide, quinidine 
Lithium 
Phenytoin 
Abx - macrolides, quinolone, gentamicin, tetracyclines
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8
Q

Gingival

Hyperplasia causes

A

Phenytoin
CCB - nifedipine
Ciclosporin

Non-drug -AML

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9
Q

Acute disseminated encephalomyelitis

A

Autoimmune

Occurs typically a few weeks after viral illness or vaccination

Px:
Encephalopathy 
Motor weakness 
Seizure 
Coma

INX:

MRI with T2 weighted —> poorly defined hyper intensities in the subcortical
White matter

Mx:
IV glucocorticoid —> fx —> IVIg

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10
Q

Essential tremor management

A

Propranolol

Second line or CI (Asthma) —> primidone

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11
Q

Aphasia

A

Wernickes:

  • superior temporal gurus lesion
  • fluent speech without meaning
  • word substitution and neoglism
  • impaired comprehension

Brocas;

  • inferior frontal gyrus lesion.
  • non fluent, effortful soeech
  • comprehension normal

Conducting aphasia:

  • Arcuate fasiculus
  • fluent speech but poor repetition- they are aware
  • comprehension normal

Global Aphasia:
- large lesion affectinf all 3 of above

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12
Q

Anterior spinal

Artery syndrome

A

Bilateral spastic paresis with loss of spinothalamic.

Lateral spinothalamic
And lateral corticopspinal

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13
Q

Subacute combined degeneration of spinal cord

A

Vitamin B12 and vitamin E deficiency

Lateral corticospinal, dorsal column and spinocerbellar - affected

B/L PERIPH NEUROPATHY & MIX OF UMN/LMN SIGNS

Bilateral spastic paresis
Bilateral loss of prioooception and vibration sensation
Bilateral limb ataxia

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14
Q

Friederichs ataxia

A

Px same as SCDC
- A.R. trinucleotide repeat

Px:

  • Absent knee and ankle reflex
  • Extensor plantar response
  • Cerebellar symptoms
  • Optic nerve atrophy
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15
Q

Syringiomyelia

A

Spinothalamic tract bellow + LMN at level

Flaccid paresis

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16
Q

Peripheral nueropathies causes

DAM IT BICH

A

Drugs and chemicals - Pb, phenytoin, metronidazole, vicristine, isoniazid

Alcohol and amyloid

Metabolic - DB, uraemia, hypoglycaemia

Infection - GBS, HIV, leprosy, lime dx, syohillis

Tumor - paraneoplastic syndrome (lung, lymphoma,
Melons)

B12 and other deficiencies

Idiopathic

CTD/ vasculitis

Hereditary/hypothyroidism

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17
Q

Ramsay hunt syndrome

A

Reactivation of VZV —> geniculare ganglion of CNVII

Ft:

  • auricular pain (1st ft)
  • cN7 palsy
  • vesicular Tash around ear (as well as ant 2/3 of tongue)
  • other ft - vertigo and tinnitus

Mx
- PO aciclovir and corticosteroids

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18
Q

Restless legs syndrome

A

TEST FOR FERRITIN

Akathisia
Paratheasia
Periodic movement in sleeps

Assoc

  • FHx
  • IDA
  • Uraemi
  • DB
  • Pregnancy

Mx:

  • simple measures such as stretching and massage
  • tx IDA
  • DA agonist = 1st LINE - R-opinirole, pramipexole
  • BZD
  • Gabapentin
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19
Q

Alzheimer’s disease

A

Frontal lobe sparing

Pathological findings:

  • extracellukar B- amyloid
  • hyperphisphorylated tau proteins
  • neurofibrillary tangles
  • loss of cholinergic fn

Temporal and parietal loves

APOE —> e2,e3,e4 alleles on chromosome 19

Early onset —> presenellin 1& 2 and amyloid precursor protein

Tx:

1) donepezile - cholinesterase inhib
2) memantime NMDA - for moderate to sev Alzheimer’s

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20
Q

Lea body dementia

A

> 65yrs

Accumulation of LBs in brain stem
And cortex

NT dysfunction

Loss of visuospatial awareness + hallucinations.

Fluctuating

Tx:

Donepezil
Tx PD

EXTREME SENSITICITY TO NEUROLEPTICS- deterioration of PD

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21
Q

FT DEMENTIA

A

2nd most common in <65 (behind early onset AD)

Cognition intact

Change in behaviour and personality —> DISINHIBITED

Decreased language production

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22
Q

Primary progressive Aphasia

A

Non fluent - left inf temporal

Semantic - left anterior temprorak

Logopenic - posterior temporal
And parietal

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23
Q

Prion disease - cJD

A

Transmissible spongiform encephalopathy.

Prions - misfplded proteins- transmitted —> propagation

Prions - resistant to standard sterilisation

Sporadic CJD:

  • 45–>75yr
  • PRNP GENE
  • myoclonus, ataxia And rapidly progressive dementia

Variant CJD:

  • 20s age of onset
  • psychiatric prodrome —> painful sensory sx

Inx MRI.

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24
Q

Normal P hydrocephalus

A

Wobbly + whacky + wet

Inx —> MRI

Mx:

  • large volume CSF removal by LP
  • VP shunt
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25
Q

M.S.diagnosis

A

Clinical picture

MRI - lesion disseminated in Time and space

Impaired oligoclonal bands on CSF

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26
Q

MS subtypes

A

Relapsing - remitting

Secondary progressive (secondary to R-R)

Primary progressive - deterioration from outset

Progressive relapsing - primary progressive with superimposed R-R

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27
Q

MS - relapse treatment

A

Relapse - period lasting 24-48 hrs, when previously stable for 30 day, and other cause especially infection is excluded

Tx: high dose steroids with an oral taper:

1g methylpred—> 500mg PO methyl pred

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28
Q

DMARD therapy in MS

A

Indicated iff

RRMS:

  • =>2 in last two years —> IFN-B
  • IFN-beta Or galtiramer resistant —> fingolimod
  • => 2 disabling relapses —> natalizumab

Secondary progressive
- tx with IFN-B

Adverse effects:

Natalizumab: PML

Fingolimod: transient AV slowing, macula oedema and Herpes reactivation

Alemtuzumab: autoimmune disease. - ITP and Goodpasteures

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29
Q

Autoimmune encephalitis - non paraneoplastic

A

Most common

Extracellukar targets

Steroid responsive

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30
Q

AI encephalitis - paraneoplastic

A

Lung and breast ca

Intracellular targets

Not steroid responsive

Limbic encephalitis is an example:

  • seizure
  • amnesia
  • confusion
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31
Q

Wernicke’s Encephalitis

A

Low thiamine vitamin B1

Confusion
Ataxia
Abnormal eye movements

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32
Q

Cortical blindness

A

Severe/complete blindness

Pupil reflexes present

Macular soaring

Bilateral occipital infarct

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33
Q

Marcus Gunn Pupil

A

Seen on RAPD

Lesion anterior to optic chiasm = optic nerve or retina

Causes:

  • Renital detachment
  • optic berve - neuritis (MS)
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34
Q

Causes of small pupil (mitosis)

A

Senile miosis
Pontine haemorrhage
Horner syndrome
Argyll Robertson: bilateralx assymetrical. Small irregular pupils - NORMAL ACCOMODATION NOT REACTIVE TO LIGHT.

Drugs- opiates/pilocarpine

Myotonic dystrophy

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35
Q

Horner syndrome

A

Miosis

Ptosis

Anhidrosis

Vasodilation and enopthalmos

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36
Q

Horner syndrome investigation

A

Hydroxyamphetamine - distinguishes between 1st and second order VS 3rd

  • 1 and 2 order pupil dilation
  • 3rd order - no dilation
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37
Q

Intranuclear opthalmoplegia presentation

A

Impaired ipsilateral addiction

Abducting nystagmus contralat

Convergence normal

No Diplopia

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38
Q

Causes of INO

A

BILATERAL INO = MS

Demyelinative disease - young

Vascular - >60

Trauma

Basilar artery occlusion

Miller fisher syndrome

Vascukitis

Overdose - barbiturates, phenytoin, amtryptilline

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39
Q

Supranuclear opthalmoplegia

A

Disorder in cerebral hemispheres, cerebellar and brainstem

DOLLS HEAD MOVEMENT - increased movement on reflex than voluntary

Examples:
PSP
Gaze palsy
Midbrain syndrome

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40
Q

Coma

A

interruption of ARAS

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41
Q

Persistent vegetative state

A

CNS intact
Roving eye movements.
Sleep wake cycle intact
Still have stable BP/Resp drive

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42
Q

Decorticate vs decerebrate

A

decorticate:

  • Flexor response
  • Upper brainstem

Decerebrate

  • Extensor
  • B/L midbrain or pontine.
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43
Q

Brain stem lesions and pupils

A

Normal - lesion is bellow pons or above thalamus

(P)inpoint - Opiate or (P)ontine lesion

Fixe (m)idpoint - (m)idbrain

Dilated pupil - Midbrain, sympathomimetic, CN3

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44
Q

Eye movements

A

Spont eye movement - Bihemispheric dysfunction

Horizontal deviation:

  • Non status epileptic
  • Ipsi hemispheric stroke
  • Contralat pontine stroke

Roving eye movements:

  • Toxic/metabolic
  • Brainstem ifarct
  • B/L hemispher.

Skew Deviation - Post fossa lesion

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45
Q

BRainstem death

A

Brainstem reflexes + Motor responses + Respiratory drive are absent in commatosed pt with irreversible known cause.

Must have satisfactory O2/Temp and no hypercapnia or pharmacological influence and no metobolic disturbance or reversible cause.

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46
Q

Encephalitis causes

A 
Viral
- HSV1 - most common 
VZV
Enterovirus
Adenovirus 
Bacteria
mTB
Streptococcus - menngitis 
meningococcus - meningitis  
Syphillis

Other:
Cryptococcus
toxoplasmosis
nnon-infective

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47
Q

Encephalitis - indications for urgent CT before LP

A 
low GCS
Focal neuro 
uncontrolled seizures
Cushing triad (raised ICP) - high BP, Low pulse, High RR
Clotting abnormality
sepsis 
immunocomp
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48
Q

Encephalitis Mx:

A

MRI/LP (CT if indicated)

Start Aciclovir straight away.

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49
Q

Meningitis - causes

A

Bacterial:
Meningococcus
Pnemococcus
mTB

Viral:
- Enterovirus
HSV
HIV
VZV
Mump
CMV

Other:
Cryptococcus
Toxoplasmosis

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50
Q

MEningitis - CSF findings

A 
Bacteria:
- High opening P
- Neutrophils
Low PRotein
Low Gluc
Viral:
- Normal opening P
- Lymphocytes
- Normal/high prtein 
Normal Gluc

Tb:

  • High/V.High opening P
  • Lymphocytes
  • V.high protein
  • VV. Low Glucose

Fungal:

  • VVVHigh opening P
  • Lymphocytes
  • VVVhigh protein
  • V. Low gluc
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51
Q

MEningitis management;

A

<3mnth or >50 - Cefotaxime + amoxicillin

3 mnth - 50 yrs - Cefotaxime

Meningococcus - IV Benpen + Cefotax

Strep - Cefotaxime

  • H.influenza - Cefotaxime

Listeria - IV Amox + gent

Contacts:

  • streptococc - no prophylaxis
  • meningococc - Rifamp
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52
Q

Infectious myelitis

A

Px: PAIN + FEVER + MENINGIM + MIXED UMN/LMN signs.

Viral

  • Entero
  • HIV
  • HTLV-1
  • VZV/ HSV/ CMV

BActerial:
- Syphillis

parasitic causes.
- Schistosomiasis –> Acute transverse myelitis + Raised Eosinophills.

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53
Q

Migraine w/o Aura criteria

A 
A - => 5 attacks 
B - Headache lasts 4-->72 hr
C- Headache with 2/4 of:
       - Unilat
       - pulsating
       -  worsened by activiy 
       - Mod sev
D => one of:
        - N/V
        - photo/phonophobia
E - not explained by other diagnosis
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54
Q

Migraine w/ Aura

A 
A - =>2 attacks
B- =>1 of: 
        - Visual 
         - Sensory 
          - brainstem
        - Motor
        - Retinal 
C - =>2 of:
         - =>1 aura sx spreading over 5 mins or >1 in succession 
         - Each sx asts 5-60mins 
         - => 1 is unilat
         - Aura = accompanied by or followed within 60 mins be headache
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55
Q

Migraine Mx

A

Acute:

1st line - Po Triptan + NSAID or Paracetamol
Fx –> Non-po prochlorperazine + metoclop + Nasal triptan

Prophylaxis:

  • 1st line = Propanolol or Topiramate
  • Fx –> accupuncture or Gabapentin

Advise suplement with Riboflavin

Menstrual migraine –> Frovatriptan or Zolmitriptan

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56
Q

Migraine Mx in Preg

A

Acute:
1st line = paracetamol
2nd line = ASA or NSAID (not 3rd trimester)

Prophylaxus - Propanolol

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57
Q

Cluster headache diagnostic criteria

A

A - =5 attacks
B - Sev/v.sev unilat orbital/supraorbital/temporal pain
- lasts 15 –> 180mins

C - Either or Both of:

1) => 1 of the following:
    - conjunctival injection/lacrimation
    - nasal congestion 
    - Eyelid oedema 
    - Forehead/facial swelling 
    - "      " "       "    flushing 
    - Fulness in ear 
    - miosis/ptosis 

2) Sensation of restlesness/agitation

D - Attacks have freq of every other day to 8/day for >1/2 time of cluster period

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58
Q

Cluster headache - Mx

A

Acute Mx:
- O2 + S/C Triptan

Prophylaxis
1st lie - Verapamil

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59
Q

MS vs NMO

A

NMO-IgG + in NMO

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60
Q

Caroticocavernous fistula

A

High flow is between intracavernous artery and cavernous sinus

Secondary to trauma

Pulsation proptosis and CN3/4/6
Raised IOP

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61
Q

Foster Kennedy syndrome

A

Ipsilateral optic atrophy
Contralat papilloedema

Direct damage if SOL - FRONTAL LOBE

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62
Q

Friederichs ataxia

A

A.R.

Trinueotide repeatbdisorder - GAA

CARDIACCC
Absent ankle jerks/extensor plantars
Cerebellar ataxia
Optic atrophy

Mixed LMN/UMN
Pea cavus

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63
Q

Valproate side effects

VALPROATE

A 
Vomiting 
Alopexia
Liver toxicity 
Pancreatitis/pancytopenia 
Retention of fat - weight gain 
Oedema 
Ataxia 
Teratogenic/ tremor 
Enzyme inhibition
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64
Q

GBS vs CIDP

A

CIDP > 8/52 History

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65
Q

Congenital nystagmus causes

A 
Idiopathic 
X-linked or AD 
Secondary to visual impairment:
-albinism 
Optic nerve hypoplasia
-retinal dystrophy
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66
Q

Acquired Nystagmus causes

A

Downbeat - foramen magnum lesion

  • Arnold chiari malformation
  • spinocerebellar degen
  • demyelinative
  • platybasia

Upbeat

  • intrinsic brainstem dx
  • cerebellar vermis lesion
  • organiphosphates
  • wernickes enceph

Pendular:
-demyelinative disease

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67
Q

Neuroleptic malignancy syndrome

A

Atypical antipsychotics Or dopaminergic drugs

Seen in first 10
Days of tx

Young male

Pyrexia
Rigidity
Tachycardia

Mx:

IV FLUIDS AND DANTROLENE

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68
Q

Migraine affects on GI

A

Delays gastric emptying during attack

Therefore combine with a pro kinetic such as metoclopramkde

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69
Q

Trigeninal neuralgia

A

Brief lancet pain

Women >50

Unilateral and trigger points

Can be presenting symptom of MS

Tx

Carbamazepine/phenytoin 
Clonazepam 
Backpfen 
Thermocoagulation of trigeminal ganglion 
Surgical micro vascular decompression
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70
Q

Vertigo causes

A

Peripheral - labyrinthine

  • BPPV
  • Trauma
  • Ménière’s disease
  • acute viral infection
  • chronic bacterial OM
  • occlusion if internal auditory artery

Central:

  • vascular disease
  • ms
  • SOL
  • alcohol or drugs
  • hypoglycaemia
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71
Q

Ménière’s disease

A

Vertigo
Tinnitus
Sensorineural HL

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72
Q

Drug induced Parkinson’s

A

Rigidity and tremor are uncommon !!

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73
Q

Vestibular schwannoma

A

Vertigo + SNHL + Absent corneal reflex

Tumour of CN8

Corneal reflex absent
Facial sensation abnormal

Inx MRI or high res CT

Mx- surgical removal

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74
Q

Lateral medullary syndrome

PIKACHU and mark whallberg with a horn on a hot sunny day

A

PICA - can’t - CHew

Posterior inferior cerebellar artery
CHew - dysphasia

Mark - Wallenberg syndrome
Big horn - Horners syndrome

Sun - tempersrion problems

  • ipsilateral OM face
  • contralat in body
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75
Q

Facial nerve paralysis

A

Supplies face, ears Tate and tear

Can present with

Forehead sign
Hyperacusis - due to paralysis of stapedius muscle
Facial expression
Loss of Tate

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76
Q

MMSE

A

Normal 30-27

Mild 26-22

Mod 21-10

Sev 9-0

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77
Q

Variant CJD

A

HOCKEY STICK SIGN

progressive dementia
Mycoclonus

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78
Q

Polyneuropathies

A

Acute - inflamm, toxic, vasculitic

Chronic - genetic or metabolic

Symmetrical distal weakness and sensory lows - lower>upper limb

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79
Q

IIH

A

YOung obese female

Headache + Paoilloedema w/o focal neuro or lesion

No neuro signs.
Normal neuro imaging
normal CSF appearance

INCREASED LP OPENING P (>25cmH2O)

Iatrogenic causes:
OCP, steroids, tetracyclin, vit A, Nitrofurantoin, Nalidic acid

Mx:
- WL
- Acetozolamid or topiramat
- Can use rpt LP 
VP SHUNT or optic Nerve fenestration
80
Q

Gersstmann syndrome

A

Acalculia, Right to left disorientation, finger agnosia and agrapgia.

Dominant parietal lobe is affected

81
Q

syringomyelia

A

collection of CSF in spinal cannal.

Causes:

  • Chairi malformation
  • trauma
  • tumour
  • idiopathic

Patter of Px:

spinothalmic tracts cross i th anteriro commisure of spinal cord –> therefore symptoms first.

CAPE LIKE loss of spinothalamic

preserved lght touch, vibrationa nd propriooception

Inx - MRI with contrast - xcl tumour and MRI bran to excl. chiari.

Untreated –> scoliosis

Mx:

  • Tx cause
  • symptomatic –> shunt
82
Q

5-HT3

A

Acts on CTZ of medulla oblongata

Ondansetron

Side effects - constipation

83
Q

CN3 palsy

A

Pupil down and out
Ptosis
Pupil maybe dilated

Causes:

PAINFUL PALSY R/O POST COMMUNICATY ARTERY ANEURYSM

  • DB
  • vasculitis
  • invaluable hernition/raised ICP
  • cavernous sinus thrombosis
  • Weber’s syndrome (midbrain strikes) - ipsilateral CN3 palsy and contralat hemiplegi

Amyloid and MS

84
Q

Stopping AED

A

Stop it seizure free for >2 years and stop over 2-3 months

85
Q

Craniopharyngioma

A

Most clmmons upratentorial lesion in children

Originates from
Rathke pouch in ventromedisl area of hypothalamus

Px:

  • bitemporal hemianopia inferior quadrant
  • hypopituitary
  • motor oil like fluid in tumour

Inx —> CT - calcification

Tx - surgical resssction

86
Q

Narcolepsy

A

Associate hla DR2

Low level of ore in (hypocretin) control sleep / appetite
Early onset REM

FT:
- inset in teens 
- hypersolmonence 
Cataplexy 
Sleep paralysis 
Vivid hallucinations on SLEEPING AND WAKING

Inx
Sleep latency eeg

87
Q

Heniballism

A

Damage to subthalmic nucleus

Contralat proximal sudden jerking movements - basilic movement (choreoform is distal)

Sx - whilst patient ASLEEP

Mx - antidopaminergic - haloperidol

88
Q

Complex regional

Pain syndrome

A

CR 1 - no demonstrable nerve lesion
CR2- demonstratable nerve lesion

Ft:
Progressive disproportionate symptoms
Temp and skin changes
Oedema and sweaty d

Mx:

Early PT
Neuropathic analgesia
Pain team

89
Q

Epilepsy management

A

Generalised –> Na Valproate

Focal –> Carbamazepine

Generalised T-C:

  • Na Valproate
  • Carbmazepine/Lamotrigine

Abscence:

  • Na Valproate
  • Ethosux

Myoclonic:

  • Na Valproate
  • 2nd clonazepam and lamotrigine
90
Q

Epilepsy Childhood syndromes

A

West’s syndrome - Infantile spasms:

  • 1st few months
  • Progressive mental handicap \
  • EEG _ Hypsoarrythmia
  • Vibagatran

Absence:

  • EEG - 3Hz spike
  • Na Valproate/Ethosux
Lennox-Gustaut:
- Hx of absence 
SEV MENTAL HANDICAP
- EEG - Slow spike 
- Ketogenic diet

Benign Rolandic Epilepsy:

  • Parasthesia
  • M>F

Juvenile myoclonic Ep:

  • Seizures in the a.m.
  • Daytime somnolence
  • Na Valproate
91
Q

Localising Epilepsy

A

Temporal lobe - H.E.A.D:

  • Hallucionations
  • Epigastric rising
  • Automatism - lip smacking/hand rubbing
  • Deja Vu/Dysphagia

Frontal lobe:

  • Motor
  • Head-leg
  • Jacksonian march

Parietal:
- Parasthesia

Occipital:
- Flashes and floaters

92
Q

Epilepsy when to start treatment

A

after 2nd seizure

or

1st seizure if:

  • Structural abnormsality
  • EEG unequivocal
  • Neuro deficit
  • PT/family thyink a second is unnaceptable.
93
Q

Epilepsy in pregnancy

A

All can be used - Na Valproate is only cobtraidicated

Folic Acid 5mg

  • Carbezapine = least teratogenic

Breatsfeeding is safe

94
Q

Epilepsy and DVLA

A

1sts eizure - 6/12 off if no structural and no EEG findings (if present 12/12 off)

Epilepsy/multiple seizures –> 12/12 seizure free. IF >5yr seizure free –> drive until 70

Cant drive whilst stopping AED + 6/12 after last dose.

95
Q

TIA

A

<24 hours

now no longer time based but tissue based = A transient epilepsy of neuro dysfunction caused by Brain, S.cord, retina ischaemia - w/o infarction - w/o infection

ABCD2 no longer used

Mx:
- ASA 300mg – after exclusion of haemorrhgagic

LT Mx:

  • Clopidogrel
  • 2nd line - Dipyradimole + ASA
96
Q

TIA - referral

A

Crescendo TIA or Cardioembolic –> urgent referral

TIA in last 1/52 –> urgent referral

Prev TIA >1/52 –> referral in 1/52

97
Q

Carotid endarterectomy

A

Recommended if Stenosis >70%

98
Q

Stroke Features and anartomical location

A

Anterior Cerebral A –> Typical Ft

Middle Cerebral A –> Typical ft + Homonious hemianopia

Post cerebral A –> Homonyous hemianopia w/ macula sparing

Basillar A –> Locked in syndrome

Opthalmic A –> Amurosis Fugax

99
Q

Stroke assesmment in hospital - ROSIER

A

ROSIER - exclude BGL then:

LOC (-1)
Seixure (-1)

unilat facial weakness (+1)
unilat arm weakness (+1)
unilat leg weakness (+1)
Speech disturbance (+1)
Visual field defect (+1)

> 0 –> stroke likely

100
Q

MX - Thrombolysis

A

<4.5 hours

absolute - CI:

  • Prev haemorrhage
  • Seizure @ onset
  • Neoplasm
  • suspected SAH
  • Stroke or TBI in last 3/12
  • Prev GI haewmorrgage in last 3/52
  • LP prev 7/7
  • Active bleed
  • PREG
  • varices
  • malignnast HTN
101
Q

Stroke - secondar precention

A

Clopidogrel life long

2nd line or cantr tolerate : Dipyradimole and ASA

AF post stroke:
- Warfarin or FXa inhib - start 2/52 after stroke

102
Q

Degenerative cervical myelopathy

A

Rf:

  • Smoking]
  • Genetics
  • Occupation
  • Asians have different aetiology as increased occification of posterior longitudinal ligament

Px sx unknown

Px:

  • Pain - neck or limbs
  • Hoffmans sign
  • loss of motor f/dexterity
  • loss of sensory
  • loss of autonomic fn

Inx –> MRI C spine

Mx:
- urgewnr eferral for spinal decompression - early tx within 6 months

103
Q

Trigeminal neuralgia management

A

1st line - Carbamezapine

104
Q

S.A.H - Risk factors

A

PCKD

Ehlers-danlos

Fibromuscular dysplasia

medium vessel vasculitis

Aortic coarctation

105
Q

SAH inx

A

CT immed.

LP at 12 hours - Xanthochroia - Bili

106
Q

SAH poor prognostic factor + Mx

A
  • low GCS
  • > 65
  • Bleed on CT
Mx:
- Nimodipine 60mg 4hrly 
-Urgent for clipping/coiling 
\
Prevention if => 2 relatives w/ SAH or PCKD --> Refer
107
Q

SAH complications

A

Neurological

  • Rebleed
  • Hydrocephalus
  • Ischaemia - secondary to vasopasm

Systemic

  • Fever
  • Tachy - secondary to catcholamine releasse
  • SIADH
  • Neurogenic pulm edema.
108
Q

Primary CNS vasculitis

A

can occur as systemic or primary neuro

primary CNS presents as 3 types:

  • MS with atypical ft - seizure, stroke like
  • Acute/subacute encephalopathy like - Acute confusional state
  • mimik an intracranial lesion

inx - R/O other cause

Mx:

  • High dose steround –> Taper with PO
  • once ion remission –> Azathioprine
109
Q

Central venous thrombosis

A

Young fat female.

Suspect if:

  • pregnancy in 3rd trimester
  • Hx VTE
  • PRogressive new neuto decloine
  • Ischaemic stroke that crosses arterial territories

Inx:
- CT / CT Venogram

Mx:

  • Anticoag w. LMWH
  • Antiepileptics.
110
Q

Reversibel vasoconstrinction syndrome

A

recurrent sev thiunderclap headache

Post partum

Angiography –> String of bead appearence –> rpt imaging shows resolution

Mx acutely with nimodopine

111
Q

Neuromyelitis optica (NMO)

A

MS like - mopre severe

Px:
- Optic neuritis + Transverse myelitis (sev - “sawn off”)

Can be triggered by MS DMARDS
IgG AQP4

Mx:
- Steroids +/ plasmophoresis +/- IV Ig

112
Q

Neurosarcoidosis

A

Non spec px

inx - ACE levels
CT
CXR - BHL
CSF - high ACE/Lympogocytes, low gluc, oligoclonal bands

Mx –> immunosupression

113
Q

CNS tumours

A

Adults:

  • Glioma & MEt dx - 60% - brai between tumour and skull
  • MEningioma - no brain between tumour and skull
  • Pit lesion 10%

Child:

  • Astrocytoma
  • medulloblastima

Inx: MRI

Mx
Surgery
- curati e in meningioma
- Glioma - lots of invasion - sx tx

114
Q

MND

A

Px Assymetrical progressive motor degen and mix of UMN/LMN

2 types:

1) ALS - UMN lower limbs and LMN upper limbs
2) Bulbar palsy - worst prognosis - FEV1
3) Progressive muscular atrophy - LMN in one limb - BEst prognosis

Inx:

  • R/O other cause - imaging
  • EMG - chronic dennervation/ N sensory/ Preserved velocity
Mx:
- Riluzole - monitor LFT and BM supression 
- MDT
- SALT
- PT
Nutionin - PEG
- Resp NIPPV
115
Q

Parkinson’s dx

A

lew body depsoitis in substansia nigra pars compacra –> decrease DA inpout into basal ganglia.

Triad:

  • Bradykinesia
  • Resting tremor (3-5Hz)
  • Rigidity

other - Mask face/micrographia/ flexed ppsture/ depression/ sleep disorder. bowel dysfn.

116
Q

PD management

A

Levodopa:

  • Good for motor symptojs
  • On + Off perdios.
  • dyskinesias
  • less effective with time

DA Agonist:

  • Ropinerole/ Rigotine patch/ Apomorphin/ PRamipexole
  • More hallucinations + IMPULSE control
  • Apomorphin e good if motor fluctuation
  • Ergot derivatives: Carbegoline/bromocriptine –> Retroperitoneal fibrosis –> prior to start Echo/ESR/CXR

MAO-B:

  • Selegeline
  • more On-time
  • less hallucination
  • fewer S.E

COMT-I

  • Entacapone
  • increase on time
  • less hallucnations

NMDA- R - antage:

  • Amantadine
  • improved dyskinesia
117
Q

Causes of parkinsonism

A 
PD
Drugs - antipsychotic/metoclop
wilsons 
psp
msa
post encephalitis 
dementia pugilistica 
toxins - CO/MPTP
118
Q

PArkinsons plus

A

LBD

MSA - autonomic

PSP - Vertical upgaze - down>up - cant walk dow stairs - poor response to lefvodopa

CBD - disorder of movement and cognition - alien hand syndrome

119
Q

Huntingtons diseaser

A

AD trinucleotide rpt disorder –> complete penetransce and anticipation

Loss of D2 in cortex + Striatum

Px:

  • Chorea
  • YOUNG PT WITH PD
  • slow saccadic ieye movements

inx - MRI

Mx

  • Symptomastic
  • SSRIs
  • Chorea –> Tetrabenazine
120
Q

Wilson’s disease

A

A.R. - chromosome 13 - decreased biliary copper exceretion

Child –> hepatic manifestion
late teen –> psychiatric –> exec dysfn/impulsivity./emotinally labile

other ft:
kayser-flaischer rings 
wing beating trremor 
chorea
dyskinesia

inx - MRI

Mx - Cu chelating wih Penicillamine

121
Q

tabes dorsalis

A

post column –> loss of dorsal column

122
Q

anterior horn cell syndrome

A

LMN signs

seen in poliomyelitis

123
Q

combined anterior horn + pyramidal

A

UMN lesions bellow and LMN @ lesion - ALS

124
Q

anterior spinal artery syndrome

A

supply anterior 2/3 of SC

Flaccid paralysis + loss of spinothalamic + preserved dorsal.

125
Q

Cauda equina vs connus medullaris syndrome

A

see notes essentiall

C.E - assymetrical LMN

CMS - symmetical UMN signs - motor preserved. - Early bladdder/biwel

126
Q

Mononeuropathies

A

Median nerve (C6 - T1):

  • Carpal tunnel
  • L.O.A(d).F
  • sensory thenar eminence

Ulnar (C7-T1):

  • Claw hand
  • Sensation - ulnar border of hand
  • distal compression –> Preserved palmar sensation
Radial N (C5-T1)
- wrist + finger drop 
Sensation loss dorsum of hand and 1st web.

Common peroneal

  • Foot drop+ weak eversion
  • Lateral shin + dorsum of foot sensation.
127
Q

Mononeuritis multiplex

WARDS PLC

A 
Wegners
amyloidosis
RA
DB
Sarcoidposis
PAN
Leprosy/lyme
Carcionmatosis/churg straus
128
Q

GBS

A

Flaccid paralysis + polyneuropathy

Follows URTI/GI infection - campylobacter

NADIR 14 dayts

can cause areflexia + Respiratory comprise (FVC)

EMG - Demyelinating dx therefore SLOW CONDUCTION

CSF - high protein otherwise normal

Mx - self terminates
if non-ambulant –> IVIg/Plasma exhange

129
Q

MG

A

ACH-R and MUSK (bulbar) . - POST SYNAPTIC

Assoc:

  • THYMOMA - CT Chest
  • AI disorder - pernicious anaemia/AI Thyroid. Rhwum/SLE
  • Thymic hyperplasia
Inx:
- EMG
- CT Chest - thymoma 
CK
- Tensilon test - IV edrophonium

Mx:

  • Pyridiostigmine - long acting acetylcholinesterase inhib
  • PRed
130
Q

MG exac factors

A
  • Penicillamine
  • Procainamide/quinidine
  • Betablocker
  • Li
  • phenytoin
  • Abx - gent/macrolide/quinolonews/tetracyclines
131
Q

Myasthenia crisis

A

increased commen in MUSK Ab + –> May req ventilation

Triggers: - Stressors/sterpods.withdrawl of pyridostigmine/ low K+ or PO4-/ anaemia

Mx:

  • Monitor FVC –> <1 –> ITU
  • IVIg + plasmophoresis
132
Q

LEMS

A

PRESYNAPTIC VOLTAGE GATED Ca channels

Assoc. SCC

rpt contractions –> STRENGTHEN

inx - EMG - shows strength with rpt

Tx

  • underlying cause
  • =3,4-DAP +/- pyridostigmine
  • I.S - pred + Aza
133
Q

Myopathies

A

Symmetrical PROXIMAL weakness - difficulty rising from chair or getting uo

Sensation/refleces all normal

Causes:

  • imflamm = polymoyositis
  • inherited - DMD/BMD.myotonic dystrophy
  • Endo - cushings/thyrotoxicosis
  • EtOH

inx - MUSCLE BIOPSY

134
Q

Myotonic dystrophy

A

20-30 yrs

Think of the Ds for DM1

  • Distal weakness
  • A.D.
  • DB –> glycosuria
  • Dysarthria

two types : DM1 and DM2

  • DM1 - distal >prox
  • DM2 - prox >distal

Ft:

  • myotonic facies - haggered
  • frontal balding
  • B/L ptosis
  • catracts –> LOSS OF RED REFLECX
  • dysarthric
135
Q

DMD and BMD

A

A.R.
Mutuation –> DYSTROPHIN GENE

DMD>BMD severity

DMD:

  • 1st 5yrs
  • calf pseudohypertophy
  • gowers sign
  • IQ DOWN

BMD:

  • 10yrs
  • IQ NORMAL
136
Q

fascioscapulohumeral dystrophy

A

A.D.

Affects what it says - facial/scapula/ upper arm

Px at 20yrs

137
Q

Dermatomyositis

A 
Prox muscle symmetrical weaskness 
Gottrens papuoles 
heliotrope rash - purple rash on face + eyelids 
 Photosensitive
macula rash on back + shoulder 
Inx: - CK!!!!!!
ANA 
Others Jo-1
SRP
MI-2 Ab

EMG
CK
MUSCLE BIOPSY

Mx - PRednisolone

138
Q

Polymyositis

A

symmetrical proximal weakness
Raynauds
Resp muscle weakness/ILD

Inx: - CK!!!!!!
JO-1 - esp assoc with raynauds !!!!
- EMG
Muscle biopsy

Mx - pred

139
Q

inclusion body myositis

A

insidious weakness @ 60yrs

PROX L.L AND DISTAL U.L.

Dysphage

Inx:

  • Muscle biops
  • Ck can be N
140
Q

Mitochondrial dx

A

exclusively maternally inherited
poor phenotype:genotype

Histology - RED RAGGED FIBRES

Examples:

  • Leber’s optic atrophy -= B/l painless LOV
  • MELAS - Stroke like episodes in <40
  • MERRF - Myoclonus/seizures/myopathy
  • KEarnes Sayres - ext opthalmoplegis + Retinitis pigmentosa + Ptosis
141
Q

Neurofibramotosis

A

NF1 - chromosome 17

  • Cafe au lait spots
  • axillary groin freckles
  • peripheral neurofibromas
  • lisch nodules
  • phaechromacytomas

NF 2 - Chromosome 22

  • Bilateral vestibular schwannomas
  • multiple intracranial schwannommas, ependyomas, meningiomas
142
Q

Tuberous sclerosis

A

Epilepsy + developmental problems

Shagreen patch 
ashleaf spot 
subungal fibromata 
adenoma sebaceoum 
Retinal harmartomas
143
Q

Absence seizure - CI AEDs

A

CARBAMEZAPINE

Phenytoin, vabigitran, gabapentin

144
Q

paraneoplastic syndromes affecting nervous system

A

LEMS

Anti-Hu
- Painful sensory neuropathy

anti-yo:

  • Cerebellar syndrome
  • assoc with Ovarian Ca and Breast Ca - Y looks like a vagina and (Y) looks like cleavage

Anti - Ri

  • Ri Ri - woman - breast cancer
  • Rhianna has great eyes
  • occular opsiclonus-myoclonus

Anti-GAD

  • stiff man syndrome
  • Oh My GAD im so stiff
145
Q

Triptan (5HT-1) Contraindication

A

Cerberovascualr disease

Ischaemic heart dx

146
Q

Miller fisher syndrome

A

typeof GBS

opthalmoplegia + Ataxia + Areflexia

Descending paralysis (Ascending in GBS)

147
Q

Risks of epilepsy on fetus

A

Birth defects
new botn epilepsy - 10% if one first degree 25% =>2
Neonatal coagulopathy - Phenytoin.phenobarbital/primidone - Give Vitamin K

148
Q

Anti-NMDA RECEPTOR encephalitis

A

Paraneoplastic syndrome - Ovarian tumour

Px - encephalitis and psychiatric features

Tx - immunosupress

149
Q

Ménière’s disease

A

Sensorineural deafness + tinnitus + vertigo

Mx:
ENT
DVLA - cease until sx control

Acute - prochloroerazine

Prevention -betahistine

150
Q

Neuropathic pain

A

Amitryptilline gabapentine pregabalin duloxetine

Fx —> tramadol

151
Q

Ataxia telangectasia

A

AR

Cerebellar ataxia
Telangectasia
IgA deficiency —> recurrent chest infections
- malignancy lymphoma leukaemia

152
Q

Friederichs atxia vs ataxia telangectasia

A

Both:
AR
CEREBELLAR ATAXIA
ONSET IN CHILDHOOD

friederichs - DONT get infections

153
Q

Guillian barre syndrome

A

Flacid weaknes

Hyporeflexia

Tachycardia

154
Q

VHL

A

Retinal and cerebral hemangiomas –> px/fhx of ICH or suddent blindness

Renal cysts –> renal ca

Phaeochromacytoma

155
Q

stroke secondary prevention

A

Clopidogrel + statin

156
Q

LEMS

A

Small cell lung ca

presynataptic voltage gated Ca channels

PROXIMAL weakness –> can repsond to STEROIDS

157
Q

Absence seizure - what % seizure freee >16 yrs

A

90-95%

158
Q

Pergolide - used in Parkinsons - complication

A

Can cause pulmonary fibrosis

159
Q

Pituitary apoplexy

A

Hypopituitarism (hypotension, low hormones and can mimic SAH

160
Q

Raised protein in CSF

A

GBS
TB/Fungal/Bacterial meningitis
Froin’s syndrome - Raised protein bellow blockage “tumour, disc infection”
Viral encephalitids

161
Q

Otitis media mx

A

Topical abx + stewroid

162
Q

Facial nerve palsy

A

Hyper acusis due to paralysis of stapedius

Facial nerve paralys
loss of supply to ant 2/3 tongue

loss of tears

163
Q

most common complication following meningitis

A

Sensorineural Hearing loss

164
Q

DVLA + NEuro

A

Stroke/ TIA - 1/12
Multiple stroke/TIA in short period - 3/12

Craniotomy for meningioma - 1 year
Craniotomy for pituitary - 6/12

Transphenoidal - drive once no no impairment

Simple faint - no
1 ep syncope explained + trated - 4/52
1 ep unexplained - 6/12
>1 Ep - 12/12

Narcolepsy/cataplexy - cease on diagnosis

165
Q

MND - MX

A

Riluzole:

  • prevents stim of glutamate receptors
  • used in ALS
  • 3/12 prolonged survival

NIV:
- bets for survival - 7/12

166
Q

Transient global amnesia

A

Retrograd and antegrade amnes + Repetitive questions - w/o other neuro or cognitive sign

lasta <24 hrs

167
Q

Menieres dx

A

tinnitus
SNL HL
VErtigo

nystagmus

mx:

  • Acute = prochlorperazine - IM or buccal
  • prevention = betahistine
168
Q

Hemiballism

A

Damage to Subthalmic nucleus.

contralat Involuntary jerking movements - Prox>dista

Sx better when sleep

Tx:
- Antia DA - Haloperidol

169
Q

Neuroleptic malignant syndrome

A

Occurs hrs or days after starting antipsychotic or in PD agter suddenlt stopping Dopaminergic drugs

Ft:

  • High Temp
  • High BP/HR/RR
  • Muscle Rigidity
  • Confudion/delirium

Tx:

  • Stop Antipsychotic
  • IVI
  • Dantrolene
170
Q

VEstibular neuronitis vs viral labyrinthitis

A

VN:
- No HL or tinnitus
- Vertigo
Horizontal nystagmus

VL:
- Vertigo + HL

171
Q

Horners syndrome - distinguishing between causes

A

Heterochromia = congenital hroners

1st order - Central lesion - think of S’s :

  • Syringiomyelia
  • stroke
  • Multiple Sclerosis
  • tumour
  • enceph
  • Anhydrosis to fce + arm + trunk

2nd order - Preganglionic - think Ts:

  • Anhydrosis to face
  • Pancoast Tumour
  • Thyroidectomy
  • Trauma

3rd order - Pos-gananglionic - think of Cs:

  • Carotid aneurysm
  • Carotid dissection
  • Cavernous sinus thrombosis
  • Cluster headache
172
Q

Stroke - ant cerebral artery vs middle cerebral artery

A

Ant:
- Lower extremity > upper extremity

MCA:

  • Upper extremity > Lower
  • Contralat homonymous hemianopia
  • Aphasia
173
Q

CLuster headache RF / Triggers

A

RF:

  • men
  • smoekrs

Trigger = EtOH

174
Q

What parkins medication can lead to pulmonary fibrosis

A

Pergolide

175
Q

Medication overuse headache mx

A

Simple analgesics - stop abruptly

Opiods - withdraw gradually

176
Q

Ataxia telangectasia

A

Cerebellar Ataxia - falling over

Ig-A- leads to recurrent chest infections

Telangectasia

177
Q

Damage to what structure causes chorea

A

Damage to the caudate nucleus of the basal ganglia

178
Q

Myotonic dystrophy - Think of the Ds

A

DM1

  • Dyarthria
  • Distal weakness
  • A.D
  • DB
179
Q

MS good prognostics

A 
Female 
young age 
R-R 
sensory sx only 
long interval between episodes
full recovery between episodes.
180
Q

Botulinism

A

Clostridia = G+ anaerobic bacillus

Seen in IIVDU / contaminated food

Block og ACh release

FLACCID PARALYSIS

Mx - anti-toxin only effective if given earluy

181
Q

Meningitis bacterial causes

A

0-3 months:.

  • grpup B strep
  • e. Coli
  • listeria

3months - 6years
- meningococcus
Pneumococcus
H. Influenzae

6-60 yrs:

  • meningococcus
  • Pneumococcus

> 60:
Meningococcus
Pneumococcus
Listeria

Immunodeficiency - listeria

182
Q

Bells oalsy vs ramsey hunt

A

Both cause LMN facial nerve palsy

Ramsey hunt - HZV - RASH around ear

Bells - NO RASH - often vira

Ramsey hunt - give aciclovir

Bells palsy - pred only

183
Q

Palatale myoclonus SOL - what ate affected?

A

Olivary nucleus

184
Q

Types of nstagmus and site of lesion

A

See-saw = occipital

Alternating + jerky - Cerebelum

Convergence-retraction - Midbrain

Downbeat = medulla

Up-beat = pons

185
Q

Nerve conduction results

A

Conduction block - ddue to segmenyal demyelination - seen in GBS

Axonal demyelination - normal conduction Velocity with low AP

Global demyelination - no conduction block

Wallerian degeneration - axonal + myelin degeneration distal to axonal damage - MY INJURY

186
Q

How to control Droolng in Parkinsons pt

A

consider gylocpyronium bromide

187
Q

Pyramidal tract lesion pattern of weakness

A

Upper limb extensor lower limb flexor

188
Q

Medication overuse headache

A

NSAIDs/paracetamol - stop ABRUPTLY

Opiates - withdraw SLOW

189
Q

Factors that affect rate of LP induced headache

A

Size of needle
Direction of bevel
not replacing stylet
Inc number of ttempts.

190
Q

Miller Fisher vs GBS

A

Miler - Fisher syndrome is a variant of GBD which STARTS with CNS

therefore often start with eye signs

anti-G1qb

191
Q

Strokke - Alexia but able to write - What area of the brain?

A

Corpus callosum

192
Q

GBS poor prognostics

A 
>40yrs 
Preceeding diarhoeal illness
Upper limbs affected 
High anti-GM1 titre 
Need for ventilatory support
193
Q

Subcortical vs cortical dementia

A

Cortical:
- Memory + language

Subcortical:

  • Frontal lobe - planning, verbal fluency, personality
  • psychomotor slowing, reduced verbal output, reduced response.
194
Q

Which AED is contraindicated in absence seizures?

A

Carbamezapine - can worsen seizures

195
Q

Myasthenia crisis

A

FvC measuring

Plasmaphoresiss and IV Ig

MRCP (20 decks)

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