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MRCP 1 > Neurology > Flashcards

Neurology Flashcards

1
Q

Acute Mx of migraine

A

triptan (5HT agonist) + NSAID/paracetamol +/- metoclopramide*/prochlorperazine
*may cause acute dystonic reactions in young

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2
Q

who should have migraine prophylaxis?

what drugs?

A

> 2 attacks/month

1) topiramate or propanolol
* propanolol preferenced for women of child bearing age as ?teratogenic for topiramate
2) acupuncture or gabapentin

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3
Q

causes of restless leg syndrome

A 
Fe deficiency
uraemia
DM
pregnancy
idiopathic - positive FH in 50%
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4
Q

Mx of restless leg syndrome

A 
massage/stretching
dopamine agonist (ropinirole)
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5
Q

Reasons to start antiepileptics after 1st seizure

A

unacceptable consequences of second seizure
structural changes on brain imaging
unequivical epileptic activity on EEG
neurological deficit

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6
Q

1st line meds for:
generalised seizures
partial seizures

A 
sodium valproate (weight gain)
carbamazepine
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7
Q

pathological changes in Alzheimers disease

A

intraneuronal neurofibrillary Tau protein tangles
neuronal plaques
deposition of type A beta-amyloid protein in cortex

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8
Q

Mx of Alzheimers disease

A

mild-mod: acetylcholinesterase inhibitors - donepezil, galantamine, rivastigmine

mod-severe: NMDAr antagonist - memantine

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9
Q

symptoms of normal pressure hydrocephalus

A

urinary incontinence
gait disturbance
dementia and bradyphrenia (slow thoughts)

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10
Q

pathological cause of normal pressure hydrocephalus
secondary to what?
Mx

A

reduced CSF absorption at the arachnoid villi
secondary to head injury, SAH, meningitis
Mx: ventriculoperitoneal shunt

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11
Q

medical management of MND

A

riluzole - prevents glutamate r stimulation
mainly used in amyotrophic lateral sclerosis
increases life by 3months

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12
Q

Chorea - which part of the brain affected

A

basal ganglia, especially caudate nucleus

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13
Q

what is Uhthoff’s phenomenon?

A

worsening of neurological symptoms following rise in body temperature with demyelinating conditions

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14
Q

symptoms of MS

A

vision: Internuclear ophthalmoplegia, optic neuritis, optic atrophy
sensory: Lhermitte’s syndrome, paraesthesia
motor: spastic weakness (legs more commonly)
cerebellar: ataxia
urinary incontinence, sexual dysfunction

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15
Q

what is Lhermitte’s sign?

A

shooting pain down the spine on flexion of the neck

ass. with MS

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16
Q

Dx criteria for migraine

A 
atleast 5 attacks of:
- headache lasting 4-72hrs
- n&v or photo/phonophobia
- >2 of:
pulsating nature
unilateral
disrupts usual activity
mod-severe
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17
Q

features of CN III palsy

A

eye “down and out”
diplopia
ptosis
mydriasis (dilated pupil if “surgical”) - affected parasympathetic innervation

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18
Q

features of Horner’s syndrome

A

miosis (constricted pupil)
ptosis
anhydrosis

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19
Q

Features of neurofibromatosis type 1:

A 
cafe-au-lait spots (>6)
axillary/groin freckles
peripheral neurofibromas
Lisch nodules in the iris (pigmented spots)
scoliosis
phaeochromocytoma
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20
Q

features of neurofibromatosis type 2

A

bilateral acoustic neuromas

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21
Q

chromosomes affected in neurofibromatosis 1 and 2

A

NF1 - 17 - 17 characters in neurofibromatosis

NF2 - 22 - all the 2s

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22
Q

risk factors for cluster headaches

A

male

smoking

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23
Q

features of cluster headache

A

lacrimation, redness, nasal congestion
pain around 1 eye,
1 or 2 attacks/day
cluster for 4-12 weeks

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24
Q

Mx of cluster headache, acute and prophylaxis

A

100% oxygen, SC sumatriptan, nasal lidocaine

prophylaxis: verapamil, pred

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25
Q

pathology of Parkinson’s disease

A

progressive neurodegeneration of dopaminergic neurones in the substantia nigra

26
Q

classical triad of Parkinson’s disease

A

bradykinesia, resting tremor, rigidity

typically asymetrical

27
Q

features of meniere’s disease

A

vertigo, tinnitus, SN hearing loss, feeling of pressure/fullness in ear

28
Q

Mx of meniere’s

A

refer to ENT
acute: prochlorperazine
prevention: beta histine
inform DVLA - cease driving until symptoms controlled

29
Q

features of MND

A

fasciculation
LMN signs in arms, UMN signs in legs
sensation and cerebellum unaffected
normal nerve conduction studies

30
Q

ABCD2 score
what is it for
what are the criteria?

A

risk strafication after a TIA
age >60 - 1
BP >140/90 - 1
clinical features: unilateral weakness - 2
speech disturbance only - 1
duration of symptoms: >60mins - 2
10-59mins - 1
Diabetes - 1

31
Q

post TIA management

A 
ABCD2 score 4-7:
- 300mg aspirin
- specialist review in <24hrs
- secondary prevention measures (BP statin clopidogrel)
ABCD2 score 0-3:
- specialist review in 1 week
32
Q

Mx of MS

A

acute relapse - IV methylpred
beta-interferon (reduce relapse rate by 30%)
baclofen and gabapentin for spasticity
physio
others: glatiramer acetate, natalizumab, fingolimod

33
Q

classic triad of wernicke’s encephalopathy

Cause

A 
nystagmus
ophthalmoplegia
ataxia
(also confusion, peripheral neuropathy)
B1 (thiamine) deficiency - can recover
34
Q

bitemporal hemianopia
upper quadrants affected ?cause
lower quadrants affected ?cause

A

upper quadrants= inferior chiasmal compression - pituitary tumour
lower quadrants = superior chiasmal compression - craniopharyngioma

35
Q

features of Lewy Body dementia

A

progressive cognitive decline
parkinsonism
visual hallucinations
worsening with antipsychotics

36
Q

pathology of Lambert-Eaton syndrome

A

paraneoplastic autoimmune reaction to pre-synaptic calcium channels
associated with small cell lung cancer.

37
Q

features of Lambert Eaton syndrome

A

limb girdle weakness (affects legs first)
hyporeflexia
autonomic dysfunction: impotence, dry mouth, difficulty micturating

38
Q

secondary prevention meds in stroke Mx

A

clopidogrel
statin if cholesterol >3.5
carotid doppler –> endarterectomy if >70% stenosed

39
Q

causes of bilateral facial nerve palsy

A 
sarcoidosis
guillian barre
polio
lyme disease
neurofibromatosis type 2 (bilateral acoustic neuromas)
40
Q

which infection is most strongly associated with Guillian-Barre syndrome?

A

campylobacter jejuni

41
Q

cause and features of lateral medullary syndrome (Wallenburg’s syn)?

A

occulsion of post inf cerebellar artery
cerebellar signs: ataxia and nystagmus
contralateral limb sensory loss
ipsilateral: dysphagia, facial numbness, CN palsy

42
Q

pathology of Brown-Sequard syndrome?

features?

A

spinal cord hemisection
ipsilateral spastic paresis
ipsilateral loss of proprioception and vibration (dorsal column)
contralateral loss of temperature and pain (spinothalamic)

43
Q

what are the features of post-concussion syndrome

A

headache
fatigue
anxiety/depression
dizziness

44
Q

Side effects of triptans?

contraindications?

A

‘triptan sensations’ - tingling, heat, tightness (chest and throat), heaviness, pressure
C/I in IHD or CVD

45
Q

definition of cataplexy

A

sudden and transient loss of muscle tone due to strong emotion
associated with narcolepsy

46
Q

features of Bells palsy

Mx

A

LMN facial nerve palsy (forehead is affected)
pts also get periauricular pain, dry eye, hyperacusis, altered taste
oral pred 25mg BD if presented within 72hrs of onset.

47
Q

which antibody is found in Guillian Barre syn

A

anti-ganglioside antibody (anti-GM1)

48
Q

What is Miller Fisher syndrome?

which antibodies are present?

A

variant of Guillian Barre syn,
ophthalmoplegia, ataxia, areflexia. Eyes are typically affected first - presents as a descending paralysis
anti-GQ1b found in 90%

49
Q

Symptoms of a parietal lobe lesion

A 
sensory inattention
Gerstmann's syndrome
inferior homonymous quadrantinopia
apraxia
tactile agnosia (asteriognosis) [unable to identify object from touch alone]
50
Q

Mx of BPPV

A 
Epley manoeuvre (sucessful in 80%)
teach pt exercises at home - Brandt-Daroff exercises
51
Q

causes of neuroleptic malignant syndrome

A

NMS is due to a sudden decrease in dopamine activity

adverse reaction to atypical antipsychotics after altering dose
sudden stopping of dopaminergic medications
anti-doperminergic meds eg metoclopramide
lithium

52
Q

Features of neuroleptic malignant syndrome

A

muscle rigidity, tachycardia, fever, autonomic instability, altered mental state
elevated CK, may have leukocytosis

53
Q

Mx of neuroleptic malignant syndrome

A

stop offending drug
IV fluids
dantrolene may be used
bromocriptine (dopamine r agonist) may be used

54
Q

Pathology and features of multifocal motor neuropathy (MMN)

A

Autoimmune demyelinating neuropathy affecting peripheral nerves
associated with motor block
raised anti-GM1
progressive asymmetric muscle weakness, no sensory signs, fasciculation, normal reflexes

55
Q

features of Human T-lymphotrophic virus - 1 (HTLV-1)

A

seen in HIV patients
tropical spastic paresis - progressive weakness, urinary retention.
HTLV-1 positive

56
Q

causes of a spastic paresis

A

UMN lesion
brain - infarct, haemorrhage, meningioma, blastoma
spine - trauma, tropical spastic paresis (HTLV-1), syringomyelia, transverse myelitis (eg HIV)
demyelination eg MS
OA cervical spine

57
Q

features of Chronic inflammatory demyelinating polyneuropathy(CIDP)

A

progressive motor and sensory neuropathy with loss of reflexes.
conduction studies show demyelination
elevated CSF protein

58
Q

contraindications to antieptileptics

a) sodium valproate
b) carbamazepine

A

sodium valproate:
C/I in hepatic disease and pregnancy
-> lamotrigine

carbamazepine:
C/I in heart defects (potentiates AV conduction problems) and pregnancy, previous bone marrow suppression

59
Q

Management of narcolepsy

A

Non pharmalogical - sleep diary, decrease alcohol

Methylphenidate (CNS stimulant)

60
Q

Mx of cataplexy

A

Fluoxetine or clomipramine

MRCP 1 (15 decks)

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