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MRCP part 2 > Neurology > Flashcards

Neurology Flashcards

1
Q

Parkinson’s disease RFs

A
  • REM sleep disorder
  • sleep apnoea
  • older males
  • CVD risk factors
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2
Q

Vertebral artery dissection symptoms

A
  • neck pain / headache
  • ataxia, dysarthria, vertigo, diplopia
  • lateral medullary syndrome: ataxia, nystagmus, ipsilateral horner’s & loss of facial sensation; contralateral limb sensory loss
  • cerebellar infarction
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3
Q

Botulism features

A
  • patient usually fully conscious with no sensory disturbance
  • flaccid paralysis (descending)
  • diplopia
  • ataxia
  • bulbar palsy
  • may have autonomic features e.g. dry mouth, dilated, slow reacting pupils
  • may have false positive tensilon test
  • NMJ problem therefore no conduction block (vs GBS)
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4
Q

Sporadic CJD clinical features

A

neuropsychiatric: dementia, anxiety, fluctuating behavioural changes, frontal lobe syndromes, apraxia, aphasia (rapid onset)
myoclonus
cerebellar: ataxia, incoordination
corticospinal: spasticity, hyperreflexia, babinski +ve
extrapyramidal features
NB: cranial nerve abnormalities and peripheral nerve involvement is rare

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5
Q

Sporadic CJD investigations

A

CSF is usually normal. CSF 14‐3‐3, S100 and tau may be positive. RT-QuIC
EEG: biphasic, high amplitude sharp waves (only in sporadic CJD). periodic sharp wave complexes
MRI: hyperintense T2 signals in the cortex, basal ganglia and thalamus. Cortical ribboning is a classic sign. DWI changes are most the most sensitive

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6
Q

Paroxysmal hemicrania

A
  • unilateral
  • retro-orbital / temporal
  • autonomic: eye watering, red eye, runny nose, miosis
  • specific: multiple short lasting atacks
  • responds well to indomethacin
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7
Q

Anterior spinal artery syndrome

A

Features

  • anterior 2/3 spinal cord stops working
  • dorsal columns preserved - vibration / proprioception
  • flaccid paresis, arreflexia
  • autonomic features e.g. hypotension, bladder/bowel dysfunction
  • cervical cord may -> ventilatory failure

Causes: aortic aneurysm / dissection (into anterior spinal), trauma, atherosclerosis, embolic stroke, disc herniation / cancer occluding anterior spinal artery

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8
Q

Anterior inferior cerebellar artery stroke

A
  • lateral pontine infarct
  • vertigo, nystagmus
  • ipsilateral tinnitus
  • ipsilateral facial LMN
  • ipsilateral conjugate lateral gaze palsy
  • cerebellar ataxia
  • ipsilateral horner’s
  • contralateral loss of pain / temp sensation
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9
Q

Posterior cerebral artery stroke

A
  • distal occlusions can be symptomatic and variable
  • agnosia
  • prosopagnosia
  • cortical blindness
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10
Q

Anterior cerebral artery stroke weakness pattern

A
  • lower limb > upper limb
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11
Q

Posterior inferior cerebellar artery stroke

A
  • ipsilateral loss temp / pain
  • +/- ipsilateral horners
  • +/- ipsilateral CN palsy
  • ipsilateral ataxia
  • nystagmus
  • contralateral loss temp / pain
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12
Q

Weber syndrome

A
  • ventrolateral midbrain infarction
  • paramedian branches basilar / posterior cerebral artery
  • ipsilateral CNIII palsy
  • contralateral weakness
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13
Q

Carotid artery dissection

A
  • pressure symptoms: CNIII and CNXII palsies, partial horners (miosis)
  • thromboembolic symptoms: anterior circulation strokes
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14
Q

Friedreich’s ataxia aetiology

A

AR trinucleotide repeat disorder (GAA)
peak incidence 8-14 yrs
chromosome 9 defect

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15
Q

Friedreich’s ataxia features

A
  • progressive condition
  • ataxia
  • diminished reflexes
  • loss of vibration sense / proprioception
  • spastic paraparesis with extensor plantars
  • dysarthric speech
  • optic atrophy
  • kyphoscoliosis
  • DM 10-20%
  • CV abnormalities e.g. HOCM / LVH
  • high arched palate, pes cavus
  • NCS: low amplitude sensory, normal motor
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16
Q

MS relapses mx

A
  • PO methylpred 500mg OD 5/7
  • 2 relapses in less than 2 years? referral for DMARDs
    1) beta-interferon
    2) fingolimod
    3) natalizumab (beware PML, ITP)
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17
Q

Muscular dystrophies general info

A
  • X linked recessive
  • Progressive muscular weakness
  • Cardiomyopathies may occur
  • Duchenne: cognitive impairment as well, cardiomyopathy more common
  • Becker: presents later, arrhythmias occur
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18
Q

Myotonic dystrophy genetics

A
  • AD trinucleotide repeat

- generational anticipation

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19
Q

Myotonic dystrophy features

A
  • myotonic facies
  • frontal balding
  • b/l ptosis
  • cataracts
  • dysarthria
  • slow relaxing reflexes (myotonia)
  • limb weakness (usually distal initially)
  • mild LD
  • testicular atrophy
  • heart block (primary)
  • dysphagia
  • IX: EMG (dive bomber), genetic testing
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20
Q

Post seizure time no driving

A

6 months

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21
Q

PML ix

A

CD4 <100 usually in HIV
Other immunosuppression
Widespread patchy demyelination

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22
Q

CNS lymphoma sx and ix

A

Fevers
Progressive GCS deterioration
LP: elevated lymphocyte count

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23
Q

PFO stroke mx

A
  • PFO closure
  • antiplatelet
  • increased risk AF - anticoagulate if develops
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24
Q

Trigeminal neuralgia red flags which require MRI / neurologist review

A
  • sensory changes
  • deafness
  • pain only in V1
  • bilateral pain
  • FHx MS
  • age <40
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25
Q

ABX for meningitis post basal skull fracture

A

S Aureus and Epidermidis cover
e.g. IV linezolid
OR IV vancomycin (but worse CNS penetrance)

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26
Q

Carotid endarterectomy in strokes

A

Symptomatic stenosis for all >70%
Consider for symptomatic stenosis >50%
No indication for 100% symptomatic stenosis

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27
Q

Subacute combined degeneration of the cord sx

A
  • dorsal and lateral columns
  • loss of proprioception and vibration sensation first
  • then paraesthesiae / numbness distal legs
  • UMN signs lower limbs - weakness, brisk knee jerks, extensor plantars
  • BUT absent ankle jerks
  • neuropsych manifestations of b12 deficiency may also occur
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28
Q

Migraine treatment

A

1) triptan + NSAID / paracetamol (nasal triptan 12-17)
2) metoclopramide

NB: triptans CI in ischaemic heart disease or CVA

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29
Q

Migraine prophylaxis

A

1) propranalol
2) topiramate
3) amitriptyline

NB: topiramate is teratogenic and interferes with COCP therefore not preferable in women of childbearing age

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30
Q

Charcot Marie Tooth aetiologies

A

Hereditary sensorimotor neuropathies

  • type 1: demyelinating (increased latency)
  • type 2: axonal (decreased amplitude)
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31
Q

Charcot Marie Tooth presentation

A
  • ascending weakness starting with intrinsic mucles of the feet
  • champagne bottle legs
  • foot drop
  • pes cavus
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32
Q

Cerebellopontine angle lesion sx (e.g. acoustic neuroma)

A
  • CN VIII: ipsilateral hearing loss, tinnitus, vertigo
  • CN V (if involved): loss of corneal reflex
  • CN VII (if involved): LMN facial palsy
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33
Q

Petrous temporal lesions sx

A
  • CN V all divisions: loss of sensation / corneal reflex

- CN VI: lateral gaze palsy

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34
Q

Superior orbital fissure lesion sx

A
  • CN V - opthalmic division only - loss of sensation / corneal reflex
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35
Q

Homocysteineuria

A
  • marfanoid features e.g. arachnodactyly
  • learning disability (not present in Marfan’s)
  • livedo reticularis
  • malar flush
  • young stroke
36
Q

Progressive supranuclear palsy sx

A
  • parkinson plus
  • cognitive impairment
  • vertical gaze palsy
  • slurred speech
  • poor response to L-dopa
37
Q

Multisystem atrophy sx

A
  • parkinson plus
  • parkinsonism +/- cerebellar signs (either may predominate)
  • autonomic symptoms: postural hypotension, erectile dysfunction, bladder / bowel disturbance
38
Q

Syringomyelia sx

A
  • spinothalamic tracts (neuropathic pain / loss of temp sensation) -> anterior horn (power) -> usually spares dorsal columns (vibration / proprioception)
  • flaccid paresis at the level of the lesion
  • spastic paraparesis below level of the lesion as syrinx expands
  • symptoms worse on coughing
  • association with arnold-chiari malformation
39
Q

Tropical spastic paraparesis

A

HTLV-1 transmission through blood / sexual contact
Caribbean / equatorial Africa / South America - regions endemic
5% of infected get tropical spastic paraparesis
No cure

40
Q

Cerebral toxoplasmosis mx

A

Sulfadiazine, pyrimethamine, folinic acid

41
Q

CMV encephalitis mx

A

Foscarnet & ganciclovir

42
Q

Cryptococcus meningitis

A

CSF: high protein, lymphocyte predominance, glucose not too low
Ix: cryptococcal antigen, india ink stain

Amphotericin B (± abx cover for bacterial meningitis e.g. ceftriaxone)

43
Q

Bell’s palsy treatment

A

60mg prednisolone OD for 1 week

44
Q

Inclusion body myositis presentation

A
  • usually men over 50
  • slower progression than polymyositis
  • affects quads and forearm flexors most - weakness and atrophy
  • CK raised but less than polymyositis
  • less responsive to immunosuppressive therapy vs polymyositis
45
Q

Carbemazepine and COCP

A

Carbemazepine reduces COCP effectiveness

Advise take preparation containing at least 50mcg ethinyloestradiol

46
Q

Juvenile myoclonic epilepsy

A

Presentation

  • myoclonic seziures
  • frequent absences
  • infrequent GTCs
  • onset teens, mostly females
  • symptoms often on waking
  • lifelong disease

Mx

  • sodium valproate
  • lamotrigine / keppra - esp for females as not teratogenic
  • NB: carbamazepine WORSENS myoclonus / absences
47
Q

Common peroneal nerve palsy symptoms

A
  • weakness of foot dorsiflexion
  • weakness of foot eversion / preservation of inversion (vs L5/S1 lesions)
  • weakness of extensor hallucis longus
  • sensory loss over the dorsum of the foot and the lower lateral part of the leg
48
Q

Basilar artery stroke

A

ventral pons infarct -> locked in syndrome

49
Q

Target bp in ICH

A

140/80

50
Q

PCA aneurysm

A

Ipsilateral facial pain / headache

Oculomotor nerve palsy with progressive increase in size

51
Q

Multifocal motor neuropathy

A 
LMN signs 
Patchy motor neuron block on EMG / NCS
Bland CSF
Raised anti-GM1 ganglioside antibody
Responds well to IVIG
52
Q

Spinal muscular atrophy

A 
AR diseases 
Flaccid paraparesis 
SMA1 - rapid perinatal death
SMA3 - juvenile onset
SMA4 - adult onset
53
Q

Jugular foramen syndrome

A
  • lesion e.g. glomus jugulare tumour
  • compression and deficit of CN IX, X, XI
  • NB: similar deficits caused by extracranial carotid artery aneurysm / haematoma expansion
54
Q

Bickerstaff’s encephalitis

A
  • progressive symmetrical opthalmoplegia
  • ataxia
  • change in gcs
    +/- hyper-reflexia
  • anti-GQ1b ab positive
  • preceding illness
  • Mx: steroids, IVIG, PEX
55
Q

Managing hallucinations in Lewy body dementia

A

AChE inhibitors e.g. rivastigmine

56
Q

Lance-Adams syndrome

A

Intention myoclonus following cerebral hypoxia (days to weeks)
Mx: clonazepam / valproate

57
Q

Idiopathic intracranial hypertension RFs

A
  • raised BMI

- drugs: OCP, vitamin A, DAs, abx, phenytoin

58
Q

Idiopathic intracranial hypertension mx

A
  • therapeutic LP
  • acetazolamide
  • topiramate if co-existing migraines
59
Q

Meningeal carcinomatosis

A
  • lung, breast, GI, melanoma, lymphoma primary
  • variable neurology
  • headache
  • sciatic pain
  • cauda equina
  • CN palsies
  • focal neurology
  • poly-radiculoneuropathy
  • seizures
  • confusion
    Ix: CSF lymphocyte pleocytosis, malignant cells
60
Q

Factors worsening myasthenia gravis

A 
Beta blockers
Phenytoin
ABX: gent, macrolides, quinolones
Penicillamine
Procainamide
Pregnancy
61
Q

Neuroleptic malignant syndrome mx

A
  • IV fluids
  • Stop antipsychotic OR restart dopamine agonist
  • dantrolene (in severe cases, reduces muscle excitation)
  • bromocriptine
62
Q

Lambert Eaton syndrome vs Myaesthenia

A
  • improvement in weakness with repeated stimulation
  • more likely to have autonomic involvement - e.g. dry mouth, erectile dysfunction
  • more commonly paraneoplastic
  • ophthalmoplegia and ptosis less commonly present
  • Mx: 3,4-diaminopyradine (not pyridostigmine!) AND immunosupression with steroids and aza/mtx
63
Q

Meralgia paraesthetica

A

Compression of the lateral cutaneous nerve of the thigh (passing through tunnel of inguinal ligament and ASIS) -> sensory loss antero-lateral thigh

64
Q

Frontal lobe seizures

A
  • usually nocturnal
  • bizarre automatisms
  • short duration
  • less post ictal symptoms
65
Q

Cluster headache mx

A 
Acute
1) high flow oxygen
2) SC or nasal sumitriptan
Prophylaxis
1) verapamil
66
Q

Stiff person syndrome

A
  • anti-GAD antibody
  • T1DM association
  • can be paraneoplastic
  • progressive stiffness and spasms -> improve during sleep
  • EMG: continuous motor unit activity
  • Mx: benzos or baclofen
67
Q

Huntington’s disease

A
  • AD trinucleotied CAG repeat
  • huntingtin gene chromosome 4
  • disease exhibits anticipation
  • symptom onset after 35 yrs
  • chorea
  • personality changes
  • saccadic eye movements
  • dystonia
  • death 20 years after symptom onset
  • no cure
68
Q

Kearns-Sayre syndrome

A
  • mitochondrial inheritance
  • onset <20 yrs old
  • external ophthalmoplegia
  • assoc retinitis pigmentosa
69
Q

Refsum’s disease

A
  • AR inheritance
  • accumulation of phytanic acid
  • cerebellar ataxia, peripheral neuropathy, deafness
  • ichthyosis (dry skin, horns)
70
Q

Venous sinus thrombosis symptoms

A

General
- headache, nausea, vomiting

Saggital: seizures, hemiplegia, haemorrhagic infarcts

Lateral: CN VI and VII palsies

Cavernous: CN III, IV, V1/V2, VI palsies
- NB: cavernous sinus syndrome causes include infection from sinusitis spreading, expanding ICA aneurysm, trauma

71
Q

MELAS: mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes

A
  • mitochondrial inheritance
  • short stature, DM2
  • recurrent migraines
  • vomiting, muscle weakness, seizures
  • strokes start in 40s
  • progressive dementia
  • lactic acidosis
  • muscle biopsy: ragged red fibres
72
Q

CADASIL: cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

A
  • AD inheritance
  • initially presents with migraines
  • then multiple TIAs/strokes
  • progressive dementia
  • psychiatric problems
  • widespread white matter infarcts
73
Q

Causes of CN III palsy

A
  • infarct e.g. midbrain e.g. Weber syndrome
  • haemorrhage
  • tumour
  • aneurysm: posterior communicating artery, ICA, basilar
  • as part of cavernous sinus syndrome
  • demyelination
  • vasculitis
  • diabetes
74
Q

McArdle’s disease

A
  • glycogen storage disease
  • AR inheritance
  • painful cramps on exercising
  • elevated CK
  • myoglobinuria
  • low lactic acid levels during exercise
  • Ix: muscle biopsy
  • Mx: carbohydrate rich diet
75
Q

Drug of choice when considering pregnancy

A

1) lamotrigine

2) keppra

76
Q

Variant CJD

A
  • acquired through eating infected meat (e.g. bovine spongiform encephalopathy)
  • earlier onset vs sCJD
  • early symptoms often more neuropsychiatric -> neurological symptoms later
  • CSF RT-QuIC often negative
  • EEG often no periodic sharp waves
  • PrP immunochemistry - cluster plaques
77
Q

Subacute sclerosing panencephaliits

A
  • progressive CNS degeneration following early measles infection
  • intelectual deteriorating
  • myoclonic jerks
  • choroidoretinitis -> deteriorating vision
  • seizures
  • pyramidal signs, rigidity
  • ultimately death, no cure
78
Q

Median nerve muscles

A
  • most forearm flexors
  • pronators
    LOAF muscles
  • lateral two lumbricles
  • opponens pollicis brevis
  • abductor pollicis brevis
  • flexor pollicis brevis
79
Q

Ulnar nerve muscles

A
  • flexor carpi ulnaris
  • flexor digitorum profundus
  • small muscles of the hand (except LOAF)
80
Q

Radial nerve muscles

A
  • triceps
  • brachioradialis
  • supinator
  • extensors of the wrist and fingers
81
Q

CIDP (chronic inflammatory demyelinating polyneuropathy)

A
  • chronic version of GBS type symptoms -> symmetrical flaccid weakness > sensory deficit
  • can relapse and remit OR be progressive
  • IX: NCS show conduction delay, MRI shows inflamed nerve roots
  • Mx: corticosteroids, azathioprine, IVIG, PEX
82
Q

Best anti-convulsant in alcoholics

A

Lamotrigine OR keppra

  • as carbemazapine is cyp450 inducer
  • valproate is cyp450 inhibitor
83
Q

Acute dystonia and tardive dyskinesia mx

A

Procyclidine, stop offending agent

84
Q

ABCD2 score

A 
A 1) Age ≥60
B 1) SBP ≥140; DBP ≥90
C 1) speech impairment
C 2) unilateral weakness 
Du 1) 10-59 mins
Du 2) ≥60 mins
Di 1) Diabetes

≥4 is high risk -> admit

85
Q

Exacerbating factors in myaesthia

A
  • B blockers
  • antibiotics: gent, clary, cipro, doxy
  • lithium
  • phenytoin
  • penicillamine
  • quinidine
  • procainamide
  • magnesium
86
Q

Restless legs mx

A

1) ropinerole / other dopamine agonists
2) Gabapentinoids
3) ? carbemazepine
3) Mild opioids / benzos

MRCP part 2 (11 decks)

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