Neurology Flashcards

1
Q

What are 5-HT3 antagonists, examples and adverse effects?

A
  • anti-mimetics
  • chemotherapy related nausea
  • ondansetron, graniestron
  • ADR: constipation, prolonged QT
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2
Q

What are absence seizures, features and management?

A
  • generalised epilepsy mostly seen in children
  • unaware, quick, triggered by hyperventilation or stress
  • EEG: bilateral, symmetrical 3Hz spike and wave pattern
  • manage with sodium valproate and ethosuximide
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3
Q

Wernicke’s (receptive) aphasia:

A
  • lesion of superior temporal gyrus
  • inferior division of left MCA
  • sentences make no sense but speech remains fluent
  • comprehension impaired
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4
Q

Broca’s (expressive) aphasia:

A
  • lesion of inferior frontal gyrus
  • superior division of left MCA
  • speech non-fluent, repetition impaired
  • normal comprehension
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5
Q

Conduction aphasia:

A
  • stroke affecting arcuate fascicles (connecting Wernicke’s and Broca’s)
  • speech fluent but repetition poor
  • aware of errors
  • normal comprehension
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6
Q

Global aphasia:

A
  • large lesion affecting all 3 areas
  • severe expression and receptive aphasia
  • can communicate using gestures
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7
Q

What is an Arnold-Chiari malformation and features:

A
  • downward displacement or herniation of cerebellar tonsils through foramen magnum
  • congenital or trauma
  • non-communicating hydrocephalus due to CSF outflow obstruction
  • headache
  • syringomyelia
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8
Q

What causes ataxia?

A
  • cerebellar hemisphere lesions cause peripheral ataxia

- cerebellar vermis lesions cause gait ataxia

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9
Q

Ataxia Telangiectasia

A
  • autosomal recessive
  • defect in ATM gene coding for DNA repair enzymes
  • early childhood with abnormal movements
  • IgA deficiency resulting in recurrent chest infections
  • 10% risk of malignancy, lymphoma, leukaemia and non-lymphoid tumours
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10
Q

Autonomic dysreflexia

A
  • spinal cord injury above T6
  • briefly afferent signals cause sympathetic spinal reflex
  • triggered by faecal impaction or urinary retention
  • cord lesion prevents parasympathetic response
  • causes extreme hypertension, flushing and sweating above level or lesion
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11
Q

What are the features of Bell’s palsy?

A
  • acute, unilateral, idiopathic, facial nerve paralysis
  • lower motor neurone facial nerve palsy (including forehead)
  • post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis
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12
Q

How do you manage Bell’s palsy?

A

prednisolone 1mg/kg for 10 days within 73 hours of onset

acyclovir no benefit

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13
Q

Brachial Plexus

A

see notes

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14
Q

What is Erb-Duchenne paralysis?

A
  • damage to C5-6 roots
  • winged scapula
  • may be caused by breech presentation
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15
Q

What is Klumpke’s paralysis?

A
  • damage to T1
  • loss of intrinsic hand muscles
  • due to traction
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16
Q

What can cause brain abscesses?

A
  • extension of sepsis from middle ear or sinuses
  • trauma or surgery to scalp
  • penetrating head injuries
  • embolic events from endocarditis
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17
Q

Features of brain abscesses:

A
  • headache
  • fever
  • focal neurology
  • raised ICP: nausea, papilloedema, seizures
18
Q

Management of brain abscesses:

A
  • surgery: craniotomy and debridement
  • IV antibiotics: IV 3rd generation cephalosporin and metronidazole
  • ICP management e.g. dexamethasone
19
Q

Parietal lobe lesion symptoms:

A
  • sensory inattention
  • apraxia
  • astereognosis
  • inferior homonymous quadrantopia
  • Gerstmann’s syndrome (dominant parietal): alexia, acalculia, finger agnosia and right-left disorientation
20
Q

Occipital lobe lesion symptoms:

A
  • homonymous hemianopia (with macula sparing)
  • cortical blindness
  • visual agnosia
21
Q

Temporal lobe lesions:

A
  • Wernicke’s aphasia
  • superior homonymous quadrantopia
  • auditory agnosia
  • prosopagnosia
22
Q

Frontal lobe lesions:

A
  • Broca’s aphasia
  • disinhibition
  • perseveration
  • anosmia
  • inability to generate list
23
Q

Cerebellum lesions:

A
  • midline lesions: gait and truncal ataxia

- hemisphere lesions: intention tremor, past pointing, dysdiadokinesis, nystagmus

24
Q

What condition is associated with the sub thalamic nucleus of the basal ganglia?

A

Hemiballism

25
Q

What conditions is associated with the striatum of the basal ganglia?

A

Huntington’s chorea

26
Q

What condition is associated with the substantia nigra of the basal ganglia?

A

Parkinson’s

27
Q

What condition is associated with the amygdala?

A

Kluver-Bucy syndrome: hyper sexuality, hyperorality, hyperplasia, visual agnosia

28
Q

Which cancer spreads most commonly to the brain?

A

lung

also breast, bowel, skin and kidney

29
Q

Which primary brain tumour is the most common in adults?

A
  • glioblastoma
  • solid tumours with central necrosis and rim
  • vasogenic oedema
  • pleomorphic tumour cells
30
Q

Which is the second most common primary brain tumour in adults?

A
  • meningioma
  • typically benign
  • arise from dura of meninges
  • symptoms of compression rather than invasion
  • spindle cells in concentric whorls and calcified bodies
31
Q

What is a vestibular schwannoma?

A

(acoustic neuroma)

  • benign tumour arising from vestibulocochlear nerve
  • seen in cerebellopontine angle
  • presents with hearing loss, facial nerve palsy and tinnitus
  • bilateral assoc with neurofibromatosis type II
  • Antoni A or B patterns and verocay bodies seen
32
Q

What is the most common primary brain tumour in children?

A
  • pilocytic astrocytoma

- rosenthal fibres

33
Q

What is a medulloblastoma?

A
  • aggressive paediatric tumour
  • infratentorial compartment
  • spreads through CSF
  • small blue cells, rosette pattern of cells
34
Q

What is an ependymoma?

A
  • 4th ventricle
  • may cause hydrocephalus
  • perivascular pseudoreosettes
35
Q

What is an oligodendroma?

A
  • benign, slow-growing tumour common in frontal lobes

- calcifications with fried egg appearance

36
Q

What is a haemangioblastoma?

A
  • vascular tumour of cerebellum
  • associated with von Hippel-Lindau
  • foam cells and high vascularity
37
Q

What is a craniopharyngioma?

A
  • most common paediatric supratentorial tumour
  • solid, cystic tumour of cellar region derived from remnants of Rathke’s pouch
  • hormonal disturbance, hydrocephalus, bitemporal hemianopia
38
Q

What is Brown-Sequard syndrome?

A
  • lateral hemisection of spinal cord
  • ipsilateral weakness below lesion
  • ipsilateral loss of proprioception and vibration sensation
  • contralateral loss of pain and temperature sensation
39
Q

Indications of carbamazepine, mechanism of action, ADR:

A
  • used for epilepsy, trigeminal neuralgia, bipolar disorder
  • binds to sodium channels to increase refractory period
  • ADR: P450 enzyme inducer, dizziness and ataxia, drowsiness, headache, visual disturbances (diplopia), Steven-Johnson syndrome, leucopenia and agranulocytosis, hyponatraemia
40
Q

What is cataplexy?

A

sudden and transient loss of muscular tone caused by strong emotion (2/3 of narcoleptics have cataplexy)