Neurology Flashcards
1
Q
What are 5-HT3 antagonists, examples and adverse effects?
A
- anti-emetics
- chemotherapy related nausea
- ondansetron, graniestron
- ADR: constipation, prolonged QT
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 ethosuximide
- alternatively sodium valproate in male and lamotrigine/levetiracetam in females
- exacerbated by carabamazpine
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
4
Q
Broca’s (expressive) aphasia:
A
- lesion of inferior frontal gyrus
- superior division of left MCA
- speech non-fluent, repetition impaired
- normal comprehension
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
6
Q
Global aphasia:
A
- large lesion affecting all 3 areas
- severe expression and receptive aphasia
- can communicate using gestures
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
8
Q
What causes ataxia?
A
- cerebellar hemisphere lesions cause peripheral ataxia
- cerebellar vermis lesions cause gait ataxia
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
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 of lesion
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
12
Q
How do you manage Bell’s palsy?
A
prednisolone 1mg/kg for 10 days within 73 hours of onset
acyclovir no benefit
13
Q
What is Erb-Duchenne paralysis?
A
- damage to C5-6 roots
- winged scapula
- may be caused by breech presentation
14
Q
What is Klumpke’s paralysis?
A
- damage to T1
- loss of intrinsic hand muscles
- due to traction
15
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
16
Q
Features of brain abscesses:
A
- headache
- fever
- focal neurology
- raised ICP: nausea, papilloedema, seizures
17
Q
Management of brain abscesses:
A
- surgery: craniotomy and debridement
- IV antibiotics: IV 3rd generation cephalosporin and metronidazole
- ICP management e.g. dexamethasone
18
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
19
Q
Occipital lobe lesion symptoms:
A
- homonymous hemianopia (with macula sparing)
- cortical blindness
- visual agnosia
20
Q
Temporal lobe lesions:
A
- Wernicke’s aphasia
- superior homonymous quadrantopia
- auditory agnosia
- prosopagnosia
21
Q
Frontal lobe lesions:
A
- Broca’s aphasia
- disinhibition
- perseveration
- anosmia
- inability to generate list
22
Q
Cerebellum lesions:
A
- midline lesions: gait and truncal ataxia
- hemisphere lesions: intention tremor, past pointing, dysdiadokinesis, nystagmus
23
Q
What condition is associated with the sub thalamic nucleus of the basal ganglia?
A
Hemiballism
24
Q
What conditions is associated with the striatum of the basal ganglia?
A
Huntington’s chorea
25
What condition is associated with the substantia nigra of the basal ganglia?
Parkinson's
26
What condition is associated with the amygdala?
Kluver-Bucy syndrome: hyper sexuality, hyperorality, hyperplasia, visual agnosia
27
Which cancer spreads most commonly to the brain?
lung
| also breast, bowel, skin and kidney
28
Which primary brain tumour is the most common in adults?
- glioblastoma
- solid tumours with central necrosis and rim
- vasogenic oedema
- pleomorphic tumour cells
29
Which is the second most common primary brain tumour in adults?
- meningioma
- typically benign
- arise from dura of meninges
- symptoms of compression rather than invasion
- spindle cells in concentric whorls and calcified bodies
30
What is a vestibular schwannoma?
(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
31
What is the most common primary brain tumour in children?
- pilocytic astrocytoma
| - rosenthal fibres
32
What is a medulloblastoma?
- aggressive paediatric tumour
- infratentorial compartment
- spreads through CSF
- small blue cells, rosette pattern of cells
33
What is an ependymoma?
- 4th ventricle
- may cause hydrocephalus
- perivascular pseudoreosettes
34
What is an oligodendroma?
- benign, slow-growing tumour common in frontal lobes
| - calcifications with fried egg appearance
35
What is a haemangioblastoma?
- vascular tumour of cerebellum
- associated with von Hippel-Lindau
- foam cells and high vascularity
36
What is a craniopharyngioma?
- most common paediatric supratentorial tumour
- solid, cystic tumour of cellar region derived from remnants of Rathke's pouch
- hormonal disturbance, hydrocephalus, bitemporal hemianopia
37
What is Brown-Sequard syndrome?
- lateral hemisection of spinal cord
- ipsilateral weakness below lesion
- ipsilateral loss of proprioception and vibration sensation
- contralateral loss of pain and temperature sensation
38
Indications of carbamazepine, mechanism of action, ADR:
- 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
39
What is cataplexy?
sudden and transient loss of muscular tone caused by strong emotion (2/3 of narcoleptics have cataplexy)
