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Year 4 Medical specialties > Neurology > Flashcards

Neurology Flashcards

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USMLE® Step 1 flashcards
1
Q

what should you look for on inspection in a neuro exam

A 
SWIFT
scars 
wasting of muscle 
involuntary movements: dystonia, tics, chorea
fasciculations 
tremor
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2
Q

what signs indicate an UMN lesion

A 
hypertonia - spasticity 
hyperreflexia 
pyramidal weakness: UL extensors, LL flexors 
clonus 
\+ve Babinski (extensor response)
pronator drift
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3
Q

causes of UMN lesions

A 
stroke 
tumours 
MS 
CP 
MND
pseudobulbar palsy
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4
Q

what signs indicate an LMN lesion

A 
hypotonia - flaccid 
hypo/arreflexia 
weakness, wasting, fasciculations 
no clonus 
-ve Babinski (flexor response)
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5
Q

causes of LMN lesions

A 
Peripheral neuropathy - ABCDEE
GBS 
Charcot Marie Tooth disease 
MND 
Bulbar palsy 
mononeuritis multiplex 
Bell's palsy 
Polio
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6
Q

signs of extra pyramidal disease (hypokinetic)

A

bradykinesia - slow to think, respond, loss of finger tap amplitude
rigidity - hypertonicity
resting tremor - highlighted when counting backwards
hypomimia, hypophonia
shuffling gait
loss of arm swing

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7
Q

causes of hypokinetic extra pyramidal disease

A

Parkinsonism - drugs

Idiopathic Parkinsons disease

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8
Q

Parkinsonism is a/symmetrical and PD is a/symmetrical

A 
Parkinsonism = symmetrical 
PD = asymmetrical
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9
Q

signs of cerebellar disease on examination

A 
DANISH 
dysdiadichokinesia 
ataxia 
nystagmus 
intention tremor 
slurred speech 
hypotonia / heel to toe test
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10
Q

bulbar palsy is UMN/LMN?

A

bulbar palsy = LMN

pseudobulbar palsy = UMN

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11
Q

MRI with/out contrast is used for imaging MS

A

WITH contrast

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12
Q

what drug do you give in SAH to prevent cerebral vasospasm

A

nimodipine

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13
Q

what is the triad in Wernicke’s encephalopathy

A

ophthalmoplegia/nystagmus
ataxia
confusion

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14
Q

what are the features of Korsakoff’s syndrome

A

antero/retrograde amnesia

confabulation

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15
Q

causes of cerebellar disease

A 
MAVIS 
MS 
Alcohol 
Vascular (stroke)
Inherited (Freidreich's ataxia)
Space occupying lesion SOL
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16
Q

where does the spinal cord end?

A

L1/2

therefore spinal anaesthesia is at L3/4

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17
Q

Broca’s aphasia?

A

expressive aphasia

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18
Q

Wernicke’s aphasia?

A

receptive aphasia

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19
Q

red flags for headache

A 
>55
worse in the morning / wakes them up 
worse with valsalva 
vomiting 
immunosuppression 
history of malignancy
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20
Q

what emergency conditions would you want to rule out in someone with a headache

A 
meningitis 
SAH 
temporal arteritis 
closed angle glaucoma 
SOL 
IIH
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21
Q

list causes of peripheral neuropathy

A 
ABCDEE 
Alcohol
B12 deficiency 
Cancer / CKD 
DM 
Every vasculitis 
Especially ANCA and RA
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22
Q

Hypoventilation causes raised/low CO2 and therefore vasoconstriction/dilatation of cerebral vessels

A

hypoventilation causes raised CO2

therefore cerebral vasoDILATATION

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23
Q

Hyperventilation causes raised/low CO2 and therefore vasoconstriction/dilatation of cerebral vessels

A

hyperventilation causes low CO2

therefore cerebral vasoCONSTRICTION

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24
Q

what imaging technique is diagnostic of degenerative cervical myelopathy

A

MRI

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25
Q

what type of seizure is carbamazepine used to treat

A

FOCAL seizures!!

never generalised

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26
Q

which antiepileptic drug is considered ‘safe’ in pregnancy

A

lamotrigine

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27
Q

what is a risk of lamotrigine

A

SJS

Therefore build up the dose very slowly

28
Q

which antiepileptics are teratogenic

A

sodium valproate
carbamazepine
topiramate
phenytoin

29
Q

side effects of sodium valproate

A 
VALPROATE
Appetite increased / weight gain 
Liver failure 
Pancreatitis 
Reversible hair loss 
Oedema 
Ataxia 
Teratogenic, thrombocytopaenia, tremor 
Encephalopathy

also P450 inhibitor

30
Q

if someone has a one off seizure, how long can they not drive for?

A

6 months if it is one off

31
Q

if someone has a diagnosis of epilepsy what are the driving rules for a car

A

can only drive after having a full year of not having seizures

32
Q

if someone has a diagnosis of epilepsy what are the driving rules for a bus/lorry

A

can only drive after being medication free for 10 years

33
Q

management of status epilepticus

A

ABCDE

  1. IV lorazepam / buccal midazolam / PR diazepam
  2. after 5 min repeat BZD
  3. phenytoin + call anaesthetics/ICU
  4. Na valproate
  5. Keppra
  6. ICU
34
Q

describe obstructive hydrocephalus

A

aka non-communicating
blockage within ventricular system
therefore enlargement of lateral and 3rd ventricles and a normal 4th ventricle

35
Q

describe communicating hydrocephalus

A

no blockage within the system, rather outwith the ventricles
all ventricles are enlarged

36
Q

what are consequences of raised ICP

A 
herniation 
midline shift 
impaired blood flow 
CN palsies 
low GCS
37
Q

what are the different types of brain herniation

A 
supratentorial 
- subfalcine / cingulate (ACA compression)
- uncal (CN3 compression)
- central 
- transcalvarial (skull #)
infratentorial 
- tonsilar (cerebellum)
38
Q

drug causes of parkinsonism

A 
dopamine antagonists - metaclopramide, haloperidol, chlopromazine 
lithium 
amiodarone 
B blockers 
Na valproate
39
Q

Management of Parkinsons disease

A

levodopa + carbidopa (co-careldopa)
MAOB inhibitors - selegeline, resegiline
dopamine agonists - pramiprexole

40
Q

what drugs are used for tremor relief in Parkinsons?

A

anticholinergics - procyclidine

41
Q

what are the Parkinsons plus syndromes

A

multisystem atrophy - PD plus autonomic instability

progressive supranuclear palsy - impaired upward gaze

42
Q

features of MS

A

Pyramidal - weakness, spasticity, hyperreflexia
Ophthalmological - optic neuritis, INO
Sensory - paraesthesia, trigeminal neuralgia
LUTS - frequency, urgency, incontinence
Cerebellar - DANISH
Fatigue

43
Q

dystonia

A

abnormal muscle spasm

44
Q

chorea

A

irregular jerky involuntary movement

45
Q

tics

A

brief repetitive stereotyped involuntary actions

46
Q

myoclonus

A

sudden shock like involuntary movement

47
Q

hemiballism

A

flinging of one arm

48
Q 
what are the proteinopathies in the following neurodegenerative conditions:
Alzheimers 
Frontotemporal dementia 
DLB 
Huntingtons 
CJD
A

Alzheimers - extracellular amyloid plaques, intracellular neurofibrillary tangles of tau
Frontotemporal dementia - tau, Pick’s bodies
DLB - alpha synuclein
Huntingtons - huntington, CAG repeat
CJD - prion

49
Q

pupil is spared/involved in PCOM aneurysm

A

involved

external compression of CN3

50
Q

most common ocular CN lesion

A

CNVI

51
Q

features of a CN3 palsy

A

down and out
ptosis
± pupillary involvement

52
Q

features of a CN6 palsy

A

LR palsy

INO

53
Q

features of a CN4 palsy

A

diplopia exacerbated on down gaze
head tilt down away from affected muscle
inability to adduct and depress the eye

54
Q

which CN is more vulnerable to traumatic injury

A

CN4

55
Q

CN involved in RAPD

A

CN2 Afferent

CN3 Efferent

56
Q

causes of RAPD

A 
MS
demyelination 
optic neuritis 
vitreous haemorrhage
ischaemic optic neuropathy
57
Q

causes of UMN CN7

A

stroke
tumour
demyelination

58
Q

causes of LMN CN7

A

bell palsy
iatrogenic - LA
trauma
infection - Ramsey hunt

59
Q

Horner’s syndrome features

A

disruption of sympathetics resulting in:
partial ptosis
miosis
hemifacial anhydrosis

60
Q

causes of Horners syndrome

A

1st: stroke, demyelination, neoplasm, syringomyelia
2nd: cervical rib, Pancoast tumour, brachial plexus injury, trauma, iatrogenic
3rd: trauma, iatrogenic, ICA dissection/aneurysm, tumour, cavernous sinus lesion

61
Q

PBP = UMN lesion, true or false

A

true

62
Q

BP = LMN lesion, true or false

A

true

63
Q

BP features

A

fasciculations

tongue wasting

64
Q

what features in a history make a swallowing problem more likely to be neurological

A

dysphagia to liquids, then solids

65
Q

LP of GBS

A

high protein and no cells

66
Q

antibody for GBS

A

anti ganglioside antibodies

67
Q

differential for papilloedema and loss of vision

A

SOL
cerebral venous sinus thrombosis
IIH

Year 4 Medical specialties (3 decks)

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