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Medicine - Finals > Neurology and Neurosurgery > Flashcards

Neurology and Neurosurgery Flashcards

1
Q

What would you be worried about in a patient with breathing difficulties following head trauma?

A

Patients with raised ICP may exhibit Cushing’s triad:

  • widening pulse pressure (hypertension)
  • bradycardia
  • irregular breathing (Cheyne–Stokes respirations)
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2
Q

What dementia is associated with MND?

A

Frontotemporal dementia is associated with motor neurone disease

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3
Q

LEMS - features

A

Lambert Eaton syndrome (LES) is a rare autoimmune disorder in which antibodies are formed against pre-synaptic voltage-gated calcium channels in the neuromuscular junction. A significant proportion of those affected have an underlying malignancy, most commonly small cell lung cancer. It is therefore regarded as a paraneoplastic syndrome.

The weakness from LES typically involves the muscles of the proximal arms and legs. In contrast to myasthenia gravis, the weakness affects the legs more than the arms. This leads to difficulties climbing stairs and rising from a sitting position. Weakness is often relieved temporarily after exertion or physical exercise, in contrast to myasthenia gravis.

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4
Q

Diagnosis of Guillain Barre

A

Nerve conduction studies

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5
Q

Features of Syringomyelia

A

The classical presentation of a syrinx is a patient who has a ‘cape-like’ (neck and arms) loss of sensation to temperature but preservation of light touch, proprioception and vibration.

Syringomyelia - spinothalamic sensory loss (pain and temperature)

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6
Q

Triad of symptoms in LB dementia

A

resting tremor, visual hallucinations and cognitive decline

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7
Q

Lateral Medullary Syndrome

A

A combination of ipsilateral ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy with contralateral hemisensory loss indicates this diagnosis.

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8
Q

Normal CSF pressure

A

12-20mmHg

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9
Q

Describe the headache that occurs with increased ICP

A

Morning headache - wakes them up
Worse on valsalva
Associated with N+V

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10
Q

Which genetic syndrome is acoustic neuromas associated with?

A

NF2 - Neurofibromatosis

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11
Q

Symptoms of acoustic neuroma

A

hearing loss
tinitus
dysequilibrium

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12
Q

Management of acoustic neuroma

A

If hearing is affected then either surgery or conservative management with hearing aids
If hearing preserved then try and avoid surgery
Stereotactic Radiosurgery is tumour is less than 3 cm
Main aim of surgery is to preserve hearing

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13
Q

Which tests are offered to children with midline brain tumours?

A

AFP
BHCG
LDH

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14
Q

Surgical management of childhood hydrocephalus?

A

VP shunt - 50% require 10 yr revision

Endoscopic Third Ventriculostomy - permanent solution

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15
Q

Medical management of PRLoma

A

Cabergoline first- line followed by surgery

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16
Q

Why does GHoma require excision?

A

Risk of HOCM

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17
Q

What is the most common metastatic brain tumour?

A

Lung

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18
Q

Most common primary brain tumour

A

Glioblastoma multiforme

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19
Q

Brain tumour. solid tumours with central necrosis and a rim that enhances with contrast

A

Glioblastoma multiforme

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20
Q

Brain Histology: Pleomorphic tumour cells border necrotic areas

A

Glioblastoma multiforme

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21
Q

Second most common primary brain tumour

A

Meningioma

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22
Q

Where are meningiomas typically located?

A

They typically are located at the falx cerebri, superior sagittal sinus, convexity or skull base.

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23
Q

Brain Histology: Spindle cells in concentric whirls and calcified psammoma bodies

A

Meningioma

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24
Q

Where do vestibular schwannomas typically occur?

A

Cerebellopontine angle

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25
Q

Bilateral vestibular schwannomas

A

NF2

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26
Q

Brain Histology: Rosenthal fibres (corkscrew eosinophilic bundle)

A

Pilocystic astrocytoma

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27
Q

Most common brain tumour in children

A

Pilocystic astrocytoma

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28
Q

Brain Histology: Small, blue cells. Rosette pattern of cells with many mitotic figures

A

Medulloblastoma

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29
Q

Brain Histology: perivascular pseudorosettes

A

Ependymoma

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30
Q

Brain Histology: Calcifications with ‘fried-egg’ appearance

A

Oligodendroma

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31
Q

Brain Histology: foam cells and high vascularity

A

Haemangioblastoma

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32
Q

Brain Histology: Derived from remnants of Rathke pouch

A

Craniopharyngioma

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33
Q

Most common supratentorial brain tumour in children

A

Craniopharyngioma

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34
Q

Brain tumour with dural tail seen on CT

A

Meningioma

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35
Q

Percentage of self-limiting vertebral disc prolapses

A

80% - only refer for MRI after 6 weeks of physiotherapy

unless foot drop - refer in 2 weeks as you risk permanent change

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36
Q

Sciatica. Nerve root. radiates to bottom of the foot and the little toe

A

S1

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37
Q

Which action tests L5 spinal nerve alone?

A

extensor hallicus longus

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38
Q

Spinal nerve. dorsiflex ankle

A

L4 (a little L5)

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39
Q

Spinal nerve. hip flexion

A

L1/2

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40
Q

Spinal nerve. knee extension

A

L3/4

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41
Q

Spinal nerve. ankle plantarflexion

A

S1 (a little L5)

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42
Q

Features of cauda equina

A

saddle anaethesia
bladder incontinence
bilateral sciatica
impotence

refer for urgent MRI and neurosurgery within 48 hours

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43
Q

Night sweats and back pain

A

Vertebral TB

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44
Q

Features of lumbar claudication

A

bilateral tingling
decreased walking distance
relieved when leaning over (shopping troller +ve)
not worse walking uphill

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45
Q

What causes lumbar claudication?

A

Ligamentum flavum thickening and buckling forwards to compress spinal cord (whereas disc prolapse slips posteriorly to compress nerve root)

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46
Q

Management of lumbar claudication

A

surgical removal of ligamentum flavum

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47
Q

Features of cervical myelopathy

A

banana fingers
legs jump at night (hyperreflexia)
poor balance when closing eyes (e.g. when shampooing hair)

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48
Q

Cerebellar symptoms

A 
Dysdiadokinesia 
Ataxia 
Nystagmus 
Intention tremor 
Slurred speech
Hypotonia
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49
Q

Spastic gait

A

scissoring foot movements e.g. in cerebral palsy

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50
Q

High stepping gait

A

foot drop due to L3/4 disc prolapse or common peroneal nerve injury

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51
Q

Broad based gait

A

cerebellar

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52
Q

Hemiplegic gait

A

circumducting foot movement as lower limb extensors are stronger (UL flexors are stronger) e.g. due to stroke

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53
Q

Festinant gait

A

looks like centre of gravity is in front of them e.g. Parkinsonism

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54
Q

Shuffling gait

A

Normal Pressure Hydrocephalus

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55
Q

Trendelenburg gait

A

weak hip abductors e.g. OA

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56
Q

Myotome. deltoid

A

C4/5

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57
Q

Myotome. biceps

A

C5/6 (mostly 6)

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58
Q

Myotome. wrist flexion

A

C7

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59
Q

Myotome. finger flextion

A

C8

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60
Q

Myotome. interossei (finger abduction)

A

T1

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61
Q

Management of trigeminal neuralgia

A

1 - Carbamazepine
2 - Gabapentin or Pregablin
3 - Topiramate or Phenytoin
4 - Surgery

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62
Q

Signs of a base of skull fracture

A

Periorbital bruising (Racoon eyes)
Bruising over mastoid process (Battlesign)
Blood or CSF leak from eyes or nose
Head bump

Note: Nasopharyngeal airway is contraindicated

63
Q

GCS: eyes

A

4 - opens spontaneously
3 - opens to verbal command
2 - opens to pain
1 - none

64
Q

GCS: verbal

A 
5 - orientated 
4 - confused
3 - inappropriate words
2 - groans (incomprehensible sounds)
1 - none
65
Q

GCS: motor

A 
6 - obeys commands 
5 - localises to pain (flexes towards the pain)
4 - withdraws from pain
3 - abnormal flexion 
2 - extension 
1 - none
66
Q

GCS: coma

A

≤8

67
Q

Head CT following trauma. Crescent shaped hyper dense accumulation that crosses suture lines

A

Acute subdural

68
Q

Head CT following trauma. Convex shaped hyper dense accumulation occurring after pteriod trauma

A

MMA damage causing extradural haematoma

69
Q

Calculate cerebral perfusion pressure

A

CPP = Mean arterial pressure - ICP

Normal CPP is 70-100
Cerebral ischaemia if <50

70
Q

Auto-immune Disorder. Anti-MOG and Anti-Aquaporin-4

A

Neuromyelitis Optica Spectrum (N.O.S) Disorder

71
Q

Neuromyelitis Optica Spectrum Disorder features.

A

Sub acute visual loss in 1 eye with painful movement and a poor prognosis for visual recovery

72
Q

Visual loss associated with B12/Folate deficiency

A

bilateral and painless

73
Q

Features of demyelinating optic neuropathy

A

Unilateral painful loss of vision over 2-3 days occurring in individuals aged 20-50

Blurring of vision lasts about 2 weeks and 80% improves

74
Q

Difference between binocular and monocular diplopia

A

Binocular - diplopia always there

Monocular - diplopia goes if an eye is covered

75
Q

Diplopia going down stairs

A

CNIV palsy

76
Q

Inability to look up

A

Hydrocephalus -> pressure on tectal plate

77
Q

Diplopia. How to tell which eye is pathological?

A

The eye which when covered causes the outer image to disappear

78
Q

Hepatic enzyme inducers

A

Carbamazepine
Topiramate
Phenytoin
Rifampicin

reduces COCP and morning after pill efficacy, so increase dose

79
Q

Use of EEG in epilepsy

A

To classify epilepsy
Confirm non-epileptic attacks
To evaluate surgical options

80
Q

Treatment of focal seizures

A

1 - Carbmazepine

2 - Lamotrigine (safe in pregnancy)

81
Q

Treatment of generalised seizures

A

1 - Sodium Valproate

2 - Lamotrigine

82
Q

Treatment of absence seizures

A

Ethosuximide

83
Q

In which type of seizure is carbmazepine contraindicated

A

Myoclonic and absence

84
Q

Side effects. Sodium Valproate

A

Weight gain, teratogenic, hair loss, fatigue

85
Q

Side effects. Topiramate

A

Sedation, dysphasia, weight loss

86
Q

What is epilepsia partialis continua?

A

Continuous focal seizure - consciousness is preserved

87
Q

What is status epilepticus?

A

a single seizure lasting >5 minutes, or

>= 2 seizures within a 5-minute period without the person returning to normal between them

88
Q

Management of prolonged seizure (more than 5-10 mins)

A

Community: Rectal diazepam (10-20mg) and buccal midazolam (10-20mg)
Hospital: IV Lorazepam (4mg) if venous access; otherwise Rectal diazepam (10-20mg) and IM Midazolam (5-10mg)

89
Q

Seizures and Driving

A

generally patients cannot drive for 6 months following a seizure

for patients with established epilepsy they must be fit free for 12 months before being able to drive

withdrawal of epilepsy medication: should not drive whilst anti-epilepsy medication is being withdrawn and for 6 months after the last dose

90
Q

Adverse effect of Lamotigine

A

SJ syndrome

91
Q

Difference in the CSF of viral and bacterial meningitis

A

Bacteria - elevated opening pressure, cloudy, neutrophilia, high protein, low glucose

Virus - normal opening pressure, clear, lymphocytosis, high protein and normal glucose

92
Q

CSF with oligoclonal bands

A

MS

93
Q

CSF with high phosphorylated TAU-protein and low B-amyloid

A

Alzheimer’s

94
Q

CSF with high I 4-3-3 protein

A

Creutzdeldt-Jakob disease

95
Q

CSF with low orexin/hypocretin

A

Narcolepsy

96
Q

CSF with elevated opening pressure, fibrin webs, lymphocytes, high protein, low glucose

A

TB meningitis

97
Q

Most common cause of encephalitis

A

HSV

98
Q

Management of community acquired meningitis

A

If in GP then give IM benzylpenicillin whilst waiting for transer
Hospital: IV Ceftriaxone and Dexamethasone

99
Q

Management. Meningitis in <3 months

A

Intravenous cefotaxime + amoxicillin (or ampicillin)

100
Q

Meningitis management. Initial empirical therapy aged 3 months - 50 years

A

Intravenous cefotaxime (or ceftriaxone)

101
Q

Management of Meningitis caused by Listeria

A

Intravenous amoxicillin (or ampicillin) + gentamicin

102
Q

Meningitis prophylaxis if in contact with someone in previous 7 days

A

oral ciprofloxacin or rifampicin

103
Q

Management of idiopathic intracranial hypertension

A

Weight loss
Acetazolamide
LP shunt

104
Q

MRI brain. Slit like ventricles

A

Increased ICP

105
Q

Features of SUNCT headaches

A 
Short-lived (15-120s) 
Unilateral 
Neuralgiaform headache (stabbing)
Conjunctival injections 
Tearing
106
Q

Management of CUNCT headaches

A

Lamotrigine or Gabapentin

107
Q

Management of Paroxysmal Hemicrania

A

Absolute response to indomethacin

108
Q

Features of paroxysmal hemicrania

A

Only last 10-30 mins (rather that a couple hours like cluster headaches), and occur much more frequently upto 40x per day

109
Q

Management of cluster headaches

A

Acute: O2 and SC sumitriptan
Prophylaxis: Verapamil

110
Q

Features of Cluster headaches

A

Unilateral, ipsilateral autonomic features, usually occurs at night, lasts 10 mins- 3 hours, occurs 1-8 times daily

111
Q

Management of Migraine

A

Acute - PO Sumatriptan, NSAID and Antiemetic

Prophylaxis - Propanolol, Topiramate

112
Q

First line in primary progressive MS

A

Ocrelizumab

113
Q

First line in relapsing remitting MS

A

Tecfedira

114
Q

Management of MS acutely

A

Oral Prednisolone if moderate

IV methylprednisolone if severe

115
Q

Sign caused by demyelination of medial longitudinal fasciculus

A

INO - right sided -> cannot adduct right eye

+ Left eye nystagmus

116
Q

Which condition is both Lhermitte’s sign and Uhthoff’s phenomenon associated with? What are they?

A

MS

Lhermitte’s sign - electric shock pain on neck flexion
Uhthoff’s phenomenon - exacerbation of current symptoms in hot environments (hot bath)

117
Q

Two variants of FT dementia

A
  • Behavioural (most common)
  • Primary progressive aphasia
    > Sematic dementia (impaired object naming and loss of recognition of faces or objects)
    > Progressive non-fluent aphasia (word-finding deficits with slow and hesitant speech)
118
Q

Management of alzheimers

A

mild/mod -> ACHE - donepezil, galantamine, rivastigmine

severe -> Memantine (NMDA receptor antagonist)

119
Q

Most common cause of Guillain Barre

A

Campylobacter

120
Q

Is Myasthenia Gravis pre or post -synaptic ?

A

Post

121
Q

Features of Myasthenia Gravis

A

Myalgia - worse at the end of the day or on exercise
Ocular features - diplopia and ptosis
Proximal > Distal Myalgia
Associated with Thymoma

122
Q

Which conditions are associated with Myasthenia Gravis?

A

Thymoma, hyperthyroidism, SLE

123
Q

Auto-antibodies. Myasthenia Gravis

A

Anti-AChR

Anti-MUSK

124
Q

Management of Myasthenia Gravis

A

Pyridostigmine

125
Q

Is LEMS pre or post -synaptic ?

A

Pre

126
Q

Features of LEMS

A 
Anti-VGCC
Associated with SCLC
Distal myalgia - better on movement 
Waddling gait 
Autonomic features - constipation, postural hypotension, impotence
Diminished tendon reflexes
127
Q

Auto-antibodies. LEMS

A

Anti-VGCC

128
Q

Which condition is associated with LEMS?

A

SCLC

129
Q

Management. LEMS

A

3,4-Diaminopyridine

130
Q

Features of myotonic dystrophy

A 
Autosomal Dominant 
Foot drop 
Grip myotonia 
Facial weakness ("haggard" appearance)
Ptosis, ophthalmoplegia and bilateral "christmas tree" cataracts
Wasting of the temporalis muscle 
Frontal balding
131
Q

Which antiemetic is used in Parkinson’s?

A

Domperidome

132
Q

Meningitis. CSF LP reveals yeast and a capsule in the CSF stained with India ink

A

Cryptococcal Meningitis - common in immunodeficient patients e.g. HIV

133
Q

Features of Lateral Medullary Syndrome (posterior inferior cerebellar artery stroke) AKA Wallenberg’s syndrome

A

Remember Dysphagia-Ataxia-Nystagmus-Vertigo-Anaesthetic-Horner’s

Ipsilateral - ataxia, nystagmus, hoarseness, dysphagia, facial numbness, CN palsy (E.g, Horner’s)

Contralateral - limb sensory loss and loss of pain and temperature

Depressed Consciousness

134
Q

Features of Weber’s Syndrome

A

Ipsilateral CN3 palsy

Contralateral weakness

135
Q

Most common brainstem stroke

A

Wallenberg’s syndrome (Lateral Medullary Syndrome)

136
Q

Describe a diet that may be beneficial in childhood seizure syndromes

A

Ketogenic

  • High fat
  • Low Carbs
  • Controlled protein
137
Q

Prophylaxis of meningococcal meningitis for close contacts

A

Oral Ciprofloxacin or Rifampicin - 1 dose

138
Q

Acute management of suspected meningitis in community setting

A

IM Benzylpenicillin

139
Q

Meningitis Management. Initial empirical therapy aged < 3 months

A

Intravenous cefotaxime + amoxicillin (or ampicillin)

140
Q

Meningitis Management. Initial empirical therapy aged 3 months - 50 years

A

Intravenous cefotaxime (or ceftriaxone)

141
Q

Meningitis Management. Initial empirical therapy aged > 50 years

A

Intravenous cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)

142
Q

Management of meningococcal meningitis

A

Intravenous benzylpenicillin or cefotaxime (or ceftriaxone)

143
Q

Management of pneumococcal meningitis

A

Intravenous cefotaxime (or ceftriaxone)

144
Q

When is meningitis prophylaxis justified?

A

people who have been exposed to a patient with confirmed bacterial meningitis should be given prophylactic antibiotics if they have close contact within the 7 days before onset

145
Q

Diagnosing TB Meningitis from CSF

A

Ziehl-Neelsen stain is only 20% sensitive in the detection of tuberculous meningitis and therefore PCR is sometimes used (sensitivity = 75%)

146
Q

Most common complication following meningitis

A

SN hearing loss

147
Q

Contraindications to Lumbar Puncture

A

Signs of increased ICP e.g.

focal neurological signs
papilloedema
significant bulging of the fontanelle
disseminated intravascular coagulation
signs of cerebral herniation
148
Q

What is contraindicated in patients with meningococcal septicaemia?

A

Lumbar Puncture

149
Q

What should be done for patients with meningococcal septicaemia?

A

Lumbar Puncture is Contraindicated

blood cultures and PCR for meningococcus should be obtained

150
Q

What other than antibiotics should be given in meningitis management?

A

Dexamethasone - except in <3months

151
Q

Management of Viral Meningitis

A

Self-limiting 7-14 days

If suspicion of bacterial cause or encephalitis then commence on ceftriaxone and aciclovir intravenously

152
Q

Precipitating factors of Migraine

A

CHOCOLATE

Chocolate
Hangovers
Orgasms
Cheese, Caffeine
Oral contraceptive pill
Lie-ins
Alcohol
Travel
Exercise
153
Q

Features of Bell’s Palsy + Management

A

lower motor neuron facial nerve palsy - forehead affected*
patients may also notice post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis

All patients should receive oral prednisolone within 72 hours of onset + Antivirals if severe

Medicine - Finals (21 decks)

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