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MRCP Part 1 > Neurology Clinical > Flashcards

Neurology Clinical Flashcards

1
Q

What is the acute treatment for cluster headache?

A

Oxygen

SC triptan

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2
Q

What is the treatment for prophylaxis of cluster headaches?

A

Verapamil

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3
Q

What drugs are used to reduce the relapse rate in multiple sclerosis?

A

Beta interferon - reduces relapse rate by up to 30%
Glatiramer acetate
Natalizumab
Fingolimod

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4
Q

What are the absolute contraindications to thrombolysis?

A 
Previous intracranial haemorrhage 
Seizure at onset of stroke
Intracranial neoplasm 
Suspected subarachnoid haemmorhage 
Stroke or traumatic brain injury in the past 3 months 
LP in the last 7 days 
GI heammorhagge in the last 3 weeks 
Active bleeding 
Pregnancy 
Oesophageal varices 
Uncontrolled hypertension <200/120
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5
Q

When should thrombectomy be offered in acute stroke?

A
  • As soon as possible within 6 hours of symptoms onset, together with IV thrombolysis (if within 4.5 hours) to people who have a confirmed occlusion of the proximal anterior circulation demonstrated by CTA or MRA
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6
Q

Whereabouts in the brain does herpes simplex encephalitis characteristically affect?

A

The temporal lobe

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7
Q

What do you see on a CT scan of someone with HSV encephalitis?

A

Peticial haemmorhages in the medial temporal and inferior frontal lobes

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8
Q

What is lateral medullary syndrome?

A

A stroke which presents with ipsilatera; facial numbness, cranial nerve palsy and contralateral limb sensory loss. Also ataxia and nystagmus. It results from an occlusion of the posterior inferior cerebellar artery

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9
Q

What drugs can worsen myasthenia gravis?

A 
Penicillamine 
Quinidine
Beta blockers 
Lithium 
Phenytoin 
Gentamicine, macrolides, quinolones, tetracyclines
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10
Q

What happens in anterior spinal artery occlusion?

A
  • Most common spinal stroke
  • Bilateral motor and sensory paralysis below the level of the infarct
    Sparing of the dorsal column medial leminniscal pathway (proprioception is preserved) .
  • Autonomic dysfunction inferior to the level of the lesion
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11
Q

What happens in posterior spinal infarcts?

A

Sensory loss of proprioception, vibration and light touch sensations

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12
Q

What happens in central spinal infarcts?

A

Bilateral sensory and spinothalamic defecit

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13
Q

What does the dorsal colum do?

A

Responsible for fine touch and proprioception (made up of gracile and cuneate pathways)

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14
Q

What does the lateral corticospinal tract do?

A

carried motor signals to the limbs

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15
Q

What does the ventral corticospinal tract to?

A

Carries motor signals to the axial muscles

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16
Q

What does the lateral spinothalamic tract do?

A

carries pain and temperature signals from the body

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17
Q

What does the anterior spinothalamic tract do?

A

Carries crude touch sense from the body

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18
Q

What is ramsey hunt syndrome?

A

Herpes zoster of the seventh cranial nerve

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19
Q

What medication is used in subarachnoid haemmorhage?

A

Nimodipine (prevents vasospasm)

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20
Q

What is wernickes aphasia?

A

Due to a lesion in the superior temporal gyrus
Lesions results in sentances that make no sense byt speech remains fluent
Comprehension is also impaired

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21
Q

What is brocas aphasia?

A

Due to a lesion of the inferior frontal gyrus.
Speech is non fluent laboured and halting. Repetition is impaired.
Comprehension is normal

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22
Q

What is conduction aphasia?

A

Due to a stroke affecting the arcuate fasiculus which is the connection between wernickes and brocas area.
Speech is fluent but repetition is poor.
The patients is aware of the errors in speech.
Comprehension is normal

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23
Q

What is global ahasia?

A

Large lesion affecting all 3 areas (arcutate fasiculus, inferior frontal gyrus and the superior temporal gyrus

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24
Q

What us von hippel lindau syndrome?

A

An autosomal dominant condition caused by a mutation in the VHL gene in chromosome 3. This results in an increase in hypoxia inducible factor and causes tumour formation.

25
Q

What tumours at associated with von hippel landau syndrome?

A 
Retinal haemangiomas
Clear cell carcinoma
Phaechromocytoma
Pancreatic neuroendocrine tumours
Cerebella haemangiomas
26
Q

What is the treatment for neuroleptic malignant syndrome?

A

IV fluids
Dantrolene
Bromocriptine may be used

27
Q

How does phenytoin work?

A

Binds to sodium to increase the refactory period

28
Q

What is the treatment for secondary prevention of stroke if clopidogrel cannot be given?

A

Aspirin + Dipyrimadole lifelond

29
Q

List some drugs that cause peripheral neuropathy?

A 
Amiodarone
Isoniazid 
Vincristine
Nitrofurantoin 
metronidazole
30
Q

What is a syringomyelia?

A

A collection of CSF within the spinal cord

31
Q

What is syringobulbia?

A

A fluid filled cavity within the medulla of the brainstem

32
Q

What spinal cord tracts are the first to be affected by syringomyelia?

A

Spinothalamic tracts in the anterior commissure of the spinal cord.

33
Q

What is the treatment for idiopathic intracranial hypertension?

A 
Weight loss 
Diuretics such as acetazolamide 
Topiraamte 
Theraputic lumbar puncture 
LP or VP shunt
34
Q

What might the lumbar puncture show in guillian barre syndrome?

A

A rise in protein with a normal white cell count

35
Q

What immune problem is ataxic telangictasia associated with?

A

IGA deficiency

36
Q

Which type of brain presents with a lucid interval followed by collapse?

A

Extradural haemmorhage

37
Q

What drugs can cause tinnitus?

A

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

38
Q

What is the inheritence pattern of myotonic dystrophy?

A

Autosomal dominant

39
Q

Where is the lesion if you have a bitemporal hemianopia predominately affecting the upper quadrants

A

Superior chiasmal compression usually a craniopharyngioma

40
Q

Where is the lesion if you have a bitemporal hemianopia predominately affecting the lower quadrants

A

Inferior chiasmal compression commonly a pituitary tumour

41
Q

What is miller fisher syndrome?

A

A variant of guillan barre that presents with opthalmoplegia, areflexia and ataxia.
Presents as a descending paralysis rather than an ascending paralysis
Anti GQ1b antibodies are present in 90% of cases

42
Q

What are the main features of wernickes encephalopathy?

A 
Nystagmus
Opthalmoplegia
ataxia 
Confusion 
peripheral sensory neuropathy
43
Q

What symptoms are seen in korsakoffs syndrome but not werneickes encephalopathy?

A

antero and retrograde amnesia

Confabulation

44
Q

What is the first line medication for myoclonic seizures?

A

Sodium valporate

45
Q

What is lateral medullary syndrome?

A

A stroke caused by occlusion of the posterior inferior cerebellar artery..
symptoms include:
Cereberllar: nystagmus, ataxia, Brain stem (ipsilateral) horners syndrome, dysphagia
Contralateral limb sensory loss

46
Q

What is the trinucleotide repeat in huntingtons disease?

A

CAG

47
Q

What is the pathophysiology of huntingtons disease?

A

Degeneration of the cholinergic and GABAergic neurons in the striatum f the basal ganglia

48
Q

What spinal cord colums are affected first in subacute combined degeneration if the spinal cord?

A

Dorsal and lateral colums - resulting in loss of fine touch and proprioception

49
Q

What symptoms do you get from a stroke of the anterior cerebral artery?

A

Contralateral hemiparesis and sensory loss, lower extremity worse than upper

50
Q

What symptoms do you get from a stroke of the middle cerebral artery?

A

Contralateral hemiparesis, worse in the arms.

Contralateral homonymous hemianopia, aphasia

51
Q

What symptoms do you get from a stroke of the posterior cerebral artery?

A

Contralateral homonymous hemianopia with macular sparing

Visual agnosia

52
Q

Where is the medial longitudinal fasiculus?

A

Paramedian area of the midbrain and pons

53
Q

What three drugs cause gingival hyperplasia?

A

Phenytoin
Ciclosporin
Calcium channel blockers (especially nifedipine)

54
Q

What are the features of tuberous sclerosis?

A

Ash leaf spots
Roughened patches of spots over lumbar spine (shagreen patches)
Adenoma sebaceum (angiofibromas) over the nose
Fibromata beneath nails
Cafe au lait spots

55
Q

What are the causes of a bilateral facial nerve palsy?

A

Sarcoidosis
Guillain barre syndrome
Lyme disease
Bilateral acoustic neuromas (seen in neurofibromatosis type 2)

56
Q

What is opsoclous myoclonus syndrome? (OMS)

A

Random eye movements in all directions and also limb jerks.
Also causes ataxia and loss of speech.
Autoimmune condition that is often due to a paraneoplastic syndrome (often due to lung or breast cancer) In children this may be caused by a brain tumour or infection.

57
Q

What are the antibodies against in lambort eaton syndrome?

A

Pre synapric voltage gated calcium channel

58
Q

What cancer is lambort eaton syndrome associated with?

A

Small cell lung cancer

also breast and ovarian

59
Q

What medication can be used in motor neurone disease?

A

Riluzole

  • prevents stimulation of glutamate receptors
  • Prolongs life by around 3 months

MRCP Part 1 (30 decks)

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