Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neurology > Neurology Important P2 > Flashcards

Neurology Important P2 Flashcards

1
Q

What is narcolepsy:

A
  • HLA DR2
  • low levels of orexin (responsible for appetite and sleep patterns)
  • early onset of REM sleep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Features of narcolepsy:

A
  • teenage onset
  • hypersomnolence
  • cataplexy
  • sleep paralysis
  • vivid hallucinations on going to sleep or waking up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Investigation of narcolepsy:

A

multiple sleep latency EEG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Management of narcolepsy:

A

daytime stimulants e.g. modafinil and nighttime sodium oxybate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Neurofibromatosis I

A
  • von Recklinghausen’s syndrome
  • gene mutation on chromosome 17
  • encodes neurofibromas
  • autosomal dominant
  • cafe au lait spots
  • axillary/groin freckles
  • peripheral neurofibromas
  • iris hamatomas
  • scoliosis
  • phaeochromocytomas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Neurofibromatosis II

A
  • bilateral vestibular schwannomas
  • multiple intracranial schwannomas
  • meningiomas and ependymomas
  • chromosome 22
  • autosomal dominant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does neuroleptic malignant syndrome come about?

A
  • antipsychotic medication
  • dopaminergic drugs e.g. levodopa for Parkinson’s
  • usually when suddenly stopped or dose reduced
  • massive glutamate release causes neurotoxicity and muscle damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Typical features of neuroleptic malignant:

A
  • pyrexia
  • muscle rigidity
  • autonomic lability: hypertension, tachycardia and tachypnoea
  • agitated delirium with confusion
  • raised creatinine kinase
  • AKI secondary to rhabdomyolysis
  • leukocytosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Management of neuroleptic malignant syndrome:

A
  • stop antipsychotic
  • ICU
  • IV fluids to prevent renal failure
  • dantrolene
  • bromocriptine, dopamine agonist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which conditions commonly cause neuropathic pain?

A
  • diabetic neuropathy
  • post herpetic neuralgia
  • trigeminal neuralgia
  • prolapsed intervertebral disc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of neuropathic pain:

A
  • first line: amitriptyline, duloxetine, gabapentin, pregabalin (try all)
  • switch drugs rather than adding
  • tramadol as rescue therapy
  • topical capsaicin
  • pain management clinic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is normal pressure hydrocephalus?

A
  • reversible cause of dementia
  • secondary to reduced CSF absorption at arachnoid vili
  • triad: urinary incontinence, dementia and bradyphrenia, gait abnormality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Investigations and management of normal pressure hydrocephalus?

A
  • hydrocephalus with an enlarged fourth ventricle
  • ventriculomegaly, absence of substantial sulcal atrophy
  • manage with ventriculoperitoneal shunting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Metabolic consequences of refeeding syndrome:

A
  • hypophosphataemia
  • hypokalaemia
  • hypomagnesaemia
  • abnormal fluid balance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management of refeeding syndrome:

A
  • start with 10kcal/kg/day increasing to full needs over 4-7 days
  • oral thiamine 200-300mg/day, vit B co strong 1 tds and supplements immediately before and during feeding
  • give potassium (2-4mmol/kg/day), phosphate (0.3-0.6mmol/kg/day), magnesium (0.2-0.4mmol/kg/day)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Parkinson’s disease:

A
  • progressive neurodegenerative condition caused by degeneration of dopaminergic neurons in substantia nigra
  • triad: bradykinesia, tremor and rigidity
  • asymmetrical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Tremor in Parkinson’s disease:

A
  • most marked at rest 3-5Hz
  • worse when stressed or tired, improves with voluntary movement
  • typically pill rolling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Bradykinesia in Parkinson’s disease:

A
  • poverty of movement (hypokinesia)
  • short, shuffling steps with reduced arm swinging
  • difficulty in initiating movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Rigidity in Parkinson’s:

A
  • lead pipe

- cogwheel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Other characteristic features of Parkinson’s:

A
  • mask like facies
  • flexed posture
  • micrographia
  • drooling of saliva
  • psychiatric features
  • impaired olfaction
  • REM sleep behaviour disorder
  • fatigue
  • autonomic dysfunction (postural hypotension)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Drug induced parkinsonism:

A
  • motor symptoms generally rapid onset and bilateral

- rigidity and rest tremor uncommon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Diagnosis of Parkinson’s:

A
  • usually clinical
  • 123I-FP-CIT SPECT
  • Lewy bodies (stained brown)
  • discolouration of substantia nigra due to loss of pigmented nerve cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Causes of Parkinsonism:

A
  • Parkinson’s disease
  • drug induced e.g. antipsychotics, metoclopramide
  • progressive supra nuclear palsy
  • multiple system atrophy
  • Wilson’s disease
  • post-encephalitis
  • dementia pugilistica
  • toxins: carbon monoxide, MPTP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Predominantly motor loss peripheral neuropathy:

A
  • Guillain-Barre
  • porphyria
  • lead poisoning
  • hereditary sensorimotor neuropathies (HSMN) - Charcot-Marie-Tooth
  • chronic inflammatory demyelinating polyneuropathy (CIDP)
  • diphtheria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Predominately sensory loss peripheral neuropathy:

A
  • diabetes
  • uraemia
  • leprosy
  • alcoholism
  • vitamin B12 deficiency
  • amyloidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Alcohol neuropathy:

A
  • secondary to both direct toxic effects and reduced absorption of B vitamins
  • sensory symptoms prior to motor symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How does vitamin B12 deficiency cause peripheral neuropathy:

A
  • subacute combined degeneration of spinal cord

- dorsal columns usually affected first (joint position, vibration) prior to distal paraesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Idiosyncratic ADR of phenytoin:

A
  • fever
  • rashes e.g. toxic epidermal necrolysis
  • hepatitis
  • Dupuytren’s contracture
  • aplastic anaemia
  • drug-induced lupus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What teratogenic effect dose phenytoin have?

A
  • cleft palate

- congenital heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is progressive supra nuclear palsy?

A
  • Steele-Richardson-Olszewski syndrome
  • Parkinson Plus syndrome
  • poor response to L-dopa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Features of progressive supra nuclear palsy:

A
  • postural instability and falls: stiff, broad-based gait
  • impairment of vertical gaze (difficulty reading or descending stairs)
  • parkinsonism: bradykinesia prominent
  • cognitive impairment: primarily frontal lobe dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Factors favouring psychogenic non-epileptic seizures:

A
  • pelvic thrusting
  • family member with epilepsy
  • much more common in females
  • crying after seizure
  • not when alone
  • gradual onset
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Factors favouring true epileptic seizures:

A
  • tongue biting

- raised serum prolactin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Origination of radial nerve:

A

continuation of posterior cord of brachial plexus (root values C5-T1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Regions innervated by radial nerve:

A 
motor (main nerve):
-triceps
-anconeus
-brachioradialis
-extensor carpi radialis
motor (posterior interosseous branch)
-supinator
-extensor carpi ulnaris
-extensor digitorum
-extensor indicis
-extensor digiti minimi
-extensor pollicis longis and brevis
-abductor pollicis longus 
sensory: proximal phalanges on dorsal hand (not little finger and part of ring finger)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Effect of radial paralysis at shoulder:

A
  • affects long head of triceps (extension of elbow)

- minor effect on shoulder stability in abduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Effect of radial paralysis in arm:

A
  • affects triceps

- loss of elbow extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Effect of radial paralysis in forearm:

A
  • supinator, brachioradialis, extensor carpi, radialis longus and brevis
  • weakning of supination of prone hand and elbow flexion in mid prone position
39
Q

Patterns of damage in radial nerve:

A
  • wrist drop

- sensory loss to small area between dorsal 1st and 2nd metacarpals

40
Q

Normal ICP in supine position:

A

7-15mmHg

41
Q

Causes of raised ICP:

A
  • idiopathic intracranial hypertension
  • traumatic head injuries
  • infection
  • tumours
  • hydrocephalus
42
Q

Features of raised ICP:

A
  • headache
  • vomiting
  • reduced consciousness
  • papilloedema
  • Cushing’s triad: widening pulse pressure, bradycardia, irregular breathing
43
Q

At what ICP level is treatment considered?

A

> 20mmHg

44
Q

Management of raised ICP:

A
  • underlying
  • head elevation 30 degrees
  • IV mannitol as osmotic diuretic
  • controlled hyperventilation: aim to reduced pCO2 - vasoconstriction of cerebral arteries (caution for ischaemic parts of brain)
  • drain from intraventricular monitor
  • repeated lumbar puncture
  • ventriculoperitoneal shunt (for hydrocephalus)
45
Q

Ankle reflex root:

A

S1-2

46
Q

Knee reflex root:

A

L3-L4

47
Q

Biceps reflex root:

A

C5-6

48
Q

Triceps reflex root:

A

C7-8

49
Q

Acute seizures rectal diazepam dose adults:

A

10-20mg

50
Q

Acute seizures midazolam oromucosal solution adults:

A

10mg (unlicensed)

51
Q

Motor lesions:

A

ALS:
-both upper and lower motor neurons
Poliomyelitis:
-affects anterior horns resulting in lower motor neurone signs

52
Q

Brown sequard syndrome tracts affected:

A

-lateral corticospinal tract
-dorsal columns
-lateral spinothalamic tract
(ipsilateral spastic paresis below, ipsilateral loss of proprioception and vibration, contralateral loss of pain and temp sensation)

53
Q

Friedrich’s ataxia tracts affected:

A

-same as subacute combined degeneration of spinal cord
-lateral corticospinal tracts
-dorsal columns
-spinocerebellar tracts
(bilateral spastic paresis, bilateral loss of proprioception and vibration sensation, bilateral limb ataxia)

54
Q

Anterior spinal artery occlusion tracts affected:

A

-lateral corticospinal tracts
-lateral spinothalamic tracts
(bilateral spastic paresis, bilateral loss of pain and temperature sensation)

55
Q

Syringomyelia tracts affected:

A

-ventral horns
-lateral spinothalamic tract
(flaccid paresis, loss of pain and temp sensation)

56
Q

Multiple sclerosis tracts affected:

A
  • asymmetrical
  • varying spinal tracts
  • combination of motor, sensory and ataxia
57
Q

Neurosyphilis tracts affected:

A
  • dorsal columns

- loss of proprioception and vibration sensation

58
Q

Risk factors spontaneous ICH:

A

CTD - Marfan’s

59
Q

Features of spontaneous ICH, investigations and management:

A
  • strong postural relationship
  • worse upright
  • MRI with gadolinium: pachymeningeal enhancement
  • manage conservatively or epidural blood patch
60
Q

Management status epilepticus:

A
  • ABC
  • benzodiazepines: diazepam or lorazepam
  • prehospital: rectally
  • hospital: IV lorazepam (repeat after 10-20 minutes)
  • on going: phenytoin or phenobarbital infusion
  • no response within 45 minutes: general anaesthesia
61
Q

What sign can you use to differentiate between organic and non-organic lower leg weakness?

A

Hoover’s sign

62
Q

Paralysis of which nerve is likely to result in hyperacusis?

A

facial nerve

63
Q

What type of dementia does motor neurone disease put you at increased risk of?

A

frontotemporal dementia

64
Q

What is subacute combined degeneration of spinal cord?

A
  • due to vitamin B12 deficiency
  • dorsal and lateral columns affected
  • joint position and vibration sense lost first then distal paraesthesia
  • UMN signs in legs (extensor planters, brisk knee reflexes, absent ankle jerks)
  • if untreated stiffness and weakness persist
65
Q

Acute subdural haematoma:

A
  • most commonly high impact trauma
  • CT first line
  • crescenteric collection not limited by suture lines
  • hyperdense
  • can cause midline shift or herniation
  • small or incidental - conservative
  • monitor ICP and decompressive craniectomy
66
Q

Chronic subdural haematoma:

A
  • wekks to months
  • rupture of small bridging veins in subdural space rupture and cause slow bleeding
  • elderly and alcoholics (brain atrophy)
  • shaken baby syndrome
  • crescenteric not restricted by suture lines
  • hypodense
  • if neurological deficit or severe image findings: surgical decompression with burr holes
67
Q

What is syringomyelia:

A
  • collection of CSF in spinal cord
  • caused by Chiari malformation, trauma, tumours, idiopathic
  • cape like loss of sensation to temperature
  • preserved light touch proprioception and vibration
  • ‘accidentally burning without realising’
  • due to crossing spinothalamic tracts in anterior commissure of spinal cord being first affected
  • spastic weakness upper limbs, paraesthesia, neuropathic pain, upping planters and bowel and bladder dysfunction
  • scoliosis over years, Horner’s syndrome
  • full spine MRI
68
Q

Characteristics of tension-type headaches:

A
  • tight band around head
  • bilateral
  • lower intensity than migraine
  • no aura, n&v, aggravation by routine physical activity
  • may be stress related
  • may co-exist with migraine
69
Q

What qualifies as chronic tension headaches?

A

15 or more days per month

70
Q

Treatment of tension headaches:

A

aspirin, paracetamol or NSAID

71
Q

Third nerve palsy features:

A
  • down and out eye
  • ptosis
  • may have dilated pupil
72
Q

Causes of third nerve palsy:

A
  • diabetes mellitus
  • vasculitis e.g. temporal arteritis, SLE
  • false localising sign due to uncle herniation through tentorium if raised ICP
  • posterior communicating artery aneurysm: pupil dilated, often associated pain
  • cavernous sinus thrombosis
  • Weber’s syndrome: ipsilateral third nerve palsy with contralateral hemiplegia caused by midbrain strokes
  • other possible causes: amyloid, MS
73
Q

What is thoracic outlet syndrome?

A
  • disorder involving compression of brachial plexus, subclavian artery or vein at site of thoracic outlet
  • neurogenic or vascular (most neurogenic)
  • neck trauma, soft tissue anomalies (scalene muscle hypertrophy and anomalous bands) or osseous structure e.g. cervical rub
74
Q

Clinical presentation of neurogenic thoracic outlet syndrome:

A
  • painless muscle wasting go hands and weakness
  • sensory symptoms such as numbness and tingling
  • autonomic nerve: cold hands, blanching, swelling
75
Q

Clinical presentation of vascular thoracic outlet syndrome:

A
  • subclavian vein compression leads to painful diffuse arm swelling with distended veins
  • subclavian artery compression leads to painful arm claudication and sometimes ulceration and gangrene
76
Q

What does a parkinsonism tremor look like?

A
  • resting, pill rolling
  • bradykinesia
  • rigidity
  • flexed posture, short, shuffling steps
  • micrographia
  • mask like face
  • depression and dementia
  • anti-psychotic history
77
Q

What does an essential tremor look like?

A
  • postural: worse if outstretched
  • improved by alcohol and rest
  • titubation
  • often strong family history
78
Q

What does tremor look like in cerebellar disease:

A
  • intention tremor

- cerebellar signs: past pointing, nystagmus etc.

79
Q

Characteristics of trigeminal neuralgia:

A
  • unilateral, brief, electric shock-like pains, abrupt
  • limited to one or more division of trigeminal nerve
  • evoked by light touch
  • trigger areas
  • pains remit for variable periods
80
Q

Management of trigeminal neuralgia:

A
  • carbamazepine

- failure to respond or atypical features: referral to neurology

81
Q

What are triptans, indications, ADR, CONTRA:

A

5HT1b and 5HT1d agonists

  • acute migraines
  • with NSAID or paracetamol
  • ASAP after onset of headache rather than at onset of aura
  • ADR: triptan sensations - tingling, heat, tightness, heaviness, pressure
  • CONTRA: ischaemic heart disease or cerebrovascular disease
82
Q

Cutaneous features of tuberous sclerosis:

A
  • depigmented ash leaf spots which fluoresce under UV
  • roughened patches of skin over lumbar spine (Shagreen patches)
  • adenoma sebaceous: butterfly distribution over nose
  • fibromata beneath nails
  • cafe au lait spots
83
Q

Neurological features of tuberous sclerosis:

A
  • developmental delay
  • epilepsy
  • intellectual impairment
84
Q

Other features of tuberous sclerosis:

A
  • retinal hamartomas: dense white areas of retina
  • rhabdomyomas of the heart
  • gliomatous changes can occur in lesions
  • polycystic kidneys, renal angiomyolipomata
  • lymphangioleiomyomatosis: multiple lung cysts
85
Q

Where does the ulnar nerve arise from:

A

medial cord of brachial plexus (C8, T1)

86
Q

Ulnar nerve innervates:

A

motor:

  • medial two lumbricals
  • adductor pollicis
  • interossei
  • hypothenar muscles: abductor digit minimise, flexor digiti minimi
  • flexor carpi ulnas
    sensory: medial 1 1/2 fingers palmar and dorsal
87
Q

Presentation of vestibular schwannoma:

A
  • CN VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
  • CN V: absent corneal reflex
  • CN VII: facial palsy
88
Q

Investigation of vestibular schwannoma:

A

cerebellopontine angle MRI

89
Q

What does homonymous hemianopia indicate?

A
  • incongruous defects: lesion of optic tract
  • congruous defects: lesion of optic radiation or occipital cortex
  • macular sparing: lesion of occipital cortex
90
Q

What does homonymous quadrantopia indicate?

A

-suprior: lesion of inferior optic radiations in temporal lobe
-inferior: lesion of the superior optic radiations in parietal lobe
PITS

91
Q

What does bitemporal hemianopia indicate?

A
  • lesion of optic chiasm
  • upper quadrant defect > lower quadrant defect = inferior chasmal compression, commonly pituitary tumour
  • lower quadrant defect > upper quadrant defect = superior chasmal compression, commonly a craniopharygioma
92
Q

What is Von Hippel-Lindau syndrome and what are the features:

A
  • autosomal dominant condition predisposing to neoplasia
  • abnormality in VHL gene on short arm of chromosome 3
  • cerebellar haemangiomas: SAH
  • retinal haemangiomas: vitreous haemorrhages
  • renal cysts (premalignant)
  • phaeochromocytomas
  • extra renal cysts: epididymal, pancreatic, hepatic
  • endolymphatic sac tumours
  • clear-cell renal cell carcinoma
93
Q

How does Wernicke’s encephalopathy present?

A
  • thiamine deficiency
  • persistent vomiting, stomach cancer, dietary deficiency
  • triad: opthalmoplegia/nystagmus, ataxis and confusion
  • can get petechial haemorrhages
  • peripheral sensory neuropathy
94
Q

Investigations for Wernicke’s and treatment:

A
  • decreased red cell transketolase
  • MRI
  • urgent replacement of thiamine

Neurology (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions