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Neurology MSRA passmed Flashcards

1
Q

Jacksonian movement (clonic movements travelling proximally

A

Frontal lobe seizures

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2
Q

seizures with sensory abnormalities?

A

PArietal lobe

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3
Q

seziures with aura - lip smacking/ clothes plucking, rising epigastric sensation?

A

Temporal lobe seizures

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4
Q

Absolute CI to thrombolysis in stroke?

A

ICH, seizures, cancer sus, SAH, stroke/ injury in 3 months before, LP 7 days before, GI bleed 3 weeks before, Oesophageal varices, HTN>200/120mmHg

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4
Q

Relative CI to thrombolysis?

A
  • Pregnancy
  • Concurrent anticoagulation (INR >1.7)
  • Haemorrhagic diathesis
  • Active diabetic haemorrhagic retinopathy
  • Suspected intracardiac thrombus
  • Major surgery / trauma in the preceding 2 weeks
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5
Q

Lacunar stroke features?

A

purely motor/
purely sensory
ataxic hemiparesis
ipsilateral weakness and limb ataxia that is out of proportion to the motor deficit
dysarthria-clumsy hand syndrome
affect: internal capsule, thalamus and basal ganglia.

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6
Q

Bilateral median N Dysfunction and twitches in elderly “fibrillation” think?/ hx of carpal tunne/ new imbalance/ sensnory/motor dysfunction

A

Degenerative cervical myelopathy.
MRI: gold standardL

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7
Q

fever, headache, malaise focal neurology, seizures, immunocompromised. what does CT show? dx?

A

CT: temporal lobe/ frontal changes (hypodensities). CSF: lymphocytosis and raised protein.
HSV encephalitis

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8
Q

asymmetric limb weakness, fasciculations, tibialis anterior wasting, small hand muscle wasting

A

ALS MND. risk frontotemporal dementia

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9
Q

Features of tuberus sclerosis?

A

AD, epilepsy, retinal haematoma, ash leaf spots, shagreen patches, sublingual fibromata, adenoma sebaceum, angiofibromas, poliosis

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10
Q

Neurofibromatosis features?
CRABBing?
Risks?

A

lisch nodules, AD, cafe au lait spots, phaechromocytomas, axillary/ groinfreckles,
CRABBING: cafe au lait, renal A stensosi (HTN/ relative), axillary nodules/ inguinal, Bone dysplasia/ bowing scapula, iris nodules, neurpfibroma, glioma eyes
NF2: acoustic neuroma, cns tumours

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11
Q

pyramidal tract lesions?

A

Upper limb - flexors>extensors
lower: extensores >flexors
pronator drift
acute;y flaccid paralysis then becoming spastic and increased tone over weeks with clonus/ brisk reflexes

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12
Q

Variation of gbs with descending demyelination?

A

miller fischer syndrome
ophthalmoplegia, areflexia and ataxia. The eye muscles are typically affected first
Anti GQ1B antibodies present

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13
Q

32 year-old female 3 day history of altered sensation of her left foot and right forearm. She had an episode of visual loss/ nystagmus?

A

Multiple sclerosos. ON with female <50 YO.

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14
Q

60 YO male with clumsy hand, dropping cups, struggles to use phone, worse over months?

A

degenerative cervical meylopathy (UMN signs with loss of dexterity, hoffman’s)

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15
Q

trigeminal neuralgia tx?

A

carbemazepine. if fail to respond and atypical features eg <50 - refer to neuro. preceded by pain in ear

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16
Q

red flag features of trigeminal neuralgia?

A

Sensory changes
Deafness or other ear problems
History of skin or oral lesions that could spread perineurally
Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally
Optic neuritis
A family history of multiple sclerosis
Age of onset before 40 years

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17
Q

Migraine tx?
menstrual migraine tx?

A

acute: triptan + nsaid/ paracetamol
child@ nasal triptan,
Others: non oral metoclopramide, domperidone
proph: propanolol/ topiramatee (teratogenic)/ amitryptiline/ riboflavin (for some),

predictable menstrual migraine: frovatriptan (2.5 mg twice a day) or zolmitriptan (2.5 mg twice or three times a day) as a type of ‘mini-prophylaxis’

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18
Q

differentiate between PD and essential tremour?

A

SPECT
features: essential: improves with alcohol, worse with intention, symmetrical

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19
Q

Parkinson’s symptoms?

tx?

A

features: resting tremour, bradykinesia, rigidity, shuffling gait, arm swinging, stooped,

tx: levodopa with peripheral decarboxylase inhibitors Co-beneldopa (levodopa and benserazide), with the trade name Madopa
Co-careldopa (levodopa and carbidopa), with the trade name Sinemet

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20
Q

parkinson plus syndome?

A

Multiple system atrophy: autonomic dysfunction (sweating, ED, postural hypotension), ataxia

Normal pressure hydrocephalus (wet, wobbly, wacky - incontinence, falls, dementia)

Lewy body dementia

progressive supranuclear palsy (virtical gaze palsy, speech/ swallowing issues)

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21
Q

levodopa SE?

A

dyskinesia :excessive motor activity, chorea, dystonia, athetosis.
MX: amantadine

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22
Q

PD drugs:
COMT inhibitors?
dop agonists?
MOBI?monoamine oxidase-B enzymes

when might PD sx worsen?

A

COMT - entacapone, slows breakdown to levodopa in brain

dopamine agonist: bromocriptine/ cabergoline/ pergolide. SE: pulmonary fibrosis. less effective but delays need for levodopa and then combined to reduce necessary dose. more risk of hallucinations

MOBi: selegiline, rasagiline
(slow breakdown)

drug holiday Ge/ missed doses

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23
Q

cx of brain abscess?

A

extension of sepsis from middle ear or sinuses, trauma or surgery to the scalp, penetrating head injuries and embolic events from endocarditis

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24
15 min headache 5 weeks men, smoker, alcohol, crying around eye. tx?
cluster headache. get advice from specialist, imaging and acute: 02, sc triptan, prophylaxis: verapamil
25
features favouring epileptic seziure?
tongue biting, raised serum prolactin
26
wernicke's encephalopathy triad?
Confusion, gait ataxia, nystagmus + opthalmoplegia. thiamine deficinecy
27
32 YO, F, altered sensation left foot and right forearm. B/L clonus in legs, and hyperreflexia in all limbs.
Multiple sclerosis
28
carbemazepine se?
dizziness, ataxia, and diplopiap
29
phenytoin se?
peripheral neuropathy, (numbness and reduced sensation in a glove-and-stocking distribution). gingival hyperplasia, bleeding gums, osteomalacia, p450 inducer, megaloblastic anaemia, Lymphadenopathy. check trough level (before dose) if dose change/ tox suspicion/ compliance doubt
30
lumbar spondylosis and chronic back pain presents with gradually worsening bilateral upper limb paraesthesias and leg stiffness
degenerative cervical myelopathy. do MRI c spine
31
Huntington's disease features?
35 +, chromosome 4 (H, 4 arms), chorea personality changes (e.g. irritability, apathy, depression) and intellectual impairment dystonia saccadic eye movements
32
stroke of: Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
Ipsilateral: facial pain and temperature loss Contralateral: limb/torso pain and temperature loss Ataxia, nystagmus
33
stroke: ipsilateral facial paralysis and deafness?
anterior inferior cerebellar artery
34
stroke: Ipsilateral CN III palsy Contralateral weakness of upper and lower extremity
Weber's syndrome (branches of the posterior cerebral artery that supply the midbrain)
35
site of lacunar stroke?
isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia AF: hypertension common sites: basal ganglia, thalamus and internal capsule
36
Cushing triad?
bradycardia, irregular breathing, wide pulse pressure, systolic HTN (response to raised ICP). also dilated poorly reactive pupils, gcs low, CN6 palsy, pappiloedema
37
Tx of ischaemic stroke? TIA presenting within 24 hrs. tx? DAPT? and non DAPT? TIA - when to discuss with specialist same day? 7 days? 24 hrs? stroke: when to do thrombectomy and thrombolysis? When do you do thrombolysis? when do you do thrombectomy for wake up strokes? when do you do carotid enterectomy? secondary tx like statin/ anticoagulation for AF? clopidogrel not tolerated?
Aspirin 300mg 2/52 then lifelong chlopi TIA: Clopidogrel 300mg then 75mg od lifelong. Aspirin 300mg+ 75mg od 21 days). _ppi Not appropriate for DAPT: clopidogrel 300mg+ 75mg od -TIA: in 24 hrs Aspirin 300mg and stroke r/v within 24 hrs Within 7 day - see stroke before imaging. corotid duplex uss. TIA - discuss asap if cresencod TIA. if within 7 days - r/v within 24 hrs. if 7days + - refer within 7 days Thrombolysis: alteplase. Tenecteplase 4.5-9hrs BP needs to be <185/110 thrombectomy: <6 hrs 6-12 hrs if confirmed salvageable brain tissue confirmed within 24 hrs if proximal posterior circulation (basilar. PCA) salvageable brain tissues Both: Proximal AntCS and <4.5hrs do both thrombolysis and thrombectomy (within 6 hrs of symptoms) (ensure BP 185/110) - carotid enterectomy within 7 days if 50% + stenosis -statin if cholesterol 3.5+ (usually delayed 48 hrs due to risk of haemorrhagic transformation) Af anticoagulation - normally 14 days after dipyramidole
38
(CN8)vertigo, hearing loss, tinnitus and an absent corneal reflex (CN5)? and facial nerve palsy (CN7)
acoustic neuroma/ vestibular schwannoma
39
serotonin syndrome? NMS?
presents hours rather than days, sweating, myoclonus, diarrhoea and hyperreflexia. TX: chlorpromazine, cryptoheptadine NMS: pyrexia muscle rigidity, reduced reflexes, HTN, hgih HR/ RR, delerium, raised CK/ WCC. over days. TX: dantrolene
40
Weber lateralises to?
contralasteral SN HL ipsilateral conductive HL
41
valporate SE?
Teratogenic (harmful in pregnancy) Liver damage and hepatitis Hair loss Tremor Reduce fertility now not recced in men or women <55YO, unless no alternative
42
1st line for focal seizures?
lamotrigine/ keppra
43
abscent seizures tx first line ?
ethoxusimide. made worse by carbemazepine
44
Myoclonic seizures first line?
valporate/ then keppra
45
starting IV phenytoin, what to monitor?
cardiac monitoring
46
Amantidine SE?
ataxia, slurred speech, confusion, dizziness and livedo reticularis
47
SE dopamine agonists?
cabergoline/ bromocriptine: pulmonary fibrosis, retroperitoneal/ cardaic. do CXR, echo, ESR, raised hallucinations, postural hypotension, nasal congestion
48
tx of drug induced parkinsonions?
procyclidine (antimuscarinics),
49
TIa and informing DVLA?
1 month no neuro deficit, 3 months if multiple TIA and inform DVLA, craniotomy for meningioma : 1 yr, for pit adenoma craniotomy - 6 months (if vision clear)
50
laughter/ fear triggering loss of msucle tone?
cataplexy
51
Stokes-adams attack?
LOC/ collapse without warning, 10-30 secs with pallor, flushing on recovery. AF: complete heartblock/ eCG changes, IHD
52
MS ix?
MRI with contrast
53
PAtient on DOAC/ anticoagulant and has sx of TIA even if resolved. tx?
admit to ED to exclude haemorrhagic stroke
54
Raised protein/ lymphocytes CSF with swelling on CT, fever,
HSV enceph
55
Seizures like a ''dream'', lip smacking without remembering?
focal impaired awareness
56
most common initial sx of posterior circulation stroke?
dizziness
57
70 year-old man has pain and weakness in both legs on walking. It settles with rest
Lumbar spinal stenosis (PVD)
58
Types of aphasia? Speech is fluent but repetition is poor. Aware of the errors they are making. normal comprehension
conduction aphasia (connection between broca's and wernicke's)
59
Speech is non-fluent, laboured, and halting. Repetition is impaired Comprehension is normal, type of aphasia?
broca's aphasia - superior left MCA, inferior frontal gyrus (frontal lobe)
60
type of aphasia - speech fluent but comprehension is impaired?
expressive. superior temporal gyrus supplies by inferior left CMA
61
impairement of all 3 areas of aphasia: broca's, wernicke's and conductive?
global aphasia. can communicate with signs
62
CI of triptans?
cardiovascular disease,
63
the delusion that a friend or partner has been replaced by an identical-looking impostor
capgras syndrome
64
Fregoli's syndrome?
delusional idea that the various people that the patient meets are in fact the same person.
65
cotard's syndrome?
belief they are dead
66
Types of MS that have deteriorated sx between relapses?
secondary progressive. gait and baldder disorders also seen
67
bell's nerve is also seen with?
hyperacusis (CN7 palsy, supplies stapes), post auricular pain, dry eyes, altered taste
68
double vision, right eye fails to adduct, left eye has nystagmus on abduction
Right sided intranuclear opthalmoplegia (can be feature in MS)
69
visual symptoms preceding the headache. B/L 'wavy' and 'shimmering' lines in his vision (scintillating scotoma)
migraine with aura
70
LEft inferior homonymous hemianopia. where is lesion?
right parietal lobe
71
Exacerbate myasthenic crisis?
penicillamine quinidine, procainamide beta-blockers lithium phenytoin antibiotics: gentamicin, macrolides, quinolones, tetracyclines
72
causes of flapping tremour?
encephalopathies phenytoin CO2 retention Wilson's disease
73
pit adenoma visual field defect?
Bitemporal hemianopia, upper quadrant defect
74
Visual field defect with primary open angle glaucoma?
unilateral peripheral VL
75
bitemporal hemianopia - with worse VL in lower quadrants?
craniopharyngioma
76
headache with greying out vision worse in morning and at night. better when standing, double vision,
Raised ICP
77
Tx for TV - with and wihtout cns
RIPE - 2months without CNS - RI for 4 months, wiht CNS - RI for 10 furthe rmonths
78
reduced visual acuity, eye pain worse with exercise, swollen optic disc?
optic neuritis (uhtoff's phenomenon - worse with exercise/ heat), lines appear striaght o wavey
79
Bacterial Meng CSF? TB CSF?
high protein, glucose <50% of serum glucose, low TB: protein ++, glucose low
80
CTH within 1 hr?
GCS<15 initially, or GCS <13 within 2 hrs, suspected basal skull #, post traumatic seizure, 1 vomit, neurology
81
CTH within 2 hrs?
LOC/ amnesia with 65+/bleeding disorder, mechanism dangerous, retrograde amnesia 30 mins+
82
CTH within 8 hrs?
any patient on warfarin
83
CTH for children within 1 hr?
non accidental injury, post truamatic seizure (not known epileptic), intial GCS <14/ 15 paeds, GCS<15 2 hrs after, tense fontanelle, basal skull #, neuro sx, <1YO with laceration/swelling/bruise 5cm+ or 2 factors of: LOC 5mins, 3+vomit, dangerous mechanism, amnesia 5 mins+. if only 1, then observe and CTH if GCS<15, vomiting, drowsiness
84
When to tx if first T-C seizure?
EEG chasnges, unacceptable risk of reoccurance, known cerebral structual issue, previous myoclonic/ abscence/ focal seziures
85
8YO boy staring into space/ daydreaming?
Abscent seizure
86
60YO F, derranged LFTs, acutely confused, ataxic gait, B/Lhorizontal nystagmus. CTH petechial haemorrhages
Glucose infusion with chronic thiamine deficiency precipitating wernickes
87
10YO east asian, gait issues, slurred speech, scoliosis, diabetes weak arms and legs?
freidrich's ataxia. autosomal recessive. risk: cardiomyopathies and DM
88
PD sx, urine dysfunction, postural hypotension, cerebellar ataxia?
multiple system atrophy
89
Diagnosis of normal pressure hydrocephalus?
LP and evaluation post CSF removal. cT - enlarged ventricles without convolusional atrophy)
90
when to tx tension headaches prophylactically?
if more than 2 days a week, trial amitryptiline first line
91
13 YO girl progressive difficulty whistling/ sucking through straw?
facioscapulohumeral muscular dystrophy:
92
76 YO man with dementia, painful resteless legs, cant turn in bed, presents with sleep difficulty?
parkinsons
93
13YO boy, pulls legs up to walk upstairs, milestones delayed by 18 months, big calves?
duchenne muscular dystrophy
94
extrapyramidal SE present 1 yr then cognitive decline?
parkinsons disease with dementia dementia with Lewy bodies - in cortical neurones. the motor SX and cognitive decline present within a year
95
45YO M, BL cataracts, worsening stiffness muscles of shoulders and hips 3 months
myotonic dystrophy - Autosomal dom. facila weakness, ptosis, frotnal balding, weakness in grip and shoulder, hallowed temples, hypernasal speech, PMR - 50YO+
96
headache associated with sexual activity? type 1/ type2? mx?
coital cephalgia t1 - B/L occipital, increases with sexual excitement type 2- thunderclap like at point of orgasm acute: BB (pre-emptive)/triptan, proph:Indomethacin, propanolol/metoprolol,CCB diltiazem
97
charcot's neurological triad?
AF MS but not pathognomonic. nystagmus, intention tremour, staccato speech
98
When is mirtazipine/ trazadone/ reboxetine best to start in depression with chronic illness?
if patient is on NSAID/ warfarin/ aspirin, triptans, selegiline/ rasagiline (MAO-B)
99
best antidepressant for patient on anti-epileptics?
sertraline
100
T2DM with distal limb weakness, tonic muscle spasm, bald in front, eye problemsa dn small testicles. FH positive?
Myotonic dystrophy. autosomal dominant. AF: TM, testicular atrophy, dysphagia, B/L ptosis, cataracts, long myotonic face with bald front
101
1-5 YO with red spots, cerebella ataxia, recurrent chest infections. low platelets? 10YO with t1dm, cerebellar ataxia, visual problems?
Ataxic telangectasia - autosomal recessive, IGA deficiency, increased risk of lymphoma and leukaemia Freidrich's ataxia. autosomal recessive, AF: optic atrophy, hyphoscoliosis
102
most common hereditary polyneuropathy? frequent sprained ankles, hammer toes stork leg with distal leg wasting??
charcot marie tooth distal muscle weakness, atrophy, hyporeflexia, foot drop,, high arched feet

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