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AMC MCQ > Neurology & Neurosurgery > Flashcards

Neurology & Neurosurgery Flashcards

1
Q

brain lesion on the left side

A

body symptoms on right side

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2
Q

List of anticholinergics

A
  • Banzhexol
  • Levodopa
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3
Q

Brain tumour vs brain abscess

A

brain tumour enhance on contrast CT

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4
Q

-Rapidly fluctuating cognition + Visual hallucinations + Spontaneous motor Parkinsonism

A

Lewy bodies

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5
Q

Cardinal symptom of dementia with Lewy bodies

A

Visual hallucinations

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6
Q

Ptosis + Myosis + anhidrosis

A

Horner’s syndrome

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7
Q

ptosis + mydriasis

A

3rd CN palsy

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8
Q

Most common cause 3rd CN palsy

A

Diabetic neuropathy

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9
Q

key feature of DM 3rd nerve palsy

A

Normal pupillary reflex

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10
Q

common cause of 6th nerve palsy

A

diabetes

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11
Q

6th nerve palsy diseases

A
  • diabetes
  • Meningitis
  • multiple sclerosis
  • Wernicke’s encephalopathy
  • nasopharyngeal tumour
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12
Q

Ramsay Hunt syndrome treatment

A

valacyclovir/acyclovir 7 to 10 days + prednisone 5 days

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13
Q

Campylobacter jejuni + Normal cell count + high protein

A

Guillain-Barre syndrome

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14
Q

muscular weakness +
mild distal sensory loss

A

Guillain-Barre syndrome

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15
Q

Guillain-Barre syndrome respiratory investigation

A

Forced vital capacity

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16
Q

Guillain-Barre syndrome treatment

A
  • IV immune globulin
  • plasma exchange,
    -for severe cases, mechanical ventilation
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17
Q

most common parotid tumour

A

pleomorphic adenoma

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18
Q

slow growing + parotid gland

A

pleomorphic adenoma

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19
Q

fast growing + parotid gland involvement + causing symptoms

A

pleomorphic carcinoma

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20
Q

Unilateral headaches
+ nasal stuffiness + conjunctival injection + lacrimation

A

Cluster headache

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21
Q

Cluster headache acute treatment

A

100% oxygen

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22
Q

Cluster headache prophylaxis

A

CCB

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23
Q

Unilateral headaches +

A
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24
Q

SS vs NMS

A

SS: hyperreflexia + nausea/vomiting
NMS: hyporeflexia

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25
Q

short hx of unilateral facial droop + dysphasia

A

CAS/TIA

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26
Q

TIA dx

A

Initial: Carotid artery doppler US
Best: CTPA

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27
Q

Parkinsons disease

A

U/L tremors
Good response to Levodopa

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28
Q

CAS referral cut-off

A

Asymptomatic:
- < 80% + yearly follow-up with CDUS
- >80 + refer

Symptomatic:
- <50% medical therapy + antiplatelet + follow-up
- >50% surgery -2 weeks of event + medical therapy

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29
Q
A
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30
Q

pain in lateral shin + dorsum of foot + weakness of eversion + dorsiflexion

A

Common peroneal nerve injury

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31
Q

diabetic neuropathy treatment

A

TCA

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32
Q

peripheral neuropathy investigation

A
  1. Check B12 level as this can be low -metformin can lead to low b12.
    2.thyroid function tests to assess for hypothyroidism.
  2. Assess for autoimmune neuropathy
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33
Q

family hx + acute painful eye loss of vision + hyperreflexia + increase tone

A

multiple sclerosis (MS)

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34
Q

Migraine treatment

A
  • BB (propranolol)
  • TCA
  • pizotifen,
  • sodium valproate
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35
Q

Migraine treatment in children

A

1st line: Ibuprofen
2nd: paracetamol

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36
Q

severe “thunderclap” a headache + loss of consciousness

A

SAH

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37
Q

most common cause of SAH

A

Rupture of saccular aneurysm

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38
Q

most common location of SAH

A

anterior circulation on the circle of Willis 85%

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39
Q

Post SAH + stiffness + photophobia + hyperreflexia + unilateral weakness

treatment

A

Nimodipine
-decreases the probability of stroke

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40
Q

SAH complications

A
  • Re-rupture
  • Hyponatremia
  • Hydrocephalus
  • Hydrocephalus
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41
Q

clock drawing test assesses

A

severity of dementia

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42
Q

clock drawing test

A

Frontal and Temporo-parietal functioning

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43
Q

occupational therapist / ophthalmologist referral to drive

A

persistent hemianopia after stroke

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44
Q

Permanent commercial driving restriction

A
  1. stable angina
  2. ICD (defibrillator)
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45
Q

diseases that cause neck stiffness

A

– Meningitis.
– Subarachnoid haemorrhage.
– Tetanus.
– Upper lobe pneumonia.
– Tender posterior cervical adenopathy.
– Retropharyngeal abscess.
– Rheumatoid arthritis

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46
Q

degenerative disease of the central nervous system caused by infectious proteins

A

Creutzfeldt-Jakob disease (CJD)
prion

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47
Q

restless leg syndrome dx

A

clincal + Iron studies

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48
Q

restless leg syndrome treatment

A

Dopamine agonist:
- ropinirole
- levodopa

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49
Q

Alzheimer’s vs Fronto-temporal dementia

A
  • behavioural change early in fronto-temporal
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50
Q

Alzheimer EEG

A

Generalized background slowing

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51
Q

Alzheimer’s lobe atrophy

A

frontotemporal lobe atrophy

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52
Q

medications avoided in patients with rest less leg syndrome

A

– Metoclopramide (dopamine antagonists)
– Droperidol (dopamine antagonists)
– Lithium
– Naloxone (opioid antagonist)
– Antidepressants that increase serotonin levels

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53
Q

unexplained falls + axial rigidity + dysphagia +
vertical gaze deficits

A

supranuclear palsy

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54
Q

ataxia + falls + past pointing + positive Romberg’s sign
+ nystagmus

A

Cerebellar stroke

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55
Q

resting tremors + cogwheel rigidity +
bradykinesia + festinating gait

A

Parkinson’s disease

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56
Q

Parkinson speech decrement

A

Progressively inaudible speech

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57
Q

Parkinson’s disease vs Drug-induced parkinsonism

A

drug induced:
- bilateral bradykinesia/tremor
- disappear when the offending agent is ceased
- inadequate response to anti-cholinergic agents

Parkinson’s:
- Asymmetric symptoms
- dramatic response to anti-cholinergics
- Dementia
- presence of tremors

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58
Q

Carbidopa/levodopa + dyskinesias + intense akinesia / uncontrollable hyperactivity

A

Drug-induced dyskinesias

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59
Q

Drug-induced dyskinesias treatment

A

1st: reduction in dopaminergic supplementation
2nd: alternate medication like amantadine, pergolide

60
Q

Parkinson’s disease vs Atypical parkinsonism

A

Parkinson’s disease:
- dramatic response to anti-cholinergics
- diplopia while reading
-autonomic dysfunction (constipation, urinary urgency, impotence, orthostasis?

Atypical parkinsonism:
- absence of response to high-dose levodopa
- absence of tremor

60
Q

High frequency stimulation for Parkison’s aims at which areas

A

Globus pallidus, subthalamic nucleus, thalamus

61
Q

most significant risk factor for falls in elderly

A

Visual impairment

62
Q

action tremor which gets worse with doing activity

A

distal essential tremor

63
Q

essential tremor treatment

A

1st line: Propranolol and primidone

64
Q

tremor which occurs at rest

A

Parkinsons

65
Q

resting tremor treatment

A

anticholinergics
- Benzhexol
- benztropine

66
Q

children / young adults + hepatic
failure +rigidity + clumsy gait + dysarthria + copper

A

Wilson’s disease

67
Q

Acalculia + Dysgraphia + Finger anomia + -Right-left confusion

A

Gerstmann’s syndrome

68
Q

Gerstmann’s syndrome lesion location

A

Inferior parietal lobule (usually left)

69
Q

Loss of the ability to recognize items based on touch Loss of the ability to recognize items based on touch

A

posterior parietal lobe

70
Q

Gerstmann’s syndrome affects which side

A

contralateral to upper limbs presentation

71
Q

URTI+ acute onset of vertigo + An absence of tinnitus and hearing loss

A

Vestibular Neuritis

72
Q

Dix-Hallpike Test +ve

A

Likely BPPV

73
Q

“raccoon eyes” + blood behind the ears + mastoid ecchymosis (battle)

A

Basilar skull fracture

74
Q

vascular dementia features

A

-Sudden onset of memory decline after a stroke with step-wise deterioration
-Variable cognitive impairment and emotional lability.
-Gait abnormalities.
-Urinary dysfunction.
-Parkinsonian motor features.
-Vascular lesions on MRI/CT.

75
Q

vascular dementia treatment

A
  • prevent strokes
  • control hypertension
76
Q

vascular dementia memory treatment

A

acetylcholinesterase inhibitor (donepezil)

77
Q

dementia protective factor

A

diet rich in polyunsaturated and monounsaturated fats
(nuts, salmon)

78
Q

raised ICP causes

A

●Parenchymal brain swelling
●Interstitial and vasogenic Edema
●Alterations in cerebral blood volume (CBV)
●Obstruction of CSF outflow
●Focal cerebral perfusion deficits
●Variable levels of CBF
●Cerebrovascular carbon dioxide (CO) reactivity
●Cerebral vasculitis

79
Q

Posterior column syndrome

A

bilateral loss of proprioception below the lesion,
preservation of pain and
temperature sensation

80
Q

most common manifestation of muscle weakness with myasthenia gravis

A

Ocular muscle weakness

81
Q

myasthenia gravis disease location

A

Neuromuscular junction

82
Q

Myasthenia Gravis best diagnostic test

A

Single-fibre electromyography

83
Q

pubertal patient + inferior portion iris Lisch nodules + an optic pathway glioma + Ectropion uveae

A

neurofibromatosis type 1 (NF1)

84
Q

down syndrome most likely to develop what disease

A

Alzheimer disease

85
Q

diabetic foot ulcers risk factors

A
  • diabetic neuropathy 80%
  • previous foot ulceration
  • vascular disease,
  • foot deformity
86
Q

diabetic foot ulcers assessment

A

Monofilament testing

87
Q

recurrent continuous convulsions > 5 mins

A

status epilepticus

88
Q

status epilepticus treatment

A

IV diazepam/lorazepam

89
Q

Alzheimer’s medication

A

Donepezil

90
Q

alcoholic + rapid correction of hyponatremia + quadriplegia

A

central pontine
myelinolysis (CPM)

91
Q

Focal weakness lasting for 24 hours following a motor seizure

A

postictal paralysis (Todd)

92
Q

symmetric upper non sensory motor neuron pattern of weakness involving the face, arm, and leg.

A

Pure motor stroke
Internal capsule

93
Q

most common type of
lacunar stroke

A

Pure motor stroke

94
Q

Px following MVA alert on hospital arrival loses consciousness when taking tests + pupil dilation + contralateral hemiparesis

A

epidural hematoma

95
Q

tear of the middle meningeal artery

A

epidural hematoma

96
Q

impaired walk along a straight line touching the heel of one foot to the toe of the other

A

Tandem gait
Cerebellar dysfunction

97
Q

poor naming ability + non-fluent

A

Transcortical motor aphasia

98
Q

poor naming ability + non-fluent + poor repetition

A

Broca aphasia

99
Q

upper torso stooped forward + shuffling feet + lost arm swing

A

Parkinsonian gait

100
Q

affected foot is raised higher than normal + brought down with a slap

A

Steppage gait

101
Q

painful + limited weight bearing leg

A

Antalgic gait

102
Q

Post stroke + stiff leg + foot drop+ flexed/adducted hand

A

Spastic hemiparetic gait

103
Q

short steps + extended stiff legs crossing on each other+ foot dragging

A

Spastic diplegia gait/ scissor gait

104
Q

abrupt onset of right face and hand weakness +
disturbed speech production, + a right homonymous hemianopsia

A

Left middle cerebral artery occlusion

105
Q

young female + weakness after exertion + Diplopia/Ptosis + chewing weakness

A

myasthenia gravis

106
Q

Severe myasthenia gravis treatment

A

Corticosteroids (prednisone)

107
Q

fluctuating level of consciousness + trivial force

A

Subdural hematoma

108
Q

head trauma + no loss of consciousness + deteriorating a few hours/days later

A

epidural hematoma

109
Q

Visual hallucinations + Parkinsonism +
+Fluctuation in the mental state

A

Lewy body dementia

110
Q

A headache exacerbated by coughing, sneezing or straining

A

brain tumours and raised intracranial pressure

red flag

111
Q

TIA 1st line treatment

A

Aspirin + dipyridamole

112
Q

Contraceptive pills + headache nausea and vomiting + Visual obscuration

A

Benign intracranial hypertension

113
Q

stroke secondary prevention medication

A

Warfarin
Aspirin
Enalapril
Atorvastatin

114
Q

symptoms which can aggravate dementia

A

-Depression.
-Subdural haematoma.
-Neoplasms.
-Alcohol.
-Intracerebral lesions (tumour, normal pressure hydrocephalus).
-Infections (urinary tract, respiratory tract)

115
Q

sudden, brief and very severe + paroxysms of pain + no sensory loss in the painful area + does not awaken + from
sleep

A

trigeminal neuralgia

116
Q

trigeminal neuralgia treatment

A

1st line: Carbamazepine
2nd line: Gabapentin and amitriptyline

117
Q

feeling detached/unreal surroundings/deja vu + occasional headaches

A

Temporal lobe epilepsy

118
Q

lumbar puncture contraindications

A

– Unstable patient.
– Altered level of consciousness
– Space occupying lesion in the brain.
– Localised infection in the lumbar region.
– Coagulopathy (High INR)

119
Q

BPPV investigation

A

Hallpike manoeuvre

120
Q

BPPV treatment

A

Epley manoeuvre

121
Q

Meniere’s disease treatment

A

Frusemide

122
Q

Vestibular neuritis treatment

A

Steroids

123
Q

Epileptic px planning to conceive + seizure free 2 years

A

Gradually cease anti-epileptic over 6 months

124
Q

partial seizures 1st line treatment

A

Carbamazepine

125
Q

Horner’s syndrome + nystagmus + facial sensory deficit + side of the body sensory deficit

A
  • posterior inferior cerebellar artery infarct (PICA)
  • lateral medullary syndrome (Wallenberg syndrome)
126
Q

contralateral hemiparesis + contralateral homonyms hemianopia + aphasia + sensory neglect

A

middle cerebral artery lesion (MCA)

127
Q

generalized
tonic–clonic seizures + right eye swelling + testis tenderness + well-defined cystic lesions on cerebral cortex

A

Neurocysticercosis (tape worm)

128
Q

Absolute contraindications to thrombolytics therapy

A
  • Uncertainty about the time of stroke onset (e.g. patients awakening from sleep).
  • Neurologic surgery, serious head trauma, or previous stroke in past 3 months.
  • Hypertension: systolic blood pressure above 180mmHg; or diastolic blood
    pressure above 110mmHg on repeated measures.
  • Clinical presentation suggestive of subarachnoid haemorrhage even if the CT scan is normal.
  • History of intracranial haemorrhage.
  • Seizure at stroke onset.
  • Suspected/confirmed endocarditis
129
Q

Trigeminal neuralgia vs post-herpetic neuralgia

A

history of herpes zoster eruption
trigeminal neuralgia involves a young person > 40

130
Q

adolescent with mild dementia+ tremor, + rigidity + acutely agitated + has jerking limbs when on l-dopa

A

Huntington disease

131
Q

Acute loss of peripheral vision + constricted pupils

A

concussion

132
Q

ventriculoperitoneal shunting for NPH major complication

A

Subdural hematoma

133
Q
A
134
Q

abdominal aortic aneurysm repair + nilateral flaccid paresis + mpaired pinprick sensation

A

Spinal cord infarct

135
Q

progressive weakness + horizontal nystagmus horizontal nystagmus +ataxia + hyperreflexia + altered mental status

A

Phenytoin toxicity

136
Q

corneal abrasion + lack of eye pain

A

Trigeminal (CN) V lesion
- herpes zoster

137
Q

(in epidural hematoma)uncal herniation in temporal lobe causes:

A
  • Ipsilateral fixed and dilated pupil from compression of the ipsilateral
    oculomotor nerve (CN III)
  • Contralateral hemiparesis Contralateral hemiparesis (compression of the ipsilateral cerebral peduncle)

-Contralateral homonymous hemianopsia with macular sparing from
compression of the ipsilateral posterior cerebral artery

worsening herniation = psilateral hemiparesis, a false localizing sign known as Kernohan phenomenon

138
Q

pregnant + obese + papilledema + Pulsatile tinnitus + positional headaches positional headaches worse when lying flat

A

Idiopathic intracranial hypertension (IIH)

139
Q

head injury to the left temporal region + unresponsive after a lucid interval + progressive right-sided weakness

A

epidural hematoma

features Rapid expansion of the EH:
- Increase intracranial pressure (eg, Cushing
-triad of hypertension, bradycardia, and bradypnea),
- compress compress the temporal lobe leads to uncal herniation

140
Q

Idiopathic intracranial hypertension (IIH) investigation

A

MRI

141
Q
A
142
Q

linear growth + pubertal delay, + worsening headaches + papilledema

A

craniopharyngioma
calcified suprasellar mass

143
Q

craniopharyngioma location

A

suprasellar region adjacent to the optic chiasm

144
Q

hemineglect syndrome lovation

A

ipsilateral parietal cortex

145
Q

most common risk factor of stoke in young patients

A

Patent foramen ovale

146
Q

shoulder-tip pain ddx

A
  • ectopic pregnancy
  • Pulmonary embolism
    Pneumothorax
    Myocardial infarction
    Perforation of peptic ulcer disease
    Diaphragmatic irritation

AMC MCQ (55 decks)

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