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Phase 3a Everything > neurology_20231205142311 > Flashcards

neurology_20231205142311 Flashcards

1
Q

How would an old subdural haemorrhage show on CT?

A

Hypodense crescent shaped lesion

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2
Q

How would a new subdural haemorrhage show on CT?

A

Hyperdense crescent shaped lesion

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3
Q

Where is a subdural haemorrhage?

A

Between the dura and arachnoid mater

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4
Q

What are the risk factors for subdural haemorrhage?

A

Historic head trauma Anticoagulant use Alcoholism Old age

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5
Q

What kind of patient does a subdural haemorrhage tend to occur in?

A

Older patient > 65

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6
Q

What are the symptoms of a subdural haemorrhage?

A

Gradually increasing headache and confusion

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7
Q

Where is an extra dural haemorrhage?

A

Between the skull and the dura mater

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8
Q

What is the commonest cause of extradural haemorrhage?

A

Trauma to the pterion which tears the middle meningeal artery

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9
Q

What is the pterion?

A

where the frontal, parietal, sphenoidal and temporal bones meet

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10
Q

How does an extradural haemorrhage present?

A

Severe headache
Contralateral hemiplegia
Rapid deterioration in GCS following a lucid period

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11
Q

How is an extradural haemorrhage seen on CT?

A

Lemon shaped haematomaShift of the ventricles

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12
Q

Where is a subarachnoid haemorrhage?

A

Between the arachnoid and pia mater

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13
Q

What is the presentation of a subarachnoid haemorrhage?

A

Severe sudden onset of headache - worst headache of their lifeOften in the occipital region

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14
Q

What are subarachnoid haemorrhages caused by?

A

Trauma Spontaneous haemorrhage - most commonly due to the rupture of a berry aneurysm

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15
Q

What are the investigations used to diagnose SAH?

A

Non-contrast CT brain Lumbar puncture

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16
Q

What would be seen on CT in a SAH?

A

A white area in the centre of the brain, expanding bilaterally

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17
Q

What would be seen on lumbar puncture in a SAH?

A

Blood in the CSF or xanthacromia

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18
Q

What is the preferred surgical intervention for SAH?

A

Endovascular coiling

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19
Q

What other surgical intervention can be performed for SAH?

A

Surgical clipping

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20
Q

What condition is associated with subarachnoid haemorrhage?

A

Polycystic kidney disease (patients with PCKD can develop berry aneurysms)

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21
Q

When would a lumbar puncture be performed to diagnose SAH?

A

If a CT head is inconclusive

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22
Q

When should a lumbar puncture be performed to diagnose SAH if a CT is inconclusive?

A

12 hours after SAH (+onwards)

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23
Q

What is the criteria for a CT in one hour after a head injury?

A

More than one episode of vomiting Clinical evidence of a skull fractureMore than 30 minutes of retrograde amnesiaGCS <13GCS < 15 after 2 hours Any sign of basal skull fracture - panda eyes, haemotympanum, CSF leakage from ear or nose Focal neurological deficit Post-trauma seizure

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24
Q

What is the criteria for a CT in one hour after head injury in children?

A

Suspicion of non-accidental injury Post-traumatic seizure GCS < 14 or GCS < 15 if infant Evidence of skull fractureTense fontanelle Signs of a basal skull fracture Focal neurological deficits

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25
Q

What is the immediate treatment of a SAH?

A

IV nimodipine or IV mannitol Immediate neurosurgical referral

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26
Q

What is motor neuron disease?

A

A group of progressive and fatal conditions where motor neurons stop functioning.

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27
Q

Is sensation affected in MND?

A

No - only motor is affected

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28
Q

What is the most common form of MND?

A

ALS - amyotrophic lateral sclerosis

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29
Q

What are the other forms of MND?

A

Progressive bulbar palsyProgressive muscular atrophyPrimary lateral scleorosis

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30
Q

Which motor neurons does ALS affect?

A

Upper and lower motor neurons

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31
Q

What is the aetiology of MND?

A

Most cases are sporadic but there are genetic components.

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32
Q

What are 3 risk factors for developing MND?

A

Smoking PesticidesHeavy metal exposure

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33
Q

Which motor neurons does progessive bulbar palsy affect?

A

Upper and lower motor neurons

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34
Q

Which motor neurons does progressive muscular atrophy affect?

A

Only lower motor neurons

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35
Q

Which motor neurons does primary lateral sclerosis affect?

A

Only upper motor neurons

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36
Q

What type of patient typically presents with MND?

A

Middle to late middle aged male patient

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37
Q

What are the classical symptoms of MND at presentation?

A

Asymmetrical weakness - typically in the upper limb first Slurred speech Fatiguability Tripping overClumsinessWasting of muscles

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38
Q

What are the UMN signs?

A

Hypertonia Hyperreflexia SpasticityPositive babinski sign

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39
Q

What are the LMN signs?

A

HypotoniaHyporeflexia FasciculationsMuscle atrophy

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40
Q

What investigations can be performed in the diagnosis of MND?

A

EEGEMG MRI brain and spine ACh and MuSK antibodiesLumbar punctureBlood tests

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41
Q

What types of cells die in ALS?

A

Anterior horn cells and motor cortex neuronal cells

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42
Q

What features on history would point away from MND?

A

Sensory loss
Involvement of ocular muscles

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43
Q

What is the only disease modifying treatment for MND?

A

Riluzole

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44
Q

What does riluzole do?

A

Slows down the progression of ALS and prolongs life by a few months

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45
Q

What other management options are involved in MND?

A

Analgesia Botox injections Baclofen injections Anticholinergics for drooling NG/PEG tube Advance care planningPsychological supportCough assist machinesVoice banking

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46
Q

What are the differentials of MND?

A

Myasthenia Gravis Malignancy Stroke Motor neuropathy MSDisc prolapse

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47
Q

Which type of MND has the best prognosis?

A

Progressive muscular atrophy

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48
Q

Which type of MND has the worst prognosis?

A

Progressive bulbar palsy

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49
Q

What type of dementia is associated with motor neuron disease?

A

Fronto-temporal dementia

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50
Q

What is multiple sclerosis?

A

A cell-mediated autoimmune disorder characterised by demyelination in the CNS

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51
Q

Who is MS most common in?

A

MS is 3 times more common in women

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52
Q

When does MS typically present?

A

In people under 50

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53
Q

What are the three sub-types of MS?

A

Primary progressive Secondary progressive Relapsing-remitting

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54
Q

What is the most common subtype of MS?

A

Relapsing-remitting

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55
Q

What is the pathophysiology of MS?

A

The myelin sheath of oligodendrocytes becomes inflamed, and is infiltrated by immune cells

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56
Q

What are some risk factors for developing MS?

A

Genetics EBVLow vitamin DSmoking Obesity

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57
Q

What is the most common initial presentation of MS?

A

Optic neuritis

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58
Q

What is relapsing-remitting MS?

A

Periods of neurological disease and illness followed by recovery.

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59
Q

What is primary progressive MS?

A

MS that progressively worsens, without relapsing and remitting episodes

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60
Q

What is secondary progressive MS?

A

Progressive worsening of the disease with relapses that have incomplete remissions

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61
Q

What is required for a diagnosis of MS?

A

Lesions disseminated in space and time

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62
Q

What investigations can be carried out to confirm MS?

A

Contrast MRI Lumbar puncture

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63
Q

What would be seen on MRI?

A

Periventricular white matter lesions

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64
Q

What would be found on lumbar puncture in the CSF?

A

Oligoclonal bandsMildly raised protein Lymphocytes

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65
Q

What is the first line management of an MS relapse?

A

1g IV methylprednisolone for 3 days

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66
Q

What is the second line management of an MS relapse?

A

Plasma exchange

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67
Q

What is the long term treatment of MS?

A

Disease modifying therapies- Natalizumab- Interferon beta - Glatiramer- Dimethyl fumarate- Diroximel fumarate

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68
Q

What are the symptoms of MS?

A

Fatigue Difficulty walking Vision problems NumbnessTingling Muscle spasms Muscle stiffnessWeakness

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69
Q

What factors are associated with a worse prognosis in MS?

A

Male Motor signs at onsetEarly relapsesMany MRI lesions Axonal loss

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70
Q

Why is a contrast MRI performed to diagnose MS?

A

You can age the different lesions on a contrast MRI (to see lesions disseminated in space and time)

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71
Q

What contrast is used in a contrast MRI scan?

A

Gadolinium

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72
Q

What medication is first line for muscle spasticity in MS?

A

BaclofenGabapentin

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73
Q

What is a surgical third nerve palsy?

A

A third nerve palsy with a fixed and dilated pupil

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74
Q

What is a medical third nerve palsy?

A

A third nerve palsy that is pupil sparing

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75
Q

What are the symptoms of a third nerve palsy?

A

PtosisDown and out eye

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76
Q

What is the most common cause of a surgical third nerve palsy?

A

Posterior communicating artery aneurysm

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77
Q

What is Lambert-Eaton syndrome?

A

Autoimmune condition characterised by antibodies against the pre-synaptic voltage gated calcium channels

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78
Q

What conditions are associated with Lambert-Eton syndrome?

A

Small cell lung cancer
Other autoimmune diseases

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79
Q

What is myotonic dystrophy?

A

A trinucleotide repeat disorder affecting muscle-specific chloride channels

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80
Q

What is the inheritance of myotonic dystrohpy?

A

Autosomal dominant

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81
Q

What are the features of myotonic dystrophy?

A

Patient presents in their 20sFrontal balding Distal wasting and weaknessSlow relaxing gripDysarthria

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82
Q

What is NMO?

A

Neuromyelitis optica

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83
Q

What is the triad of NMO?

A

Optic neuritis Transverse myelitis Positive NMO-IgG - an antibody that targets aquaporin 4

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84
Q

Which damaged nerve can lead to foot drop?

A

Common peroneal nerve

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85
Q

What is Cushing’s triad?

A

Labile breathing BradycardiaHypertension

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86
Q

What are the most common causes of peripheral neuropathy?

A

ABCDE- Alcohol - B12/folate- Chronic renal failure - Diabetes- Everything else - vasculitis, paraneoplastic

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87
Q

What is the distribution of peripheral neuropathy?

A

Glove and stocking

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88
Q

Where is the lesion in a superior quadrantanopia?

A

Temporal optic radiations

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89
Q

Where is the lesion in an inferior quadrantantopia?

A

Parietal optic radiations

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90
Q

What are the symptoms of increased ICP?

A

Headache worse in the morning Vomiting (can relieve symptoms)Blurred vision Behavioural changes Reduced consciousness levels

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91
Q

What investigation is contraindicated in increased ICP?

A

Lumbar puncture

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92
Q

Why is lumbar puncture contraindicated in increased ICP?

A

Brainstem herniation

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93
Q

What is a positive Romberg’s sign?

A

When a patient becomes unsteady upon closure of their eyes when standing upright

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94
Q

What kind of ataxia does a positive Romberg’s sign suggest?

A

Sensory ataxia

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95
Q

What is the first line preventative treatment of migraine?

A

Amitryptyline or a beta blocker

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96
Q

What is modafinil used for?

A

To treat drowsiness in narcolepsy (and other conditions)

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97
Q

On what side does ischaemia to the cerebellum cause symptoms?

A

Ipsilateral side

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98
Q

Where does the PICA supply?

A

Inferior cerebellum

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99
Q

What is the gold standard investigation for stroke?

A

Diffusion weighted MRI

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100
Q

What features are caused by an anterior inferior cerebellar artery infarct?

A

Ipsilateral deafness and facial paralysis
Sudden onset of vertigo and vomiting

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101
Q

What features are caused by a posterior inferior cerebellar artery infarct?

A

Ipsilateral facial pain and temperature loss
Contralateral limb/torso pain and temperature loss
Ataxia and nystagmus

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102
Q

What are the risk factors for haemorrhagic stroke?

A

Anticoagulation therapy
Age
Hypertension
Arteriovenous malformation
Drugs that mimic sympathetic nervous system

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103
Q

What are the risk factors for ischaemic stroke?

A

AgeHypertension Smoking Hyperlipidaemia DiabetesAtrial fibrillationHRTOral contraceptive

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104
Q

What symptoms are seen in a total anterior circulation infarct?

A

Unilateral hemiparesis, or unilateral hemisensory loss of upper or lower limb Homonymous hemianopia Higher cognitive dysfunction e.g dyphasia

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105
Q

Which limbs are more typically affected in anterior circulation infarcts?

A

Lower limbs

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106
Q

Which limbs are more typically affected in middle cerebral artery infarcts?

A

Upper limbs

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107
Q

What kind of symptoms would be seen with an ophthalmic artery stroke?

A

Amaurosis fugax

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108
Q

What is the first line investigation for a suspected stroke?

A

Non-contrast CT head

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109
Q

What is the difference between stroke and Bell’s palsy?

A

Strokes are forehead sparing, whereas Bell’s palsy involves the forehead

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110
Q

What is the Bamford classification?

A

A system of classifying and diagnosing ischaemic stroke

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111
Q

What is the Bamford classification of a total anterior circulation infarct?

A

All three symptoms: - Homonymous hemianopia- Unilateral weakness or sensory deficit of the face, arm and leg- Higher cerebral dysfunction

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112
Q

What is the Bamford classification of a partial anterior circulation infarct?

A

Two out of three symptoms: - Homonymous hemianopia- Unilateral weakness or sensory deficit of the face, arm and leg- Higher cerebral dysfunction

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113
Q

What is the Bamford classification of a posterior circulation stroke?

A

One of the following symptoms?- Cranial nerve palsy and contralateral motor/sensory deficit- Cerebellar dysfunction - Bilateral sensory or motor deficit- Conjugate eye movement disorder- Isolated homonymous hemianopia

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114
Q

What is the Bamford classification of a lacunar stroke?

A

One of the following symptoms:- Pure sensory stroke - Pure motor stroke - Sensori-motor stroke- Ataxic hemiparesis

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115
Q

What is the initial management of an ischaemic stroke?

A

300mg aspirin Thrombolysis if presented within 4.5 hours Thrombectomy if between 4.5-6 hours

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116
Q

What drug is used in thrombolysis?

A

Alteplase

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117
Q

What secondary prevention will be given after an ischaemic stroke?

A

Clopidogrel 75mg daily
Statin
Anti hypertensives
Carotid endarterectomy

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118
Q

What is the initial management of a haemorrhagic stroke?

A

Aim for BP 140/90Stop anticoagulants and antithromboticsReverse any anticoagulationRefer to neurosurgery

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119
Q

What tools can be used to assess stroke?

A

FASTROSIERABCD2

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120
Q

What is a TIA?

A

A sudden onset of a focal neurological deficit (of vascular origin) that resolves in 24 hours

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121
Q

What are crescendo TIAs?

A

More than 1 TIA in 7 daysTIAs that are increasing in frequency and severity

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122
Q

What is the definition of a stroke?

A

Sudden onset of a focal neurological deficit of vascular cause, with symptoms lasting more than 24 hours.

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123
Q

What are the contraindications to thrombolysis?

A

BP > 180/110Recent head traumaGI or intracranial haemorrhageRecent surgery - 2 weeks Platelet count INR > 1.7

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124
Q

What are the symptoms of a basilar artery stroke?

A

Locked in syndrome - Complete loss of movement with preserved consciousness and ocular movements

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125
Q

What are the symptoms of an anterior spinal artery stroke?

A

Loss of pain, temperature and motor function below the level of infarction

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126
Q

What is the management of a TIA?

A

300mg of aspirin Clopidogrel long term StatinsArrange urgent carotid doppler

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127
Q

What are the symptoms of a basilar artery stroke?

A

Locked in syndrome - Where the muscles of the body and face are paralysed but consciousness and eye movements are preserved

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128
Q

What is myasthenia gravis?

A

An autoimmune disease characterised by antibodies to the nicotinic acetylcholine receptors

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129
Q

What are the symptoms of myasthenia gravis?

A

Weakness of limbsDrooping eyelidsDiplopiaDifficulty smiling or chewing Difficulty swallowing Change in speech

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130
Q

When are symptoms typically worst in MG?

A

At the end of the day

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131
Q

What condition is myasthenia gravis associated with most commonly?

A

Thymic hyperplasia

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132
Q

What investigations are carried out in myasthenia gravis?

A

ACh receptor antibodiesCT chest (for thymoma)Single fibre elecetromyography (EMG for single muscle fibres)

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133
Q

What is the first line medical management of MG?

A

Long acting cetylcholinesterase inhibitors

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134
Q

What is the first line long acting acetylcholinesterase inhibitor used in MG?

A

Pyridostigmine (neostigmine may also be used)

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135
Q

What other management options are available?

A

Immunosuppression - prednisolone or azathioprineThymectomy

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136
Q

What other antibodies can cause MG?

A

MuSK antibodiesLRP4

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137
Q

What is the treatment of a myasthenic crisis?

A

IV immunoglobulins Plasma exchange

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138
Q

What condition is myasthenia gravis a paraneoplastic syndrome of?

A

Thymoma

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139
Q

What is lambert-eaton syndrome?

A

A myasthenic syndrome that is a paraneoplastic syndrome of small cell lung cancer

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140
Q

What is the difference between myasthenia gravis and lambert-eaton syndrome?

A

MG worsens with exercise and activity, whereas lambert-eaton syndrome improves with exercise

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141
Q

What is epilepsy?

A

Tendency to have seizures due to abnormal electrical activity in the brain

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142
Q

What are the features of tonic-clonic seizures?

A

Loss of consciousnessMuscle jerking (clonic)Muscle tensing (tonic)Tongue biting Incontinence

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143
Q

Which phase usually comes first in a tonic-clonic seizure?

A

Tonic phase

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144
Q

What is the first line treatment of tonic-clonic seizures?

A

Sodium valproate for males Lamotrigine or levetiracetam for females

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145
Q

What is the second line treatment of tonic-clonic seizures?

A

Lamotrigine or carbamezapine

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146
Q

How does an absence seizure present?

A

Usually children Stare into space for a few secondsAbruptly returns to normal Lasts around 20 seconds

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147
Q

What is the first line management of absence seizures?

A

Ethosuximide

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148
Q

When is sodium valproate contraindicated?

A

In females of fertile age

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149
Q

What are the side effects of sodium valproate?

A

Teratogenic Liver damageHair lossTremorWeight gain Oedema Ataxia

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150
Q

What is the first line medication for focal seizures?

A

Lamotrigine or leveteracitam

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151
Q

What is the second line medication for focal seizures?

A

Carbamezapine

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152
Q

What are the features of a frontal focal seizure?

A

Jacksonian features - numbness of tingling starts isolated, and then moves to the other limbs on the same side of the body Dysphasia Todd’s paresis

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153
Q

What is Todd’s paresis?

A

When a seizure is followed by a brief period of paralysis

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154
Q

What are the features of a temporal lobe focal seizure?

A

Deja vu Lip smacking Emotional disturbance - sudden onset of fearHallucinations - auditory, gustatory or olfactory

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155
Q

What are the features of a parietal lobe focal seizure?

A

Sensory symptoms - tingling and numbnessMotor symptoms - from spread of seizure into pre-frontal gyrus where motor cortex is

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156
Q

What are the features of an occipital focal seizure?

A

Visual symptoms - dots and lines in the vision

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157
Q

What are the features of a myoclonic seizure?

A

Sudden jerking of the limbs, face or trunk

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158
Q

What is the first line medication for a myoclonic seizure?

A

Sodium valproate for males Levetiracetam for females

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159
Q

What drug worsens myoclonic seizures?

A

Carbamezapine

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160
Q

What is the first line medication in hospital for status?

A

IV lorazepam

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161
Q

What is status epilepticus?

A

5 or more minutes of continuous seizure

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162
Q

What is the driving guidance for patients with epilepsy?

A

1 seizure - 6 months seizure freeMore than 1 seizure - one year seizure free

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163
Q

What are the features of an atonic seizure?

A

Sudden loss of muscle tone, which leads to a fallNo loss of consciousness

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164
Q

What is the first line management of status epilepticus in the community?

A

Buccal medazolam or rectal diazepamRepeat 15 minutes later

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165
Q

What medication can worsen absence seizures?

A

Carbamezapine

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166
Q

What investigations are performed to diagnose epilepsy?

A

EEG (after 2 seizures)MRI brain ECGElectrolytes Blood glucose Blood cultures, urine culturesLumbar puncture

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167
Q

What is juvenile myoclonic epilepsy?

A

An epilepsy syndrome characteristed by infrequent generalised seizures (often in the morning), absence seizures and sudden shock like myoclonic jerks

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168
Q

When is the typical onset of juvenile myoclonic epilepsy?

A

In teenage years

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169
Q

Who is juvenile myoclonic epilepsy more common in?

A

Girls

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170
Q

What is benign rolandic epilepsy?

A

An epileptic syndrome characterised by either tonic-clonic seizures, or focal seizures with abnormal sensation in the face - These seizures typically occur during sleep

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171
Q

When can medication be started for seizures?

A

After a patient has had 2 seizures, and has been investigated with an EEG

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172
Q

What are the fetal complications of antiepileptics in pregnancy?

A

Orofacial defects Haemorrhagic disease of the newborn Congenital heart defects Spina bifida

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173
Q

What are the complications of sudden withdrawal of antiepileptics?

A

Status epilepticus Suddent unexpected death in epilepsy

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174
Q

Do antiepileptic levels increase or decrease in pregnancy?

A

Decreased due to increased hepatic metabolism and increased renal clearance

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175
Q

Can breastfeeding women take antiepileptics?

A

Yes

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176
Q

What investigation can be used to distinguish between a true seizure and a pseudoseizure?

A

Prolactin - prolactin will be raised in a true eplipetic seizure

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177
Q

What is the definition of a seizure?

A

A transient episode of abnormal electrical activity in the brain

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178
Q

What general advice should be offered to parents of children with epilepsy?

A

Take caution when swimming
Take caution with heights
Shower rather than have a bath
Record any further episodes
Call 999 if a seizure lasts more than 5 minutes, or more than 2 minutes with LOC

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179
Q

What is a bulbar palsy?

A

A lower motor neuron lesion affecting cranial nerves 9, 10 and 12

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180
Q

What are the causes of bulbar palsy?

A

Myasthenia Gravis MND - progressive bulbar palsyGuillain Barre syndrome Brainstem stroke

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181
Q

What are the symptoms of a bulbar palsy?

A

Speech difficultyDysphagiaDrooling

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182
Q

What are the signs of a bulbar palsy on examination?

A

Quiet nasal speech Absent or normal jaw jerk reflexAbsent gag reflex Flaccid fasciculating tongue

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183
Q

What is the management of a bulbar palsy?

A

Speech and language therapy Medication for drooling NG tube - swallowing difficulties

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184
Q

What is pseudobulbar palsy?

A

An upper motor neuron lesion affecting cranial nerves 9, 10 and 12

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185
Q

What are the signs of psuedobulbar palsy on examination?

A

Quiet speech Spastic tongue Brisk jaw jerk reflexEmotional lability

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186
Q

What is Bell’s Palsy?

A

An idiopathic syndrome affecting the facial nerve

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187
Q

What are the symptoms of Bell’s Palsy?

A

Acute onset of unilateral facial weaknessEar pain - postauricular otalgia Hyperacusis - finding loud noises unbearable Drooling Drooping eyelid or corner of mouth Altered tasteDry eyes or mouth

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188
Q

Does Bell’s palsy involve the forehead?

A

Yes (stroke is forehead sparing)

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189
Q

What is the main treatment of Bell’s palsy?

A

Oral steroids - 50mg OD for 10 days

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190
Q

What other management options are involved in Bell’s palsy?

A

Supportive treatments - artificial saliva/tears, eye patch/tape

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191
Q

What is Ramsay Hunt syndrome?

A

A facial nerve palsy caused by shingles near the ear

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192
Q

How is Ramsay-Hunt syndrome differentiated from Bell’s Palsy?

A

Patients with Ramsay-Hunt syndrome will have profound ear pain, and a rash in the ear

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193
Q

What extra treatment would be given to someone with Ramsay-Hunt syndrome?

A

Acyclovir

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194
Q

What is the classic triad of Parkinson’s?

A

BradykinesiaResting tremorRigidity

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195
Q

What is the pathophysiology of Parkinson’s?

A

A reduction in the amount of dopaminergic neurons in the substantia nigra

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196
Q

What are some other common symptoms of Parkinson’s?

A

Stooped postureFacial maskingReduced arm swing Shuffling gaitSmall handwriting Difficulty initiating movement

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197
Q

What kind of tremor can be seen in Parkinson’s?

A

Pill rolling tremor

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198
Q

What is the difference between Parkinson’s and benign essential tremor?

A

Parkinson’s- Worsens with rest- Asymmetrical- Improves with intentional movement - No change with alcohol Benign essential tremor - Improves with rest- Symmetrical - Worsens with intentional movement - Improves with alcohol

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199
Q

What are the differential diagnoses of Parkinson’s?

A

Lewy body dementia Benign essential tremor Drug-induced Parkinsonism Progressive supranuclear palsyMultiple system atrophy

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200
Q

What is the first line treatment of Parkinson’s?

A

Levodopa/carbidopa

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201
Q

What is levodopa?

A

L-dopa is a precursor to dopamine

202
Q

What is carbidopa?

A

Carbidopa prevents levodopa from being broken down before reaching the brain - leads to a lower dose of levodopa needed, and fewer side effects

203
Q

What is the second line treatment of Parkinson’s?

A

Dopamine agonists, COMT inhibitors, MAO-B inhibitors

204
Q

When might a dopamine agonist be considered for initial therapy?

A

To delay starting levodopa, as levodopa’s effectiveness reduces overtime

205
Q

What are the signs of multiple system atrophy?

A

Parkinsonism Autonomic dysfunctionCerebellar signs

206
Q

What is multiple system atrophy?

A

A rare neurodegenerative disorder that causes gradual damage to neurons

207
Q

What are the common side effects of levodopa?

A

Dry mouth Palpitations Psychosis Anorexia Postural hypotension

208
Q

Give an example of a dopamine receptor antagonist.

A

Cabergoline

209
Q

What medications are contraindicated in Parkinson’s?

A

Haloperidol - it promotes dopamine blockadeDopamine antagonists such as olanzapine

210
Q

What medication can be used to sedate Parkinson’s patients?

A

Lorazepam

211
Q

What is the most important side effect of dopamine agonists?

A

Impulsivity

212
Q

What is cortico-basal degeneration?

A

A parkinson-plus syndrome where there is spontaneous uncontrolled movements of the affected limbs (in addition to the Parkinsonian triad)

213
Q

What is progressive supranuclear palsy?

A

A parkinson-plus syndrome characterised by the parkinsonian triad + a vertical gaze palsy

214
Q

What is multiple system atrophy?

A

A parkinson-plus syndrome characterised by Parkinsonianism and early autonomic features - postural hypotension, impotence and incontinence

215
Q

Give examples of MAO-B inhibitors.

A

RasagilineSelegiline

216
Q

Give examples of COMT inhibitors.

A

EntacaponeTolcapone

217
Q

What are the differences between idiopathic and drug induced parkinson’s?

A

Drug induced parkinsons tends to be symmetrical Rigidity and resting tremor are uncommon in drug induced parkinsonism

218
Q

What are the most common bacterial causes of meningitis?

A

Streptococcus pneumoniae Neisseria meningitidisHaemophilus influenzaeListeria monocytogenes

219
Q

What are the most common viral causes of meningitis?

A

EchovirusesCoxsackie A and B Poliovirus Herpes viruses

220
Q

What are the most common fungal causes of meningitis?

A

Cryptococcus neoformans Mycobacterial meningitis

221
Q

What are the non-infective causes of meningitis?

A

MalignancyChemical meningitis Drugs - NSAIDs, trimethoprimSarcoidosisSLE

222
Q

What are the clinical features of meningitis?

A

HeadachePyrexia Neck stiffnessPhotophobia Nausea and vomiting Focal neurology SeizuresNon-blanching rash

223
Q

What is Kernig’s sign?

A

Patient is supine with hips flexed at 90 degrees- Positive test if there is pain on passive extension of the knee

224
Q

What is Brudzinski’s sign?

A

Positive sign - reflexive hip and knee extension when a patient’s neck is flexed

225
Q

What is the acute management of suspected bacterial meningitis?

A

2g IV ceftriaxone BD

226
Q

What is the acute management of suspected bacterial meningitis in very young and old patients?

A

IV ceftriaxone + IV amoxicillin ( to cover for listeria)

227
Q

What is the management of patients with a non-blanching rash in community?

A

IM benzylpenicillin and immediate transfer to hospital

228
Q

What are the investigations for meningitis?

A

Lumbar puncture Bloods - FBC, U&E, glucose, clotting ABGBlood culturesCT head

229
Q

What are the features of CSF in bacterial meningitis?

A

Cloudy appearanceWBC - 1000-2000Predominantly neutrophils Protein raised Low glucose Elevated opening pressure

230
Q

What are the features of CSF in viral meningitis?

A

Clear appearance WBC - <300Predominantly lymphocytesProtein normal or elevatedGlucose normalNormal or elevated opening pressure

231
Q

What are the features of CSF in fungal meningitis?

A

Cloudy appearance WBC <500Predominantly lymphocytes Protein rasiedLow glucose Elevated opening pressure

232
Q

What medication may be given to those with meningitis to reduce the chance of long term neurological deficit?

A

IV dexamethasone

233
Q

What prophylactic antibiotic is given to close contacts of those with meningitis?

A

Oral ciprofloxacin

234
Q

What is Huntington’s?

A

An autosomal dominant disorder with more than 38 CAG trinucleotide repeats in the gene encoding for the huntingtin protein

235
Q

What is the triad of Huntington’s features?

A

Choreoathetosis
Dominant inheritance
Dementia

236
Q

What is choreoathetosis?

A

Uncontrollable movements of the arms and legs

237
Q

What other features can be seen in Huntington’s?

A

Saccadic eye movementsPersonality changesDystonia - muscle spasms and contractions

238
Q

What investigations can be performed to diagnose Huntington’s?

A

MRI CT Genetic testing - gold standard

239
Q

What is the most effective medication to control chorea?

A

Tetrabenazine

240
Q

What are the typical MRI findings in Huntington’s?

A

Atrophy of the caudate nucleus and putamen

241
Q

What are the causes of spinal cord compression?

A

Trauma Neoplasia Infection Disc prolapseEpidural haematoma

242
Q

What are the features of spinal cord compression?

A

Acute UMN signs Sensory disturbance below the lesion Deep and localised back pain Bladder and bowel involvement

243
Q

What is the gold standard investigation for spinal cord compression?

A

URGENT MRI spine

244
Q

What is the first line treatment of spinal cord compression?

A

Surgical decompression within 48 hours

245
Q

What is added to the treatment in patients where the cause is suspected to be malignant?

A

Empiric steroids - dexamethasone

246
Q

What is the distribution of peripheral neuropathy?

A

Glove and stocking

247
Q

What are the causes of peripheral neuropathy?

A

ABCDE A - alcohol B - B12/folate deficiency C - chronic renal failureD - DiabetesE - everything else - vasculitis, paraneoplastic

248
Q

What nerve does cubital tunnel syndrome affect?

A

Ulnar nerve

249
Q

Where does cubital tunnel syndrome affect?

A

Medial one and a half digits

250
Q

How does alcohol contribute to peripheral neuropathy?

A

Causes thiamine deficiency

251
Q

Which medication for TB may cause a peripheral neuropathy?

A

Isoniazid

252
Q

Why does isoniazid cause a peripheral neuropathy?

A

It causes a B6 deficiency

253
Q

What nerve causes carpal tunnel syndrome?

A

Median nerve

254
Q

Where in the hand does the palmar branch of the median nerve supply?

A

ThumbIndex and middle fingerLateral half of the ring finger

255
Q

Which thenar muscles does the median nerve supply?

A

Abductor pollicis brevis Opponens pollicisFlexor pollicis brevis

256
Q

What are the risk factors for carpal tunnel syndrome?

A

Obesity Repetitive movements DiabetesPerimenopause Rheumatoid arthritis Hypothyroidism Acromegaly Trauma

257
Q

What is the presentation of carpal tunnel syndrome?

A

NumbnessParaesthesia Burning sensation Pain Weakness of thumb movements Weakness of grip strength Difficulty with fine movements Wasting of thenar muscles

258
Q

What is Phalen’s test?

A

Fully flexing the wrists and holding them in this position - elicits numbness and paraesthesia in the median nerve distribution

259
Q

What is Tinnel’s test?

A

Tapping the wrist at the location where the median nerve passes through the carpal tunnel - elicits numbness and paraesthesia in the median nerve distribution

260
Q

What is the management of carpal tunnel syndrome?

A

Rest and altered activitiesWrist splints Steroid injections Carpal tunnel release surgery

261
Q

What type of injury causes a common peroneal nerve palsy?

A

Injury at the neck of the fibula

262
Q

What is the most common presentation of a common peroneal nerve lesion?

A

Foot drop

263
Q

What are the other presentations of a common peroneal nerve lesion?

A

Weak dorsiflexion Weak eversion of the foot Weakness of extensor hallucis longis Sensory loss over the dorsum of the foot

264
Q

What drugs commonly cause peripheral neuropathies?

A

Amiodarone Isoniazid Vincristine Nitrofurantoin Metronidazole

265
Q

What are the other causes of foot drop?

A

L5 radiculopathy Sciatic nerve lesion Superficial or deep peroneal nerve lesion

266
Q

What symptoms does radial nerve damage cause?

A

Wrist drop Sensory loss across the dorsal aspect of the 1st and 2nd metacarpals

267
Q

What is Guillain Barre syndrome?

A

Ascending inflammatory demyelinating polyneuropathy

268
Q

What are the features of GBS?

A

Ascending symmetrical limb weaknessPreceding paraesthesia May involve respiratory system May present with cranial nerve palsies

269
Q

What signs would be seen on examination of GBS?

A

LMN signs in the lower limbs Type 2 respiratory failureCranial nerve signs

270
Q

What investigations would be performed in the diagnosis of GBS?

A

Spirometry - look for reduced FVCABG - type 2 respiratory failureAnti-gangloside antibodiesLumbar puncture

271
Q

What would a lumbar puncture show in GBS?

A

Raised protein Normal cell counts Normal glucose

272
Q

What is the first line treatment of GBS?

A

IV immunoglobulins

273
Q

What is the second line treatment of GBS?

A

Plasmapheresis

274
Q

What is the gold standard investigation in GBS?

A

Lumbar puncture

275
Q

What is normal pressure hydrocephalus?

A

CSF buildup in the ventricles of the brain

276
Q

What is the cause of normal pressure hydrocephalus?

A

Imparied absorption of CSF at the arachnoid granulationsAqueductal stenosis

277
Q

What are the causes of hydrocephalus?

A

Trauma Brain bleedIdiopathic

278
Q

What is the triad of features in normal pressure hydrocephalus?

A

Urinary incontinence Dementia Gait abnormality

279
Q

What is the time frame of normal pressure hydrocephalus?

A

Develops over a few months

280
Q

What is the definitive investigation for normal pressure hydrocephalus?

A

Walking and cognitive assessments before and after draining a large volume of CSF

281
Q

What other investigation can show evidence of NPH?

A

MRI head can show enlarged ventricles

282
Q

What is the management of NPH?

A

CSF drainageVentriculoperitoneal shunt

283
Q

What is a ventriculoperitoneal shunt?

A

A small catheter that drains CSF from the ventricles into the peritoneal cavity where it is more easily absorbed

284
Q

What are the complications of a ventriculoperitoneal shunt?

A

Infection
Blockage
Excessive drainage - prevented by a valveIntraventricular haemorrhage during surgery

285
Q

What is encephalitis?

A

Inflammation of the brain

286
Q

What is the most common cause of encephalitis?

A

Viral

287
Q

What are the causes of encephalitis?

A

Viral Bacterial Fungal Autoimmune

288
Q

What age range do people typically get encephalitis?

A

Under one Over 65

289
Q

What is the msot common viral cause of encephalitis?

A

HSV-1

290
Q

What other viruses cause encephalitis?

A

HSV-1
EBV
VZV
Cytomegalovirus
HIV

291
Q

What are the symptoms of encephalitis?

A

Altered consciousnessAltered cognition Unusual behaviour Acute onset of focal neurological symptoms Acute onset of focal seizuresFever

292
Q

What investigations should be performed in suspected encephalitis?

A

Lumbar puncture Viral PCR of CSFCT MRIEEG if seizures or vague symptoms HIV testing

293
Q

What is the treatment of encephalitis?

A

Empirical treatment of IV ceftriaxone and acyclovir

294
Q

What is an acoustic neuroma?

A

A benign schwann cell tumour surrounding the vestibulocochlear nerve

295
Q

Where in the brain do acoustic neuromas occur?

A

Cerebellopontine angle

296
Q

Where are schwann cells found?

A

In the peripheral nervous system

297
Q

What is the typical presentation of an acoustic neuroma?

A

40-60 years old Gradual onset of:- Unilateral hearing loss- Unilateral tinnitus - Vertigo - Sensation of fullness in the ear

298
Q

What is the presentation of a progressed acoustic neuroma?

A

Cranial nerve 5, 6, 7, 8, 9 and 10 palsies

299
Q

What condition is associated with a bilateral acoustic neuroma?

A

Neurofibromatosis type 2

300
Q

What investigations are carried out to diagnose acoustic neuroma?

A

Audiometry
CT
MRI - provides more detail than CT

301
Q

What is the management of acoustic neuroma?

A

Conservative management - monitoring if no symptoms Partial or total surgical removal Radiotherapy

302
Q

What cranial nerve palsies does acoustic neuroma typically present with?

A

5, 7 and 8

303
Q

What is the definitive investigation for acoustic neuroma?

A

MRI of the cerebellopontine angle

304
Q

What is the presentation of trigeminal neuralgia?

A

Intense shooting facial pain Lasts a few seconds to a few hoursMostly affects one side of the face

305
Q

What kinds of actions can the pain be triggered by?

A

Talking Eating Touching the face

306
Q

What is the first line treatment for trigeminal neuralgia?

A

Carbamezapine

307
Q

What is the clinical triad of Wernicke’s encephalopathy?

A

Ataxia Confusion Nystagmus

308
Q

What is the cause of Wernicke’s encephalopathy?

A

Thiamine deficiency (vitamin B1)

309
Q

What are the causes of thiamine deficiency?

A

Chronic alcohol abuse Malnutrition Bariatric surgery Hyperemesis gravidarum

310
Q

What is the treatment of Wernicke’s encephalopathy?

A

IV Pabrinex

311
Q

What is IV Pabrinex?

A

IV high-dose thiamine

312
Q

What can Wernicke’s encephalopathy progress to if left untreated?

A

Korsakoff’s syndrome

313
Q

What is the presentation of Korsakoff’s syndrome?

A

Anterograde amnesia Retrograde amnesia Confabulation

314
Q

What is Horner’s syndrome?

A

An interruption of the sympathetic nervous system to the eye

315
Q

What is the classic triad of symptoms in Horner’s syndrome?

A

Ptosis
Miosis
Anhidrosis

316
Q

What are the common causes of Horner’s syndrome?

A

Pancoast tumour Stroke Carotid artery dissection

317
Q

What are the differentials of Horner’s syndrome?

A

Occulomotor nerve palsy Myasthenia gravis Bell’s palsy

318
Q

What is the name for not being able to extend the knee when the hip is flexed?

A

Kernig’s sign

319
Q

What condition can Kernig’s sign be seen in?

A

Meningitis

320
Q

What investigations should be ordered in a patient with suspected meningitis?

A

Blood culture, lumbar puncture, CRP, ESR, head CT, serum meningococcal and pWneumococcal PCR, throat swabs

321
Q

What antibiotic should be given to patients with neisseria meningitidis?

A

IV cefotaxime

322
Q

Give 7 signs of Parkinson’s disease.

A

Resting tremor, bradykinesia, resting tremor, increased tone/rigidity, stooped posture, decreased arm swing, decreased amplitude or accuracy of repetitive movement

323
Q

How does dopamine normally stimulate movement?

A

It inhibits the inhibitory pathway of the striatum, allowing movement.

324
Q

What is the first line treatment of Parkinson’s disease?

A

Levodopa

325
Q

How does levodopa work?

A

Levodopa is a precursor molecule to dopamine. It therefore increases the amount of dopamine available to act upon receptors.

326
Q

What drug is given with levodopa?

A

Carbidopa

327
Q

Why is carbidopa given with levodopa?

A

It inhibits peripheral metabolism of levodopa

328
Q

What are the two second line treatments for Parkinson’s disease?

A

Dopamine agonists - pramipexole, ropinirole| MAO/COMT inhibitors

329
Q

How do MAO/COMT inhibitors work?

A

They reduce the metabolism of dopamine - more available

330
Q

Give 2 conditions that are associated with Parkinson’s.

A

Depression, dementia

331
Q

What symptoms are specific to a MCA stroke?

A

Contralateral motor weakness of upper limbs
Contralateral loss of sensation of the upper limbs
Hemianopia
Dysphasia
Aphasia
Face drop

332
Q

What symptoms are specific to a ACA stroke?

A

Contralateral motor weakness of the lower limbs| Contralateral loss of sensation of the lower limbs

333
Q

Which arteries does a total anterior circulation stroke involve?

A

Anterior and middle cerebral arteries

334
Q

What is the difference between a partial and total anterior stroke?

A

A partial stroke has two of the following criteria, whereas a total has all 3:- Homonymous hemianopia - Unilateral hemiparesis or hemisensory loss - Higher cognitive dysfunction e.g dysphasia

335
Q

What type of stroke is AF a risk factor for?

A

Ischaemic stroke

336
Q

Give 6 red flag symptoms associated with headache.

A 
Altered consciousnessConfusion New headache with a history of cancerPapilloedema Cluster headacheSeizure
337
Q

What drug is given to reduce ICP?

A

IV Mannitol

338
Q

Give 4 lower motor neuron signs.

A

Decreased tone Decreased reflexesMuscle wastingFasciculations

339
Q

Give 4 upper motor neuron signs

A

Brisk reflexes
Increased tone
Babinski’s sign
Minimal muscle atrophy - muscle weakness

340
Q

How does normal pressure hydrocephalus present?

A

DementiaUrinary incontinenceUnsteady gait

341
Q

What are the pathological findings in normal pressure hydrocephalus?

A

CSF pressure is normal, but the ventricles are dilated

342
Q

In a right superior homonymous quadrantanopia where would the lesion be?

A

Meyer’s loop - left temporal optic radiation

343
Q

In a right inferior homonymous quadrantanopia, where would the lesion be?

A

Left parietal optic radiation

344
Q

What is dysarthria?

A

A motor disorder where the muscles of speech are damaged, paralysed or weakened

345
Q

Where in the brain is affected to cause chorea in Huntington’s?

A

Striatum of the basal ganglia (caudate nucleus)

346
Q

What pattern of inheritance does Huntington’s show?

A

Autosomal dominant

347
Q

What kind of mutation is seen in Huntington’s?

A

A trinucleotide repeat - CAG

348
Q

What are the features of Huntington’s disease?

A

Chorea
Personality changes
Dystonia
Saccadic eye movements

349
Q

After what age do Huntington’s symptoms typically start to develop?

A

35

350
Q

Which neurones are affected in Huntington’s disease?

A

GABAnergic and cholinergic neurons

351
Q

What is the first line medication for chorea in Huntington’s disease?

A

Tetrabenazine

352
Q

What is the first line treatment of behavioural problems in Huntington’s?

A

SSRIs - citalopram or fluoxetine

353
Q

What is the first line treatment of psychosis in Huntington’s?

A

Haloperidol

354
Q

What kind of motor neuron symptoms does Huntington’s result in?

A

UMN

355
Q

What type of hypersensitivity reaction is Guillain-Barre syndrome?

A

Type 4

356
Q

Which infection classically causes Guillain-Barre syndrome?

A

Campylobacter jejuni

357
Q

What is the characteristic feature of Guillain-Barre syndrome?

A

Progressive, symmetrical weakness of all limbs

358
Q

What is the initial presenting feature of Guillain-Barre syndrome in many patients?

A

Back/leg pain

359
Q

What are the first line investigations for Guillain-Barre syndrome?

A

Lumbar puncture| Nerve conduction studies

360
Q

What will a lumbar puncture in a patient with Guillain-Barre syndrome show?

A

CSF with raised protein, and normal cell counts

361
Q

What is the first line treatment for Guillain-Barre syndrome?

A

IV immunglobulins or plasma exchange

362
Q

What features are typical of a temporal lobe seizure?

A

Lip-smacking, recurrent sense of deja vu, and postictal dyphasia.

363
Q

What kind of features will a lesion below L1 cause?

A

Lower motor neuron symptoms

364
Q

What are the symptoms of cerebellar disease?

A

Mnemonic DANISH

D - dysdiadochokinesia A - ataxiaN - nystagmus I - intention tremorS - slurred, stachato speechH - hypotonia
365
Q

What is the classic history of extra dural haemorrhage?

A

Brief loss of consciousness, followed by a lucid period ad then a quick deterioration

366
Q

What is an extra dural haemorrhage commonly caused by?

A

Trauma to the head, which leads to a tear in the middle meningeal artery

367
Q

What is the classic presentation of a subarachnoid haemorrhage?

A

Sudden onset of thunderclap headacheOcciptal headacheSigns of meningism

368
Q

What is the most common cause of subarachnoid haemorrhage?

A

Berry aneurysm

369
Q

What is the history of a subdural haemorrhage?

A

Typically more chronic:- Headache- Cognitive decline - Fluctuating consciousness

370
Q

What is the classic triad of symptoms in Parkinson’s disease?

A

Bradykinesia, rigidity, tremor

371
Q

What is the acute management of cluster headache?

A

100% high flow oxygen

372
Q

What is the prophylactic treatment of cluster headache?

A

Verapamil

373
Q

What symptoms other than pain around the eye are seen in cluster headache?

A

Ipsilateral watering of the eye, red eye, nasal congestion and constricted pupil/drooping eyelid

374
Q

What is the first line medication for patients with focal seizures?

A

Lamotrigine or levetiracetam

375
Q

What is the first line medication for patients with generalised seizures?

A

Sodium valproate

376
Q

How long must patients be seizure free before they can drive?

A

12 months

377
Q

What is the first line acute management to terminate a seizure?

A

Benzodiazepines

378
Q

What are the first line investigations after a patient first has a seizure?

A

Electroencephelogram (EEG), MRI

379
Q

What features are typical of a frontal lobe seizure?

A

Proximal spread of clonic jerking| Affected muscles remain weak after seizure (called post ictal Todd’s paralysis)

380
Q

What features are typical of a temporal lobe seizure?

A

Pre-seizure aura/hallucinationsLip smacking during seizurePost-ictal confusion

381
Q

What features are typical of an occipital lobe seizure?

A

Flashing and floaters

382
Q

What features are typical of a parietal lobe seizure?

A

Non-specific sensory symptoms - paraethesia

383
Q

Which limbs does an anterior cerebral artery stroke typically affect?

A

Lower limbs

384
Q

Which limbs does a middle cerebral artery stroke commonly affect?

A

Upper limbs

385
Q

What symptoms does a basilar artery stroke cause?

A

Locked in syndrome - complete paralysis of all muscles apart from the eyes

386
Q

What is the initial management of a suspected TIA?

A

300mg aspirin daily

387
Q

What is the first line long term anti-thrombotic therapy for patients who have had a confirmed TIA?

A

75mg clopidogrel daily

388
Q

What are the symptoms of brown-sequard syndrome?

A

Ipsilateral weakness below the lesion
Ipsilateral loss of proprioception and vibration
Contralateral loss of pain and temperature

389
Q

Where does the cauda equina begin?

A

L1/L2

390
Q

What kind of symptoms does cauda equina syndrome cause?

A

Lower motor neuron symptoms

391
Q

What kind of symptoms does a spinal cord compression present with?

A

UMN symptoms above the lesion| LMN symptoms below the lesion

392
Q

How long after infection does Guillain-Barre syndrome typically develop?

A

2-3 weeks

393
Q

Which infection classically causes Guillain-Barre syndrome?

A

Campylobacter jejuni

394
Q

What is the first line investigation for suspected stroke?

A

CT head

395
Q

Give an example of a benzodiazepine.

A

Clonazepam

396
Q

What is the first line treatment for temporal arteritis?

A

Oral prednisolone

397
Q

Give 3 symptoms of cauda equina.

A

Inability to open bowels/urinateReduced anal tone Saddle anaethesia

398
Q

What is the first line treatment of myasthenia gravis?

A

Acetylcholinesterase inhibitors

399
Q

Name 2 acetylcholinesterase inhibitors.

A

Pyridostigmine| Neostigmine

400
Q

How long after the onset of symptoms can IV alteplase be given for acute ischaemic stroke?

A

4.5 hours

401
Q

Who does Wernicke’s encephalopathy typically affect?

A

Alcoholics

402
Q

What symptoms are seen in Wernicke’s encephalopathy?

A

Ataxia, opthalmoplegia, confusion

403
Q

What is the cause of spina bifida?

A

Multifactorial

404
Q

What receptors are found in the sympathetic nervous system?

A

Adrenergic and nicotinic

405
Q

What receptors are found in the somatic nervous system?

A

Acetylcholine

406
Q

What mutation is found in patients with Huntington’s?

A

36 or more CAG repeats

407
Q

What is the best prognostic treatment of motor neuron disease?

A

Riluzole

408
Q

What happens in a tonic seizure?

A

The patient goes tense and stiff

409
Q

What happens in a tonic-clonic seizure?

A

The patient goes tense and stiff, then has muscle tensing and relaxing

410
Q

What is the first line treatment of tension headache?

A

Paracetamol

411
Q

What are the CSF findings in bacterial meningitis?

A

High proteinLow glucoseHigh neutrophil polymorphs

412
Q

What are the CSF findings in viral meningitis?

A

High or normal protein Normal glucoseHigh lymphocytes

413
Q

What are the CSF findings in fungal meningitis?

A

High protein Low glucoseHigh lymphocytes

414
Q

What is a complication of temporal arteritis?

A

Blindness (amaurosis fugax)

415
Q

Why can temporal arteritis cause blindness?

A

Emboli occluding the retinal artery

416
Q

What type of seizures is Jacksonian march associated with?

A

Frontal lobe seizure

417
Q

What is Jacksonian march?

A

Where the seizures ‘march’ up and down the motor homonculus

418
Q

What is the definition of multiple sclerosis?

A

An autoimmune demyelinating condition causing lesions disseminated in time and space

419
Q

What is a common initial symptom of multiple sclerosis?

A

Optic neuritis

420
Q

What is Uhthoff’s phenomenon?

A

When symptoms (of MS) are worse with heat

421
Q

What virus is a risk factor for MS?

A

EBV

422
Q

What type of symptoms does motor neuron disease present with?

A

Upper and lower motor neuron symptoms

423
Q

What is the first line for bacterial meningitis in a primary setting?

A

IM benzylpenicillin

424
Q

What is the first line for bacterial meningitis in a secondary setting?

A

IV benzylpenicillin or IV ceftriaxone

425
Q

What is the treatment of viral meningitis?

A

Analgesia, antipyretic and hydration

426
Q

What is the second line treatment of viral meningitis?

A

Aciclovir

427
Q

What symptoms are seen in Horner’s syndrome?

A

Anhydrosis (reduced sweating), miosis (pupil constriction), ptosis (eyelid droop)

428
Q

Give a cause of Horner’s syndrome.

A

A pancoast tumour (rare tumour in the apex of the lung)

429
Q

What sensory deficits are seen in Brown-sequard syndrome?

A

Ipsilateral loss of proprioception, vibration and motor function at the level of the lesion
Contralateral loss of pain and temperature sensation 2 levels below the lesion

430
Q

Which vessel are extradural haematomas associated with?

A

Middle meningeal artery

431
Q

What drug is given after subarachnoid haemorrhage to prevent vasospasm?

A

Nimodipine

432
Q

What is the most common cause of Guillain-Barre syndrome?

A

Campylobacter jejuni

433
Q

What symptoms can cluster headache cause other than pain?

A

Rhinorrhoea, ptosis, red eyes, lacrimation

434
Q

What is the most appropriate first line investigation for MS?

A

MRI head

435
Q

What is the classic history of an extradural haemorrhage?

A

Loss of consciousness, followed by a lucid period, then rapid onset of neurological defecits

436
Q

What kind of brain bleeds are common in elderly patients who have fallen?

A

Subdural

437
Q

Why are elderly patients more susceptible to subdural bleeds?

A

They have smaller brains and more fragile bridging veins

438
Q

What is the first line acute treatment of migraine?

A

Sumatriptan

439
Q

What is the first line cluster headache prophylaxis?

A

Verapamil

440
Q

What type of dementia causes early memory loss?

A

Alzheimer’s

441
Q

What type of dementia causes early personality changes?

A

Fronto-temporal

442
Q

What type of personality changes are seen in fronto-temporal dementia?

A

Aggression, disinhibition, hypersexuality

443
Q

What type of progression does vascular dementia cause?

A

Stepwise progression

444
Q

What is the only life prolonging medication available for MND?

A

Riluzole

445
Q

What is baclofen used for?

A

To treat cramps in MND

446
Q

What other investigation should also be ordered in suspected MS?

A

Lumbar puncture

447
Q

What type of weakness is associated with Charcot-Marie Tooth syndrome?

A

Champagne bottle weakness - wasting of the muscles in the lower legs

448
Q

What is the first line treatment of generalised seizures in women of child bearing age?

A

Lamotrigine

449
Q

What symptoms are likely seen in a brain tumour?

A 
HeadacheBehavioural changesNauseaSpeech problems Weakness
450
Q

What is the pathophysiology of Alzheimer’s disease?

A

Buildup of extravascular beta amyloid plaques and neurofibrillary triangles in the brain

451
Q

What is the cause of fronto-temporal dementia?

A

Atrophy of the frontal lobe

452
Q

What is Phalen’s test used for?

A

Carpal tunnel syndrome

453
Q

What is a positive Phalen’s test result?

A

The patient is only able to flex their wrist for a maximum of 1 minute

454
Q

Which receptors are affected in myasthenia gravis?

A

Nicotinic acetylcholine receptors of the neuromuscular junction

455
Q

Up to a 1/5 of myasthenia gravis patients also have what other condition?

A

Thymoma

456
Q

What cells predominate in the CSF of someone with bacterial meningitis?

A

Neutrophils

457
Q

What is the first line prophylaxis of migraine?

A

Topiramate

458
Q

What other medications can be used for migraine prophylaxis?

A

Beta blockers| Tricyclic antidepressants - amitriptyline

459
Q

What is the definition of stroke?

A

Sudden onset of neurological defecits, due to ischaemic or haemorrhagic compromise of blood supply to the brain

460
Q

What tract carries sensation of pain and temperature?

A

Spinothalamic tract

461
Q

What tract carries sensation of proprioception, vibration and fine touch?

A

Doral column lemniscus pathway

462
Q

Where does the dorsal column lemniscus pathway decussate?

A

Medulla oblongata

463
Q

What is the name for a loss of sensation in the genital area?

A

Saddle anaesthesia

464
Q

Give 4 causes of cauda equina syndrome.

A

TraumaDisc herniation TumoursSpine metastases

465
Q

What is the first line management of cauda equina?

A

Lumbar decompression surgery

466
Q

What is the first line investigation of cauda equina?

A

Emergency MRI spine

467
Q

What distinguishes meningitis from meningococcal septicaemia?

A

Non-blanching petechial rash + signs of septic shock

468
Q

What two signs will be positive on examination in meningitis?

A

Kernig’s sign| Brudzinski’s sign

469
Q

What is Brudzinski’s sign?

A

When the neck is flexed in a patient with meningitis, the hips and knees will also flex

470
Q

What are the two most common causative organisms o bacterial meningitis?

A

Neisseria meningitidis| Streptococcus pneumoniae

471
Q

What is the gold standard investigation for meningitis?

A

Lumbar puncture

472
Q

What is the treatment of meningitis in the community?

A

IM benzylpenicillin

473
Q

What is the treatment of meningitis in hospital?

A

IV cefotaxime/ceftriaxone (3rd generation cephalosporins)

474
Q

What are the risk factors for folate deficiency?

A

Alcohol
Crohn’s
Age
Diet

475
Q

How long should a patient who has had a single TIA stop driving for?

A

1 month

476
Q

How long should a patient who has had multiple TIAs stop driving for?

A

3 months - inform the DVLA

477
Q

How long should a patient who has had a single seizure stop driving for?

A

6 months - inform the DVLA

478
Q

What is the prophylactic treatment of cluster headache?

A

Verapamil

479
Q

What is the immediate managment of cauda equina?

A

Immediate surgical decompression

480
Q

What medications are recommended by NICE for migraine prophylaxis?

A

TopiramatePropanalolAmitriptyline Acupuncture

481
Q

What is the first line prophylaxis of migraines?

A

Beta blockers

482
Q

When is topiramate used for prophylaxis of migraines?

A

When beta blockers are unsuitable e.g in asthma

483
Q

What is the resting tremor seen in Parkinson’s often described as?

A

Pill rolling tremor

484
Q

What is Charcot’s neurological triad?

A

Dysarthria, nystagmus, intension tremor

485
Q

What condition is Charcot’s neurological triad seen in?

A

Multiple sclerosis

486
Q

What is relapsing-remitting MS?

A

Flare ups are followed by a period of reduced symptoms - this baseline sees progressive disability with each remission.

487
Q

What is progressive relapsing MS?

A

Progressive increase in disability with intermittent flares that resolve to the increasing baseline

488
Q

What is the prophylactic treatment of meningitis?

A

Ciprofloxacin

489
Q

What is the pathophysiology of Alzheimer’s disease?

A

Extra-neuronal beta amyloid plaquesIntra-neuronal neurofibrally triangles Cortical atrophy

490
Q

Give 4 risk factors for Alzheimer’s disease.

A

Family history Caucasian Increasing ageDown’s syndrome

491
Q

What is the Oxford classification of stroke?

A

Assesses the following criteria:- Unilateral hemiparesis- Homonymous hemianopia - Higher cognitive dysfunction

492
Q

What is the first line treatment of trigeminal neuralgia?

A

Carbamezapine

493
Q

What cells are targeted in MS?

A

Oligodendrocytes

494
Q

What constitutes a complex partial seizure?

A

The patient is not aware of goings on during the seizure, and is confused afterwards

495
Q

Which nerve opens the fist?

A

Radial nerve

496
Q

What is giant cell arteritis also called?

A

Temporal arteritis

497
Q

What is GCA?

A

GCA is a systemic vasculitis that affets medium to large sized arteries

498
Q

Where does GCA typically affect?

A

The temporal arteries

499
Q

What age patients does GCA typically affect?

A

Over 50s Incidence peaks in 70s

500
Q

What is the presentation of GCA?

A

Scalp tendernessTemporal headache Jaw claudicationBlurred or double vision

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