Passmed Neuro Flashcards
1
Q
What medicine is used to treat raised intracranial pressure caused by brain mets?
A
dexamethasone
2
Q
What medication is used to manage spasticity in multiple sclerosis?
A
Baclofen and gabapentin
3
Q
What medication should not be used in patients with epilepsy who are trying to stop smoking?
A
Bupropion
4
Q
What are the typical features of toxoplasmosis encephalitis?
A
HIV +ve patient
Neuro symptoms
Multiple brain lesions with ring enhancement
Negative thallium SPECT scan
5
Q
What is the management of cerebral toxoplasmosis?
A
Sulfadiazine, pyrimethamine
6
Q
What is Creutzfledt-Jakob disease?
A
- progressive neurological condition
- presents with rapid onset dementia and myoclonus
7
Q
What are the side effects of levodopa?
A
- dry mouth
- anorexia
- palpitations
- postural hypotension
- psychosis
- dystonia, chorea and athetosis at peak dose
8
Q
What is the first line treatment of myasthenia gravis?
A
pyridostigmine (acetylcholinesterase inhibitor). prednisolone can be used as an adjunct
9
Q
What does Wernicke’s aphasia sound like?
A
Fluent speech, with nonsense or irrelevant words, patient does not realise that they are making no sense (receptive aphasia), abnormal comprehension
10
Q
What does Broca’s aphasia sound like?
A
Expressive aphasia, cannot speak fluently, speech limited and effortful. They can understand speech and read well.
11
Q
What is conduction aphasia?
A
Fluent aphasia, preserved comprehension with frequent errors in the selection of words, often try to repeatedly correct their errors
12
Q
What are the four patterns of motor neurone disease?
A
Amyotrophic lateral sclerosis (50%) (UMN and LMN signs)
Primary lateral sclerosis (UMN only)
Progressive muscular atrophy (LMN only, distal muscles first)
Progressive bulbar palsy (difficulty swallowing, chewing etc)
13
Q
What symptoms are associated with a posterior inferior cerebellar artery stroke?
A
Cerebellar features: Ataxia, nystagmus.
Brainstem features: Ipsilateral: dysphagia, facial numbness, cranial nerve palsy
Contralateral: limb sensory loss
14
Q
What is the management following a first self-terminating seizure?
A
Refer to specialist
DVLA should be informed
15
Q
When are antiepileptics started in seizure patients?
A
After second seizure, unless there is a neurological deficit, brain imaging shows structural abnormality or EEG shows unequivocal epileptic activity
16
Q
What is the first line treatment for generalised tonic-clonic seizures in males and females?
A
Males: sodium valproate
Females: lamotrigine or levetiracetam
17
Q
What is the first line treatment for focal seizures?
A
lamotrigine or levetiracetam
18
Q
What is the first line treatment for absence seizures?
A
ethosuximide
19
Q
What is the first line treatment for myoclonic seizures in males and females?
A
Males: sodium valproate
females: levetiracetam
20
Q
What medications are used in migraine attacks?
A
triptan + NSAID/ paracetamol
21
Q
What medications are used for migraine prophylaxis?
A
Topiramate or propanolol (not in asthmatics)
22
Q
What are the features of a focal aware seizure?
A
A sudden but short lived change in the senses during which the patient remains fully conscious. Can be accompanied by sweating, twitching or gaze deviation. typically no post-ictal period.
23
Q
What are the features of a complex focal seizure?
A
Seizure in a specific part of the brain. Loss of awareness, memory loss and impaired responsiveness during the seizure.
24
Q
A
25
Which antiemetics should be used in gastric dysmotility caused nausea and vomiting?
Pro-kinetic agents such as metoclopramide and domperidone
26
Which antiemetics should be given in chemically mediated nausea and vomiting?
Ondansetron, haloperidol, levomepromazine
27
What antiemetics should be used in treating vestibular nausea?
Cyclizine first line
Metoclopramide or prochlorperazine
28
What is chiari malformation?
Herniation of the cerebellar tonsils through the foramen magnum
29
What is syringomyelia?
dilatation of a CSF space in the spinal cord - causes compression of spinothalamic tracts causing loss of pain, temperature and crude touch sensation in a cape-like distribution
30
Which cranial nerve lesion would cause ptosis?
CN III
31
Which cranial nerve lesion is head tilt usually seen in?
Trochlear
32
What causes conduction aphasia?
Usually a stroke in the connection between Wernicke's and Broca's. poor speech repetition.
33
What is the presentation of a total anterior circulation infarct?
Unilateral hemiparesis/hemi-sensory loss
homonymous hemianopia
dysfunction of a higher cognitive function
34
What is the first line treatment of essential tremor?
Propanolol
35
What are the typical features of essential tremor?
Autosomal dominant - family history
usually bilateral
worse if arms outstretched
improved by rest and alcohol
36
When do you order a CT head for a head injury?
Loss of consciousness > 5 mins
Amnesia
Abnormal drowsiness
Three or more discrete episodes of vomiting
battle's sign, csf leakage
37
What findings are present on nerve conduction studies in GBS?
Decreased motor neuron conduction velocity, secondary to demyelination
38
What is the Miller Fischer variant?
Guillain-BS with Progressive proximal weakness with ophthalmoplegia, areflexia and ataxia
39
What is the classical presentation of a basilar artery stroke?
'locked in syndrome' quadriplegia with preserved consciousness and blinking
40
What is the typical presentation of an anterior inferior cerebellar artery stroke?
Facial paralysis - due to damage of the facial nerve nuclei, ataxia
41
What is the typical presentation of a posterior cerebral artery stroke?
Contralateral hemianopia - macula sparing (affects occipital lobe)
42
What is lateral medullary syndrome?
PICA lesion - cerebellar signs, contralateral sensory loss and ipsilateral horners
43
What is the presentation of an anterior inferior cerebellar artery stroke?
Vertigo, vomiting, ipsilateral facial paralysis and deafness
44
What is the presentation of a posterior inferior cerebellar artery stroke?
vertigo, vomiting, dysphagia, ipsilateral facial pain and temp loss, contralateral limb pain and temp loss, ataxia
45
What medication is used in the prophylaxis of cluster headaches?
Verapamil
46
What treatments are used for the acute management of cluster headaches?
Oxygen therapy, sumatriptan
47
What are the physiological signs of raised ICP - coning? (Cushing reflex)
Bradycardia, hypertension, wide pulse pressure
48
What is cushings reflex?
response to ICP hypertension, bradycardia, irregular breathing
49
What are the typical features of a temporal lobe seizure?
Plucking of clothes, lip smacking, aura, deja-vu
50
What are the typical features of a frontal lobe seizure?
Head/leg movements, Jacksonian march, post-ictal weakness
51
52
What are the typical features of a patient lobe seizure?
parasthesia
53
What are the typical features of an occipital lobe seizure?
Floaters/flashes
54
What adverse effect should you be worried about with lamotrigine?
stevens-johnson syndrome
55
What is the treatment for suspected encephalitis?
Aciclovir
56
What are the CSF findings in bacterial and viral meningitis?
LP: lymphocytes and proteins - viral
LP: neutrophils and proteins - bacterial
57
What is the classical presentation of syringomyelia?
Cape-like distribution of loss of pain and temperature sensation
spastic weakness is lower limbs
upgoing plantars
58
What is amaurosis fugax?
A stroke in the retinal/ophthalmic artery
59
What is the classical presentation of amaurosis fugax?
A black curtain coming down over the eye
60
What blood test can differentiate a true seizure from a psuedoseizure?
Prolactin
61
What factors differentiate pseudoseizures from seizures?
pseudo: pelvic thrusting, FH of epilepsy, crying after seizure, doesn't occur when alone, gradual onset
seizure: tongue biting, raised prolactin
62
What test helps to confirm the diagnosis of myasthenia gravis?
Acetylcholine receptor antibody test
63
What is the first line treatment of myasthenia gravis?
pyridostigmine
64
Which neurological disorder is associated with thymomas?
Myasthenia gravis
65
How do you cure a medication overuse headache?
Stop simple analgesia and triptans immediately
Withdraw opioid dose gradually
66
Why cant patients with migraines with aura take the COCP?
Increased risk of ischaemic stroke
67
What is the typically presentation of a focal impaired awareness seizure?
Staring into space with lack of awareness, automatism (lip smacking)
68
What type of postural hypotension occurs in parkinsons?
No compensatory tachycardia postural hypotension due to autonomic failure
69
Which nerve is affected in a loss of corneal reflex?
V1
70
When is a lumbar puncture contraindicated in headache?
When there are signs of raised intracranial pressure
71
What is the management of idiopathic intracranial hypertension?
weight loss, carbonic anhydrase inhibitors, lumboperitoneal or ventriculoperitoneal shunt
72
What are the first line investigations that should be done in status epilepticus?
Capillary blood glucose - rule out hypoxia and hyperglycaemia
73
What is the first line management of status epilepticus?
Benzodiazepines - lorazepam
74
What do you give if status epilepticus lasts more than 45 mins?
General Anaesthesia, Phenobarbital
75
What is the management of a myasthenic crisis?
Plasmapheresis and IV IgG
76
What is the standard target time for thrombectomy and thrombolysis in acute ischaemic stroke?
Thrombolysis within 4.5 hrs, thrombectomy within 6 hrs
77
What are the typical features of juvenile myoclonic epilepsy?
Seizures in the morning/ following sleep deprivation, daytime absences, sudden myoclonic jerk
78
Can you start aciclovir alongside antibiotics?
Yes
79
What is the classical presentation of ALS?
LMN signs in the upper limbs. UMN signs in the lower limbs. sensory sparing. asymmetric limb weakness
80
What is the classical presentation of Charcot-Marie-Tooth disease?
Hereditary motor and sensory neuropathy, progressive loss of muscle in the peripheries, It typically presents with high-arched feet, foot drop, distal muscle weakness and atrophy, and hyporeflexia. LMN signs.
81
What is the classical presentation of temporal arteritis?
rapid onset < 1 month, of unilateral headache, jaw claudication, tender palpable temporal artery, raised ESR. Usually in patients over 60y/o
82
What is the classical presentation triad of normal pressure hydrocephalus?
Urinary incontinence, gait abnormality (shuffling gait), dementia (wet, wobbly, wacky)
83
What is the classical presentation of ramsey hunt syndrome?
Otalgia, one sided facial paralysis, no forehead sparing
84
What medications cause intracranial hypertension?
tetracycline antibiotics, contraceptives, steroids, levothyroxine, lithium, vitamin A
85
What is the classical presentation of primary lateral sclerosis?
UMN signs only MND
86
Name some causes of tremor
Parkinsonism, essential tremor, anxiety, thyrotoxicosis, hepatic encephalopathy, CO2 retention, cerebellar disease
87
What are the features of essential tremor?
Postural tremor - worse if hands outstretched, improved by rest and alcohol, titubation, family history
88
What are the features of a carbon-dioxide retention tremor?
Liver flap, COPD history
89
What are the typical features of neuroleptic malignancy syndrome?
Rigidity, hyperthermia, autonomic instability (hypotension, tachycardia), altered mental state, AKI
90
What is the cause of neuroleptic malignancy syndrome?
Antipsychotics
91
What is the treatment of degenerative cervical myelopathy?
Cervical decompressive surgery
92
What are the imaging features of a brain abscess?
CT - rim-enhancing lesion with a central cavity and oedema
MRI - diffusion restricting
93
What is the management of a brain abscess?
Craniotomy - abscess debridement, IV 3rd gen cephalosporin + metronidazole, manage intracranial pressure with dexamethasone
94
What are the features of a unilateral third nerve palsy?
eye down and out, ptosis, pupil dilation, absent light reflex but intact consensual constriction
95
What are the key signs of raised intracranial pressure?
headache, diplopia, bilateral papilloedema
96
What are the features of intracranial venous thrombosis?
Headache (can be sudden onset), nausea, vomiting, reduced consciousness
97
What is the gold standard investigation for intracranial venous thrombosis?
MRI venography
sagittal sinus thrombosis - empty delta sign
98
What is the first line management of trigeminal neuralgia?
Carbamazepine
99
What is bell's palsy?
LMN lesion of CN VII - forehead affected
100
What is the management of a symptomatic chronic and acute subdural haematoma?
Chronic: Burr hole evacuation
Acute: decompressive craniectomy
101
What is the difference between acute and chronic subdural haematoma on CT?
Acute: hyperdense (bright)
Chronic: hypodense (dark)
Like a banana - older are darker
102
What is the management of neuroleptic syndrome?
stop antipsychotics
IV fluids
dantrolene/bromocriptine
103
How do you interpret rinne's and Weber's tests?
Conductive: bone>air. weber's localises to bad ear
Sensorineural: air>bone. weber's localises to good ear
104
What are the features of an acoustic neuroma?
Unilateral sensorineural hearing loss and/or tinnitus, vertigo, absent corneal reflex, facial palsy
105
What investigations are done in GBS?
Lumbar puncture (raised proteins), nerve conduction studies (slow velocity)
106
What is mydriasis?
Dilation of the pupil
107
What is miosis?
Constriction of the pupil
108
What is enophthalmos?
Displacement of the eyeball within the orbit
109
What is exophthalmos?
Bulging of the eye out of the orbit
110
What are the features of infantile spasms (West syndrome)?
Repeated flexion of head/arms/trunk followed by extension of arms
111
What is the preferred way of supporting nutrition in patients with MND who can no longer swallow?
PEG
112
What is high protein in the CSF with no other CSF finding indicative of?
GBS
113
What are the features of cerebellar dysfunction?
D - Dysdiadochokinesia, Dysmetria (past-pointing), patients may appear 'Drunk'
A - Ataxia (limb, truncal)
N - Nystamus (horizontal = ipsilateral hemisphere)
I - Intention tremor
S - Slurred staccato speech, Scanning dysarthria
H - Hypotonia
114
What issue can arise from taking folate before replacing B12 levels?
Subacute combined degeneration of the spinal cord. Hyperreflexia, loss of proprioception and vibration, gait ataxia
115
What bedside test can you do to check rhinorrhea is CSF?
Glucose
Gold standard test would be for beta-2 transferrin
116
what are the features of normal pressure hydrocephalus on a CT?
Ventriculomegaly out of proportion with or without sulcal enlargement
117
What columns does B12 subacute combined degeneration of the cord affect?
dorsal columns, lateral corticospinal tracts and spinocerebellar tracts. Loss of proprioception and vibration, muscle weakness and hyperreflexia
118
What is the barthel index/scale?
An outcome/disability measure in patients after stroke
119
What drugs give you pinpoint pupils?
opiates
120
What does cabergoline do?
Stimulates dopamine release in the brain - used alongside levodopa in parkinsons treatment. S/E pulmonary fibrosis
121
What drug is used to help with tremor symptoms in parkinsons?
Procyclidine
122
When would you do a carotid endarterectomy?
When the stenosis is > 50% and a previous TIA. or above 70% with no TIA.
123
What is the investigation for narcolepsy?
Multiple sleep latency EEG
124
What medication can you give to a child having a febrile seizure?
Buccal benzodiazepines (midalozam)
125
What imaging should be used in patients with suspected MS?
MRI with contrast
126
What do you give to patients presenting with Bell’s palsy within 72hrs?
Oral Prednisolone
127
What is the treatment for an ischaemic stroke that has presented within 4.5 hours?
alteplase plus thrombectomy
128
What is the first line treatment for neuropathic pain?
Pregabalin
129
What is the first-line treatment for spasticity in MS?
Baclofen and gabapentin
130
What is the first line antiemetic for intracranial nausea and vomiting?
Cyclizine
131
What is the difference between a medical and a surgical third nerve palsy presentation?
Surgical - fixed dilated pupil
medical - pupil sparing and painless
132
What areas of the brain show the most atrophy in alzheimers?
Cortex and hippocampus
133
Where is the location of the lesion in a painful third nerve palsy?
posterior communicating artery
134
What is the gold standard investigation for cervical myelopathy?
MRI spine
135
What are the features of lumbar canal stenosis?
pain and weakness on both legs on walking - relieved by rest
136
What medication should be avoided in patients with myasthenia gravis?
Beta-blockers
137
Which part of the brain is usually damaged in dyskinetic cerebral palsy?
Basal ganglia and substantia nigra
138
How long do clusters of cluster headaches usually last for?
4-12 weeks
139
How do you differentiate between parkinsons and multi-system atrophy?
multi-system atrophy has autonomic dysfunction - postural hypotension and erectile dysfunction
140
What features are present in progressive supranuclear palsy?
Vertical gaze palsy - plus other parkinsons symptoms
141
How can you differentiate between drug induced and idiopathic parkinsons?
Idiopathic rarely has symmetrical symptoms
142
What is the management of bell's palsy?
oral prednisolone within 72 hours of onset
143
What is the management of status epilepticus?
Oh my lord phone the anaesthetist
Oxygen, midazolam, lorazepam, phenytoin, general anaesthetic
144
What is the most important cause of status epilepticus to rule out first?
hypoxia and hypoglycaemia
145
What do you give in status epilepticus outside a hospital?
Buccal midazolam or PR diazepam
146
How do you differentiate between the two types of optic chiasm lesions?
Both have bitemporal hemianopia
upper quadrant defect > = inferior chiasmal compression, commonly a pituitary tumour
lower quadrant defect > = superior chiasmal compression, commonly a craniopharyngioma
SPIC (superior pituitary, inferior craniop)
147
Which antiepileptic causes peripheral neuropathy?
Phenytoin
148
What is the first line medication for myoclonic seizures in females?
levetiracetaM Myoclonic
149
What imaging would you do in patients with previous suspected TIA?
MRI with diffusion weighted imaging
150
Which patients do you not give triptans to?
Patients with coronary artery disease due to risk of vasospasm,and patients on SSRIs due to risk of serotonin syndrome
151
What are the features of wernicke's encephalopathy?
Confusion, gait ataxia, nystagmus + ophthalmoplegia
152
What are the presenting features of a venous sinus thrombosis?
headache, reduced consciousness, vomiting
153
How is a diagnosis of Duchenne Muscular dystrophy made?
Genetic testing
154
What is the treatment for a cerebral abscess?
ceftriazone + metrondiazole
155
What do you do if a Bell's palsy shows no signs of improvement after 3 weeks?
Urgent referral to ENT
156
What is the treatment of a low pressure headache?
Fluids and Caffeine
157
What are the features of lambert Eaton syndrome?
proximal leg muscle weakness, repeated muscle contractions lead to increased muscle strength, hyporeflexia, autonomic symptoms
158
Oculomotor palsy is caused by a stroke in which artery?
Posterior cerebral
159
What medication can be used in idiopathic intracranial hypertension?
acetazolamide
160
What are the reflexes like in GBS?
Reduced - LMN problem
161
What symptoms are associated with cavernous sinus syndrome?
pain, ophthalmoplegia, proptosis, trigeminal nerve lesion (ophthalmic branch) and Horner's syndrome.
162
What are the features of C8/T1 radiculopathy?
Loss of sensation to little finger and medial forearm, claw hand
163
What is the first-line treatment for parkinson's symptoms?
Levodopa - works best for motor symptoms
164
What method of imaging is used to assess carotid artery stenosis?
duplex ultrasound
165
What does a chronic subdural look like on a CT?
hypodense (dark), crescentic collection not limited by the suture lines
166
What are the nerve roots for the main myotomes?
S1-S2 button my shoe
L3-L4 kick the door
C5-C6 pick up sticks
C7-C8 open the gate
167
What is Weber's syndrome?
A stroke of the midbrain - ipsilateral 3rd nerve palsy and contralateral hemiparesis
