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Phase 3A > Passmed Neuro > Flashcards

Passmed Neuro Flashcards

1
Q

What medicine is used to treat raised intracranial pressure caused by brain mets?

A

dexamethasone

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2
Q

What medication is used to manage spasticity in multiple sclerosis?

A

Baclofen and gabapentin

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3
Q

What medication should not be used in patients with epilepsy who are trying to stop smoking?

A

Bupropion

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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

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5
Q

What is the management of cerebral toxoplasmosis?

A

Sulfadiazine, pyrimethamine

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6
Q

What is Creutzfledt-Jakob disease?

A
  • progressive neurological condition
  • presents with rapid onset dementia and myoclonus
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7
Q

What are the side effects of levodopa?

A
  • dry mouth
  • anorexia
  • palpitations
  • postural hypotension
  • psychosis
  • dystonia, chorea and athetosis at peak dose
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8
Q

What is the first line treatment of myasthenia gravis?

A

pyridostigmine (acetylcholinesterase inhibitor). prednisolone can be used as an adjunct

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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

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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.

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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

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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)

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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

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14
Q

What is the management following a first self-terminating seizure?

A

Refer to specialist
DVLA should be informed

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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

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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

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17
Q

What is the first line treatment for focal seizures?

A

lamotrigine or levetiracetam

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18
Q

What is the first line treatment for absence seizures?

A

ethosuximide

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19
Q

What is the first line treatment for myoclonic seizures in males and females?

A

Males: sodium valproate
females: levetiracetam

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20
Q

What medications are used in migraine attacks?

A

triptan + NSAID/ paracetamol

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21
Q

What medications are used for migraine prophylaxis?

A

Topiramate or propanolol (not in asthmatics)

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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.

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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.

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24
Q
A
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25
Q

Which antiemetics should be used in gastric dysmotility caused nausea and vomiting?

A

Pro-kinetic agents such as metoclopramide and domperidone

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26
Q

Which antiemetics should be given in chemically mediated nausea and vomiting?

A

Ondansetron, haloperidol, levomepromazine

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27
Q

What antiemetics should be used in treating vestibular nausea?

A

Cyclizine first line
Metoclopramide or prochlorperazine

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28
Q

What is chiari malformation?

A

Herniation of the cerebellar tonsils through the foramen magnum

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29
Q

What is syringomyelia?

A

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

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30
Q

Which cranial nerve lesion would cause ptosis?

A

CN III

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31
Q

Which cranial nerve lesion is head tilt usually seen in?

A

Trochlear

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32
Q

What causes conduction aphasia?

A

Usually a stroke in the connection between Wernicke’s and Broca’s. poor speech repetition.

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33
Q

What is the presentation of a total anterior circulation infarct?

A

Unilateral hemiparesis/hemi-sensory loss
homonymous hemianopia
dysfunction of a higher cognitive function

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34
Q

What is the first line treatment of essential tremor?

A

Propanolol

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35
Q

What are the typical features of essential tremor?

A

Autosomal dominant - family history
usually bilateral
worse if arms outstretched
improved by rest and alcohol

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36
Q

When do you order a CT head for a head injury?

A

Loss of consciousness > 5 mins
Amnesia
Abnormal drowsiness
Three or more discrete episodes of vomiting
battle’s sign, csf leakage

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37
Q

What findings are present on nerve conduction studies in GBS?

A

Decreased motor neuron conduction velocity, secondary to demyelination

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38
Q

What is the Miller Fischer variant?

A

Guillain-BS with Progressive proximal weakness with ophthalmoplegia, areflexia and ataxia

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39
Q

What is the classical presentation of a basilar artery stroke?

A

‘locked in syndrome’ quadriplegia with preserved consciousness and blinking

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40
Q

What is the typical presentation of an anterior inferior cerebellar artery stroke?

A

Facial paralysis - due to damage of the facial nerve nuclei, ataxia

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41
Q

What is the typical presentation of a posterior cerebral artery stroke?

A

Contralateral hemianopia - macula sparing (affects occipital lobe)

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42
Q

What is lateral medullary syndrome?

A

PICA lesion - cerebellar signs, contralateral sensory loss and ipsilateral horners

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43
Q

What is the presentation of an anterior inferior cerebellar artery stroke?

A

Vertigo, vomiting, ipsilateral facial paralysis and deafness

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44
Q

What is the presentation of a posterior inferior cerebellar artery stroke?

A

vertigo, vomiting, dysphagia, ipsilateral facial pain and temp loss, contralateral limb pain and temp loss, ataxia

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45
Q

What medication is used in the prophylaxis of cluster headaches?

A

Verapamil

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46
Q

What treatments are used for the acute management of cluster headaches?

A

Oxygen therapy, sumatriptan

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47
Q

What are the physiological signs of raised ICP - coning? (Cushing reflex)

A

Bradycardia, hypertension, wide pulse pressure

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48
Q

What is cushings reflex?

A

response to ICP hypertension, bradycardia, irregular breathing

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49
Q

What are the typical features of a temporal lobe seizure?

A

Plucking of clothes, lip smacking, aura, deja-vu

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50
Q

What are the typical features of a frontal lobe seizure?

A

Head/leg movements, Jacksonian march, post-ictal weakness

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51
Q
A
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52
Q

What are the typical features of a patient lobe seizure?

A

parasthesia

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53
Q

What are the typical features of an occipital lobe seizure?

A

Floaters/flashes

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54
Q

What adverse effect should you be worried about with lamotrigine?

A

stevens-johnson syndrome

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55
Q

What is the treatment for suspected encephalitis?

A

Aciclovir

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56
Q

What are the CSF findings in bacterial and viral meningitis?

A

LP: lymphocytes and proteins - viral
LP: neutrophils and proteins - bacterial

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57
Q

What is the classical presentation of syringomyelia?

A

Cape-like distribution of loss of pain and temperature sensation
spastic weakness is lower limbs
upgoing plantars

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58
Q

What is amaurosis fugax?

A

A stroke in the retinal/ophthalmic artery

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59
Q

What is the classical presentation of amaurosis fugax?

A

A black curtain coming down over the eye

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60
Q

What blood test can differentiate a true seizure from a psuedoseizure?

A

Prolactin

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61
Q

What factors differentiate pseudoseizures from seizures?

A

pseudo: pelvic thrusting, FH of epilepsy, crying after seizure, doesn’t occur when alone, gradual onset
seizure: tongue biting, raised prolactin

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62
Q

What test helps to confirm the diagnosis of myasthenia gravis?

A

Acetylcholine receptor antibody test

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63
Q

What is the first line treatment of myasthenia gravis?

A

pyridostigmine

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64
Q

Which neurological disorder is associated with thymomas?

A

Myasthenia gravis

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65
Q

How do you cure a medication overuse headache?

A

Stop simple analgesia and triptans immediately
Withdraw opioid dose gradually

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66
Q

Why cant patients with migraines with aura take the COCP?

A

Increased risk of ischaemic stroke

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67
Q

What is the typically presentation of a focal impaired awareness seizure?

A

Staring into space with lack of awareness, automatism (lip smacking)

68
Q

What type of postural hypotension occurs in parkinsons?

A

No compensatory tachycardia postural hypotension due to autonomic failure

69
Q

Which nerve is affected in a loss of corneal reflex?

A

V1

70
Q

When is a lumbar puncture contraindicated in headache?

A

When there are signs of raised intracranial pressure

71
Q

What is the management of idiopathic intracranial hypertension?

A

weight loss, carbonic anhydrase inhibitors, lumboperitoneal or ventriculoperitoneal shunt

72
Q

What are the first line investigations that should be done in status epilepticus?

A

Capillary blood glucose - rule out hypoxia and hyperglycaemia

73
Q

What is the first line management of status epilepticus?

A

Benzodiazepines - lorazepam

74
Q

What do you give if status epilepticus lasts more than 45 mins?

A

General Anaesthesia, Phenobarbital

75
Q

What is the management of a myasthenic crisis?

A

Plasmapheresis and IV IgG

76
Q

What is the standard target time for thrombectomy and thrombolysis in acute ischaemic stroke?

A

Thrombolysis within 4.5 hrs, thrombectomy within 6 hrs

77
Q

What are the typical features of juvenile myoclonic epilepsy?

A

Seizures in the morning/ following sleep deprivation, daytime absences, sudden myoclonic jerk

78
Q

Can you start aciclovir alongside antibiotics?

A

Yes

79
Q

What is the classical presentation of ALS?

A

LMN signs in the upper limbs. UMN signs in the lower limbs. sensory sparing. asymmetric limb weakness

80
Q

What is the classical presentation of Charcot-Marie-Tooth disease?

A

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
Q

What is the classical presentation of temporal arteritis?

A

rapid onset < 1 month, of unilateral headache, jaw claudication, tender palpable temporal artery, raised ESR. Usually in patients over 60y/o

82
Q

What is the classical presentation triad of normal pressure hydrocephalus?

A

Urinary incontinence, gait abnormality (shuffling gait), dementia (wet, wobbly, wacky)

83
Q

What is the classical presentation of ramsey hunt syndrome?

A

Otalgia, one sided facial paralysis, no forehead sparing

84
Q

What medications cause intracranial hypertension?

A

tetracycline antibiotics, contraceptives, steroids, levothyroxine, lithium, vitamin A

85
Q

What is the classical presentation of primary lateral sclerosis?

A

UMN signs only MND

86
Q

Name some causes of tremor

A

Parkinsonism, essential tremor, anxiety, thyrotoxicosis, hepatic encephalopathy, CO2 retention, cerebellar disease

87
Q

What are the features of essential tremor?

A

Postural tremor - worse if hands outstretched, improved by rest and alcohol, titubation, family history

88
Q

What are the features of a carbon-dioxide retention tremor?

A

Liver flap, COPD history

89
Q

What are the typical features of neuroleptic malignancy syndrome?

A

Rigidity, hyperthermia, autonomic instability (hypotension, tachycardia), altered mental state, AKI

90
Q

What is the cause of neuroleptic malignancy syndrome?

A

Antipsychotics

91
Q

What is the treatment of degenerative cervical myelopathy?

A

Cervical decompressive surgery

92
Q

What are the imaging features of a brain abscess?

A

CT - rim-enhancing lesion with a central cavity and oedema
MRI - diffusion restricting

93
Q

What is the management of a brain abscess?

A

Craniotomy - abscess debridement, IV 3rd gen cephalosporin + metronidazole, manage intracranial pressure with dexamethasone

94
Q

What are the features of a unilateral third nerve palsy?

A

eye down and out, ptosis, pupil dilation, absent light reflex but intact consensual constriction

95
Q

What are the key signs of raised intracranial pressure?

A

headache, diplopia, bilateral papilloedema

96
Q

What are the features of intracranial venous thrombosis?

A

Headache (can be sudden onset), nausea, vomiting, reduced consciousness

97
Q

What is the gold standard investigation for intracranial venous thrombosis?

A

MRI venography
sagittal sinus thrombosis - empty delta sign

98
Q

What is the first line management of trigeminal neuralgia?

A

Carbamazepine

99
Q

What is bell’s palsy?

A

LMN lesion of CN VII - forehead affected

100
Q

What is the management of a symptomatic chronic and acute subdural haematoma?

A

Chronic: Burr hole evacuation
Acute: decompressive craniectomy

101
Q

What is the difference between acute and chronic subdural haematoma on CT?

A

Acute: hyperdense (bright)
Chronic: hypodense (dark)
Like a banana - older are darker

102
Q

What is the management of neuroleptic syndrome?

A

stop antipsychotics
IV fluids
dantrolene/bromocriptine

103
Q

How do you interpret rinne’s and Weber’s tests?

A

Conductive: bone>air. weber’s localises to bad ear
Sensorineural: air>bone. weber’s localises to good ear

104
Q

What are the features of an acoustic neuroma?

A

Unilateral sensorineural hearing loss and/or tinnitus, vertigo, absent corneal reflex, facial palsy

105
Q

What investigations are done in GBS?

A

Lumbar puncture (raised proteins), nerve conduction studies (slow velocity)

106
Q

What is mydriasis?

A

Dilation of the pupil

107
Q

What is miosis?

A

Constriction of the pupil

108
Q

What is enophthalmos?

A

Displacement of the eyeball within the orbit

109
Q

What is exophthalmos?

A

Bulging of the eye out of the orbit

110
Q

What are the features of infantile spasms (West syndrome)?

A

Repeated flexion of head/arms/trunk followed by extension of arms

111
Q

What is the preferred way of supporting nutrition in patients with MND who can no longer swallow?

A

PEG

112
Q

What is high protein in the CSF with no other CSF finding indicative of?

A

GBS

113
Q

What are the features of cerebellar dysfunction?

A

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
Q

What issue can arise from taking folate before replacing B12 levels?

A

Subacute combined degeneration of the spinal cord. Hyperreflexia, loss of proprioception and vibration, gait ataxia

115
Q

What bedside test can you do to check rhinorrhea is CSF?

A

Glucose
Gold standard test would be for beta-2 transferrin

116
Q

what are the features of normal pressure hydrocephalus on a CT?

A

Ventriculomegaly out of proportion with or without sulcal enlargement

117
Q

What columns does B12 subacute combined degeneration of the cord affect?

A

dorsal columns, lateral corticospinal tracts and spinocerebellar tracts. Loss of proprioception and vibration, muscle weakness and hyperreflexia

118
Q

What is the barthel index/scale?

A

An outcome/disability measure in patients after stroke

119
Q

What drugs give you pinpoint pupils?

A

opiates

120
Q

What does cabergoline do?

A

Stimulates dopamine release in the brain - used alongside levodopa in parkinsons treatment. S/E pulmonary fibrosis

121
Q

What drug is used to help with tremor symptoms in parkinsons?

A

Procyclidine

122
Q

When would you do a carotid endarterectomy?

A

When the stenosis is > 50% and a previous TIA. or above 70% with no TIA.

123
Q

What is the investigation for narcolepsy?

A

Multiple sleep latency EEG

124
Q

What medication can you give to a child having a febrile seizure?

A

Buccal benzodiazepines (midalozam)

125
Q

What imaging should be used in patients with suspected MS?

A

MRI with contrast

126
Q

What do you give to patients presenting with Bell’s palsy within 72hrs?

A

Oral Prednisolone

127
Q

What is the treatment for an ischaemic stroke that has presented within 4.5 hours?

A

alteplase plus thrombectomy

128
Q

What is the first line treatment for neuropathic pain?

A

Pregabalin

129
Q

What is the first-line treatment for spasticity in MS?

A

Baclofen and gabapentin

130
Q

What is the first line antiemetic for intracranial nausea and vomiting?

A

Cyclizine

131
Q

What is the difference between a medical and a surgical third nerve palsy presentation?

A

Surgical - fixed dilated pupil
medical - pupil sparing and painless

132
Q

What areas of the brain show the most atrophy in alzheimers?

A

Cortex and hippocampus

133
Q

Where is the location of the lesion in a painful third nerve palsy?

A

posterior communicating artery

134
Q

What is the gold standard investigation for cervical myelopathy?

A

MRI spine

135
Q

What are the features of lumbar canal stenosis?

A

pain and weakness on both legs on walking - relieved by rest

136
Q

What medication should be avoided in patients with myasthenia gravis?

A

Beta-blockers

137
Q

Which part of the brain is usually damaged in dyskinetic cerebral palsy?

A

Basal ganglia and substantia nigra

138
Q

How long do clusters of cluster headaches usually last for?

A

4-12 weeks

139
Q

How do you differentiate between parkinsons and multi-system atrophy?

A

multi-system atrophy has autonomic dysfunction - postural hypotension and erectile dysfunction

140
Q

What features are present in progressive supranuclear palsy?

A

Vertical gaze palsy - plus other parkinsons symptoms

141
Q

How can you differentiate between drug induced and idiopathic parkinsons?

A

Idiopathic rarely has symmetrical symptoms

142
Q

What is the management of bell’s palsy?

A

oral prednisolone within 72 hours of onset

143
Q

What is the management of status epilepticus?

A

Oh my lord phone the anaesthetist
Oxygen, midazolam, lorazepam, phenytoin, general anaesthetic

144
Q

What is the most important cause of status epilepticus to rule out first?

A

hypoxia and hypoglycaemia

145
Q

What do you give in status epilepticus outside a hospital?

A

Buccal midazolam or PR diazepam

146
Q

How do you differentiate between the two types of optic chiasm lesions?

A

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
Q

Which antiepileptic causes peripheral neuropathy?

A

Phenytoin

148
Q

What is the first line medication for myoclonic seizures in females?

A

levetiracetaM Myoclonic

149
Q

What imaging would you do in patients with previous suspected TIA?

A

MRI with diffusion weighted imaging

150
Q

Which patients do you not give triptans to?

A

Patients with coronary artery disease due to risk of vasospasm,and patients on SSRIs due to risk of serotonin syndrome

151
Q

What are the features of wernicke’s encephalopathy?

A

Confusion, gait ataxia, nystagmus + ophthalmoplegia

152
Q

What are the presenting features of a venous sinus thrombosis?

A

headache, reduced consciousness, vomiting

153
Q

How is a diagnosis of Duchenne Muscular dystrophy made?

A

Genetic testing

154
Q

What is the treatment for a cerebral abscess?

A

ceftriazone + metrondiazole

155
Q

What do you do if a Bell’s palsy shows no signs of improvement after 3 weeks?

A

Urgent referral to ENT

156
Q

What is the treatment of a low pressure headache?

A

Fluids and Caffeine

157
Q

What are the features of lambert Eaton syndrome?

A

proximal leg muscle weakness, repeated muscle contractions lead to increased muscle strength, hyporeflexia, autonomic symptoms

158
Q

Oculomotor palsy is caused by a stroke in which artery?

A

Posterior cerebral

159
Q

What medication can be used in idiopathic intracranial hypertension?

A

acetazolamide

160
Q

What are the reflexes like in GBS?

A

Reduced - LMN problem

161
Q

What symptoms are associated with cavernous sinus syndrome?

A

pain, ophthalmoplegia, proptosis, trigeminal nerve lesion (ophthalmic branch) and Horner’s syndrome.

162
Q

What are the features of C8/T1 radiculopathy?

A

Loss of sensation to little finger and medial forearm, claw hand

163
Q

What is the first-line treatment for parkinson’s symptoms?

A

Levodopa - works best for motor symptoms

164
Q

What method of imaging is used to assess carotid artery stenosis?

A

duplex ultrasound

165
Q

What does a chronic subdural look like on a CT?

A

hypodense (dark), crescentic collection not limited by the suture lines

166
Q

What are the nerve roots for the main myotomes?

A

S1-S2 button my shoe
L3-L4 kick the door
C5-C6 pick up sticks
C7-C8 open the gate

167
Q

What is Weber’s syndrome?

A

A stroke of the midbrain - ipsilateral 3rd nerve palsy and contralateral hemiparesis

Phase 3A (14 decks)

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