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3a 2023 > Passmed (Neuro) > Flashcards

Passmed (Neuro) Flashcards

1
Q

Two month history of electric shock like pains on the right side of her face. First line medication?

A

Carbamezapine

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2
Q

Features of a third nerve palsy?

A

eye is deviated ‘down and out’
ptosis
pupil may be dilated (sometimes called a ‘surgical’ third nerve palsy)

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3
Q

The temporal lobe is responsible for memory, hearing & understanding language. What are signs of a temporal lobe epilepsy?

A

Automasations, lip smacking

Automatic behaviours such as fidgeting, undressing, running or walking,

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4
Q

Which nerve inverts abduction of the thumb?

A

Median nerve (LOAF muscles)

Ulnar does like ring finger side & Adduction of thumb

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5
Q

Required MRI site for acoustic neuromas

A

MRI of cerebellopontine angle

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6
Q

Explain the vascularisation of the brain stem?

A

1) Midbrain is part of the PCA
2) Pons & medulla mid is followed by basillar then anterior spinal artery
3) Pons & medulla lateral is followed by AICA & PICA

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7
Q

Explain the Rule of 4s for brainstem stroke

Cortical would either be MCA (FAST), ACA = leg, vision lang = PCA

A

Medial = motor (corticospinal/eye motor/proprioception)
Lateral = sensory (spinothalamic/sympathetic chain/sensory CN nuclei)

CN 1-4 = midbrain, 5-8= pons, 9=12 = medulla, ones that divide into 12 are midline (i.e. 3,4 |6 | 12)

N.b 1 & 2 aren’t in midbrain. Also Facial pain = PICA

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8
Q

Why do you get contralateral homonymous hemianopia in PCA stroke?

A

Because right side of the brain controls the right retina side but light is flipped through the lense, i.e. left eye sign block is due to right brain issue

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9
Q

What would webbers syndrome present as?

A

W like an upside down M
So according to rules of 4 would include occulomotor palsy & random brainstem hemiplegia

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10
Q

What does lacunar infarct mean?

A

Basically means small pit, so like small blood vessels affected deep in the brain

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11
Q

How would a pontine haemorrhage present as?

A

Quadriplegia

Pinpoint pupils points to pons

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12
Q

The gold standard for investigating demyelinating lesions?

A

MRI with contrast (i.e. investigating MS due to optic neuritis)

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13
Q

How does juvenile myoclonic epilepsy usually present as?

A

JME, usually different types of seizures associated w/ sleep deprivation

Goes from GTC to myoclonic after few months

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14
Q

Homonmyous heminaopia with or with/out?

A

with macular sparing would be PCA. w/o is MCA

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15
Q

Most common and most severe type of MND?

A

ALS & PBP (recurrent-remitting is also a type too)

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16
Q

What does amyotrophic lateral sclerosis actually mean?

A

a-myo-trophic (i.e. wasting) and lateral sclerosis (scarring of lateral tracts) i.e. UMN signs

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17
Q

In GBS: flaccid/spastic hypo/hypereflexia

A

flaccid & hyporeflexia as these are LMN signs (extra-pyramidal)

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18
Q

The first-line treatment for neuropathic pain?

A

Pregabalin is

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19
Q

How to manage Bells palsy?

A

Give prednisolone if w/i 72hr. Ensure eye drops too. Acyclocvir (if rash/ramsey)

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20
Q

Signs of wernikes encephalopathy

A

Confuison, ataxia, nystagmus & opthalmoplegia

21
Q

Primary prophylaxis for pregnant woman with migraines?

A

Propanolol (since topiramate is teratogenic)

22
Q

First line drug for acute confusion in elderly patient?

A

Haloperidol (anti-psych)

23
Q

What is anomic aphasia?

A

A deficit of having the word to speak

24
Q

Peroneal nerve vs L5 root nerve radiculopathy

A

PED vs LIED
Peroneal, Eversion, dorsiflexion
L5 Root, inversion, eversion, dorsiflexion

25
Q

Features of frontal seizure?

A

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

Jacksonian march is through the homonculus, so swallow to arm etc

Todd’s Paraesis

26
Q

What action would mean a seizure isn’t absence seizure?

A

If they’re having automatisations

27
Q

What indicates a vascular dementia?

A

A stepwise deterioration

28
Q

Which cranial nerves will decussate then with their output being opposite?

A

Cn4 & Cn7 (trochlear & facial)

29
Q

Preferred imaging in TIA clinic?

A

MRI

30
Q

Which anti-psychotic is contraindicated in parkinsons? Haloperidol or olanzapine?

A

Haloperidol (apparently)

31
Q

What are the features of intracranial venous thrombosis?

A

Headache, N&V, reduced consciousness

32
Q

Gold standard Ix for venous sinus thrombosis

A

MRI venography

33
Q

How does syringomyelia present as?

A

Spinothalamic things especially cape area

34
Q

Time window to give alteplase for ischemic stroke? If not what?

A

4.5 hrs (n.b. 6 for thrombectomy) give aspirin after

35
Q

Phenytoin haemolytic side effect?

A

Cause macroblastic (affects folate thing)

36
Q

Acute treatment of cluster headaches? Side effect of taking the medication?

A

Subcut sumatriptan + 100% O2

Chest tightness

37
Q

What are important blood tests in ‘young’ people and why?

A

Thrombophilia and autoimmune screening

38
Q

What is presentation of a fracture of the shaft of the humerus?

A

Wrist drop (radial nerve damage)

39
Q

How to acutely manage acute stroke? & best prevention

A

Aspirin 300mg as soon as haemorrhagic ruled out & clopidogrel for prevention!

40
Q

Apart from the optic neuritis, what are other features of MS? (autoimmune condition of myelin in brain & spinal cord)

A

Lethargy, parasthesia, spastic weakness

41
Q

Where does wenickes aphasia lesion come from?

A

Superior temporal gyrus

42
Q

CT with or without contrast in the context of a newly presenting SAH

A

CT w/o contrast (slower and not needed to see particular fistulaes etc)

43
Q

What is the first line drug for spasticity in MS?

A

Baclofen ( It works by inhibiting reflexes at the spinal level, thus reducing muscle tone and frequency of spasms)

44
Q

What is internuclear opthalmoplegia?

A

When looking to the side, ABducting eye has nystagmus and ADducting eye doesn’t noramlly

45
Q

A right temporal lobe results in a superior homonymous quadrantanopias. Explain why?

A

Because the tract for that top left quadrant goes through the opposite. So right temproal lobe

Lowerr would be parietal

46
Q

How to remember why we get macular sparing and in which lobe?

A

In an occipital lobe lesion because it’s like evoltionary

47
Q

What is the difference between type 1 and type 2 neurofibromatosis?

A

type 1 is more neurofibromas/optic gliomas whereas type 2 associated with schwanomas

48
Q

What is Ramsay-Hunt Syndrome?

A

Where there’s facial palsy (due to herpes-zoster). Think ethan hunt ate a rooster?

49
Q
A

3a 2023 (19 decks)

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