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Passmed neuro/neurosurg Flashcards

1
Q

First line investigation for suspected stroke?

A

Non-contrast CT

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2
Q

Long term antiplatelet for TIA/ischaemic stroke?

A

Clopidogrel

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3
Q

What is indicative of Guillian Barre on an LP?

A

Isolated result of high protein

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4
Q

Which anti-epileptics should be started after a first seizure?

A

Only started after specialist review

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5
Q

Features of viral encephalitis?

A

Fever, headache, psychiatric symptoms, seizures and focal features

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6
Q

Most common cause of viral encephalitis?

A

HSV

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7
Q

What is a Jacksonian March and what does it signify?

A

Clonic movements moving proximally - indicates frontal lobe epilepsy

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8
Q

When is carotid endarterectomy considered?

A

Patients who’ve had a TIA and carotid artery stenosis exceeds 50% on side contralateral to symptoms

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9
Q

How to differentiate syncope and seizures?

A

Post-ictal period: syncope has a short post-ictal time and fast recovery

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10
Q

Which drugs should be avoided in myasthenia gravis?

A

Beta-blockers - they interfere with acetylcholine receptors and exacerbate MG symptoms

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11
Q

Features of multiple system atrophy?

A

Parkinsonism with autonomic features (atonic bladder, postural hypotension)

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12
Q

What symptoms suggest Guillain-Barré syndrome?

A

Progressive peripheral polyneuropathy with hyporeflexia
(usually ascending)

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13
Q

What should be given in a stroke once haemorrhagic stroke is ruled out on CT?

A

Aspirin 300mg

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14
Q

If a patient on anticoagulation has a suspected TIA what is done?

A

Urgent imaging to exclude haemorrhage

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15
Q

What is the Barthel index?

A

A scale that measures disability or dependence in ADLs in stroke patients

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16
Q

What are Chiari malformations associated with and why?

A

Syringomyelia due to disturbed CSF flow at foramen magnum

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17
Q

What symptoms does anterior cerebral artery stroke cause and not cause?

A

Leg weakness but not face weakness or speech impairment

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18
Q

What is used to treat idiopathic cranial hypertension?

A

Acetazolamide (carbonic anhydrase inhibitor)

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19
Q

Features of subacute degeneration of the cord?

A

Distal sensory loss, tingling, absent knee jerks/extensor planters, gait abnormalities and Romberg’s positive

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20
Q

What suggests Korsakoff’s syndrome over Wernicke’s encephalopathy?

A

An inability to acquire new memories and confabulation

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21
Q

How does subacute degeneration of the cord occur and how is it avoided?

A

Giving folate before b12 can precipitate it so correct B12 before folate

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22
Q

Features of ALS?

A

Mixed UMN and LMN signs with usually no sensory deficit

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23
Q

How is Creutzfeld-Jakob disease characterised?

A

Rapid onset dementia and myoclonus

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24
Q

Which cranial nerves are affected by acoustic neuromas?

A

V, VII, VIII

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25
Q

2nd line management of status epilepticus?

A

If not responding to benzodiazepines then:

-IV phenytoin
-IV levetiracetam
-IV sodium valproate

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26
Q

How does lateral medullary syndrome present?

A

PICA lesion:

Cerebellar signs, contralateral sensory loss and ipsilateral Horner’s

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27
Q

What is conduction dysphasia?

A

Speech is fluent, repetition is poor but comprehension is intact

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28
Q

What is spared in MND?

A

Sensory and eye movements

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29
Q

What is a common trigger for cluster headaches?

A

Alcohol

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30
Q

What is controlled hyperventilation used for?

A

Raised ICP

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31
Q

What is a rare but serious side effect of Lamotrigine?

A

Steven-Johnson syndrome

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32
Q

How does an MCA stroke present?

A

Contralateral hemiparesis and sensory loss - upper extremity more affected than lower
Contralateral homonymous hemianopia and aphasia

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33
Q

What’s used for spasticity in MS?

A

Baclofen and gabapentin

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34
Q

Typical patient with idiopathic intracranial hypertension?

A

Obese, young female with headaches and blurred vision

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35
Q

If there is fluid loss from nose/ear after trauma, how do you tell if it is CSF?

A

Test for glucose

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36
Q

What must be ruled out before diagnosing a TIA?

A

Hypoglycaemia

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37
Q

What is a very common early symptom of MS?

A

Lethargy

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38
Q

What is an important consideration when assessing GCS?

A

Take the best response from both sides

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39
Q

What does a loss of corneal reflex suggest?

A

Acoustic neuroma

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40
Q

How does an AICA stroke present?

A

Sudden onset vertigo and vomiting with ipsilateral facial paralysis and deafness

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41
Q

Features of intracranial venous thrombosis?

A

Risk factors for thrombosis, headache, vomiting and reduced consciousness

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42
Q

What does a painful third nerve palsy suggest?

A

Posterior communicating artery aneurysm

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43
Q

Causes of cerebellar syndrome?

A

PASTRIES:

Posterior fossa tumours, alcohol, stroke, trauma, paRaneoplastic syndromes, inherited (Freidereich’s), epilepsy drugs (phenytoin), sclerosis (multiple)

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44
Q

What are common precipitants of myasthenia crises?

A

Beta blockers

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45
Q

Headache linked to Valsalva manoeuvres?

A

Rated ICP until proven otherwise

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46
Q

Treatment of essential tremor?

A

Propranolol

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47
Q

Which GCS number do you intubate at?

A

8 or below

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48
Q

What reduces relapse the most in MS?

A

Monoclonal antibodies such as natalizumb

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49
Q

What features points to a pseudo seizure?

A

Widespread convulsions without conscious impairment

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50
Q

What is the most likely operation for symptomatic subdural haematomas?

A

Burr hole evacuation

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51
Q

What is paroxysmal hemicranial and how is it treated?

A

Rare headache with severe throbbing pain around eye and back of neck
Treated with indomethacin

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52
Q

What features suggest a brain abscess?

A

Headache, fever and focal neurology

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53
Q

What is Weber’s syndrome?

A

Midbrain stroke characterised by an ipsilateral CNIII palsy and contralateral hemiparesis

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54
Q

What are common symptoms in children with migraine?

A

Nausea, vomiting and abdominal pain

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55
Q

What causes superior homonymous quadrantopias?

A

Lesions of inferior optic radiations in the temporal lobe

56
Q

How to differentiate drug induced and idiopathic Parkinson’s disease?

A

Drug induced - may be symmetrical
Idiopathic - rarely symmetrical

57
Q

How does syringomyelia present?

A

Cape-like loss of pain and temperature sensation due to compression of spinothalamic tract fibres decussating in the anterior white commissure of the spinal cord

58
Q

What is Hoover’s sign used for?

A

To differentiate organic and non-organic lower leg weakness

59
Q

How does a PCA stroke present?

A

Contralateral homonymous hemianopia with macular sparing and visual agnosia

60
Q

What is done in patients under 55 with no obvious cause of their stroke?

A

Bloods - thrombophilia and autoimmune screening

61
Q

Which spinal tracts are affected in subacute degeneration of the spinal cord?

A

Dorsal columns and lateral corticospinal tracts

62
Q

What is amaurosis fugax?

A

Form of stroke that affects the retinal/ophthalmic artery

63
Q

Where is Broca’s area?

A

Left inferior frontal gyrus

64
Q

What is the most common complication of meningitis?

A

Sensorineural hearing loss

65
Q

How long does a cluster headache last?

A

15m to 2h

66
Q

Which stroke causes aphasia?

A

Dominant MCA

67
Q

Why are carbonic anhydrase inhibitors used for raised ICP?

A

They’re thought to exert their effect on ICP by reducing CSF production in the choroid plexus

68
Q

What isa feature of lacunar stroke?

A

Isolated hemisensory loss

69
Q

What are axillary freckles indicative of?

A

Neurofibromatosis type I

70
Q

Where is Wernicke’s area?

A

Superior temporal gyrus

71
Q

Which artery stroke can cause locked-in syndrome?

A

Basilar artery

72
Q

What is observed in patients taking levodopa?

A

Wearing off phenomenon - symptomatic when they’re ready for their next dose

73
Q

What is pituitary apoplexy?

A

Rare, life threatening complication of pituitary adenoma - bleeding/infarction within a pituitary macro adenoma

74
Q

How is pituitary apoplexy treated?

A

Urgent steroids due to loss of ACTH

75
Q

What is the first-line drug in ocular myasthenia gravis?

A

Pyridostigmine

76
Q

What is a common contraindication of triptan use and why?

A

Cardiovascular disease due to coronary artery vasospasm (also why people may experience throat/chest tightness on triptans)

77
Q

Which cranial nerve is most commonly affected by raised ICP?

A

Third nerve palsy - ptosis, mydriasis, down and out eye

78
Q

What is used to treat neuroleptic malignant syndrome?

A

Dantrolene and bromocriptine

79
Q

Pathophysiology of neuroleptic malignant syndrome?

A

Isn’t understood, one theory suggests the dopamine blockade by antipsychotics triggers massive glutamate release and subsequent neurotoxicity and muscle damage

80
Q

What are found in the CSF of patients with MS?

A

Oligoclonal bands (up to 95%)

81
Q

What is hemispatial neglect?

A

After damage to one hemisphere of the brain, inability of a person to process and perceivestimulitowards the contralesional side of the body or environment

82
Q

What has to be ruled out in status epileptics first?

A

Hypoglycaemia (A-E assessment)

83
Q

Features of normal pressure hydrocephalus?

A

Wet, wacky, wobbly:

Incontinence, dementia, gait abnormality

84
Q

What is a lifestyle modification for children with hard-to-control epilepsy?

A

Ketogenic diet - low carbs, high fat, controlled protein

85
Q

In patients with suspected TIA who require brain imaging, which method is preferred?

A

Diffusion-weighted MRI

86
Q

First line treatment for females with myoclonic seizures?

A

Levetiracetam

87
Q

How does neuroleptic malignant syndrome present on bloods?

A

Leukocytosis and raised CK

88
Q

Which nerves does Charcot-Marie-Tooth syndrome affect?

A

Motor and sensory peripheral nerves

89
Q

What is the Cushing reflex?

A

Physiological response to raised ICP:

Hypertension, bradycardia

90
Q

Neuroimaging findings of normal pressure hydrocephalus?

A

Ventriculomegaly in the absence of, or out of proportion to sulcal enlargement

91
Q

Features of progressive supranuclear palsy?

A

Postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction

92
Q

Which drugs increase the risk of idiopathic intracranial hypertension?

A

Tetracyclines

93
Q

What is neurofibromatosis type II associated with?

A

Bilateral acoustic neuromas

94
Q

Types of bilateral hemianopia and their causes?

A

Upper quadrant more than lower = inferior chiasm compression - pituitary tumour

Lower quadrant more than upper = superior chiasm compression - craniopharyngioma

95
Q

Which imaging method is best for viewing demyelinating lesions?

A

MRI with contrast

96
Q

Which type of seizures do you see plucking of clothes in?

A

Temporal lobe seizures

97
Q

What is an ataxic gait?

A

Wide based gait with loss of heel-toe walking

98
Q

What is required when starting phenytoin infusion?

A

Cardiac monitoring due to pro-arrhythmogenic effects

99
Q

Treatment of brain abscess?

A

Metronidazole and 3rd gen cephalosporin

100
Q

What is the best way to nutritionally support patients with MND?

A

Percutaneous gastrostomy tube (PEG)

(NG tube not recommended for long term)

101
Q

What is an important lifestyle modification with patients with idiopthaic intracranial hypertension?

A

Weight loss

102
Q

What should be considered if falls occur soon after a diagnosis of Parkinson’s?

A

Alternative diagnosis such as Parkinson-plus syndrome -

103
Q

Acute management of cluster headaches?

A

100% oxygen
Subcut triptans (faster than oral)

104
Q

How do patients present with a pontine haemorrhage?

A

Reduced GCS, quadriplegia, miosis, horizontal eye movements

105
Q

Which Parkinson’s drug is associated with greatest improvement in symptoms and ADLs?

A

Levodopa

106
Q

How may a frontal lobe lesion present?

A

Disinhibition

107
Q

What is a common side effect of sodium valproate?

A

Weight gain

108
Q

What is Lhermitte’s sign?

A

Tingling in hands when the neck is flexed

109
Q

Do you get pain more in Ramsay-Hunt syndrome or Bell’s palsy?

A

Ramsay-Hunt but up to 50% of patients get pain with Bell’s palsu

110
Q

Which type of dementia is associated with MND?

A

Frontotemporal dementia

111
Q

Difference between Weber’s and Wallenberg’s?

A

Weber’s - weakness in eyes/body
Wallenberg’s - ataxia (no weakness)

112
Q

Describe the tremor in Parkinson’s disease?

A

Unilateral, improves with movement

113
Q

First-imaging investigation for acoustic neuroma?

A

Audiogram and gadolinium-enhanced MRI

114
Q

What is seen on venography is sagittal sinus thrombosis?

A

Empty delta sign

115
Q

What is juvenile myoclonic epilepsy associated with?

A

Seizures in the morning following sleep deprivation

-Typcially affects teenage girl
-Absence, myoclonic and tonic-clonic

116
Q

Common complication of intraventricular haemorrhages?

A

Hydrocephalus

117
Q

Most common neurosurgical cause of sudden collapse and LOC?

A

Subarachnoid haemorrhage

118
Q

Management of patients with intracranial bleeds who become unresponsive?

A

Urgent CT to check for hydrocephalus

119
Q

If SAH is suspected, they present within 6h and the CT scan is normal, what is done?

A

Nothing - consider alternative diagnosis

120
Q

If SAH is suspected, they present after 6h and CT is normal, what is done?

A

LP 12 hours after symptom onset

121
Q

What is a common neurosurgical condition in premature neonates?

A

Intraventricular haemorrhages

122
Q

What is a basal skull fracture characterised by?

A

Battle’s sign (mastoid bruising) and periorbital bruising (raccoon eyes)

123
Q

Which drug is used in SAH and why?

A

Nimodipine - to prevent cerebral artery vasospasm

124
Q

Difference on CT between extradural and subdural bleeds?

A

Extradural - biconvex shape
Subdural - crescent shape

125
Q

What is seen on LP of SAH?

A

Xanthochromia (RBC breakdown products - bilirubin)
May also have normal/raised opening pressure

LP done 12h after onset to allow xanthochromia to develop

126
Q

Which brain bleed has fluctuating consciousness/cognition?

A

Subdural

127
Q

Which brain bleed is initially fine then a reduced GCS/consciousness after?

A

Extradural

128
Q

What is a common complication of SAH?

A

SIADH and hyponatraemia

129
Q

What requires a CT head within an hour? (mnemnonic)

A

Skilled fighters never get violent:

Seizures
Fractures - battle’s sign, fluid leakage
Neurological deficit
GCS score <13 at injury, <15 2h after
Vomiting

130
Q

What requires a CT head within 8 hours?

A

LATE:

Legendary story (dangerous mechanism)
Amnesia (30m+ retrograde)
Thrombin (bleeding/clotting disorders, anticoagulants)
Elderly (>65)

131
Q

What is the primary pathology in subdural bleeds?

A

Rupture of bridging veins

132
Q

What is the primary pathology in extradural bleeds?

A

Rupture of middle meningeal artery

133
Q

What is the best imaging to diagnose diffuse axonal injury?

A

MRI

134
Q

How are intracranial aneurysms treated after SAH?

A

Coiling by interventional neuroradiologist

135
Q

What is a risk factor for SAH?

A

ADPKD due to their association with cerebral berry aneurysms

136
Q

Which tests used to confirm death?

A

Pupillary reflex, corneal reflex, oculo-vestibular reflex, cough reflex, absent response to supraorbital pressure, no spontaneous respiratory effort

137
Q
A

Passmed (6 decks)

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