Passmed neuro/neurosurg Flashcards
1
Q
First line investigation for suspected stroke?
A
Non-contrast CT
2
Q
Long term antiplatelet for TIA/ischaemic stroke?
A
Clopidogrel
3
Q
What is indicative of Guillian Barre on an LP?
A
Isolated result of high protein
4
Q
Which anti-epileptics should be started after a first seizure?
A
Only started after specialist review
5
Q
Features of viral encephalitis?
A
Fever, headache, psychiatric symptoms, seizures and focal features
6
Q
Most common cause of viral encephalitis?
A
HSV
7
Q
What is a Jacksonian March and what does it signify?
A
Clonic movements moving proximally - indicates frontal lobe epilepsy
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
9
Q
How to differentiate syncope and seizures?
A
Post-ictal period: syncope has a short post-ictal time and fast recovery
10
Q
Which drugs should be avoided in myasthenia gravis?
A
Beta-blockers - they interfere with acetylcholine receptors and exacerbate MG symptoms
11
Q
Features of multiple system atrophy?
A
Parkinsonism with autonomic features (atonic bladder, postural hypotension)
12
Q
What symptoms suggest Guillain-Barré syndrome?
A
Progressive peripheral polyneuropathy with hyporeflexia
(usually ascending)
13
Q
What should be given in a stroke once haemorrhagic stroke is ruled out on CT?
A
Aspirin 300mg
14
Q
If a patient on anticoagulation has a suspected TIA what is done?
A
Urgent imaging to exclude haemorrhage
15
Q
What is the Barthel index?
A
A scale that measures disability or dependence in ADLs in stroke patients
16
Q
What are Chiari malformations associated with and why?
A
Syringomyelia due to disturbed CSF flow at foramen magnum
17
Q
What symptoms does anterior cerebral artery stroke cause and not cause?
A
Leg weakness but not face weakness or speech impairment
18
Q
What is used to treat idiopathic cranial hypertension?
A
Acetazolamide (carbonic anhydrase inhibitor)
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
20
Q
What suggests Korsakoff’s syndrome over Wernicke’s encephalopathy?
A
An inability to acquire new memories and confabulation
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
22
Q
Features of ALS?
A
Mixed UMN and LMN signs with usually no sensory deficit
23
Q
How is Creutzfeld-Jakob disease characterised?
A
Rapid onset dementia and myoclonus
24
Q
Which cranial nerves are affected by acoustic neuromas?
A
V, VII, VIII
25
2nd line management of status epilepticus?
If not responding to benzodiazepines then:
-IV phenytoin
-IV levetiracetam
-IV sodium valproate
26
How does lateral medullary syndrome present?
PICA lesion:
Cerebellar signs, contralateral sensory loss and ipsilateral Horner's
27
What is conduction dysphasia?
Speech is fluent, repetition is poor but comprehension is intact
28
What is spared in MND?
Sensory and eye movements
29
What is a common trigger for cluster headaches?
Alcohol
30
What is controlled hyperventilation used for?
Raised ICP
31
What is a rare but serious side effect of Lamotrigine?
Steven-Johnson syndrome
32
How does an MCA stroke present?
Contralateral hemiparesis and sensory loss - upper extremity more affected than lower
Contralateral homonymous hemianopia and aphasia
33
What's used for spasticity in MS?
Baclofen and gabapentin
34
Typical patient with idiopathic intracranial hypertension?
Obese, young female with headaches and blurred vision
35
If there is fluid loss from nose/ear after trauma, how do you tell if it is CSF?
Test for glucose
36
What must be ruled out before diagnosing a TIA?
Hypoglycaemia
37
What is a very common early symptom of MS?
Lethargy
38
What is an important consideration when assessing GCS?
Take the best response from both sides
39
What does a loss of corneal reflex suggest?
Acoustic neuroma
40
How does an AICA stroke present?
Sudden onset vertigo and vomiting with ipsilateral facial paralysis and deafness
41
Features of intracranial venous thrombosis?
Risk factors for thrombosis, headache, vomiting and reduced consciousness
42
What does a painful third nerve palsy suggest?
Posterior communicating artery aneurysm
43
Causes of cerebellar syndrome?
PASTRIES:
Posterior fossa tumours, alcohol, stroke, trauma, paRaneoplastic syndromes, inherited (Freidereich's), epilepsy drugs (phenytoin), sclerosis (multiple)
44
What are common precipitants of myasthenia crises?
Beta blockers
45
Headache linked to Valsalva manoeuvres?
Rated ICP until proven otherwise
46
Treatment of essential tremor?
Propranolol
47
Which GCS number do you intubate at?
8 or below
48
What reduces relapse the most in MS?
Monoclonal antibodies such as natalizumb
49
What features points to a pseudo seizure?
Widespread convulsions without conscious impairment
50
What is the most likely operation for symptomatic subdural haematomas?
Burr hole evacuation
51
What is paroxysmal hemicranial and how is it treated?
Rare headache with severe throbbing pain around eye and back of neck
Treated with indomethacin
52
What features suggest a brain abscess?
Headache, fever and focal neurology
53
What is Weber's syndrome?
Midbrain stroke characterised by an ipsilateral CNIII palsy and contralateral hemiparesis
54
What are common symptoms in children with migraine?
Nausea, vomiting and abdominal pain
55
What causes superior homonymous quadrantopias?
Lesions of inferior optic radiations in the temporal lobe
56
How to differentiate drug induced and idiopathic Parkinson's disease?
Drug induced - may be symmetrical
Idiopathic - rarely symmetrical
57
How does syringomyelia present?
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
What is Hoover's sign used for?
To differentiate organic and non-organic lower leg weakness
59
How does a PCA stroke present?
Contralateral homonymous hemianopia with macular sparing and visual agnosia
60
What is done in patients under 55 with no obvious cause of their stroke?
Bloods - thrombophilia and autoimmune screening
61
Which spinal tracts are affected in subacute degeneration of the spinal cord?
Dorsal columns and lateral corticospinal tracts
62
What is amaurosis fugax?
Form of stroke that affects the retinal/ophthalmic artery
63
Where is Broca's area?
Left inferior frontal gyrus
64
What is the most common complication of meningitis?
Sensorineural hearing loss
65
How long does a cluster headache last?
15m to 2h
66
Which stroke causes aphasia?
Dominant MCA
67
Why are carbonic anhydrase inhibitors used for raised ICP?
They're thought to exert their effect on ICP by reducing CSF production in the choroid plexus
68
What isa feature of lacunar stroke?
Isolated hemisensory loss
69
What are axillary freckles indicative of?
Neurofibromatosis type I
70
Where is Wernicke's area?
Superior temporal gyrus
71
Which artery stroke can cause locked-in syndrome?
Basilar artery
72
What is observed in patients taking levodopa?
Wearing off phenomenon - symptomatic when they're ready for their next dose
73
What is pituitary apoplexy?
Rare, life threatening complication of pituitary adenoma - bleeding/infarction within a pituitary macro adenoma
74
How is pituitary apoplexy treated?
Urgent steroids due to loss of ACTH
75
What is the first-line drug in ocular myasthenia gravis?
Pyridostigmine
76
What is a common contraindication of triptan use and why?
Cardiovascular disease due to coronary artery vasospasm (also why people may experience throat/chest tightness on triptans)
77
Which cranial nerve is most commonly affected by raised ICP?
Third nerve palsy - ptosis, mydriasis, down and out eye
78
What is used to treat neuroleptic malignant syndrome?
Dantrolene and bromocriptine
79
Pathophysiology of neuroleptic malignant syndrome?
Isn't understood, one theory suggests the dopamine blockade by antipsychotics triggers massive glutamate release and subsequent neurotoxicity and muscle damage
80
What are found in the CSF of patients with MS?
Oligoclonal bands (up to 95%)
81
What is hemispatial neglect?
After damage to one hemisphere of the brain, inability of a person to process and perceive stimuli towards the contralesional side of the body or environment
82
What has to be ruled out in status epileptics first?
Hypoglycaemia (A-E assessment)
83
Features of normal pressure hydrocephalus?
Wet, wacky, wobbly:
Incontinence, dementia, gait abnormality
84
What is a lifestyle modification for children with hard-to-control epilepsy?
Ketogenic diet - low carbs, high fat, controlled protein
85
In patients with suspected TIA who require brain imaging, which method is preferred?
Diffusion-weighted MRI
86
First line treatment for females with myoclonic seizures?
Levetiracetam
87
How does neuroleptic malignant syndrome present on bloods?
Leukocytosis and raised CK
88
Which nerves does Charcot-Marie-Tooth syndrome affect?
Motor and sensory peripheral nerves
89
What is the Cushing reflex?
Physiological response to raised ICP:
Hypertension, bradycardia
90
Neuroimaging findings of normal pressure hydrocephalus?
Ventriculomegaly in the absence of, or out of proportion to sulcal enlargement
91
Features of progressive supranuclear palsy?
Postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction
92
Which drugs increase the risk of idiopathic intracranial hypertension?
Tetracyclines
93
What is neurofibromatosis type II associated with?
Bilateral acoustic neuromas
94
Types of bilateral hemianopia and their causes?
Upper quadrant more than lower = inferior chiasm compression - pituitary tumour
Lower quadrant more than upper = superior chiasm compression - craniopharyngioma
95
Which imaging method is best for viewing demyelinating lesions?
MRI with contrast
96
Which type of seizures do you see plucking of clothes in?
Temporal lobe seizures
97
What is an ataxic gait?
Wide based gait with loss of heel-toe walking
98
What is required when starting phenytoin infusion?
Cardiac monitoring due to pro-arrhythmogenic effects
99
Treatment of brain abscess?
Metronidazole and 3rd gen cephalosporin
100
What is the best way to nutritionally support patients with MND?
Percutaneous gastrostomy tube (PEG)
(NG tube not recommended for long term)
101
What is an important lifestyle modification with patients with idiopthaic intracranial hypertension?
Weight loss
102
What should be considered if falls occur soon after a diagnosis of Parkinson's?
Alternative diagnosis such as Parkinson-plus syndrome -
103
Acute management of cluster headaches?
100% oxygen
Subcut triptans (faster than oral)
104
How do patients present with a pontine haemorrhage?
Reduced GCS, quadriplegia, miosis, horizontal eye movements
105
Which Parkinson's drug is associated with greatest improvement in symptoms and ADLs?
Levodopa
106
How may a frontal lobe lesion present?
Disinhibition
107
What is a common side effect of sodium valproate?
Weight gain
108
What is Lhermitte's sign?
Tingling in hands when the neck is flexed
109
Do you get pain more in Ramsay-Hunt syndrome or Bell's palsy?
Ramsay-Hunt but up to 50% of patients get pain with Bell's palsu
110
Which type of dementia is associated with MND?
Frontotemporal dementia
111
Difference between Weber's and Wallenberg's?
Weber's - weakness in eyes/body
Wallenberg's - ataxia (no weakness)
112
Describe the tremor in Parkinson's disease?
Unilateral, improves with movement
113
First-imaging investigation for acoustic neuroma?
Audiogram and gadolinium-enhanced MRI
114
What is seen on venography is sagittal sinus thrombosis?
Empty delta sign
115
What is juvenile myoclonic epilepsy associated with?
Seizures in the morning following sleep deprivation
-Typcially affects teenage girl
-Absence, myoclonic and tonic-clonic
116
Common complication of intraventricular haemorrhages?
Hydrocephalus
117
Most common neurosurgical cause of sudden collapse and LOC?
Subarachnoid haemorrhage
118
Management of patients with intracranial bleeds who become unresponsive?
Urgent CT to check for hydrocephalus
119
If SAH is suspected, they present within 6h and the CT scan is normal, what is done?
Nothing - consider alternative diagnosis
120
If SAH is suspected, they present after 6h and CT is normal, what is done?
LP 12 hours after symptom onset
121
What is a common neurosurgical condition in premature neonates?
Intraventricular haemorrhages
122
What is a basal skull fracture characterised by?
Battle's sign (mastoid bruising) and periorbital bruising (raccoon eyes)
123
Which drug is used in SAH and why?
Nimodipine - to prevent cerebral artery vasospasm
124
Difference on CT between extradural and subdural bleeds?
Extradural - biconvex shape
Subdural - crescent shape
125
What is seen on LP of SAH?
Xanthochromia (RBC breakdown products - bilirubin)
May also have normal/raised opening pressure
LP done 12h after onset to allow xanthochromia to develop
126
Which brain bleed has fluctuating consciousness/cognition?
Subdural
127
Which brain bleed is initially fine then a reduced GCS/consciousness after?
Extradural
128
What is a common complication of SAH?
SIADH and hyponatraemia
129
What requires a CT head within an hour? (mnemnonic)
Skilled fighters never get violent:
Seizures
Fractures - battle's sign, fluid leakage
Neurological deficit
GCS score <13 at injury, <15 2h after
Vomiting
130
What requires a CT head within 8 hours?
LATE:
Legendary story (dangerous mechanism)
Amnesia (30m+ retrograde)
Thrombin (bleeding/clotting disorders, anticoagulants)
Elderly (>65)
131
What is the primary pathology in subdural bleeds?
Rupture of bridging veins
132
What is the primary pathology in extradural bleeds?
Rupture of middle meningeal artery
133
What is the best imaging to diagnose diffuse axonal injury?
MRI
134
How are intracranial aneurysms treated after SAH?
Coiling by interventional neuroradiologist
135
What is a risk factor for SAH?
ADPKD due to their association with cerebral berry aneurysms
136
Which tests used to confirm death?
Pupillary reflex, corneal reflex, oculo-vestibular reflex, cough reflex, absent response to supraorbital pressure, no spontaneous respiratory effort
137
