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Medicine and Surgery Mushkies > Passmed Neurology mushkies > Flashcards

Passmed Neurology mushkies Flashcards

1
Q

What causes a bitemporal hemianopia?

A
  1. Lesion of the optic chiasm
  2. Upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
  3. Lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
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2
Q

What would cause a left homonymous hemianopia?

A

Lesion of the right optic tract

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3
Q

What would cause homonymous quadrantanopia?

A

PITS
Parietal = inferior lesion
Temporal = superior lesion

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4
Q

What innervates the adductor pollicis?

A

The ulnar nerve

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5
Q

What does damage to the ulnar nerve result in?

A

Wasting of the hypothenar muscles, loss of thumb adduction, wasting of 1st web space and ulnar claw hand

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6
Q

How does radial nerve palsy present?

A

Wrist drop and loss of sensation from 1st dorsal web space

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7
Q

How does musculocutaneous nerve palsy present?

A

Reduced flexion at elbow and loss of supination

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8
Q

How does axillary nerve palsy present?

A

Wastage of deltoid muscles and loss of sensation from badge area

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9
Q

What are the 4 primitive reflexes?

A

Moro
Grasp
Rooting
Stepping

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10
Q

When do the primitive reflexes disappear?

A

All at 4 months except for stepping which disappears at 2 months

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11
Q

What are 2 differentials for an elderly man who has pain and weakness in both legs on walking that settles with rest?

A
  1. Lumbar spinal canal stenosis

2. Claudication

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12
Q

What muscles are supplied by the median nerve?

A 
LOAF
Lateral lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
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13
Q

What are two tests for carpal tunnel syndrome?

A

Tinnels test and Phalens test

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14
Q

What is a cause of loss of fine motor function in both upper limbs?

A

Degenerative cervical myelopathy

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15
Q

What is a modifiable risk factor for degenerative cervical myelopathy?

A

Smoking

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16
Q

What is the characteristic pathological feature of Lewy body dementia?

A

Alpha synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas

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17
Q

What percentage of Alzheimer’s pts also have Lewy bodies?

A

40%

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18
Q

What are features of Lewy body dementia?

A
  1. Progressive cognitive impairment
  2. Parkinsonism
  3. Visual hallucinations
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19
Q

What can be used to diagnose Lewy body dementia?

A

DaTscan

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20
Q

What medications can be used to manage Lewy body dementias?

A

ACh inhibitors (donepezil, rivastigmine) and Memantine

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21
Q

Where, geographically, is MS more common?

A

At higher latitudes

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22
Q

What are established risk factors associated with MS?

A
  1. High latitudes (5x more common than in tropics)
  2. EBV
  3. Vit D deficiency
  4. Smoking
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23
Q

What are the 3 types of MS?

A
  1. Relapsing-remitting (85%)
  2. Primary Progressive (10%)
  3. Secondary Progressive (from RR)
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24
Q

What percentage of pts with RR MS go on to develop secondary progressive disease within 15 years of diagnosis?

A

65%

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25
Q

What is the definition for trigeminal neuralgia?

A

A unilateral disorder characterised by brief electric shock like pains, abrupt in onset and termination, limited to one or more divisions of the trigeminal nerve

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26
Q

What are the causes of trigeminal neuralgia?

A
  1. Idiopathic
  2. Tumours
  3. Vascular
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27
Q

What is the first line treatment for trigeminal neuralgia?

A

Carbamazepine

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28
Q

What is the most common neurological sequalae of bacterial meningitis?

A

Deafness

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29
Q

When can anticoagulants for AF be started after an ischaemic stroke?

A

14 days

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30
Q

When should pts with a stroke be commenced on a statin?

A

If cholesterol >3.5mmol/l

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31
Q

When can thrombolysis with alteplase be given for stroke?

A

If haemorrhage has been excluded and it is administered within 4.5hrs of onset of stroke symptoms

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32
Q

What are absolute contrainidications for stroke thrombolysis?

A
  1. Previous intracranial haemorrhage
  2. Seizure at onset of stroke
  3. Intracranial neoplasm
  4. Suspected subarachnoid haemorrhage
  5. Stroke or traumatic brain injury in preceding 3 months
  6. Lumbar puncture in preceding 7 days
  7. Gastrointestinal haemorrhage in preceding 3 weeks
  8. Active bleeding
  9. Pregnancy
  10. Oesophageal varices
  11. Uncontrolled hypertension >200/120mmHg
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33
Q

When should thrombectomy be offered to patients?

A

Within 6 hours of symptom onset to pts with confirmed occlusion of the proximal anterior circulation demonstrated by CTA/MRA, or if b/w 6h and 24h if there is potentially salvageable brain tissue seen on CTA/MRA

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34
Q

When should a carotid endarterectomy be offered?

A

If carotid stenosis >70%/50% depending on which criteria you are looking at

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35
Q

What is the secondary prevention for stroke?

A

Clopidogrel + modified released dipyridamole in pts who have had an ischaemic stroke

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36
Q

Should dipyridamole be given in the acute treatment of ischaemic stroke?

A

No, should be given in the chronic setting after 14 day s

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37
Q

What are 4 drugs that can be given for post-herpetic neuralgia?

A
  1. Amitryptiline
  2. Duloxetine
  3. Gabapentin
  4. Pregabalin
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38
Q

What should be considered if a fall occurs soon after the diagnosis of Parkinson’s disesae?

A

An alternative diagnosis, most likely a Parkinsons plus syndrome such as PSP

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39
Q

What is a middle aged adult with insidious onset dementia and personality changes most likely to be?

A

Pick’s disease

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40
Q

What is the type of frontotemporal dementia which presents with the inability to produce speech and loss of literacy skills called?

A

Primary progressive aphasia

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41
Q

What are the 3 recognised types of Frontotemporal lobar degeneration?

A
  1. Frontotemporal dementia (Pick’s disease)
  2. Progressive non-fluent aphasia
  3. Semantic dementia
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42
Q

What kind of pain may precede paralysis in Bell’s palsy?

A

Post-auricular pain

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43
Q

If untreated, what percentage of Bells palsy pts develop moderate to severe weakness?

A

15%

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44
Q

What is the motor component of GCS?

A
  1. Obeys commands
  2. Localises to pain
  3. Withdraws from pain
  4. Abnormal flexion to pain (decorticate)
  5. Extension topain (decerebrate)
  6. None
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45
Q

What is the verbal component of GCS?

A
  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None
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46
Q

What is the eye component of GCS?

A
  1. Spontaneous
  2. To speech
  3. To pain
  4. None
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47
Q

How does a haemorrhagic stroke present?

A

Suddenly with a thunderclap headache

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48
Q

What nerve roots are responsible for the ankle reflex?

A

S1-2

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49
Q

What nerve roots are responsible for the patellar reflex?

A

L3-4

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50
Q

What nerve roots are responsible for the biceps reflex?

A

C5-6

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51
Q

What nerve roots are responsible for the triceps reflex?

A

C7-8

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52
Q

How long must people not drive for after a first unprovoked/isolated seizure?

A

6 months off if there are no relevant structural abnormalities on brain imaging and no definite epileptiform activity on EEG. If these conditions are not met then this is increased to 12 months

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53
Q

For patients with established epilepsy or those with multiple unprovoked seizures, when can they qualify for a driving license?

A

May qualify for a driving licence if they have been free from any seizure for 12 months

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54
Q

What are the driving restrictions for syncope?

A
  1. Simple faint = no restriction
  2. Single episode + explained + treated = 4w off
  3. Single episode + unexplained = 6m off
  4. 2+ episodes = 12m off
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55
Q

When can pts drive after a stroke/TIA?

A

1 month off driving, may not need to inform DVLA if no residual neurological deficit

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56
Q

What migraine prophylactic should be stopped in pregnant women due to risk of clift lip/palate?

A

Topiramate

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57
Q

When should migraine prophylaxis be given?

A

2 or more attacks per month

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58
Q

What is first line management of migraines?

A

Oral triptan and NSAID/paracetamol

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59
Q

What is the first line radiological investigation for suspected stroke>

A

Non-contrast CT head

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60
Q

What score can be used to help diagnose a stroke?

A

The ROSIER score

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61
Q

What are the components of the ROSIER score?

A
  1. LOC
  2. Seizure
  3. Acute asymmetric facial weakness
  4. Acute asymmetric arm weakness
  5. Acute asymmetric leg weakness
  6. Speech disturbance
  7. Visual field defect
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62
Q

What must be excluded before investigating a possible stroke further?

A

Hypoglycaemia

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63
Q

What ROSIER score suggests a stroke is likely?

A

> 0

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64
Q

Which muscular dystrophy presents later?

A

Becker’s muscular dystrophy

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65
Q

What is the inheritance pattern of dystrophinopathies?

A

X-linked recessive

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66
Q

What is the function of dystrophin?

A

Connects the muscle membrane to actin

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67
Q

When assessing GCS, should you use the best or worst responses from both sides?

A

The best responses

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68
Q

What are 3 features of normal pressure hydrocephalus?

A
  1. Progressive mental impairment and dementia
  2. Difficulty walking
  3. Impaired bladder control
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69
Q

What are the features of MSA?

A
  1. Parkinsonism
  2. Autonomic disturbance (atonic bladder, postural hypotension, erectile dysfunction)
  3. Cerebellar signs
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70
Q

What are the 2 predominant types of MSA?

A
  1. MSA-P = predominant Parkinsons features

2. MSA-C = predominant Cerebellar features

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71
Q

What medications are first line for migraine prophylaxis?

A

Topiramate or propranolol

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72
Q

What kind of 5-HT receptor medications are given for acute treatment and then for prophylaxis of migraine?

A
  1. 5-HT receptor agonists = acute treatment (e.g. triptans)

2. 5-HT receptor antagonists = prophylaxis (e.g. propranolol or topiramate)

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73
Q

What are the most common secondary brain tumours?

A
  1. Lung
  2. Breast
  3. Kidney
  4. Melanoma
  5. Colorectal
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74
Q

Where are the majority of adult brain tumours located?

A

Supratentorial

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75
Q

Where are the majority of childhood brain tumours located?

A

Infratentorial

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76
Q

What is the commonest primary brain tumour in adults?

A

Glioblastoma multiforme

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77
Q

What is the second most common primary brain tumour in adults?

A

Meningiomas

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78
Q

What structure do meningiomas typically arise from?

A

Dura mater

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79
Q

What do you see with glioblastoma multiforme on histology?

A

Pleomorphic tumour cells with border necrotic areas

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80
Q

What do you see with meningiomas on histology?

A

Spindle cells in concentric whorls and calcified psammoma bodies

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81
Q

What is the most common brain tumour in children?

A

Pilocytic astrocytoma

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82
Q

What do you see on histology of pilocytic astrocytomas?

A

Rosenthal fibres (corkscrew eosinophilic bundles)

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83
Q

What tumours are commonly seen in the 4th ventricle and may cause hydrocephalus?

A

Ependymomas

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84
Q

What brain tumour is associated with vHL?

A

Haemangioblastoma

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85
Q

What is the most common paediatric supratentorial tumour?

A

Craniopharyngioma

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86
Q

Where are craniopharyngiomas derived from?

A

Remnants of Rathke’s pouch

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87
Q

What may be seen with a meningioma on MRI that helps idenfity it?

A

A dural tail where the dura ‘connects’ to the dura

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88
Q

What does glioblastoma multiforme look like on imaging?

A

Solid tumours with central necrosis and a rim that enhances with contrast. There is disruption of the BBB and is therefore associated with vasogenic oedema

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89
Q

How does a pontine haemorrhage typically present?

A

Reduced GCS
Quadriplegia
Miosis
Absent horizontal eye movements

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90
Q

What are infantile spasms (Wests syndrome)?

A

A type of childhood epilepsy thich typically presents in the first 4-8 months of life and is more common in males. They are often associated with a serious underlying condition e.g. tuberous sclerosis

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91
Q

What is first line treatment for Wests syndrome?

A

Vigabatrin, and ACTH is also used

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92
Q

How does an ACA stroke present?

A
  1. Contralateral hemiparesis and sensory loss, legs > arms
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93
Q

How does an MCA stroke present?

A
  1. Contralateral hemiparesis and sensory loss, arms > legs
  2. Contralateral homonymous hemianopia
  3. Aphasia
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94
Q

How does a PCA stroke present?

A
  1. Contralateral homonymous hemianopia with macular sparing

2. Visual agnosia

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95
Q

How does Weber’s syndrome present?

A
  1. Ipsilateral CN III palsy

2. Contralateral weakness of upper and lower extremities

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96
Q

What arteries are affected in Weber’s syndrome?

A

Branches of posterior cerebral artery that supply the midbrain

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97
Q

What vessel is affected in lateral medullary syndrome and how does it present?

A

PICA

  1. Ipsilateral facial pain and temperature loss
  2. Contralateral limb/torso pain and temperature loss
  3. Ataxia, nystagmus
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98
Q

What vessel is affected in lateral pontine syndrome and how does it present?

A

Anterior inferior cerebellar artery

1. Ipsilateral facial paralysis and deafness

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99
Q

How does occlusion of the retinal/ophthalmic artery present?

A

Amaurosis fugax

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100
Q

How does occlusion of the basilar artery present?

A

Locked-in syndrome

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101
Q

What is Jacksonian march?

A

Where a simple partial seizure spreads from the distal part of the limb towards the ipsilateral face

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102
Q

What are the 3 key features that basic seizure classification is based on?

A
  1. Where seizures begin in the brain
  2. Level of awareness during a seizure
  3. Other features of seizure
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103
Q

Please discuss focal seizures

A

Focal seizures are ones that start in a specific area, on one side of the brain. The level of awareness can vary in focal seizures, and can thus be divided into simple partial seizures and complex partial seizures. Furthermore, focal seizures can be classified as being either motor (e.g. Jacksonian march) or non-motor (e.g. deja vu, jamais vu) or having other features such as aura

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104
Q

Please discuss generalised seizures

A

Generalised seizures involve networks on both sides of the brain at onset. By definition, consciousness is lost immediately. They can be dividied into motor and non-motor seizures. Specific types include tonic-clonic, tonic, clonic, absence, myoclonic and atonic

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105
Q

What is the management for a myasthenic crisis?

A

IVIG and plasma electrophoresis

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106
Q

What is the management for neuroleptic malignant syndrome?

A

Dantrolene and lorazepam

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107
Q

What is the management for a thyroid storm crisis?

A

IV hydrocortisone, propranolol, IV fluids

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108
Q

What are some features of myasthenia gravis?

A
  1. Muscle fatiguability
  2. Extraocular muscle weakness = diplopia
  3. Ptosis
  4. Dysphagia
  5. Proximal muscle weakness
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109
Q

What are 3 associations of myasthenia gravis?

A
  1. Thymic hyperplasia in 50=70%
  2. Thymoma in 15%
  3. Autoimmune disorder = pernicious anaemia, autoimmune thyroiditis, RA, SLE
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110
Q

What are the investigations for myasthenia gravis?

A
  1. Bedside = FEV
  2. Bloods = Anti-AchR. Anti-Muscle-specific tyrosine kinase
  3. Imaging = CT thorax (thymus)
  4. Special = Nerve conduction (EMG). Tensilon test
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111
Q

What is the management of myasthenia gravis?

A
  1. Conservative = assess FVC
  2. Medical = Steroids slowly increasing dose, steroid-sparing agent, pyridostigmine (long-acting AChesterease inhibitors)
  3. Surgical = Thymectomy
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112
Q

What nerve injury are mid-shaft humeral fractures associated with?

A

Radial nerve

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113
Q

What is the cause of wrist drop?

A

Radial nerve palsy

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114
Q

What is the MOA of ondansetron?

A

5-HT3 antagonist that acts in the CTZ of the medulla oblongata

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115
Q

What is found in the CSF of pts with MS?

A

Oligoclocal bands in the CSF of 80% MS patients. Elevated IgG levels is another common finding

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116
Q

When should degenerative cervical myelopathy be treated?

A

Ideally within 6m of diagnosis by neurosurgical services

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117
Q

How can you classify peripheral neuropathy?

A

Predominantly motor loss vs. predominantly sensory loss

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118
Q

What are the causes of peripheral neuropathy with a predominantly motor loss? x6

A
  1. GBS
  2. Porphyria
  3. Lead posoning
  4. HSMN e.g. CMT
  5. Chronic inflammatory demyelinating polyneuropathy
  6. Diphtheria
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119
Q

What are the causes of a peripheral neuropathy with a predominantly sensory loss? x6

A
  1. DM
  2. Vit B12 deficiency
  3. Alcoholism
  4. Uraemia
  5. Leprosy
  6. Amyloidosis
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120
Q

What part of the spinal column is typically affected first by SCDC?

A

Dorsal columns

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121
Q

What are the diagnostic criteria for migraine?

A 
A = at least 5 attacks fulfilling B-D
B = 4-72hrs
C = 2 of unilateral/pulsating/severe pain/avoidance of physical activity
D = 1 of N+V/Photo+phonophobia 
E = Not attributed to another disorder
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122
Q

What are some possible aura symptoms?

A
  1. Motor weakness
  2. Double vision
  3. Visual symptoms affecting only one eye
  4. Poor balance
  5. Decreased level of consciousness
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123
Q

What are 5 causes of foot drop?

A
  1. L5 radiculopathy
  2. Sciatic nerve lesion
  3. Common peroneal nerve lesion
  4. Superficial/deep peroneal nerve lesion
  5. Central e.g. stroke
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124
Q

What is the most common cause of a foot drop?

A

Common peroneal nerve lesion (often secondary to compression at the neck of the fibula)

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125
Q

What else other than the hands can essential tremor affect?

A

The vocal chords

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126
Q

What is the 1st line drug in the management of ocular myasthenia gravis?

A

Pyridostigmine

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127
Q

What kind of medication should be avoided in pts with Lewy body dementia and why?

A

Neuroleptics e.g. haloperidol as it may cause irreversible parkinsonism

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128
Q

What can be given to treat REM sleep behaviour disturbances in LBD?

A

Clonazepam 30mins before bedtime

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129
Q

What is considered first line treatment for generalised seizures?

A

Sodium valproate

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130
Q

What is considered first line treatment for focal seizures?

A

Carbamazepine

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131
Q

What is used to treat absence seizurs?

A

Sodium valproate or ethosuximide

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132
Q

What may exacerbate absence and myoclonic seizures?

A

Carbamazepine

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133
Q

How can you differentiate between organic and non-organic lower leg weakness?

A

Hoover’s sign of leg paresis (relies upon the concept of synergistic contraction)

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134
Q

How does one perform Hoover’s sign?

A

If a patient is genuinely making an effort, the examiner would feel the ‘normal’ limb pushing downwards against their hand as the patient tries to lift the ‘weak’ leg. Noticing this is indicative of an underlying organic cause of the paresis. If the examiner, however, fails to feel the ‘normal’ limb pushing downwards as the patient tries to raise their ‘weak’ leg, then this is suggestive of an underlying functional weakness, also known as ‘conversion disorder’

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135
Q

How can you classify the way MS presents?

A
  1. Visual
  2. Sensory
  3. Motor
  4. Cerebellar
  5. Others
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136
Q

What are the visual features of MS?

A
  1. Optic neuritis
  2. Optic atrophy
  3. Internuclear ophthalmoplegia
  4. Uhthoff’s phenomenon
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137
Q

What are the sensory features of MS?

A

Pins/needles
Numbness
Trigeminal neuralgia
Lhermitte’s sign

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138
Q

What are the motor features of MS?

A

Spastic weakness: most commonly seen in the legs

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139
Q

What are the cerebellar features of MS?

A

Ataxia

Tremor

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140
Q

What are the ‘other’ features of MS?

A

Urinary incontinence
Sexual dysfunction
Intellectual dysfunction

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141
Q

What is Lhermitte’s sign?

A

Paraesthesiae in limbs on neck flexion

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142
Q

What is the treatment of status epilepticus?

A
  1. Buccal midazolam/IV lorazepam
  2. IV lorazepam
  3. IV phenytoin (phenobarbital if already on regular phenytoin)
  4. Rapid sequence induction of anaesthesia using thiopental sodium
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143
Q

What is second line treatment for generalised tonic-clonic seizures?

A

Lamotrigine or carbamazepine

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144
Q

What is the inheritance pattern for tuberous sclerosis?

A

Autosomal dominant

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145
Q

How can you classify the features of tuberous sclerosis?

A
  1. Cutaneous
  2. Neurological
  3. Other
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146
Q

What are the cutaneous features of tuberous sclerosis?

A 
1. Ash leaf spots under UV 
2 .Shagreen patch
3. Nose angiofibromas
4. Subungual fibromata
5. Cafe au lait spots
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147
Q

What are the neurological features of tuberous sclerosis?

A
  1. Developmental delay
  2. Epilepsy
  3. Intellectual impairment
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148
Q

What are the ‘other’ features of tuberous sclerosis? x5

A
  1. Retinal hamartomas
  2. Rhabdomyomas of the heart
  3. Gliomatous changes in the brain
  4. Polycystic kidneys
  5. Lymphoangioleiomyomatosis
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149
Q

What nerve may be injured in a Colles’ fracture?

A

Median nerve

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150
Q

What is autonomic dysreflexia?

A

A clinical syndrome which occurs in pts who have had a spinal cord injury at, or above the T6 spinal level, classically characterized by uncontrolled hypertension and bradycardia,

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151
Q

What causes the symptoms of autonomic dysreflexia?

A

AD is triggered by either noxious or non-noxious stimuli, resulting in sympathetic stimulation and hyperactivity.[6] The most common causes include bladder or bowel over-distension, from urinary retention and fecal compaction, respectively.[7] The resulting sympathetic surge transmits through intact peripheral nerves, resulting in systemic vasoconstriction below the level of the spinal cord lesion.[8] The peripheral arterial vasoconstriction and hypertension activates the baroreceptors, resulting in a parasympathetic surge originating in the central nervous system to inhibit the sympathetic outflow; however, the parasympathetic signal is unable to transmit below the level of the spinal cord lesion.[8] This results in bradycardia, vasodilation, flushing, pupillary constriction and nasal stuffiness above the spinal lesion, while there’s piloerection, pale and cool skin below the lesion due to the prevailing sympathetic outflow

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152
Q

How does autonomic dysreflexia present?

A

Extreme hypertension, flushing and sweating above the level of the cord lesion, and agitation. There is NO congruent increase in heart rate.

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153
Q

How can a raised ICP cause a third nerve palsy?

A

Trans-tentorial (uncal) herniation

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154
Q

What are the 4 main features of neuroleptic malignant syndrome?

A
  1. Rigidity
  2. Hyperthermia
  3. Autonomic instability (hypotension, tachycardia)
  4. Altered mental status (confusion)
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155
Q

Why might U&Es be deranged in NMS?

A

It can cause AKI

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156
Q

What blood marker might be raised in NMS?

A

Creatine kinase

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157
Q

What is the management of NMS?

A
  1. Stop antipsychotic
  2. IV fluids to prevent renal failure
  3. Dantrolene
  4. Bromocriptine in selected cases
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158
Q

Where is the lesion in a Wernicke’s dysphasia?

A

Superior temporal gyrus, inferior division of left MCA

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159
Q

Where is the lesion in a conductive dysphasia?

A

Arcuate fasiculus, superior division of the left MCA

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160
Q

Where is the lesion in Broca’s dysphasia?

A

Inferior frontal gyrus

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161
Q

Where is the lesion in a global aphasia?

A

A large lesion affecting Wernicke’s + arcuate fasciculus + Broca’s area resulting in severe expressive and receptive aphasia

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162
Q

What nerve is at risk during shoulder dislocation?

A

Axillary nerve, it winds around the bone at the neck of the humerus

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163
Q

What roots are involved in Klumpke’s paralysis?

A

C8-T1

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164
Q

What roots are involved in Erb’s palsy?

A

C5-6

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165
Q

What does the common peroneal nerve supply?

A

The muscles of the peroneal and anterior compartment o the leg and sensation to the dorsum of the foot

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166
Q

What are 5 features of a common peroneal nerve lesion?

A
  1. weakness of foot dorsiflexion
  2. weakness of foot eversion
  3. weakness of extensor hallucis longus
  4. sensory loss over the dorsum of the foot and the lower lateral part of the leg
  5. wasting of the anterior tibial and peroneal muscles
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167
Q

What is the triad of Wernicke’s encephalopathy?

A

Confusion
Ataxia
Ophthalmoplegia

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168
Q

Why should folate never be given to a pt with a likely B12 deficiency?

A

It can worsen SCDC

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169
Q

What are the 2 main features of Korsakoff’s psychosis?

A
  1. Anterograde amnesia

2. Confabulation

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170
Q

What is the treament for an acute stroke once it is confirmed?

A

Aspirin 300 mg daily for 2 weeks then clopidogrel 75 mg daily long-term. A statin should also be offered.

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171
Q

What muscle does the 4th (trochlear) nerve supply?

A

The superior oblique (depresses eye, moves inwards)

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172
Q

What are the features of a 4th nerve palsy?

A

Vertical diplopia classically noticed when reading book or going down stairs

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173
Q

What is the most common cause of headache in children?

A

Migraine

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174
Q

What is a common trigger for cluster headaches?

A

Alcohol

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175
Q

What is the acute management of a cluster headache?

A

100% oxygen and subcutaneous triptan

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176
Q

What is cluster headache prophylaxis?

A

Verapamil

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177
Q

What are 2 causes of motor–only spinal lesions?

A

ALS and Poliomyelitis

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178
Q

What are 6 causes of combined motor-sensory spinal lesions?

A
  1. Brown-Sequard
  2. SCDC
  3. Friedrich’s ataxia
  4. Anterior spinal artery occlusion
  5. Syringomyelia
  6. MS
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179
Q

What is a cause of a sensory-only spinal lesion?

A

Tabes dorsalis

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180
Q

What is the MOA of memantine?

A

NMDA antagonist

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181
Q

What is the MOA of donepezil?

A

Cholinesterase inhibitor

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182
Q

Where would the lesion lie for an incongruous visual field defect?

A

Optic tract lesion

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183
Q

Where would the lesion lie for a congruous visual field defect?

A

Optic radiation lesion or occipital cortex

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184
Q

What is the mnemonic to help you remember the site of a homonymous quadrantanopia?

A

PITS

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185
Q

Where is the seizure if there is lip smacking and post-ictal dysphasia?

A

Temporal lobe

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186
Q

What are the features of a temporal lobe seizure?

A

HEAD

  1. Hallucinations = auditory/gustatory/olfactory
  2. Epigastric rising/emotional
  3. Automatisms = lip smacking/grabbing/plucking
  4. Deja vu/Dysphasie post-ctal
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187
Q

What are the features of a frontal lobe seizure?

A

Motor

  1. Head/leg movements
  2. Posturing
  3. Post-ictal weakness
  4. Jacksonian march
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188
Q

What are the features of a parietal lobe seizure?

A

Sensory = Paraesthesia

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189
Q

What are the features of an occipital lobe seizure?

A

Visual = Floaters/flashes

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190
Q

What is ROSIER an acronym for?

A

Recognition of Stroke in the Emergency Room

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191
Q

What is used to treat cerebral oedema in patients with brain tumours?

A

Dexamethasone

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192
Q

`What classically presents with a cape-like loss of pain and temperature sensation and why?

A

Syringomyelia, due to compression of the spinothalamic tract fibres decussating in the anterior white commissure of the spine

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193
Q

What is syringomyelia?

A

A collection of CSF within the spinal cord

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194
Q

What is syringobulbia?

A

A fluid filled cavity within the medulla of the brainstem

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195
Q

What are causes of a syringomyelia?

A
  1. Chiari malformation
  2. Trauma
  3. Tumours
  4. Idiopathic
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196
Q

How can you treat a persistent/symptomatic syrinx?

A

A shunt can be placed into the syrinx

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197
Q

Why is the COCP c/i for migraine?

A

Significantly increased risk of ischaemic stroke

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198
Q

What investigation should be performed in those under 55 with no obvious cause of a stroke?

A

Thrombophilia and autoimmune screening

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199
Q

What causes gait ataxia?

A

A cerebellar vermis lesion

200
Q

What causes finger-nose ataxia?

A

Cerebellar hemisphere lesions

201
Q

What can be given for migraine prophylaxis?

A

Propranolol or topiramate (propranolol preferable in women of childbearing age)

202
Q

Which type of NF are axillary freckles indicative of?

203
Q

What is NF1 also known as?

A

Von Recklinghausen’s syndrome

204
Q

Which is more common, NF1 or 2?

A 
NF1 = 1/4000
NF2 = 1/100,000
205
Q

Where is the mutation in NF1?

206
Q

What is the mutation in NF2?

207
Q

What condition are subungual fibromata associated with?

A

Tuberous sclerosis

208
Q

Finger abduction weakness - which nerve root is affected?

209
Q

What is a clue that a Parkinsonian tremor is drug-induced?

A

It is symmetrical

210
Q

How can you classify the causes of hearing loss in children?

A

Conductive and sensorineural

211
Q

What are the most common causes of conductive hearing loss in children?

A
  1. Secretory otitis media

2. Down’s syndrome

212
Q

What are the most common causes of sensorineural hearing loss in children?

A
  1. Hereditary = Pendred syndrome
  2. Infective = Rubella, meningitis
  3. Traumatic = head injury
  4. Cerebral palsy
  5. Perinatal insult
213
Q

What are the common migraine triggers?

A 
CHOCOLATE
Chocolate
Hangovers
Orgasms
Cheese/caffeine
Oral contraceptives
Lie-ins
Alcohol
Travel
Exercise
214
Q

What are the surgical causes of a 3rd nerve palsy?

A

4 Cs

  1. Posterior communicating artery aneurysm
  2. Cancer
  3. Cerebral uncal herniation
  4. Cavernous sinus thrombosis
215
Q

What are the medical causes of a 3rd nerve palsy?

A

4 Ms

  1. Mellitus
  2. MS
  3. Midbrain infarct
  4. Migraines
216
Q

What are the possible arteries that can be occluded thus causing a cerebellar stroke?

A
  1. Superior cerebellar artery
  2. Anterior inferior cerebellar artery
  3. Posterior inferior cerebellar artery (LMS)
217
Q

What two things must you rule out as a cause of status epilepticus before thinking of other causes?

A

Hypoxia and hypoglycaemia

218
Q

Name 3 conditions that have an association with epilepsy?

A
  1. Cerebral palsy (30% have epilepsy)
  2. Tuberous sclerosis
  3. Mitochondrial diseases
219
Q

What is typical of a benign rolandic epilepsy?

A

Paraesthesia (e.g. unilateral face), usually on waking up

220
Q

What kind of epilepsy is typically found in girls, and has infrequent generalised seizures often in the morning?

A

Juvenile myoclonic epilepsy

221
Q

What 4 things must be considered when managing pts with epilepsy?

A

DOPS

  1. Driving
  2. Other medications/Occupation
  3. Women wishing to get pregnant/contraception
  4. SUDEP
222
Q

What is the MOA of sodium valproate?

A

Increases GABA activity

223
Q

What are 3 s/e of sodium valproate?

A
  1. Increased appetite and weight gain
  2. Alopecia
  3. P450 enzyme inhibitor
224
Q

What is the MOA of carbamazepine?

A

Binds to Na channels and increases their refractory period

225
Q

What are 3 s/e of carbamazepine?

A
  1. P450 enzyme inducer
  2. SIADH
  3. Leucopenia and agranulocytosis
226
Q

What is the MOA of lamotrigine?

A

Na channel blocker

227
Q

What is a s/e of lamotrigine?

A

Stevens-Johnson Syndrome

228
Q

What is the MOA of phenytion?

A

Binds to sodium channels increasing their refractory period

229
Q

What are 3 s/e of phenytoin?

A
  1. P450 enzyme inducer
  2. Gingival hyperplasia
  3. Peripheral neuropathy
230
Q

What is the treatment for an acute relapse of MS?

A

High dose steroids e.g. oral/IV methylprednisolone may be given for 5 days to reduce the length of an acute relapse

231
Q

What is a disease-modifying drug that can be given for MS?

A
  1. Beta interferon (reduce relapse rate)

2. Natalizumab (anti a4 integrin mAb)

232
Q

What are first line treatments for spasticity in MS?

A

Baclofen and gabapentin

233
Q

What is the first line treatment of oscillopsia in MS?

A

Gabapentin

234
Q

What are the first line investigations for pts with a suspected vestibular schwannoma?

A

Audiogram and gadolinium-enhanced MRI scan of the CPA

235
Q

Papilloedema and diplopia when asked to look laterally - which nerve is affected and why?

A

Abducens nerve, as the long intracranial course of this nerve makes it susceptible to damage early in the course of raised ICP

236
Q

What causes RAPD?

A

Damage to the optic nerve or severe retinal disease

237
Q

Where does the olfactory nerve pass through?

A

The cribriform plate

238
Q

Where does the optic nerve pass through?

A

The optic canal

239
Q

Where does the oculomotor nerve pass through?

A

Superior orbital fissure

240
Q

What are the functions of the oculomotor nerve?

A

EPEA

  1. Eye movement
  2. Pupil constriction
  3. Accomodation
  4. Eyelid opening
241
Q

What muscles are supplied by the oculomotor nerve?

A

Medial rectus
Inferior oblique
Superior rectus
Inferior rectus

242
Q

What does 3rd nerve palsy result in?

A
  1. Ptosis
  2. Down and out
  3. Dilated, fixed pupil
243
Q

What does the trochlear nerve pass through?

A

Superior orbital fissure

244
Q

What does a 4th nerve palsy result in?

A

Defective downward gaze –> vertical diplopia

245
Q

What is the trigeminal nerve responsible for?

A
  1. Facial sensation

2. Mastication

246
Q

What may a lesion to the trigeminal nerve result in?

A
  1. Trigeminal neuralgia
  2. Loss of corneal reflex (afferent)
  3. Loss of facial sensation
  4. Paralysis of mastication muscles
  5. Deviation of jaw to weak side
247
Q

Where do the branches of the trigeminal nerve pass through>

A 
V1 = Superior orbital fissure
V2 = Foramen rotundum 
V3 = Foramen ovale
248
Q

Where does the Abducens nerve pass through?

A

Superior orbital fissure

249
Q

What muscle does the abducens nerve supply?

A

Lateral rectus

250
Q

What is the facial nerve responsible for?

A
  1. Facial movement
  2. Taste (anterior 2/3rd of tongue)
  3. Lacrimation
  4. Salivation
251
Q

Where does the facial nerve pass through?

A

The internal auditory meatus

252
Q

What may a facial nerve palsy result in?

A
  1. Flaccid paralysis of upper and lower face
  2. Loss of corneal reflex (efferent)
  3. Loss of taste
  4. Hyperacusis
253
Q

Where does the vestibulocochlear nerve pass through?

A

The internal auditory meatus

254
Q

What may damage to the vestibulocochlear nerve result in?

A
  1. Hearing loss
  2. Vertigo
  3. Nystagmus
255
Q

Where does the glossopharyngeal nerve pass through?

A

Jugular foramen

256
Q

What is the glossopharyngeal nerve responsible for?

A
  1. Taste (posterior 13rd of tongue)
  2. Salivation
  3. Swallowing
  4. Mediated input from carotid body and sinus
257
Q

What may a lesion to the glossopharyngeal nerve result in?

A
  1. Hypersensitive carotid sinus reflex

2. Loss of gag reflex (afferent)

258
Q

Where does the vagus nerve pass through?

A

Jugular foramen

259
Q

What is the vagus nerve responsible for?

A
  1. Phonation
  2. Swalling
  3. Innervates viscera
260
Q

What may a lesion to the vagus nerve result in?

A
  1. Uvula deviates away from site of lesion

2. Loss of gag reflex (efferent)

261
Q

Where does the accessory nerve pass through?

A

Jugular foramen

262
Q

What is the accessory nerve responsible for?

A

Head and shoulder movement

263
Q

What may a lesion to the accessory nerve cause?

A

Weakness in turning head to the contralateral side

264
Q

Where does the hypoglossal nerve pass through?

A

Hypoglossal canal

265
Q

What would a lesion to the hypoglossal nerve result in?

A

Tongue deviates towards the side of the lesion

266
Q

Where are the cranial nerve nuclei located?

A 
Midbrain = 1-4
Pons = 5-8
Medulla = 9-12
267
Q

What are the nerves that control the corneal reflex?

A 
Afferent = Ophthalmic nerve (V1)
Efferent = Facial nerve
268
Q

What are the nerves that control the jaw jerk?

A

Afferent and efferent = Mandibular nerve (V3)

269
Q

What are the nerves that control the gag reflex?

A 
Afferent = Glossopharyngeal
Efferent = Vagus
270
Q

What are the nerves that control the carotid sinus?

A 
Afferent = Glossopharyngeal
Efferent = Vagus
271
Q

What are the nerves that control the pupillary reflex?

A 
Afferent = Optic nerve 
Efferent = Oculomotor nerve
272
Q

What are the nerves that control lacrimation?

A 
Afferent = ophthalmic nerve (V1)
Efferent = Facial nerve
273
Q

What does a combination of liver and neurological disease point towards?

A

Wilsons disease

274
Q

How is haemochromatosis transmitted?

A

Autosomal recessive

275
Q

What is the investigation of choice for PSC?

276
Q

What do you see on liver biopsy with PSC?

A

Onion skin fibrosis

277
Q

What is the investigation of choice for an anal fistula?

A

MRI pelvis

278
Q

What are 4 types of fistula?

A
  1. Enterocutaneous
  2. Enteroenteric/enterocolic
  3. Enterovaginal
  4. Enterovesicular
279
Q

What is the pathophysiology of pernicious anaemia?

A

Autoimmune destruction of gastroparietal cells

280
Q

What blood group is Pernicious Anaemia more common in?

A

Blood Group A

281
Q

How does one manage Pernicious Anaemia?

A

3 monthly injection of Vitamin B12

282
Q

What is the annual incidence of HCC in pts with liver cirrhosis secondary to Hep C?

283
Q

What is the most sensitive and specific lab finding for dx of liver cirrhosis in those with chronic liver disease?

A

Thrombocytopenia

284
Q

What is the AST:ALT ratio like in pts with cirrhosis?

285
Q

What disease is characterised by a PTEN mutation and intestinal hamartomas?

A

Cowden disease

286
Q

What condition is characterised by multiple intestinal hamartomas and pigmentation spots around the mouth?

A

Peutz-Jeghers

287
Q

What condition is most likely causative of right sided colonic cancers occurring at a young age?

A

Lynch syndrome

288
Q

What is a lemon tinge to the skin associated with?

A

Pernicious anaemia

289
Q

What is a characteristic biochemical sign in patients at risk of refeeding syndrome?

A

Hypophosphataemia

290
Q

What are 3 electrolyte abnormalities associated with refeeding syndrome?

A

HYPO magenesaemia, kalaemia and phosphataemia

291
Q

How does Budd-Chiari syndrome present?

A

Triad of:

  1. Sudden onset abdominal pain
  2. Ascites
  3. Tender hepatomegaly
292
Q

What are 4 causes of Budd-Chiari syndrome?

A
  1. Polycythaemia Rubra Vera
  2. Thrombophilia
  3. Pregnancy
  4. OCP
293
Q

What is the investigation of choice for Budd-Chiari?

A

US with Doppler flow

294
Q

What are 4 complications of H. pylori?

A
  1. Peptic ulcer disease
  2. Gastric cancer
  3. B cell lymphoma of MALT tissue
  4. Atrophic gastritis
295
Q

What is the management of H. pylori?

A

Triple therapy with

  1. PPI + Amoxicillin + Clarithromycin
  2. PPI + Metronidazole + Clarithromycin
296
Q

What is the MOA of loperamide?

A

Reduction in gastric motility through stimulation of opioid receptors

297
Q

What is Sister Mary Joseph’s node?

A

A palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen

298
Q

What is Peabody’s sign?

A

Found in pts with DVT, calf muscle spasm occurring on elevation and foot extension of the affected leg

299
Q

What is the most common inheritable form of colorectal cancer?

300
Q

What is the second most common inheritable form of colorectal cancer?

301
Q

What drugs can cause acute pancreatitis?

A
  1. Azathioprine
  2. Mesalazine
  3. Bendroflumethiazide
  4. Furosemide
  5. Steroids
  6. Sodium valproate
302
Q

How can IBS be diagnosed?

A

ABC for 6 months:

  1. abdominal pain, and/or
  2. bloating, and/or
  3. change in bowel habit

Abdominal pain relieved by defecation or associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms:
1. altered stool passage (straining, urgency, incomplete evacuation)
2. abdominal bloating (more common in women than men)
3. distension, tension or hardness
4. symptoms made worse by eating
passage of mucus

303
Q

What artery is a common source of GI bleeding as a result of peptic ulcer disease?

A

Gastroduodenal artery

304
Q

What pain medication should be stopped during C. diff infections?

A

Opioids (they are anti-motility and anti-peristaltic, and thus can predispose to toxic megacolon by slowing the clearance of C.diff toxin)

305
Q

What is Wernicke’s encephalopathy?

A

A neuropsychiatric disorder caused by thiamine deficiency which is most commonly seen in alcoholics

306
Q

3 rarer causes of Wernicke’s?

A
  1. Persistent vomiting
  2. Stomach cancer
  3. Dietary deficiency
307
Q

Wernicke’s triad?

A
  1. Ophthalmoplegia/nystagmus
  2. Ataxia
  3. Confusion
308
Q

Wernicke’s encephalopathy pathophysiology?

A

Petechial haemorrhages occur in a variety of structures in the brain, including the mamillary bodies and ventricle walls

309
Q

Atrophy of mamillary bodies?

A

Acute Wernicke’s encephalopathy

310
Q

Ix for Wernicke’s?

A
  1. Decreased RBC transketolase

2. MRI

311
Q

Trigeminal autonomic cephalgia?

A

A grouping of:

  1. Cluster headache
  2. Paroxysmal hemicrania
  3. SUNCT
312
Q

What is SUNCT?

A

Short-lived unilateral neuralgiform headache with conjunctival injection and tearing

313
Q

Paroxysmal hemicrania mx?

A

Indomethacin

314
Q

3 uses of carbamazepine?

A
  1. Epilepsy, esp. partial
  2. Trigeminal neuralgia
  3. Bipolar disorder
315
Q

What is carbamazepine autoinduction?

A

When pts start carbamazepine, they may see a return of seizures after 3-4 weeks of tx

316
Q

Cluster headache acute tx?

A

Subcutaneous sumatriptan + 100% O2 (at least 12L/min)

317
Q

Cluster headache epidemiology?

A

Men (3:1) and smokers

318
Q

Cluster headache prophylaxis?

319
Q

Acute ischaemic stroke presenting within 4.5 hrs mx?

A

Thrombolysis AND thrombectomy (UPDATED NICE GUIDELINES 2019)

  1. Thrombectomy should be offered as soon as possible and within 6 hours of symptom onset, together with intravenous thrombolysis (if within 4.5 hours), to people who have:
  2. Acute ischaemic stroke and confirmed occlusion of the proximal anterior circulation demonstrated by computed tomographic angiography (CTA) or magnetic resonance angiography (MRA)
  3. between 6-24 if there is also the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume
320
Q

How to distinguish drug-induced Parkinsons?

A
  1. Motor sx are generally rapid onset and bilateral

2. Rigidity and rest tremor are uncommon

321
Q

What anaesthetic agent would a myasthenia pt be resistant to?

A

Suxamethonium (is a depolarising neuromuscular blocking drug, NMBD)

322
Q

Myasthenia exacerbators?

A
  1. BBs
  2. Lithium
  3. Phenytoin
  4. Abx = macrolides, gentamicin, quinolones, tetracyclines
323
Q

Characteristic feature of GBS?

A

Progressive weakness of all 4 limbs, classically ascending, but affects proximal muscles earlier than distal

324
Q

GBS Dx?

A
  1. LP (rise in protein with normal WCC, albuminocytologic dissociation, found in 66%)
  2. Nerve conduction studies may be performed
325
Q

MND defn?

A

A neurological condition of unknown cause which can present with both upper and lower motor neuron signs

326
Q

Initial features of MND?

A
  1. Fasciculations
  2. Absence of sensory signs/sx
  3. Mixture of UMN + LMN signs
  4. Wasting of the small hand muscles/tibialis anterior
  5. Doesnt affect external ocular muscles
  6. No cerebellar signs
  7. Abdominal reflexes usually preserved
  8. Sphincter dysfunction, if present, is a late feature
327
Q

MND Dx?

A
  1. Mainly Clinical
  2. Normal nerve conduction studies
  3. MRI to rule out DDx
  4. EMG shows reduced no. APs with increased amplitude
328
Q

Hyperacusis cause?

A

Paralysis of the stapedius muscle due to facial nerve palsy

329
Q

Facial nerve supplies?

A

Face, ear, taste, tear

  1. Facial expression
  2. Nerve to stapedius
  3. Anterior 2/3rds taste
  4. Parasympathetic fibres to lacrimal and salivary glands
330
Q

Causes of bilateral facial nerve palsy?

A
  1. Sarcoidosis (Inflammatory)
  2. Guillain Barre Syndrome (Inflammatory)
  3. Lyme disease (infectious)
  4. Bilateral acoustic neuromas (NF2) (Malignancyish)
  5. Bell’s Palsy (Idiopathic)
331
Q

Classification of unilateral facial nerve palsy?

A
  1. UMN = e.g. stroke

2. LMN

332
Q

LMN causes of unilateral facial nerve palsy?

A
  1. Infection = Ramsay-Hunt (Zoster), HIV
  2. Inflammation = MS
  3. Malignancyish = Acoustic neuroma, parotid tumour
  4. Metabolic = DM
333
Q

First line tx for trigeminal neuralgia?

A

Carbamazepine

334
Q

von Recklinghausen’s?

335
Q

NF1 features?

A
  1. Cafe au lait spote >=6, 15mm in diameter
  2. Axillary/groin freckling
  3. Peripheral neurofibromas
  4. Iris hamartomas (Lisch nodules)
  5. Scoliosis
  6. Phaeochromocytoma
336
Q

NF2 features?

A
  1. Bilateral vestibular schwannomas

2. Multiple intracranial schwannomas, meningiomas and ependymomas

337
Q

3 similar fx b/w NF and TS?

A
  1. Neurocutaneous disorders
  2. AD
  3. Ocular hamartomas
338
Q

Widespread convulsions without conscious impairment?

A

Pseudoseizure (psychogenic non-epileptic seizure)

339
Q

Head trauma and biconvex mass/lentiform mass on CT?

A

Extradural haemorrhage

340
Q

Lucid interval?

A

Extradural haemorrhage

341
Q

Crescent-shaped CT head?

A

Subdural haemorrhage

342
Q

Why do you get a fixed and dilated pupil with an extradural haemorrhage?

A

As the haematoma expands the uncus of the temporal lobe herniates around the tentorium cerebelli and the patient develops a fixed and dilated pupil due to the compression of the parasympathetic fibers of the third cranial nerve.

343
Q

Neuropathic pain defn?

A

Pain which arises following damage or disruption of the nervous system

344
Q

4 examples of neuropathic pain?

A
  1. Diabetic neuropathy
  2. Post-herpetic neuralgia
  3. Trigeminal neuralgia
  4. Prolapsed intervertebral disc
345
Q

Neuropathic pain mx?

A
  1. Amitryptiline, Duloxetine, Gabapentin, Pregabalin

2. If one of the drugs doesnt work, try one of the other 3

346
Q

Localised neuropathic pain mx>

A

Capsaicin cream for e.g. post-herpetic neuralgia

347
Q

Anti-emetic for Parkinsons?

A

Domperidone

348
Q

1st line tx of absence seizures?

A

Sodium valproate and ethosuximide

349
Q

Most common presentation of MS?

A

Optic neuritis

350
Q

Features of MS?

A
  1. Visual = optic neuritis, optic atropy, Uhthoff’s phenomenon, internuclear opthalmoplegia
  2. Sensory = pins/needles, numbness, trigeminal neuralgia, Lhermitte’s phenomenon
  3. Motor = spastic weakness, most commonly seen in legs
  4. Cerebellar = ataxia, tremor
  5. Others = urinary incontinence, sexual dysfunction, intellectual dysfunction
351
Q

TS features?

A
  1. Neurocutaneous
  2. Neurological
  3. Eye
  4. Heart
  5. Lungs
  6. Kidneys
352
Q

TS neurocutaneous features?

A
  1. Depigmented ‘ash leaf’ spots which fluoresce under UV light
  2. Shagreen patch (roughened skin over lumbar spine)
  3. Adenoma sebaceum (angiofibromas) over nose
  4. Subungual fibromata
  5. Cafe au lait spots
353
Q

TS neurological features?

A
  1. Development delay
  2. Seizures
  3. Intellectual impairment
354
Q

Tuberous sclerosis eye, heart, lungs and kidney signs?

A
  1. Eye = retinal hamartomas
  2. Heart = rhabdomyomas
  3. Lungs = lymphangioleiomyomatosis (multiple lung cysts)
  4. Renal = polycystic kidneys, renal angiomyolipomata
355
Q

Lhermitte’s sign pathophysiology?

A

Disease near the dorsal column nuclei of the cervical cord

356
Q

3 causes of Lhermitte’s sign?

A
  1. MS
  2. SCDSC
  3. Cervical stenosis
357
Q

Neuroleptic malignant syndrome bloods?

A

Raised creatine kinase and WCC

358
Q

NMS pathophysiology?

A

Dopamine blockade induced by antipsychotics triggers massive glutamate release and subsequent neurotoxicity and muscle damage.

359
Q

Typical fx of NMS?

A
  1. Pyrexia
  2. Muscle rigidity
  3. Autonomic lability (HTN, tachycardia, tachypnoea)
  4. Agitated delirium with confusion
360
Q

NMS Mx?

A
  1. Stop antipsychotic
  2. IV fluid to prevent AKI
  3. Dantrolene
361
Q

Dantrolene MOA?

A

Decreasing excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, and decreasing the release of calcium from the sarcoplasmic reticulum

362
Q

Mx of severe serotonin syndrome?

A
  1. Cyproheptadine

2. Chlorpromazine

363
Q

Epilepsy classification?

A
  1. Where seizures begin in the brain
  2. Level of awareness
  3. Other features of seizure
364
Q

Classification of phenytoin s/e?

A
  1. Acute = diplopia, nystagmus, ataxia
  2. Chronic = megaloblastic anaemia, peripheral neuropathy, gingival hyperplasia
  3. Idiosyncratic = fever, rash, hepatitis
  4. Teratogenic = cleft palate and congenital heart disease
365
Q

Ataxia, urinary incontinence, dementia?

A

Normal pressure hydrocephalus

366
Q

Normal pressure hydrocephalus cause?

A

Secondary to reduced CSF absorption at the arachnoid villi, secondary to:

  1. Head injury
  2. Subarachnoid haemorrhage
  3. Meningitis
367
Q

Mx of normal pressure hydrocephalus?

368
Q

3 s/e of VP sunts?

A
  1. Seizures
  2. Infection
  3. Intracerebral haemorrhage
369
Q

Dementia associated with MND?

370
Q

Subdural haemorrhage pathophysiology?

A

Damage to bridging veins between the cortex and venous sinuses

371
Q

Classification of subdural haemorrhage?

A
  1. Acute
  2. Subacute
  3. Chronic
372
Q

Wide based gait with loss of heel to toe walking?

A

Ataxic gait

373
Q

Ataxia anatomical location for peripheral and gait ataxia?

A
  1. Peripheral = cerebellar hemisphere

2. Gait = cerebellar vermis

374
Q

Classification of peripheral neuropathy?

A
  1. Predominantly motor loss

2. Predominantly sensory loss

375
Q

Predominantly motor neuropathy causes?

A
  1. GBS
  2. Porphyria
  3. Lead poisoning
  4. HSMN e.g. CMT
  5. Diptheria
  6. Chronic inflammatory demyelinating polyneuropathy
376
Q

Predominantly sensory neuropathy causes?

A
  1. Diabetes
  2. Uraemia
  3. Alcoholism
  4. Vit B 12 deficincy
  5. Leprosy
  6. Amyloidosis
377
Q

Blood test ut differentiate b/w true and pseudoseizure?

A

Prolactin is raised after a true seizure (spread of electrical activity to the ventromedial hypothalamus, leading to release of a specific prolactin regulator into the hypophyseal portal system)

378
Q

Chemo anti-emetic?

A

Ondansetron

379
Q

GI anti-emetic?

A

Metoclopramide

380
Q

Intracranial raised ICP anti-emetic?

A

Haloperidol

381
Q

Vestibular anti-emetic?

A

Prochlorperazine

382
Q

Interossei muscle supply?

A

Ulnar nerve

383
Q

Extension of fingers supply?

A

Radial nerve

384
Q

DCM neuro meaning?

A

Degenerative cervical neuropathy

385
Q

Hoffman’s sign?

A

Reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.

386
Q

Cerebral venous sinus thrombosis Ix?

A

MR Venogram

387
Q

First line tx of parkinsons?

A
  1. Motor symptoms affecting QOL = levodopa
  2. Motor symptoms not affecting QOL = DA agonist/levodopa/MAO-B inhibitor
  3. If still sx despite tx/dyskinesia develops –> add DA agoinist/MAO-Bi/COMTi
388
Q

3 s/e of parkinsons medications?

A
  1. Excessive sleepiness
  2. Hallucinations
  3. Impulse control disorders
389
Q

Mx of drooling in Parkinsons?

A

Glycopyrronium bromide

390
Q

Levodopa usually combined with?

A

Carbidopa (decarboxylase inhibitor)

391
Q

MAO-Bi example?

A

Selegiline

392
Q

COMT examples?

A
  1. Entecapone

2. Tolcapone

393
Q

4 classic MS RFs?

A
  1. Smoking
  2. Previous infectious mononucleosis
  3. Genetics
  4. Hypovitaminosis D
394
Q

Most common cause of titubation?

A

Essential tremor

395
Q

Mx of essential tremor?

A
  1. Propranolol 1st line

2. Primidone sometimes used

396
Q

Migraine acute tx vs. prophylaxis?

A
  1. Acute tx = 5-HT receptor agonists

2. Prophylaxis = 5-HT receptor antagonists

397
Q

Migraine acute tx?

A
  1. Oral triptan and NSAID OR

2. Oral triptan and paracetamol

398
Q

What is jacksonian movement?

A

Clonic movements travelling proximally

399
Q

Jacksonian march epilepsy type?

A

Frontal lobe epilepsy

400
Q

Aura, lip smacking, clothes plucking?

A

Temporal lobe epilepsy

401
Q

Temporal lobe epilepsy features?

A

HEAD

  1. Hallucinations (auditory/gustatory/olfactory)
  2. Epigastric rising/emotional
  3. Automatisms (lip smacking/gabbing/plucking)
  4. Deja vu/dysphasia post-ictal
402
Q

Paraesthesia epilepsy type?

A

Parietal lobe

403
Q

Can DCM be diagnosed by Cervical X-ray?

404
Q

What is DCM?

A

Spinal cord compression due to degenerative changes of the surrounding spinal structures; e.g. from disc herniation, ligament hypertrophy or calcification, or osteophytes

405
Q

Causes of postural hypotension with compensatory tachycardia?

A

4Ds

  1. Deconditioning
  2. Dysfunctional heart (AS)
  3. Dehydration, dialysis
  4. Drugs
406
Q

Commonest neurological manifestation of sarcoid?

A

Facial nerve palsy

407
Q

HSMN types?

A
  1. HSMN Type I = demyelinating pathology

2. HSMN Type II = axonal pathology

408
Q

Syringomyelia defn?

A

A collection of CSF within the spinal cord

409
Q

4 causes of syringomyelia?

A
  1. Chiari malformation
  2. Trauma
  3. Tumours
  4. Idiopathic
410
Q

‘Cape-like’ (neck and arms) loss of sensation to temperature but preservation of light touch, proprioception and vibration?

A

Syringomyelia

411
Q

Mx of myasthenia?

A
  1. Long acting anticholinesterase inhibitors e.g. pyridostigmine
  2. Immunnosuppression e.g. prednisolone initially
  3. Thymectomy
412
Q

Mx of myasthenic crisis?

A
  1. Plasmapharesis

2. IVIG

413
Q

A differential for unilateral deafness/tinnitus?

A

Acoustic neuroma

414
Q

4 Rfs for idiopathic intracranial HTN?

A
  1. Obesity
  2. Female
  3. Pregnancy
  4. Drugs = OCP, steroids, tetracycline, Vitamin A, lithium
415
Q

Mx of IIH?

A
  1. Conservative = weight loss
  2. Medical = diuretics (acetazolamide), topramate
  3. Surgical = repeated LP, LP/VP shunt
416
Q

Mx of TIA?

A
  1. 300mg aspirin immediately if presenting w/in 7 days of a clinically suspected TIA
  2. Specialist review w/in 24 hours
417
Q

Carotid endarterectomy indications?

A
  1. Recommend if patient has suffered stroke or TIA in the carotid territory and are not severely disabled
  2. Should only be considered if carotid stenosis > 70% according ECST* criteria or > 50% according to NASCET** criteria
418
Q

Weakness of foot dorsiflexion and foot eversion?

A

Common peroneal nerve lesion

419
Q

Headache linked to valsalva manoeuvres is caused by?

A

Raised ICP until proven otherwise

420
Q

Todd’s paresis?

A

Post-ictal weakness, usually due to a focal-onset seizure

421
Q

Diet for children with epilepsy?

A

Ketogenic diet = high fat, low carb, controlled protein

422
Q

IBS diet?

A

FODMAP (Fermentable Oligo-Di-Monosaccharides and Polyols)

423
Q

Generalised seizures first line mx?

A

Sodium valproate

424
Q

Partial seizures first line mx?

A

Carbamazepine

425
Q

Saturday night palsy?

A

Radial nerve palsy

426
Q

FHx of early blindness and tunnel vision?

A

Retinitis pigmentosa

427
Q

Incongruous homonymous hemianopia location?

A

Lesion of optic tract

428
Q

Congruous homonymous hemianopia location?

A

Lesions of optic radiation or occipital cortex

429
Q

Macula sparing homonymous hemianopia location?

A

Lesion of occipital cortex

430
Q

What are the majority of quadrantanopias ‘actually’ caused by?

A

Occipital lobe lesions

431
Q

Adverse effect of Lamotrigine?

A

Stevens Johnson syndrome

432
Q

Bell’s palsy defn?

A

An acute, unilateral, idiopathic facial nerve paralysis

433
Q

Features of Bell’s palsy?

A
  1. LMN facial nerve palsy
  2. Post-auricular pain
  3. Altered taste
  4. Dry eyes
  5. Hyperacusis
434
Q

Bell’s palsy Mx?

A
  1. Prednisolone 1mg/kg for 10 days w/in 72hrs

3. Artificial tears and eye lubricants

435
Q

Brown Sequard syndrome?

A

Lateral hemisection of the spinal cord

436
Q

Brown Sequard syndrome features?

A
  1. Same sided weakness
  2. Same sided proprioception/vibration loss
  3. Contralateral pain/temperature loss
437
Q

HSMN Type I (CMT) inheritance?

438
Q

Cluster headache prophylaxis?

439
Q

Pathophysiology of GBS?

A

Cross reaction of Abs with gangliosides in the peripheral nervous system, anti-GM1 Abs in 25% of pts

440
Q

Miller Fisher syndrome?

A
  1. A variant of Guillain Barre syndrome
  2. Associated with ophthalmoplegia, areflexia, ataxia
  3. Descending paralyss rather than ascending paralysis
  4. Anti-GQ1b Abs present in 90%
441
Q

IIH medication?

A
  1. Acetozolamide, a carbonic anhydrase inhibitor, that reduces the productoin of CSF
  2. Topiramate
442
Q

Mx of haemorrhage following thrombolysis?

A

Stop aspirin and control BP

443
Q

Most common complication following meningitis?

A

Sensorineural hearing loss

444
Q

Complications of meningitis?

A
  1. Sensorineural hearing loss
  2. Neurological = Epilepsy, paralysis
  3. Infective = sepsis, intracerebral abscess
  4. Pressure = brain herniation, hydrocephalus
445
Q

Status epilepticus in hospital with cannula in situ Mx?

A

IV Lorazepam 4mg

446
Q

Bilateral median nerve dysfunction?

A

Degenerative cervical myelopathy

447
Q

MS Ix?

A

Dx requires demonstration of lesions disseminated in time and space

  1. MRI contrast = high signal T2 lesions, periventricular plaques, Dawson fingers (hyperintense lesions perpendicular to the corpus callosum, often seen on FLAIR images)
  2. CSF = oligoclonal bands (and not in serum), increased intrathecal synthesis of IgG
  3. Visual evoked potentials = delayed, but well preserved waveform
448
Q

Pyridostigmine MOA?

A

Long acting anticholinesterase inhibitor

449
Q

4 types of MND?

A
  1. ALS (50%)
  2. Primary lateral sclerosis
  3. Progressive muscular atrophy
  4. Progressive bulbar palsy
450
Q

ALS features?

A
  1. Typically LMN signs in arms and UMN in legs

2. In familial cases, the gene responsible lies on chromosome 21 and codes for superoxide dismutase

451
Q

Primary lateral sclerosis presentation?

A

UMN signs only

452
Q

Progressive muscular atrophy presentation?

A
  1. LMN signs only
  2. Affects distal muscles before proximal
  3. Carries best prognosis
453
Q

Progressive bulbar palsy features?

A
  1. Palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei
  2. Carries worst prognosis
454
Q

CRPS?

A

Complex regional pain syndrome

455
Q

CRPS types?

A
  1. Type I = most common, no demonstrable lesion to a major nerve
  2. Type II = lesion to a major nerve
456
Q

Features of CRPS?

A
  1. Progressive, disproportionate sx to the original injury/surgery
  2. Allodynia
  3. Temp and skin colour changes
  4. Oedema and sweating
  5. Motor dysfunction
457
Q

Diagnostic criteria for CRPS?

A

Budapest Diagnostic Criteria

458
Q

Mx of CRPS?

A
  1. Early physiotherapy
  2. Neuropathic analgesia in-line with NICE guidelines
  3. Specialist mx e.g. pain team is required
459
Q

Parkinsonism with autonomic disturbance (atonic bladder, postural hypotension)?

460
Q

Antiplatelet for secondary prevention following stroke?

A
  1. First line = clopidogrel

2. Second line = aspirin with modified release dipyramidole

461
Q

Most affected movement in adhesive capsulitis?

A

External rotation

462
Q

Mx of MND?

A
  1. Riluzole = prevents stimulation of glutamate receptors, used mainly in ALS, prolongs life by about 3m
  2. Resp care = NIV (usually BiPAP) used a tnight, survival benefit of around 7 months
463
Q

When to consider stopping AEDs?

A

Can be considered if seizure free for > 2 years, with AEDs being stopped over 2-3 months

464
Q

Third nerve palsy with dilated pupil?

A

‘Surgical’ third nerve palsy

465
Q

NIHSS?

A

National Institutes of Health Stroke Scale, used to measure impairment caused by stroke

466
Q

2 types of ischaemic stroke?

A

Thrombotic or embolic

467
Q

2 types of haemorrhagic stroke?

A
  1. Intracerebral (bleeding within the brain)

2. Subarachnoid (bleeding on the surface of the brain)

468
Q

4 RFs for haemorrhagic stroke?

A
  1. Age
  2. HTN
  3. AVM
  4. Anticoagulation therapy
469
Q

Subacute combined degeneration of the spinal cord defn?

A

Degeneration of the posterior and lateral columns of the spinal cord, often due to vitamin B12 deficiency.

  1. Damage to the posterior columns - loss of proprioception, light touch and vibration sense (sensory ataxia and a positive Romberg’s test).
  2. Damage to lateral columns - spastic weakness and upgoing plantars (UMN signs).
  3. Damage to peripheral nerves - absent ankle and knee jerks (LMN signs).
470
Q

Arnold Chiari malformation?

A

Cerebellar tonsils herniating through the foramen magnum, can be congenital or acquired (trauma)

471
Q

Syringomyelia sensory loss pathophysiology?

A

It occurs within the cervical and thoracic segments and causes compression of the spinothalamic tracts decussating in the anterior white commissure. This results in dissociative loss of sensation of pain, temperature and non-discriminative touch. There is classically a ‘cape-like’ distribution of this sensory loss.

472
Q

What is spontaneous intracranial hypotension?

A

Spontaneous intracranial hypotension is a very rare cause of headaches that results from a CSF leak. The leak is typically from the thoracic nerve root sleeves.

473
Q

RF for spontaneous intracranial hypotension?

A

Marfan’s

474
Q

Features of spontaneous intracranial hypotension?

A

Headache worse when upright

475
Q

Ix of spontaneous intracranial hypotension?

A

MRI with gadolinium = typically shows pachymeningeal enhancement

476
Q

Mx of spontaneous intracranial hypotension?

A
  1. Usually conservative

2. If this fails, an epidural blood patch may be tried

477
Q

What monitoring is required when starting a phenytoin infusion for status?

A

Cardiac monitoring due to pro-arrhythmogenic effects

478
Q

RLS?

A

Restless legs syndrome

479
Q

Restless legs syndrome definition?

A

A syndrome of spontaneous, continuous lower limb movements that may be associated with paraesthesia

480
Q

Features of RLS?

A
  1. Akathisia of legs
  2. Paraesthesias
  3. Movements during sleep e.g. PLMS = periodic limb movements of sleep
481
Q

5 causes of restless legs syndrome?

A
  1. FHx
  2. IDA
  3. Uraemia
  4. DM
  5. Pregnancy
482
Q

Mx of restless legs syndrome?

A
  1. Conservative = walking, stretching, massaging affected limbs
  2. Medical = Tx IDA, DA agonist (e.g. ropinirole 1st line), Benzos, gabapentin
483
Q

Weakness of foot dorsiflexion and foot eversion?

A

Common peroneal nerve lesion

484
Q

Cerebral perfusion pressure eqn?

A

CPP = Mean arterial pressure - intracranial pressure

485
Q

Fluid coming out of nose, how to test if it is CSF?

A

Test for glucose (present in CSF, not present in mucus)

486
Q

What is cataplexy?

A
  1. The sudden and transient loss of muscular tone causes by strong emotion (e.g. laughter, fear)
  2. Around 2/3rd with narcolepsy have cataplexy
  3. Features range from buckling knees to collapse
487
Q

Shaft of humerus fracture, what nerve is damaged?

A

Radial nerve

488
Q

Sinusitis + focal neurology and fever?

A

Brain abscess

489
Q

Ptosis + dilated pupil?

A

3rd nerve palsy

490
Q

Ptosis + constricted pupil?

A

Horner’s

491
Q

Primary open angle glaucoma visual field loss?

A

Unilateral peripheral visual field loss

492
Q

Anti-Mi-2 antibodies?

A

Dermatomyositis

493
Q

LEMS?

A

Lambert Eaton Myasthenic Syndrome

494
Q

LEMS Abs?

A

VG-Calcium channel Abs

495
Q

Painful 3rd nerve palsy?

A

Posterior communicating artery aneurysm

496
Q

Rescue therapy for exacerbations of neuropathic pain?

497
Q

Imaging finding of normal pressure hydrocephalus?

A

Hydrocephalus with an enlarged 4th ventricle

Medicine and Surgery Mushkies (52 decks)

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