Passmed Neurology mushkies Flashcards
1
Q
What causes a bitemporal hemianopia?
A
- Lesion of the optic chiasm
- Upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
- Lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
2
Q
What would cause a left homonymous hemianopia?
A
Lesion of the right optic tract
3
Q
What would cause homonymous quadrantanopia?
A
PITS
Parietal = inferior lesion
Temporal = superior lesion
4
Q
What innervates the adductor pollicis?
A
The ulnar nerve
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
6
Q
How does radial nerve palsy present?
A
Wrist drop and loss of sensation from 1st dorsal web space
7
Q
How does musculocutaneous nerve palsy present?
A
Reduced flexion at elbow and loss of supination
8
Q
How does axillary nerve palsy present?
A
Wastage of deltoid muscles and loss of sensation from badge area
9
Q
What are the 4 primitive reflexes?
A
Moro
Grasp
Rooting
Stepping
10
Q
When do the primitive reflexes disappear?
A
All at 4 months except for stepping which disappears at 2 months
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
- Lumbar spinal canal stenosis
2. Claudication
12
Q
What muscles are supplied by the median nerve?
A
LOAF Lateral lumbricals Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis
13
Q
What are two tests for carpal tunnel syndrome?
A
Tinnels test and Phalens test
14
Q
What is a cause of loss of fine motor function in both upper limbs?
A
Degenerative cervical myelopathy
15
Q
What is a modifiable risk factor for degenerative cervical myelopathy?
A
Smoking
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
17
Q
What percentage of Alzheimer’s pts also have Lewy bodies?
A
40%
18
Q
What are features of Lewy body dementia?
A
- Progressive cognitive impairment
- Parkinsonism
- Visual hallucinations
19
Q
What can be used to diagnose Lewy body dementia?
A
DaTscan
20
Q
What medications can be used to manage Lewy body dementias?
A
ACh inhibitors (donepezil, rivastigmine) and Memantine
21
Q
Where, geographically, is MS more common?
A
At higher latitudes
22
Q
What are established risk factors associated with MS?
A
- High latitudes (5x more common than in tropics)
- EBV
- Vit D deficiency
- Smoking
23
Q
What are the 3 types of MS?
A
- Relapsing-remitting (85%)
- Primary Progressive (10%)
- Secondary Progressive (from RR)
24
Q
What percentage of pts with RR MS go on to develop secondary progressive disease within 15 years of diagnosis?
A
65%
25
What is the definition for trigeminal neuralgia?
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
26
What are the causes of trigeminal neuralgia?
1. Idiopathic
2. Tumours
3. Vascular
27
What is the first line treatment for trigeminal neuralgia?
Carbamazepine
28
What is the most common neurological sequalae of bacterial meningitis?
Deafness
29
When can anticoagulants for AF be started after an ischaemic stroke?
14 days
30
When should pts with a stroke be commenced on a statin?
If cholesterol >3.5mmol/l
31
When can thrombolysis with alteplase be given for stroke?
If haemorrhage has been excluded and it is administered within 4.5hrs of onset of stroke symptoms
32
What are absolute contrainidications for stroke thrombolysis?
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
33
When should thrombectomy be offered to patients?
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
34
When should a carotid endarterectomy be offered?
If carotid stenosis >70%/50% depending on which criteria you are looking at
35
What is the secondary prevention for stroke?
Clopidogrel + modified released dipyridamole in pts who have had an ischaemic stroke
36
Should dipyridamole be given in the acute treatment of ischaemic stroke?
No, should be given in the chronic setting after 14 day s
37
What are 4 drugs that can be given for post-herpetic neuralgia?
1. Amitryptiline
2. Duloxetine
3. Gabapentin
4. Pregabalin
38
What should be considered if a fall occurs soon after the diagnosis of Parkinson's disesae?
An alternative diagnosis, most likely a Parkinsons plus syndrome such as PSP
39
What is a middle aged adult with insidious onset dementia and personality changes most likely to be?
Pick's disease
40
What is the type of frontotemporal dementia which presents with the inability to produce speech and loss of literacy skills called?
Primary progressive aphasia
41
What are the 3 recognised types of Frontotemporal lobar degeneration?
1. Frontotemporal dementia (Pick's disease)
2. Progressive non-fluent aphasia
3. Semantic dementia
42
What kind of pain may precede paralysis in Bell's palsy?
Post-auricular pain
43
If untreated, what percentage of Bells palsy pts develop moderate to severe weakness?
15%
44
What is the motor component of GCS?
6. Obeys commands
5. Localises to pain
4. Withdraws from pain
3. Abnormal flexion to pain (decorticate)
2. Extension topain (decerebrate)
1. None
45
What is the verbal component of GCS?
5. Orientated
4. Confused
3. Words
2. Sounds
1. None
46
What is the eye component of GCS?
4. Spontaneous
3. To speech
2. To pain
1. None
47
How does a haemorrhagic stroke present?
Suddenly with a thunderclap headache
48
What nerve roots are responsible for the ankle reflex?
S1-2
49
What nerve roots are responsible for the patellar reflex?
L3-4
50
What nerve roots are responsible for the biceps reflex?
C5-6
51
What nerve roots are responsible for the triceps reflex?
C7-8
52
How long must people not drive for after a first unprovoked/isolated seizure?
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
53
For patients with established epilepsy or those with multiple unprovoked seizures, when can they qualify for a driving license?
May qualify for a driving licence if they have been free from any seizure for 12 months
54
What are the driving restrictions for syncope?
1. Simple faint = no restriction
2. Single episode + explained + treated = 4w off
3. Single episode + unexplained = 6m off
4. 2+ episodes = 12m off
55
When can pts drive after a stroke/TIA?
1 month off driving, may not need to inform DVLA if no residual neurological deficit
56
What migraine prophylactic should be stopped in pregnant women due to risk of clift lip/palate?
Topiramate
57
When should migraine prophylaxis be given?
2 or more attacks per month
58
What is first line management of migraines?
Oral triptan and NSAID/paracetamol
59
What is the first line radiological investigation for suspected stroke>
Non-contrast CT head
60
What score can be used to help diagnose a stroke?
The ROSIER score
61
What are the components of the ROSIER score?
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
62
What must be excluded before investigating a possible stroke further?
Hypoglycaemia
63
What ROSIER score suggests a stroke is likely?
>0
64
Which muscular dystrophy presents later?
Becker's muscular dystrophy
65
What is the inheritance pattern of dystrophinopathies?
X-linked recessive
66
What is the function of dystrophin?
Connects the muscle membrane to actin
67
When assessing GCS, should you use the best or worst responses from both sides?
The best responses
68
What are 3 features of normal pressure hydrocephalus?
1. Progressive mental impairment and dementia
2. Difficulty walking
3. Impaired bladder control
69
What are the features of MSA?
1. Parkinsonism
2. Autonomic disturbance (atonic bladder, postural hypotension, erectile dysfunction)
3. Cerebellar signs
70
What are the 2 predominant types of MSA?
1. MSA-P = predominant Parkinsons features
| 2. MSA-C = predominant Cerebellar features
71
What medications are first line for migraine prophylaxis?
Topiramate or propranolol
72
What kind of 5-HT receptor medications are given for acute treatment and then for prophylaxis of migraine?
1. 5-HT receptor agonists = acute treatment (e.g. triptans)
| 2. 5-HT receptor antagonists = prophylaxis (e.g. propranolol or topiramate)
73
What are the most common secondary brain tumours?
1. Lung
2. Breast
3. Kidney
4. Melanoma
5. Colorectal
74
Where are the majority of adult brain tumours located?
Supratentorial
75
Where are the majority of childhood brain tumours located?
Infratentorial
76
What is the commonest primary brain tumour in adults?
Glioblastoma multiforme
77
What is the second most common primary brain tumour in adults?
Meningiomas
78
What structure do meningiomas typically arise from?
Dura mater
79
What do you see with glioblastoma multiforme on histology?
Pleomorphic tumour cells with border necrotic areas
80
What do you see with meningiomas on histology?
Spindle cells in concentric whorls and calcified psammoma bodies
81
What is the most common brain tumour in children?
Pilocytic astrocytoma
82
What do you see on histology of pilocytic astrocytomas?
Rosenthal fibres (corkscrew eosinophilic bundles)
83
What tumours are commonly seen in the 4th ventricle and may cause hydrocephalus?
Ependymomas
84
What brain tumour is associated with vHL?
Haemangioblastoma
85
What is the most common paediatric supratentorial tumour?
Craniopharyngioma
86
Where are craniopharyngiomas derived from?
Remnants of Rathke's pouch
87
What may be seen with a meningioma on MRI that helps idenfity it?
A dural tail where the dura 'connects' to the dura
88
What does glioblastoma multiforme look like on imaging?
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
89
How does a pontine haemorrhage typically present?
Reduced GCS
Quadriplegia
Miosis
Absent horizontal eye movements
90
What are infantile spasms (Wests syndrome)?
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
91
What is first line treatment for Wests syndrome?
Vigabatrin, and ACTH is also used
92
How does an ACA stroke present?
1. Contralateral hemiparesis and sensory loss, legs > arms
93
How does an MCA stroke present?
1. Contralateral hemiparesis and sensory loss, arms > legs
2. Contralateral homonymous hemianopia
3. Aphasia
94
How does a PCA stroke present?
1. Contralateral homonymous hemianopia with macular sparing
| 2. Visual agnosia
95
How does Weber's syndrome present?
1. Ipsilateral CN III palsy
| 2. Contralateral weakness of upper and lower extremities
96
What arteries are affected in Weber's syndrome?
Branches of posterior cerebral artery that supply the midbrain
97
What vessel is affected in lateral medullary syndrome and how does it present?
PICA
1. Ipsilateral facial pain and temperature loss
2. Contralateral limb/torso pain and temperature loss
3. Ataxia, nystagmus
98
What vessel is affected in lateral pontine syndrome and how does it present?
Anterior inferior cerebellar artery
| 1. Ipsilateral facial paralysis and deafness
99
How does occlusion of the retinal/ophthalmic artery present?
Amaurosis fugax
100
How does occlusion of the basilar artery present?
Locked-in syndrome
101
What is Jacksonian march?
Where a simple partial seizure spreads from the distal part of the limb towards the ipsilateral face
102
What are the 3 key features that basic seizure classification is based on?
1. Where seizures begin in the brain
2. Level of awareness during a seizure
3. Other features of seizure
103
Please discuss focal seizures
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
104
Please discuss generalised seizures
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
105
What is the management for a myasthenic crisis?
IVIG and plasma electrophoresis
106
What is the management for neuroleptic malignant syndrome?
Dantrolene and lorazepam
107
What is the management for a thyroid storm crisis?
IV hydrocortisone, propranolol, IV fluids
108
What are some features of myasthenia gravis?
1. Muscle fatiguability
2. Extraocular muscle weakness = diplopia
3. Ptosis
4. Dysphagia
5. Proximal muscle weakness
109
What are 3 associations of myasthenia gravis?
1. Thymic hyperplasia in 50=70%
2. Thymoma in 15%
3. Autoimmune disorder = pernicious anaemia, autoimmune thyroiditis, RA, SLE
110
What are the investigations for myasthenia gravis?
1. Bedside = FEV
2. Bloods = Anti-AchR. Anti-Muscle-specific tyrosine kinase
3. Imaging = CT thorax (thymus)
3. Special = Nerve conduction (EMG). Tensilon test
111
What is the management of myasthenia gravis?
1. Conservative = assess FVC
2. Medical = Steroids slowly increasing dose, steroid-sparing agent, pyridostigmine (long-acting AChesterease inhibitors)
3. Surgical = Thymectomy
112
What nerve injury are mid-shaft humeral fractures associated with?
Radial nerve
113
What is the cause of wrist drop?
Radial nerve palsy
114
What is the MOA of ondansetron?
5-HT3 antagonist that acts in the CTZ of the medulla oblongata
115
What is found in the CSF of pts with MS?
Oligoclocal bands in the CSF of 80% MS patients. Elevated IgG levels is another common finding
116
When should degenerative cervical myelopathy be treated?
Ideally within 6m of diagnosis by neurosurgical services
117
How can you classify peripheral neuropathy?
Predominantly motor loss vs. predominantly sensory loss
118
What are the causes of peripheral neuropathy with a predominantly motor loss? x6
1. GBS
2. Porphyria
3. Lead posoning
4. HSMN e.g. CMT
5. Chronic inflammatory demyelinating polyneuropathy
6. Diphtheria
119
What are the causes of a peripheral neuropathy with a predominantly sensory loss? x6
1. DM
2. Vit B12 deficiency
3. Alcoholism
4. Uraemia
5. Leprosy
6. Amyloidosis
120
What part of the spinal column is typically affected first by SCDC?
Dorsal columns
121
What are the diagnostic criteria for migraine?
```
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
```
122
What are some possible aura symptoms?
1. Motor weakness
2. Double vision
3. Visual symptoms affecting only one eye
4. Poor balance
5. Decreased level of consciousness
123
What are 5 causes of foot drop?
1. L5 radiculopathy
2. Sciatic nerve lesion
3. Common peroneal nerve lesion
4. Superficial/deep peroneal nerve lesion
5. Central e.g. stroke
124
What is the most common cause of a foot drop?
Common peroneal nerve lesion (often secondary to compression at the neck of the fibula)
125
What else other than the hands can essential tremor affect?
The vocal chords
126
What is the 1st line drug in the management of ocular myasthenia gravis?
Pyridostigmine
127
What kind of medication should be avoided in pts with Lewy body dementia and why?
Neuroleptics e.g. haloperidol as it may cause irreversible parkinsonism
128
What can be given to treat REM sleep behaviour disturbances in LBD?
Clonazepam 30mins before bedtime
129
What is considered first line treatment for generalised seizures?
Sodium valproate
130
What is considered first line treatment for focal seizures?
Carbamazepine
131
What is used to treat absence seizurs?
Sodium valproate or ethosuximide
132
What may exacerbate absence and myoclonic seizures?
Carbamazepine
133
How can you differentiate between organic and non-organic lower leg weakness?
Hoover's sign of leg paresis (relies upon the concept of synergistic contraction)
134
How does one perform Hoover's sign?
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'
135
How can you classify the way MS presents?
1. Visual
2. Sensory
3. Motor
4. Cerebellar
5. Others
136
What are the visual features of MS?
1. Optic neuritis
2. Optic atrophy
3. Internuclear ophthalmoplegia
4. Uhthoff's phenomenon
137
What are the sensory features of MS?
Pins/needles
Numbness
Trigeminal neuralgia
Lhermitte's sign
138
What are the motor features of MS?
Spastic weakness: most commonly seen in the legs
139
What are the cerebellar features of MS?
Ataxia
| Tremor
140
What are the 'other' features of MS?
Urinary incontinence
Sexual dysfunction
Intellectual dysfunction
141
What is Lhermitte's sign?
Paraesthesiae in limbs on neck flexion
142
What is the treatment of status epilepticus?
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
143
What is second line treatment for generalised tonic-clonic seizures?
Lamotrigine or carbamazepine
144
What is the inheritance pattern for tuberous sclerosis?
Autosomal dominant
145
How can you classify the features of tuberous sclerosis?
1. Cutaneous
2. Neurological
3. Other
146
What are the cutaneous features of tuberous sclerosis?
```
1. Ash leaf spots under UV
2 .Shagreen patch
3. Nose angiofibromas
4. Subungual fibromata
5. Cafe au lait spots
```
147
What are the neurological features of tuberous sclerosis?
1. Developmental delay
2. Epilepsy
3. Intellectual impairment
148
What are the 'other' features of tuberous sclerosis? x5
1. Retinal hamartomas
2. Rhabdomyomas of the heart
3. Gliomatous changes in the brain
4. Polycystic kidneys
5. Lymphoangioleiomyomatosis
149
What nerve may be injured in a Colles' fracture?
Median nerve
150
What is autonomic dysreflexia?
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,
151
What causes the symptoms of autonomic dysreflexia?
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
152
How does autonomic dysreflexia present?
Extreme hypertension, flushing and sweating above the level of the cord lesion, and agitation. There is NO congruent increase in heart rate.
153
How can a raised ICP cause a third nerve palsy?
Trans-tentorial (uncal) herniation
154
What are the 4 main features of neuroleptic malignant syndrome?
1. Rigidity
2. Hyperthermia
3. Autonomic instability (hypotension, tachycardia)
4. Altered mental status (confusion)
155
Why might U&Es be deranged in NMS?
It can cause AKI
156
What blood marker might be raised in NMS?
Creatine kinase
157
What is the management of NMS?
1. Stop antipsychotic
2. IV fluids to prevent renal failure
3. Dantrolene
4. Bromocriptine in selected cases
158
Where is the lesion in a Wernicke's dysphasia?
Superior temporal gyrus, inferior division of left MCA
159
Where is the lesion in a conductive dysphasia?
Arcuate fasiculus, superior division of the left MCA
160
Where is the lesion in Broca's dysphasia?
Inferior frontal gyrus
161
Where is the lesion in a global aphasia?
A large lesion affecting Wernicke's + arcuate fasciculus + Broca's area resulting in severe expressive and receptive aphasia
162
What nerve is at risk during shoulder dislocation?
Axillary nerve, it winds around the bone at the neck of the humerus
163
What roots are involved in Klumpke's paralysis?
C8-T1
164
What roots are involved in Erb's palsy?
C5-6
165
What does the common peroneal nerve supply?
The muscles of the peroneal and anterior compartment o the leg and sensation to the dorsum of the foot
166
What are 5 features of a common peroneal nerve lesion?
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
167
What is the triad of Wernicke's encephalopathy?
Confusion
Ataxia
Ophthalmoplegia
168
Why should folate never be given to a pt with a likely B12 deficiency?
It can worsen SCDC
169
What are the 2 main features of Korsakoff's psychosis?
1. Anterograde amnesia
| 2. Confabulation
170
What is the treament for an acute stroke once it is confirmed?
Aspirin 300 mg daily for 2 weeks then clopidogrel 75 mg daily long-term. A statin should also be offered.
171
What muscle does the 4th (trochlear) nerve supply?
The superior oblique (depresses eye, moves inwards)
172
What are the features of a 4th nerve palsy?
Vertical diplopia classically noticed when reading book or going down stairs
173
What is the most common cause of headache in children?
Migraine
174
What is a common trigger for cluster headaches?
Alcohol
175
What is the acute management of a cluster headache?
100% oxygen and subcutaneous triptan
176
What is cluster headache prophylaxis?
Verapamil
177
What are 2 causes of motor--only spinal lesions?
ALS and Poliomyelitis
178
What are 6 causes of combined motor-sensory spinal lesions?
1. Brown-Sequard
2. SCDC
3. Friedrich's ataxia
4. Anterior spinal artery occlusion
5. Syringomyelia
6. MS
179
What is a cause of a sensory-only spinal lesion?
Tabes dorsalis
180
What is the MOA of memantine?
NMDA antagonist
181
What is the MOA of donepezil?
Cholinesterase inhibitor
182
Where would the lesion lie for an incongruous visual field defect?
Optic tract lesion
183
Where would the lesion lie for a congruous visual field defect?
Optic radiation lesion or occipital cortex
184
What is the mnemonic to help you remember the site of a homonymous quadrantanopia?
PITS
185
Where is the seizure if there is lip smacking and post-ictal dysphasia?
Temporal lobe
186
What are the features of a temporal lobe seizure?
HEAD
1. Hallucinations = auditory/gustatory/olfactory
2. Epigastric rising/emotional
3. Automatisms = lip smacking/grabbing/plucking
4. Deja vu/Dysphasie post-ctal
187
What are the features of a frontal lobe seizure?
Motor
1. Head/leg movements
2. Posturing
3. Post-ictal weakness
4. Jacksonian march
188
What are the features of a parietal lobe seizure?
Sensory = Paraesthesia
189
What are the features of an occipital lobe seizure?
Visual = Floaters/flashes
190
What is ROSIER an acronym for?
Recognition of Stroke in the Emergency Room
191
What is used to treat cerebral oedema in patients with brain tumours?
Dexamethasone
192
`What classically presents with a cape-like loss of pain and temperature sensation and why?
Syringomyelia, due to compression of the spinothalamic tract fibres decussating in the anterior white commissure of the spine
193
What is syringomyelia?
A collection of CSF within the spinal cord
194
What is syringobulbia?
A fluid filled cavity within the medulla of the brainstem
195
What are causes of a syringomyelia?
1. Chiari malformation
2. Trauma
3. Tumours
4. Idiopathic
196
How can you treat a persistent/symptomatic syrinx?
A shunt can be placed into the syrinx
197
Why is the COCP c/i for migraine?
Significantly increased risk of ischaemic stroke
198
What investigation should be performed in those under 55 with no obvious cause of a stroke?
Thrombophilia and autoimmune screening
199
What causes gait ataxia?
A cerebellar vermis lesion
200
What causes finger-nose ataxia?
Cerebellar hemisphere lesions
201
What can be given for migraine prophylaxis?
Propranolol or topiramate (propranolol preferable in women of childbearing age)
202
Which type of NF are axillary freckles indicative of?
NF1
203
What is NF1 also known as?
Von Recklinghausen's syndrome
204
Which is more common, NF1 or 2?
```
NF1 = 1/4000
NF2 = 1/100,000
```
205
Where is the mutation in NF1?
Chr 17
206
What is the mutation in NF2?
Chr 22
207
What condition are subungual fibromata associated with?
Tuberous sclerosis
208
Finger abduction weakness - which nerve root is affected?
T1
209
What is a clue that a Parkinsonian tremor is drug-induced?
It is symmetrical
210
How can you classify the causes of hearing loss in children?
Conductive and sensorineural
211
What are the most common causes of conductive hearing loss in children?
1. Secretory otitis media
| 2. Down's syndrome
212
What are the most common causes of sensorineural hearing loss in children?
1. Hereditary = Pendred syndrome
2. Infective = Rubella, meningitis
3. Traumatic = head injury
4. Cerebral palsy
5. Perinatal insult
213
What are the common migraine triggers?
```
CHOCOLATE
Chocolate
Hangovers
Orgasms
Cheese/caffeine
Oral contraceptives
Lie-ins
Alcohol
Travel
Exercise
```
214
What are the surgical causes of a 3rd nerve palsy?
4 Cs
1. Posterior communicating artery aneurysm
2. Cancer
3. Cerebral uncal herniation
4. Cavernous sinus thrombosis
215
What are the medical causes of a 3rd nerve palsy?
4 Ms
1. Mellitus
2. MS
3. Midbrain infarct
4. Migraines
216
What are the possible arteries that can be occluded thus causing a cerebellar stroke?
1. Superior cerebellar artery
2. Anterior inferior cerebellar artery
3. Posterior inferior cerebellar artery (LMS)
217
What two things must you rule out as a cause of status epilepticus before thinking of other causes?
Hypoxia and hypoglycaemia
218
Name 3 conditions that have an association with epilepsy?
1. Cerebral palsy (30% have epilepsy)
2. Tuberous sclerosis
3. Mitochondrial diseases
219
What is typical of a benign rolandic epilepsy?
Paraesthesia (e.g. unilateral face), usually on waking up
220
What kind of epilepsy is typically found in girls, and has infrequent generalised seizures often in the morning?
Juvenile myoclonic epilepsy
221
What 4 things must be considered when managing pts with epilepsy?
DOPS
1. Driving
2. Other medications/Occupation
3. Women wishing to get pregnant/contraception
4. SUDEP
222
What is the MOA of sodium valproate?
Increases GABA activity
223
What are 3 s/e of sodium valproate?
1. Increased appetite and weight gain
2. Alopecia
3. P450 enzyme inhibitor
224
What is the MOA of carbamazepine?
Binds to Na channels and increases their refractory period
225
What are 3 s/e of carbamazepine?
1. P450 enzyme inducer
2. SIADH
3. Leucopenia and agranulocytosis
226
What is the MOA of lamotrigine?
Na channel blocker
227
What is a s/e of lamotrigine?
Stevens-Johnson Syndrome
228
What is the MOA of phenytion?
Binds to sodium channels increasing their refractory period
229
What are 3 s/e of phenytoin?
1. P450 enzyme inducer
2. Gingival hyperplasia
3. Peripheral neuropathy
230
What is the treatment for an acute relapse of MS?
High dose steroids e.g. oral/IV methylprednisolone may be given for 5 days to reduce the length of an acute relapse
231
What is a disease-modifying drug that can be given for MS?
1. Beta interferon (reduce relapse rate)
| 2. Natalizumab (anti a4 integrin mAb)
232
What are first line treatments for spasticity in MS?
Baclofen and gabapentin
233
What is the first line treatment of oscillopsia in MS?
Gabapentin
234
What are the first line investigations for pts with a suspected vestibular schwannoma?
Audiogram and gadolinium-enhanced MRI scan of the CPA
235
Papilloedema and diplopia when asked to look laterally - which nerve is affected and why?
Abducens nerve, as the long intracranial course of this nerve makes it susceptible to damage early in the course of raised ICP
236
What causes RAPD?
Damage to the optic nerve or severe retinal disease
237
Where does the olfactory nerve pass through?
The cribriform plate
238
Where does the optic nerve pass through?
The optic canal
239
Where does the oculomotor nerve pass through?
Superior orbital fissure
240
What are the functions of the oculomotor nerve?
EPEA
1. Eye movement
2. Pupil constriction
3. Accomodation
4. Eyelid opening
241
What muscles are supplied by the oculomotor nerve?
Medial rectus
Inferior oblique
Superior rectus
Inferior rectus
242
What does 3rd nerve palsy result in?
1. Ptosis
2. Down and out
3. Dilated, fixed pupil
243
What does the trochlear nerve pass through?
Superior orbital fissure
244
What does a 4th nerve palsy result in?
Defective downward gaze --> vertical diplopia
245
What is the trigeminal nerve responsible for?
1. Facial sensation
| 2. Mastication
246
What may a lesion to the trigeminal nerve result in?
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
Where do the branches of the trigeminal nerve pass through>
```
V1 = Superior orbital fissure
V2 = Foramen rotundum
V3 = Foramen ovale
```
248
Where does the Abducens nerve pass through?
Superior orbital fissure
249
What muscle does the abducens nerve supply?
Lateral rectus
250
What is the facial nerve responsible for?
1. Facial movement
2. Taste (anterior 2/3rd of tongue)
3. Lacrimation
4. Salivation
251
Where does the facial nerve pass through?
The internal auditory meatus
252
What may a facial nerve palsy result in?
1. Flaccid paralysis of upper and lower face
2. Loss of corneal reflex (efferent)
3. Loss of taste
4. Hyperacusis
253
Where does the vestibulocochlear nerve pass through?
The internal auditory meatus
254
What may damage to the vestibulocochlear nerve result in?
1. Hearing loss
2. Vertigo
3. Nystagmus
255
Where does the glossopharyngeal nerve pass through?
Jugular foramen
256
What is the glossopharyngeal nerve responsible for?
1. Taste (posterior 13rd of tongue)
2. Salivation
3. Swallowing
4. Mediated input from carotid body and sinus
257
What may a lesion to the glossopharyngeal nerve result in?
1. Hypersensitive carotid sinus reflex
| 2. Loss of gag reflex (afferent)
258
Where does the vagus nerve pass through?
Jugular foramen
259
What is the vagus nerve responsible for?
1. Phonation
2. Swalling
3. Innervates viscera
260
What may a lesion to the vagus nerve result in?
1. Uvula deviates away from site of lesion
| 2. Loss of gag reflex (efferent)
261
Where does the accessory nerve pass through?
Jugular foramen
262
What is the accessory nerve responsible for?
Head and shoulder movement
263
What may a lesion to the accessory nerve cause?
Weakness in turning head to the contralateral side
264
Where does the hypoglossal nerve pass through?
Hypoglossal canal
265
What would a lesion to the hypoglossal nerve result in?
Tongue deviates towards the side of the lesion
266
Where are the cranial nerve nuclei located?
```
Midbrain = 1-4
Pons = 5-8
Medulla = 9-12
```
267
What are the nerves that control the corneal reflex?
```
Afferent = Ophthalmic nerve (V1)
Efferent = Facial nerve
```
268
What are the nerves that control the jaw jerk?
Afferent and efferent = Mandibular nerve (V3)
269
What are the nerves that control the gag reflex?
```
Afferent = Glossopharyngeal
Efferent = Vagus
```
270
What are the nerves that control the carotid sinus?
```
Afferent = Glossopharyngeal
Efferent = Vagus
```
271
What are the nerves that control the pupillary reflex?
```
Afferent = Optic nerve
Efferent = Oculomotor nerve
```
272
What are the nerves that control lacrimation?
```
Afferent = ophthalmic nerve (V1)
Efferent = Facial nerve
```
273
What does a combination of liver and neurological disease point towards?
Wilsons disease
274
How is haemochromatosis transmitted?
Autosomal recessive
275
What is the investigation of choice for PSC?
ERCP
276
What do you see on liver biopsy with PSC?
Onion skin fibrosis
277
What is the investigation of choice for an anal fistula?
MRI pelvis
278
What are 4 types of fistula?
1. Enterocutaneous
2. Enteroenteric/enterocolic
3. Enterovaginal
4. Enterovesicular
279
What is the pathophysiology of pernicious anaemia?
Autoimmune destruction of gastroparietal cells
280
What blood group is Pernicious Anaemia more common in?
Blood Group A
281
How does one manage Pernicious Anaemia?
3 monthly injection of Vitamin B12
282
What is the annual incidence of HCC in pts with liver cirrhosis secondary to Hep C?
3-5%
283
What is the most sensitive and specific lab finding for dx of liver cirrhosis in those with chronic liver disease?
Thrombocytopenia
284
What is the AST:ALT ratio like in pts with cirrhosis?
>2.5
285
What disease is characterised by a PTEN mutation and intestinal hamartomas?
Cowden disease
286
What condition is characterised by multiple intestinal hamartomas and pigmentation spots around the mouth?
Peutz-Jeghers
287
What condition is most likely causative of right sided colonic cancers occurring at a young age?
Lynch syndrome
288
What is a lemon tinge to the skin associated with?
Pernicious anaemia
289
What is a characteristic biochemical sign in patients at risk of refeeding syndrome?
Hypophosphataemia
290
What are 3 electrolyte abnormalities associated with refeeding syndrome?
HYPO magenesaemia, kalaemia and phosphataemia
291
How does Budd-Chiari syndrome present?
Triad of:
1. Sudden onset abdominal pain
2. Ascites
3. Tender hepatomegaly
292
What are 4 causes of Budd-Chiari syndrome?
1. Polycythaemia Rubra Vera
2. Thrombophilia
3. Pregnancy
4. OCP
293
What is the investigation of choice for Budd-Chiari?
US with Doppler flow
294
What are 4 complications of H. pylori?
1. Peptic ulcer disease
2. Gastric cancer
3. B cell lymphoma of MALT tissue
4. Atrophic gastritis
295
What is the management of H. pylori?
Triple therapy with
1. PPI + Amoxicillin + Clarithromycin
2. PPI + Metronidazole + Clarithromycin
296
What is the MOA of loperamide?
Reduction in gastric motility through stimulation of opioid receptors
297
What is Sister Mary Joseph's node?
A palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen
298
What is Peabody's sign?
Found in pts with DVT, calf muscle spasm occurring on elevation and foot extension of the affected leg
299
What is the most common inheritable form of colorectal cancer?
HNPCC
300
What is the second most common inheritable form of colorectal cancer?
FAP
301
What drugs can cause acute pancreatitis?
1. Azathioprine
2. Mesalazine
3. Bendroflumethiazide
4. Furosemide
5. Steroids
6. Sodium valproate
302
How can IBS be diagnosed?
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
What artery is a common source of GI bleeding as a result of peptic ulcer disease?
Gastroduodenal artery
304
What pain medication should be stopped during C. diff infections?
Opioids (they are anti-motility and anti-peristaltic, and thus can predispose to toxic megacolon by slowing the clearance of C.diff toxin)
305
What is Wernicke's encephalopathy?
A neuropsychiatric disorder caused by thiamine deficiency which is most commonly seen in alcoholics
306
3 rarer causes of Wernicke's?
1. Persistent vomiting
2. Stomach cancer
3. Dietary deficiency
307
Wernicke's triad?
1. Ophthalmoplegia/nystagmus
2. Ataxia
3. Confusion
308
Wernicke's encephalopathy pathophysiology?
Petechial haemorrhages occur in a variety of structures in the brain, including the mamillary bodies and ventricle walls
309
Atrophy of mamillary bodies?
Acute Wernicke's encephalopathy
310
Ix for Wernicke's?
1. Decreased RBC transketolase
| 2. MRI
311
Trigeminal autonomic cephalgia?
A grouping of:
1. Cluster headache
2. Paroxysmal hemicrania
3. SUNCT
312
What is SUNCT?
Short-lived unilateral neuralgiform headache with conjunctival injection and tearing
313
Paroxysmal hemicrania mx?
Indomethacin
314
3 uses of carbamazepine?
1. Epilepsy, esp. partial
2. Trigeminal neuralgia
3. Bipolar disorder
315
What is carbamazepine autoinduction?
When pts start carbamazepine, they may see a return of seizures after 3-4 weeks of tx
316
Cluster headache acute tx?
Subcutaneous sumatriptan + 100% O2 (at least 12L/min)
317
Cluster headache epidemiology?
Men (3:1) and smokers
318
Cluster headache prophylaxis?
Verapamil
319
Acute ischaemic stroke presenting within 4.5 hrs mx?
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
How to distinguish drug-induced Parkinsons?
1. Motor sx are generally rapid onset and bilateral
| 2. Rigidity and rest tremor are uncommon
321
What anaesthetic agent would a myasthenia pt be resistant to?
Suxamethonium (is a depolarising neuromuscular blocking drug, NMBD)
322
Myasthenia exacerbators?
1. BBs
2. Lithium
3. Phenytoin
4. Abx = macrolides, gentamicin, quinolones, tetracyclines
323
Characteristic feature of GBS?
Progressive weakness of all 4 limbs, classically ascending, but affects proximal muscles earlier than distal
324
GBS Dx?
1. LP (rise in protein with normal WCC, albuminocytologic dissociation, found in 66%)
2. Nerve conduction studies may be performed
325
MND defn?
A neurological condition of unknown cause which can present with both upper and lower motor neuron signs
326
Initial features of MND?
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
MND Dx?
1. Mainly Clinical
2. Normal nerve conduction studies
3. MRI to rule out DDx
4. EMG shows reduced no. APs with increased amplitude
328
Hyperacusis cause?
Paralysis of the stapedius muscle due to facial nerve palsy
329
Facial nerve supplies?
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
Causes of bilateral facial nerve palsy?
1. Sarcoidosis (Inflammatory)
2. Guillain Barre Syndrome (Inflammatory)
3. Lyme disease (infectious)
4. Bilateral acoustic neuromas (NF2) (Malignancyish)
5. Bell's Palsy (Idiopathic)
331
Classification of unilateral facial nerve palsy?
1. UMN = e.g. stroke
| 2. LMN
332
LMN causes of unilateral facial nerve palsy?
1. Infection = Ramsay-Hunt (Zoster), HIV
2. Inflammation = MS
3. Malignancyish = Acoustic neuroma, parotid tumour
4. Metabolic = DM
333
First line tx for trigeminal neuralgia?
Carbamazepine
334
von Recklinghausen's?
NF1
335
NF1 features?
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
NF2 features?
1. Bilateral vestibular schwannomas
| 2. Multiple intracranial schwannomas, meningiomas and ependymomas
337
3 similar fx b/w NF and TS?
1. Neurocutaneous disorders
2. AD
3. Ocular hamartomas
338
Widespread convulsions without conscious impairment?
Pseudoseizure (psychogenic non-epileptic seizure)
339
Head trauma and biconvex mass/lentiform mass on CT?
Extradural haemorrhage
340
Lucid interval?
Extradural haemorrhage
341
Crescent-shaped CT head?
Subdural haemorrhage
342
Why do you get a fixed and dilated pupil with an extradural haemorrhage?
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
Neuropathic pain defn?
Pain which arises following damage or disruption of the nervous system
344
4 examples of neuropathic pain?
1. Diabetic neuropathy
2. Post-herpetic neuralgia
3. Trigeminal neuralgia
4. Prolapsed intervertebral disc
345
Neuropathic pain mx?
1. Amitryptiline, Duloxetine, Gabapentin, Pregabalin
| 2. If one of the drugs doesnt work, try one of the other 3
346
Localised neuropathic pain mx>
Capsaicin cream for e.g. post-herpetic neuralgia
347
Anti-emetic for Parkinsons?
Domperidone
348
1st line tx of absence seizures?
Sodium valproate and ethosuximide
349
Most common presentation of MS?
Optic neuritis
350
Features of MS?
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
TS features?
1. Neurocutaneous
2. Neurological
3. Eye
4. Heart
5. Lungs
6. Kidneys
352
TS neurocutaneous features?
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
TS neurological features?
1. Development delay
2. Seizures
3. Intellectual impairment
354
Tuberous sclerosis eye, heart, lungs and kidney signs?
1. Eye = retinal hamartomas
2. Heart = rhabdomyomas
3. Lungs = lymphangioleiomyomatosis (multiple lung cysts)
4. Renal = polycystic kidneys, renal angiomyolipomata
355
Lhermitte's sign pathophysiology?
Disease near the dorsal column nuclei of the cervical cord
356
3 causes of Lhermitte's sign?
1. MS
2. SCDSC
3. Cervical stenosis
357
Neuroleptic malignant syndrome bloods?
Raised creatine kinase and WCC
358
NMS pathophysiology?
Dopamine blockade induced by antipsychotics triggers massive glutamate release and subsequent neurotoxicity and muscle damage.
359
Typical fx of NMS?
1. Pyrexia
2. Muscle rigidity
3. Autonomic lability (HTN, tachycardia, tachypnoea)
4. Agitated delirium with confusion
360
NMS Mx?
1. Stop antipsychotic
2. IV fluid to prevent AKI
3. Dantrolene
361
Dantrolene MOA?
Decreasing excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, and decreasing the release of calcium from the sarcoplasmic reticulum
362
Mx of severe serotonin syndrome?
1. Cyproheptadine
| 2. Chlorpromazine
363
Epilepsy classification?
1. Where seizures begin in the brain
2. Level of awareness
3. Other features of seizure
364
Classification of phenytoin s/e?
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
Ataxia, urinary incontinence, dementia?
Normal pressure hydrocephalus
366
Normal pressure hydrocephalus cause?
Secondary to reduced CSF absorption at the arachnoid villi, secondary to:
1. Head injury
2. Subarachnoid haemorrhage
3. Meningitis
367
Mx of normal pressure hydrocephalus?
VP shunt
368
3 s/e of VP sunts?
1. Seizures
2. Infection
3. Intracerebral haemorrhage
369
Dementia associated with MND?
FTD
370
Subdural haemorrhage pathophysiology?
Damage to bridging veins between the cortex and venous sinuses
371
Classification of subdural haemorrhage?
1. Acute
2. Subacute
3. Chronic
372
Wide based gait with loss of heel to toe walking?
Ataxic gait
373
Ataxia anatomical location for peripheral and gait ataxia?
1. Peripheral = cerebellar hemisphere
| 2. Gait = cerebellar vermis
374
Classification of peripheral neuropathy?
1. Predominantly motor loss
| 2. Predominantly sensory loss
375
Predominantly motor neuropathy causes?
1. GBS
2. Porphyria
3. Lead poisoning
4. HSMN e.g. CMT
5. Diptheria
6. Chronic inflammatory demyelinating polyneuropathy
376
Predominantly sensory neuropathy causes?
1. Diabetes
2. Uraemia
3. Alcoholism
4. Vit B 12 deficincy
5. Leprosy
6. Amyloidosis
377
Blood test ut differentiate b/w true and pseudoseizure?
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
Chemo anti-emetic?
Ondansetron
379
GI anti-emetic?
Metoclopramide
380
Intracranial raised ICP anti-emetic?
Haloperidol
381
Vestibular anti-emetic?
Prochlorperazine
382
Interossei muscle supply?
Ulnar nerve
383
Extension of fingers supply?
Radial nerve
384
DCM neuro meaning?
Degenerative cervical neuropathy
385
Hoffman's sign?
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
Cerebral venous sinus thrombosis Ix?
MR Venogram
387
First line tx of parkinsons?
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
3 s/e of parkinsons medications?
1. Excessive sleepiness
2. Hallucinations
3. Impulse control disorders
389
Mx of drooling in Parkinsons?
Glycopyrronium bromide
390
Levodopa usually combined with?
Carbidopa (decarboxylase inhibitor)
391
MAO-Bi example?
Selegiline
392
COMT examples?
1. Entecapone
| 2. Tolcapone
393
4 classic MS RFs?
1. Smoking
2. Previous infectious mononucleosis
3. Genetics
4. Hypovitaminosis D
394
Most common cause of titubation?
Essential tremor
395
Mx of essential tremor?
1. Propranolol 1st line
| 2. Primidone sometimes used
396
Migraine acute tx vs. prophylaxis?
1. Acute tx = 5-HT receptor agonists
| 2. Prophylaxis = 5-HT receptor antagonists
397
Migraine acute tx?
1. Oral triptan and NSAID OR
| 2. Oral triptan and paracetamol
398
What is jacksonian movement?
Clonic movements travelling proximally
399
Jacksonian march epilepsy type?
Frontal lobe epilepsy
400
Aura, lip smacking, clothes plucking?
Temporal lobe epilepsy
401
Temporal lobe epilepsy features?
HEAD
1. Hallucinations (auditory/gustatory/olfactory)
2. Epigastric rising/emotional
3. Automatisms (lip smacking/gabbing/plucking)
4. Deja vu/dysphasia post-ictal
402
Paraesthesia epilepsy type?
Parietal lobe
403
Can DCM be diagnosed by Cervical X-ray?
No
404
What is DCM?
Spinal cord compression due to degenerative changes of the surrounding spinal structures; e.g. from disc herniation, ligament hypertrophy or calcification, or osteophytes
405
Causes of postural hypotension with compensatory tachycardia?
4Ds
1. Deconditioning
2. Dysfunctional heart (AS)
3. Dehydration, dialysis
4. Drugs
406
Commonest neurological manifestation of sarcoid?
Facial nerve palsy
407
HSMN types?
1. HSMN Type I = demyelinating pathology
| 2. HSMN Type II = axonal pathology
408
Syringomyelia defn?
A collection of CSF within the spinal cord
409
4 causes of syringomyelia?
1. Chiari malformation
2. Trauma
3. Tumours
4. Idiopathic
410
‘Cape-like’ (neck and arms) loss of sensation to temperature but preservation of light touch, proprioception and vibration?
Syringomyelia
411
Mx of myasthenia?
1. Long acting anticholinesterase inhibitors e.g. pyridostigmine
2. Immunnosuppression e.g. prednisolone initially
3. Thymectomy
412
Mx of myasthenic crisis?
1. Plasmapharesis
| 2. IVIG
413
A differential for unilateral deafness/tinnitus?
Acoustic neuroma
414
4 Rfs for idiopathic intracranial HTN?
1. Obesity
2. Female
3. Pregnancy
4. Drugs = OCP, steroids, tetracycline, Vitamin A, lithium
415
Mx of IIH?
1. Conservative = weight loss
2. Medical = diuretics (acetazolamide), topramate
3. Surgical = repeated LP, LP/VP shunt
416
Mx of TIA?
1. 300mg aspirin immediately if presenting w/in 7 days of a clinically suspected TIA
2. Specialist review w/in 24 hours
417
Carotid endarterectomy indications?
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
Weakness of foot dorsiflexion and foot eversion?
Common peroneal nerve lesion
419
Headache linked to valsalva manoeuvres is caused by?
Raised ICP until proven otherwise
420
Todd's paresis?
Post-ictal weakness, usually due to a focal-onset seizure
421
Diet for children with epilepsy?
Ketogenic diet = high fat, low carb, controlled protein
422
IBS diet?
FODMAP (Fermentable Oligo-Di-Monosaccharides and Polyols)
423
Generalised seizures first line mx?
Sodium valproate
424
Partial seizures first line mx?
Carbamazepine
425
Saturday night palsy?
Radial nerve palsy
426
FHx of early blindness and tunnel vision?
Retinitis pigmentosa
427
Incongruous homonymous hemianopia location?
Lesion of optic tract
428
Congruous homonymous hemianopia location?
Lesions of optic radiation or occipital cortex
429
Macula sparing homonymous hemianopia location?
Lesion of occipital cortex
430
What are the majority of quadrantanopias 'actually' caused by?
Occipital lobe lesions
431
Adverse effect of Lamotrigine?
Stevens Johnson syndrome
432
Bell's palsy defn?
An acute, unilateral, idiopathic facial nerve paralysis
433
Features of Bell's palsy?
1. LMN facial nerve palsy
2. Post-auricular pain
3. Altered taste
4. Dry eyes
5. Hyperacusis
434
Bell's palsy Mx?
1. Prednisolone 1mg/kg for 10 days w/in 72hrs
| 3. Artificial tears and eye lubricants
435
Brown Sequard syndrome?
Lateral hemisection of the spinal cord
436
Brown Sequard syndrome features?
1. Same sided weakness
2. Same sided proprioception/vibration loss
3. Contralateral pain/temperature loss
437
HSMN Type I (CMT) inheritance?
AD
438
Cluster headache prophylaxis?
Verapamil
439
Pathophysiology of GBS?
Cross reaction of Abs with gangliosides in the peripheral nervous system, anti-GM1 Abs in 25% of pts
440
Miller Fisher syndrome?
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
IIH medication?
1. Acetozolamide, a carbonic anhydrase inhibitor, that reduces the productoin of CSF
2. Topiramate
442
Mx of haemorrhage following thrombolysis?
Stop aspirin and control BP
443
Most common complication following meningitis?
Sensorineural hearing loss
444
Complications of meningitis?
1. Sensorineural hearing loss
2. Neurological = Epilepsy, paralysis
3. Infective = sepsis, intracerebral abscess
4. Pressure = brain herniation, hydrocephalus
445
Status epilepticus in hospital with cannula in situ Mx?
IV Lorazepam 4mg
446
Bilateral median nerve dysfunction?
Degenerative cervical myelopathy
447
MS Ix?
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
Pyridostigmine MOA?
Long acting anticholinesterase inhibitor
449
4 types of MND?
1. ALS (50%)
2. Primary lateral sclerosis
3. Progressive muscular atrophy
4. Progressive bulbar palsy
450
ALS features?
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
Primary lateral sclerosis presentation?
UMN signs only
452
Progressive muscular atrophy presentation?
1. LMN signs only
2. Affects distal muscles before proximal
3. Carries best prognosis
453
Progressive bulbar palsy features?
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
CRPS?
Complex regional pain syndrome
455
CRPS types?
1. Type I = most common, no demonstrable lesion to a major nerve
2. Type II = lesion to a major nerve
456
Features of CRPS?
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
Diagnostic criteria for CRPS?
Budapest Diagnostic Criteria
458
Mx of CRPS?
1. Early physiotherapy
2. Neuropathic analgesia in-line with NICE guidelines
3. Specialist mx e.g. pain team is required
459
Parkinsonism with autonomic disturbance (atonic bladder, postural hypotension)?
MSA
460
Antiplatelet for secondary prevention following stroke?
1. First line = clopidogrel
| 2. Second line = aspirin with modified release dipyramidole
461
Most affected movement in adhesive capsulitis?
External rotation
462
Mx of MND?
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
When to consider stopping AEDs?
Can be considered if seizure free for > 2 years, with AEDs being stopped over 2-3 months
464
Third nerve palsy with dilated pupil?
'Surgical' third nerve palsy
465
NIHSS?
National Institutes of Health Stroke Scale, used to measure impairment caused by stroke
466
2 types of ischaemic stroke?
Thrombotic or embolic
467
2 types of haemorrhagic stroke?
1. Intracerebral (bleeding within the brain)
| 2. Subarachnoid (bleeding on the surface of the brain)
468
4 RFs for haemorrhagic stroke?
1. Age
2. HTN
3. AVM
4. Anticoagulation therapy
469
Subacute combined degeneration of the spinal cord defn?
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
Arnold Chiari malformation?
Cerebellar tonsils herniating through the foramen magnum, can be congenital or acquired (trauma)
471
Syringomyelia sensory loss pathophysiology?
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
What is spontaneous intracranial hypotension?
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
RF for spontaneous intracranial hypotension?
Marfan's
474
Features of spontaneous intracranial hypotension?
Headache worse when upright
475
Ix of spontaneous intracranial hypotension?
MRI with gadolinium = typically shows pachymeningeal enhancement
476
Mx of spontaneous intracranial hypotension?
1. Usually conservative
| 2. If this fails, an epidural blood patch may be tried
477
What monitoring is required when starting a phenytoin infusion for status?
Cardiac monitoring due to pro-arrhythmogenic effects
478
RLS?
Restless legs syndrome
479
Restless legs syndrome definition?
A syndrome of spontaneous, continuous lower limb movements that may be associated with paraesthesia
480
Features of RLS?
1. Akathisia of legs
2. Paraesthesias
3. Movements during sleep e.g. PLMS = periodic limb movements of sleep
481
5 causes of restless legs syndrome?
1. FHx
2. IDA
3. Uraemia
4. DM
5. Pregnancy
482
Mx of restless legs syndrome?
1. Conservative = walking, stretching, massaging affected limbs
2. Medical = Tx IDA, DA agonist (e.g. ropinirole 1st line), Benzos, gabapentin
483
Weakness of foot dorsiflexion and foot eversion?
Common peroneal nerve lesion
484
Cerebral perfusion pressure eqn?
CPP = Mean arterial pressure - intracranial pressure
485
Fluid coming out of nose, how to test if it is CSF?
Test for glucose (present in CSF, not present in mucus)
486
What is cataplexy?
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
Shaft of humerus fracture, what nerve is damaged?
Radial nerve
488
Sinusitis + focal neurology and fever?
Brain abscess
489
Ptosis + dilated pupil?
3rd nerve palsy
490
Ptosis + constricted pupil?
Horner's
491
Primary open angle glaucoma visual field loss?
Unilateral peripheral visual field loss
492
Anti-Mi-2 antibodies?
Dermatomyositis
493
LEMS?
Lambert Eaton Myasthenic Syndrome
494
LEMS Abs?
VG-Calcium channel Abs
495
Painful 3rd nerve palsy?
Posterior communicating artery aneurysm
496
Rescue therapy for exacerbations of neuropathic pain?
Tramadol
497
Imaging finding of normal pressure hydrocephalus?
Hydrocephalus with an enlarged 4th ventricle
