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Neurology > Passmed questions > Flashcards

Passmed questions Flashcards

1
Q

Urinary incontinence + gait abnormality + dementia

A

normal pressure hydrocephalus

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2
Q

a reversible cause of dementia seen in elderly patients ?

A

normal pressure hydrocephalus

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3
Q

variant of fast score to assess stroke risk?

A

stROke ROsier score

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4
Q

Obese, young female with headaches and blurred vision, think?

A

idiopathic, intercranial hypertension.

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5
Q

idiopathic intercranial hypertension treatment?

A

weight loss and diuretic (acetazolamide)

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6
Q

two drugs that may cause peripheral neuropathy? “feels like walking on cotton wool”

A

nitrofurentoin and metronidazole

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7
Q

Normal pressure hydrocephalus management?

A

Normal pressure hydrocephalus

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8
Q

What is the most common presentation of multiple sclerosis?

A

optic neuritis

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9
Q

worsening of vision following rise in body temperature?

A

Uhthoff’s phenomenon: worsening of vision following rise in body temperature. Seen in MS

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10
Q

Colours, particularly reds, may appear “washed out” or less bright than usual. Which eye condition?

A

optic neuritis

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11
Q

Patients with MS can present with non specific symptoms. How do 75% present?

A

significant lethargy

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12
Q

what can you get in neck flexion in MS?

A

paraesthesia in limbs (Lhermittes syndrome)

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13
Q

what is paraesthesia?

A

abnormal sensation such as tingling, tickling or burning of a person’s skin with no apparent physical cause

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14
Q

Progressive degenerative disesase of brain. Accounts for majority of dementia in the UK?

A

alzheimers disease

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15
Q

what is thought to cause the inherited form?

A

mutations in amyloid precursor protein

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16
Q

what is apoE4?

A

class of proteins involved in the metabolism of fats in the body

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17
Q

macroscopic changes in alzheimers>

A

macroscopic: widespread cerebral atrophy, particularly involving the cortex and hippocampus

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18
Q

microscopic changes in alzheimers?

A

cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein

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19
Q

biochemically, what is there a deficit of in alzheimers?

A

acetylcholine

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20
Q

paired helical filaments are partly made from a protein called tau?

A

neurofibrillary tangles

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21
Q

There is a deficit of acetylcholine in amlzheimers. NICE now recommend the three acetylcholinesterase inhibitors. what are they?

A

donepezil, galantamine and rivastigmine

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22
Q

if intolerant of first l in drugs, what can be given second line ?

A

memantine (clementine)

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23
Q

DVLA advice post multiple TIAs: cannot drive for

A

3 months

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24
Q

if you have a seizure/fit, what must you do?

A

inform the DVLA

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25
Q

for patients with established epilepsy or those with multiple unprovoked seizures:
→ may qualify for a driving licence if they have been free from any seizure for?

A

12 months

if there have been no seizures for 5 years (with medication if necessary)

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26
Q

single episode syncope, explained and treated. restriction on driving?

A

4 weeks

27
Q

single episode syncope, unexplained?

A

6 months off driving

28
Q

stroke or TIA. If not residual neurological deficit. how long do you need to take off driving and do you need to inform DVLA?

A

1 month off driving. may not need to inform DVLA

29
Q

craniotomy e.g. For meningioma. How long off driving

A

1 year

30
Q

chronic neurological disorders e.g. multiple sclerosis, motor neuron disease: DVLA should be informed, what form is filled out?

A

PK1 form

31
Q

levodopa side effects?

A 
!Reduced effectiveness with time!
dyskinesia (writhing movements) 
palpitations 
psychosis 
postural hypotension
32
Q

name 3 dopamine receptor agonists?

A

dope

bromocriptine, ropinirole, cabergoline

33
Q

what kind of drug is cabergoline?

A

dopamine agonist

34
Q

what should patients being started on dopamine agonists be warned about ?

A

potential to cause impulse control disorders

35
Q

side effect of dopamine agonist>

A

hallucinations

36
Q

which drugs are associated with pulmonary and cardiac fibrosis?

A

dopamine agonists

37
Q

when do most neurologists start ant epileptic treatment ?

A

following a second epileptic seizure

38
Q

in what situations would you start an anti epileptic following a first seizure?

A

the patient has a neurological deficit
brain imaging shows a structural abnormality
the EEG shows unequivocal epileptic activity
the patient or their family or carers consider the risk of having a further seizure unacceptable

39
Q

first line in generalised seizures?

A

sodium valpraote (sodium is a general flavouring)

40
Q

second line?

A

lamotrigine and carbamazepine

41
Q

which drug can precipitate absence seizures?

A

carbamazepine

42
Q

first line for partial/focal seizures?

A

carbamazepine or lamotrigine (carbs only part of balanced diet)

43
Q

2nd line in partial/focal seizures?

A

levetiracetam, oxcarbazepine or sodium valproate

44
Q

myoclonic seizure treatment ?

A

sodium valproate (mayoclinic eating)

45
Q

2 drugs you can use in absence seizures? (petit mal)

A

2 drugs that don’t like being absent from each other. sodium valproate and ethoSUXamide

46
Q

Useful in patients with absence seizures who are intolerant of sodium valproate?

A

ethosuxamide

47
Q

A 24-year-old man with focal seizures. He previously developed a rash whilst taking lamotrigine?

A

carbamazepine

48
Q

what drug does carbamazepine always go with?

A

lamotrogine

49
Q

what is titubation?

A

head tremor

50
Q

that is made worse by intentional movement, made better by alcohol and propranolol?

A

essential tremor

51
Q

if you see “fasciculations” think of?

A

motor neurone disease

52
Q

if you have first seizure and if there are no relevant structural abnormalities on brain imaging and no definite epileptiform activity on EEG. how long off driving ?

A

6 months

53
Q

what is phenytoin used in ?

A

the management of seizures

54
Q

side effects of phenytoin?

A

large list of side effects
Acute
initially: dizziness, diplopia, nystagmus, slurred speech, ataxia
later: confusion, seizures

Chronic
common: gingival hyperplasia (secondary to increased expression of platelet derived growth factor, PDGF), hirsutism, coarsening of facial features, drowsiness
megaloblastic anaemia (secondary to altered folate metabolism)
peripheral neuropathy
enhanced vitamin D metabolism causing osteomalacia
lymphadenopathy
dyskinesia

Idiosyncratic
fever
rashes, including severe reactions such as toxic epidermal necrolysis
hepatitis
Dupuytren's contracture*
aplastic anaemia
drug-induced lupus

Teratogenic
associated with cleft palate and congenital heart disease

55
Q

what is saturday night palsy?

A

compression of the radial nerve against the humeral shaft, possibly due to sleeping on a hard chair with his arm draped over the back. cannot extend wrist

56
Q

Leg crossing, squatting or kneeling may cause a foot drop secondary to a common peroneal neuropathy. women who works in a nursery with foot drop. management?

A

avoid to stop leg crossing, kneeling and squatting. review in 4 weeks

57
Q

cluster headache - acute treatment?

A

subcutaneous sumatriptan + 100% O2

58
Q

risk factors for developing idiopathic inter cranial hypertension?

A

obesity
female sex
pregnancy
drugs*: oral contraceptive pill, steroids, tetracycline, vitamin A, lithium

59
Q

features of tuberous sclerosis?

A

“ash leaf spots” which fluoresce under UV light
roughened patches of skin over the lumbar spine
adenoma sebaceum (angiofibromas) in butterfly distribution over nose

fibromata beneath nails
café au lait spots may be seen

60
Q

if you get nausea in parkinson, which anti emetic?

A

domperidone

61
Q

reduced sensation in a glove-and-stocking distribution

A

peripheral neuropathy. hands and feet are affected first, then the reduced sensation travels up the limbs

62
Q

A positive Hoffmans sign is a sign of?

A

upper motor neuron dysfunction and points to a disease of the central nervous system

63
Q

Neuroleptic malignant syndrome is typically seen in patients?

A

who have just started treatment. its a rare but dangerous condition seen in young males who have just started anti psychotic medication

Neurology (19 decks)

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