PassQues Flashcards
1
Q
Inferior homonymous quadrantanopias are caused by lesions in what area?
A
Superior optic radiations in the parietal lobe
2
Q
Which cranial nerves carry parasympathetic fibres?
A
1973
(X, IX, VII, III)
3
Q
Neurodegenerative disorder involving death of neurones in the substantia nigra
A
Parkinson’s
4
Q
Faecal incontinence since vaginal delivery of child. Which nerve is damaged?
A
Pudendal
(S2,3,4 keeps the poo off the floor. POOdendal nerve)
5
Q
Stimulation of the cornea causes afferent signals via which nerve?
A
CN V1 - opthalmic nerve
6
Q
Cortical plaques
due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein
A
Alzheimer’s
7
Q
Duchenne muscular dystrophy is caused by a mutation in which gene ?
A
Dystrophin gene
8
Q
Diabetes insipidus = deficiency in which hormone ?
+ where is that hormone produced ?
A
ADH
Produced in posterior pituitary
9
Q
Stroke followed by wasting of the right masseter and temporalis muscles.
Which nerve is affected ?
A
CN V
Paralysis of muscles of mastication. Causes eating problems.
10
Q
At which vertebral level does the IVC exit the abdominal cavity ?
A
T8
11
Q
Subarachnoid haemorrhage occurs between which two meningeal layers ?
A
Arachnoid mater and pia mater
(subarachnoid space)
12
Q
Which nerve is anaesthetised during an episiotomy (cut made in the perineum during childbirth) ?
A
Pudendal
13
Q
Right sided hemiparesis and sensory loss, lower limbs more affected than upper limbs.
What artery is affected?
A
Left anterior cerebral artery
14
Q
Right sided hemiparesis and sensory loss, upper limbs more affected than lower limbs.
What artery is affected?
A
Left middle cerebral artery
15
Q
Bevacizumab is a monoclonal antibody which binds to and inhibits what?
A
VEGF (Vascular endothelial growth factor)
16
Q
Progressive peripheral polyneuropathy weeks following a GI infection =
A
Guillain-Barre syndrome
17
Q
Which branch of the facial nerve innervates frontalis, orbicularis oculi and corrugator supercilii ?
A
Temporal branch
18
Q
At which foraminae do the branches of the trigeminal nerve exit the skull ?
A
Standing Room Only
V1 = Superior orbital fissure
V2 = Foramen rotundum
V3 = Foramen Ovale
19
Q
Ring and little fingers on his right hand are extended at the metacarpophalangeal joint and flexed at the interphalangeal joint.
Which nerve is affected?
A
Ulnar nerve
(“ulnar claw hand”)
20
Q
Eye ‘down and out’ - which nerve?
A
Oculomotor
21
Q
Increased fatigue following exercise, quiet speech, and difficulty swallowing.
What condition?
A
Myasthenia gravis
22
Q
Treatment for myasthenia gravis ?
A
Pyridostigmine
(a long-acting acetylcholinesterase inhibitor that reduces the breakdown of acetylcholine in the neuromuscular junction)
23
Q
Mechanism for myasthenia gravis ?
A
Antibodies are produced against acetylcholine receptors
24
Q
Guillain-Barre syndrome is classically caused by which bacteria ?
A
Campylobacter jejuni
25
Innervation of the scrotum?
Ilioinguinal nerve + pudendal nerve
26
Median nerve motor supply =
LOAF
L ateral 2 lumbricals
O pponens pollicis
A bductor pollicis brevis
F lexor pollicis brevis
27
Limited depression, adduction of the eye, and persistent diplopia when looking down.
Which nerve palsy?
4th nerve palsy
28
Hypotonia + hyporeflexia.
Where is the motor neurone lesion?
Lower MN lesion
29
Hypertonia + hyporeflexia. Where is the motor neurone lesion?
Upper MN lesion
30
Nerve - cannot adduct thumb
Ulnar
(innervates adductor pollicis)
31
What causes subacute combined degeneration of the spinal cord (SACD) ?
Vitamin B12 deficiency
32
SACD affects which parts of the spinal cord ?
Dorsal column and lateral corticospinal tracts
33
At what level does the carotid artery bifurcate?
C4
34
Mandibular nerve CN V3 passes through which skull foramen ?
Foramen ovale
35
Facial nerve CN VII passes through which skull foramen ?
Internal acoustic meatus
(alongside the CN VIII - vestibulocochlear nerve)
36
Hallucinations occur in seizures of which lobe of the brain ?
Focal temporal lobe seizures
37
At what level does the aorta bifurcate ?
L4
38
Miosis + ptosis + enophthalmos +/- anhydrosis.
Diagnosis?
Horner's syndrome
often due to Pancoast tumour
39
Loss of gag reflex = damage to which nerve ?
Glossopharyngeal
40
Which area of the basal ganglia is particularly affected in Parkinson's disease?
Substantia nigra pars compacta
41
Very high blood pressure + headache + altered mental status
Malignant hypertension
42
Lingual nerve is a branch of which nerve ?
Mandibular CN V3
43
Redness, photophobia, lacrimation, pupils contract to light.
Which neurotransmitter is involved ?
Acetylcholine
(parasympathetic)
44
In Alzheimer's, cerebral atrophy affects which areas of the brain ?
Cortex + hippocampus
45
CN V1, V2, V3.
From which foraminae do they exit the skull ?
V1 - Superior orbital fissure
V2 - Foramen rotundum
V3 - Foramen ovale
46
What is dysdiadochokinesia ?
Inability to perform repetitive hand movements
47
Dysdiadochokinesia, ataxia, nystagmus, intention tremor, slurred speech, hypotonia (on occasion).
What area of the brain is affected ?
Cerebellum
48
What structure separates the occipital lobes from cerebellum ?
Tentorium cerebelli
49
Sudden occipital headache
Subarachnoid haemorrhage
50
What is the embryological origin of Prader-Willi syndrome ?
Diencephalon
51
Medical treatment for migraines
Oral -triptan (e.g. sumitriptan) + ibuprofen
52
Balance issues leading to recurrent falls and vertical gaze palsy - diagnosis ?
Progressive supranuclear palsy
53
Migraine relief treatment for under 18s
Nasal -triptan
(Oral triptan is only licensed in over 18s)
54
First line treatment for absence seizures
Sodium valproate
55
Motor neuron disease with only lower motor neuron features
Progressive muscular atrophy (type of MND)
56
Motor neuron disease with both lower and upper MN features
Spinal amyotrophic lateral sclerosis (ALS)
57
Suspected stroke - what is the next step in management?
CT head to rule out intracranial haemorrhage
Once bleed is excluded, prescribe 300mg oral aspirin
58
Bell's palsy vs Ramsay Hunt syndrome
Ramsay Hunt = viral cause e.g. reactivation of Herpes Zoster (presence of vesicles) + worse prognosis
Bell's palsy = idiopathic
59
Urinary incontinence, gait abnormality and dementia
Diagnosis?
Normal pressure hydrocephalus
(WET, WOBBLY, WACKY)
60
Treatment for normal pressure hydrocephalus ?
(Wet, wobbly, wacky)
Ventriculoperitoneal shunt
61
India ink stain tests for which fungus ?
Cryptococcus neoformans
(causes cryptococcal meningitis - common in immunocompromised patients)
62
Major bleed occurs when on warfarin
Stop warfarin, give IV Vitamin K and prothrombin complex concentrate
63
Management of idiopathic cranial hypertension
Weight loss + acetazolamide (carbonic anhydrase inhibitor)
64
Chronic subdural haematoma - CT findings
Hypodense (dark), crescent-shaped and not limited by suture lines
65
Acute subdural haematoma - CT findings
Hyperdense (bright), crescent/concave-shaped and not limited by suture lines
66
Fatiguable, painless muscle weakness that improves with rest
Myasthaenia gravis
67
Confusion, ataxia and nystagmus/ophthalmoplegia
Wernicke's encephalopathy
- caused by acute brain damage due to thiamine deficiency
68
Treatment for Wernicke's encephalopathy
IV Pabrinex
69
Cancer associated with myasthaenia gravis
Thymoma
(15% of MG have a thymoma)
70
First line prophylaxis for migraines
Propanolol
71
Treatment for stroke
Within 4.5 hours: Thrombolysis with Alteplase, followed 24 hours later by aspirin 300mg
After 4.5 hours: No thrombolysis; just give Aspirin 300mg
72
First line prophylaxis for cluster headaches
Verapamil
C for Cluster - C for Calcium Channel Blocker
73
Facial asymmetry, drooping and paralysis + normal ENT exam
Bell's palsy
74
Facial asymmetry, drooping and paralysis + ENT exam shows hearing loss and ear pain
Ramsay-Hunt syndrome
*be aware that ear pain occurs in 50% of Bell's palsy
76
Facial asymmetry, drooping and paralysis + ear pain + normal hearing test
Bell's palsy
77
First line management for Bell's palsy
Oral prednisolone
78
Right-sided inferior homonymous quadrantanopia
Which lobe?
Left parietal lobe
PITS!!!
(Parietal Inferior Temporal Superior)
79
Right-sided homonymous hemianopia with macular sparing
Which lobe?
Left occipital lobe
80
Right-sided superior homonymous quadrantanopia
Which lobe?
Left parietal lobe
PITS!!! Parietal inferior Temporal Superior
81
Vertigo, tinnitus and hearing loss =
Labyrinthitis
Neuritis = No hearing loss
Labyrinthitis = Loss of hearing
82
Drug used to prevent cluster headaches?
Verapamil
(+ nasal sumatriptan for relief)
83
Drug used to relieve cluster headaches
Sumatriptan
(+ verapamil for prevention)
84
Which drug worsen symptoms of myasthenia gravis?
Beta-blockers
85
First-line treatment of Bell's palsy ?
Prednisolone
86
Stab in the back
Brown-Sequard Syndrome
87
Suspected meningitis <3 y.o. or >50 y.o.
Treatment = ?
IV cephalosporin (Cefotaxime or ceftriaxone)
IV amoxicillin
88
Raised protein and normal white cells on lumbar puncture =
Guillain-Barre syndrome
89
Drugs associated with impulse control disorder
Dopamine agonists (e.g. rotigotine)
90
First-line treatment of absence seizures
Ethosuximide
91
Symptomatic patient with at least 70% carotid stenosis
Treatment = ?
Carotid endarterectomy
92
First-line treatment for tonic-clonic seizures =
1. Lamotrigine
or
2. Sodium valproate - however, not in females of reproductive age
93
Poorly controlled diabetes + postural hypotension + gastroparesis (feeling full quickly)
Autonomic neuropathy
94
Guillain-Barre protein and white cell counts ?
Raised protein + NORMAL white cell
(albumino-cytologic dissociation)
95
Guillain-Barre vs Miller-Fisher
Guillain-Barre = starts lower limbs (ascending polyneuropathy)
Miller-Fisher = starts proximally e.g. eyes
96
Guillain-Barre most common causative organism?
Campylobacter jejuni (30%)
97
Treatment for Guillain-Barre syndrome
Plasmapheresis and Immunoglobulin
98
What is used to measure respiratory involvement in Guillain-Barre syndrome?
Forced Vital Capacity (FVC)
99
slow "hot potato" speech. Potatoes look like bulbs =
Wernicke's =
Broca's =
slow "hot potato" speech. Potatoes look like bulbs = corticobulbar
Wernicke's = what? (difficulty understanding)
Broca's = broken speech
100
Tonic-clonic seizure =
tonic stage – you lose consciousness, your body goes stiff, and you may fall to the floor
clonic stage – your limbs jerk about, you may lose control of your bladder or bowel, you may bite your tongue or the inside of your cheek, and you might have difficulty breathing
101
Family history of a motor-predominant (but nonetheless mixed) length-dependent polyneuropathy
+ distal motor weakness with hypotonia and hyporeflexia
Charcot Marie Tooth disease
102
PITS - quadrantanopias
Parietal inferior
Temporal superior
103
Treatment of choice for subarachnoid haemorrhage
Endovascular coiling
(some argue surgical clipping!)
104
Pain, numbness, and paresthesia along the outer thigh (lateral cutaneous nerve)
No other symptoms
Meralgia paraesthetica
(Obesity/pregnancy)
105
Treatment of ALS/motor neurone disease
Riluzole
106
Drugs which cause Stevens-Johnson syndrome
SCALP
- Sulfonamides
- Carbamazepine
- Allopurinol
- Lamotrigine
- Penicillins
107
Broca's =
Wernicke's =
Broca's = broken speech
Wernicke's = Weird
108
First-line prophylaxis for migraines
Propanolol
109
What is mononeuritis multiplex? (in diabetics)
Two discrete incidents of neuropathy with gradual recovery
110
Acute + prophylactic management of cluster headaches
ACUTE = High flow oxygen + triptan
PROPHYLACTIC = Verapamil
111
Gait instability, urinary incontinence, mild dementia
Normal pressure hydrocephalus
112
Seizure initiating in one part of the limb and moving proximally
Jacksonian march
- Frontal lobe seizure
113
Trauma to right leg.
Increased tone and weakness in right leg.
Loss of pain and temperature sensation in left leg.
Brown-Sequard syndrome
114
1st and 2nd line for focal seizures =
1st = Lamotrigine
2nd = Levetiracetam
115
Pelvic thrusting in a seizure =
Non-epileptic attack disorder (pseudoseizure)
116
Describe trigeminal neuralgia
Chronic condition causing brief, intermittent unilateral electric-shock-like excruciating pain across one or more branches of the trigeminal nerve
117
Obese young woman headache
Raised ICP
Diagnosis + causes =
Idiopathic intracranial hypertension
Think of a moon-faced obese woman trying to treat her acne:
1. Moon-faced - steroids
2. Female, obese - self explanatory
3. Trying to treat acne - isotretinoin, tetracyclines, and COCP are used to manage acne (+ lithium)
118
First-line Parkinson's
Levodopa
+ carbidopa (prevents peripheral side effects)
119
Acetylcholine receptor antibodies = what condition?
Myasthenia gravis
120
Cancer associated with myasthenia gravis
Thymoma (10-30%)
2/3rds have thymic hyperplasia
121
Acute SOB + crepitations treatment
(Transition block)
IV furosemide + nitrate infusion
122
Focal seizures - each lobe causes what symptoms?
Frontal Lobe: Jacksonian March
Parietal Lobe: Paraesthesia
Occipital Lobe: Visual phenomena
Temporal Lobe: HEAD
- Hallucinations
- Epigastric rising
- Automatisms (e.g. lip-smacking)
- De ja vu
123
Definitive diagnostic investigation for CJD (Creudzfeldt-Jakob disease)
Tissue biopsy
(most commonly post-mortem, sometimes brain biopsy)
124
Subarachnoid haemorrhage - CT findings unrevealing - what investigation?
Lumbar puncture after 12 hours
shows xanthochromia (pink/yellow discolouration)
125
Guillain-Barre antibodies
Anti-ganglioside antibodies
126
Chronic vs acute subdural haematoma
Chronic = hypodense
Acute = hyperdense
127
Treatment for Wilson's disease (accumulation of copper)
Penicillinamine
(binds with the copper and facilitates increased urinary excretion)
128
Puerperal psychosis management ?
Hospital admission
even if no clear danger to baby/mother
129
Electrolyte abnormalities in refeeding syndrome
Low phosphate, magnesium and potassium
+ hyperglycaemia
130
Hypokalaemia ECG =
Prominent U waves
131
Mild-moderate Alzheimer's treatment =
Moderate-severe Alzheimer's treatment =
Mild-moderate = Donepezil
Moderate-severe = Memantine
132
Symptomatic treatment in idiopathic intracranial hypertension
(apart from weight loss)
Acetazolamide
133
Investigations for subarachnoid haemorrhage depending on hours post-onset
0-6hrs = CT
After 12hrs = lumbar puncture (showing xanthochromia)
134
Trigeminal neuralgia treatment
Carbamazepine
135
Lower back pain, relieved when he assumes a stooped posture and when he walks uphill rather than downhill
+ bilateral leg weakness and pain on walking
Spinal claudication and weakness
136
Investigation for encephalitis
CSF viral PCR
137
Myoclonic epilepsy treatment - first and second line
1st = Sodium valproate
2nd = Levetiracetam
138
Mood disorders contraindicate which epilepsy drug?
Levetiracetam
139
Painless monocular vision loss + sudden return to normal vision =
Amaurosis fugax
(TIA affecting one eye)
140
Korsakoff's syndrome =
Confabulations and anterograde amnesia
141
Charcot Marie Tooth is also known as ...
Hereditary motor and sensory neuropathy (HMSN)
142
Diagnosis of subarachnoid haemorrhage confirmed - what is the next investigation?
CT angiogram
(to look for evidence of aneurysm/vascular abnormalities)
143
Eye findings in idiopathic intracranial hypertension
- Loss of visual acuity when changing posture
- Enlargement of blind spots and circumferential restriction in visual fields
- Papilloedema
144
Features of temporal lobe seizures
Temporal (HEAD):
- Hallucinations (auditory/gustatory/olfactory)
- Epigastric rising sensational/Emotional
- Automatisms (lip smacking/grabbing/plucking)
- Deja vu/Dysphasia post-ictal)
145
Intracranial haemorrhage - why should you hyperventilate the patient?
- lowers carbon dioxide levels
- causes cerebral vessels to constrict
- which decreases the blood flow to the brain
- therefore decreases ICP
146
Normal pressure hydrocephalus treatment ?
Ventriculo-peritoneal shunting
147
Motor fluctuations in Parkinson's - what to prescribe for symptomatic treatment ?
MAO-B inhibitor (e.g. rasagiline) or COMT inhibitor or dopamine antagonist
148
What drug is co-prescribed with levodopa for Parkinson's
Carbidopa
- reduces the breakdown of levodopa peripherally, leading to a better therapeutic effect
149
Why is carbidopa co-prescribed with levodopa for Parkinson's?
Reduces the breakdown of levodopa peripherally, leading to a better therapeutic effect
150
Tear drop cells on the peripheral blood film
Myelofibrosis
151
MRI findings in Huntington's =
Atrophy of the caudate nucleus and putamen
152
Riluzole delays progression of which disease?
Motor neuron disease (MND)
153
