Pastest Flashcards
1
Q
This disease is caused by degeneration and inclusion body deposition within the v pars compacta of the substantia nigra
A
Parkinson’s disease
2
Q
How is speech affected in parkinson’s disease?
A
- monotone pronounciation progressing to slurred dysarthria
- speech may even be lost completely
3
Q
The following triad is a common presentation of what?
- Gait disturbance
- Urinary incontinence
- Dementia
A
Normal pressure hydrocephalus
usually a disorder of the elderly
4
Q
“A 23 year old man with mild headache, low grade fever and malaise. He has been unwell for 5 days. On examination, you notice facial Molluscum contagiosum”
A
Cryptococcal meningitis
This is an AIDS-defining illness. It occurs in patients with a low CD4 count. It often has a slowly evolving prodromal phase with fever, malaise and headache. Patients may have nausea, vomitting and photophobia and neck stiffness at the time of presentation. Treatment is with IV antifungal agents, amphotericin and/or flucytosine. Molluscum contagiosum is a good indicator of immunosuppression in HIV infection.
5
Q
How does a subarachnoid haemorrhage classically present?
Also, where is the initial pain often located?
A
Classically presents with a VERY severe headache of sudden onset
The initial pain is often in the occipital region.
6
Q
How would you diagnose a subarachnoid haemorrhage?
A
CT scan or lumbar puncture if the CT scan is negative
7
Q
Saccular berry aneurysms and AV malformations are associated with this?
A
Subarachnoid haemorrhage
8
Q
Drug therapy for bacterial meningitis?
A
Cefotaxime/ceftriaxone !!!
9
Q
Who is most at risk of chronic subdural haematoma?
A
The elderly and alcohol abusers (this is due to the fragility of bridging veins = slow bleeding from vein into the subdural space)
Trauma is a cause in any age group.
Gradually symptoms resulting from haematoma accumulate over a period of days/weeks)
10
Q
What kind of people suffer from benign intracranial hypertension? Clue you probably don’t like them
A
Overweight women
11
Q
Conditions particularly associated with visual hallucinations
A
- Delirium
- Drug intoxication
12
Q
Orthello syndrome
A
Patient’s believe their partners to be cheating on them
13
Q
Cotard’s syndrome
A
Patients believe parts of their body to be dead/decaying
14
Q
Ekbom’s syndrome
A
Patient delusionally thinks that their body is infested by insects or animals
-associated with ‘matchbox sign’
15
Q
What is schizophreniform?
A
Disorder typified by symptoms of schizophrenia of less than 6 months
16
Q
Hebephrenic schizophrenia
A
Predominant affective symptoms causing childish behaviour and prominent thought disorder
e.g. shallow mood, giggling, pranks, disorganised thoughts, rambling speech
17
Q
Residual schizophrenia
A
The patient has negative symptoms after previous episodes of delusions and hallucinations:
“predominant social withdrawal with a previous history of marked hallucinations and delusions”
18
Q
Characterised by rapidly progressive dementia, myoclonus and distinctive electroencephalographic and neuropathologic findings
A
Creutzfeldt Jakob disease
19
Q
Avoidant personality disorder
A
These patients are socially inhibited, sensitive to rejection and timid with overwhelming feelings of inadequacy
20
Q
Schizoid personality disorder
A
These patients exhibit voluntary social exclusion and limited emotional expression
21
Q
Schizotypal personality disorder
A
These patients demonstrate odd though patterns, interpersonal awkwardness and can have an odd appearance
22
Q
Reaction formation
A
A.k.a 2 faced bitch syndrome
When a person adopts a behaviour opposite to that of their true feelings
23
Q
Sublimation
A
This is when a patient turns “unacceptable” thoughts or impulses into socially acceptable ones
24
Q
Best treatment for social phobia
A
Cognitive behaviour therapy
25
What is the name given to seizures that are confined to the limbic structures?
Partial complex seizures
26
Damage to this part of the brain leads to loss of the capacity for new learning and short-term memory
Hippocampus
27
This nucleus is where you'll find lots of adrenergic neurones
Locus coeruleus
28
This nucleus is the centre for serotonin-containing cell bodies
Median raphe nucleus
29
Triad of ADHD
Hyperactivity
Inattention
Impulsiveness
30
Triad of ASD
Social impairment
Lack of imagination
Very limited activities or something
31
Features of tremor in Parkinson's
- most marked at rest
- 3-5 Hz
- worse when stressed or tired
- typically 'pill-rolling' i.e. in thumb and index finger
32
Differentiating between PD and drug induced parkinsons?
Drug induced:
- motor symptoms generally have rapid onset and BILATERAL
- rigidity and resting tremor are uncommon
33
Medications for prophylaxis of migraine?
Propanolol or topiramate (propanolol is preferred in women of childbearing age)
34
What is Zolmitriptan used for?
Useful for aborting migraine attacks (i.e. I think good when you're having the attack but not used for prophylaxis)
35
When should you give prophylaxis for migraine?
If patient is experiencing 2 or more attacks per month
36
Which scoring system is most appropriate to evaluate whether someone has had a stroke or not?
The ROSIER score
| stroke is likely if >1
37
What might a patient do to obtain some relief from carpal tunnel syndrome?
Shake their hand for relief, classically at night
38
If you suspect someone has subarachnoid haemorrhage, when would you do lumbar puncture?
Done after 12 hours to allow time for xanthochromia to develop (xanthochromia - yellow discolouration of CSF due to bilirubin from blood breakdown I think)
39
Conditions associated with berry anuerysms
APCKD
Ehlers-Danlos syndrome
Coarction of the aorta
40
Most dreaded early complication of subarachnoid haemorrhage?
Re-bleeding
| risk greatest within the first 24 hours of rupture
41
Bacteria typically causing Guillain Barre
Campylobacter jejuni
42
Treatment for paroxysmal hemicrania?
Indomethacin
43
Which type of motor neurone disease carries the worst prognosis?
Progressive bulbar palsy
44
WHich type of motor neurone disease carries the best prognosis?
Progressive muscular atrophy
45
When can you give aspirin for stroke?
Give as soon as haemorrhagic stroke has been excluded!
46
Imaging features of normal pressure hydrocephalus?
Enlarged fourth ventricle
47
Management of normal pressure hydrocephalus?
Ventriculoperitoneal shunting
48
A 41 year old presents with a two week history of headaches around the left side of his face associated with watery eyes. He describes having about 2 episodes a day each lasting around 30 minutes.
Cluster headache
49
Features of cluster headache
Episodic eye pain
Lacrimation (watery eyes)
Nasal stuffiness
Occurring daily
50
Management of cluster headache
acute: 100% oxygen, subcutaneous or a nasal triptan
prophylaxis: verapamil, prednisolone
51
Which artery is involved in a PAINFUL THIRD NERVE palsy?
Posterior communicating artery (aneurysm)
52
A patient is referred due to the development of a third nerve palsy associated with a headache. On examination meningism is present. What diagnosis should you exclude RAPIDLY?
Posterior communicating artery aneurysm
53
What is Weber's syndrome?
Ipsilateral 3rd nerve palsy with contralateral hemiplegia - caused by midbrain strokes
54
NICE guidance for neuropathic pain?
First line: amitryptiline, duloxetine, gabapentin or pregabalin
55
Most common presentation of multiple sclerosis?
Optic neuritis
56
What is Uhthoff's phenomenon?
Worsening of vision following rise in body temperature
| seen in MS - visual symptoms
57
What is Lehrmitte's syndrome?
Paraesthesia in limbs on neck flexion (seen in MS)
58
Motor symptoms seen in MS
Spastic weakness, most commonly seen in the legs
59
Fasciculations, what should you think?
MND :(
60
A 64-year-old man presents with a eight-month history of generalised weakness. On examination he has fasciculation and weakness in both arms with absent reflexes. Examination of the lower limbs reveal increased tone and exaggerated reflexes. Sensation was normal and there were no cerebellar signs. What is the most likely diagnosis?
Motor Neurone disease
61
Chief extensor of the forearm
Triceps
62
Nerve supply to the triceps
Radial nerve C7
63
Klumpke is associated with which syndrome?
Horner's syndrome
64
Nerve roots damages in Erb's palsy
C5, C6
65
Nerve roots damaged in Klumpke's palsy?
C8, T1
66
Shoulder abduction (deltoid)
Axillary nerve
67
What is cabergoline?
A dopamine receptor agonist
68
Side effects of dopamine agonists?
Impulse disorders and excessive daytime somnolence
Bromocriptine and carbergoline can cause pulmonary, cardiac and retropertioneal fibrosis
Dopamine agonists more likely to cause visual hallucinations in the elferly than levodopa
69
Side effects of amantadine
```
Ataxia
Slurred speech
Confusion
Dizziness
Livedo reticularis
```
70
This type of haematoma is associated with a lucid interval!! E.g. gets hit on the head, feels fine, collapses later
Extradural haematoma
71
Anticoagulation is associated with this type of haematoma?
Subdural haematoma
72
This haematoma is associated with features of raised ICP
Extradural haematoma
73
Often results from acceleration-deceleration trauma or a blow to the side of the head
Extra-dural haematoma
74
Risk factors for headache
Young male smoker with a positive family history
75
Driving regulations for stroke/TIA
1 month off driving
76
Driving restrictions for multiple TIA's over a short period of time?
3 months off driving
77
Which other conditions do you have to inform DVLA of?
Multiple sclerosis
| Motor neuron disease
78
Petit mal seziure
Absence seziure
79
Jacksonian seizures arise from which lobe?
The temporal lobe
80
Adverse effects of triptans?
'Triptan sensations'
| e.g. tingling, heat, tightness (throat and chest), heaviness and pressure
81
Contraindications to triptans
patients with a history of, or significant risk factors for, ischaemic heart disease or cerebrovascular disease
82
Medication for acute seizure management
Rectal diazepam (10-20mg in adults, max 30 mg.)
83
What is visual agnosia
Person can see but cannot recognise or interpret visual information due to a disorder in the parietal lobes
84
Which vessel is involved in a stroke which would cause "locked in syndrome"
basilar artery
85
What is cataplexy?
Sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened)
Features range from buckling knees to collapse
86
Management of Bell's palsy
Prednisolone 1mg/kg for 10 days should be prescribed for patients within 72 hours of onset of Bell's palsy
Eye care is important - prescription of artificial tears and eye lubricants should be considered
87
Blood pressure and ACUTE stroke management?
Elevated blood pressure should not be treated in the acute phase following a stroke (unless complications develop e.g. hypertensive encephalopathy)
Make sure you treat things like blood glucose, oxygen sats, temp etc first
88
Causes of bilateral facial nerve palsy
- Sarcoidosis
- Guillain Barre
- Polio, Lyme disease
89
Difference between LMN and UMN lesions of the face?
UMN lesions "spare" the upper face i.e. forhead
| LMN lesions affect all facial muscles
90
Medication which should be prescribed for someone who is being discharged home who had a stroke
Clopidogrel and a statin
91
How does sodium valproate work?
Increases GABA activity
92
When should you give prophylaxis for migraine?
When pt is experiencing 2 or more attacks per month
93
Side effects of metoclopramide in children and young adults?
Extra-pyramidal side effects
94
What is Shy-Drager Syndrome?
A type of multiple system atrophy:
- parkinsonism
- autonomic features (atonic bladder, postural hypotension)
- cerebellar signs
95
Which medication can exacerbate absence seizures?
Carbamazepine
96
Selegiline mechanism of action
MAO-B inhibitor
| -inhibits breakdown of dopamine secreted by the dopaminergic neurones
97
Anti-muscarinics and parkinsons?
Now used more to treat drug-induced parkinsonism rather than idiopathic parkinson's disease
98
Name 2 epilepsy medications that are P450 enzyme inducers
Carbamazepine
| Phenytoin
99
This epilepsy medication can cause agranulocytosis
Carbamazepine
100
This epilepsy medication can cause SIADH
Carbamazepine
101
This epilepsy medication can cause gingival hyperplasia
Phenytoin
102
This epilepsy medication can cause coarsening of facial features
Phenytoin
103
A 23-year-old woman is referred to the neurology clinic after developing a unilateral hand tremor. Over the past 12 months her family report changes in her behaviour and mood associated with some speech problems. On examination a tremor is noted in the right-hand at rest. There also appears to be paucity of movement and some bradykinesia. Dark circular marks are also noted around the iris. The patient reports that her uncle died of liver cirrhosis at the age of 40 years. What is the most likely diagnosis?
Wilson's disease
104
Wilson's inheritence
Autosomal recessive
105
Onset of Wilson's disease symtposm
Between 10 and 25
106
Features of Wilson's disease
Features result from excessive copper deposition in the tissues, especially the brain, liver and cornea:
liver: hepatitis, cirrhosis
neurological: basal ganglia degeneration, speech and behavioural problems are often the first manifestations. Also: asterixis, chorea, dementia
Kayser-Fleischer rings
renal tubular acidosis (esp. Fanconi syndrome)
haemolysis
blue nails
107
Diagnosis of Wilson's disease
Reduced serum caeruloplamsmin
| Increased 24hr urinary copper excretion
108
Management of Wilson's disease
Penicillamine (chelates copper)
109
Patients with sub-arachnoid haemorrhage may suffer from cerebral vasospasm, how can you minimise the chances of this?
Prescribe a calcium channel blocker e.g. Nimodopine
110
Why don't you want to decrease blood pressure acutely following a stroke?
Because higher blood pressure may be required to drive the same cerebral perfusion pressure
111
Ptosis + dilated pupil
Third nerve palsy
112
Ptosis + miosis
Horner's syndrome
113
Which features are more common in children with migraines?
GI disturbance (nausea, vomiting, abdominal pain)
114
Most likely congenital heart defects to be found in adulthood
Atrial septal defects
(two types are recognised: ostium secundum and ostium primum)
Ostium secundum is the most common
115
Features of ASD
Ejection systolic murmur, fixed splitting of S2
| -Embolism may pass from the venous system to the left side of the heart causing a stroke
116
Most common ASD?
Ostium secundum
| associated with Holt-Oram syndrome
117
ECG findings of ostium secundum
RBBB with right axis deviation
118
How is Ostium primum different from ostium secundum?
- usually presents earlier than ostium secundum
- associated with abnormal AV valves
- ECG: RBBB with LEFT axis deviation, PROLONGED PR interval
119
ECG findings ostium primum?
- RBBB with LEFT axis deviation
| - prolonger PR interval
120
What is conveyed in the dorsal column?
Fine touch, vibration and proprioception
121
Which part of the spinal cord does poliomyelitis affect?
Affects anterior horns, resulting in lower motor neurone signs
122
Which tracts are affected in subacute degeneration of the cord and what symptoms does this result in?
- Lateral corticospinal tracts
- Dorsal columns
- Spinocerebellar tracts
=bilateral spastic paresis
- bilateral loss of proprioception and vibration sensation
- Bilateral limb ataxia
123
1. Bilateral spastic paresis
2. Bilateral loss of proprioception and vibration sensation
3. Bilateral limb ataxia
Subacute degeneration of the cord
124
Which deficiencies result in subacute degeneration of the cord?
Vitamin B12 and E
125
Which tracts are affected in neurosyphilis?
Dorsal columns
| -loss of vibration and proprioception sensation
126
Most common type of MS?
Relapsing remitting
127
Percentage of people with relapsing-remitting MS who go on to develop secondary progressive MS?
About 65%
128
Drugs used in acute relapse of MS
High dose steroids
129
Drug used to prevent relapses and new lesion formation in MS
High dose steroids
130
What is natalizumab? (MS)
A monoclonal antibody (prevents white blood cells crossing the BBB where I guess they would cause damage/inflammation or something)
131
Treatment for fatigue in MS?
Mindfulness training, CBT
132
Treatment for spasticity in MS?
Baclofen and gabapentin are first line
Physiotherapy is important
Cannabis and botox are undergoing evaluation
133
Treatment for Oscillopsia (visual fields appear to oscillate)
Gabapentin
134
Treatment for bladder dysfunction in MS?
Intermittent self catheterisation/anticholinergics
Bladder dysfunction
may take the form of urgency, incontinence, overflow etc
guidelines stress the importance of getting an ultrasound first to assess bladder emptying - anticholinergics may worsen symptoms in some patients
if significant residual volume → intermittent self-catheterisation
if no significant residual volume → anticholinergics may improve urinary frequency
135
Side effects of dopamine agonists e.g. bromocriptine/cabergoline
- pulmonary fibrosis, retroperitoneal and cardiac fibrosis
- impulse control disorders
- excessive daytime somnolence
136
Side effects of Levodopa
```
Movement disorders
Palpitations
Postural hypotension
Dry mouth
Anorexia
Psychosis
Drowsiness
```
137
Side effects of Amantadine
```
Ataxia
Slurred speech
Livedo reticularis
Confusion
Drowsniess
Dizziness
```
138
What does anticipation mean in genetics counselling?
Anticipation = earlier onset of disease
139
Give an example of a disease which shows anticipation?
Huntington's (anticipation in trinucleotide repeat disorders - earlier onset in successive generations)
Fragile X
Myotonic dystrophy
Spinobulbar muscular atrophy
140
Someone with parkinson's has bad nausea, what drug could you give them?
Domperidone
-domperidone doesn't cross the BBB so does not cause extra-pyramidal side effects
(do not give metoclopramide!!! it causes parkinson's)
141
Drugs which could cause parkinson's
Metoclopramide
Haloperidol
Chlorpromazine
142
Why can you give domperidone for nause in parkinson's?
Doesn't cross BBB so doesn't cause extra-pyramidal side effects
143
What is syringomyelia and which tracts are affected?
a chronic progressive disease in which longitudinal cavities form in the cervical region of the spinal cord. This characteristically results in wasting of the muscles in the hands and a loss of sensation
Ventral horn and lateral spinothalamic horns affected
(cyst forms in the spinal cord)
Also seen in Horner syndrome
144
When can you stop your anti-epileptic medication?
If you have been seziure free for >2 years
| -stop the medication over 2-3 months
145
A 69-year-old woman presents with a 3 week history of a headache which is worse on the right side. She is generally unwell and feels 'weak', noting particular difficulty in getting up from a chair
Temporal arteritis
146
What is Lehrmitte's sign?
When you flex your neck and you get tingling in your hands
- indicated disease near the dorsal column of the spinal cord
- also seen in cervical stenosis and subacute degeneration of the cord
147
A 23-year-old man is admitted following the sudden onset of an occipital headache. On examination GCS is 15/15, neurological examination is unremarkable but neck stiffness is noted. A subarachnoid haemorrhage is suspected but the CT scan is normal. At what time should a lumbar puncture be done to exclude the diagnosis?
12 hours
148
A 24-year-old woman with Charcot-Marie-Tooth disease (type 1) asks how likely it is that any future children will have the disease. What is the most accurate answer?
50%
149
When do features of charcot marie tooth usually appear?
Appear at puberty:
- motor symptoms predominate
- FOOT DROP and LEG WEAKNESS are often the first features
- distal muscle weakness, high arches, clawed toes
150
A 67-year-old man is reviewed in the neurology clinic due to concerns about increasing clumsiness. Examination reveals an ataxic gait and increased upper limb tone with cog-wheel rigidity. Blood pressure is 135/80 lying and 95/70 standing. What is the most likely diagnosis?
Multiple System Atrophy
151
First line treatment for neuropathic pain
Amitryptiline, pregabalin, gabapentin, duloxetine
152
First line treatment for trigeminal neuralgia
Carbamazepine
153
First line for MS spasticity
Baclofen and gabapentin
154
Adverse effects of triptans
'triptan sensations'
| Tingling, heat, tightness (e.g. throat and chest), heaviness, pressure
155
Contraindications to triptans
Patients with a history of/signifcant risk factors for ischemic heart disease or cerebrovascular disease
156
Migraine and pregnancy
1st line: paracetemol
| 2nd line: aspirin/ibuprofen (can be used in 1st and 2nd trimester)
157
Migraine and menstruation
Mefanamic acid or combination of aspirin, paracetemol and caffeine
Triptans are also recommended in the acute situation
158
Which type of dementia is extremely sensitive to neuroleptic agents (anti-psychotic drugs)?
Lewy Body dementia
159
Why should you avoid neuroleptics in Lewy body dementia?
Patients are extremely sensitive and may develop irreversible parkinsonism
160
Features of Lewy Body dementia
- progressive cognitive impairment
- parkinsonism
- visual hallucinations (other features such as delusions and non-visual hallucinations may be seen)
161
Difference between drug induced PD and PD?
Rigidity and rest tremor are uncommon in drug induced parkinsonism
162
Causes of bilateral facial nerve palsy?
Sarcoidosis
Guillain-Barre syndrome
Polio
Lyme disease
163
What group of people are most likely to get cluster headaches?
Men (5:1) and smokers
164
Long term preventative management of cluster headaches
Verapamil
165
First line treatment for a migraine?
Offer a combination of oral triptan and an NSAID (or an oral triptan and paracetemol)
166
Migraine prophylaxis?
Topiramate or propanolol (propanolol favoured in women of child-bearing age)
167
What makes an essential tremor worse/better?
Worse when arms are outstretched
| Better by alcohol and propanolol
168
Treatment for essential tremor?
Propanolol
169
Which bacteria is most strongly associated with the development of Guillain-Barre syndrome?
Campylobacter jejuni
170
Normal pressure hydrocephalus imaging
Enlarged 4th ventricles
171
Management of normal pressure hydrocephalus
Ventriculoperitoneal shunting
172
NF II has a defect on which chromosome?
22
173
NF I, which chromosome has a defect?
17
174
Von Hippel Lindau, which chromosome has a defect?
3
175
Tuberose sclerosis, which chromosome has defect?
16
176
Treatment for restless legs syndrome?
Dopamine agonists such as ROPINIROLE
177
Medication for tremor in drug induced PD tremor?
Procyclidine (an antimuscarinic)
178
Role of antimuscarinics in parkinsons disease?
Now used for drug-induced PD rather than idiopathic
179
Management of MND
- Riluzole (used mainly in ALS, prolongs life by about 3 months)
- Respiratory care (non-invasive ventilation at night, survival benefit of about 7 months)
180
You are 3 times more likely to develop Bell's palsy if ____
If you are pregnant!!
181
Treatment for Bell's palsy?
NICE recommend prednisolone 1mg/kg for 10 days for patients who present within 72 hours of onset
182
When can you give thrombolysis for stroke?
- when haemorrhagic stroke has been excluded
| - within 4.5 hours of onset of stroke symptoms
