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Clinical Neurology > Random Clinical Neuro > Flashcards

Random Clinical Neuro Flashcards

1
Q

What drugs may lead to drug induced Parkinsonism?

A 
Prochlorperazine
Metoclopramide
Antipschychotics
CCBs
Amiodarone
Choroquinine
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2
Q

What type of tremor is present in drug induced parkinsonism?

A

course postural tremor

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3
Q

Is there a response to Levodopa in Progressive supranuclear palsy?

A

no

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4
Q

When is the age of onset of multiple system atrophy (Shy-Drager)?

A

60s/70s

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5
Q

Triad of features in Shy Drager?

A

dysautonomia, cerebellar features eg hyperreflexia and parkinsonism

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6
Q

In who does dropped head (Marked Antecollis) occur?

A

Shy drager

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7
Q

In what condition does alien limb phenomenon occur?

A

Cortico-basal degeneration

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8
Q

What is essentiaal tremor often confused with?

A

PD

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9
Q

What type of inheritance does essential tremor have?

A

Autosomal Dominant

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10
Q

Is essential tremor a resting tremor?

A

not so much

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11
Q

What reduces an essential tremor?

A

small amounts of alcohol

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12
Q

In patients with abnormal repeats in FMR1 gene, with a slow progressing disease of Parkinsonism?

A

Fragile X tremor ataxia syndrome

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13
Q

What will an MRI show in Fragile X tremor ataxia syndrome?

A

MCP sign (hyperintensity in middle cerebellar peduncles)

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14
Q

In whom are there milder symptoms of Fragile X tremor ataxia?

A

females with POF/menopause

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15
Q

Most common type of MS?

A

relapsing remitting

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16
Q

Describe relapsing remitting MS.

A

Acute attacks lasting 1-2 months, followed by periods of remission

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17
Q

What is secondary progressive MS?

A

relapsing/remitting patients who go on to develop neurological signs between relapses/deteriorate

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18
Q

Are gait and bladder disturbance issues seen in secondary progressive MS?

A

yes

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19
Q

Who is primary progressive disease of MS more common in?

A

older people

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20
Q

What is the least common form of MS?

A

progressive relapsing, involving progressive worsening of the condition from the beginning

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21
Q

Is cognitive impairment common in MS?

A

no

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22
Q

Is MS a disease of white or grey matter?

A

white

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23
Q

Where are MS plaques commonly seen?

A

optic nerve, preventricular white matter, corpus callosum, brain stem, spinal cord

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24
Q

What are the 3 different types of plaques in MS.

A 
active (ongoing myelin breakdown, abundant macrophages)
inactive (contain little or no myelin, astocyte growht and gliosis occur)
Shadow plaques (border between normal and affeted white matter not clear)
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25
Q

What are the two types of active plaques?

A

acute (yellow/brown)

chronic (grey brown)

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26
Q

Which type of active plaque has well defined edges?

A

chronic

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27
Q

What is the most serious long term complication of measles?

A

sub acute sclerosis panencephalitis

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28
Q

What can cause metabolic demyelination?

A

vitamin deficiencies

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29
Q

What can cause toxic demyelination?

A

chronic, low grade, solvent

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30
Q

In early onset Alzheimer’s, what is the trait?

A

autosomal dominant

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31
Q

In what genetic condition is there an increased risk of Alzheimers?

A

Down’s syndrome

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32
Q

What happens to sulci in Alzheimer’s?

A

widen

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33
Q

What happens to gyri in Alzheimer’s?

A

narrow

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34
Q

In alzheimer’s, what is seen on micrscopic pathology?

A

neurofibrillary triangles, AB amyloid plaques, amyloid angiopathy, extensive neuronal loss with atrocytosis

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35
Q

Dementia with hallucination/fluctuatin levels of attention?

A

Lewy Body Dementia

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36
Q

What occurs in L B D?

A

degeneration of substantia nigra

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37
Q

How can L B D be detected?

A

immunochemical staining for ubiquitin

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38
Q

Age of onset of Huntington’s?

A

35-50

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39
Q

Inheritance of Huntington’s?

A

autosomal dominant

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40
Q

Pathology of Huntingtons?

A

loss of neurons in caudate nucleus and cerebral cortex

Reactive fibrillary gliosis

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41
Q

Early signs of Huntington’s?

A

Clumsiness, agitation, irritability, abnormal eye movements

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42
Q

Progression to severe dependency and death in Hungtintons occurs over how many years?

A

15-20 years

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43
Q

Briefly describe the progression of Huntington’s.

A

Chorea ≫ Agitation ≫ Dementia ± seizures ≫ Death

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44
Q

Treatment of Huntington’s?

A

Is typically only supportive

Antipsychotics (e.g. chlorpromazine, haloperidol) can be useful o reduce chorea and agitation

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45
Q

What is Pick’s disease also known as>

A

frontotemporal dementia

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46
Q

Describe the pathology in the brain in Pick’s disease.

A 
Pick cells (swollen neurons)
and Pick's bodies (intracytoplasmic filamentous inclusions)
EXTREME ATROPHY of frontal and temporal lobes
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47
Q

How long does Pick’s tend to last?

A

2-10 years (rapidly progressive)

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48
Q

What type of dementia has stepwise progression?

A

Multi-infarct

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49
Q

In mult infarct dementia, are sufferes aware of their mental deficits?

A

yes - leads to depression/anxiety

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50
Q

Diagnosis of stroke?

A

Urgent CT

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51
Q

Secondary prevention in stroke?

A

clopidogrel = 1st line
Aspirin/dipyridamole
Carotid endartectomy if patient has suffered stroke in carotid territory and are not severely disabled

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52
Q

What is the syndrome involving antibodies to the presynaptic calcium channels leading to less vesicle release?

A

Lambert Eaton Myasthenic Syndrome

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53
Q

In what ways does Lambert Eaton Myasthenic Syndrome differ from myasthenia gravis?

A
  • gait problems occur first (before eyes)
  • autonomic involvement eg dry mouth, impotence, constipation
  • hyporeflexia and weakness improves after exercise
  • less response to edrophonium
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54
Q

Ratio of F:M in MG?

A

3:2

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55
Q

In whom, men or women, does MG occur younger?

A

women (occurs in 30s compared to 60s in men)

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56
Q

MG is an autoimmune disease in which antibodies to what interfere with neuromuscular transmission?

A

ACh receptors

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57
Q

Describe tendon reflexes in MG.

A

Normal

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58
Q

Give 4 signs of MG.

A

diplopia
ptosis
Snarl on smiling
peek sign (after gentle lid closure, eyes open to show white sclera)

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59
Q

What happens to patients with MG when they count to 40?

A

voice fades

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60
Q

What do symptoms of Lambert Eaton myasthenic syndrome precede?

A

cancer by 4 years - do CXR/CT

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61
Q

Treatment for Lambert Eaton myasthenic syndrome?

A

3-4 diaminopyridine or IV immunoglobin

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62
Q

Treatment for MG?

A 
ACh inhibitor (Pyridostigame)
Prednisolone
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63
Q

Investigation of MG?

A

check for antiCHR antibodies

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64
Q

Imaging in MG?

A

ct of thymus

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65
Q

What may occur in a myasthenic crisis and what should be monitored?

A

weakness of resp muscles

monitor FVC

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66
Q

Commonest muscular dystrophy?

A

myotonic dystrophy

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67
Q

Inheritance of Myotonic dystrophy?

A

AD

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68
Q

What is myotonia?

A

tonic spasm of muscle

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69
Q

Other symptoms of Duchenne MD?

A

weakness, cataracts, ptosis, frontal balding, cardiac defects

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70
Q

What is the condition in which damage to skeletal muscle causes leakage of large quantities of toxic intracellular contents into plasma?

A

rhabdomyolysis

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71
Q

Causes of rhabdomyolysis?

A

crush injuries, toxins, post convulsions

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72
Q

Triad in rhabdomyolysis?

A

Myalgia, muscle weakness, myoglobulinuria

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73
Q

What complications are there inrhabdomyolysis?

A

acute renal failure

DIC

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74
Q

What will bacterial meningitis show in the SA space?

A

neutrophils

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75
Q

Bacterial meningitis cause in NEONATES?

A

listeria, group B strep, E coli

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76
Q

Bacterial meningitis cause in CHILDREN?

A

Haem influenza

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77
Q

Bacterial meningitis cause in 10-21 years?

A

Meningococcal/neisseria

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78
Q

Bacterial meningitis cause in over 21a?

A

Pneumococcal

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79
Q

Bacterial meningitis cause in elderly?

A

pneumococcal

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80
Q

Open head trauma Bacterial meningitis cause ?

A

staph aureus/epidermis

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81
Q

Bacterial meningitis cause in AIDs?

A

cryptococcus neoformans

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82
Q

What is Kernig’s sign in bacterial meningitis?

A

pain and resistance on passive knee extension with hip fully flexed

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83
Q

In whom are the signs of bacterial meningitis not always present?

A

elderly, children, immunocompromised

84
Q

Who is most likely to get niesseria meningitis?

A

young children

85
Q

What type of viruses cause viral meningitis?

A

enteroviruses eg ECHO cirus

86
Q

Treatment of viral encephalitis?

A

rapid IV aciclovir, high dose

87
Q

Treatment of viral meningitis?

A

supportive

88
Q

In whom does crytococcal meningitis occur?

A

HIV

89
Q

Treatment of HIV meningitis?

A

IV emphotericin B/Flucytosine

Fluconoazole

90
Q

Causative organism of meningitis in neonates?

A

Group B strep, listeria or E coli

91
Q

Treatment of Group B strep/neonate meningitis?

A

benzylpenicillin and gentamicin

92
Q

Which bacteria which can be found in soft cheeses and pate?

A

Listeria

93
Q

Treatment of listeria meningitis?

A

amoxicillin and gentamicin

94
Q

Classic triad in brain abscess?

A

fever, headache, focal neurological signs

95
Q

Investigation of Brain absceess?

A

CT brain with contrast

96
Q

Treatment of brain abscess?

A

antibx (ceftriaxone and metronidazole)

Drainage

97
Q

Two peaks of onset of narcolepsy?

A

15 and 36

98
Q

What is cataplexy?

A

strong emotion causes a person to collapse

99
Q

What is RBC in narcolepsy?

A

REM behavioural disorder

100
Q

Investigation of narcolepsY?

A

overnight polysomnography

record of EEG, muscle activity and eye movement recorded

101
Q

What will a lumbar puncture show in narcolepsy?

A

lower hypocretin levels

102
Q

Two peak ages of onset of narcolepsy?

A

15/36

103
Q

Is motor neurone disease treatable?

A

NO

104
Q

Average survival time in MND?

A

3 years

105
Q

What can prolong life in MND by about 3 months?

A

Riluzole

106
Q

What characterizes MND?

A

selective loss of neurons in motor cortex, cranial nerve nuclei and anterior horn cells

107
Q

Name the 4 types of motor neurone disease.

A

ALS -occurs in 50%
Progressive bulbar palsy
Progressive muscular atrophy
Primary lateral sclerosis

108
Q

What type of dementia occurs in around 25% of patients with MND?

A

frontotemporal

109
Q

Describe a typical patient with MND.

A

40 yr old, stumbling, spatic gait, foot drop, proximal myopathy, weak grip and shoulder abduction - tasks such as hair washing become hard

110
Q

What type of pneumonia may occur in MND?

A

aspiration pneumonia

111
Q

Progressive muscular atrophy affects which muscle groups first?

A

distal before proximal

112
Q

In which type of MND is there loss of Betz cells in the motor cortex?

A

Primary lateral sclerosis

113
Q

Where is the lesion in progressive muscular atrophy ?

A

anterior horn cell lesion

114
Q

Where is motor neuron loss in ALS?

A

motor cortex AND anterior horn of the cord

115
Q

Are eye movements affected in MND?

A

no

116
Q

Babinskis sign (weakness and upper motor neuron signs?

A

ALS

117
Q

What does progressive bulbar palsy affect?

A

cranial nerves 9-12

118
Q

Two types of progressive bulbar palsy?

A

Bulbar

Corticobulbar

119
Q

Which is the most common type of progressive bulbar palsy?

A

corticobulbar

120
Q

How do the symptoms of bulbar and corticobulbar palsies differ?

A

Speech is quiet in bulbar, but slow and deliberate in corticobulbar
Jaw jerk is increased in corticobulbar but normal in bulbar

121
Q

Headache which is worse on coughing and leaning forwards?

A

Raised ICP

122
Q

What happens to pulse and bp if there is raised ICP?

A

falling pulse and rising BP (Cushing’s response)

123
Q

What type of respiration occurs in raised ICP?

A

Cheyne-Stokes
Progressively deeper and sometimes faster breathing, following by a gradual decrease,
leading to a temporary apnoea

124
Q

What pupil changes occur in raised ICP?

A

constriction initially, then dilation

125
Q

Treatment of raised ICP?

A

ABCDE
Maintain MAP at more than 90mm/Hg
Elevate the head of the bed to 30-40 degrees
Hyperventilate to decrease PCO2 (This causes vasoconstriction and reduces ICP almost immediately
Mannitol can be given
-Corticosteroids only useful in reducing oedema surrounding tumours
-Restrict fluid
-MAKE DIAGNOSIS

126
Q

Is there a diagnostic test for MND?

A

no

127
Q

Name 3 herniation syndromes.

A

Uncal herniation
Cerebellar tonsil herniation
Subfalcian/cingulate herniation

128
Q

A subfalcian herniation is silent unless what occurs?

A

anterior cerebral artery is compressed causing STROKE

129
Q

Which type of cerebral herniation causes dilated ipsilateral pupil then opthalmoplegia due to 3rd nerve compression?

A

UNCAL herniation

130
Q

What mainly causes Sub dural haematoma?

A

trauma

131
Q

Is a sub dural haematoma the same as a sub dural haemorrhage?

A

yes

132
Q

Symptoms of Sub dural Haemorrhage?

A 
fluctuating consciousness
insidious physical/intellectual slowing
Sleepiness
Headache
personality change
unsteadiness
133
Q

What on the CT/MRI differentiates a subdural haemorrhage from an extradural haemorrhage?

A

crescent shaped collection of blood over one hemisphere

134
Q

Treatment of SDH?

A

irrigation/evacuation via BURR TWIST DRILL and craniostomy

135
Q

What term describes the condition of ventricular dilation of the absence of raised CSF pressure on lumbar puncture?

A

Normal pressure hydrocephalus

136
Q

Is Normal pressure hydrocephalus a cause of dementia?

A

yes - a potentially reversible cause

137
Q

Triad of features in Normal pressure hydrocephalus?

A

Gait abnormality
Urinary incontinence
Dementia

138
Q

Treatment of Normal pressure hydrocephalus?

A

Acetozolamide and repeated lumbar puncture

Surgical insertion of a shunt

139
Q

Who are more likely to get migraines, females or males?

A

females

140
Q

Associations with migraines?

A

obesity, patent foramen ovale

141
Q

Describe a classic migraine.

A

aura lasting 15-30 mins followed within 1 hr by unilateral throbbing headache

142
Q

What type of drugs are anti migraine?

A

triptan

143
Q

Describe a tension headache.

A

pressing tingling quality to pain
Bilateral
NO other features eg nausea, photophobia

144
Q

Describe a cluster headache.

A

Rapid onset of excruciating pain around 1 eye, eye becomes water and bloodshot with lid swelling
Rhinorrhea, facial flushing
Pain is UNILATERAL and normally affects same side

145
Q

Treatment of cluster headache?

A

O2
Sumatriptan
Prevention: prednisolone, lithium, verpramil

146
Q

What is the type of headache ass with large vessel vasculitis?

A

giant cell arteritis

147
Q

Symptoms of Giant Cell arteritis?

A

headache, temporal artery/scalp tenderness, jaw claudication, am fugax, sudden blindness

148
Q

Can you get skip lesions in giant cell arteritis?

A

yes

149
Q

Management of GCA?

A

Start prednisolone immediately

150
Q

What is GCA associated with?

A

polymyalgia rheumatica (50% of the time)

151
Q

In whom is trigeminal neuralgia more common in?

A

males, over 50

152
Q

Describe trigeminal neuralgia.

A

moments of intense stabbing pain for a few seconds, unilateral

153
Q

Investigation for trigeminal neuralgia?

A

MRI

154
Q

Treatment for trigeminal neuralgia?

A
  • Carbamazepine
  • Lamotrigine
  • Phenytoin
  • Gabapentin
  • Surgery
155
Q

Describe an extradural haemorrhage.

A

Accumulation of blood between the bone and the dura.

156
Q

What often causes an extradural haemorrhage?

A

fractured temporal/parietal bone, due to traume just lateral to eye

157
Q

What will any tear in the dural sinus cause?

A

an extradural bleed

158
Q

What will CT show in extradural haemorrhage?

A

biconvex shape

may also see skull fracture on X ray

159
Q

Treatment of an extradural haemorrhage?

A

clot evacuation and ligation of bleeding vessel

160
Q

Subarachnoid haemorrhage - describe the headache?

A

sudden onset, severe, like being hit on the back of head with a brick

161
Q

What is Subarachnoid haemorrhage usually caused by?

A

underlying Berry aneurysm

162
Q

Symptoms of Subarachnoid haemorrhage?

A

meningism eg photophobia neck stiffness etc

headache

163
Q

Investigation of Subarachnoid haemorrhage?

A

CT, lumbar puncture

164
Q

How can Subarachnoid haemorrhage be differentiated from a traumatic tap?

A

by taking 3 CSF samples (blood should decrease)

165
Q

Associations of Berry aneurysms?

A

Ehler-Danlos
Polycystic kidneys
Coarctation of aorta

166
Q

What does menopause do to risk of Berry aneurysm?

A

increase risk

167
Q

Gold standard investigation for Berry aneurysm?

A

cerebral angiography via femoral artery

168
Q

In what does Charcot Bouchard microaneurys,s arise of small perforating artieres?

A

intracerebral haemorrhage

169
Q

Investigation for intracerebral haemorrhage?

A

urgent CT

angiography

170
Q

What about the clot means an improved prognosis in intracerebral haemorrhage?

A

if it is superficial and there is a good neurological status

171
Q

Who typically gets idiopathic intracranial hypertension?

A

obese women

172
Q

Symptoms of idiopathic intracranial hypertension?

A

headache, with diurnal variation
blurred vision and narrowed visual fields
enlarged blind spot and papilloedema

173
Q

Who does hypnic headache affect?

A

elderyl

174
Q

What type of headache is a hypnic headache?

A

moderate throbbing headache, wakes patient from sleep

175
Q

Treatment for a hemicrania continua (causes continous one sided head pain)?

A

indomethacin

176
Q

What drugs are most likely to cause medication overuse headache?

A

triptans/opoids

177
Q

Investigations in epilepsy?

A

refer to specialist

who will do ECG and EEG(confirm type)

178
Q

In which seizure type are there features referable to a part of ONE hemisphere?

A

partial seizures

179
Q

What is often seen with partial seizures underlying?

A

structural disease

180
Q

Describe the 2 types of partial seizures.

A

Simple partial - awareness UNIMPAIRED

Complex partial - awareness IMPAIRED

181
Q

List the 5 subtypes of Primary generalized seizures.

A 
Absence
Tonic clonic
Myoclonic
Atonic (akinetic)
Infantile
182
Q

Describe an absence seizure and its treatment.

A 
Brief pauses (less than 10 secs)
presenting in childhood
Treatment = sodium valproate
183
Q

Describe a tonic clonic seizure and its treatment.

A

Loss of consciousness, limbs stiffen (tonic) and jerk (clonic), following which there is confusion/drowsiness
Treatment = sodium valproate

184
Q

Describe a myoclonic seizure and its treatment.

A

Sudden limb/face/trunk jerk, may be suddenly thrown to ground. Violently disobedient limb
Treatment = sodium valproate

185
Q

Describe atonic seizures and treatment.

A

sudden loss of muscle tone causing fall
NO loss of consciousness
Treatment = sodium valproate

186
Q

Describe treatment for partial seizures.

A

Carbamazepine

then lamotrigine

187
Q

Define status epilepticus.

A

seizures lasting more than 30 mins

188
Q

What is the likely cause if a pregnancy woman has status epilepticus.

A

pre eclampsia

189
Q

Investigation of status epilepticus?

A

FBCs

190
Q

Treatment of status epilepticus?

A

lorazepam, phenytoin, diazepam, dexamethosone if possible oedema

191
Q

What is non epileptiform attack disorder?

A

Seizures without electrical activity changes in brain, may be functional. Rapid recovery soon after attacks, patients recognise triggers

192
Q

Investigation if a space occupying lesion is suspected?

A

CT/MRI

Biopsy

193
Q

Symptoms of space occupying lesion?

A

headache worse on waking, lying down, bending forward, with coughing etc
seizures in 50%

194
Q

Treatment of benign space occupying lesion?

A

removal

195
Q

Treatment of malignant SOL?

A

excision may be difficult, chemoradiotherpy/shunt may be needed

196
Q

Triggers for Guillian Barre syndrome?

A

campylobacter infection, CMV, mycoplasma, zoster, HIV, EBV, vaccinations

197
Q

Describe Guillian Barre syndrome.

A

An acute inflammatory demyelinating polyneuropathy, occuring several weeks after an infection

198
Q

Describe the pattern of muscle weakness in Guillian Barre.

A

symmetrical ascending muscle weakness

sensory symptoms precede weakness

199
Q

Treatment of Guillian Barre?

A

IV immunoglobulin

Plasmapharesis

200
Q

Name the disease of peoneal muscular atrophy causing week legs, foot drop and starting in puberty?

A

Charcot Marie Tooth

201
Q

Treatment of hereditary spastic paraplegia (causes weakness/stiffness over time, sparing hands and arms)?

A

muscle relaxants and physio

202
Q

What term is used if 2 or more peripheral nerves are affected?

A

Mononeuritis multiplex

203
Q

Causes of Mononeuritis multiplex?

A 
WARDS PLC
Wegeners
AIDS/Amyloid
Rheumatoid
Diabetes
Sarcoidosis
PAN
Leprosy
Carcinomatosis
204
Q

1st line for neuropathic pain?

A

amitriptyline/duloxetine/gabapentin/pregabalin

Tramadol can be used as rescue therapy

205
Q

Examples of neuropathic pain?

A

diabetic neuropathy
trigeminal neuralgia
Prolapsed disc
Post herpetic neuralgia

Clinical Neurology (9 decks)

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