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Med School Finals > Neurology > Flashcards

Neurology Flashcards

1
Q

Deep tendon reflexes and their nerve roots?

A

Ankle (S1-S2)
Knee (L3-L4)
Biceps (C5-C6)
Triceps (C7-C8)

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2
Q

Motor (descending) pathways?

A

Pyramidal tracts
→ corticospinal
Extrapyramidal tracts
→ rubrospinal
→ reticulospinal
→ vestibulospinal
→ tectospinal

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3
Q

Function of the motor (descending) pathways?

A

Pyramidal = conscious movement
Extrapyramidal = unconscious movement
→ rubrospinal = flexors and extensors
→ reticulospinal = eye and respiratory muscles
→ vestibulospinal = posture and balance
→ tectospinal = reflex movements

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4
Q

Sensory (ascending) pathways?

A

DCML
Spinocerebellar tracts
Spinothalamic tracts

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5
Q

Function of the sensory (ascending) pathways?

A

DCML = proprioception, fine touch, pressure, vibration
Spinocerebellar = proprioception
Spinothalamic = pain and temperature

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6
Q

Types of stroke?

A

Ischaemic (85%)
Haemorrhagic (15%)

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7
Q

Features of anterior vs middle vs posterior cerebral artery stroke?

A

Anterior = contralateral hemiparesis and sensory loss, lower limbs > upper limbs
Middle = contralateral hemiparesis and sensory loss, lower limbs < upper limbs, contralateral homonymous hemianopia, aphasia
Posterior = contralateral homonymous hemianopia with macular sparing, visual agnosia

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8
Q

Oxford stroke classification assessment criteria?

A
  1. Hemiparesis +/- hemisensory loss
  2. Homonomyous hemianopia
  3. Higher cognitive dysfunction e.g. dysphasia
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9
Q

Oxford stroke classification features of TACI vs PACI?

A

TACI = all 3 features
PACI = 2 features

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10
Q

FAST stroke campaign?

A

Face = is one side droopy? can they smile?
Arms = can they raise them and keep them there?
Speech = is it slurred?
Time = call 999 if there is any of the above

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11
Q

Investigation for suspected stroke?

A

Non-contrast CT head

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12
Q

Acute management options for ischaemic stroke?

A

Thrombolysis (if < 4.5 hours)
Thrombectomy (if < 6 hours)
Aspirin 300mg daily

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13
Q

Long-term management of ischaemic stroke?

A

1st line = clopidogrel
N.B. add anti-hypertensive, statin etc. if needed

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14
Q

Advice for starting anticoagulants for AF post-stroke?

A

Only commence after haemorrhagic stroke excluded and at least 14 days has passed

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15
Q

Transient ischaemic attack (TIA)?

A

Transient neurological dysfunction without acute infarction
Symptoms typically resolve within 1 hour

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16
Q

Investigations for TIA?

A

MRI
Carotid artery doppler

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17
Q

Dysarthria vs dysphasia vs aphasia?

A

Dysarthria = weakness of muscles involved in speech
Dysphasia = partial loss of language
Aphasia = complete loss of language

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18
Q

Where is Broca’s vs Wernicke’s area?

A

Broca’s = frontal lobe
Wernicke’s = temporal

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19
Q

Cause of Wernicke’s aphasia and features?

A

Lesion of the superior temporal gyrus
→ non-sensical speech
→ remains fluent
→ comprehension/insight impaired

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20
Q

Cause of Broca’s aphasia and features?

A

Lesion of the inferior frontal gyrus
→ laboured and halting speech
→ non-fluent
→ repetition is poor
→ comprehension/insight preserved

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21
Q

Cause of conduction aphasia and features?

A

Lesion of the arcuate fasciculus (connection between Wernicke’s → Broca’s)
→ fluent speech
→ repetition is poor
→ comprehension/insight preserved

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22
Q

Red flags of headache?

A

Immunosuppressed
PMH malignancy
Sudden and severe
Age < 20
Neurological deficit
Worse on coughing, sneezing etc.

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23
Q

Features of a migraine?

A

Unilateral or bilateral throbbing pain
N&V, photophobia, phonophobia
Preceding aura e.g. visual change
Can last up to 72 hours

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24
Q

Acute management of a migraine?

A

Triptan + NSAID or paracetamol

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25
Q

Drug options for migraine prophylaxis?

A

Propanolol
Topiramate
Amitriptyline

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26
Q

Advice for contraception in women with migraines?

A

COCP absoutely contraindicated

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27
Q

Triptan examples, mechanism of action and side effects?

A

Examples = sumatriptan, zolmitriptan
Mechanism of action = 5-HT1 agonists
Side effects = tingling, heat, chest tightness

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28
Q

Features and management of tension headaches?

A

Bilateral, band-like pain
No aura or associated symptoms
May be related to stress
Management = aspirin, paracetamol or NSAID

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29
Q

Features and management of cluster headaches?

A

Sharp, stabbing pain around eye
Redness, lacrimation, eyelid swelling
Clusters usually last 4-12 weeks
Management = oxygen + triptan (acute), verapamil (prophylaxis)

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30
Q

Investigation for cluster headaches?

A

MRI with gadolinium contrast

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31
Q

Management of trigeminal neuralgia?

A

Carbamazepine

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32
Q

Seizure vs epilepsy?

A

Seizure = single episode of abnormal electrical activity with many causes e.g. fever, hypoglycaemia
Epilepsy = chronic seizure activity

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33
Q

Generalised vs focal seizure subtypes?

A

Generalised
→ tonic-clonic (grand mal)
→ myoclonic
→ absence (petit mal)
→ atonic
Focal
→ focal aware
→ focal impaired awareness

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34
Q

Management of focal, tonic-clonic, myoclonic, absence and atonic seizures?

A

Focal = lamotrigine or levetiracetam
Tonic-clonic = lamotrigine (female), sodium valproate (male)
Myoclonic = levetiracetam (female), sodium valproate (male)
Absence = ethosuximide
Atonic = lamotrigine (female), sodium valproate (male)

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35
Q

DVLA guidance for epilepsy?

A
  • Must surrender licence if has a seizure
  • Reapply after 6 months if one-off
  • Reapply after 12 months if more than one
  • Established epilepsy may qualify if at least 12 months seizure-free
  • No driving if withdrawing from medication and for 6 months after last dose
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36
Q

Status epilepticus?

A

Seizure lasting > 5 minutes or ≥ 2 seizures within 5 minutes

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37
Q

Pre-hospital mangement of status epilepticus?

A

Rectal diazepam or buccal midazolam

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38
Q

Hospital manegement of status epilepticus?

A

1st line = IV lorazepam
2nd line = IV phenytoin or phenobarbital

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39
Q

Features and management of narcolepsy?

A

Hypersomnolence
Cataplexy
Sleep paralysis
Management = daytime stimulant + nighttime sodium oxybate

40
Q

UMN vs LMN lesion features?

A

UMN = spastic paresis, hyperreflexia, hypertonia, Babinski +ve
LMN = flaccid paralysis, muscle wasting, fasiculations, hyporeflexia, hypotonia

41
Q

MS subtypes?

A

Relapsing-remitting (~85%)
Secondary progressive
Primary progressive

42
Q

Features of MS?

A

Fatigue
Optic neuritis
Sensory changes
Spastic weakness
Urinary incontinence

43
Q

Investigations and findings for MS?

A

MRI
→ lesions and plaques
Lumbar puncture
→ oligoclonal bands

44
Q

Acute management of MS?

A

Methylprednisolone for 5 days

45
Q

Disease-modifying drugs for MS?

A

Natalizumab (1st line)
Ocrelizumab (1st line)
Fingolimod
Beta-interferon
Glatiramer acetate

46
Q

Drug options for spasticity?

A

Baclofen
Gabapentin

47
Q

Features and management of of Gullain-Barre syndrome?

A

Progressive (ascending) weakness of limbs
1-3 weeks post-infection
Back pain, leg pain
Reduced or absent reflexes
Mild sensory changes
Management = IV immunoglobulins (1st line), plasmapharesis (2nd line)

48
Q

Lumbar puncture features of Guillain-Barre syndrome?

A

Raised protein with normal WCC

49
Q

Features and management of MND?

A

Mixed UMN and LMN signs
Limb atrophy and weakness
Wasting of small hand muscles
Management = riluzole, respiratory support, nutritional support

50
Q

Features and management of myasthenia gravis?

A

Muscle fatiguability
Diplopia
Proximal muscle weakness
Management = pyridostigimine

51
Q

Investigations for myasthenia gravis?

A

EMG studies
Antibodies to ACh receptors

52
Q

Management of a myasthenic crisis?

A

IV immunoglobulins
Plasmapharesis

53
Q

Condition associated with myasthenia gravis?

A

Thymoma (~15%)

54
Q

Cerebellar syndrome features?

A

DANISH
→ dysdiadochokinesia
→ ataxia
→ nystagmus
→ intention tremor
→ scanning dysarthria
→ hypotonia

55
Q

Clonus vs myoclonus?

A

Clonus = rhythmic movement in response to muscle stretch e.g. testing a reflex
Myoclonus = random, jerky movements

56
Q

Features and management of Parkinson’s disease?

A

Bradykinesia
Resting tremor (3-5 Hz)
Muscle rigidity
Loss of facial expression
Mental health problems
Management = levodopa (motor symptoms prominent), dopamine agonist or MAO-B inhibitor (fewer motor symptoms)

57
Q

Parkinson’s disease vs drug-induced Parkinsonism?

A

Parkinson’s = progressive, unilateral, variable symptoms
Drug-induced = rapid, bilateral, rigidity and tremor rare

58
Q

Features and management of essential tremor?

A

Postural
Worse with arms outstretched
Improves with alcohol and rest
Management = propanolol

59
Q

EMG features of a myopathy vs neuropathy?

A

Myopathy = ↑ action potential duration and ↑ action potential amplitude
Neuropathy = ↓ action potential duration and ↓ action potential amplitude

60
Q

Most common hereditary peripheral neuropathy?

A

Charcot-Marie-Tooth disease

61
Q

Management of neuropathic pain?

A

1st line = amitriptyline, duloxetine, gabapentin, pregabalin
2nd line = switch to one of other 3
3rd line = pain management team referral
N.B. topical capsaicin can be used for localised pain and tramadol can be used as “rescue” medication

62
Q

Features, investigation and management of degenerative cervical myelopathy?

A

Neck and arm pain
Loss of motor and sensory function
Urinary incontinence
Investigation = MRI cervical spine
Management = surgical decompression

63
Q

Features of ulnar nerve (C8-T1) vs radial nerve (C5-T1) vs median nerve (C6-T1) lesion?

A

Ulnar = “claw hand,” hypothenar wasting, sensory loss over dorsal/palmar medial 1 1/2 digits
Radial = “wrist drop,” sensory loss over dorsal lateral 2 1/2 digits
Median nerve = carpal tunnel syndrome, thenar wasting, sensory loss over palmar 2 1/2 digits

64
Q

Features of common peroneal nerve (L4-S2) lesion?

A

Foot drop
Weak extension of big toe
Sensory loss on dorsum of foot and lateral lower leg

65
Q

Glasgow Coma Scale (GCS) criteria?

A

Motor response:
6. Obeys commands
5. Localises to pain
4. Withdraws from pain
3. Abnormal flexion to pain
2. Extending to pain
1. None
Verbal response:
5. Orientated
4. Confused
3. Words
2. Sounds
1. None
Eye opening:
4. Spontaneous
3. To speech
2. To pain
1. None

66
Q

Cerebral perfusion pressure (CPP) calculation?

A

CPP = MAP - ICP

67
Q

Normal ICP?

A

7-15 mmHg

68
Q

Features and management of raised ICP?

A

Cushing’t triad (bradycardia, wide pulse pressure, irregular breathing)
Headache
Vomiting
Papilloedema
Reduced consciousness
Management = head elevation, IV mannitol, CSF drainage

69
Q

Cause of communicating vs non-communicating hydrocephalus?

A

Communicating = increased CSF production or impaired reabsorption via arachnoid granules e.g. meningitis
Non-communicating = pathology obstructing the flow of CSF e.g. tumour

70
Q

Features and management of normal pressure hydrocephalus?

A

Weird, wet and wobbly:
→ dementia
→ urinary incontinence
→ ataxic gait
Management = V-P shunt

71
Q

Features and management of meningitis?

A

Headache
Fever
Neck stiffness
Photophobia
Reduced consciousness
Purpuric rash (meningococcus)
Management = IV ceftriaxone + IV amoxicillin + IV aciclovir (if viral suspected)

72
Q

CSF features of bacterial vs viral meningitis?

A

Bacterial = cloudy, low glucose, high protein, very raised WCC
Viral = clear/cloudy, 60-80% plasma glucose, normal/high protein, raised WCC

73
Q

Management of post-lumbar puncture headache?

A

Supportive e.g. fluids, caffeine
If > 72 hours = blood patch, epidural saline, IV caffeine

74
Q

Investigation for suspected TB meningitis?

A

PCR

75
Q

Management of a brain abscess?

A

Craniotomy with debridement + IV cephalosporin + IV metronidazole

76
Q

Most common cause and site of encephalitis?

A

HSV-1
Temporal lobes

77
Q

Features and management of encephalitis?

A

Acute headache
Meningism e.g. photophobia, seizures
Sudden behavioural change
Management = IV aciclovir + IV broad-spectrum antibiotic

78
Q

UMN vs LMN facial nerve lesion?

A

UMN spares upper face
LMN affects all facial muscles

79
Q

Features and management of Bell’s palsy?

A

Unilateral facial LMN weakness
Sparing of extraocular and mastication muscles
Postauricular otlagia
Management = prednisolone, eye care e.g. artificial tears

80
Q

First line investigation for head trauma?

A

Non-contrast CT

81
Q

Criteria for CT head < 1 hour?

A
  • GCS < 13 on initial assessment
  • GCS < 15 at 2 hours post-injury
  • Suspected open or depressed skull fracture
  • Any sign of basal skull fracture
  • Post-traumatic seizure
  • More than 1 episode of vomiting
  • Focal neurological deficit
82
Q

Criteria for CT head < 8 hours?

A

Those with LoC or amnesia plus:
- Age 65 years or older
- Bleeding or clotting disorders
- Anticoagulant use
- Dangerous mechanism of injury
- More than 30 minutes retrograde amnesia of events immediately before the head injury

83
Q

Classification of primary brain injuries?

A

Focal (e.g. haematoma)
→ subdural
→ epidural
→ intracerebral
Diffuse (e.g. diffuse axonal injury)

84
Q

Herniation vs coning?

A

Herniation = displacement of brain structures
Coning = specifically displacement of the cerebellar tonsils through the foramen magnum

85
Q

CT feature of a subdural vs epidural haematoma?

A

Subdural = crescent shape
Epidural = biconcave/lentiform shape

86
Q

CT feature of an acute vs chronic subdural haematoma?

A

Acute = hyperdense lesion
Chronic = hypodense lesion

87
Q

Origin and management of a subdural haematoma?

A

Bridging veins
Management = supportive (small), decompression with burr holes (large)

88
Q

Origin and management of an epidural (extradural) haematoma?

A

Middle meningeal artery
Management = supportive (small), craniotomy with evacuation (large)

89
Q

Typical history of an epidural haematoma?

A

Patient with head injury loses consciousness, regains it (“lucid interval”), then loses it again

90
Q

Features and management of a subarachnoid haemorrhage?

A

“Thunderclap” occipital headache
Photophobia, neck stiffness
N&V, seizures, coma
Management = nimodipine, aneurysm coil or clipping

91
Q

Investigations for subarachnoid haemorrhage?

A

Non-contrast CT
CT < 6 hours and -ve = alternative diagnosis
CT > 6 hours and -ve = lumbar puncture

92
Q

CSF features of subarachnoid haemorrhage?

A

Xanthochromia
Normal or raised LP opening pressure

93
Q

Features of subacute combined degeneration of the spinal cord?

A

Vitamin B12 deficiency
Dorsal column disease
→ impaired sensation, parasthesia
Lateral corticospinal tract disease
→ UMN signs
Spinocerebellar disease
→ gait abnormalities

94
Q

Features of Brown-Sequard syndrome?

A

Ipsilateral hemiplegia
Ipsilateral loss of proprioception/vibration
Contralateral loss of pain/temperature sensation

95
Q

Features and management of neuroleptic malignant syndrome?

A

Fever
Muscle rigidity
Hypertension, tachycardia
Raised CK and WCC
Management = stop antipsychotic, IV fluids, dantrolene

Med School Finals (18 decks)

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