Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RACP 2023 > NEURO > Flashcards

NEURO Flashcards

1
Q

Features of psychogenic seizures? Which ones most sensitive?

A

Most sensitive: ictal eye closure, pelvic thrusting

Longer than 2 mins
Variable motor activity; waxing/waning
Vocalisation
Rapidly awake and reoriented
Twitching all 4 limbs
No prolactin rise
Surface EEG normal

UNCOMMON
- autonomic signs
- incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Limbic encephalitis? Causes: 3 categories?

A

Paraneoplastic
- NMDA: ovarian
- AMPA: breast lung thymoma
- GABA: SCLC
- LGI1: SCLC, thymoma
- CV2/CRMP5: SCLC, thymoma
- Hu: SCLC
- Anti-Ma2: testicular
- GAD: SCLC, thymoma

Infection
- HSV
- VZV
- HHV

AI
- check for oligoclonal bands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Limbic encephalitis imaging findings?

A

Temporal lobe/ limbic/hippocampal changes

T2 FLAIR hyperintensities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ACA stroke features

A

Dear motivation
Limb apraxia
LL > UL
Incontinence: faecal/urinary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

MCA superior stroke features

A

Broca
Temporal vision loss, opposite side
UL > LL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MCA inferior stroke features

A

Wernicke
Parietal vision, opp side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MCA dominant side stroke features

A

Gerstmann Syndrome

Agraphia: can’t write
Acalculia: can’t calculate
Finger agnosia
L-R disorientation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MCA non-dominant side stroke features

A

Contralateral neglect
Hemianopia
Hemiparesis
Constructional aprexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Posterior communicating artery stroke features

A

CN III palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PCA stroke features

A

CN III, IV
Vision: homonymous hemianopia with macular sparing
Alexia: can’t read but can write

Weber
- CNIII
- hemiplegia contralateral

Clause
- CNIIII
- contralateral ataxia and sensory loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lenticular/subcortical stroke features

A

Pure motor MOST COMMON
Pure sensory
Sensorimotor
Hemiballismus
Dysarthria-clumsy hand syndrome
Ataxic hemiparesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Basilar stroke features

A

LOC

Locked in syndrome

Medial pontine syndrome
- CN VI, VII
- contralateral hemiparesis and sensation loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

AICA stroke features

A

Lateral pontine syndrome
- V, VII, VIII ipsi
- Ipsi horners
- Ipsi cerebellar
- Contralateral pain/temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PICA stroke features

A

Lateral medullary syndrome
- IX, X, XI ipsi
- Ipsi horners
- Ipsi cerebellar
- Contralateral pain/temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Anterior spinal a stroke features

A

Medial medullary syndrome
- XII ipsi
- contralateral hemiparesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Carotid stroke features
- internal
- common

A

ICA
- amaurosis fugax
- ipsi dysphagia, tongue deviation
- CL vision/ sensory/ weakness

CCA
- Horner
- MCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Carpel tunnel vs proximal median n lesion?

A

Proximal
- hypothenar, proximal thenar, dorsal of hypothenar numbness
- flexor weakness

Carpel tunnel
- pain/paraesthesia
- numbness on palm under 2/3/4th funger
- proximal thenar sensation PRESERVED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ulnar nerve: elbow vs wrist lesion

A

WRIST
- sensation fibres don’t pass through guyon canal
- weakness ONLY

Elbow
- weakness and paraesthesiae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Difference between common peroneal/ L5/S1 neuropathy?

A

Check notes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Difference between radial n and C7 palsy

A

Check notes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PRRF lesion on (R) –> manifestations?

A

Can’t abduct (R) eye and adduct (L) eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

MLF lesion on (R)

A

Can’t adduct (R) eye
(L) eye nystagmus

INO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

FEF lesion on (L)

A

Can’t look to the (R)
- drift slowly to (L)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How to differentiate MS/NMO/MOG

A

Check notes: non compressive myelopathy table

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Nystagmus: peripheral vs central?

A

Peripheral
- torsional
- direction depends on canal (post = up, mid = horizontal, anterior=down)
- away from lesion

Central
- pure vertical
- toward lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Head impulse; how to differentiate central vs peripeheral?

A

Normal = Stroke
Abnormal = Peripheral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Migraine pathophysiology?

A

CNS dysfunction –> cortical depression spreads –> irritates trigeminal –> CGRP release –> meninges irritated –>

Chemicals
- 5HT
- GABA
- Glutamate
- DA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Features of migraine headache?

A

Unilateral
Photophobia
Phonophobia
Throbbing
Aggravated by movement
Lasts 4-72 hours
Moderate intensity
N+V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Migraine treatment

A

ACUTE
- 5HT (CI CVS NVS disease)
- NSAIDs/paracetamol/aspirin
- DA antagonists
- MAB against CRGP

PROPHYLAXIS
- SSRIs (pztoifen)
- CCB/BB
- TCA
- Anticonvulsants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Tardive dyskinesia/ drug induced Parkinsonism commonly assoc with? Treatment?

A

Antispychotics

Benztropine, Tetrabenazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Hemiballismus assoc with:

A

Huntingtons
Basilar stroke
Lesions of Subthalamic nucleus, basal ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Tourettes: associations and treatment

A

ADHD: Clonidine
OCD: SSRI

Habit reversal training
Risperdone
Tetrabenezine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Dystonia treatment?

A

Levodopa
Clonaz
Botox

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

RLS causes and treatment

A

Fe def
Low DA

TX
- opioids
- dopamine agonists
- Fe replacement
- gabapentin, pregabalin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How would latent and active TB be differentiated on testing?

A

Active: TST, IGRA, culture (+)
Latent: TST, IGRA (+)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Treatment for latent TB?

A

Monotherapy
- rifamp 4 months
- isoniazid 9 months
- rifapentine 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

When would you treat latent TB?

A

Immunocomp
Recent negative –> positive
Young
HCW
Recent exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How to treat TB meningitis?

A

Moxiflox: penetrates meninges
Dex: reduces mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How to treat TB in pregnancy?

A

Same: most safe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

MDR TB options?

A

Moxiflox/ levoflox
Mero
Amikacin
Linezolid
Bedaquiline
Cycloserine
Clofazimine
Pyrazinimide
Delamanid
Ethionamide
p-aminosalicylic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Risk factors for TB infection?

A

Acquired immunodeficiency = MOST POTENT
HIV
Transplantation
Renal failure
Length of exposure
Infectiousness of contact
Smear positive
Transplant

42
Q

How to diagnose TB?

A

Smear/culture/ microscopy/ PCR

Tissue, sputum, pleural fluid, CSF

43
Q

What is IGRA used for? What is the significance?

A

Evidence of past exposure

Detects T cell producing IFN-gamma to TB antigens
- false negative in immunocompromised
- can be active/latent/past/reinfection

44
Q

Which genetic diagnosis associated with aortic coarctation?

A

Turners

45
Q

Which immunosuppressed states are at highest risk of PJP?

A

Steroids
Lymphopenia
TNF-alpha
Transplant

46
Q

Tests for aspergillus?

A

Serum galactomann
PCG Aspergillus precipitans

47
Q

Management of C diff?
- first episode
- second episode
- third episode
- severe

A

1st: vanc/metro
2nd: vanc/fidoxamicin
3rd: FMT (comp –> bowel perd)

Severe: IV metro or PO vanc

48
Q

When do you repeat stool culture for C diff?

A

If symptomatic

If asymptomatic, remains (+) for > 1 month so means nothing

49
Q

What drugs frequently cause C diff?

A

Clindamycin
2nd/3rd cephalosporins
Fluoroquinolones
Amoxicillin/ Ampicillin

50
Q

ACA features?

A

Motor and/or sensory deficit (leg > face, arm)
Limb apraxia
- Inability to perform coordinated movements

Urinary/faecal incontinence

Decr motivation

51
Q

MCA features? Dominant and non dominant? Superior and inferior?

A

Face/ arm > leg: motor and sensory deficit
Ipsilateral gaze deviation

Wernicke’s - IF DOMINANT inferior
- Wernicke’s (receptive) aphasia if in dominant hemisphere: impaired ability to comprehend speech
Broca’s - IF DOMINANT superior
- Expressive aphasia

Optic radiations
- Contralateral homonymous hemianopia

Non dominant parietal lobe (R)
- Contralateral spatial Neglect, hemianopia, hemiparesis, constructional apraxia (difficulty with dressing)

Dominant parietal lobe (ANGULAR GYRUS) –> GERSTMANN SYNDROME (L)
- Agraphia: deficiency in ability to write
- Dyscalculia: def comprehending mathematics
- Finger agnosia: inability to distinguish fingers on hand
- L-R disorientation

52
Q

Posterior community artery stroke?

A

CN III

53
Q

PCA stroke?

A

CNII
Contralateral hemiparesis/ataxia
Homonomynous hemianopia with macular sparing
Alexia WITHOUT agraphia
Hallucinations

54
Q

Penetrating vessel stroke?

A

Pure motor
Pure sensory
Hemiballismus
Ataxic hemiparesis
Dysarthria-clumsy hand
Sensorimotor

55
Q

Basilar artery stroke?

A

Medial pontine

Decr consc

CN VI VII

56
Q

AICA stroke?

A

Lateral pontine

CN V VII VII

Horners

Ipsi cerebella

Contra sensation

57
Q

PICA stroke?

A

Lateral medullary

CN IX X XI

Horners

Ipsi cerebella

Contra sensation

58
Q

Anterior spinal a stroke?

A

CN XII
Contralateral weakness + sensation loss

59
Q

What causes the pupil to constrict?

A

CNIII
Parasympathetics

60
Q

What causes the pupil to dilate?

A

Sympathetics –> long ciliary nerve

61
Q

Pathway from CNII to CNIII?

A

CNII –> Edinger Westphal (part of OM nucleus) –> CNIII

62
Q

Nerves in cavernous sinus?

A

II IV V VI

63
Q

Physiology behind Horner’s

A

Travels from:

Hypothalamus –> pons –> C8 –> T2

Crosses over to sympathetic trunk –> up towards lung apex + bifurcation of common carotid

Follows ICA –> cavernous sinus –> innervates iris and Mullers muscle

64
Q

Causes of Horners at each synapse?

A

1st neuron: (hypothalamus/pons/brainstem/spinal cord)
lateral medullary syndrome, spinal cord lesion above T1, pontine haemorrhage

2nd neuron: (sympathetic trunk to neck)
Pancoast tumour, tumour involvement thoracic outlet/ spinal cord/ lung apex

3rd neuron: (bifurcation of CC –> cavernous sinus –> eye)
ICA dissection / cavernous carotid aneurysm, neck mass, otitis media

65
Q

Essential tremor treatment?

A

Propanolol - 1st line
Primedone
Clonaz
Gaba/barbituates

66
Q

Neutrotransmitters: receptors + action

SEROTONIN

A
  • GI
    ○ Entochromoaffin cells -> regulate intestinal motility
  • CNS (limbic system)
    ○ Mood
    ○ Appetite
    ○ Sleep
    ○ N+V
    ○ Arousal
  • Vascular
    ○ Stored in platelets -> released when platelets bind to a clot -> regulate haemostasis + blood clotting
    Inhibits release of noradrenaline
67
Q

Neutrotransmitters: receptors + action

ACh

A

Nicotinic
Muscarinic

  • Neuromuscular junction
    • Removed by acetylcholinesterase
      ANS - sympathetic and parasympathetic
68
Q

Neutrotransmitters: receptors + action

Glutamate

A

NMDA
Kainate
AMPA

  • Main neurotransmitter in brain/spinal cord
69
Q

PE treatment?

A
  • Provoked (surgery, hospitalisation with immobilisation, estrogen therapy, postpartum)
    ○ Distal + transient risk factor: 6 weeks
    ○ Proximal + Transient risk factor: 3 months
    ○ Permanent risk factor: indefinite
    • Unprovoked 3-6 months
    • Submassive 6-12 months
    • Massive - indefinite
70
Q

DVT treatment

A
  • Distal DVT provoking factor no longer present - 6 weeks
    • Proximal DVT, provoking factor no longer present - 3 months
    • Unprovoked distal DVT - 3 months

Continue therapy after 3 months if
Multiple prior unprovoked episodes of DVT/PE

71
Q

CN control of blinking:

A

CN V
CN VII

72
Q

Bell’s palsy: how to differentiate

A

Central
Spares eyelid and forehead muscles
CANT SOMETIMES be due to peripheral cause

Peripheral
RARELY CAN spare eyelid and forehead muscles if distal peripheral cause

Upper and low facial weakness
- Inability to close eye
- Drooping corner of mouth
- Disappearance basolabial fold
- Eyebrow sagging

Impairment in volitonal movements of facial muscles
Impaired in emotional expression

Ipsilateral impaired taste
Decreased tearing/salivation
Ear pain

73
Q

Cavernous sinus syndrome features:

A

3rd,4th, sixth
Trigeminal neuropathy: V1 and sometimes V2

74
Q

Cerebellopontine syndrome features:

A

Vestibular schwannoma,
- Junction between pons + cerebellum
- Lateral cranial nerves
○ V, VI, VIII

75
Q

Superior orbital fissure lesion

A

III, IV, first division V, VI

Invasive tumors of sphenoid bone; aneurysms

76
Q

Brain death definition

A

Complete + irreversible cessation of brain function (permanent absence of cerebral and brainstem function)
+
Preservation of cardiac activity + maintenance of respiratory/somatic function artificially

77
Q

Brain death criteria

A

(1) Widespread cortical destruction reflected by
- Deep coma
- No brain- originating motor response to all forms of stimulation
- Pain
- Seizures
- Posturing

(2) Global brainstem damage
Absent pupillary light reaction
Midposition/dilated 4-9mm
Loss of corneal reflexes
Loss of oculocephalic reflex
Oculocephalic (Doll’s eye): moving head + neck –> eyes turn with movement
Loss of vestibuloocular reflex
Vestibulo=ocular (caloric testing): put ice water in wear –> absence of eyes turning to irrigated side

Loss of jaw jerk
Loss of gag reflex
Absent cough with tracheal suctioning 
Absent sucking/rooting reflexes

Complete + irreversible apnea

78
Q

Brain death IX

A

Cerebral angiography: gold standard
EEG
Transcranial doppler
MRA with agolinium
CTA

79
Q

Drug induced parkinsonism signs + tx

A

Tardive dyskinesia
Dystonia
Akathisia

Tx: Benztropine

80
Q

Dystonia treatment

A

Levodopa
Clonaz
Botox
DBS

81
Q

Changes of hormones during sleep: what increases and decreases?

Prolactin
GH
TSH
Cortisol
Urine
Body

A
  • Prolactin secretion increases
    • GH secretion enhanced

LOW
○ Cortisol + thyroprotin inhibited
○ Urine production
○ Body temp

82
Q

Components of sleep wake cycle?

A

Circadian timing
○ Driven by suprachiasmatic nuclei of hypothalamus
○ Imposes 24 hour rhythms onto a wide range of behaviours, including sleep

Pineal gland
○ Synthesises + secretes melatonin into blood + CSF

SCN
○ Has 2 melatonin receptors
Promotes sleepiness; helps synchronise light-dark cycle (exposure to light = wakefulness)

Neurotransmitters
- GABA, histamine : inhibitory
- Orexin
- NE
- Serotonin

83
Q

Cerebellar: midline vs hemispheric signs/symptoms

A

MIDLINE
Imbalance:
Truncal ataxia: swaying of head when patient is sitting
Titubation: involuntary rhythmic nodding of head/neck/trunk
LL dysmetria
Saccadic intrusions
Nystagmus
Vertigo

HEMISPHEREIC
Dysfidokinesia
Dysmetria UL
Limb ataxia
Intention tremor
Dysarthria
Broken pursuits

84
Q

Genes assoc with ALS/FTD

A

○ SOD1 mutation
○ TDP43 inclusions
○ Chr 21
○ C9ORF72 –> linked with ALS/FTD
Increased CSF glutamate = excitotoxicity theory

85
Q

ALS features?

A

Upper and motor neuron weakness
NO SENSORY
Cognitive: FTD
Flail Limb
Split hand syndrome

86
Q

ALS treatment

A

Riluzole
Glutamate release blocker

Mutlidiscplinary care improves survival
NIV: improved survival, improved QOL

Symptomatic therapy
§ Spasticity: baclofen, botox
§ Sialorrhea: botox, amitrytilline
§ Dyspnea: NIV
§ Weight loss/dysphagia: PEG, high protein diet

87
Q

JVP:

Describe waveform

A

a’ wave = atrial contraction ( a for atrial)
‘c’ wave (c for closure)
‘v’ wave (v for volume filling)
‘x’ descent = fall in atrial pressure during ventricular systole
‘y’ descent = opening of tricuspid valve

88
Q

JVP: cases for
- absent a wave
- large a wave
- cannon a wave
- large v wave
- rise in JVP during inspiration (Kussmaul’s)

A
  • absent a wave: AF
  • large a wave: pHTN/ pstenosis
  • cannon a wave: beating against closed valve –> CHB, vent arrhythmias
  • large v wave: TR
  • rise in JVP during inspiration (Kussmaul’s): constrictive pericarditis
89
Q

Medications that can trigger MG crises?

A

○ Aminoglycosides
○ Quinolones
○ Mg
○ BB
Hydroxychloroquine

90
Q

GBS treatment?

A

Ventilatory support
IVIG 0.4 g/kg intravenously, daily for 5 days = NOT STEROIDS
Plasma exchange

91
Q

CIDP treatment?

A

IVIG
CIDP responds to steroids but GBS does not
Plasma exchange
○ Less preferred

92
Q

MG medication triggers?

A

○ Aminoglycosides
○ Quinolones
○ Mg
○ BB
○ Hydroxychloroquine

93
Q

MG signs? Which ones are earliest?

A

PRESERVED REFLEXES
NO CARDIAC INVOLVEMENT

Weakness
- fatiguable

Earliest signs
- ptosis
- diplopia
- bulbar

94
Q

MG antibodies + associations?

A
  • Acetylcholine receptor Abs
    ○ Assoc with thymoma
    • Anti muscle specific kinase (MuSK) Abs
      ○ More likely to cause severe bulbar/ resp/ cervical weakness
      ○ Post synaptic
    • LRP4 antibodies
    • Stiational antibodies
      ○ In patients with onset < 50
      ○ 95% Incr likelihood thymoma
    • Neuronal + titn
      ○ Assoc with thymoma, late onset
95
Q

MG treatment

A

Mild + symptomatic:
- anti-acetylcholineterases (pyridostigmine, neostigmine)

Adv
- steroids (NOT HIGH DOSE = WILL WORSEN)
- immunosuppressants:

96
Q

MG treatment

A

Mild + symptomatic:
- anti-acetylcholineterases (pyridostigmine, neostigmine)

Adv
- steroids (NOT HIGH DOSE = WILL WORSEN)
- immunosuppressants: AZA, mycoph, MTX
- refractory: rites, cyclo, efgartidimod (accelerates pathogenic removal)

Crises
- IVIG
- plasmapharesis

97
Q

Thymemectomy indications in MG?

A

○ Even if hyperplasia only + < 65 years age
○ Allows you to wean
○ Can’t tell if malignancy on imaging
Supported by 2016 RCT –> even if MG only mild

98
Q

Anti MUSK treatment?

A

More aggressive

  • Needs, PLEX, steroids, ritux
99
Q

MG risk in pregnancy?

A

Transient neonatal MG for up to 3 months for 15%

100
Q

Diference between LEMS and MG?

A

VGCC: pre synpatic

No opthalmoparesis, bulbar involvement

Incremental CMAP

101
Q

Vestibular syndrome: midline vs hemispheric symptoms?

A

MIDLINE
- Vermis, vestibulocerebellum (flocculus, nodulus), paravermis
- Function
○ Motor execution
○ Rapid and slow eye movement
○ Balance/ LL coordination
○ Vestibular function
- Damage causes
○ Imbalance:
○ Truncal ataxia: swaying of head when patient is sitting
○ Titubation: involuntary rhythmic nodding of head/neck/trunk
○ LL dysmetria
○ Saccadic intrusions
○ Nystagmus
○ Vertigo

HEMISPHEREIC
- Function
○ Motor planning, coordination of complex tasks
- Damage causes
○ Ipsilateral
§ Dysfidokinesia
§ Dysmetria UL
§ Limb ataxia
§ Intention tremor
§ Dysarthria
§ Broken pursuits

RACP 2023 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions