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mrcp > Neurology > Flashcards

Neurology Flashcards

1
Q

Examples of neuropathic pain

A

1) Post-hermetic neuralgia.
2) Trigeminal neuralgia.
3) Prolapsed intervertebral disc.
4) Diabetic neuropathy.

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2
Q

Next step if the patient did not improve on one agent (patient with neuropathic pain?)

A

Switch to another agent. Don’t add

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3
Q

What agent can be used as a rescue therapy for neurpathic pain?

A

Tramadol

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4
Q

Examples of agents used in neuropathic pain?

A
  • Gabapentin, Doluxetin, pregabalin, Amitryptylin.
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5
Q

First line agent for trigeminal neuralgia?

A

Carbamezapine

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6
Q

Topical capsaicin can be used in?

A

Post-herpetic neuralgia

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7
Q

associated with chromosome 9 GAA mutation?

A

Friedrich ataxia

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8
Q

Affect cerebellum and spinal cord, causing wide gait + absent reflex

A

Friedrich ataxia

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9
Q

Shortness of breath, lower limb weakness improve with activity, dryness and impotence. Antibody?

A

Antibody against presynaptic Voltage gated calcium channel (VGCC)
Lambert eaton syndrome

Other features: hyporeflexia, difficulty micturation

VS MG:
- Improve with activity.
- No ophthalmoplagia.

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10
Q

Association of lambert eaton and cancer?

A

SCC

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11
Q

Lambert eaton management?

A

1) Treat underlying cause (malignancy).
2) Steroid and azathioprine.
3) K channel efflux blockers 3,4-diaminopyridine on trials now

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12
Q

Pathophysiology of Lambert eaton

A

1) Antibody blocks Pre-synaptic calcium channel. (VGCC)
2) Lead to decrease calcium influx
3) Impair Ach release in NMJ

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13
Q

Featuers of autonomic neuropathy

A

1) Failure to decrease HR After deep breath
2) Postural hypotension
3) Inability to sweat and impotence
4) Pupils: dilate following adrenaline installation.

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14
Q

Diseases associated with autonomic neuropathy

A

1) Parkinson. 2) DM 3) GBS 4) Multisystem atrophy
5) Drugs: TCA, anti hypertensive agents.
6) Infections: HIV, neurosyphilis and chagas disease
7) Cranipharyngoma

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14
Q

rise in protein with a normal white blood cell count (albuminocytologic dissociation) - found in 66% suggest?

A

GBS

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15
Q

Clinical features of GBS

A

1) Sensation:
- Stock and glove appearance.
- Back and limb pain.

2) Motor dysfunctions: 
- Facial nerve palsy. 
- Areflexia. 
- Ascending symmetric paralysis. 

3) Autonomic dysfunction: 
- Respiratory failure. 
- Cardiac arrest Fluctuation in BP.
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15
Q

Types of subdural hemorrhage?

A

1) Acute
2) Sub-acute
3) Chronic

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15
Q

Etiology of subdural hemorrhage?

A

Rupture of the bridging veins

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15
Q

Mention 5 risk factors for SAH

A

1) Aneurysmal rupture (berry aneurysm).
2) Mycotic aneurysm.
3) Pituitary apoplexy.
4) Coarctation of aorta.
5) APCKD

3 CAUSED BY Aneurysm: APCKD, Berry, mycotic

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16
Q

How to differ between the types of subdural hemorrhage?

A

1) Onset 3 days, 3 to 20. More than 20 days.
2) CT:
Acute: hyperdense bright
Chronic: hypodense dars
3) Clinically:
- Acute: coma.
- Chronic: memory loss

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16
Q

CT findings of Subdural hemorrhage?

A

Cross suture lines.

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16
Q

Role of LP in SAH?

A

Negative CT after 6 hours of symptoms.
Shows Xanthochromia.

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17
Q

Next step if you suscpect re-bleeding?

A
  • Usually occur within 12 hours.
  • Do head CT STAT
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18
Q

Next step after confirming SAH by CT?

A

Digital substraction angiogram (looking for aneurysmal rupture as it is the most common cause)

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18
Q

4 complications of SAH

A

1) Re-bleeding.
2) Hydrocephalus.
3) SIADH
4) Delayed cerebral ischemia (vasospasm)

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19
Q

Next step if you suscpect vasospsm?

A
  • It occur usually after 1 to 2 weeks.
  • Ensure euvolemia.
  • Use of vasopressor if needed.
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20
Q

Poor prognostic factors of GBS? 5

A
  • age > 40 years
  • poor upper extremity muscle strength
  • previous history of a diarrhoeal illness (specifically Campylobacter jejuni)
  • high anti-GM1 antibody titre
  • need for ventilatory support
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21
Q

Chromosome p3 mutation.

A

Von-hipped lindau disease (mutation in chromosome p3 short arm)

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22
Q

VHL predispose the patient to?

A

1) Cerebellar and retinal hemangioma.
2) Clear renal cell cancer.
3) Renal cyst.
4) Extra-renal cyst (pancreas and liver)
5) Pheochromocytoma

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23
Q

trinucleutide repeat disorder causes mutation in chromosome 4

A

Huntington disease

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24
Q

In huntington disease there is repeat expansion of? which lead to degeneration of GABAnergic and cholinergic neurons in?

A

CAG
Basal ganglia

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25
Q

Mention 5 causes of chorea

A

1) Ataxic talengactesia.
2) Wilson disease
3) HD
4) Thyroitoxicosis.
5) Chorea gravidarum.
6) Autoimmune: APS and SLE
7) Med’s: anti-pshycotic and levodopa.
8) PCV
9) CO Poisining.

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26
Q

Mutation in ATM gene?

A

Ataxic talengacteisa
AR condition
While HD is AD

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27
Q

Trinucleutide repeat disorder mutation in GAA

A

Fredrich ataxia
whild HD mutation in CAG

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28
Q

This area ‘forms’ the speech before ‘sending it’ to Broca’s area. Lesions result in sentences that make no sense, word substitution and neologisms but speech remains fluent - ‘word salad’

Comprehension is impaired

A

Wernikie

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29
Q

It is typically supplied by the superior division of the left MCA. Lesion lead to which type of aphasia?

A

Broca

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30
Q

Speech is non-fluent, laboured, and halting. Repetition is impaired

Comprehension is normal. Which type of aphasia?

A

Broca

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31
Q

Speech is fluent but repetition is poor. Aware of the errors they are making

Comprehension is normal. Type of aphasia?

A

Speech is fluent but repetition is poor. Aware of the errors they are making

Comprehension is normal

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32
Q

What can effect dorsal columns, lateral corticospinal tracts and spinocerebellar tracts..

A

Subacute combined degeneration of the spinal cord secondary to B12 defiecency

33
Q

What can cause functional low B12?

A

NO inhalation.
Here measure MMA will be high

34
Q

Syndrome consist of inability to count + impairment in reading comprehension

A

Grestmann syndrome, acalculia + alexia
Lesion in parietal lobe

35
Q

Chorea occur due to a lesion in which part of the brain?

A

Basal ganglia (C)audate nucleus

36
Q

Hemibalism occur after a lesion in which part of the brain?

A

Subthalamic nucleus of basal ganglia

37
Q

Patient with hyper-sexuality, put everything in mouth

A

Kluver-Buncy syndrome (lesion in amygdala)

38
Q

Visual agnosia occur after damage in which part of the temporal lobe?

A

Ventral: visual

39
Q
A
39
Q

Orexin is associated with which condition?

A

Narcolepsy. Hormone associated with destruction of neurons lead to sleepfulness during daytime

40
Q

EEG findings of narcolepsy?

A

Multiple sleep cycle in EEG

41
Q

Two diseases affect the anterior horn of the spinal cord?

A

ALS And polio

42
Q

What is the major effect of uremia? Motor or sensory?

A

Causes polyneuropathy, mainly sensory loss secondary to uremia.
Causes loss of proprioception, temprature.

43
Q

4 causes of predominantly sensory loss?

A

DM, uremia, alcoholism, B12

44
Q

For how long the patient should stop driving after his first episode of seizure?

A

A) Unprovoked, normal CT, MRI And EEG:
- 6 MONTHS
B) Evidence in EEG, CT or MRI:
- 12 months.
_____
Others:
1) one syncope episode, explained: 4 weeks.
2) One episode of syncope, not explained: 6 months.

45
Q

Mention 3 drugs causes peripheral neuropathy

A

Amiodarone, metronidazole, nitrofurantoin, vincristine.

46
Q

Clinical features of neuroleptic malignant syndrome

A

(FEVER):
F: Fever. E: Encephalopathy. V: Vital signs (high HR, BP, T + Autonomic symptoms like sweating and urinary incontinence). E: Enzymes (high CK) R: Lead pipe rigidity.

47
Q

What is the effect of levodopa on prolactin production?

A

Increase dopamine inhibit prolactin in pituitary

48
Q

one example of MAO- inhibitor

A

Selegiline

49
Q

example of COMT inhibitor

A

Entacapone

50
Q

What pulmonary test is used to monitor patient with GBS?

A

FVC

51
Q

features of UMN Lesion?

A

UMN effect the cortex, brain or white matter of spinal cord.
Hyper-reflexia, hypertonia, positive plantar reflex, no or little muscle atrophy

52
Q

Indication of amantadine?

A

1) Parkinson.
2) MS For fatigue.
3) Influenza.

dopamin reuptake inhibitor is the MOA

53
Q
A
54
Q

Relationship of migraine with aura + Use of OCP?

A

OCP increases the risk of stroke in patient with migraine with Aura
Other notes:
- HRT might increase the frequency of migraines but it is safe

55
Q

First line for migraine during pregnancy?

A

Paracetamol
Second line: NSAID’s in T1 AND T2
Avoid aspirin

56
Q

Clinical features of medications overuse headache?

A
  • more than 15 days per month
  • Worsening with taking analgesia
57
Q

Ophtalmoplagia, areflexia, ataxia and ascending paralysis

A

Miller- Fischer syndrome, variant of GBS.
- Present with ascending paralysis.
- Eyes effected first
- GQ1B antibodies seen in 90 % of cases

58
Q

Mention three skin findings of tuberous sclerosis

A

1) Angiomfibroma (under the nails and skin of the hand)
2) Angioma
3) Ashleaf spots
4) Shagreen patches.

59
Q

Renal masses caused by Tuberous sclerosis?

A

Angiomyolipoma (increase risk of bleeding)

60
Q

Effect of phenytoin on the fetus?

A

Cleft palate, low vitamin k (Risk of bleeding), congenital heart disease

61
Q

Lymphadenopathy, gum bleeding and glove and stock numbness: after taking anti-epileptic medication

A

Phenytoin

62
Q

Hair loss and tremor after taking anti-epileptic

A

Na Valproate

63
Q

Kidney stones after taking anti-epileptic

A

Topiramate

64
Q

Ataxia and diplopia after taking anti-epileptic medication

A

Carbamezapine

65
Q

Indications of thrombectomy?

A

1) Proximal anterior circulation within 6 hours or within 24 hours if there is evidence of salvage brain tissue on CT-diffusion image or MRI.
2) Proximal posterior circulation within 24 hours if there is salvage brain tissue.

66
Q

Indications for endarictomy in stroke

A

1) Patient not disabled.
2) Occlusion less than 70 %

67
Q

Contraindications for thrombolysis?

A

Brain:
1) History of stroke or TIA within 3 months.
2) Intracranial neoplasm.
3) Suspicion of SAH
4) LP within 7 days.
5) Seizure at onset of stroke.

Others:
6) Esophageal varices.
7) GI bleeding within 3 weeks.
8) Pregnancy.
Uncontrolled hypertension.

68
Q

What is astereognosis. What brain part effected?

A

Parietal lobe
Inability to identify objects.

69
Q

Break : )

A
70
Q

What is prosopagnosia ? what brain part effected?

A
  • Difficulty in recognizing faces.
  • Temporal area
71
Q

conductive deafness, tinnutis + positive family history of deafness

A

Otosclerosis where the normal bone replaced by spongy bone.
AD condition

72
Q

Bleeding from .. artery occur in epidural hematoma

A

Middle meningeal artery
Other notes:
- Does not cross suture lines.
- Lucid vivid interval

73
Q

EEG: bilateral, symmetrical 3Hz spike and wave pattern
Diagnosis?

A

Absece seizure.
There is 90-95 % chance that the patient will be seizure free at 16 years old.

74
Q

First line management for absence seizure?

A

Na Valproate or ethosuximide

75
Q

Pregnant lady on phenytoin. What to give her in the last month of pregnancy?

A

Vitamin K
Phenytoin causes bleeding + cleft palate

76
Q

Hyperacusis results from which cranial nerve damage?

A

Facial nerve. As it supplies the Stapedius muscle

77
Q

High arch feet, weakness in LL and UL with sensory impairment + LL muscle atrophy

A

Charcot marie tooth disease
It is one of the heriditary sensory motor neuropathy.
Type I is AD With predominant motor features
Type II: Mainly axonal

78
Q

Medication contraindicated in absence seizure?

A

Carbamezapine

79
Q
A
80
Q

Which medication used for parkinsonism causes ataxia and levido reticularis?

A

Amantadine

81
Q

Which anti-parkinson medication causes postural hypotension, dry mouth and palpitation?

A

Levodopa

82
Q

Stroke causes ataxia, dysphagia, horner, vertigo + contralateral impaired temprature and proprioception sensation

A

Lateral medullary syndrome (PICA syndrome)
Caused by damage in: PICA or vertebral artery

83
Q

Stroke with weakness on the left side + occulomotor occlusion

A

Weber syndrome (midbrain)
Vessel: PCA

84
Q

What anti-epileptic contraindicated in absence seizure?

A

Carbaezapine

85
Q

What feature of parkinson suggest Idiopathic parkinsonism rather than secondary parkinsonism?

A

Assymetrical tremor

86
Q

What feature suggest drug induced parkinson?

A

Bilateral rapid motor symptoms.
Tremor is less common

87
Q

Where is the location of medial longitudinal faciculus?

A

Paramedian area of pons and midbrain

88
Q

Multiple strokes, TIA and dementia. MRI shows multiple infarction in cebellum and pons.

A

CADASIL

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