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From Flashcardlet > 28.5.2013 (neurology) 20 > Flashcards

28.5.2013 (neurology) 20 Flashcards

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0
Q

Neuronal neuropathy causes

A

Sjogren
Cisplatin
Pyridoxine

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1
Q

Axonal neuropathy NCS. Sensory amplitude is more affected in

A

Radial >sural

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2
Q

Axonal neuropathy causes

A 
CMT2
DM
HIV
Toxic
Metabolic
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3
Q

Demyelinating neuropathy

A

GBS
diphtheria
CIDP
DM

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4
Q

Sensory signs in demyelinating neuropathy

A

Vibration and proprioception affected

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5
Q

Sensory signs in axonal neuropathy

A

Pain and temperature > vibration and proprioception

Opposite in Demyelinating neuropathy

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6
Q

Brachial plexopathy seen with use of which drug

A

Ara-C

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7
Q

Chemotherapeutic agents associated with neuropathies

A 
Cisplatin
Vincristine
Taxanes(predominantly large fibre)
Ara-c
Etoposide
Bortezomib(predominantly small fibre)
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8
Q

GBS like neuropathy is seen with use of

A

Ara-c

Nitrofurantoin

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9
Q

Drug induced neuropathies

A 
Metronidazole
Nitrofurantoin
Amiodarone
Chloroquine ,hydroxychloroquine
Colchicine 
Thalidomide
Dapsone
Leflunamide
Disulfiram
Isoniazid
Ethambutol
Phenytoin
Lithium
Nucleoside analogues(zalcitabine,stavudine,lamivudine,didanosine)
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10
Q

Toxins causing neuropathy

A 
Lead
Mercury
Arsenic
Thallium
Gold
Ethylene oxide
OPC
carbon disulfide
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11
Q

Inheritance of Becker muscular dystrophy

A

X linked recessive

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12
Q

Diff btw Becker and duchenne

A

Becker
Able to walk after 15yrs(duchenne unable to walk after 12)
No mental impairment

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13
Q

Mode of inheritance of myotonic dystrophy

A

Autosomal dominant

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14
Q

Muscular dystrophy associated with coats disease

A

Fascioscapulo humeral dystrophy

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15
Q

Preferential proximal involvement is seen in which type of myotonic dystrophy

A

DM2 (CCTG repeats)

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16
Q

Associated features of myotonic dystrophy

A 
Frontal baldness
Cataract
Gonadal atrophy
Mental impairment
Cardiac conduction defect
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17
Q

Distal myopathies

A 
Welander
Udd
Markesbery-Griggs
Laing
Nonaka(AR)
Miyoshi(AR)
Myofibrillar myopathies

All are dominantly inherited

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18
Q

Distal myopathy heralded by tibial weakness

A

Laing

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19
Q

Diagnosis of inflammatory myopathy should be questioned if which muscles are involved

A

Ocular

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20
Q

Myositis that occurs after 60yrs

A

Inclusion body myositis

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21
Q

Mysositis associated with scleroderma and mixed connective tissue diseases

A

DM

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22
Q

Mysositis associated with familial history

A

Inclusion body myositis

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23
Q

Mysositis associated with systemic autoimmune diseases frequently

A

Polymyositis

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24
Mysositis associated with malignancy
DM
25
Drugs causing myositis
``` Zidovudine(polymyositis) Penicillamine(DM,polymyositis) Contaminated tryptophan(DM like illness) ```
26
Viruses associated with polymyositis and inclusion body myositis
HIV | HTLV1
27
Mysositis associated with parasites and bacteria
Polymyositis
28
Neuropathy associated with HIV
Distal symmetric polyneuropathy CIDP mononeuritis multiplex
29
Role of thymectomy in MG
Should be done in all patients with generalised MG
30
Facies in myotonic dystrophy
Hatchet
31
Serum CK is not elevated in which dystrophy
Myotonic dystrophy
32
Headache that awakened the pt from sleep
Cluster headache
33
Associated symptoms of cluster headache
``` Homolateral lacrimation Reddening of eye Nasal stuffiness Ptosis Nausea ```
34
Visual aura in migrane
``` Bright or dark spots Zig zags Heat haze distortions Fig San puzzle defects Scintillating scotoma Fortification spectra Hemianopia(opposite to headache site) ```
35
Type of migrane with occipital headache
Basilar migrane
36
Defect in voice production
Dysphonia
37
Reaction of degeneration in muscles is present in
LMN palsy
38
Bulbar paralysis
Palsy of CN 9-12
39
Pseudobulbar palsy
Hyperactive jaw jerk | Emotional lability
40
Adult SMA
Aran duchenne
41
Anterior spinothalamic tract carries
Crude touch | Crude pressure
42
Diff btw extramedullary and intramedullary lesion Bladder and bowel Paresthesias Lhermitte sign
Bladder involvement late Lhermitte sign present Paresthesias less common In extramedullary
43
Paresthesias and diffuse burning pain common in which spinal cord lesion
Intramedullary
44
Meniscus sign,spinal cord tumors
Intradural tumor
45
Brush border sign,spinal cord tumor
Extradural tumor
46
Conus medullaris syndrome | Babinski
Positive
47
Both ankle and knee jerks are absent in | Cauda equina/conus medullaris?
Cauda equina Conus(only ankle absent)
48
Conus medullaris is a
Intramedullary lesion Cauda equina is extramedullary
49
Saddle anesthesia is seen in
Conus medullaris | Cauda equina lesions
50
Spinal shock is characterised by
Sensory loss Arreflexia Flaccidity Urinary retention
51
``` Which of the following signs is not suggestive of cervical spinal cord injury Flaccidity Increased rectal sphincter tone Priapism Diaphragmatic breathing ```
Increased rectal tone Rectal tone is reduced
52
C4 dermatome
Covers the area just below clavicle
53
C2 dermatome
Covers occiput and top part of neck
54
Beevor sign
Upward movement of umbilicus due to T9-T10 lesion
55
Endocrine disturbance associated with friederich ataxia
Diabetes mellitus
56
Duret hemorrhages are found in
Brainstem due to transtentorial herniation
57
3rd nerve palsy in SAH
Aneurysm at ICA,PCA junction
58
6th nerve palsy with SAH
Cavernous sinus
59
Occipital pain and posterior cervical pain | SAH
Inferior cerebellar artery aneurysm
60
Retro orbital pain | SAH
MCA aneurysm
61
Primitive reflexes in ACA occlusion
Involvement of supplementary motor area
62
Tactile aphasia of left limbs
Lesion of corpus callosum
63
Assymetry of optokinetic nystagmus is seen in
Lesions of parietal lobe
64
Artery of cerebral thrombosis
Anterior choroidal artery | Branch of internal carotid artery
65
Supply of ant.choroidal artery
Sublentiform | Retrolentiform part of internal capsule
66
Charcot artery of cerebral hemorrhage is a branch of
MCA-lateral striate branch
67
Recurrent artery of heubner is a branch of
Medial striate branch of ACA or proximal MCA
68
Athetosis is caused due to lesion of
Globus pallidus
69
Ocular disturbances in thalamic hemorrhage
``` Downward and inward deviation of eyes Skew deviation Unequal pupil with loss of light reflex I/L Horner syndrome Absence of convergence Paralysis of vertical gaze Retraction nystagmus ```
70
Flexion of arms in decorticate posturing
Rubrospinal
71
Thiamine deficiency results in degeneration of
Dorsomedial nucleus of thalamus Hippocampus Mammillary bodies Vermis of cerebellum
72
Most common lacunar syndrome
Pure motor hemiparesis
73
Locked in syndrome
Bilateral ventral pontine lesion Quadriplegia Corticobulbar tracts(unable to speak or show facial movements) Horizontal gaze palsy Vertical eye movements and blinking are INTACT preserved consciousness
74
Anticonvulsants that can aggravate janz syndrome
Carbamazepine | Phenytoin
75
First line drugs in Rx of janz syndrome
Valproate | Lamotrigene
76
Post traumatic epilepsy
Seizures after 1 week of head trauma
77
Poor prognostic factors for febrile seizures
``` Complex febrile seizures Focal Prolonged>15min Repetitive Family history Neurodevelopmental abnormalities ```
78
First line agents in treatment of primary generalised tonic clonic,atypical,absence,Myoclonic,atonic
Valproate Lamotrigine Topiramate
79
Lesions at foramen of Munro
Subependymal giant cell astrocytoma(calcified) | Central neurocytoma
80
Post operative illeus is maximum with
Colon
81
Return of motility after surgery
SI(24hrs)
82
Occlusion which gut artery has least chance for causing damage
IMA Arc of riolan Marginal artery of Drummond
83
Meandering mesenteric artery connects
Proximal middle colic with left colic Arc of riolan
84
After RTA a male presented with nonpulstaile retro peritoneal hematoma.IVU was done.rt kidney not visualised.next step? Nephrectomy On table angiography
On table angiography
85
Best investigation for detecting renal and retroperitoneal injuries
Contrast CT
86
Surgery for renal injuries in trauma
``` Penetrating injuries Blunt injuries: Persistent retroperitoneal bleed Vascular pedicle injuries Urinary extravasation Evidence of non viable kidney parenchyma ```
87
Smoking is dangerous for | PVD or CAD
Equally risky for both
88
ABI signifying critical ischemia
<0.5 Normal ABI:1
89
ABI
Ratio of ankle systolic pressure to brachial systolic pressure
90
Falsely elevated ABI
Vascular calcification in DM and renal disease Value >1.3 is strongly suggestive of false value
91
Effect of exercise on ABI
Changes
92
Uses of ABI measurement
PVD Vascular injury in Trauma Risk of MI(more if <0.9) Prognosis after vascular grafting
93
Most common complication following illeoanal pouch anastomoses ? Second?
Pouchitis Second: intestinal obstruction
94
Most common configuration used in illeoanal pouch anastomoses
J
95
Liver capsular plates
Cystic plate Umbilical plate Hilar plate Arantin plate
96
Arantin plate underlies
Ligamentum venosum
97
Serum amylase and severity of pancreatitis
No correlation Mild pancreatitis associated with significant elevation
98
Ranson criteria
``` Age in years > 55 years White blood cell count > 16000 cells/mm3 Blood glucose > 10 mmol/L (> 200 mg/dL) Serum AST > 250 IU/L Serum LDH > 350 IU/L Within 48 hours: Serum calcium < 2.0 mmol/L (< 8.0 mg/dL) Hematocrit fall > 10% Oxygen (hypoxemia PO2 < 60 mmHg) BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration Base deficit (negative base excess) > 4 mEq/L Sequestration of fluids > 6 L ``` GA LAW C HOBBS
99
Ranson criteria is used for
NON GALLSTONE pancreatitis
100
Most common morphological type of cholangiocarcinoma
Nodular
101
Most common site of cholangiocarcinoma
Hilum(klatskin tumor)
102
Investigation of choice of cholangiocarcinoma
MRI
103
Tumor marker elevated in cholangiocarcinoma
CA19-9
104
Classification of klatskin tumors
Bismuth corlette
105
Bile staining of cholangiocarcinoma
NIL
106
Investigation of choice for congenital hypertrophic pyloric stenosis
USG
107
Criteria for USG diagnosis of CHPS
canal length >16mm | Pyloric thickness>4mm
108
Investigation of choice for zenker diverticulum
Barium swallow Endoscopy has risk of perforation
109
Zenker diverticulum occurs through
Killing dehiscence
110
Zenker diverticulum,type
Pulsion diverticulum(not a true diverticulum)
111
Most common esophageal diverticulum
Zenker
112
Example of true esophageal diverticula
Traction diverticula
113
Sac of zenker diverticula projects
Left laterally
114
Condition associated with zenker diverticula causing dysphagia postoperatively
Cervical webs
115
First and most common muscle to undergo atrophy in osteoarthritis
Quadriceps
116
Indication of Sx for dupuytren contracture
Flexion at MCP>30 degree | PIP >15 degree
117
Sx for dupuytren contracture | Involvement of one or two digit
Selective fasciotomy
118
Causes of dupuytren
``` Phenytoin DM Smoking Alcohol AIDS TB ```
119
First digit to be affected in dupuytren
Ring finger
120
Screening tests in heterotopic ossification
Alkaline phosphatase | 24hrs urinary PGE2
121
Hereditary form of heterotopic ossification
Myositis ossificans progressive
122
Causes of heterotopic ossification
Musculoskeletal trauma,after orthopaedic procedures(arthroplasty) Spinal cord or CNS injury
123
Most sensitive imaging modality for HO
Three phase bone scintigraphy
124
Rx for HO
``` Passive range of motion exercises NSAID local radiation Surgery Diphosphonate ```
125
Game keeper thumb
Injury to ulnar collateral ligament of thumb Skier thumb
126
Mode of injury of skier thumb
Hyperabduction
127
Attitude in posterior HIP location
Flexion Adduction Internal rotation FADIR
128
Ulnar collateral ligament of thumb stabilises
MCP
129
Test done in de quervain tenosynovitis
Finklestein test
130
De quervain tenosynovitis
Inflammation of synovial sheath of abductor pollicis longus Extensor pollicis brevis
131
Presentation of dequervain
Pain over radial styloid
132
Cause of de quervain
Rheumatoid arthritis | Overuse
133
Tingling in carpal tunnel syndrome is more common during
Sleep
134
Tests for carpal tunnel syndrome
Phalen Tinel Tourniquet Durkan compression test
135
Markers of bone formation
Serum Alkaline phosphatase Serum Osteocalcin Serum propeptide of type1 procollagen
136
Deep heat therapies
Short wave diathermy US waves Micro waves
137
Surface heat therapy
Infrared lamp | Paraffin wax
138
Weakness of extension of great toe
L5 Extensor hallucis longus(more specific) Also dorsiflexors of foot
139
S1 lesion
Plantar Flexion lost
140
L4 L5 S1 Sensation lost in lesions
L4 over great toe,medial side of leg L5 dorsum of foot , lateral aspect of leg S1 sole and lateral side of foot
141
Methyl prednisolone dose following acute spinal cord injury
30mg/kg within 8 hours of injury
142
Diastolic pressure in pregnancy
Falls at midterm | Pre pregnant values at term
143
CVS parameter unchanged during pregnancy
CVP
144
Test used to detect pseudo cholinesterase defect
Dibucaine number Fluoride Chloride number
145
Dibucaine number of normal butyrylcholineesterase
70-80
146
Dibucane number of homozygous atypical plasma cholinesterase
20-30
147
Drugs causing lowering of cholinesterase activity
``` Oral contraceptives MAO inhibitors Anti cholinesterase drugs Metoclopramide Cytotoxic drugs Esmolol Bambuterol(prolongation of Sch induced blockade) ```
148
Conditions lowering activity of plasma cholinesterase
``` Liver disease Advanced age Malnutrition Pregnancy Burns ```
149
Major component of sodalime
Ca(OH)2
150
Decreased dose of local anesthesia is required in neuraxial anaesthesia in pregnancy due to
Engorged epidural veins Decreased volume of subarachnoid space Increased sensitivity of nerve to local anaesthetics Progesterone induced hyperventilation---alkalosis---inc LA action
151
Tachyphylaxis is seen in which neuromuscular blockers
Non depolarising
152
MAC and pregnancy
Decreased
153
BIS value recommended for GA
<55
154
Methods employed to assess awareness during anesthesia
Entropy Patient state index Mid latency auditory evoked potentials Narcotrend
155
Anaesthetic combination used for peribulbar block
Lidocaine+bupivacaine +hyaluronidase
156
Max dose of bupivacaine
3-5mg/kg
157
Max dose of lignocaine with adrenaline
7mg/kg
158
Max dose of xylocaine without adrenaline
5mg/kg
159
Induction agent of choice in patients with poor cardiovascular status
Etomidate
160
Induction agent that causes myoclonus
Etomidate
161
Drugs metabolised by esterases
Sch Mivacurium Remifentanyl Esmolol
162
Neuroleptanesthesia
Fentanyl+droperidol
163
Contrast used in esophageal atresia
Dianosil
164
Contrast used to check integrity of surgical anastamosis
Gastrograffin
165
Contrast in myelography
Iopamidol
166
Bracket calcification in skull X-ray is seen in
Corpus callosum lipoma
167
Ionic iodinated contrast media
Diatriazoate Iothalmate Metrizoate Ioxithalamate
168
Non ionic iodinated contrast media
Iohexol Iopamidol Xenetix
169
Tramtrack calcification
Sturge weber syndrome
170
Cardiac calcification
Carcinoid
171
Periventricular calcification
CMV
172
Diffuse Nodular calcification
Toxoplasmosis
173
Suprasellar calcification
Craniopharyngioma
174
Stereotactic radiotherapy requisites
Small target and treatment volume Sharply defined target Accurate radiation delivery Sensitive structures excluded from target
175
Period in which foetus is most sensitive to radiation
8-15 wks
176
Maximum radiation exposure in which imaging modality
CT scan(400CXR)>bone scan(200CXR)
177
Most reliable test for diagnosing spinal TB
CT guided biopsy
178
Most sensitive imaging for spinal TB
MRI
179
Most frequent site of spinal TB
Lower dorsal and upper lumbar | Paradiscal(vertebral body end plates)
180
Pattern of involvement in spine TB
Paradiscal---central---anterior---posterior
181
Earliest sign of spinal TB
Reduction of Disc space
182
Disc involvement in spinal TB
Late(unlike pyogenic infections)
183
Arrythmias in TCA overdose
3-4 days after overdose due to long half life
184
Antipsychotic drugs available as depot preparation
``` Fluphenazine Flupenthixol Haloperidol Risperidone Zuclopenthixol ```
185
"Oral depot" antipsychotic
Penfluridol(DOA 1 week)
186
Knights move thinking
Derailment
187
Characteristic feature of schizophrenia
Formal thought disorder
188
Inability to identify and articulate feelings
Alexithymia
189
Hallucinations in PTSD
NOT seen
190
Features of PTSD
Re-experiences Avoidance of similar situation Nightmares Autonomic arousal
191
Commotio retina
Berlin edema
192
Berlins Edema most commonly involves
Temporal retina
193
Pigmentary disturbances in commotio retina may mimic
RP
194
Rx of macular hole
Pars plana vitrectomy Peeling of posterior hyaloid face Gas tamponade
195
Cherry red spot
``` CRAO Berlin Edema Tay Sachs Neiman pick Sandhoff Generalised gangliosidosis ```
196
Limited abduction and adduction is seen in
Duane retraction syndrome type3
197
Duane retraction syndrome is a type of
Restrictive strabismus
198
Congenital defects associated with Duane syndrome
Goldenhar syndrome Klippel feil Wildervanch syndrome
199
Most common type of Duane retraction syndrome
Type 1
200
Defect in type 1 Duane
Abduction absent Retraction during adduction Slight esotropia
201
Type 2 Duane
Abduction normal Limited adduction with retraction Exotropia Least common type
202
Type 3 Duane
``` Both adduction Abduction Impaired with retraction Slight esotropia ```
203
Indications for surgery in Duane
Eso/exotropia in primary position Anomalous head posture Severe globe retraction Cosmetically unacceptable upshoot or downshoot
204
Double elevator palsy
Paralysis of SR and IO
205
Rx of Double elevator palsy
Knapp procedure | Transposition of medial and lateral rectus
206
Large fiber sensory neuropathy
``` Sjogren b12 deficiency(post column inv) Pyridoxine Friedreich ataxia Cisplatin ``` Ataxic neuropathies
207
Small and large fiber sensory neuropathies
``` Diabetic Carcinomatous Hereditary Vacor intoxication Xanthomatous neuropathy of primary biliary cirrhosis ``` Global sensory loss
208
Motor predominant neuropathies
``` GBS AIP Diphtheritic Lead Brachial neuritis Diabetic lumbosacral plexus neuropathy ```
209
ELECTROPHYSIOLOGY: Conduction block and temporal dispersion seen in Axonal / demyelinating
Demyelinating neuropathy
210
Hyperacusis and macrosomia is seen in which storage disorder
Tay sach | Sandoff
211
Hypohidrosis is seen in which storage disorder
Fabry
212
Farber disease
Arthropathy Dermatitis(subcutaneous nodules) Mental retardation
213
Fabry disease
``` Angiokeratoma Painful Acroparesthesia Corneal verticillata Renal failure Small fibre neuropathy Hypohidrosis ``` No mental retardation
214
Pulmonary infiltrates and lung failure is seen in which lysosomal storage disease
Niemann pick
215
Drug used as prophylactic agent in menstrual migrane
Naratriptan
216
Most common intradural extramedullary neoplasm
Schwanomma 2nd meningioma
217
Most common intradural extramedullary neoplasm in paediatric population
Leptomeningeal metastasis from primary brain tumors

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