Brainscape's Knowledge GenomeTM

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


See full index

Finals Difficult Topics > Neurology > Flashcards

Neurology Flashcards

1
Q

A 69-year-old woman presents with a 3 week history of a headache which is worse on the right side. She is generally unwell and feels ‘weak’, noting particular difficulty in getting up from a chair.

A

Temporal arteritis
The weakness is due to the presence of polymyalgia rheumatica, a condition which is on the same spectrum as temporal artertitis.

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

homonymous quadrantanopias mnemonic

A

PITS (Parietal-Inferior, Temporal-Superior)

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

You are called to see a 62-year-old female inpatient, with a known history of epilepsy, who is having a seizure. The nurse who witnessed the seizure says it began by affecting her right hand before involving her entire right arm and then progressing to a loss of consciousness with her entire body shaking. What is the most likely diagnosis?

A

A Jacksonian march is a type of simple partial seizure.

Simple highlights how there is no loss of consciousness.

Partial highlights how it is focal epilepsy that involves abnormal electrical activity in just one part of the brain.

It characteristically starts by affecting a peripheral body part such as a toe, finger or section of the lip and then spreads quickly ‘marches’ over the respective foot, hand or face.

In some with Jacksonian march seizures (as in this case), the electrical disorder spreads over larger areas of the brain, causing the seizure to develop into a tonic-clonic seizure.

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

What is the most common clinical pattern seen in motor neuron disease?

A

Amyotrophic lateral sclerosis (50% of patients)
typically LMN signs in arms and UMN signs in legs
in familial cases the gene responsible lies on chromosome 21 and codes for superoxide dismutase

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

A 71-year-old woman is presecribed ondansetron to help treat nausea which has not responded to either metoclopramide or cyclizine. What is the mechanism of action of ondansetron?

A

5-HT3 antagonists are antiemetics used mainly in the management of chemotherapy related nausea. They mainly act in the chemoreceptor trigger zone area of the medulla oblongata.

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

Drugs causing Parkinsonism

A

phenothiazines: e.g. chlorpromazine, prochlorperazine
butyrophenones: haloperidol, droperidol
metoclopramide

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

She complains of ‘antsy’ legs and a ‘horrible, creeping sensation’. Her symptoms generally come on in the evening and are only relieved by moving round.

A

Restless leg syndrome - management includes dopamine agonists such as ropinirole

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

Generalised headache that is worse on lying down. She reports it has gradually become worse and she has also noticed blurred vision since yesterday.

A

Idiopathic intracranial hypertension

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

Triptans mechanism of action

A

5-HT1 agonists

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

ondansetron mechanism of action

A

5-HT3 antagonists in medulla oblongata

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

posterior communicating artery aneurysm causes

A

pupil dilated III nerve palsy

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

ipsilateral third nerve palsy with contralateral hemiplegia -where is the lesion?

A

caused by midbrain strokes: Weber’s syndrome:

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

As this is a transient ischaemic attack (symptoms last less than 24 hours) what should be given as soon as possible?

A

300 mg of aspirin should be given as soon as possible.

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

Why do you delay the treatment of patients with Parkinson until they are disabling?

A

side effects of dopamine receptor agonist - bromocriptine such as organ fibrosis

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

NICE updated their guidance on the management of neuropathic pain in 2013:

A

amitriptyline, duloxetine, gabapentin or pregabalin

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

Why progessive bulbar palsy carries the worst prognosis?

A

palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei

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

is considered the first line treatment for patients with generalised seizures

A

….Sodium valproate

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

First Line treatment used for partial seizures

A

Carbamazepine

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

first line treatment for female children, female adolescents, women of childbearing potential or pregnant women

A

Lamotrigine

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

A 72-year-old man who is being treated for Parkinson’s disease is reviewed. He has diplopia

A

This would suggest alternative diagnosis such as progressive supra nuclear palsy

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

the most common type of motor neurone disease

A

Amyothropic Lateral Scleriosis. Think upper and lower motor neuron signs

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

IV phenytoin is the next treatment step following seizure What else needs to be considered when starting phenytoin?

A

arrythmogenic thus it needs cardiac monitoring

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

Triptans mechanism of action

A

Triptans are specific 5-HT1 agonists

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

Comm on side effects of triptans are

A

‘triptan sensations’ - tingling, heat, tightness (e.g. throat and chest), heaviness, pressure

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

Triptans Contradictions

A

patients with a history of, or significant risk factors for, ischaemic heart disease or cerebrovascular disease

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

An x-ray confirms a fracture of the surgical neck of the humerus. Which nerve is at risk?

A

axilary nerve

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

Which nerve is at risk of shoulder dyslocation?

A

axilary nerve

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

A 32-year-old window cleaner is admitted after falling off the roof. He reports that he had slipped off the top of the roof and was able to cling onto the gutter for a few seconds. The patient has Horner’s syndrome.

A

The patient has a Klumpke’s paralysis involving brachial trunks C8-T1. Classically there is weakness of the hand intrinsic muscles. Involvement of T1 may cause a Horner’s syndrome. It occurs as a result of traction injuries or during delivery. Horner syndrome is due to involvement of sympathethic fibers of T1

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

falls, poor response to levodopa, impotence, urinary retention and age group.

A

Multiple System Atrophy

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

Obese, young female with headaches / blurred vision

A

Think idiopathic intracranial hypertension not MS

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

Which one of the following features would suggest a diagnosis of essential tremor rather than Parkinson’s disease?

A

Essential tremor (previously called benign essential tremor) is an autosomal dominant condition which usually affects both upper limbs.

Features:
postural tremor: worse if arms outstretched
improved by alcohol and rest
most common cause of titubation (head tremor)

Management:
propranolol is first-line

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

Reduced Glasgow coma score

  • quadriplegia
  • miosis
  • absent horizontal eye movements
  • longstanding uncontrolled hypertension
A

Pontine Haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q
  • urinary incontinence
  • dementia and bradyphrenia
  • gait abnormality (may be similar to Parkinson’s disease)
A

Normal pressure hydrocephalus

34
Q

The patient has become agitated and is threatening to attack another patient as she believes the second patient has stolen her night gown. Attempts to calm her are failing and she is becoming more agitated. How should you proceed?

A

Offer the patient oral lorazepam 2mg, if she refuses proceed to give 5mg of intramuscular olanzapine

35
Q

Ophthalmoplegia, areflexia and ataxia

A

Miller-Fisher variant. Miller-Fisher variant is a type of Guillain-Barre syndrome that starts by affecting the cranial nerves and therefore manifests with eye signs.

36
Q

Migraine with aura (seen in around 25% of migraine patients) tends to be easier to diagnose with a typical aura being progressive in nature and may occur hours prior to the headache. Typical aura include a transient hemianopic disturbance or a spreading scintillating scotoma

A

a transient hemianopic disturbance or a spreading scintillating scotoma

37
Q

What is the most appropriate long-term management of patients following TIA ?

A

Antiplatelet therapy is initiated by secondary care on diagnosis of ischaemic stroke or TIA without paroxysmal or permanent atrial fibrillation for long-term vascular prevention:
The standard treatment is clopidogrel 75mg daily (licenced for use in ischaemic stroke, off-label use in TIA).
Modified-release dipyridamole 200 mg twice daily may be used if both clopidogrel and aspirin are contraindicated or cannot be tolerated.

38
Q

What should you avoid in migranr prophylaxis of asthmathic patients?

A

Propanolol

39
Q

Visual examination reveals a bitemporal superior quadrantanopia.

A

A pituitary adenoma

40
Q

bitemporal inferior quadrantanopia visual field defect.

A

A craniopharyngioma

41
Q

bilateral arm pain, stiffness and imbalance.

A

degenerative cervical myelopathy

42
Q

Median nerve entrapment 55%
Carpal tunnel syndrome results from median nerve compression at the wrist, within the carpal tunnel, and results in lower motor neuron signs, with thenar muscle wasting and weakness of the which muscles?

A 
LOAF muscles 
Lateral lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor policis brevis
43
Q

First line treatment for trigeminal neuralagia:

A

carbamazepine is first-line

failure to respond to treatment or atypical features (e.g. < 50 years old) should prompt referral to neurology

44
Q

Mechanism of action of carbmazepine

A

It’s Ca channel blocker

45
Q

What is pathology of the amyotrophic lateral scleriosis?

A

Amyotrophic lateral sclerosis (ALS) is characterised by death of both upper and lower motor neurons in the motor cortex of the brain, the brain stem, and the spinal cord.

46
Q

degenerative cervical myelopathy [DCM] sign

A

Hoffman Sign - flicking of the distal phalynx of the middle finger causes the flexion of the thumb. Also positive in MS

47
Q

Patients have global restriction of shoulder movements, in at least two axes

A

adhesive capsulitis- the external rotation of the shoulder is the most painful

48
Q
  • this is positively associated with radicular pathology such as disc herniation.
A

Straight leg raise. - The patient feels pain in the back when the leg is raised between 30-60 degrees.

49
Q

Neuropathic Pain

A

NICE updated their guidance on the management of neuropathic pain in 2013:
first-line treatment*: amitriptyline, duloxetine, gabapentin or pregabalin
if the first-line drug treatment does not work try one of the other 3 drugs
tramadol may be used as ‘rescue therapy’ for exacerbations of neuropathic pain

50
Q

nephrogenic diabetes insipidus. He was recently diagnosed after his parents noticed that he was experiencing excessive polydipsia and polyuria.

A

In simple terms DI leads to the production of vast amounts of dilute urine which is dehydrating and raises the plasma osmolarity, stimulating thirst. The effect of the thiazide causes more sodium to be released into the urine. This lowers the serum osmolarity which helps to break the polyuria-polydipsia cycle.

51
Q

Pain (affecting the neck, upper or lower limbs)
Loss of motor function (loss of digital dexterity, preventing simple tasks such as holding a fork or doing up their shirt buttons, arm or leg weakness/stiffness leading to impaired gait and imbalance
Loss of sensory function causing numbness
Loss of autonomic function (urinary or faecal incontinence and/or impotence) - these can occur and do not necessarily suggest cauda equina syndrome in the absence of other hallmarks of that condition

A

Degenerative Cervical Myopathy

52
Q

involves perforating arteries around the internal capsule, thalamus and basal ganglia
presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

A

Lacunar infarcts (LACI, c. 25%)

53
Q

presents with 1 of the following:

  1. cerebellar or brainstem syndromes
  2. loss of consciousness
  3. isolated homonymous hemianopia
A

Posterior circulation infarcts (POCI, c. 25%)

involves vertebrobasilar arteries

54
Q

ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss

A

Lateral medullary syndrome (posterior inferior cerebellar artery)
aka Wallenberg’s syndrome

55
Q

ipsilateral III palsy

contralateral weakness

A

Weber’s syndrome

56
Q

A 45-year-old lady recovering from a mastectomy and axillary node clearance notices that sensation in her armpit is impaired.

A

The intercostobrachial nerves are frequently injured during axillary dissection. These nerves traverse the axilla and supply cutaneous sensation.

57
Q

if patients have migraine with aura then the COC is absolutely contraindicated due to an increased risk of stroke

A

Migraine and the combined oral contraceptive (COC) pill

58
Q
  1. Bilateral spastic paresis
  2. Bilateral loss of proprioception and vibration sensation
  3. Bilateral limb ataxia
A
  1. Corticospinal
  2. Dorsal
  3. Spinocereberal

Subacute combined degeneration of the spinal cord (vitamin B12 & E deficiency)

59
Q

affects anterior horns resulting in lower motor neuron signs

A

Poliomyelitis

60
Q
  1. Ipsilateral spastic paresis below lesion
  2. Ipsilateral loss of proprioception and vibration sensation
  3. Contralateral loss of pain and temperature sensation
A
  1. lateral cortico-spinal
  2. dorsal columns
  3. spinothalamic

Brown-Sequard syndrome (spinal cord hemisection)

61
Q
  1. Bilateral spastic paresis
  2. Bilateral loss of proprioception and vibration sensation
  3. Bilateral limb ataxia
    In addition cerebellar ataxia → other features e.g. intention tremor
A

Friedrich’s ataxia

62
Q
  1. Bilateral spastic paresis

2. Bilateral loss of pain and temperature sensation

A
  1. Lateral corticospinal track
  2. Lateral spinothalamic

Anterior Spinal Cereberal Artery Occlusion

63
Q
  1. Flaccid paresis (typically affecting the intrinsic hand muscles)
  2. Loss of pain and temperature sensation
A
  1. Ventral horns
  2. Lateral-spinothalamic tract
    Syringomyelia
64
Q
  1. Loss of proprioception and vibration sensation
A

Dorsal columns. Neursophyllis

65
Q

First-line anti-epileptic in a 17-year-old girl with tonic-clonic seizures. She is not sexually active and does not use any form of contraception currently.

A

Lamotrigine

66
Q

Which one of the following side-effects is most commonly associated with sumitryptan?

A

Tightness of the throat and chest

67
Q

The homonymous hemianopia is always on the same side as the paresis.

A

Patient who has had an extensive stroke with right-sided hemiplegia

68
Q

Difficulty in initiating movement

A

Bradykinesia

69
Q

A 42-year-old teacher is admitted with a fall. An x-ray confirms a fracture of the surgical neck of the humerus. Which nerve is at risk?

A

The Axillary nerve winds around the bone at the neck of the humerus. The axillary nerve is also at risk during shoulder dislocation.

70
Q

A 32-year-old window cleaner is admitted after falling off the roof. He reports that he had slipped off the top of the roof and was able to cling onto the gutter for a few seconds. The patient has Horner’s syndrome.

A

The patient has a Klumpke’s paralysis involving brachial trunks C8-T1. Classically there is weakness of the hand intrinsic muscles. Involvement of T1 may cause a Horner’s syndrome. It occurs as a result of traction injuries or during delivery.

71
Q

A 32-year-old rugby player is hit hard on the shoulder during a rough tackle. Clinically his arm is hanging loose on the side. It is pronated and medially rotated.

A

The patient has an Erb’s palsy involving brachial trunks C5-6.

72
Q

A 60-year-old gentleman with a background of lumbar spondylosis and chronic back pain presents with gradually worsening bilateral upper limb paraesthesias and leg stiffness.

Which one of the investigations below is diagnostic for his likely condition?

A
  • The presence of upper limb neurological symptoms indicates that there is pathology either within his cervical spinal cord or brain.
  • Brain disease is more likely to cause unilateral problems.
73
Q

Neuropathic pain may be defined as pain which arises following damage or disruption of the nervous system. It is often difficult to treat and responds poorly to standard analgesia.

A

Neuropathic Pain Differentialls:

  • diabetic neuropathy
  • post-herpetic neuralgia
  • trigeminal neuralgia
  • prolapsed intervertebral disc
74
Q

NICE updated their guidance on the management of neuropathic pain in 2013:

A

amitriptyline, duloxetine, gabapentin or pregabalin

75
Q

drug used in migrane prophylaxis to reduce the frequency of the migrane attacks in asthmatic patient?

A

Topimirate

76
Q

One test you would do in Guillian Barre?

A

FVC monitoring regurarly - type II respiratory failure.

77
Q

What’s the management of patients with Gullian Barre?

A

IvIg or plasma exchange

78
Q

What do you see on the blood tests in patients with C.Diff problem?

A

Hight WBC, loss of albumin, profused diarrohoea. 1st line Metronidazole 2nd line Vancomycin. It needs to be ORAL

79
Q

What are the three causes of rapidly progressive Vascullitis?

A

Guillian Barree Poryphyria Vascullitis

80
Q

Subacute degeneration of the spinal cord leads to…

A

…..degeneration of dorsal column

Finals Difficult Topics (3 decks)

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