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Exam Revision > Neurology 6 > Flashcards

Neurology 6 Flashcards

1
Q

triad of symptoms in Parkinsonism

A

resting tremor
rigidity
bradykinesia

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2
Q

pathology of idiopathic Parkinsonism

A

degernation of dopaminergic neurones in the substantial nigra

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3
Q

other features of Parkinsonism

A 
micrographia
decreased facial expression - masked face
olfactory dysfunction- change in smell
decreased blinking
difficulty initiating movement
shuffling gate
slow speech 
REM sleep disorders
dementia 
depression/anxiety
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4
Q

what is levodopa

A

dopamine precursor

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5
Q

what drug gives best improvement in motor symptoms in Parkinsonism

A

levodopa

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6
Q

side effects of levodopa

A

decreased efficacy with time

painful dystonia, postural hypotension, nausea, dystonia, dyskinesia

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7
Q

what is co prescribed with levodopa to decrease side effects

A

carbidopa

dopa-decarboxylase inhibitor

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8
Q

drug used to treat nausea in Parkinson’s

A

domperidone

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9
Q

what it cabergoline

A

dopamine agonist

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10
Q

what is ropinirole

A

dopamine agonist

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11
Q

what drug used in Parkinson’s causes impulse control disorders

A

dopamine agonists e.g. cabergoline

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12
Q

what drug used in Parkinson’s can cause pulmonary fibrosis

A

cabergoline

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13
Q

when are dopamine agonists used in Parkinson’s

A

early stages in younger patients to delay levodopa use (as efficacy decreases over time)

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14
Q

what is entacapone

A

Catechol O methyl transferase inhibitor – COMT

used as adjunct to levodopa

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15
Q

what is rasagiline

A

MAO-B inhibitor

  • used in early Parkinson’s
  • AF/postural hypotension are side effects
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16
Q

what things might be protective of Parkinson’s

A

smoking
NSAIDS
high uric acid

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17
Q

treatment of REM sleep disorder in Parkinson’s

A

Clonazepam / melatonin at bed time

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18
Q

what are lewy bodies

A

misfolded alpha synuclein

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19
Q

what type of drug is amantadine

A

anticholinergic

block acetylcholine binding to its receptor

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20
Q

what side effect does cabergoline have in elderly patients

A

hallucinations

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21
Q

treatment of psychosis in Parkinson’s

A

clozapine

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22
Q

what is a +ve froments manoeuvre

A

rigidity increased in body part being examined by voluntary movement of other body parts
- seen in Parkinson’s

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23
Q

features of vascular Parkinson’s

A

caused by small stroked in basal ganglia
often history of ischaemic heart disease
affects lower limbs

24
Q

what drugs can cause drug induced Parkinson’s

A

typical antipsychotics - haloperidol/ chlorpromazine
metoclopramide
amiodarone

25
Q

features of drug induced Parkinson’s

A

symmetrical

course postural tremor

26
Q

treatment of drug induced Parkinson’s

A

stop drug

procyclidine

27
Q

proclyclide

A

used to treat tremor/extra pyramidal side effects in drug induced Parkinson’s

28
Q

features of multi system atrophy

A

cerebellar features, Parkinsonism, autonomic dysfunction ( e.g. postural hypotension/ incontinence)

29
Q

MRI features multi system atrophy

A

hot cross bun sign

cerebellar + pontine atrophy

30
Q

features of progressive supra nuclear palsy

A

symmetrical akinetic rigid syndrome

  • predicament axial involvement
  • gait + balance is affected
  • pseudo bulbar symptoms - slow speech, dysphagia, vertical gaze palsy
31
Q

what does a +ve Rhombergs test indicate

A

sensory dysfunction causing ataxia

32
Q

SNCA

A

encodes alpha synuclein

33
Q

greatest genetic risk factor for Parkinson’s

A

GBA mutation

34
Q

what is rivastigmine

A

anticholinesterase

- prevents breakdown of acetylcholine

35
Q

treatment of psychosis in patients with pre-existing dementia

A

rivastigmine

36
Q

+ve levodopa challenge

A

patients symptoms improve with levodopa – likely Parkinson’s

37
Q

what is bulbar palsy

A

LOWER motor neurone lesion affecting cranial nerves 9-12

38
Q

symptoms of bulbar palsy

A

dysarthria, dysphagia, nasal regurgitation

tongue is weak, wasted + fasiculating

39
Q

what is pseudo bulbar palsy

A

UPPER motor neuron lesion of cranial nerves 9-12

40
Q

symptoms of pseudo bulbar palsy

A

exaggerated jaw jerk
emotional lability
dysarthria, dysphagia, nasal regurgitation
tongue is small + spastic

41
Q

most common cause of pseudo bulbar palsy

A

stroke

42
Q

features of bells palsy

A

Unilateral facial nerve palsy- affects SAME side
weakness of muscles of facial expression
dry eye - loss of lacrimation
drooping of mouth - dribbling
hyperacusis - loud noises as loss of supply to stapes
change in taste

more common in pregnancy

43
Q

treatment bells palsy

A

prednisone + eye drops

44
Q

features of an UMN facial nerve palsy

A

weakness on OPPOSITE side to lesion
spares forehead - can raise eyebrows + blink
most common cause is stroke

45
Q

what causes Ramsay hunt

A

herpes zoster

  • LMN facial palsy + herpetic vesicles
  • tx aciclovir
46
Q

what is syringomyelia

A

cyst formation in spinal cord

  • blocked CSF circulation
  • associated with Arnold chiari malformation (herniation of cerebellar tonsils)
47
Q

symptoms of syringomyelia

A

horners
spinothalamic sensory loss
weakness of arms

48
Q

tx brain abscess

A

ceftriaxone / metronidazole

49
Q

Lambert Eaton

A

antibodies to presynaptic calcium channels

50
Q

what is Lambert eaton associated with

A

small cell lung cancer

51
Q

why is PAINFUL occulomotor nerve palsy an emergency

A

most likely due to subarachnoid haemorrhage and should be investigated urgently

52
Q

gold standard test for SAH

A

cerebral angiography

53
Q

drug used to improve delayed ischaemic neuro deficit after brain bleed

A

nimodipine

54
Q

first line Ix for intracerebral haemorrhage

A

CT

55
Q

what is steal syndrome

A

due to AV malformation - steal blood from surrounding brain causing ischaemia

56
Q

what type of stroke is most common

A

lacunar

57
Q

types of lacunar stroke

A
  1. unilateral weakness
  2. pure sensory stroke
  3. ataxic hemiparesis

Exam Revision (32 decks)

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