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Neurology SB > Extra > Flashcards

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1
Q

An 18-year-old male patient describes periods of twitching of the left side of his face that spreads to affect his left arm and shoulder. Afterwards he describes weakness of his left arm

A

Jacksonian seizure/march

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2
Q

what is a Jacksonian seizure/march

A

form of simple complex seizures

seizure spreads from the distal part of the limb toward the ipsilateral face (on same side of body

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3
Q

what is the first line treatment for Delirium in the elderly

A

0.5mg Haloperidol

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4
Q

what causes Wernicke Encephalopathy

A

Thiamine deficiency

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5
Q

what is pathological seen in W.E

A

petechial haemorrhages in mamillary bodies and ventricle walls

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6
Q

Tx for W.E

A

Thiamine replacement

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7
Q

what would developing the inability to acquire new memories and confabulation suggest with the background of W.E.

A

patient has developed Korsakoff’s Syndrome

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8
Q

Urinary incontinence + gait abnormality + dementia = ???

A

Normal pressure hydrocephalus

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9
Q

what would be seen on imaging in normal pressure hydrocephalus

A

enlarged forth ventricle

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10
Q

what is Tx of normal pressure hydrocephalus

A

Ventriculoperitoneal shunting

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11
Q

what is used as a prognostic score in TIAs

A

ABCD2

Age > 60 (1 pt)
Blood pressure > 140/90 (1 pt)
Clinical features - unilateral weakness (2 pts)
- speech disturbance, no weakness (1pt)
Duration of Sx - >60mins (2 pts)
- 10-59 mins (1pt)
Diabetes (1pt)

Total = 7

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12
Q

what is Tx if patient has ABCD2 > 4

A

Aspirin 300mg daily (and Dipyridamole)

measures for secondary prevention

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13
Q

what should be given to stroke patients immediately IF a haemorrhagic stroke has been excluded

A

Aspirin 300mg (as soon as possible)

Thrombolysis (Alteplase)

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14
Q

what are Sx of Brown-Sequard Syndrome

A

IPSILATERAL

  • loss of touch, vibration, proprioception
  • hyper-reflexia
  • extensor plantar reflex

CONTRALATERAL
- loss of pain and temperature

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15
Q

what are Sx/signs seen in Tuberous Sclerosis

A

Café-Au-Lait
“Ash-leaf” spots
Shagreen patches (roughened patches of skin over lumbar spine)
Subungual fibromata

Epilepsy (infantile spasms or partial)
Development delay
Polycystic kidneys

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16
Q

what are the mnemonics of Neurofibromatosis

A

NF1 Chr 17 (Neurofibromatosis has 17 characters)

NH2 Chr 22 (all the 2’s)

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17
Q

what are features of NF1

A 
Cafe-au-lait spot 
Axillary/Groin freckles 
Peripheral Neurofibromas 
Lisch nodules 
Scoliosis
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18
Q

what are features of NF2

A

Bilateral acoustic neuromas

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19
Q

what is seen in ALS

A

LMN signs in the arm

UMN signs in the leg

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20
Q

in familial cases of ALS what gene is affected

A

Chr 21

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21
Q

what is seen in PLS

A

UMN signs only

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22
Q

what is seen in progressive muscular atrophy

A

LMN signs only

Affects distal muscle before proximal

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23
Q

what is seen in Bulbar palsy

A

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

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24
Q

what muscles common waste in MN disease

A

small hand muscles

tibialis anterior

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25
what will nerve conduction studies shows in MN disease
normal conduction
26
what will electromyography show in MN disease
decrease number of AP with increase amplitude
27
what anti-glutamate drug is used in ALS
Riluzole
28
what signs show UMN and what shows LMN
UMN - extensor plantar LMN - absent ankle jerk
29
what seizures can carbamazepine exacerbate
absence seizures
30
what is a characteristic EEG of an absence seizure
bilateral, symmetrical 3Hz (spike and wave) pattern
31
what should a women do if she is pregnant and on anti-epileptic medication
stop anti-epileptic medication | take 5mg/day folic acid (prevents neural tube defects)
32
what AED are associated with what birth defects
Sodium Valproate = neural tube defects Phenytoin = cleft palate (expecting mums taking this are given Vit K last month of pregnancy to prevent clotting disorders)
33
what is the gold standard investigation for functional seizures
Video Telemetry
34
what drugs lead to drug induced parkinsonism
Metoclopramide Haloperidol Chlorpromazine
35
Levodopa is sometimes the initial treatment of Parkinsons, what are the side effects of the drug
``` Dyskinesia Postural hypotension Cardiac Arrhytmias Nausea and Vomiting Psychosis Reddish discolouration of urine on standing ```
36
how do MAO-B inhibitors worj
inhibits the breakdown of dopamine secreted by the dopaminergic neurones
37
parkinsonsim + impairment of vertical gaze (complain of difficulty reading/going down stairs)
Progressive Supranucleur Palsy
38
what is Pick disease
frontotemporal lobar degeneration
39
Sx of Pick disease
``` aggressiveness inappropriate behaviour change in behaviour apathy depression ``` speech and language abnormalities begin early and progress rapidly memory less affected than in Alzheimer and may score high on MMSE
40
what is an essential tremor (features)
AD condition made worse when arms are outstretched made better by alcohol and propranolol
41
what is second line treatment in essential tremor if propranolol is contraindicated
Primidone (anti-convulsant)
42
what is Creutzfeldt-Jakob Disease (CJD)
incurable and universally fatal neurodegenerative disease caused by prion protein
43
Sx of CJD
Dementia Cerebellar ataxia Myoclonic jerks
44
what are key Ix findings suggestive of CJD
EEG = non specific slowing periodic sharp wave complexes (PSWCs) of 1-2 Hz Prior protein in CSF and in tonsils Pulvinar sign on MRI
45
Facial Palsy + convergent squint
lesion in the pons
46
how does a UMN lesions and a LMN lesion on the face differ
UMN lesion - spares upper face i.e. forehead LMN lesion - affects all facial muscles
47
what is seen on MRI and CSF in MS
MRI - high signal T2 lesions - periventricular plaques CSF - oligoclonal bands (and not is serum)
48
ptosis + dilated pupil = ??
Third nerve palsy
49
ptosis + constricted pupil = ??
Horner's Syndrome
50
what is Argyll-Robertson pupil and why is it also known as "Whore's Eye"
small irregular pupils that do not react to light but react to accommodation (reduce in size when focusing on a near object) associated with tertiary syphilis
51
what causes Argyll-Robertson pupil
MS, Sarcoidosis, DM, Tertiary Syphilis
52
painful 3rd nerve palsy + headache =
posterior communicating artery aneurysm
53
features of 3rd nerve palsy
eye deviated 'down and out' ptosis dilated pupil
54
what is Weber's Syndrome
ipsilateral 3rd nerve palsy with contralateral hemiplegia caused by midbrain strokes
55
what is Lambert-Eaton Myasthenia syndrome
seen in associated with small cell lung cancer but can occur independently as an autoimmune condition caused by antibody directed against pre-synaptic voltage gated calcium channel in the PNS
56
what are features of Lambert-Eaton
repeated muscle contractions leads to increased muscle strength limb girdle weakness - proximal more commonly hyporeflexia autonomic Sx = dry mouth, impotence no eye features like myasthenia gravis
57
Tx of Lambert Eaton
Immunosuppresion | - prednisolone and/or azathioprine
58
what are features of a vestibular schwannoma
HL, vertigo, tinnitus absent corneal reflex facial palsy
59
Ix for vestibular schwannoma
MRI of cerebellopontine angle
60
drug that can cause demyelinating peripheral neuropathy
amiodarone
61
how does alcoholic neuropathy present
sensory symptoms present before motor symptoms
62
what does a vitamin B12 deficiency cause
subacute combined degeneration of the spinal cord Dorsal column usually affected first
63
how do nerve conduction studies differ in demyelinating and axonal neuropathy
demyelinating - reduced conduction velocity - normal amplitude axonal - normal conduction velocity - reduced amplitude
64
what infection classically triggers Guillain Barre Syndrome
Campylobacter jejuni but also can be Chlamydia, HBV, Mycoplasma pneumonia, CMV, EBV, HZV, HIV
65
what Sx are seen in Guillain Barre Syndrome
paralysis noted by weakness in the legs that spreads to upper limbs and face loss of deep tendon reflexes
66
what is seen in Toxoplasmosis if a CT was done and Tx
multiple ring enhancing lesions Tx = sulfadiazine and pyrimethamine
67
what is Tx of migraine during pregnancy
1st line = paracetamol 1g 2nd line = in 2nd and 3rd trimester - Aspirin 300mg or Ibuprofen 400mg
68
when is the COC pill an absolute contraindication
migraine with aura

Neurology SB (23 decks)

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