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RACP > Neuro > Flashcards

Neuro Flashcards

1
Q

Friedrich’s ataxia

A

Progressive limb and gait ataxia / Loss of tendon reflex / Motor weakness LL -> UL / Sensory loss proprio/vibration / DYsphagia / Hearing loss / Visual / Bladder / Kyphoscoliosis/ Motor neuropathy / Daytime somno / Preserved cog

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2
Q

Optic neuritis

A

Painful eye with loss of vision and ipsilateral RAPD. Causes include MS, neuromyelitis optica, B12 def, Ischaemia, Leber’s, EBV, Drugs (etoh, ethambucol)

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3
Q

Features of MS

A

Relapse/Remit | Onset 15-50y | optic neuritis | Lhermitte sign | internuc ophthalmoplegia | fatigue | heat sensitive (Uhthoff)

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4
Q

Features of PML (JC virus). Which MS drug is it assoc. with?

A

Progression over weeks / presence of cortical sx / behavioural alter / hemiparesis / retrochiasmal visual deficit (?contralateral homonymous hemianopia)

Assoc. with Natalizumab

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5
Q

What is Ocrelizumab used for? What is its mechanism

A

Primary progressive MS. Anti-CD20 expressing cells

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6
Q

Wallenburg / lateral medullary syndrome features. Which vessel affected?

A

PICA. Sx vertigo, n+v, ataxia

Ipsilateral facial pain/temp, palate/vocal cord, Horner’s syndrome, cerebellar signs incl. nystagmus

Contralateral trunk lower limb pain/temp

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7
Q

Features of Gerstmann syndrome

A

Agraphia, acalculia, finger agnosia, L/R disorientation

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8
Q

Features of idiopathic intracranial hypertension IIH

A

Loss of vision, swollen optic discs, persistent headache

Rx: Weight loss, acetazolamide, frusemide, topiramate. NOT steroids

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9
Q

Difference between EMG and NCS

A

EMG - electrical signals from muscles when at rest / being used

NCS - how fast and how well electrical signals conduct down your nerves

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10
Q

Riluzole - what condition is it used for and what is its mechanism

A

Marginally slows progression in motor neuron disease.

Na channel blocker inhibiting glutamate release

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11
Q

What is the difference between primary muscular atrophy and primary lateral sclerosis?

A

PMA - LMN signs only

PLS - UMN signs only

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12
Q

Features of 3rd nerve palsy and DDx >5

A

Down and out, ptosis +/- dilated pupil
1) Diabetic - pupil sparing
2) Vasculitis e.g. GCA
3) Weber syndrome - Midbrain. Ipsilateral 3rd with contralateral hemiplegia
4) PICA aneurysm with headache
5) Cavernous sinus thrombosis
6) MS/amyloid

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13
Q

Features of PSP (2 types)

A

“Classic” - Gait disturbance, frequent falls, supranuclear gaze palsy. Poor response to Levodopa

PSP-parkinsonism - Asymmetric limb sx, tremor and initial response to Levodopa (but not sustained)

Dysarthria, dysphasia, rigidity, frontal cog, sleep disturbances

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14
Q

Features of radial nerve palsy?

A

C5-8 – affects finger extensors
Wrist drop
Absent sensation over snuffbox
Weakness of finger and thumb extension
Loss of triceps reflex

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15
Q

Features of median nerve palsy?

A

C6-T1

Carpal tunnel - weakness abductor pollicis brevis

Cubital fossa lesion - failure of index finger flexion, loss of sensation over palmar thumb+2/3/lateral 4th. Weakness of thumb abduction and opposition

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16
Q

Features of ulnar nerve?

A

C8-T1 – affects small muscles of hand

Clawing of 4/5th finger
Loss of sensation over palmar 5th and medial half 4th
Weakness of 5th finger flex and add/abd fingers

17
Q

Features of complete brachial plexopathy

A

Horner’s syndrome
LMN
Sensory loss over whole arm limb

18
Q

Deep tendon reflexes - which nerve roots?

A

Biceps C5
Brachioradialis C6
Triceps C7

Knee L4
Ankle S1

19
Q

DDx of foot drop (3)

A

Common peroneal nerve
Sciatic nerve
L5 radiculopathy – absent ankle jerk

20
Q

What is syringomyelia?

A

Fluid filled cyst (syrinx) forms within spinal cord and can cause compression

21
Q

Features of femoral nerve palsy

A

L2-4

Weakness of knee extension (quads)
Absent knee jerk
Sensory loss inner thigh/leg

22
Q

Features of Charcot Marie Tooth

A

Hereditary sensory motor neuropathy
HMSN1 and 2

HMSN1 - motor >sensory (glove/stocking) with loss of balance, muscle weak, foot deformities. Slowed NVCs and hypertrophic myelin with onion bulbs and 2’ axonal disease. Onset teens-young adult

HMSN2 - Milder weakness of feet and leg muscles and sensory distal LL>UL. Normal NCVs and axons

23
Q

Most common type of muscular dystrophy? Features

A

Facioscapulohumeral dystrophy FSHD. A dominant. Onset 20y. Initial facial weakness then shoulders w winging, mildly raised CKD.

24
Q

Features of myotonic dystrophy

A

Muscle wasting, cataracts, heart conduction, endocrine changes and myotonia. Onset at any age

25
Q

EMG features of dermatomyositis, MND and Myasthenia?

A

DM - reduced amplitude and duration of motor units

MND - fibrillation

MG - diminished response to repetitive stimulation

26
Q

Features of SUNCT

A

Short lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing

Men >50y. Severe headaches lasting seconds-minutes. >20 attacks. No acute Rx but preventative including anti-epileptics

27
Q

What is paroxysmal hemicrania

A

Unilateral severe headaches lasting 2-45mins, up to x5/day with marked autonomic symptoms. Rx Indomethacin

28
Q

RCVS features

A

Reversible Cerebral Vascoconstriction syndrome

Bilateral recurrent thunderclap headaches. Spontaneous, exertion, or hx weed/amphe use. Rx with Verapamil to prevent infarction

29
Q

Rx for MS (5)

A

1/ IV methylpred if functional status impaired
2/ IF beta 1a/b - reduces risk of relapse and slows disability progression
3/ Glatiramer acetate - reduces relapse rate. No SE
4/ Natalizumab - monoclonal ab a4 integrin. Assoc. JC PML
5/ Mitoxantrone DNA topoisomerase - used for rapidly worsening disease. SE leukaemia, cardiotoxicity, infertility

30
Q

What is Dandy’s criteria used for and what is it?

A

Idiopathic intracranil hypertension / pseudotumour cerebri - Rx acetazolamide, frusmide, topiramate

  1. Sx raised ICP
  2. No focal neurology other than CN6 palsy
  3. Pt awake and alert
  4. Normal CT/MRI
  5. LP pressure >25 with normal biochem/cyto CSF
    6, No other explanation
31
Q

Location and features of Millard-Gubler syndrome

A

Pons - CN 6-7 affected

Contralateral hemiplegia (not face)
Ipsilateral LR palsy + diplopia
Ipsilateral facial paresis

RACP (12 decks)

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