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Finals Revision > Neuro > Flashcards

Neuro Flashcards

1
Q

How do you treat seizures in the community?

A

PR diazepam or buccal midazolam

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2
Q

How would you localise a lesion which causes facial paralysis with forehead sparring?

A

UMN lesion caused by the contralateral side

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3
Q

Sx of Ramsay Hunt Syndrome?

A

Ipsilateral LMN lesion
Facial paralysis (including the forehead), vertigo, hearing loss or hyperacusis, tinnitus and ear pain/rash

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4
Q

Which CNs can be affected by acoustic neuroma, what symptoms will this cause?

A

CN V, VII and VIII
V = absent corneal reflex
VII = facial nerve paralysis
VIII = vertigo, unilateral hearing loss and tinnitus

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5
Q

What is the commonest neurological presentation of sarcoidosis?

A

Facial nerve palsy

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6
Q

What should you always do in patients with a GCS of 3-8 and a known head injury?

A

ICP monitoring

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7
Q

What should you suspect in blurred (binocular) vision post-facial trauma?

A

Depressed fracture of the zygoma (cheek bone)

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8
Q

Which nerve injury will result in weakness of finger abduction and thumb adduction?

A

T1 injuries

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9
Q

Which features characterise Creutzfeldt-Jakob disease?

A

Rapid onset dementia and myoclonus

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10
Q

What causes a bitemporal hemianopia?

A

Optic chiasm compression

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11
Q

How can you localise homonymous quadrantopias?

A

Inferior quadrantopias are in the parietal lobe
Superior quadrantopias are in the temporal lobe

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12
Q

A patient has a left sided visual field defect, which side of the brain is affected?

A

Right

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13
Q

Sx and Mx of trigeminal neuralgia?

A

Unilateral electric-shock pains evoked by light touch e.g. brushing hair/teeth
Mx = carbamazepine, refer to neurology if they fail to respond

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14
Q

What is the 1st line management of focal seizures?

A

Lamotirgine

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15
Q

Which type of amnesia is an indication for non-contrast CT head in head injury?

A

Retrograde amnesia of >30 mins

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16
Q

Sx of syringomyelia?

A

Cape like loss of pain and temperature sensation due to spinothalamic compression

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17
Q

What do ring enhancing lesions of the brain imply? How do you treat?

A

Brain abscesses. Treat with IV cephalosporins (e.g. ceftriaxone) and IV metronidazole

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18
Q

What should you suspect as a cause of fluctuating consciousness in the elderly and alcoholics?

A

SDH

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19
Q

What is the most common cause of EDH?

A

Middle meningeal artery rupture due to a pterion fracture

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20
Q

In a non-contrast CT what will cause a hyperdense collection?

A

An acute bleed

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21
Q

Sx and Mx of Bell’s Palsy?

A

Ipsilateral LMN paralysis
Facial paralysis (including the forehead), post-auricular pain, altered taste, dry eyes and hyperacusis
Mx = oral prednisolone within 72 hours

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22
Q

When should you non-contrast CT head in <1 hour?

A

Head injury with:
GCS <13 initially or <15 after 2 hours of the incident
Suspected open or depressed skull #
Sx of base of skull #
Post-traumatic seizure
Focal neurological deficit
>1 episode of vomiting

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23
Q

Which condition is associated with bilateral vestibular schwannomas?

A

Neurofibromatosis Type 2

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24
Q

Where do acoustic neuromas most commonly occur?

A

At the cerebellopontine angle

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25
Q

What is the gold standard for diagnosis of venous sinus thrombosis?

A

MRI venogram

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26
Q

When should you CT head a patient within 8 hours?

A

If they have loss of consciousness or amnesia following a head injury and one of:
>= 65 years old, bleeding disorder or clotting abnormality including anticoagulants, dangerous mechanism of injury (e.g. fall from more than 5 stairs or >1m), >30 mins retrograde amnesia

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27
Q

If a patient is on warfarin and has a head injury but no other symptoms, should you CT head?

A

Yes within 8 hours

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28
Q

What is the most common tumour to metastasise to the brain? What are some other tumours which commonly metastasise?

A

Lung - most common
Also breast, bowel, kidney and skin (mainly melanoma)

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29
Q

What is the difference between a medical and surgical 3rd nerve palsy

A

Medical = spares the pupils and will be painless e.g. in diabetes
Surgical = painful and associated with fixed dilated pupil

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30
Q

Which nerves control eye movements?

A

All are controlled by CNIII except lateral rectus (controlled by CN VI) and superior oblique (controlled by CN IV)

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31
Q

How do you investigate GBS?

A

Nerve conduction studies

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32
Q

How do you investigate MG?

A

Anti-acetylcholine receptor antibodies

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33
Q

How do you localise focal seizures?

A

Temporal = aura (often epigastric) and automatisms
Frontal = head/leg movements and posturing, post-ictal weakness and dysphagia, Jacksonian march and Todd’s paresis
Parietal = paraesthesia
Occipital = floaters/flashes

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34
Q

What is seen on LP in GBS?

A

Isolated raised proteins

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35
Q

What should you consider in a painful 3rd nerve palsy?

A

Posterior communicating artery aneurysm

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36
Q

How does a posterior inferior cerebellar stoke present?

A

Ataxia, nystagmus, dysphagia, ipsilateral facial nerve palsy/Horner’s syndrome with contralateral limb sensory loss

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37
Q

Which type of seizures are worsened by carbamazepine?

A

Myoclonic and absence seizures

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38
Q

Name 1 important side effect of phenytoin?

A

Peripheral neuropathy

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39
Q

What is a common complication of intraventricular heaemorrhages?

A

Hydrocephalus

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40
Q

What causes subacute degeneration of the spinal cord? Which tracts does it affect?

A

Vitamin B12 deficiency
Affects the dorsal columns and lateral corticospinal tracts - impaired proprioception and vibration with UMN signs in the legs

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41
Q

Sx of subacute degeneration of the spinal cord?

A

Loss of proprioception and vibration then distal paraesthesia
UMN signs in the legs (Babinski positive, brisk knee but absent ankle jerk reflexes)

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42
Q

How should you immediately treat TIA? What should you give for secondary prevention?

A

Immediate = 300mg aspirin
Secondary prevention = 75mg clopidogrel

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43
Q

What is seen on scan in normal pressure hydrocephalus? What symptoms are seen?

A

Large ventricles but normal pressure
Sx = dementia, incontinence and disturbed gait

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44
Q

What is a sunsetting gaze?

A

Failure of upward gaze, it occurs in children presenting with severe hydrocephalus

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45
Q

What is the most common symptom of carbon monoxide poisoning? What other symptoms may occur?

A

Headache = most common
Also nausea and vomiting, vertigo, confusion and weakness

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46
Q

How do we investigate carbon monoxide poisoning?

A

Do ABG, pulse oximetry may be falsely elevated.
Measure carboxyhaemoglobin levels, they should be <10% in smokers and <3% in non-smokers. If raised treat!

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47
Q

How do we treat carbon monoxide poisoning?

A

100% high flow oxygen, target sats 100%. Continue treatment until all symptoms have resolved

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48
Q

Sx of lambert eaton syndrome? What antibodies are seen?

A

Limb girdle weakness mainly affecting the lower limbs, hyporeflexia, and autonomic symptoms. In the beginning muscle strength improves with use. Eye symptoms are not commonly seen
Voltage gated calcium channel antibodies may be seen

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49
Q

Which condition is associated with anti-Mi-2 antibodies? What are the symptoms?

A

Dermatomyositis
Proximal muscle weakness, systemic upset and rash will be seen

50
Q

What is seen in Cushing’s triad?

A

Widening pulse pressure, irregular breathing and bradycardia.
There will also be hypertension

51
Q

Mx of Tonic-Clonic seizures?

A

M = Sodium Valproate
F = Lamotrigine or Levetiracetam

52
Q

Mx of Focal seizures?

A

1st line Lamotrigine or Levetiracetam for everyone
2nd line = Carbamezepine

53
Q

Mx of Absence seizures?

A

1st line = Ethosuximide
2nd line = M = Sodium Valproate
F = Lamotrigine or Levetiracetam

54
Q

Mx Myoclonic seizures?

A

M = Sodium Valproate
F = Levetiracetam

55
Q

Mx of Atonic or Tonic seizures?

A

M = Sodium Valproate
F = Lamotrigine or Levetiracetam

56
Q

Describe Broca’s Aphasia?

A

Occurs secondary to a frontal lobe stroke
Normal comprehension but impaired repetition and non-fluent speech

57
Q

Describe Wernicke’s Aphasia?

A

Occurs secondary to a temporal lobe stroke
Impaired comprehension and repetition but fluent illogical/word salad speech

58
Q

Describe Conduction Aphasia?

A

Occurs secondary to an arcuate fasciculus stroke
Normal comprehension, speech is fluent but repetition is impaired - patients are aware of their mistakes

59
Q

How is sodium commonly affected in brain injury?

A

You often get hyponatraemia secondary to SIADH

60
Q

How can we differentiate between drug induced and idiopathic PD?

A

Idiopathic is asymmetrical, drug induced is symmetrical

61
Q

What is postural hypotension?

A

A drop in systolic BP of >= 20 and/or a fall in diastolic BP of >=10 within 3 mins of standing

62
Q

Describe essential tremor?

A

An AD condition which causes a tremor of both upper limbs which is worse when arms are outstretched. It will be relieved by rest and alcohol.
Mx = propranolol or primidone

63
Q

Describe Idiopathic Intracranial Hypertension?

A

Headache, blurred vision and papilloedema (bilaterally blurred optic disc) with an enlarged blind spot and CN VI palsy seen in overweight women
Mx = weight loss, acetazolamide and topiramate

64
Q

Which cranial nerves control the light reflex?

A

CN II = afferent (sensory)
CN III = efferent (motor)

65
Q

Which cranial nerves control the corneal reflex?

A

CN V = afferent (sensory)
CN VII = efferent (motor)

66
Q

How can we differentiate clinically between brain abscesses and meningitis?

A

Brain Abscesses are more likely to cause focal neurology where as meningitis is more likely to cause reduced consciousness or confusion

67
Q

What is seen in EEG in absence seizures?

A

3Hz spike and wave

68
Q

What do nerve conduction studies show in MND?

A

Normal motor conduction

69
Q

Why should you always correct B12 levels before you give folate replacement?

A

To avoid subacute combined degeneration of the spinal cord

70
Q

What is the first line Mx of Raynaud’s?

A

Nifedipine

71
Q

What should you give to prevent vasospasm in SAH?

A

Nimodipine

72
Q

What are the commonest type of focal seizure?

A

Temporal lobe seizures

73
Q

What are some red flag symptoms which may be seen in trigeminal neuralgia which would require refferal?

A

Sensory changes, Deafness/hearing changes, Hx of skin/oral lesions which may have spread, pain only in the ophthalmic division or bilaterally, optic neuritis, family Hx of MS and <40 at age of onset

74
Q

What is the management of an intracranial aneurysm which has bled?

A

Coiling

75
Q

Sx of Guillain-Barre Syndrome?

A

Symmetrical progressive weakness of all limbs which starts in the legs and is ascending), reduced or absent reflexes and distal paraesthesia may be present

76
Q

Mx of cluster headaches?

A

100% oxygen and s/c triptan acutely, prophylaxis is with verapamil

77
Q

Which nerve is commonly damaged in a Colles #?

A

Median nerve

78
Q

How quickly should symptoms resolve/return to baseline after stopping using opioids in opioid overuse headaches?

A

2 months

79
Q

How quickly should you refer patients presenting with a TIA to see a specialist?

A

If they have presented within the first week refer to see a specialist within 24 hours
If they have presented after the first week refer to see a specialist within 1 week
Give all patients 300mg aspirin

80
Q

What happens in internuclear opthalmoplegia?

A

A lesion of the medial longitudinal fasciculus causes impaired eye adduction of the ipsilateral eye and nystagmus during abduction of the contralateral eye

81
Q

Which nerve is affected in wrist drop? Which fracture is this commonly associated with?

A

Radial nerve. Commonly associated with a shaft of Humerus #

82
Q

Mx of MG?

A

1st line = Long acting acetylcholinesterase inhibitors e.g. Pyridostigmine
Immunosuppression e.g. with prednisolone or azathioprine
Consider thymectomy

83
Q

In CN V (trigeminal nerve) damage, what do you see?

A

Loss of the afferent aspect of the corneal reflex, loss of facial sensation, paralysis of muscles of mastication and the jaw deviates to the weak side

84
Q

In CN VII (facial nerve) damage, what do you see?

A

Flaccid paralysis of upper and lower face, loss of the efferent aspect of the corneal reflex, loss of taste and hyperacusis

85
Q

In CN IX (glossopharyngeal nerve) damage, what do you see?

A

Hypersensitive carotid sinus reflex and loss of the afferent aspect of the gag reflex

86
Q

In CN X (vagus nerve) damage, what do you see?

A

Loss of the efferent aspect of the gag reflex and the uvula deviates away from the site of the lesion

87
Q

In CN XI (accessory nerve) damage, what do you see?

A

Weakness in turning the head to the contralateral side

88
Q

In CN XII (hypoglossal nerve) damage, what do you see?

A

The tongue deviates towards the side of the lesion

89
Q

Describe Juvenile Myoclonic Epilepsy?

A

Classically begins in the teen years (more common in girls)
There are infrequent generalized seizures often worse in the morning/following sleep deprivation, daytime absences, sudden shock-like myoclonic seizures which may go on to generalised tonic-clonic seizures.
Responds well to sodium valproate

90
Q

How may a craniopharyngioma present?

A

Bitemporal Hemianopia (worse in the lower aspect), growth retardation, diabetes insipidus (patients will produce large amounts of urine).
CT brain scan will show calcification

91
Q

What is mononeuritis multiplex?

A

Simultaneous damage to multiple nerves which are not linked. There may be acute or subacute sensory loss or motor function loss of individual nerves

92
Q

Which drugs increase the risk of IIH?

A

COCP, Steroids, Tetracycline Abx, Retinoids and Lithium

93
Q

What organism classically triggers Guillain-Barre Syndrome?

A

Campylobacter Jejuni

94
Q

What is the adult dose for rectal diazepam used to Mx seizures?

A

10mg

95
Q

Describe Multiple System Atrophy?

A

Parkinsonism, autonomic disturbance (e.g. erectile dysfunction, postural hypotension and atonic bladder) and cerebellar signs

96
Q

True or false, pregnancy is a risk factor for Bell’s Palsy?

A

True

97
Q

When should you CT head a patient with a coagulation disorder and LOC/amnesia post-head injury?

A

Within 8 hours

98
Q

What normally causes encephalitis? Ix and Mx?

A

Normal caused by HSV1
Ix = CSF PCR, there will be an increased WCC and increased protein on CSF
Mx = IV aciclovir

99
Q

What type of tumour is MG associated with?

A

Thyomas

100
Q

Which nerve is damaged if there is an inability to flex the 1st, 2nd and 3rd digits?

A

Median nerve

101
Q

Which nerve is damaged if there is an inability to extend the 4th and 5th digits?

A

Ulnar nerve

102
Q

Sx of a myoclonic seizure?

A

Clonus (upper and lower limb contraction and relaxation) without LOC, tongue biting, incontinence or a post-ictal period

103
Q

What is Thoracic outlet obstruction?

A

Compression of the brachial plexus/subclavian artery/vein - often caused by a cervical rib
Sx: nerve compression = painless muscle wasting of the hands, weakness and tinging
vein compression = arm swelling
artery compression = pain and claudication
Sx may be worse when the arm is raised

104
Q

What is the cause of SDH?

A

Damage to the bridging veins between the cortex and venous sinuses

105
Q

How long do cluster headache clusters typically last for?

A

4-12 weeks

106
Q

When should you suspect SJS?

A

Fever, photophobia and a rash after starting a new medication

107
Q

Mx of Myasthenia Gravis Crisis?

A

IVIG and plasma electrophoresis

108
Q

What are the common migraine triggers?

A

CHOCOLATE
Chocolate, Hangovers, Orgasms, Caffeine/Cheese, Oral contraceptives, Lie-ins, Alcohol, Travel and Exercise

109
Q

Which type of dementia are those with MND more at risk of?

A

Frontotemporal dementia

110
Q

Syringomyelia is associated with Chiari malformation. What may be seen? Ix?

A

Cape like loss of pain and temperature. Spastic weakness of the lower limbs and upgoing plantars may be seen
Ix = full spine and brain MRI

111
Q

True or false essential tremors can affect the vocal cords? How do you manage essential tremor?

A

TRUE
Mx with propranolol

112
Q

Sx of Progressive Supranuclear Palsy?

A

Parkinsonism + Dysarthria + Reduced vertical eye movements

113
Q

What is the ROSIER score used for?

A

Used to differentiate stroke and stroke mimics

114
Q

True or false if a person on warfarin has sustained a head injury you should CT head <8 hours even if there are no other symptoms

A

TRUE

115
Q

What is conductive dysphasia?

A

Speech is fluent but repetition is poor. Comprehension is intact
Seen in parietal lobe strokes

116
Q

Where are the inferior and superior optic radiations found?

A

Inferior optic radiation is found in the temporal lobe - temporal lobe stroke = superior quadrantopia
Superior optic radiation is found in the parietal lobe - parietal lobe stroke = inferior quadrantopia

117
Q

What does the empty delta sign indicate when seen on MR venogram?

A

Sagittal sinus thrombosis

118
Q

What should you start before giving phenytoin?

A

Cardiac monitoring

119
Q

What is the cause of a wrist drop after a night of heavy drinking?

A

Saturday night palsy, due to compression of the radial nerve

120
Q

True or false, abdominal symptoms are not commonly seen in children with migrains?

A

False! children often experience nausea, vomiting and abdo pain with migrains

121
Q

What is the cause of a high stepping gait?

A

Compensating for a peripheral neuropathy leading to foot drop
Unilateral = common peroneal nerve damage
Bilateral = peripheral neuropathy

122
Q

What type of anaemia can phenytoin cause?

A

A macrocytic anaemia as it alters folate metabolism

Finals Revision (23 decks)

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