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FINALS: PASSMED/QUESMED > Neuro > Flashcards

Neuro Flashcards

1
Q

How does MND present on nerve conduction studies?

A

Normal motor conduction

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2
Q

What are adverse side effects of phenytoin?

A

Acute: dizziness, visual changes, slurred speech, seizures
Chronic: gingival hyperplasia, drowsiness, megaloblastic anaemia, peripheral neuropathy, lymphadenopathy
Teratogenic: associated with cleft palate and congenital heart disease

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3
Q

How do the pattern of signs present in GBS?

A

Flaccid weakness with hyporeflexia

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4
Q

What is the management of autonomic dysreflexia?

A

Remove stimulus (distended bowel/bladder) and treat lift-threatening complications e.g. bradycardia

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5
Q

reduced GCS, paralysis and bilateral pin point pupils suggests what?

A

Pontine haemorrhage

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6
Q

Patient with new onset stroke?

A

Admit to hospital for urgent CT head -> ?stroke assessment

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7
Q

What should be considered when starting someone on phenytoin?

A

Cardiac monitoring due to arrhythmogenic effects

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8
Q

What is a common side effect of triptans?

A

Tightness of the chest and throat

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9
Q

clonic movements travelling proximally suggests what?

A

Jacksonian march - frontal lobe epilepsy

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10
Q

What is the most common complication of meningitis?

A

Sensorineural hearing loss

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11
Q

What is the management of headache linked to valsalva manoeuvres?

A

Raised ICP until proven otherwise so needs CT

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12
Q

Management of seizures?

A

Rectal diazepam

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13
Q

What is used to treat idiopathic intracranial HTN?

A
  • Weight loss
  • Acetazolamide
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14
Q

Ipsilateral oculomotor palsy and contralateral weakness of the upper and lower extremity

A

Posterior cerebral artery

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15
Q

What is the mode of action of ondansetron?

A

Selective 5-HT3 receptor antagonist which acts in the medulla oblongata

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16
Q

Subdural vs extradural?

A

Subdural will have fluctuating consciousness

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17
Q

patients with dangerous mechanism of injury, including falling more than 1 metre or from a height of 5 stairs or more require what?

A

CT head within 8 hours

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18
Q

criteria for CT head within 1 hour?

A

GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting

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19
Q

CSF findings for SAH?

A
  • Normal or raised opening pressure
  • Xanthochromia
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20
Q

criteria for CT head within 8 hours?

A

age 65 years or older
any history of bleeding or clotting disorders including anticogulants
dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
more than 30 minutes’ retrograde amnesia of events immediately before the head injury

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21
Q

Idiopathic vs drug induced Parkinsons

A

Idiopathic - asymmetrical symptoms
Drug induced - symmetrical

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22
Q

Seizures vs syncopal episodes

A

Syncopal episodes - rapid recovery and short post ictal period

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23
Q

Sudden onset vertigo and vomiting, facial paralysis and sensorineural deafness - which artery

A

Anterior inferior cerebellar artery

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24
Q

Progressive supranuclear palsy vs multiple system atrophy?

A

PSP will have an upward gaze impairment

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25
Q

What is a patient with alcoholism at risk of?

A

Subdural haematoma

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26
Q

pain, ophthalmoplegia, proptosis, trigeminal nerve lesion and Horner’s?

A

Cavernous sinus syndrome

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27
Q

Cerebral Herniation can cause what?

A

Third nerve palsy: eye down and out with dilated pupil

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28
Q

What are the signs of lateral medullar syndrome/PICA stroke?

A
  • Ipsilateral facial pain and loss of temperature
  • Contralateral loss of limb and torso pain/temperature
  • Ipsilateral Horners syndrome
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29
Q

Which anticoagulant is used for prophylaxis post TIA?

A

Lifelong clopidogrel

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30
Q

What visual features will be present in a patient with IIH?

A
  • Blurred vision
  • Papilledema
  • Enlarged blind spot
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31
Q

What imaging is used to diagnose carotid artery stenosis?

A

Duplex US

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32
Q

What drug should be avoided in patients with myasthenia gravis?

A

Bisoprolol

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33
Q

Ventriculomegaly without sulcal enlargement suggests what?

A

Normal pressure hydrocephalus

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34
Q

What is the response that can occur following raised ICP?

A

Cushings reflex - hypertension and bradycardia with wide pulse pressure

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35
Q

Which opiate should be used if standard neuropathic medications are not working?

A

Tramadol

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36
Q

Which Parkinsons medication is linked with impulse control disorders?

A

Dopamine agonists

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37
Q

Which anaesthetic agent would someone with MG be resistant to?

A

NMBDs e.g suxamethonium

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38
Q

reduced GCS, paralysis and bilateral pin point pupils suggests what?

A

Pontine haemorrhage

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39
Q

Fluent speech, comprehension intact but poor repetition?

A

Conduction dysphasia

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40
Q

Gait ataxia is caused by what?

A

Cerebellar vermis lesions

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41
Q

Which drugs are associated with IIH?

A

A - Vit A and metabolites
L - Lithium/Levothyroxine
O - OCP
S - Steroids
T - Tetracycline
C - Cimetidine

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42
Q

What is a very common early symptom of MS?

A

Lethargy

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43
Q

What is associated with autonomic dysreflexia?

A

Stroke

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44
Q

Which cranial nerves are affected in acoustic neuromas?

A

5,7,8

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45
Q

What is the sensory loss in syringomyelia?

A

Spinothalamic - pain and temperature

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46
Q

How long can cluster headaches last?

A

15 mins - 2 hours

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47
Q

Muscle wasting of hands, numbness and tinging with autonomic symptoms suggests what?

A

Thoracic outlet syndrome

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48
Q

Which anti-epileptic drug can cause weight gain?

A

Sodium valproate

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49
Q

What is paroxysmal hemicrania?

A
  • Unilateral headache in the orbital/temporal region
  • Similar to cluster headaches
  • Responsive to indomethacin
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50
Q

Which anti epileptic medication can cause numbness of fingers and feet?

A

Phenytoin

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51
Q

Empty delta sign on venography suggests what?

A

Sagittal sinus thrombosis

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52
Q

Vision worse on going down the stairs?

A

4th nerve palsy

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53
Q

What can be done in patients with raised ICP?

A

Hyperventilation to reduce blood CO2 to induce cerebral vasoconstriction

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54
Q

What can be used to differentiate between a seizures and a pseudo seizure?

A

Prolactin

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55
Q

What is the eye examination signs for 3rd nerve palsy?

A

Ptosis + dilated pupil + absent light reflex with intact consensual constriction

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56
Q

Where is the most common cause of obstructive hydrocephalus?

A

Cerebral aqueduct stenosis

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57
Q

Which anti-epileptic drug causes weight loss, renal stones and cognitive and behaviour changes?

A

Topiramate

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58
Q

sudden and severe back pain, followed immediately by rapidly progressive bilateral flaccid limb weakness and loss of sensation, particularly for pain and temperature?

A

Spinal cord infarction

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59
Q

What is the management of stroke in patients <60 with severe symptoms and atleast 50% infarct of MCA on CT?

A

Decompressive hemicraniectomy

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60
Q

What is the most common cause of third nerve palsy?

A

Diabetes

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61
Q

What causes painful third nerve palsy?

A

Posterior communicating artery aneurysm

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62
Q

What is the gold standard investigation for venous sinus thrombosis?

A

MR venogram

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63
Q

What is the triad for lewy-body dementia?

A

fluctuating cognition, parkinsonism and visual hallucinations

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64
Q

unilateral wide-amplitude flinging movements, usually of the proximal limb post stroke?

A

Hemiballismus secondary to lesion in the contralateral sub thalamic nucleus

65
Q

Causes of SAH?

A

PKD, Ehlers Danlos, aortic cortication

66
Q

Other symptoms of SAH except headache?

A

Vomiting, collapse, coma, visual disturbance, focal neurology

67
Q

What is Kernigs sign?

A
  • Demonstrates meningeal irritation
  • Hip and Knee bent to 90 degrees, pain causes when knee is straightened
68
Q

Extradural vs subdural

A

Extradural - lens shaped/lemon/biconvex, subdural - crescent shaped

69
Q

What is Todds palsy?

A

T temporary weakness following a seizure - usually of affected limb(s).

70
Q

What are causes of seizures?

A

Uraemia, hypoglycaemia, hyponatraemia, hypernatraemia, hypocalcaemia

71
Q

What airway adjunct should be used if someone is having a seizure?

A

Nasopharyngeal

72
Q

Management of seizure?

A
  • Roll the patient into the recovery position and move any items away from him that could cause harm
  • Place a pillow under head
73
Q

What is the management of bladder dysfunction/incontinence in someone with MS?

A

US KUB

74
Q

Sudden onset vertigo and vomiting, ipsilateral facial paralysis and deafness

A

Anterior inferior cerebellar artery

75
Q

What is Freidreich’s ataxia?

A

Autosomal recessive neuro condition with weakness, cerebellar signs and scoliosis

76
Q

What signs would be present to indicate GBS?

A

LMN signs: hypotonia, paralysis, no reflexes

77
Q

What is the most common cause of surgical third nerve palsy?

A

Posterior communication artery aneurysm

78
Q

Damage to which structures can cause a homonymous hemianopia?

A

Unilateral damage to optic radiation or visual cortex

79
Q

What are symptoms of raised ICP?

A
  • Headache
  • Vomiting
  • Papilledema
  • Seizures
  • Reduced consciousness
80
Q

Drugs to manage ICP?

A
  • Mannitol
  • Dexamethasone
81
Q

What are causes of Horners syndrome?

A
  • Pancoast tumour: non-small cell carcinoma
  • Stroke
  • Carotid artery dissection
82
Q

Atrophy of the caudate nucleus and putamen?

A

Huntingtons

83
Q

Dementia + Depression/Irritability + Involuntary movements?

A

Huntingtons

84
Q

Acute cord compression in someone on anticoagulation should make you think what?

A

Epidural haematoma

85
Q

What can present very similarly to carpal tunnel syndrome?

A

degenerative cervical myelopathy?

86
Q

What are C/I to thrombolysis?

A
  • Haemorrhagic stroke
  • Active bleedig
  • Major surgery within 14 days
  • Pregnancy
  • Previous intracranial haemorrhage
87
Q

Where is the damage in spastic cerebral palsy?

A

UMN in the periventricular white matter

88
Q

What is the management of myasthenia crisis?

A

IV Immuniglobulins / Plasmapheresis

89
Q

What is the most common cause of viral meningitis?

A

Enteroviruses e.g. coxsackie B

90
Q

Vision worse going down stairs?

A

CN4 - Trochlear

91
Q

What is a common complication of SAH?

A

Hyponatraemia -> can cause SIADH

92
Q

What should FEV1 increase by when testing for asthma with short acting bronchodilators?

A

12% or more

93
Q

What genes are associated with Parkinsons?

A

SNCA, LRRK2, PINK1

94
Q

What are some non motor symptoms of Parkinsons?

A
  • Cognitive impairment
  • Depression
  • Hallucinations
  • Constipation
  • Sleep disorders
95
Q

Investigations for TIA?

A
  • CT/MRI
  • Echo
  • 24 hour ECG
  • Carotid doppler
96
Q

What are complications of GCA?

A
  • Visual loss
  • Aortic aneurysm
  • Seizures
  • Stroke
97
Q

Which chromosome is affected in Huntingtons?

A

Chromosome 4

98
Q

What is the pathophysiology of Huntingtons?

A

Expansion of CAG triple repeats in the huntingtin gene

99
Q

What are Alzheimers symptoms?

A
  • Confusion
  • Apraxia
  • Depression
  • Hallucinations
100
Q

What are the 2 drugs for Alzheimers?

A

Cholinesterase inhibitors - Donepezil
NMDA antagonists - Memantine

101
Q

Third nerve palsy with decreasing consciousness and heamatoma?

A

Trans-tentorial herniation

102
Q

What investigation could be done to investigate suspected trigeminal neuralgia?

A

MRI head -> assess for underlying cause e.g MS

103
Q

If CT is done within 6 hours of suspected SAH and is normal….

A

Do not do LP - consider alternative diagnosis

104
Q

weakness of foot dorsiflexion and foot eversion

A

common peroneal lesion

105
Q

what causes action potential prolongation in both sensory and motor axons?

A

Carpal tunnel

106
Q

How long should symptoms be present before being able to diagnose chronic fatigue syndrome?

A

3 months

107
Q

burning and tingling sensation over the upper lateral area of the thigh with no motor deficits

A

Think merralgia paraesthetica

108
Q

loss of sensation to the palmar and dorsal aspect of the 5th digit

A

Ulnar

109
Q

What occular signs are seen in Wernickes?

A
  • Nystagmus
  • Opthalmoplegia: lateral rectus palsy
110
Q

When should amoxicillin be given to cover for Listeria in meningitis?

A

Over 60s

111
Q

Fever on alternating days?

A

Malaria

112
Q

Falling from a tree and grabbing a branch whilst falling -> claw hand?

A

Klumpke’s palsy -> T1 nerve damage

113
Q

What should be given in non falciparum malaria?

A

Primaquine

114
Q

Why is primaquine used in non-falciparum malaria?

A

Destroy liver hypnozoites and prevent relapse

115
Q

Which MND has the worst prognosis?

A

Progressive bulbar palsy

116
Q

lymphocytic CSF with high protein and low glucose

A

TB meningitis

117
Q

What are options to reduce relapses in MS?

A
  • Natalizumab
118
Q

What are the 2 first line drugs for spasticity in MS?

A

Baclofen and Gabapentin

119
Q

What are complications of spinal cord compression?

A
  • Aspiration
  • Pressure sores
  • Depression
  • Pneumonia
  • Autonomic dysfunction
120
Q

Epilepsy DVLA rules

A

First unprovoked/isolated seizure - 6 months
Established epilepsy - seizure free for 12 months

121
Q

What causes short headaches before an SAH?

A

Small leaks from the aneurysm

122
Q

What kind of signs would MS give?

A

UMN

123
Q

What autoimmune conditions are associated with myasthenia gravis?

A
  • Graves
  • Hashimotos
  • RA
124
Q

What is the key feature of MG?

A

Fatigability - muscles become progressively weaker during periods of activity and improve after rest

125
Q

What are the antibodies of MG?

A
  • Anti-acetylcholine receptors
  • anti muscle-specific tyrosine kinase antibodies
126
Q

What is the Tensilon test?

A

IV edrophonium which reduces muscle weakness temporarily

127
Q

What is the main complication with MG?

A

Acute respiratory failure due to weakness of the muscles of ventilation.

128
Q

CT head showing temporal lobe changes

A

Herpes encephalitis

129
Q

Sensory loss posterolateral aspect of leg and lateral aspect of foot

A

S1

130
Q

Which organisms can cause GBS?/

A
  • Campylobacter
  • CMV
  • Hepatitis
  • Mycoplasma pneumoniae
  • EBV
  • HIV
131
Q

What are types of CNS tumours?

A

Glioma - most common
Meningioma
Glioblastoma

132
Q

What is the treatment for Lewy-Body dementia?

A
  • Same as Alzheimers
  • Donepezil/Rivastigmine
133
Q

What criteria is used for MS diagnosis?

A

McDonald

134
Q

Cushings reflex

A
  • HTN
  • Bradycardia
  • Irregular breathing
135
Q

Signs of expanding EDH?

A
  • N+V
  • Slurred speech
  • Seizures
  • Reduced GCS
136
Q

What is coning?

A

Herniation of cerebellar tonsils through foramen magnum causing compression of brainstem

137
Q

Management of ?brain abscess on CT?

A

IV Abx
MRI to rule out brain mets
Drainage if confirmed abscess

138
Q

Meningitis complications?

A

Septic shock
Hearing loss
Seizures
Intellectual impairment
Abscess

139
Q

Memantine side effect?

A

Constipation

140
Q

CSF antibodies against NMDA?

A

Autoimmune encephalitis

141
Q

What test should be done before starting acetylcholinesterase inhibitors?

A

ECG - can prolong QT

142
Q

cerebral venous sinus thrombosis treatment?

A

LMWH

143
Q

A hyperdense artery sign on CT can be a sign of what?

A

Ischaemic stroke

144
Q

Effacement of the cerebral ventricles and loss of grey-white matter differentiation

A

Raised ICP

145
Q

Hyperdense material in the cerebral sulci and basal cisterns

A

SAH

146
Q

What is cortical basal degeneration?

A

Parkinson’s triad + spontaneous activity of an affected limb

147
Q

What is internuclear opthalmoplegia?

A

Lesion in medial longitudinal fasciculus causing impaired adduction in affected side and nystagmus in opposite eye

148
Q

What are some factors with worsen prognosis of MS?

A
  • Older
  • Male
  • Many MRI lesions
  • Early relapses
149
Q

What is myotonic dystrophy?

A
  • 20s year old with cataracts, muscle wasting of hands, slow relaxing grip
150
Q

Management of lumbar spine stenosis?

A
  • Pain management, physio
  • Surgery only for severe cases e.g. laminectomy
151
Q

Most common cause of spontaneous intracerebral haemorrhage?

A

HTN

152
Q

REM sleep disturbances is a feature of what?

A

Lewy body dementia

153
Q

What is decorticate?

A

Abnormal flexion in response to pain

154
Q

India ink stain is used to test for what?

A

Cryptococcus -> Fungal meningitis

155
Q

HIV patient with meningitis signs?

A

Fungal -> Cryptococcus

156
Q

Excessive nitrous oxide inhalation can cause what?

A

Subacute degeneration of spinal cord

157
Q

Vertigo, nystagmus, dysphagia, Horners?

A

PICA

158
Q

CAG triple repeat with anticipation through spermatogenesis?

A

Huntingtons

FINALS: PASSMED/QUESMED (22 decks)

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