Neuro Flashcards
(266 cards)
1
Q
petechial haemorrhages within mammillary bodies
A
wencieks
2
Q
decreased red cell transketolase
A
wernickes
3
Q
Von hippel Lindau predisposes to neoplasia and you get
A
cerebellar haemangiomas causing SAH
4
Q
left homonymous hemianopia affects
A
right optic tract
5
Q
in a bitemporal hemianopia if upper quadrant worse
A
pituitary adenoma
6
Q
in bitemporal hemianopia is lower quadrant worse then
A
craniopharyngioma
7
Q
macular sparing
A
lesion of occipital cortex
8
Q
what is an important differential in unilateral deafness
A
vestibular schwanoma (acoustic neuroma)
9
Q
ix of choice in vestibular schwanoma
A
MRI of cerebellopontine angle
10
Q
loss of thumb adduction (adductor policies)
A
ulnar nerve
11
Q
claw hand
A
ulnar nerve
12
Q
you get cafe au lait spots more commonly associated with NF but also in
A
Tuberose sclerosis
13
Q
4 big features of TS
A
ash leaf macules
roughened patches of skin over spine (shagreen patch)
angiofibromas (butterfly distribution over nose)
subungal fibromata
14
Q
TS and NF both have what inheritance
A
dom
15
Q
triptans are specific for
A
5HT1B and d agonists
16
Q
when are triptans given
A
first line with nsaids or paracetamol for migraine
17
Q
when should triptans be taken
A
as soon as possible after onset of headache rather than onset of aura
18
Q
s/e of triptans
A
tingling sensation
tightness of throat and chest
19
Q
contraindications for triptans
A
heart disease
20
Q
what is first line for trigeminal neuralgia
A
carbamazepine
21
Q
unilateral brief like shock pains and may be evoked by shaving, washing
A
22
Q
where can be trigger areas for trigeminal neuralgia
A
nasolabial fold or chin
23
Q
mx of TIA
A
aspirin asap
24
Q
mimic of TIA
A
hypoglycaemia
intracranial haemorrhage
25
best test for a TIA
MRI ( including diffusion weights and blood sensitive sequences)
26
carotid endarterectomy if stenos greater than
50%
27
aim of statin therapy is to reduce no HDL cholesterol by more than
40%
28
thoracic outlet syndrome compresses
brachial plexus, subclavian artery or vein
29
thoracic outlet syndrome can cause wasting of hand muscles, sensory symptoms to hands, arm swelling or claudication
30
what can be a rf for thoracic outlet syndrome
extra cervical rib
31
third nerve palsy with a dilated pupil needs
urgent brain imaging
32
painful third nerve palsy
posterior communicating artery aneurysm
33
prophylaxis for tension type headache
acupuncture
34
syringomyelia describes
collection of CSF within the spinal cord
35
how does a syringomyelia present
cape like loss of temperature sensation
36
lateral medullary syndrome also known as
posterior inferior cerebellar artery
37
ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner's
contralateral: limb sensory loss
lateral medullary syndrome
38
what should be given immediately once haemorhagic stroke has been excluded
aspirin
39
in a fib when can you start anticoagulants after stroke
not for 14 days after
40
thrombolysis should be done for stroke within
4.5hrs
41
how long from symptom onset or from waking up should thrombolysis be started
9hrs
42
blood pressure should be lowered to what before thrombolyssi
185/110
43
if present within 6 hrs can have thrombolysis and thrombectomy
if present after 6 hrs but before 24hrs can have thrombectomy
44
what is recommend post stroke
clopidogrel
45
although can't totally differentiate what symptoms are more likely in haemorrhage stroke
decreased level of consciousness
headache
N+V
46
when can you not give aspirin for a TIA immediately
if got bleeding disorder or takin an anticoagulant as need to exclude a haemorrhage first
47
if have a hypertensive emergency post stroke and need to use anti hypertensive what are first line
labetealol, nicardipine, clevidipine
48
what index is used post stroke to assess disability
Barthel
49
lacunar strokes have a strong association with
hypertension
50
middle cerebral artery stroke affects what limb more
arm
51
anterior cerebral artery stroke affects what limbs more
lower
52
does anterior cerebral artery stroke have contralaterall homonymous hemianopia and aphasia
no
53
what does anterior inferior cerebellar artery syndrome have that posterior doesn't
Ipsilateral facial paralysis and deafness
54
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
posterior inferior cerebellar artery
55
amaurosis fugax affects what artery
retinal /opthalmic
56
status epileptics if lasts greater that
5misn
57
if bentos not worked for status epilepticus
levetiracetam, phenytoin, sodium valproate- best one levetiracetam
58
headache worse when upright
spontaneous intracranial hypotesions- csf leak
59
weakness of hands and loss of pain and temp sensation
syringomyelia
60
bilateral spastic paresis and bilateral loss of pain and temp sensation
anterior spinal artery occlusion
61
Neurosyphillis only affects dorsal columns so only loss of
proprioception and vibration
62
spastic paraparesis describes
progressive weakness and increased muscle tone in both legs - UMN dysfunction
63
sodium valproate works by increasing
GABA activity
64
can you start valproate in men easily under 55
no
65
s/e of valproate
weight gain and increased appetite
66
valoprate is a
p450 inhibitor
67
basic seizure mx
check airway and give o2 if needed
recovery position
benzos
68
reyes associated with aspirin use. what is it
progressive encephalopathy affecting children that is accompanied by fatty infiltration of the liver, kidneys and pancreas
69
what is the most important blood test in restless leg syndrome
ferritin to exclude iron def anaemia
70
first lien drug for restless leg if not iron def
dopamine agonists eg ropinirole
71
TIBC are raised in
iron def anaemia but low in anaemia of chronic disease
72
triceps reflex is
C7/8
73
cushings triad is irregular breathing, bradycardia and
widening pulse pressure
74
mx of raised ICP
head elevation to 30 defress
IV mannitol
controlled hyperventilation
75
most of the back of hand is the
radial nerve
76
what nerve affects triceps and supination
radial
77
wrist drop seen in
radial nerve injury
78
what can differentiate a true from pseudo seizure
true has raised serum prolactin
79
looking where is worse in supranuclear palsy
DOWN - not what I would have thought but vertical in general so up not greta either
80
what is common post lumber puncture
headache
81
what is pituitary apoplexy
sudden enlargement of pituitary tumour secondary to haemorrhage or infarction
82
what is the urgent mx in pituitary apoplexy
urgent steroid replacement
83
valproate is an inhibitor what is an inducer
phenytoin
84
common s/e of phenytoin
gingival hyperplasia and hirsutism
85
why not give phenytoin in preg
can cause cleft palate
86
when do you need to check phenytoin levels
adjusting dose
suspect toxicity
detect non adherence to it
87
in subacute degeneration of the cord what affected first
dorsal column
88
paroxysmal hemicrania
severe unilateral headache in orbital, supraorbital or temporal region
89
meds that can cause Parkinsonism
antipsychotics and metoclopramide
90
what antiemetic does not cross the blood brain barrier so does not cause extra pyramidal s/e
domperidone
91
who can diagnose and treat parkisnosn
specialist
92
when do you give levodopa vs dopamine agonist for parkisnosn
levodopa if motor symptoms affecting quality of life if not dopamine agonist
93
important regarding Parkinson meds
risk of acute akinesia, neuroleptic malignant syndrome if stop taking meds for a few days
94
med that can be tried for parkisnosn if sleepiness develops
modafinil
95
drug in Parkinson if orthostatic hypotension
midodrine
96
what reduces s/e of levodopa
decarboxylase inhibitor eg carbidopa
97
important to not acutely stop
levodopa
98
if parksinosn pt gets admitted to hospital and can't take levodopa orally what can be given
dopamine agonist patch
99
2 big things to educate pts on about dopamine agonists
impulse control disorders
excessive daytime sleepiness
100
what is used to treat drug induced Parkinson
anti muscarine eg procyclidine
101
triad of Parkinson
tremor, bradykinesia and rigidity
102
is Parkinson symmetrical
no its asymmetrical
103
Parkinson temor improves when
tired or stressed or with voluntary movement
104
how does drug induced Parkinson's symptoms differ from parkinosns disease
motor symptoms are generally rapid onset and bilateral
rigidity and rest tremor are uncommo n
105
dx of Parkinson is usually
clinical but can do SPECT
106
neuroleptic malignant syndrome is seen in those taking
antipsychotics but also seen in levodopa suddenly stopped
107
how does neuroleptic malignant syndrome tend to present
within hours to days of starting an antipsychotic they get
- pyrexia
-muscle rigidity
- stop antipsychotic
- dantrolene may be used
108
what is raised in most cases with neuroleptic malignant syndrome
raised CK
109
what is required in NF type 1 due to phaeochromoctoms
regular blood pressure checks
110
Cafe-au-lait spots (>= 6, 15 mm in diameter)
Axillary/groin freckles
Peripheral neurofibromas
Iris hamatomas (Lisch nodules) in > 90%
Scoliosis
Pheochromocytomas
NF1
111
narcolepsy associated with
low levels of orexin (hypocretin)
112
sleeping loads
loss of muscle tone triggered by emotion
narcolepsy
113
what drugs prevents you from sleeping during day
modafinil
114
General features
myotonic facies (long, 'haggard' appearance)
frontal balding
bilateral ptosis
cataracts
dysarthria
myotonic dystrophy
115
what should be avoided if possible in myasthenia gravis
beta blockers
116
myasthenia gravis associated with
thymomas (15% )
117
first lien for myasthenia gravis
pyridostigmine
118
Parkinsonism with autonomic sitruabnce eg article dysfunction or postural hypetension or atonic bladder
multiple system atrophy
119
monoclonal antibody that has strong evidence for reducing risk of relapse in MS
natalizumab
120
drug for fatigue in MS
amantadine
121
spasticity for MS
baclofen and gabapentin
122
bladder symptoms in MS should get an
US to asses bladder emptying - may give antichoinergs or self catheterisation
123
Oscillopsia (visual fields appear to oscillate)
gabapentin is first-line
MS
124
FLAIR images of MS show
Dawson fingers- lesions perpendicular to the corpus callosum
125
CSF in MS
oligoclonal bands
increased IgG
126
uthoffs phenomen in MS
worsening of vision following rise in body temp
127
lhermittes syndrome in MS
paraesthesia in limbs on neck flexion
128
MND rarely presents
before 40
129
amyotrophic lateral sclerosi has
LMN signs in arms and UMN signs in legs
130
primary lateral sclerosis MND
UMN signs only
131
progressive muscular atrophy has
LMN signs only
affects distal muscles before proximal
best prognosis
132
MND that carries worst prognosis
progressive bulbar palsy
133
what MND med prolongs life by 3 months
riluzole
134
best nutrition for mND & been shows to prolong survival
PEG
135
what is the most common presenting symptoms of ALS
asymmetric limb weakness
136
other features of MND
wasting of small hand muscles/tibialis anterior common
fasciculations
137
what is spared in MND
eye movements
138
nerve conduction studies in MND
normal - exclude a neuropathy
139
when can NSAIDS be used in prg
1+ 2nd trimester
140
Migraine and menstruation
many women find that the frequency and severity of migraines increase around the time of menstruation
SIGN recommends that women are treated with mefanamic acid or a combination of aspirin, paracetamol and caffeine. Triptans are also recommended in the acute situation
141
confusing point about migraines
It should be noted that as a general rule 5-HT receptor agonists are used in the acute treatment of migraine whilst 5-HT receptor antagonists are used in prophylaxis.
142
first line for acute migraine
triptan and NSAID or triptan and paracetamol
143
people aged 12-17 with migraine should offer
nasal triptan instead of oral
144
2nf line for migraine
non oral metoclopramide or procholeperazine
145
caution should be exercised when prescribing --- to young patients as acute dystonic reactions may develop
metoclopramide
146
prophylaxis of migraines
propanol, topiramate *avoid if child bearing, amitriptyline
147
riboflavin can be effective in reducing migraine
for women with predictable menstrual migraine treatment NICE recommend either frovatriptan (2.5 mg twice a day) or zolmitriptan (2.5 mg twice or three times a day) as a type of 'mini-prophylaxis'
148
in children what is migraine more like
more commonly bilateral and GI disturbance is more prominent
149
aura - seeing jagged crescent ( ask about changes to vision) or may be
sensory
150
migraine headache classicaly described as
throbbing
151
most common complication of meningitis
sensorineural hearing los s
152
Patients with meningococcal meningitis are at risk of ----(adrenal insufficiency secondary to adrenal haemorrhage).
Waterhouse-Friderichsen syndrome
153
viral causes of tb that can have lo glucose on CSF
mumps and herpes encephalitis
154
most at risk for medication overuse headache
opioids and triptans
155
mx of medication overuse headache
simple analgesics and triptans should be withdrawn abruptly (may initially worsen headaches)
opioid analgesics should be gradually withdrawn
156
medication overuse headache is common cause of chronic daily headahdce and presents for
15 days or more per month
157
unable to pronate wrist and weak wrist flexion
median nerve
158
levodopa usually reduced effectiveness within
2 years
159
what can cause reddish discolouration of urine upon standing
levodopa
160
lateral medullary syndrome has what contractual
limb sensory loss
161
lamotrogine is a
sodium channel blocker
162
adverse effect of lamotrigine
stevens johnson syndorme
163
lambert eaton syndrome against what channel
calcium
164
Lambert eaton mx
trat underlying cause
steroids/azathioprine
165
intracranial venous thrombosis ix
MRI venography is gold standard
166
mx of intracranial venous thrombosis
anticoagualte
167
saggiato sinus thrombosis sign on venography
empty delta
168
cavernous sinus thrombosis
periorbital erytehma and oedema
169
impaired adduction of the eye on the same side as the lesion
horizontal nystagmus of the abducting eye on the contralateral side
internuclear ophthalmoplegia
170
headache
blurred vision
papilloedema (usually present)
enlarged blind spot
sixth nerve palsy may be present
idiopathic intracranial hypertension
171
what drugs can be used for IIH
carbonic anhydrase inhibitors eg acetazolamide
topiramate is also sued and has added benefit of cueing weight loss
172
huntingotns inheritance
auto dom
173
herpes simplex encephalitis affects
temporal lobes
174
what has a big impact on mortality in herpes simplex encephalitis
how quickly acyclovir is started
175
Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours with clusters typically lasting 4-12 weeks
Intense pain around one eye (recurrent attacks 'always' affect same side)
Patient is restless during an attack
Accompanied by redness, lacrimation, lid swelling
More common in men and smokers
cluster headache
176
rise in protein with a normal white blood cell count (albuminocytologic dissociation) - found in 66%
Lumbar puncture in Gillian barre
177
anti ganglioside antibodies in 25% of pts s
Gillian barre
178
Miller Fisher syndrome
variant of Guillain-Barre syndrome
associated with ophthalmoplegia, areflexia and ataxia. The eye muscles are typically affected first
usually presents as a descending paralysis rather than ascending as seen in other forms of Guillain-Barre syndrome
179
what is unusual about Friedrichs ataxia
even though its a tri nucleotide disroder it doesnt not demonstrate anticipation
180
what is the msot common cause of death in Friedrichs ataxia
HOCM
181
In 4th nerve palsy what does the eye look ilike on looking straight ahaead
upwards and outwards
182
Essential tremor has what inheritance
auto dom
183
first lien for essential tremor
propanolol
184
facial neeve supplies
face, ear, taste, tear ( lacrimal and salivary glands)
185
some cuases of bialeral facial nerve palsy
Bells
sarcoidosis
guillian barre
lyme
186
when do msot neurologists start antiepileptics
after second seizure. howeveerr maybe first if imaging shows structual abnormalitly or has nerological deficit or EEg shows wpileptic activity
187
first lien for mycolonic seizure vs tonic
myocolonic = levetiracetam
tonic - lamotrogine
188
what can exacerbate absence seizures
carbamazepien
189
what is not first line for tonic clonic seizures
lamotrogine or levetiracetam
190
things that suggest frontal lobe seizure
head/ leg mvoemetn s
post ictal weakness
jacksonian march
191
things that suggest seizure is in partietal lobe
(sensory) - paraesthesia
192
what suggests a temporal lobe seizur
aura- typcially rising epigastric sensation
dehaj vu
automatisms - lip smacking,
193
how long does aclochol withdrawl seizure typcially present after stop drinjing
36hrs
194
what are pts given to reduce alcohol withdrawl seizurs
benzos
195
do infantile spasms have good prognosis
NO - poor
196
what is the psot ictal phase of a seizure
15 mins after where they feel drowsy and tured for around 15 mins
197
follwoing first seizure what tests to pts get
Electroencephalogram EEG and MRI
198
antiepiletpics are generally cosndiered safe for breastfeeding the excpetion to this is
barbiturates
199
s/e of valprte
weight gain
200
s/e of lamotrongine
stevensons johnson sydnrome
201
s/e of carbamazepine and phenytoin
dizziness and ataxia
202
carabamazepine, lamotrogine and phenytoin all work by
sodium channels
203
if seizure doesn termiante in 5-10 mins it is approprite to adminster
benzos
204
absenze seizures prognosis
90-95% become seizure free in adolescence
205
juvenile myoclonic seizures often occur when
in morning/ following sleep deprivation
206
what is a key investigation in encephalitis
PCR for HSV, VZV and enteroviruses
207
calf pseudohypertrophy in
Deuchennes
208
Beckers muscular dystrophy presents
milder to deuchenens and develops later at like 10 insteaf of from 5
209
important drug to remember that can cuase peripehral neuroopathy
amiodarone
210
c7 is
middle finger
211
T4 is
nipples
212
inguinal ligament is
L1
213
big toe
L5
214
small toe is
s1
215
hoffmans sign in cervical myelopahty
flicking one finger causes all the other fingers to flick on the same hand
216
only effective tretament for cervical degenerative myelopathy
decompressive surgery
217
rapid onset dementia and myoclonus
Creutzeldt jakob disease
218
CJD caused by
prions
219
CN 3,4,V1,6
superior orbital fissur e
220
7,8
internal acoustic meatus
221
9,10,11
jugular foramen
222
CN V
v1- SOF
V2- foramen rotundum
v3- foramen ovale
223
hypersensitivity to the carotid sinus reflex
glossopharngeal aneve
224
in vag nerve palsy uvula devaites
away from lesion
225
loss of gag reflex afferent and efferent
aff- gloss
eff- vag
226
weakness of what in common peroneal nerve lesion
foot dorsiflexion and foot eversion
227
most common CNS tumour in adults vs kids
adults - glioma
kids - astrocytomas
228
cluster headhaces typically occur around a
eye
229
ix of choice in clsuter headache
MRI with gadolonium contrast
230
acute mx of cluster headache
oxygen and triptan
231
CSF is between the
pia and arachnoid
232
Cerebreal perfsuion pressure needs to be carefully controlled following trauma by monitoring of th
ICP and MAP
233
what is the H in DANISH for cerebellar signs
hypotonia
234
the cavernous sinus contains
internal carotid artery
abducens nerve
235
cataplexy is common in narcolepsy and is when
loss of msucualr tone aused by strong emotion
236
Carbamazepine is known to exhibit autoinduction, hence when patients start carbamazepine they may see a return of seizures after 3-4 weeks of treatment.
237
what is the most common brain tumour
metastatic
238
most common cancer to spread to brain
lung
239
most common primary tumour in adutls
glioblastoma multiforme
240
glioblastoma multiforme has
pleomorphic cells & central necrosis and rim
241
what arises from arachnoid cap and are typcially located next to teh dura, cause compression symptoms
- spindle cells in concentric whorls and psammomam bodies
Meningioam
242
histology of vestibular schwnomma
verocay bodies ) acellular areas surrounded by neuclear palisades
243
most common primary brain tumour in kids
pilocystic astrocytoma
244
histology in pilocystic astrocytoma
Rosenthal fibres (corkscrew eosinophilic bundle)
245
small blue cells cancer in kids
medullablastoma
246
fried egg appearnace
oligodendroma
247
tumour in 4th ventricle that may cause hydrocephalus
ependymoma
248
what tumour is derived from remnant of Rathke's pouch
craniopharyngioma
249
syndrome affectign parietal lobe
gerstmann syndrome
250
huntingtons chorea affects
striatum (caudate nucleus) of basal ganglia
251
subthamalic nucleus of basal ganglia
hemibalsim
252
prosopagnosia (difficult recognising faces) is
temporal lobe
253
erb duchenne affect c5,6
winged scapula
254
klumpke affects intrinsic hand msucles damage to
t1
255
other symptoms in bells palsy
patients may also notice
post-auricular pain (may precede paralysis)
altered taste
dry eyes
hyperacusis
256
what is this important for
-eye care is important to prevent exposure keratopathy
prescription of artificial tears and eye lubricants should be considered
If they are unable to close the eye at bedtime, they should tape it closed using microporous tape
bells palsy
257
most people with Bell's palsy make a full recovery within ---- months
if untreated around 15% of patients have permanent moderate to severe weakness
3-4
258
autonomic dysreflexia occurs if spinal cord injury at or above
T6
259
what are the most common triggers of autonomic dysreflexia
faecal impaction or urianry retention
260
feature of autonomic dsyrefelxia
extreme hypertesion
flsuhing and sweating above the level of cord lesion
261
ataxic telangiectasia presents like friedrcihs ataxia but
onset is 1-5 instead of 10-15 in friedrichs
262
what describes the downward dispalcemtn or hernaition of cerebellar tonsils throigh the foramen magnum
arnol - chairi malformation
263
brocas and wernickes supplied by what areries
Left middle cerebral arrteyr
264
conduction aphasia affects
arcuate fasiculus
265
what is bad in conduction aphasia
repitition
266
5ht3 antagonists that used in mx of chemo related nausea and s/e include prolonged QT intervak
ondansetron - cosntipation common
