neuro Flashcards
(101 cards)
1
Q
the gold standard test where cervical myelopathy is suspected.?
A
MRI of the cervical spine
2
Q
drugs has been shown to confer a survival benefit in MND?
A
Riluzole
3
Q
Painful third nerve palsy+ meningism
Which artery is affected?
A
posterior communicating artery aneurysm
4
Q
ttt of moderate AD
A
Supportive care+ Acetylcholin inhibitor ( donepezil galantamine, and rivastigmine
5
Q
ttt of severe AD or moderate but not tolerating donepezil
A
Memantine
6
Q
ttt of acute Migraine
A
triptan + NSAID or triptan + paracetamol
7
Q
prophylaxis of migrain
A
topiramate or propranolol
8
Q
Charcot-Marie-Tooth disease (type 1) asks how likely it is that any future children will have the disease
A
AD so. 50%
9
Q
Which element can be used to differentiate between a true seizure and a pseudoseizure
A
prolactin
Factors favouring true epileptic seizures
tongue biting
raised serum prolactin*
10
Q
vertigo, unilateral hearing loss, tinnitus and an absent corneal reflex
A
acoustic neuroma.
affect C.N 5.7.8
11
Q
Inv of choice for acoustic neuroma
A
MRI of the cerebellopontine angle
12
Q
recurrent cervical myelopathy require
A
Urgent referral to spinal surgery or neurosurgery
13
Q
Myasthenia gravis: exacerbating factors
A
penicillamine quinidine, procainamide beta-blockers سؤال lithium phenytoin antibiotics: gentamicin, macrolides, quinolones, tetracyclines
14
Q
isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
A
Lacunar strokes
15
Q
Contralateral hemiparesis and sensory loss, lower extremity > upper
A
Anterior cerebral artery
16
Q
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
A
Middle cerebral artery
17
Q
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
A
Posterior cerebral artery
18
Q
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
A
Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)
19
Q
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
A
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
20
Q
Symptoms are similar to Wallenberg’s (see above), but:
Ipsilateral: facial paralysis and deafness
A
Anterior inferior cerebellar artery (lateral pontine syndrome)
21
Q
Retinal/ophthalmic artery
Sussed transient loss of vision
A
Amaurosis fugax
22
Q
Locked-in’ syndrome
A
Basilar artery
23
Q
which feature is the most consistent with a diagnosis of Bell’s palsy?
A
Hyperacusis
24
Q
Blood pressure is 135/80 lying and 95/70 standing. (posturalhypotension)= Autonomic dysfunction
+ Ataxia (cerebellar affection)
+parkinson
A
Shy-Drager syndrome is a type of multiple system atrophy.
25
managemnet of TIA in the last 7 days
Aspirin 300mg immediately + specialist review within 24 hours
26
common trigger for cluster headaches is
Alcohol
27
ttt of Bell's Palsy.
Prednisolone and lubricating eye drops
28
She describes a sensation that her surroundings are unreal, 'like a dream'. Following this she has been told that she starts to smack her lips,
What is the type of this epilepsy?
Focal impaired awareness seizure
29
Which diet is most likely to be effective in epilepsy?
Ketogenic diet
30
most common long-term complication of meningitis
hearing loss
31
progressive cognitive impairment
parkinsonism
visual hallucinations
Lewy body dementia
32
roughened patches of skin over lumbar spine (Shagreen patches) + epilepsy
depigmented 'ash-leaf' spots which fluoresce under UV light
adenoma sebaceum (angiofibromas): butterfly distribution over nose
fibromata beneath nails (subungual fibromata)
café-au-lait spots* may be seen
retinal hamartomas: dense white areas on retina (phakomata)
rhabdomyomas of the heart
Tuberous sclerosis
| skin+ neuro
33
What is the most common clinical pattern seen in motor neuron disease?
Amyotrophic lateral sclerosis
34
radial nerve injury in spiral groove
wrist drop
| test.....Extend the wrist
35
sympathetic dystrophy and causalgia following surgery or a minor injury
example: painful swollen hand after successful healed fracture
following surgery or a minor injury
36
lost the ability to abduct his thumb.
which nerve affected?
ape like hand
wasting of the thenar eminence associated with sensory loss to the palmar aspect of lateral (radial) three fingers.
median
37
weakness of the ring and little fingers.
claw hand
wasting of the hypothenar eminence
weakness of finger abduction.
Thumb adduction is also weak.
ulnar
38
weakness of foot dorsiflexion
weakness of foot eversion
weakness of extensor hallucis longus
sensory loss over the dorsum of the foot and the lower lateral part of the leg
wasting of the anterior tibial and peroneal muscles
Common peroneal nerve lesion
39
pain, opthalmoplegia, proptosis, trigeminal nerve lesion (opthalmic branch) and Horner's syndrome.
Cavernous sinus syndrome
40
ttt of Restless legs syndrome
dopamine agonists such as ropinirole or Pramipexole
41
Dysphagia+ Dysarthria+ gag reflex+ tongue wasting and fasciculation
MND
Amyotrophic lateral sclerosis (ALS)
Lower motor neurone signs include flaccid paralysis, weakness, wasting, and fasciculations. Upper motor neurone signs include spastic paralysis, pyramidal weakness, hyper-reflexia and up-going plantars.
42
Obese, young female with headaches / blurred vision think of .............
idiopathic intracranial hypertension
| pseudotumour cerebri
43
adverse effect of phenytoin
```
Peripheral neuropathy
hirsutism, not alopecia سؤال
fever
toxic epidermal necrolysis
megaloblastic anaemia (secondary to altered folate metabolism)
```
peripheral neuropathy
enhanced vitamin D metabolism causing osteomalacia
44
paraesthesiae in limbs on neck flexion in MS
Lhermitte's syndrome:
45
worsening of vision following rise in body temperature in MS
Uhthoff's phenomenon:
46
‘cape-like’ (neck and arms) loss of sensation to temperature but preservation of light touch, proprioception and vibration.
Other symptoms and signs include spastic weakness (predominantly of the upper limbs), paraesthesia, neuropathic pain, upgoing plantars and bowel and bladder dysfunction.
Syringomyelia
47
ondansetron. What is the most important site of action of this drug?
They mainly act in the chemoreceptor trigger zone area of the medulla oblongata.
5-HT3 antagonists are antiemetics used mainly in the management of chemotherapy related nausea.
48
Carbamazepine is ineffective in which type of seizure?
absence seizures
49
Ptosis + dilated pupil
3rd nerve palsy
50
ptosis + constricted pupil
Horner's $
51
painful 3rd nerve palsy
posterior communicating artery aneurysm
52
sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened)
Cataplexy
53
homonymous quadrantanopias
| where is the lesion ??
PITS (Parietal-Inferior, Temporal-Superior)
example: Right superior homonymous quadrantanopia
the lesion is in left temporal lobe
54
Which infections is most strongly associated with the development of Guillain-Barre syndrome
Campylobacter jejuni
55
features of Parkinsonism + dysarthria + reduced vertical eye movements + Dementia
progressive supranuclear palsy
56
features of Parkinsonism + visual hallucination +Dementia
lewy body dementia
57
features of Parkinsonism + cerebellar signs (ataxia) +Autonomic dysfunction ( postural hypotension/ erectile dysfunction)
shy drager $ (multiple system atrophy)
58
management of Acute cluster headaches
100% oxygen at at least 12 litres per minute via a non-rebreathable mask and/or a subcutaneous or nasal triptan.
59
preventative management of cluster headaches
verapamil.
60
management of Acute migraine
combination therapy with an oral triptan and an NSAID, or an oral triptan and paracetamol
61
Prophylaxis of migraine
topiramate or propranolol
| if asthmatic ..... topiramate
62
first-line management of trigeminal neuralgia ?
carpamazipine
63
ttt of delirium
haloperidol 0.5 mg or olanzapine as the first-line sedative
Halopridol is # IF parkinson's ........ small dose of oral lorazepam may be an alternative in such a situation. سؤال
64
ttt of status epilepticus in community
buccal midazolam is first choice if not available rectal diazepam 10mg if adult سؤال .
i.v phenytoin
65
ttt of status epilepticus in hospital
I.V lorazepam
| I.V phenytoin
66
You are reviewing a patient with Parkinson's disease. Which one of the following types of medications has been most linked with impulse control disorders?
Dopamine receptor agonists
67
contraindication of triptan
ischaemic heart disease or cerebrovascular disease
68
C5.6
biceps reflex.
69
C7\8
Triceps reflex
70
T3/4
knee reflex
71
S1/2
Ankle reflex
72
bitemporal superior quadrantanopia.caused by tumor in...........
Pituitary adenoma
| associated with endocrinal manifestations
73
bitemporal inferior quadrantanopia caused by tumor in...........
craniopharyngioma
74
What needs to be considered when starting phenytoin?
cardiac monitoring is required due to the pro-arrhythmogenic effects it elicits.
75
Which medication for migraine is most likely to precipitate extrapyramidal side-effects?
metoclopramide
76
Which type of motor neuron disease carries the worst prognosis?
Progressive bulbar palsy
77
impairment of adduction of the ipsilateral eye. The contralateral eye abducts, however with nystagmus.
Internuclear ophthalmoplegia (INO
78
Which one features of migraine is more common in children?
Gastrointestinal disturbance
79
Patient on halopridole developed high fever, tachycardia, tachypnoea and muscle rigidity.
neuroleptic malignant syndrome
Ttt: Management
stop antipsychotic
IV fluids to prevent renal failure
dantrolene* may be useful in selected cases
bromocriptine سؤال , dopamine agonist, may also be used
80
Unilateral spastic paresis and loss of proprioception/vibration sensation
+ loss of pain and temperature sensation on the opposite side
- Brown-Sequard S
81
regarding the stopping of anti-epileptic drugs
| Should be seizure free for how long
Can be considered if seizure free for > 2 years, with AEDs being stopped over 2-3 months
82
Woman in child bearing peroid +migraine
| Need prophylaxis
Propranolol better thqan topiramate
83
Man with tremor that is made worse when arms are + family history
Essential tremore AD +ve family history
84
Ttt of essential tremor
Propranolol +Alcohol
85
post-herpetic neuralgia ttt
amitriptyline سؤال , duloxetine, gabapentin or pregabalin first-line.
tramadol سؤال may be used as 'rescue therapy' for exacerbations of neuropathic pain
topical capsaicin may be used for localised neuropathic pain (e.g. post-herpetic neuralgia)
86
neurological findings are suggestive of polyneuropathy. An increased gamma GT is suggestive of
alcoholic peripheral neuropathy.
87
neurological findings are suggestive of polyneuropathy. An increased gamma GT is suggestive of
alcoholic peripheral neuropathy.
88
paraesthesia and numbness of the right fourth and fifth digit, a right sided foot drop and a left sided facial weakness.
Mononeuritis multiplex.
89
Anti epileptic drug inhibition of the P450 system
Na valproat
90
Anyi epileptic drug cause stimulation of p450
Phenytoin
91
antiepileptic drugs is most associated with weight gain?
Na valproate
92
What is the most appropriate anti-emetic to patient with parkinson
Domperidone
Meteclopromide worsen parkinson
93
2nd line in the management of Generalised tonic-clonic seizures
Lamotrigine, Carbamazipine
94
1st line in focal seizure
lamotrigine, carbamazepine
95
Which nerve is most susceptible to damage from a fracture of the shaft of the humerus.
Radial
96
Supracondylar fracture of humerus is most commonly associated with Which nerve injury
Ulnar
97
. Fracture of the proximal humerus is most commonly associated with
Axillary
98
MS + increasing problems with painful involuntary contractions of the leg muscles. What is the most appropriate first-line therapy?
Beclofen
99
most common psychiatric problem associated with parkinsom
Depression
100
change in her appearance. She finds removal of rings difficult, her shoe size has changed and photographs show a marked change in her appearance....symptoms Suggestive of acromegally...... >pituitary adenomia
What's the change in visual field
Bitemporal hemianopia dur to compression of optic chiasma
101
recommended tool used to assess a patient with stroke
ROSIER is an acronym for 'Recognition Of Stroke In the Emergency Room
