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F1/ Part 1 > Neuro > Flashcards

Neuro Flashcards

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1
Q

Which medications to be avoided in PD?

A

Metoclopramide
Promethazine
Prochlorperazine
Holoperidol

Domperidone does not pass BBB

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2
Q

What is neurogenic shock?

A

Inadequate tissue perfusion from loss of sympathetic vasoconstrictive tone

Hypotension + bradycardia

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3
Q

What is spinal shock?

A

Complete flaccid paralysis immediately following spinal cord injury - may or may not be asscociated with circulatory shock

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4
Q

MRI head - what is the purpose of T1-weighted vs T2-weighted

A

T1: enhances acute haemorrhage

T2: enhances oedema, infarction, demyelination, chronic haemorrhage

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5
Q

Causes of cerebellar syndromes

A

Vascular lesions - demyelination - tumours etc.

Alcohol - hypothyroidism - phenytoin toxicity - metabolic disorders (eg Wilsons)

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6
Q

What is Kernig’s sign

A

hamstring spasm on trying to straighten leg

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7
Q

Normal lumbar puncture profile

A

Neut: 0
Lymphocytes: <5
Protein: <0.4
Glucose (ratio CSF/ serum): >0.6

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8
Q

Bacterial lumbar puncture profile

A

Neut: +++
Lymphocytes: +
Protein: >1
Glucose (ratio CSF/ serum): <0.4

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9
Q

Viral lumbar puncture profile

A

Neut: +
Lymphocytes: +++
Protein: 0.4-1.0
Glucose (ratio CSF/ serum): usually normal

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10
Q

TB lumbar puncture profile

A

Neut: +
Lymphocytes: +++
Protein: >1
Glucose (ratio CSF/ serum): <0.4

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11
Q

Describe internuclear ophthalmoplegia clinically

A

Lesion in medial longitudinal fasciculus will prevent ipsilateral adduction during conjugate gaze

(Convergence is normally fine)

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12
Q

Describe Lhermitte’s sign

A

Electric shock down spine on neck flexion

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13
Q

Types of MS

A

Relapsing-remitting
Primary progressive
Secondary progressive
Progressive relapsing

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14
Q

Management of tremor in MS

A

Clonazepam

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15
Q

What is GBS?

A

Autoimmune response causing demyelination

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16
Q

What causes GBS?

A 
Infection (usually resp/ gastro)
Malignancy
Pregnancy
Drugs
Vaccination
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17
Q

Symptoms of GBS

A

Progressive ascending weakness, sensory loss, paraesthesia, pain
Dysphasia
Dysarthria

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18
Q

What is shown in CSF in GBS?

A

Increased protein

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19
Q

Causes of facial nerve palsy

A

Bell’s, acoustic neuroma, MS, infarcts, tumours, Lyme disease, sarcoidosis, Ramsay Hunt

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20
Q

Which facial muscles are preserved in UMN lesion

A

Frontalis

Orbicularis oculi

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21
Q

How to clinically help differentiate a facial nerve palsy due to sarcoid

A

Parotid enlargement/ tenderness

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22
Q

Which side more commonly affected in trigeminal neuralgia?

A

R

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23
Q

Triggers for trigeminal neuralgia

A

touching

but also talking, smiling, chewing, swallowing

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24
Q

Horner’s

A

Miosis - ptosis - anhidrosis

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25
What is Horner's syndrome?
Interrupted sympathetic innervation to the eye
26
Causes of Horners
CENTRAL: basal meningitis - demyelinating disease - CVA - basal skull tumours - pituitary tumour - intrapontintine haemorrhage - neck trauma - syringomyelia PREGANGLIONIC: Pancoast's - cervical rib - aortic aneurysm/ dissection - lesions of middle ear POSTGANGLIONIC: Herpes Zoster - migraine - internal carotid dissection DRUGS: chlorpromazine - levodopa - prochlorperazine - COCP
27
What is a Holmes-Adie pupil?
Normal variant - more common in women Larger, irregular pupil. Slower (direct and consensual) constriction to light. Often associated with absent deep tendon reflexes (Holmes-Adie syndrome)
28
What is an Argyll-Robertson pupil?
Miosis, irreg pupil. Absent light reflex (but consensual is intact) Neurosyphilis - DM - MS - syringobulbia
29
Foot signs in Friedrich's Ataxia
Hammer-toes | Clubfoot
30
What is subacute combined degeneration of the spinal cord?
B12 deficiency leading to degeneration of the posterior column and corticospinal tracts of the spinal cord REPLACE B12 BEFORE FOLATE!
31
Presentation of syringobulbia
Dysfunction in cranial nerves
32
Presentation of syringomyelia
Slowly progressive Loss of pain and temp - sometimes in shawl-like distribution Muscle atrophy due to extension into anterior horns of spinal cord - begins in hands and p?rogresses proxinally Lower limb LMN signs Autonomic dysfunction
33
How does the botulinum toxin paralyse muscles
Prevents release of ACh from the terminal end bouton - so muscles can't respond to nerve impulses
34
How does organophosphates cause death?
Prevent destruction of ACh - so muscles like the diaphragm remain depolarised, unable to return to their resting position
35
ANS neurotransmitters
All Ach | Except sympathetic postganglionic: NA
36
What causes RAPD? | What is the presentation?
Damage anywhere between the retinal ganglion cell layer to the lateral geniculate body When light is shone on the unaffected eye, both eyes constrict fully and symmetrically When light is shone in affected eye, both pupils will constrict but to a lesser degree
37
How to confirm a Horner's syndrome?
4% cocaine drops - will dilate unaffected eye only
38
Causes third nerve palsies
Idiopathic (25%) Microvascular Vascular causes: extradural haematoma (pupil-sparing), posterior communicating artery aneurysm** **posterior communicating artery runs adjacent to third nerve - may not be picked up on MR angiography (due to vasospasm) - should be repeated
39
Which cranial nerve most susceptible to trauma?
CN IV: long, slender, paratentorial course
40
Which cranial nerve defect might involve patient tilting head?
CN IV tilted towards affected side (part of Bielschowsky sign)
41
Causes sixth nerve palsies?
Microvascular disease External compression: acoustic neuroma, raised ICP
42
Core symptoms of Meniere disease
vertigo - tinnitus - fluctuating hearing loss (should be confirmed on audiometry) (aural fullness increasingly considered a fourth cardinal symptom)
43
How long do acute attacks of Menieres last?
Typically minutes - hours | Most commonly 2-3 hours
44
How to manage Menieres
May need admission - consider labyrinthine sedatives For an acute attack: 7/7 prochlorperazine Consider trial of betahistine prophylaxis
45
Presentation of labyrinthitis
SUDDEN onset severe vertigo with N&V Sensorineural hearing loss + tinnitus Symptoms may present for up to 72h LESS LIKELY TO DESCRIBE AURAL FULLNESS
46
Investigations and management labrynthitis
Will need an audiogram Advise to stand still and close eyes!
47
Causes recurrent/ bilateral Bells palsy
Sarcoid Lyme Disease GBS HIV
48
What is Bell sign?
Eye rolls when they try to close it
49
Treatment of Ramsay Hunt
Aciclovir and steroids
50
Dose of prednisolone for Bells Palsy
Within 72h symptom onset: 25 mg BD for 10 days
51
When should recovery from Bell's Palsy occur
within 6-9 months, usually no persistent damage
52
Triggers for analgesia overuse headaches
Triptans or opioids: >10 days/ month Paracetamol or NSAIDs: >15 days/ month Includes in combination
53
Migraine prophylaxis
If >2 attacks monthly Propranolol or topiremate Or acupuncture Riboflavin or Mg supplements may help Reduce caffeine/ other triggers
54
Tension headaches prophylaxis
TCA, eg amitriptyline - titrate down over time | Acupuncture
55
What meds are chronic paroxysmal hemicranias responsive to?
Indomethacin - cluster headaches dont respond
56
Differentials to cluster headache
Chronic paroxysmal hemicrania - occurs several times a day SUNCT (short-lasting unilateral neuralgiform headache with conjunctival injection and tearing) - up to 100 times/ day - lamotrigine may help
57
Treatment of trigeminal neuralgia
Carbamazepine Second-line: gabapentin, baclofen Potential surgical mx
58
Primary care mx meningitis
IM benzylpenicillin
59
Initial empirical mx meningitis
IV ceftriaxone/ cefotaxime for at least 10 days Add IV amoxicillin if over 50 (chloramphenicol if allergic) Consider adding IV aciclovir. Consider adding dexamethasone for 4/7 (with rules regarding when dose can be given/ amounts)
60
What prophylaxis for household contacts of meningitis?
Ciprofloxacin or rifampicin
61
Most common causative bug in encephalitis?
HSV1 (herpes simplex encephalitis)
62
Triad of encephalitis
fever, headache, altered mental state
63
Mx cerebral abscess
IV ceftriaxone and neurosurgial opinion
64
*****STROKE CLASSIFICATION***
p.221
65
When should LP be done in suspected SAH?
If CT negative | 12h to allow red cell lysis to occur
66
Occular problems associated with raised ICP
Ptosis Cranial nerve III and VI palsies Papilloedema
67
Gait in normal pressure hydrocephalus
Magnetic - feet seemingly stuck to floor with small stride
68
What is Beck syndrome?
Anterior spinal artery syndrome/ vertebrobasilar occlusion Ischaemic event causing decrease in blood flow to anterior two-thirds of spinal column. Commonly caused by aortic pathology (eg aneurysm, dissection).
69
Brown-Sequard
Ipsilateral loss of proprioception and vibration sense at the level of the lesion Contralateral pain/ temp loss below level of lesion
70
Sub-acute combined degeneration of the cord
Progressive demyelination of the dorsal columns
71
Signs of Multiple System Atrophy
Parkinsonism + cerebellar signs + autonomic dysfunction
72
Signs of Progressive Supranuclear Palsy
Parkinsonism + Speech Disturbance + Personality change/ dementia + Vertical gaze palsy
73
Imaging when difficult to diagnose Parkinsons
SPECT
74
Causes of sensory neuropathy
``` Diabetic (most common - may be painful) B12 deficiency Alcoholic Vasculitis Leporasy Meds: Isoniazid, vincristine - these are contraindicated in CMT ```
75
Causes of motor neuropathy
GBS Hereditary sensory neuropathy Lead poisoning
76
Most common pathogen associated with GBS
Campylobacter
77
Autoantibodies in Lambert-Eaton
Voltage-gated calcium channel blockers
78
Ice test
used in MG - will reduce ptosi if ice is held in a latex glove against patient eyes

F1/ Part 1 (13 decks)

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