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Neurology Flashcards

1
Q

What type of drugs are 5-HT3 antagonists?

A

Antiemetics

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2
Q

Where do 5-HT3 antagonists work?

A

Chemoreceptor trigger zone of the medulla oblongata

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3
Q

Examples of 5-HT3 antagonists

A

Ondanestron

Graniestron

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4
Q

What type of drug is ondansetron?

A

5-HT3 antagonist

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5
Q

What type of drug is graniestron?

A

5-HT3 antagonist

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6
Q

Side effects of 5-HT3 antagonists

A

Constipation

Prolonged QT interval

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7
Q

Drugs causing peripheral neuropathy

A 
Amiodarone
Isoniazid
Vincristine
Nitrofurantoin
Metronidazole
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8
Q

What does the fourth cranial nerve supply?

What are its actions?

A

Superior oblique

Depresses eye, moves eye inwards

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9
Q

Features of fourth nerve palsy

A

Vertical diplopia
Subjective tilting of objects
Head tilt
Affected eye deviates upwards and is rotated out

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10
Q

Lamotrigine - indications

A

second line treatment for generalised and partial seizures

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11
Q

Lamotrigine - mechanism of action

A

Sodium channel blocker

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12
Q

Lamotrigine - side effects

A

Stevens-Johnson syndrome

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13
Q

Treatment for leg cramps

A

1) stretching calves

2) trial of quinine

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14
Q

Features of multiple system atrophy

A

Parkinsonism

Autonomic disturbance causing erectile dysfunction, postural hypotension, atonic bladder

Cerebellar signs

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15
Q

Causes of neonatal seizures

A 
Vitamin B6 deficiency
Hypoglycaemia
Meningitis
Head trauma
Opiate withdrawal
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16
Q

Who is affected by neuroleptic malignant syndrome?

A

Antipsychotics - first few days

Parkinson medication - when reducing dose or suddenly stopped

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17
Q

Neuroleptic malignant syndrome - features

A

Pyrexia
Muscle rigidity
Autonomic lability = HTN, tachycardia, tachypnoea
Agitated delirium with confusion

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18
Q

Neuroleptic malignant syndrome - investigations

A

Raised CK
AKI secondary to rhabdomyolysis
Leukocytosis

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19
Q

Neuroleptic malignant syndrome - management

A

Stop antipsychotics
IV fluids
Dantrolene
Bromocriptine

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20
Q

What is neuroleptic malignant syndrome?

A

Rare but life threatening adverse effect to antipsychotics

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21
Q

Generalised tonic clonic seizures - 1st line

A

Sodium valproate

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22
Q

Generalised tonic clonic seizures - 2nd line

A

Lamotrigine or carbamazepine

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23
Q

Absence seizures - 1st line

A

Sodium valproate or ethosuximide

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24
Q

Myoclonic seizures - 1st line

A

Sodium valproate

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25
Myoclonic seizures - 2nd line
Clonazepam or lamotrigine
26
Focal seizures - 1st line
Carbamazepine or lamotrigine
27
Focal seizures - 2nd line
Levetiracetam, oxcarbazepine or sodium valproate
28
Sodium valproate in pregnancy
Causes neurodevelopmental delay in children
29
In what circumstances would you start antiepileptics after one seizure?
Neurological deficit Structural abnormality EEG: unequivocal Patient or family consider risk of another seizure unacceptable
30
What is Lennox-Gestaut Syndrome?
Childhood epilepsy syndrome
31
Lennox-Gestaut Syndrome - features
Atypical abscences, falls, jerks | Moderate to severe mental handicap
32
Lennox-Gestaut Syndrome - EEG
slow spike
33
Lennox-Gestaut Syndrome - onset
1-5 years
34
What is Infantile Spasms?
Childhood epilepsy syndrome
35
Infantile spasm - other name
West's syndrome
36
Infantile spasms - features
Flexion of head, trunk, limbs then extension of arms - Salaam attack Lasts 1-2 secs, repeated up to 50 times Progressive mental handicap
37
Infantile spasms - EEG
Hypsarrhythmia
38
Infantile spasms - management
Vigabatrin, steroids | Poor prognosis
39
Infantile spasms - onset
4-6 months
40
Benign rolandic epilepsy - features
Paraesthesia (e.g. unilateral face), usually on waking
41
Juvenile myoclonic epilepsy syndrome - other name
Janz syndrome
42
Juvenile myoclonic epilepsy syndrome - onset
Teens
43
Juvenile myoclonic epilepsy syndrome - features
Infrequent generalised seizures, often in the morning/following sleep deprivation Daytime absences Sudden, shock-like myotonic seizure
44
Juvenile myoclonic epilepsy syndrome - management
sodium valproate
45
Neurofibromatosis - inheritence
Autosomal dominant
46
Neurofibromatosis type 1 - features
cafe au lait spots >6 Axillary/groin freckles Irish hamatomas (Lisch nodules) Pheochromocytomas
47
Neurofibromatosis type 2 - features
Bilateral vesticular schwannomas | Multiple intracranial schwannomas, meningiomas, ependymomas
48
Myotonic dystrophy - inheritence
Autosomal dominant | Trinucleotide repeat disorder
49
What is myotonic dystrophy?
Inherited myopathy | Affects skeletal, cardiac, and smooth muscle
50
Myotonic dystrophy type 1 - features
Distal weakness prominent
51
Myotonic dystrophy type 2 - features
Proximal weakness prominent | Severe congenital form not seen
52
Myotonic dystrophy - investigations
Genetic testing CK may be raised MRI - cerebellar degeneration
53
Myotonic dystrophy - features
``` Myotonic faces - long, haggared Frontal balding Bilateral ptosis Cataracts Weakness Diabetes Testicular atrophy Dysphagia Heart block, cardiomyopathy ```
54
What is myasthenia gravis?
Autoimmune disorder resulting in insufficient functioning acetylcholine receptors
55
What is the main antibody found in myasthenia gravis?
Antibodies to acetylcholine receptors
56
Myasthenia gravis - associations
Thymomas Autoimmune disorders Thymic hyperplasia
57
Myasthenia gravis - features
``` Muscle fatigability Extraocular muscles = diplopia Proximal muscle weakness = face, neck, limb girdle Ptosis Dysphagia ```
58
Myasthenia gravis - investigations
Single fibre EMG CT thorax to exclude thyoma CK normal Antibodies to acetylcholine receptors
59
Myasthenia gravis - first line management
Pyridostigmine - long acting anticholinesterase inhibitor
60
Myasthenia gravis - second/third line management
Immunosuppression - steroids, azathioprine | Thymectomy
61
Myasthenia gravis - crisis management
Plasmaphoresis | IV Ig
62
Myasthenia gravis - exacerbating drugs
Penicillamine Beta blockers Lithium Phenytoin Gentamicin Tetracyclines
63
What is multiple sclerosis?
Chronic cell mediated autoimmune disorder characterised by demyelination in the CNS
64
Multiple sclerosis - types
Relapsing remitting Primary progressive Secondary progressive
65
Multiple sclerosis - relapsing remitting
Acute attacks followed by periods of remission | 85% cases
66
Multiple sclerosis - primary progressive
10% cases Progressive deterioration from onset More common in elderly
67
Multiple sclerosis - secondary progressive
Relapsing remitting patients who have deteriorated and have signs/symptoms between relapses Primary gait and bladder disorders 65% patients with relapsing remitting
68
Multiple sclerosis - features
Lethargy Optic neuritis Paraesthesia, numbness, Lhermittes syndrome Spastic weakness Ataxia Urinary incontinence, Sexual dysfunction Intellectual deterioration
69
What is Lhermittes syndrome?
sudden brief shock that moves down the neck caused by bending the neck forward associated with MS
70
Multiple sclerosis - acute relapse management
high dose steroids
71
Multiple sclerosis - chronic management Treatment for fatigue? Treatment for spasticity? Treatment for bladder dysfunction?
Beta interferon reduces relapse rate by 30% Fatigue - amantadine Spasticity - baclofen, gabapentin Bladder dysfunction - self catheterisation or anticholingerics
72
Multiple sclerosis - good prognostic factors
``` Female Young age of onset Relapsing-remitting type Sensory symptoms only Long interval between first two relapses Complete recovery between relapses ```
73
What is motor neuron disease?
Neurological condition presenting with upper and lower motor neuron signs
74
Motor neuron disease - features
Fasiculations Mixture of LMN and UMN signs Wasting of the small hand muscles No sensory symptoms/signs
75
Motor neuron disease - Investigations
Clinical diagnosis Nerve conduction studies - normal, exclude neuropathy EMG - reduced action potentials with increased amplitude MRI - to exclude cervical cord compression and myelopathy
76
Motor neuron disease - Management
Riluzole - prolongs life by 3 months | Respiratory care - BIPAP at night
77
Migraine - features
``` Severe, unilateral, throbbing headache Nausea Photophobia, phonophobia Lasts up to 72 hours Aura in 1/3rd ```
78
Migraine in children
Shorter Bilateral GI disturbance
79
Migraine - acute management first line
Oral triptans + NSAID/paracetamol | Nasal triptan if age 12-17
80
Migraine - acute management second line
Non-oral metoclopramide | Non-oral NSAIDs/triptans
81
Migraine - prophylaxis
Topiramate or propranolol | Acupuncture
82
Migraine management if menstrual symptoms
Frovatriptan or zolmitriptan | Mefanamic acid
83
Migrane management in pregnancy
Paracetamol | NSAIDs in 2rd or 3rd month
84
Topiramate in women of child bearing age
Teratogenic and reduces effectiveness of oral contraception
85
Medication overuse headache - features
15+ days per month | Develops/worsens whilst taking regular symptomatic medications
86
Medication overuse headache - which medication is highest risk?
Opioids and triptans
87
Idiopathic intracranial hypertension - features
``` Headache Blurred vision Papilloedema Enlarged blind spot 6th nerve palsy ```
88
Idiopathic intracranial hypertension - management
Weight loss Diuretics - acetazolamide Topiramate Repeated LP
89
Idiopathic intracranial hypertension - risk factors
``` Obesity Female Pregnancy Combined oral contraceptive Steroids Tetracyclines Vitamin A Lithium ```
90
Huntington's disease - inheritence
Autosomal dominant
91
Huntington's disease - genetics
Trinucleotide repeat disorder Genetic anticipation Defect in huntington gene on chromosome 4
92
Huntington's disease - features
``` Chorea Personality change - apathy, irritable, depression Intellectual impairment Dystonia Saccadic eye movements ```
93
Huntington's disease - investigations
Genetic testing | MRI/CT
94
What is Guillain-Barre syndrome?
Immune mediated demyelination of the peripheral nervous system, often triggered by infection
95
Guillain-Barre Syndrome - classical trigger
Campylobacter jejuni
96
Guillain-Barre Syndrome - features
Early leg/back pain Progressive, symmetrical weakness of all the limbs - ascending Absent reflexes Respiratory muscle weakness
97
Guillain-Barre Syndrome - Investigations
LP - rise in protein, normal WCC | Nerve conduction studies - reduced motor nerve conduction due to demyelination
98
Guillain-Barre Syndrome - management
IV immunoglobulin | Plasma exchange
99
Miller Fisher Syndrome - features
Descending paralaysis Opthalmoplegia, areflexia, ataxia Eye muscles affected first
100
What is Friedreich's ataxia?
Early onset hereditary ataxia
101
Friedreich's ataxia - inheritance
Autosomal recessive | Trinucleotide repeat disorder - NO genetic anticipation
102
Friedreich's ataxia - onset
10-15 years Presents with gait ataxia and kyphoscoliosis
103
Friedreich's ataxia - features
Absent ankle jerk/ extensor plantars Cerebellar ataxia Optic atrophy HOCM Diabetes High arched palate
104
Friedreich's ataxia - prognosis
Wheelchair bound by 15 years after diagnosis | Life expectancy 40-50
105
Duchenne muscular dystrophy - inheritance
X linked recessive Mutation in gene encoding dystrophin Frame shift mutation = severe form
106
Becker muscular dystrophy - inheritance
X linked recessive Mutation in gene encoding dystrophin Non-frame shift mutation = less severe
107
Duchenne muscular dystrophy - features
Progressive muscle weakness from 5 years Calf pseudohypertrophy Gowers sign 30% have intellectual impairment
108
Becker muscular dystrophy - features
Develops after age 10 | Normal intellect
109
What is degenerative cervical myelopathy?
Spinal cord dysfunction from compression in the neck
110
Degenerative cervical myelopathy - risk factors
Smoking Genetics Occupation with heavy axial loading
111
Degenerative cervical myelopathy - features
Pain in neck, upper and lower limbs Loss of motor function - digital dexerity, arm/leg weakness Loss of sensory function Loss of autonomic function - incontinence, impotence Hoffman's sign
112
What is Hoffman's sign?
involuntary flexion movement of the thumb and or index finger when the examiner flicks the fingernail of the middle finger down
113
Degenerative cervical myelopathy - investigations
MRI spine
114
Degenerative cervical myelopathy - management
Early referral to spinal services for decompression surgery
115
Cluster headaches - frequency of symptoms
Occur in clusters lasting 4-12 weeks | Generally a cluster every year
116
Cluster headaches - features
Intense sharp stabbing pain around the eye Patient restless, agitated Red eye, lacrimating, lid swelling Nasal stuffiness
117
Cluster headaches - how long do symptoms last
15mins to 2 hours | Occur 1-2x per day
118
Cluster headaches - risk factors
Male Smokers Nocturnal sleep Alcohol may trigger attack
119
Cluster headaches - acute management
100% oxygen | Sub cut triptan
120
Cluster headaches - prophylaxis
Verapamil
121
What is Charcot-Marie-Tooth?
The most common hereditary peripheral neuropathy Results in predominantly motor loss
122
Charcot-Marie-Tooth - features
``` Foot drop High arched feet Hammer toes Distal muscle weakness and atrophy Hyporeflexia Stork leg deformity ```
123
Carbamazepine - uses
Epilepsy - partial seizures Trigeminal neuralgia Bipolar disorder
124
How does carbamazepine work?
Binds to sodium channels to increase their refractory period
125
Carbamazepine - side effects
P450 enzyme inducer Dizzy Drowsy Diplopia Headaches Steven Johnson Syndrome
126
What is Bell's palsy?
Acute, unilateral, idiopathic facial nerve paralysis
127
Bell's palsy - features
LMN facial nerve palsy - forehead affected
128
How to differentiate between stroke and Bell's palsy
Bell's palsy - forehead affected
129
Bell's palsy - management
Prednisolone within 72 hours Antivirals in severe cases Eyecare
130
Bell's palsy - prognosis
Most make full recovery in 3-4 months | If untreated 15% have severe weakness permanently
131
Bell's palsy - follow up
If no improvement after 3 weeks refer urgently to ENT
132
Absence seizures - features
Few seconds with quick recovery Provoked by hyperventilation or stress Children unaware May occur multiple times a day
133
Absence seizures - EEG
Bilateral, symmetrical 3Hz spike and wave pattern
134
Absence seizures - management
Sodium valproate or ethosuximide
135
Wernicke's aphasia - features
Sentences that make no sense but remain fluid "word salad" Comprehension impaired
136
Conduction aphasia - features
Speech fluent but poor repetition Aware they are making errors Normal comprehension
137
Broca's aphasia - features
Speech is non-fluent, laboured, halting Repetition impaired Normal comprehension
138
Global aphasia - features
Severe expressive and receptive aphasia
139
What location is affected in expressive dysphasia?
Broca's
140
What location is affected in receptive dysphasia?
Wernicke's
141
What is ataxia telangiectasia?
Inherited combined immunodeficiency disorder
142
Ataxia telangiectasia - inheritence
Autosomal recessive
143
Ataxia telangiectasia - features
Cerebral ataxia Telangiectasia Recurrent chest infections due to IgA deficiency 10% risk of malignancy, lymphoma or leukaemia
144
Onset of ataxia telangiectasia
Onset 1-5 years | Abnormal movements
145
Which antiepileptics should be prescribed by brand?
Carbamazepine Phenytoin Phenobarbital Primodine
146
Drugs causing peripheral neuropathy
``` Amiodarone Isoniazid Vincristine Nitrofurantoin Metronidazole ```
147
Essential tremor - inheritance
Autosomal dominant
148
Essential tremor - features
Postural tremor - worse when arms outstretched | Improved by alcohol and rest
149
What is the most common cause of head tremor?
Essential tremor
150
Essential tremor -management
Propranolol | Primidone
151
In which conditions is cannabis licensed for use?
Chemo induced nausea and vomiting Chronic pain Spasticity in MS Severe treatment resistance epilepsy
152
Who can prescribe cannabis?
Doctors on the specialist register
153
Lamotrigine - mechanism of action
Sodium channel blocker
154
Lamotrigine - adverse effects
Stevens Johnson syndrome
155
Which medication can be used to treat dementia symptoms in Parkinson's disease?
Rivastigmine
156
When are antiepileptics stopped? Over how long a time frame do you stop the drugs?
Seizure free >2 years Drugs stopped over 2-3 months
157
What is cataplexy?
Sudden transient loss of muscular tone caused by strong emotion
158
Can HRT be given if migraine history?
Yes but may worsen migraine
159
Which vitamin supplement might be helpful in migraine prevention?
Vitamin B2 | Riboflavin
160
Neuropathic pain - 1st line treatment options (4)
Amitriptyline Duloxetine Gabapentin Pregabalin Used as monotherapy
161
Neuropathic pain - rescue therapy for exacerbations
Tramadol
162
Neuropathic pain - treatment for localised neuropathic pain
Topical capsaicin
163
What is allodynia?
Nerve pain
164
What type of drugs are linked with impulse control disorders?
Dopamine receptor agonists
165
What conditions are associated with Lhermitte's sign?
MS Subacute combined degeneration of the cord Cervical stenosis
166
What is Uhthoff Phenomenon?
Worsening of symptoms due to increased heat, seen in MS
167
Diazepam in seizure dosage - 1 month to 1 year
5mg
168
Diazepam in seizure dosage - 2 years to 11 years
5-10mg
169
Diazepam in seizure dosage - 12 years to 17 years
10mg
170
Diazepam in seizure dosage - adult
10-20mg | max 30mg
171
Midazolam in seizure dosage - 1 to 2 months
300 micrograms per kg max 2.5mg
172
Midazolam in seizure dosage - 3 to 11 months
2.5mg
173
Midazolam in seizure dosage - 1 to 4 years
5mg
174
Midazolam in seizure dosage - 5 to 9 years
7.5mg
175
Midazolam in seizure dosage - 10 to 17 years
10mg
176
Midazolam in seizure dosage - adult
10mg
177
What causes Hoffman's sign?
Upper motor neuron dysfunction
178
What causes a positive Hoffman's sign?
Degenerative cervical myopathy MS Hyperthyroidism
179
Cannabis licensed for chemotherapy induced nausea
Nabilone
180
Cannabis licensed for spasticity in MS
Savitex
181
What is paroxysmal hemicrania?
Attacks of severe, unilateral headache in the orbital, supraorbital or temporal region
182
Paroxysmal hemicrania - features
Severe unilateral headache Autonomic features Last less than 30 minutes Occur multiple times per day
183
Paroxysmal hemicrania - management
Indomethacin
184
Risk factors for MS
Smoking Previous infectious mononucleosis Genetics Low vit D
185
Third nerve palsy - features
Eye is 'down and out' Ptosis Dilated pupil
186
Third nerve palsy - causes
``` Diabetes Vasculitis Posterior communicating artery Cavernous sinus syndrome MS ```
187
Side effects of triptans
Tingling, heat, tightness in throat/chest
188
Where is the lesion in a right homonymous hemianopia?
right optic tract
189
Where is the lesion in a bitemporal homonymous hemianopia?
Optic chiasm
190
If the patient has a right sided hemiplegia, what side would their homonymous hemianopia be?
Right
191
Features of common peroneal nerve injury
Foot drop Weakness of dorsiflexion and foot eversion Sensory loss over dorsum of the foot and lower lateral part of the leg Wasting of anterior tibial and peroneal muscles
192
Autonomic dysreflexia - features
Extreme hypertension Flushing Sweating above the level of cord lesion Agitation
193
Autonomic dysreflexia - management
Removal/control of stimulus Treatment of life threatening hypertension and/or bradycardia
194
Ankle reflex
S1-S2
195
Knee reflex
L3-L4
196
Biceps reflex
C5-C6
197
Triceps reflex
C7-C8
198
Visual side effects of Topiramate
Secondary angle closure glaucoma Acute myopia
199
What should absent corneal reflex make you think about?
Acoustic neuroma
200
Which area of the brain is affected in an inferior homonymous quadrantopia?
Parietal
201
Which area of the brain is affected in a superior homonymous quadrantopia?
Temporal
202
Where is the lesion in a bitemporal hemianopia?
Lesion of the optic tract
203
What is the cause of bitemporal hemianopia - upper quadrant defect
Pituitary tumour
204
What is the cause of bitemporal hemianopia - upper quadrant defect
Craniopharyngioma
205
Where is the lesion in homonymous hemianopia with macula sparing?
Occipital cortex
206
Where is the lesion in a bilateral homonymous hemianopia?
Optic radiation or occipital cortex
207
Where is the lesion in a unilateral homonymous hemianopia?
Optic tract
208
If the patient has a right sided hemiplegia, what side would their homonymous hemianopia be?
Right
209
Features of common peroneal nerve injury
Foot drop Weakness of dorsiflexion and foot eversion Sensory loss over dorsum of the foot and lower lateral part of the leg Wasting of anterior tibial and peroneal muscles
210
Examples of dopamine receptor agonists
Bromocriptine Ropinirole Cabergoline Apomorphine
211
What type of drug is bromocriptine?
Dopamine receptor agonist Used in Parkinson's
212
What type of drug is ropinirole?
Dopamine receptor agonist Used in Parkinson's
213
1st line treatment in Parkinson's if there are no motor symptoms affecting the patient's life
Dopamine agonists Levodopa MAO-B
214
What type of drug is Apomorphine?
Dopamine receptor agonist Used in Parkinson's
215
Side effects of Dopamine receptor agonists
Impulse control disorders Risk of neuroleptic malignant syndrome Excessive daytime somnolence Hallucinations Pulmonary, retroperitoneal and cardiac fibrosis
216
What type of drug is selegiline?
Monoamine Oxidase B inhibitor Used in Parkinson's
217
Parkinson's disease - investigations
Clinical diagnosis SPECT scan
218
Examples of COMT inhibitiors
Entacapone | Tolcapone
219
Drug induced Parkinson's - causes
Dopamine agonists (used in schizophrenia) Methydopa Metoclopramide Prochlorperazine
220
What type of drug is Tolcapone?
COMT inhibitor Used in Parkinson's
221
Findings in radial nerve damage
Wrist drop Sensory loss to small area between the dorsal aspect of the 1st and 2nd metacarpal Paralysis of triceps
222
What are antimuscarinic drugs used for?
Drug-induced parkinsonism
223
What type of drug is procyclidine?
Antimuscarinic Used in drug induced Parkinson's
224
Effect of sodium valproate on P450
P450 inhibitor
225
What is levodopa prescribed with?
Decarboxylase inhibitor to prevent peripheral metabolism
226
Chronic subdural haemorrhage - who is typically affected
Elderly | Alcoholics
227
What type of drug is carbidopa?
Decarboxylase inhibitor Prescribed with levodopa to prevent peripheral metabolism
228
Side effects of levodopa
Dyskinesia Postural hypotension 'On off' effect Acute dystonia if stopped Hallucinations
229
Where is the lesion in monocular blindness?
optic nerve
230
1st line treatment in Parkinson's if motor symptoms are affecting the patient's life
Levodopa
231
1st line treatmnet in Parkinson's if there are no motor symptoms affecting the patient's life
Dopamine agonists Levodopa MAO-B
232
Parkinson's disease - pathophysiology
Degeneration of dopaminergic neurons in the substania nigra
233
Parkinson's disease - key features
Bradykinesia Tremor Rigidity
234
Where is the lesion in right homonymous hemianopia with macular sparing?
Occipital lobe cortex
235
Parkinson's disease - investigations
Clinical diagnosis SPECT scan
236
Drug induced Parkinson's - features
Rapid onset motor symptoms that are bilateral | Rigidity and rest tremor uncommon
237
Drug induced Parkinson's - causes
Dopamine agonists (used in schizophrenia) Methydopa Metoclopramide Prochlorperazine
238
Causes of Parkinsonism
``` Parkinson's disease Drug induced Progressive supranuclear palsy Multiple system atrophy Wilson's disease Post-encephalitis Dementia pugilistica (secondary to chronic head trauma) Toxins - eg CO ```
239
Radial nerve - patterns of damage
Wrist drop Sensory loss to small area between the dorsal aspect of the 1st and 2nd metacarpal Paralysis of triceps
240
Sodium valproate mechanism of action
Increases GABA activity
241
Sodium valproate adverse effects
``` Teratogenic P450 inhibitor Nausea Weight gain Allopecia Ataxia, tremor Hyponatraemia ```
242
Effect of sodium valproate on P450
P450 inhibitor
243
Chronic subdural haemorrhage - presentation
Weeks to months of progressive confusion, reduced consciousness, neurological deficit
244
Chronic subdural haemorrhage - who is typically affected
Elderly | Alcoholics
245
Damage to ulnar nerve - sensory loss
Medial 1 1/2 fingers (palmar and dorsal aspect)
246
Findings in damage to ulnar nerve
Claw hand Wasting and paralysis of intrinsic hand muscles and hypothenar muscles Sensory loss to medial 1 1/2 fingers
247
Where is the lesion in bitemporal hemianopia?
Optic chiasm
248
Where is the lesion in right homonymous hemianopia?
Right optic tract
249
Where is the lesion in right superior homonymous hemianopia?
Right sided optic radiations - upper fibres
250
Where is the lesion in a right inferior homonymous hemianopia?
Right sided optic radiations - lower fibres
251
Where is the lesion in right homonymous hemianopia with macular sparing?
Occipital lobe cortex
252
Causes of monocular blindness
Optic neuritis Optic atrophy Central retinal vein occlusion
253
Causes of bitemporal hemianopia
Pituitary adenoma | Craniopharyngioma
254
Causes of right homonymous hemianopia
Middle cerebral artery occlusion - left | Tumours
255
Causes of right superior homonymous hemianopia
Middle cerebral artery occlusion - left | Tumour in the temporal lobe
256
Causes of right inferior homonymous hemianopia
Posterior cerebral artery occlusion - left | Tumour in the parietal lobe
257
Causes of right homonymous hemianopia with macular sparing
Posterior communicating artery occlusion - right | Trauma
258
Tuberous sclerosis - features
Ash leaf spots Cafe-au-lait Shagreen patches - rough patches over lumbar spine Developmental delay, epilepsy Retinal hamartomas Rhabdomyomas of the heart
259
Wernicke's encephalophy - investigations
Decreased red cell transketolase | MRI
260
Wernicke's encephalophy - management
Urgent replacement of thiamine
261
Wernicke's encephalophy - causes
Mainly alcoholics Persistent vomiting Stomach cancer Dietary deficiency
262
What is Wernicke's encephalophy?
Neuropsychiatric disorder caused by thiamine deficiency
263
What is Korsakoff's syndrome?
Wernicke's encephalophy progresses to Korsakoff's syndrome if untreated
264
Korsakoff's syndrome - features
Amnesia - both antero and retrograde Confabulation
265
What is Von Hippel-Lindau syndrome?
Autosomal dominant condition predisposing to neoplasia
266
Von Hippel-Lindau syndrome - inheritance
Autosomal dominant
267
Von Hippel-Lindau syndrome - features
Cerebellar haemangiomas (may cause SAH) Retinal haemangiomas Renal cysts Phaechromocytomas Clear cell renal carcinoma
268
Vestibular schwannoma - associations
Bilateral vestibular schwannoma is seen in neurofibromatosis type 2
269
Vestibular schwannoma - features
Vertigo Hearing loss - sensorineural, unilateral Tinnitis - unilateral Absent corneal reflex
270
Vestibular schwannoma - investigations
Audiometry | MRI of cerebellopontine angle
271
Vestibular schwannoma - when to refer
Urgent referral to ENT if any suspicion
272
Vestibular schwannoma - Management
Radiotherapy, surgery, or observation
273
What is tuberous sclerosis?
Multisystem disorder characterised by formation of hamartomas in many organs
274
Tuberous sclerosis - inheritance
Autosomal dominant
275
Tuberous sclerosis - features
``` Ash leaf spots Shagreen patches - rough patches over lumbar spine Adenoma sebaceum Subungal fibromata Cafe-au-lait Developmental delay, epilepsy Retinal hamartomas Rhabdomyomas of the heart ```
276
Trigeminal neuralgia - features
Brief shock like pain in trigeminal divisions Unilateral Pain evoked by light touch
277
Trigeminal neuralgia - management
Carbamazepine
278
Tuberous sclerosis - when to refer
Atypical features eg under age 50 Not responding to treatment Any red flags
279
What is a TIA?
Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal iscaemia, without acute infarction
280
TIA - immediate management
Aspirin 300mg UNLESS: - bleeding disorder or taking anticoagulant - already on aspirin - contraindicated
281
TIA - secondary prevention
Clopidogrel | Aspirin + dipyridamole if can't tolerate clopidogrel
282
Stroke - who is a candidate for thrombectomy between 6 and 24 hours?
If proximal anterior circulation stroke and potential to salvage brain tissue seen on imaging CONSIDER if proximal circulation (basiliar or posterior cerebral artery)
283
TIA - who to refer for assessment within 24 hours
Had symptoms <7 days ago
284
TIA - who to refer for assessment within 7 days
Had symptoms >7 days ago
285
Who is suitable for carotid endarterectomy?
Stroke/TIA without significant disability | Stenosis >70%
286
Tension headache - acute management
Aspirin, paracetamol or NSAIDS
287
Tension headache - prophylaxis
10 sessions of acupuncture over 5-8 weeks
288
What is syringomyelia?
Collection of CSF within the spinal cord
289
What is syringobulbia?
Fluid filled cavity within the medulla of the brainstem Often an extension of the syringomyelia
290
Syringomyelia - causes
Chiari malformation Trauma Tumours Idiopathic
291
Syringomyelia - treatment
Treat the cause | Persistent/causing symptoms - shunt
292
Syringomyelia - features
Loss of sensation to temperature only across neck and shoulders Spastic weakness Paraesthesia Neuropathic pain Upgoing plantars
293
Syringomyelia - investigations
Full spine MRI | Brain MRI
294
What is the ROSIER score for?
Likelihood of stroke Stroke likely if score >0
295
ROSIER scoring criteria
Exclude hypoglycaemia then assess LOC/seizure = -1 Seizure activity = -1 Asymmetrical facial/arm/leg weakness = all +1 Speech disturbance = +1 Visual field defect = +1
296
Stroke - immediate management
Aspirin 300mg when haemorrhage excluded | Thrombolysis/thrombectomy if candidate
297
Stroke - who is a candidate for thrombolysis?
Within 4.5 hours | Haemorrhage excluded
298
Stroke - who is a candidate for thrombectomy within 6 hours?
Thrombectomy + thrombolysis | If proximal anterior circulation stroke
299
Stroke - who is a candidate for thrombectomy between 6 and 24 hours?
If proximal anterior circulation stroke and potential to salvage brain tissue seen on imaging CONSIDER if proximal circulation (basiliar or posterior cerebral artery)
300
Stroke - secondary prevention
Clopidogrel Aspirin + MR dipyridamole if clopidogrel not tolerated Statin if cholesterol >3.5 Start anticoagulant for AF after 2 weeks
301
Stroke - when to start AF treatment
Start anticoagulant after 2 weeks
302
Stroke - when to start statin
if cholesterol >3.5 | After 48 hours
303
What is Reye's syndrome?
Severe progressive encephalopathy in children accompanied by fatty infiltration of the liver, kidneys and pancreas
304
Reye's syndrome - associations
Aspirin use | Possible viral illness preceeding
305
Phenytoin - teratogenic effects
Cleft palate Congenital heart disease
306
What is thoracic outlet syndrome?
Compression of brachial plexus, subclavian artery or vein at the site of the thoracic outlet
307
Phenytoin - chronic side effects
Gingival hyperplasia Hirsutism Coarse facial features Megaloblastic anaemia Peripheral neuropathy Fever Drug induced lupus Hepatitis
308
Phenytoin side effects - mneumonic
``` P450 inducer Hirsutism Enlarged gums Nystagmus Yellow/browning of skin Teratogen Osteomalacia Interference with B12 = anaemia Neuropathies = vertigo, ataxia, headache ```
309
Sodium valproate side effects - mneumonic
``` Vomiting Alopecia Liver toxicity Pancreatitis, Pancytopenia Retention of fat = weight gain Oedema - peripheral Anorexia Tremor Enzyme inhibitor ```
310
Vascular thoracic outlet syndrome - features of subclavian vein compression
Painful diffuse arm swelling, distended veins
311
Vascular thoracic outlet syndrome - features of subclavian artery compression
Painful arm claudication, risk of ulceration and gangrene
312
Vascular thoracic outlet syndrome - which vessels might be affected?
Subclavian vein | Subclavian artery
313
Thoracic outlet syndrome - investigations
CXR + C spine xray - check for obvious deformity or tumours CT/MRI spine - cervical root lesions Venogram/angiogram in vascular TOS Anterior scalene block - confirms neuro TOS
314
Thoracic outlet syndrome - management
Conservative May need decompression surgery Surgery generally first line in vascular TOS
315
Normal pressure hydrocephalus - features
Urinary incontinence Dementia and bradyphrenia Gait abnormality
316
Normal pressure hydrocephalus - management
Ventriculoperitoneal shunt 10% have complications - seizure, infection, intracranial haemorrhage
317
Topiramate - effect on contraception
Decreases efficiency | Is also teratogenic
318
Topiramate - effect on P450
P450 inducer
319
Topiramate - side effects
``` Reduced appetite, weight loss Dizziness Paraesthesia Lethargy, poor concentration Acute myopia Secondary angle closure glaucoma ```
320
Topiramate - key use
Migraine prophylaxis Avoid in women of child bearing age
321
Phenytoin - mechanism of action
Binds to sodium channels increasing their refractory periods
322
Phenytoin - teratogenic effects
Cleft palate | Congenital heart disease
323
Phenytoin - acute side effects
``` Dizziness, ataxia Diplopia Nystagmus Slurred speech Confusion Seizures ```
324
Phenytoin - chronic side effects
``` Gingival hyperplasia Hirsutism Coarse facial features Megaloblastic anaemia Peripheral neuropathy Fever Drug induced lupus Hepatitis ```
325
Phenytoin side effects - mneumonic
``` P450 inducer Hirsutism Enlarged gums Nystagmus Yellow/browning of skin Teratogen Osteomalacia Interference with B12 = anaemia Neuropathies = vertigo, ataxia, headache ```
326
Sodium valproate side effects - mneumonic
``` Vomiting Alopecia Liver toxicity Pancreatitis, Pancytopenia Retention of fat = weight gain Oedema - peripheral Anorexia Tremor Enzyme inhibitior ```
327
Restless leg syndrome - features
Uncontrollable urge to move legs - at night, worse at rest Paraesthesia - crawling or throbbing sensation Periodic limb movements of sleep
328
Restless leg syndrome - management
Walking, stretching, massage Treat any causes found Dopamine agonists - pramipexole, ropinirole
329
Restless leg syndrome - causes
``` FH in 50% Iron deficiency anaemia Uraemia Diabetes Pregnancy ```
330
What is the most important test in restless leg syndrome?
Ferritin for IDA
331
What causes absent ankle jerks and extensor plantars?
Subacute combined degeneration of the cord Motor neuron disease Friedreich's ataxia Syringomyelia Syphilis
332
What is the most common cause of foot drop?
Common peroneal nerve lesion
333
Main cause of common peroneal nerve lesion
``` Compression at the neck of fibula May be secondary to leg crossing, squatting or kneeling Baker's cysts Plaster casts Weight loss ```
334
Causes of foot drop
Common peroneal nerve lesion L5 radiculopathy Sciatic nerve lesion Superficial/deep peroneal nerve lesion
335
Signs of damage to median nerve
Paralysis and wasting of thenar eminence muscles Sensory loss to palmar aspect of lateral 2 1/2 fingers Unable to pronate forearm Weak wrist flexion Ulnar deviation of wrist
336
GCS - motor
``` 6 = obeys commands 5 = localises to pain 4 = withdraws from pain 3 = abnormal flexion from pain 2 = extending from pain 1 = none ```
337
GCS - verbal
``` 5 = orientated 4 = confused 3 = words 2 = sounds 1 = none ```
338
GCS - eyes
``` 4 = spontaneous 3 = to speech 2 = to pain 1 = none ```
339
Name of CN I
Olfactory
340
Functions of CN I
Smell
341
Name of CN II
Optic
342
Function of CN II
Sight
343
Name of CN III
Oculomotor
344
Functions of CN III
Eye movement - MR, IO, SR, IR Pupil constriction Accomodation Eyelid opening
345
3rd nerve palsy features
Ptosis Down and out eye Dilated, fixed pupil
346
Name of CN IV
Trochlear
347
Functions of CN IV
Eye movement - SO
348
4th nerve palsy features
Defective downwards gaze causing vertical diplopia
349
Name of CN V
Trigeminal
350
Functions of CN V
Facial sensation | Mastication
351
Name of CN VI
Abducens
352
Functions of CN VI
Eye movement - LR
353
6th nerve palsy features
Defective abduction causing horizontal diplopia
354
Name of CN VII
Facial
355
Functions of CN VII
Facial movement | Taste - anterior 2/3 of tongue
356
Name of CN VIII
Vestibulocochlear
357
Functions of CN VIII
Hearing | Balance
358
Name of CN IX
Glossopharyngeal
359
Functions of CN IX
Taste - posterior 1/3 of tongue
360
Name of CN X
Vagus
361
Functions of CN X
Phonation | Swallowing
362
CN X lesion features
Uvula deviates AWAY from site of lesion | Loss of gag reflex
363
Name of XI
Accessory
364
Functions of XI
Head and shoulder movement
365
Name of XII
Hypoglossal
366
Functions of XII
Tongue movement
367
CN XII lesion features
Tongue deviates TOWARDS side of lesion
368
Dermatome for thumb and index finger
C6
369
Dermatome for ventral axial line of upper limb
C5
370
Dermatome for middle finger and palm of hand
C7
371
Dermatome for ring and little finger
C8
372
Dermatome for nipples
T4
373
Dermatome for umbilicus
T10
374
Dermatome for knee caps
L4
375
Dermatome for big toe and dorsum of foot
L5
376
DVLA - chronic neurological disorders
Inform DVLA
377
Dermatome for genitalia
S2, S3
378
Dermatome for inguinal ligament
L1
379
DVLA - first seizure no structural abnormality and no definite epileptiform activity
6 months off
380
DVLA - first seizure if abnormality or definite epileptiform activity
12 months off
381
Do DVLA need informing about epilepsy/seizure?
Yes
382
DVLA - epilepsy, how long seizure free before may drive?
12 months Once seizure free for 5 years a till 70 license restored
383
DVLA - epilepsy, withdrawing medication
Cannot drive whilst medication being withdrawn and until 6 months after last dose
384
DVLA - syncope, simple faint
No restriction
385
DVLA - single syncope, explained and treated
4 weeks off
386
DVLA - single syncope, unexplained
6 months off
387
DVLA - two or more episodes of syncope
12 months off
388
DVLA - stroke or TIA
1 month off | No need to inform DVLA if no residual defiit
389
DVLA - multiple TIAs
3 months off | Inform DVLA
390
DVLA - craniotomy
1 year off
391
DVLA - trans-sphenoidal surgery
when no debarring residual impairment likely to affect safe driving
392
DVLA - narcolepsy/cataplexy
Stop driving on diagnosis | Start when have good control of symptoms
393
DVLA - chronic neurological disorders
Inform DVLA
394
Subacute combined degeneration of the cord - features
``` Loss of vibration and proprioception Full sensory loss Paraesthesia Ataxia Distal muscle weakness Dementia ```
395
Subacute combined degeneration of the cord - causes
B12 deficiency causing demyelination

AKT (20 decks)

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