Neurology Flashcards
(97 cards)
1
Q
Which drugs are used in the acute treatment of migraine?
A
Simple analgesia +/- triptan
2
Q
Give 2 examples of first-line preventative agents for migraine.
A
Topiramate and propanolol
3
Q
Which agents can be used in the acute treatment of cluster headache?
A
High-flow oxygen and triptans
4
Q
Which agent may be used to prevent attacks of cluster headache?
A
Verapamil
5
Q
What are the mainstays of treatment for idiopathic intracranial hypertension?
A
Weight loss, acetazolamide, diuretics, therapeutic LPs
6
Q
What is the first-line treatment for trigeminal neuralgia?
A
Carbamazepine
7
Q
What is the gold-standard test in suspected SOL?
A
MRI brain
8
Q
What is the first-line treatment for PD?
A
Levo-dopa (with dopa decarboxylase inhibitor)
9
Q
Give causes of a postural tremor.
A
Essential tremor, anxiety, thyrotoxicosis, physiological
10
Q
Chorea weeks to months after Group A strep infection is…
A
Syndenham chorea
11
Q
Parkinsonism + Autonomic Disturbance suggests…
A
Multi-System Atrophy
12
Q
What is the investigation of choice for narcolepsy?
A
multiple sleep latency EEG
13
Q
Defective downward gaze and vertical diplopia suggests damage to…
A
CN IV
14
Q
What is the first-line drug for Myasthenia Gravis?
A
Pyridostigmine
15
Q
Weakness that improves with exercise suggests…
A
Lambert-Eaton Syndrome
16
Q
Which myotome is shoulder abduction?
A
C5
17
Q
Which myotome is elbow flexion and wrist extension?
A
C6
18
Q
Which myotome is elbow extension and wrist flexion?
A
C7
19
Q
Which myotome is finger abduction?
A
T1
20
Q
Which myotome is hip flexion?
A
L1,2
21
Q
Which myotome is big toe extension?
A
L5
22
Q
Which myotome is ankle plantarflexion?
A
S1
23
Q
Which myotome is knee flexion?
A
S2
24
Q
What are the main ascending and descending spinal tracts?
A
Ascending - DCML and Spinothalamic
Descending - corticospinal
25
The DCML is responsible for which senses?
Fine touch and proprioception
26
The spinothalamic tract is responsible for which sensations?
Pain and temperature
27
Where does the DCML decussate?
Medulla oblongata
28
Where does the spinothalamic tract decussate?
Within a few spinal levels
29
Where does the corticospinal tract decussate?
90% of fibres decussate at the medulla → lateral corticospinal tract
30
What are the first-line agents for MS?
Beta interferons and glatiramer acetate
31
What is the time limit for thrombolysis in stroke?
4.5 hours
32
How could you differentiate between epileptic seizures and non-epileptic attacks?
Epileptic seizures same every time, NEAs often fluctuate
33
Which features would make you more suspicious of a functional neurological disorder?
* Fluctuating
* Explosive onset without any identifiable cause eg. Infarct/bleed
* If involving both sides but aware
34
How are functional neurological disorders managed?
o Treating precipitating factors eg. Migraine, postural drop
| o Neuropsychology input
35
What causes the tonic phase of an epileptic seizure?
Surge of excitatory energy firing of corticospinal tracts
36
Which medication should be given for secondary prevention of stroke/TIA?
Clopidogrel
37
Falls early in Parkinson's may suggest...
Parkinson's plus syndrome
38
Painful third nerve palsy suggests...
PCA aneurysm
39
What are the 3 signs of an anterior circulatory stroke?
unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
homonymous hemianopia
higher cognitive dysfunction e.g. dysphasia
40
What should be given in status epilepticus if not responding to BZDs?
Phenytoin
41
Carotid endarterectomy is considered in which patients with TIA?
> 70% plaque
42
Which imaging allows for best visualisation of demyelinating lesions?
MRI with contrast
43
rapid onset dementia and myoclonus suggests...
CJD
44
Patient slow to release when shaking hand suggests...
Myotonia
45
How is myotonic dystrophy inherited?
AD
46
How are Duchenne and Muscular Dystrophies inherited?
X-linked recessive
47
What is the pathophysiology of Myasthenia Gravis?
Autoimmune - autoantibodies to Acetylcholine Receptor
48
How could you differentiate Myasthenia Gravis from Lambert-Eaton Myasthenic Syndrome?
MG worsens with exertion, LEMS gets better with exertion
49
Which malignancy is associated with Lambert–Eaton myasthenic syndrome?
Small cell lung cancer
50
Give causes of a resting tremor.
Parkinsonism - may be PD, Parkinson’s plus or drug-induced
51
What is meant by a postural tremor?
Seen when the muscles are working against gravity when, e.g. hands are held outstretched
52
Give causes of postural tremor.
Essential Tremor, Thyrotoxicosis, Physiological, Anxiety
53
Which treatments may be effective in Essential Tremor?
Beta-blockers, Intractable cases: Deep brain stimulation/thalotomy
54
What is the investigation of choice for brain mets?
MRI brain
55
What is the treatment for meningitis?
Ceftriaxone + Dexamethasone
| Add Amoxicillin if > 60 or immunocompromised
56
Hypsarrhythmia on EEG suggests...
Infantile spasms
57
Which drug may extend life in MND?
Riluzole
58
What are the treatment options for lewy body dementia?
Acetylcholinesterase inhibitors
| Levo-dopa for motor symptoms
59
Which medications may be of benefit in frontotemporal dementia?
SSRIs to reduce loss of inhibition etc
| Psychotics rarely
60
What is the imaging of choice for Alzheimer's disease?
SPECT
61
Accumulation of which protein is associated with Alzheimer's dementia?
Amyloid
62
Accumulation of which protein causes FTD?
Tau
63
Which biomarker indicates recent seizure?
Prolactin
64
What are the 'red flag' features of headaches?
```
Worse in the morning
Exacerbated by valsalva
Immuno-suppressed
Known/previous malignancy
New onset > 55 yo
```
65
Which type of headache has an absolute response to indomethacin?
Paroxysmal hemicrania
66
What are the first-line agents for generalised tonic-clonic seizures?
Na Valproate (male), Lamotrigine (female)
67
What is the first-line agent for focal seizures?
Carbamazepine
68
What are the first-line agents for absence seizures?
Na Valproate & ethusuxomide
69
Lip smacking + post-ictal dysphasia suggest a focal seizure in which lobe?
Temporal lobe
70
Which anti-epileptics are enzyme inducers?
Carbamazepine, Phenytoin & Topiramate
71
What are the contraceptive options for women on enzyme-inducing anti-epileptics?
Depo-Provera, IUD, IUS
72
What is the guidance about stopping anti-epileptic drugs?
Can be stopped over 2-3 months if seizure-free for 2 years
73
Are anti-epileptic drugs safe in breastfeeding?
Yes
74
Limb movements with post-ictal weakness suggests...
Frontal lobe seizures
75
Which diet is most likely to be effective in epilepsy?
Ketogenic diet
76
What are the emergency contraceptive options for women taking enzyme-inducing AEDs?
Copper IUD or double dose levonestrogel
77
Sudden weakness during strong emotions suggests...
Cataplexy
78
What is the usual time limit for thrombolysis?
4.5 hours
79
What are the indications for thrombectomy?
proximal anterior circulation occlusion - within 6 hours or 6-24 hours if imaging shows brain tissue could be salvaged
80
Give 3 features of an anterior circulatory stroke.
Unilateral weakness
Homonymous Hemianopia
Cerebral dysfunction including dysphasia
81
What is meant by a 'lacunar' stroke?
One of:
Sensory or motor only
Sensory-motor symptoms only
Ataxic hemiparesis
82
Give features of posterior circulation stroke.
CN palsy
Bilateral sensory/motor deficit
Cerebellar dysfunction
Isolated homonymous hemianopia/cortical blindness
83
LP low gluocse and high protein suggests...
Bacterial meningitis
84
LP normal glucose and high protein suggests...
Viral meningitis
85
What is the key CSF feature in TB meningitis?
High protein
86
Which CNs may be affected by vestibular schwannoma?
CN V, VII or VIII
87
Which features are now needed for a diagnosis of TIA?
Resolved symptoms AND no acute infarction on imaging
88
Which myotome is knee extension?
L4
89
Which dermatome is the thumb?
C6
90
Which dermatome is the middle finger?
C7
91
Which dermatome is the pinky finger?
C8
92
Which nerve roots are tested in the biceps jerk?
C5,6
93
Which nerve roots are tested in the brachioradialis reflex?
C5, 6
94
Which nerve roots are tested in the triceps jerk?
C6, 7
95
Which nerve roots are tested in the patellar reflex?
L3, 4
96
Which nerve roots are tested in the ankle reflex?
S1, 2
97
What are the red flags in back pain?
```
TUNA FISH
Thoracic pain
Unexplained weight loss
Neurological symptoms
Age > 50
Fever
IVDU
Steroid use
History of cancer
```
