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Medicine Finals: HARD STUFF ONLY > Neurology > Flashcards

Neurology Flashcards

1
Q

How does a lacunar stroke present?

A

Pure sensory/pure motor/ataxic hemiparesis

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2
Q

How does a posterior circulation stroke present?

A

Isolated homonymous hemianopia / LOC / Cerebellar syndrome

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3
Q

What are contraindications to thrombolysis in stroke?

A 
Previous intracranial haemorrhage 
Seizure at onset of stroke
Lumbar puncture in last 7 days
Active bleeding
Pregnancy
Uncontrolled HTN
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4
Q

How long after symptom onset do you need to wait before doing a lumbar puncture in subarachnoid haemorrhage?

A

At least 12 hours

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5
Q

What are side effects of Levodopa?

A 
Stops being effective
Dyskinesia - involuntary movements
Psychosis
Dry mouth
Anorexia
Red discolouration of urine
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6
Q

What is the management of myasthenia gravis?

A

Pyridostigmine

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7
Q

What is the management of Lambert Eaton?

A

Amifampridine + treat underlying malignancy

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8
Q

How does a parietal lobe lesion present?

A

Contralateral inferior homonymous quadrantinopia
Inability to identify objects by feel
Inability to perform movements on command

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9
Q

How does a temporal lobe lesion present?

A

Contralateral superior homonymous quadrantinopia
Wernicke’s aphasia
Inability to recognise familiar sounds/voices

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10
Q

How does an occipital lobe lesion present?

A

Homonymous heminopia with macular sparing

Visual agnosia - inability to recognise familiar people/objects

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11
Q

How does a frontal lobe lesion present?

A

Broca’s aphasia
Disinhibition
Perserveration
Anosmia

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12
Q

What is the prophylaxis of a cluster headache?

A

Verapamil

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13
Q

What is seen on LP in bacterial meningitis?

A

Raised neutrophils
Raised protein
Low glucose

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14
Q

What is seen on LP in viral meningitis?

A

Raised lymphocytes
Normal protein
Normal glucose

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15
Q

What is seen on LP in HSV encephalitis?

A

Raised lymphocytes
Raised protein
Normal glucose

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16
Q

What are features of neurofibromatosis type 1?

A

Café au lait spots
Lisch nodules
Phaechromocytoma
Axillary/groin freckles

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17
Q

What are features of tuberous sclerosis?

A

Ash leaf spots
Shagreen patch
Adenoma sebaceum
Subungal fibromata

Developmental delay
Epilepsy
Intellectual impairment

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18
Q

How does a third nerve palsy present?

A

Eye = down and out position
Ptosis
Fixed dilated pupil (in surgical)

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19
Q

How does a fourth nerve palsy present?

A

Defective downward gaze - eye is up and in

Vertical diplopia

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20
Q

How does a sixth nerve palsy present?

A

Defective abduction - eye points inwards

Horizontal diplopia

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21
Q

Freidrich’s ataxia vs. Ataxic telangiectasia?

A

Both autosomal recessive

Freidrich’s ataxia = Ataxia, kyphoscoliosis, HOCM, pes cavus (high arch)

Ataxia telangiectasia = Ataxia, telangiectasia, IgA deficiency leading to recurrent infections

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22
Q

What are drug causes of IIH?

A

Lithium, COCP, Steroids, tetracyclines, Isotretinoin

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23
Q

How does a pituitary apoplexy present? How is it managed?

A

Meningism –> Sudden severe headache, neck stiffness, vomiting

Bitemporal superior quadrantinopia

Features of hypopit –> Hyponatraemia, hypotension (secondary to adrenal insufficiency)

Acute management = IV hydrocortisone (Definitive - surgery)

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24
Q

What is raised in a true seizure?

A

Prolactin

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25
How can you calculate GCS?
E4 M6 V5 ``` Eyes 4= opens spontaneously 3= open on command 2= open on pain 1= no opening ``` ``` Motor 6= moving spontaneously 5= localises to pain 4= withdraws from pain 3= abnormal flexion 2= abnormal extension 1= no movement ``` ``` Verbal 5= Oriented 4= confused but can answer questions 3= not making sense, inappropriate words 2= incomprehensible sounds 1= No speech ```
26
Imaging – TIA vs. stroke?
``` TIA = diffusion weighted MRI and carotid artery doppler ultrasound (Only get CT head if on blood thinning medication) Stroke = non contrast CT , then diffusion weighted MRI ```
27
Which cranial nerve palsy occurs in IIH?
6th nerve palsy – inability to abduct affected eye
28
Which eye defect is associated w/ pituitary tumours?
Bitemproal superior quadrantinopia
29
Bitemporal hemianopia causes – inferior vs. superior?
Superior = Inferior optic chiasm compression, due to pituitary tumour Inferior = superior optic chiasm compression, due to craniopharyngioma
30
Where is the lesion in Wernicke’s aphasia?
Superior temporal gyrus
31
Where is the lesion in Broca’s aphasia?
Inferior frontal gyrus
32
Where is the lesion in conduction aphasia?
Arcuate fasciulus
33
Do temporal and parietal lesions give contralateral or ipsilateral visual defects?
Contralateral
34
Wernicke's aphasia vs. Broca's aphasia?
Wernicke's aphasia: Temporal lobe Fluent speech but sentences make no sense Impaired comprehension Broca's aphasia Frontal lobe Non fluent haltered speech but sentences make sense Normal comphrension
35
What is conduction aphasia?
Fluent speech but sentences make no sense | Comprehension is normal
36
What is global aphasia?
Speech is non fluent and halted | Comprehension is impaired
37
What is the medical management of stroke?
300mg Aspirin daily for 2 weeks If AF --> wait the 2 weeks before commencing anticoagulants, stop them if already on them After 2 weeks is up.. Clopidogrel 75mg Or Aspirin + Dipyridamole Statin Anti-hypertensives If AF --> Start a DOAC
38
What is an extradural haematoma?
Rupture of the middle meningeal artery
39
What is internuclear ophthalmoplegia and what is it seen in?
Affected eye cannot adduct however baseline is fine Vertical diplopia of other eye Diff to sixth nerve palsy - sixth nerve palsy means eye is always facing inwards MS
40
What is seen on LP in MS?
Oligoclonal bands
41
How is Parkinson's disease managed?
If motor symptoms affecting quality of life: Levodopa (Co-careldopa or Co-beneldopa) If motor symptoms not affecting quality of life: Dopamine agonist – Bromocriptine/Cabergoline/Ropinirole .
42
How does a temporal lobe focal seizure present?
Déjà vu, hallucinations, memory flash backs, lip smacking/grabbing
43
How does a frontal lobe focal seizure present?
Jacksonian march | Post-ictal weakness
44
How does an occipital lobe focal seizure present?
vision loss | forced eye closure, eyelid fluttering, eye deviation and nystagmus
45
What is the management of myasthenia gravis?
Pyridostigmine
46
Which lobe is associated with Wernicke's aphasia?
Temporal lobe
47
What is the prophylaxis of a cluster headache?
Verapamil
48
How does a 5th nerve palsy present?
Trimeginal neuralgia Loss of corneal reflex Loss of facial sensation Paralysis of mastication muscles
49
What is a SURGICAL third nerve palsy?
Involvement of the pupil - fixed dilation | Most common cause = posterior communicating artery aneurysm
50
How is intracranial venous thrombosis treated?
LMWH
51
Multi system atrophy vs. progressive supranuclear palsy?
Multi system atrophy - postural hypotension, constipation, urinary retention Progressive supra nuclear palsy - postural instability, impairment of vertical gaze, Parkinsonism, frontal lobe dysfunction
52
Which lobe does HSV encephalitis characteristically affect?
Temporal lobe
53
Single ring-enhancing lesion on MRI - most likely cause?
Toxoplasmosis | /Abscess
54
What are causes of third nerve palsy?
``` DM Vasculitis - temporal arteritis, SLE Posterior communicating artery aneurysm Weber’s syndrome Cavernous sinus thrombosis ```
55
What is the main cause of a PAINFUL third nerve palsy?
Posterior communicating artery aneurysm
56
Why is the 300mg Aspirin changed to 75mg Clopidogrel after 2 weeks in acute stroke?
Due to risk of haemorrhage transformation
57
Do you get 2 weeks of 300mg Aspirin in TIA?
No just one off - can give any time in 2 weeks after having the TIA
58
Which sensations are lost in Syringomyelia?
Pain + temperature
59
What can withholding Parkinson’s meds cause?
Neuroleptic malignant syndrome
60
What level does a spinal injury have to occur for patient to be at risk of autonomic dysreflexia?
At or above T6
61
How is a post-lumbar puncture headache managed?
Caffeine + fluids
62
What are side effects of sodium valproate?
``` VALPROATE Valproate Appetite and weight gain Liver failure Pancreatitis Reversible hair loss Oedema Ataxia Tremor + teratogenicity + thrombocytopenia Encephalopathy ```
63
Which opioid is best for neuropathic pain?
Tramadol
64
How does controlled hyperventilation work in raised ICP?
Hyperventilation —> reduce co2 —> Vasoconstriction of cerebral arteries —> reduced ICP
65
What is the main risk factor for spontaneous idiopathic hypotension?
Marfan's
66
Which nerve palsy can raised ICP cause and why?
3rd nerve palsy due to herniation
67
What does isolated raised protein the CSF indicate?
Guillan-barre syndrome
68
True seizure vs pseudo seizure
X
69
Pupil: Unilateral dilation
3rd nerve palsy due to herniation
70
Pupil: Bilateral dilation
Poor CNS perfusion or bilateral 3rd nerve palsy
71
Pupil: Unilateral dilation which is cross-reactive? Marcus-Gunn
Optic nerve injury
72
Ptosis + dilated pupil
3rd nerve palsy
73
Ptosis + constricted pupil
Horner's syndrome
74
What are neurological manifestations of Wilson's disease?
1) Akathisia/Rigidity-similar to Parkinson's 2) Pseudosclerosis - tremor 3) Ataxia 4) Dystonic syndrome Other - drooling, spasticity, chorea Can also have psychiatric - impulsive, personality changes, depression, psychosis
75
How does a space occupying lesion present? How is it diagnosed?
Headache - worse on waking, lying down, coughing/straining May be associated with vomiting May be evidence of cranial nerve palsies - in particular abducens nerve Cushing’s triad = bradycardia, hypertension, abnormal breathing Diagnosis = MRI head.
76
What is the first line medication for a generalised seizure in a woman of child-bearing potential?
Lamotrigine
77
How is motor neurone disease managed?
Riluzole
78
MND with all of the symptoms upper motor neurone lesions?
Primary lateral sclerosis
79
MND with all of the symptoms only lower motor neurone?
Progressive muscular atrophy
80
MND with both UMN and LMN?
Amyotrophic lateral sclerosis
81
Do middle or anterior cerebral artery strokes more commonly cause aphasia and vision?
Middle cerebral artery
82
Which side of the brain is usually affected in a stroke which leads to aphasia?
Left
83
Which drugs should be avoided in patients with Myasthenia gravis? And why?
``` Beta blockers Lithium Phenytoin Penicillamine Abx – gentamicin, macrolides, quinolones,tetracyclines ``` Can precipitate myasthenic crisis
84
What further investigation is needed for everyone with a stroke/TIA?
Carotid doppler for consideration of carotid endarterectomy
85
What is paroxysmal hemicrania? How is it managed?
Attacks of severe unilateral headache Often associated with autonomic features – Nasal congestion, tearing Management – Indomethacin
86
What is Hoover’s sign?
Manoevure to distinguish between organic and non-organic paresis of leg
87
How is autoimmune encephalitis treated?
First line = IV methylprednisolone + IV immunoglobulins | If no response within two weeks – rituximab/Cyclophosphamide
88
How does myotonic dystrophy present?
``` Frontal Balding Mytonic face – droopy, haggard appearance Proximal weakness and muscle wasting Bilateral ptosis Cataracts Dysarthria Myotonia DM1 - distal weakness most prominent DM2 - proximal weakness most prominent ```
89
How does degenerative cervical myopathy present and how is it diagnosed?
``` Pain Loss of motor function (digital dexterity, holding a fork, doing up buttons) Numbness Urinary/faecal incontinence Hoffmann’s sign Diagnosed with MRI cervical spine ```
90
What is autonomic dysreflexia?
Occurs in patients who have had a spinal cord injury at or above T6 Hyperstimulation of the nervous system Often triggered by faecal impaction/urinary retention Causes extreme HTN, flushing and sweating, dilated pupils, headache, lightheadedness Can cause haemorrhagic stroke
91
What are classic features seen in someone with Charcot-Marie-Tooth disease?
(Most common hereditary cause of peripheral neuropathy) History of frequently sprained ankles High foot arches Distal muscle wasting - inverted champagne bottle legs Hammer toes Peripheral sensory loss
92
What are contra indications for Triptans?
Ischaemic Heart disease or cardiovascular disease Severe or uncontrolled hypertension Concurrent use of an SSRI
93
Common triggers for a migraine attack?
* tiredness, stress * alcohol * combined oral contraceptive pill * lack of food or dehydration * cheese, chocolate, red wines, citrus fruits * menstruation * bright lights
94
How does Huntington’s present?
``` Initially cognitive/psychiatric/mood problems Then movement disorders: Chorea Eye movement disorders Dysarthria Dysphagia ```
95
How is Huntington’s disease managed?
No drug therapies that can affect prognosis Tetrabenzine can help w chorea Depression - SSRIs Psychosis - Antipsychotics
96
What drugs can lower seizure threshold?
* Antibiotics: Imipenem, penicillins, cephalosporins, metronidazole, isoniazid * Antipsychotics * Antidepressents: Bupropion, Tricyclics, Venlafaxine * Tramadol * Fentanyl * Ketamine * Lidocaine * Lithium • Antihistamines
97
Which nerve is responsible for corneal reflex?
Trigeminal nerve
98
Management of chronic subdural bleed?
Chronic = burr holes if symptomatc If on blood thinner, imaging is still needed to rule out haemorrhage stroke even if transient
99
What is the most common neuro manifestation of sarcoidosis?
Facial nerve palsy
100
What is herniation?
Intracranial pressure causes normal brain structures to become displaced Displacement of brain —> Compression of important structures Most importantly = brain stem.
101
What is coning?
Brain stem compression Neurosurgical emergency Can present with 3rd nerve palsy
102
Which antiemetic is recommended in migraine?
Metoclopramide
103
How is Guillan-barre diagnosed?
LP showing rise in protein with normal WCC | Nerve conduction studies showing decreased motor nerve conduction velocity
104
How can a cerebellar stroke present?
A cerebellar stroke presents similar to vestibular neuritis Vertigo Vertical nystagmus
105
What is the most common complication of meningitis?
Sensorineural deafness
106
When to start a statin after having a stroke?
48 hours
107
Management of bacterial meningitis?
In adults = IV Cefotaxime In infants <3 months and adults >50 years - also add Amoxicillin Also give Dexamethasone Don't give dexamethasone if septic/meningococcal meningitis/under 3 months of age
108
What are complications of bacterial meningitis?
Sensorineural hearing loss Focal neurological deficit Waterhouse-Freidrichsen syndrome

Medicine Finals: HARD STUFF ONLY (23 decks)

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