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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
Q

How can you calculate GCS?

A

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
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26
Q

Imaging – TIA vs. stroke?

A 
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
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27
Q

Which cranial nerve palsy occurs in IIH?

A

6th nerve palsy – inability to abduct affected eye

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28
Q

Which eye defect is associated w/ pituitary tumours?

A

Bitemproal superior quadrantinopia

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29
Q

Bitemporal hemianopia causes – inferior vs. superior?

A

Superior = Inferior optic chiasm compression, due to pituitary tumour

Inferior = superior optic chiasm compression, due to craniopharyngioma

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30
Q

Where is the lesion in Wernicke’s aphasia?

A

Superior temporal gyrus

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31
Q

Where is the lesion in Broca’s aphasia?

A

Inferior frontal gyrus

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32
Q

Where is the lesion in conduction aphasia?

A

Arcuate fasciulus

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33
Q

Do temporal and parietal lesions give contralateral or ipsilateral visual defects?

A

Contralateral

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34
Q

Wernicke’s aphasia vs. Broca’s aphasia?

A

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

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35
Q

What is conduction aphasia?

A

Fluent speech but sentences make no sense

Comprehension is normal

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36
Q

What is global aphasia?

A

Speech is non fluent and halted

Comprehension is impaired

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37
Q

What is the medical management of stroke?

A

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

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38
Q

What is an extradural haematoma?

A

Rupture of the middle meningeal artery

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39
Q

What is internuclear ophthalmoplegia and what is it seen in?

A

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

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40
Q

What is seen on LP in MS?

A

Oligoclonal bands

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41
Q

How is Parkinson’s disease managed?

A

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 .

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42
Q

How does a temporal lobe focal seizure present?

A

Déjà vu, hallucinations, memory flash backs, lip smacking/grabbing

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43
Q

How does a frontal lobe focal seizure present?

A

Jacksonian march

Post-ictal weakness

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44
Q

How does an occipital lobe focal seizure present?

A

vision loss

forced eye closure, eyelid fluttering, eye deviation and nystagmus

45
Q

What is the management of myasthenia gravis?

A

Pyridostigmine

46
Q

Which lobe is associated with Wernicke’s aphasia?

A

Temporal lobe

47
Q

What is the prophylaxis of a cluster headache?

A

Verapamil

48
Q

How does a 5th nerve palsy present?

A

Trimeginal neuralgia
Loss of corneal reflex
Loss of facial sensation
Paralysis of mastication muscles

49
Q

What is a SURGICAL third nerve palsy?

A

Involvement of the pupil - fixed dilation

Most common cause = posterior communicating artery aneurysm

50
Q

How is intracranial venous thrombosis treated?

A

LMWH

51
Q

Multi system atrophy vs. progressive supranuclear palsy?

A

Multi system atrophy - postural hypotension, constipation, urinary retention

Progressive supra nuclear palsy - postural instability, impairment of vertical gaze, Parkinsonism, frontal lobe dysfunction

52
Q

Which lobe does HSV encephalitis characteristically affect?

A

Temporal lobe

53
Q

Single ring-enhancing lesion on MRI - most likely cause?

A

Toxoplasmosis

/Abscess

54
Q

What are causes of third nerve palsy?

A 
DM
Vasculitis - temporal arteritis, SLE
Posterior communicating artery aneurysm
Weber’s syndrome
Cavernous sinus thrombosis
55
Q

What is the main cause of a PAINFUL third nerve palsy?

A

Posterior communicating artery aneurysm

56
Q

Why is the 300mg Aspirin changed to 75mg Clopidogrel after 2 weeks in acute stroke?

A

Due to risk of haemorrhage transformation

57
Q

Do you get 2 weeks of 300mg Aspirin in TIA?

A

No just one off - can give any time in 2 weeks after having the TIA

58
Q

Which sensations are lost in Syringomyelia?

A

Pain + temperature

59
Q

What can withholding Parkinson’s meds cause?

A

Neuroleptic malignant syndrome

60
Q

What level does a spinal injury have to occur for patient to be at risk of autonomic dysreflexia?

A

At or above T6

61
Q

How is a post-lumbar puncture headache managed?

A

Caffeine + fluids

62
Q

What are side effects of sodium valproate?

A 
VALPROATE
Valproate
Appetite and weight gain
Liver failure
Pancreatitis
Reversible hair loss
Oedema
Ataxia
Tremor + teratogenicity + thrombocytopenia
Encephalopathy
63
Q

Which opioid is best for neuropathic pain?

A

Tramadol

64
Q

How does controlled hyperventilation work in raised ICP?

A

Hyperventilation —> reduce co2 —> Vasoconstriction of cerebral arteries —> reduced ICP

65
Q

What is the main risk factor for spontaneous idiopathic hypotension?

A

Marfan’s

66
Q

Which nerve palsy can raised ICP cause and why?

A

3rd nerve palsy due to herniation

67
Q

What does isolated raised protein the CSF indicate?

A

Guillan-barre syndrome

68
Q

True seizure vs pseudo seizure

A

X

69
Q

Pupil: Unilateral dilation

A

3rd nerve palsy due to herniation

70
Q

Pupil: Bilateral dilation

A

Poor CNS perfusion or bilateral 3rd nerve palsy

71
Q

Pupil: Unilateral dilation which is cross-reactive? Marcus-Gunn

A

Optic nerve injury

72
Q

Ptosis + dilated pupil

A

3rd nerve palsy

73
Q

Ptosis + constricted pupil

A

Horner’s syndrome

74
Q

What are neurological manifestations of Wilson’s disease?

A

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
Q

How does a space occupying lesion present? How is it diagnosed?

A

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
Q

What is the first line medication for a generalised seizure in a woman of child-bearing potential?

A

Lamotrigine

77
Q

How is motor neurone disease managed?

A

Riluzole

78
Q

MND with all of the symptoms upper motor neurone lesions?

A

Primary lateral sclerosis

79
Q

MND with all of the symptoms only lower motor neurone?

A

Progressive muscular atrophy

80
Q

MND with both UMN and LMN?

A

Amyotrophic lateral sclerosis

81
Q

Do middle or anterior cerebral artery strokes more commonly cause aphasia and vision?

A

Middle cerebral artery

82
Q

Which side of the brain is usually affected in a stroke which leads to aphasia?

A

Left

83
Q

Which drugs should be avoided in patients with Myasthenia gravis? And why?

A 
Beta blockers
Lithium
Phenytoin
Penicillamine
Abx – gentamicin, macrolides, quinolones,tetracyclines

Can precipitate myasthenic crisis

84
Q

What further investigation is needed for everyone with a stroke/TIA?

A

Carotid doppler for consideration of carotid endarterectomy

85
Q

What is paroxysmal hemicrania? How is it managed?

A

Attacks of severe unilateral headache
Often associated with autonomic features – Nasal congestion, tearing
Management – Indomethacin

86
Q

What is Hoover’s sign?

A

Manoevure to distinguish between organic and non-organic paresis of leg

87
Q

How is autoimmune encephalitis treated?

A

First line = IV methylprednisolone + IV immunoglobulins

If no response within two weeks – rituximab/Cyclophosphamide

88
Q

How does myotonic dystrophy present?

A 
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
Q

How does degenerative cervical myopathy present and how is it diagnosed?

A 
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
Q

What is autonomic dysreflexia?

A

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
Q

What are classic features seen in someone with Charcot-Marie-Tooth disease?

A

(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
Q

What are contra indications for Triptans?

A

Ischaemic Heart disease or cardiovascular disease
Severe or uncontrolled hypertension
Concurrent use of an SSRI

93
Q

Common triggers for a migraine attack?

A
  • tiredness, stress
  • alcohol
  • combined oral contraceptive pill
  • lack of food or dehydration
  • cheese, chocolate, red wines, citrus fruits
  • menstruation
  • bright lights
94
Q

How does Huntington’s present?

A 
Initially cognitive/psychiatric/mood problems
Then movement disorders:
Chorea
Eye movement disorders
Dysarthria
Dysphagia
95
Q

How is Huntington’s disease managed?

A

No drug therapies that can affect prognosis
Tetrabenzine can help w chorea
Depression - SSRIs
Psychosis - Antipsychotics

96
Q

What drugs can lower seizure threshold?

A
  • Antibiotics: Imipenem, penicillins, cephalosporins, metronidazole, isoniazid
  • Antipsychotics
  • Antidepressents: Bupropion, Tricyclics, Venlafaxine
  • Tramadol
  • Fentanyl
  • Ketamine
  • Lidocaine
  • Lithium
    • Antihistamines
97
Q

Which nerve is responsible for corneal reflex?

A

Trigeminal nerve

98
Q

Management of chronic subdural bleed?

A

Chronic = burr holes if symptomatc

If on blood thinner, imaging is still needed to rule out haemorrhage stroke even if transient

99
Q

What is the most common neuro manifestation of sarcoidosis?

A

Facial nerve palsy

100
Q

What is herniation?

A

Intracranial pressure causes normal brain structures to become displaced
Displacement of brain —> Compression of important structures
Most importantly = brain stem.

101
Q

What is coning?

A

Brain stem compression
Neurosurgical emergency
Can present with 3rd nerve palsy

102
Q

Which antiemetic is recommended in migraine?

A

Metoclopramide

103
Q

How is Guillan-barre diagnosed?

A

LP showing rise in protein with normal WCC

Nerve conduction studies showing decreased motor nerve conduction velocity

104
Q

How can a cerebellar stroke present?

A

A cerebellar stroke presents similar to vestibular neuritis
Vertigo
Vertical nystagmus

105
Q

What is the most common complication of meningitis?

A

Sensorineural deafness

106
Q

When to start a statin after having a stroke?

A

48 hours

107
Q

Management of bacterial meningitis?

A

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
Q

What are complications of bacterial meningitis?

A

Sensorineural hearing loss
Focal neurological deficit
Waterhouse-Freidrichsen syndrome

Medicine Finals: HARD STUFF ONLY (23 decks)

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