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Medicine Year 4 > Neurology > Flashcards

Neurology Flashcards

1
Q

CN3 lesion

A

Eye movement ‘down and out’

Ptosis and fixed dilated pupil with absent light reflex

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2
Q

Left homonymous hemianopia

A

Visual field defect to the left

Lesion of the right optic tract

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3
Q

Homonymous quadrantanopias

A

PITS

parietal inferior, temporal superior

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4
Q

Incongruous defects

A

Optic tract lesion

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5
Q

Congruous defects

A

Optic radiation lesion or occipital cortex

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6
Q

CN4 lesion

A

Defective downward gaze and vertical diplopia

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7
Q

CN6 palsy

A

Defective eye abduction and horizontal diplopia

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8
Q

Lorazepam TWICE?

A
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9
Q

Investigation for progressively worsening headache with impaired higher cognitive function

A

Urgent imaging required

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10
Q

Imaging to view demyelinating lesions

A

MRI with contrast

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11
Q

Management of brain abcess

A

IV 3rd generation cephalosporin + metronidazole

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12
Q

CN5 lesion

A

Loss of corneal reflex

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13
Q

What is hoover’s sign

A

Differentiates between organic and non-organic lower leg weakness (a sign of leg paresis)

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14
Q

What is Romberg’s test

A

Investigates the cause of ataxia (+ve = sensory)

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15
Q

What must you do before giving aspirin

A

Exclude a haemorrhagic stroke

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16
Q

Bitemporal hemianopia

A

upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

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17
Q

What movements are spared in motor neurone disease

A

Eye movebments

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18
Q

Tetrad of neuroleptic malignant syndrome

A

Hyperthermia, muscle rigidity, autonomic instability, altered mental status
(often when started on anti-psychotic medication)

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19
Q

Describe the tremor seen in Parkinsons

A

Unilateral tremor that improves with voluntary movement

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20
Q

First step in the management of obese patients with idiopathic intracranial hypertension

A

Weight loss

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21
Q

Management of autonomic dysreflexia

A

Removal/control of the stimulus and treatment of any life-threatening hypertension and/or bradycardia

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22
Q

What anaesthetic agent is contraindicated in myasthenia gravia

A

Suxamethonium

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23
Q

Give 2 localising features of a temporal lobe seizure

A

Lip smacking
Post ictal dysphasia

(plucking of clothes)

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24
Q

Treatment of patients with raised ICP

A

IV mannitol

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25
Q

What nerve is affected if there is weakness of foot dorsiflexion and foot eversion

A

Common peroneal nerve

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26
Q

3 features of normal pressure hydrocephalus

A

Urinary incontinence
Gait abnormality
Dementia

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27
Q

Obese young female with headaches and blurred vision

A

Think idiopathic intracranial hypertension

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28
Q

Most common hereditary sensorimotor neuropathy

A

Charcot-Marie-Tooth Disease

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29
Q

Treatment of acute migraine

Treatment of migraine prophylaxis

A

Acute: Triptan + NSAID + paracetamol
Prophylaxis: Topiramate or propanolol
(propanolol preferred in women of childbearing age)

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30
Q

Investigation of choice for narcolepsy

A

Multiple sleep latency EEG

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31
Q

3 features of normal pressure hydrocephalus

A

Urinary incontinence + gait abnormality + dementia

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32
Q

1st line drug in the management of ocular myasthenia gravis

A

Pyridostigmine

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33
Q

3 drugs which exacerbate Parkinson’s

A

Cyclizine
Prochlorperazine (antihistamines)
Metoclopramide

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34
Q

Anti-emetic used in parkinsons

A

Domperidone

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35
Q

MOA of sodium valproate

A

Inhibition of the P450 system

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36
Q

What does myaesthenia gravis show on an EEG

A

A diminished response to repetitive stimulation

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37
Q

How would you treat a patient with an acute ischaemic stroke who present within 4.5 hours

A

A combination of thrombolysis and thrombectomy

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38
Q

What scale measures disability or dependence in ADL in stroke patients

A

The Barthel index

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39
Q

5 most common places for brain tumours to metastasise

A 
Lung
Breast
Kidney
Melanoma
Colorectal cancers
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40
Q

Presentation of syringomyelia

A

Cape-like loss of pain and temperature sensation due to compression of the spinothalamic tract fibres decussating in the anterior white commissure of the spine

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41
Q

What is neuroleptic malignant syndrome and what is it treated with

A

Life threatening reaction that can occur in response to antipsychotic medication
Treated with bromocriptine (dopamine agonist)

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42
Q

MOA of pydridostigmine and what is it used for

A

Long acting acetylcholinesterase inhibitor that reduces the breakdown of acetylcholine in the neuromuscular junction
Temporarily improves the symptoms of mysesthenia gravis

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43
Q

Difficulty swallowing is a feature of what neurological condition

A

Myaesthenia Gravis

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44
Q

Myaesthenia Gravis VS Lambert Eaton

A

Same but lambert eaton with LUNG CANCER

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45
Q

GCS

A

Eye Very Much (want to die)
Eye = 4
Verbal = 5
Motor = 6

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46
Q

Head CT showing temporal lobe changes

A

Herpes simplex encephalitis

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47
Q

CT scan in meningitis

A

Often unremarkable

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48
Q

CT scan in HIV encephalitis

A

Changes to white matter and basal ganglia

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49
Q

Presentation of Creutzfeldt-Jakob disease

A

4 months of general neuro dysfunction

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50
Q

Time target for thrombolysis and thrombectomy

A

Thrombolysis: 4 hrs
Thrombectomy: 6 hrs

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51
Q

Management if a patient was not suitable for thrombolysis or thrombectomy

A

Aspirin

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52
Q

Painful third nerve palsy

A

Posterior communicating artery aneurysm

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53
Q

What medications are associated with idiopathic intracranial hypertension

A 
tetracycline antibiotics
isotretinoin
contraceptives
steroids
levothyroxine
lithium
cimetidine
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54
Q

Diagnostic test for Guillain-Barre

A

Lumbar Puncture

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55
Q

Young person presenting with a stroke, what investigations must be done to rule out the cause

A

Thrombophilia and autoimmune screening

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56
Q

What is a holter analysis

A

Records the hearts rhythm

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57
Q

Most common complication following meningitis

A

Sensioneural hearing loss

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58
Q

First line treatment for parkinsons (newly diagnosed)

A

Levodopoa

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59
Q

4 features of progressive supranuclear palsy

A

Postural instability
Impairment of vertical gaze
Parkinsonism
Frontal lobe dysfunction

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60
Q

Hallmark of myasthenia gravis

A

Fatiguable painless muscle weakness that improves with rest

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61
Q

Tuberous sclerosis skin presentation

A

Roughened patches of skin over lumbar spine (shagreen patches)

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62
Q

Laughter followed by fall/collapse

A

Cataplexy

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63
Q

MRC scale

A

5: normal
4: against gravity and resistance
3: against gravity
2: gravity eliminated
1: flicker
0: nothing

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64
Q

Management of a medication overuse headache

A

Simple analgesia: stop

Opioid: withdraw gradually

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65
Q

Classic organism for guillian-barre

A

Campylobacter

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66
Q

5 features of wernicke’s encephalopathy

A 
nystagmus (the most common ocular sign)
ophthalmoplegia
ataxia
confusion, altered GCS
peripheral sensory neuropathy
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67
Q

Wernicke vs Korsakoff

A

Amnesia and confabulation develop in korsakoff

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68
Q

What is Brown Sequard syndrome the result of

A

Lateral hemisection of the spinal cord

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69
Q

Frontal lobe seizure

A

Motor symptoms such as jerking of the limb

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70
Q

Parietal lobe seizure

A

Paraesthesia

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71
Q

Temporal lobe seizures

A

Automatisms and hallucinations

De-ja-vu and aura

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72
Q

Occipital lobe seizure

A

Visual disturbance

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73
Q

Brainstem seizure

A

Very rare and not well researched

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74
Q

Fracture with wrist in a flexed position with weakness to extension noted on examination

A

Left mid shaft humeral fracture

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75
Q

Cause of postural hypotension in a patient with parkinsons

A

The parkinsons

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76
Q

Characteristic of pseudoseizures

A

Gradual onset

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77
Q

Patient with Bell’s Palsy

No sign of improvement after 3 weeks

A

Refer urgently to ENT

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78
Q

How long can Bell’s palsy take to recover

A

12 months

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79
Q

3 features of broca’s dysphagia

A

speech no fluent, comprehension normal, repetition impaired

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80
Q

Smiths fracture with loss of thumb opposition

A

Median nerve

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81
Q

Armpit sensation lost during axillary node dissection

A

Intercostobrachial

82
Q

Supracondylar fracture gives a weak radial pulse and loss of pronation

A

Median

83
Q

Where is broca’s area and what is its blood supply

A

Middle cerebral artery

It is often in the dominant hemispehre (often left) in the inferior frontal gyrus

84
Q

Diet in epilepsy

A

Ketogenic

85
Q

Which parkinson medication increases inhibition disorders e.g. gambling

A

Dopamine receptor agonists e.g. Ropinirole

86
Q

Vertical diplopia - nerve lesion

A

Trochlear

87
Q

Aspirin prescription after stroke

A 
high dose (300mg) for 14 days
then switch to clopidogrel
88
Q

Medication that worsens myasthenia

A

Bisoprolol

89
Q

Nail bed of the index finger - nerve sensation

A

Median

90
Q

First step in managing raised ICP

A

Elevating the head of the bed to 30 degrees

91
Q

Acoustic neuromas

  • presentation
  • management
A

hearing loss and ringing in the ear

MRI of cerebellopontine angle

92
Q

Tracts affected (and sx) in subacute combined degeneration of the cord (B12)

A

Loss of proprioception and vibration sensation, muscle weakness and hyperreflexia

Dorsal columns and lateral corticospinal tracts affected

93
Q

Conduction aphasia

A

Speech fluent but repetition poor

Comprehension is relatively intact

94
Q

Parkinsons with automonomc disturbance (atonic bladder, postural hypotension, erectile dysfunction)

A

Multiple system atrophy

95
Q

Medications that can cause a megaloblastic anaemia

A

hydroxyurea, methotrexate, zidovudine, azathioprine, antiretroviral agents, valproic acid, and phenytoin

96
Q

Mid-shaft humeral fracture

Test the nerve

A

Extend the wrist (radial nerve injury)

97
Q

NICE HEAD CT

A
98
Q

Clonic movements travelling up the arm indicates a seizure in what area of the brain

A 
Frontal lobe (jacksonian march)
A type of focal aware seizure
99
Q

GCS below 8 - management

A

Intubate and ventilate

100
Q

Most common type of MS

A

Relapsing remitting

101
Q

Carotid bruit investigation

A

Duplex ultrasound (diagnosis of stenosis)

102
Q

Gold standard investigation for cervical myelopathy

A

MRI cervical spine

103
Q

STROKE CLASSIFICATION

A
104
Q

What nerve is damaged in a colles fracture

A

Median

105
Q

First line treatment of wernickes

A

Pabrinex IV

106
Q

Parkinsons symptoms with a symmetrical tremor

A

NOT idiopathic parkinsons

Drug induced or other cause

107
Q

Malignancy associated with myasthenia

A

Thymoma

108
Q

Most common trigger for cluster headaches

A

Alcohol

109
Q

Ptosis and dilated pupil

Ptosis and constricted pupil

A

Dilated: CN3 palsy
Constricted: Horners

110
Q

Post RTA patient with extremely high blood pressure, flushing and sweating

A

Autonomic dysreflexia

111
Q

Side effect of carbemazapine

A

Steven Johnson syndrome

Painful erythematous macules evolving to target lesions with mucosal ulceration

112
Q

First line treatment for trigemninal neuralgia

A

Carbamazepine

113
Q

Electric shock pains across the face that worsen when touching the skin

A

Trigeminal neuralgia

114
Q

Investigation for vestibular schwannoma

A

Audiogram and MRI head (gadolinium enhanced)

115
Q

What is mononeuritis multiplex

A

painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas

116
Q

Treatment of guillian-barre

A

IV immunoglobulin

117
Q

Biceps reflex nerve root

Triceps reflex nerve root

A

Biceps: C5-C6
Triceps: C7-C8

118
Q

Fine tremor in middle aged woman losing weight

A

Thyrotoxicosis

119
Q

28 year old with a fine tremor with FHx

A

Essential tremor

120
Q

Lateral medullary syndrome signs

A

PICA lesion
Cerebellar signs
Contralateral sensory loss
Ipsilateral Horners

121
Q

Side effects of phenytoin

A

Teratogenic
CYP450 interactions
Loads of adverse effects - if in doubt put phenytoin

122
Q

Parkinsons drug with reduced effectiveness over time

A

Levodopa

123
Q

Parkinsons drug associated with pulmonary fibrosis

A

Cebergoline

124
Q

Parkinsons drug useful for managing tremor in drug-induced parkinsons

A

Procyclidine

125
Q

Treatment of paroxysmal hemicrania

A

Indomethacin

Completely responsive

126
Q

What is paroxysmal hemicrani

A

Severe attacks of unilateral headaches in the orbital or temporal region

127
Q

Investigation for optic neuritis

A

MRI head with contrast as gold standard for MS

128
Q

Where is the chemoreceptor trigger zone

A

Medulla

129
Q

Stroke - CT with or without contrast

A

WITHOUT

130
Q

What is the cushing reflex

A

Physiological nervous system response to ICP that results in hypertension and bradycardia
Bad sign

131
Q

Autonomic dysreflexia

A

Faecal impaction and urinary retention are the most common triggers
Hypertension, bradycardia and sympathetic overdrive
Often after a spinal cord injury

132
Q

Bedside test for CSF

A

Glucose

133
Q

Third nerve palsy same or opposite side

A

Same side

134
Q

Arnold-Chiari malformation - 2 associations

A

Cause of congenital hydrocephalus

Syringomyelia

135
Q

Contraindication for triptans

A

Ischaemic heart disease

136
Q

CSF of patients with MS

A

Oligoclonal bands

137
Q

First line for spasticity in MS

A

Baclofen and gabapentin

138
Q

Syringiomyelia is associated with RA

A
139
Q

Management of MS acute relapse

A

Oral steroids e.g. methylprednisolone

140
Q

CT aneurysm that does and does not cross suture lines

A

Does cross suture lines: subdural

Doesn’t cross suture lines: extradural

141
Q

Chronic subdural on CT

A

Hypodense (dark)

142
Q

Gold standard for venous sinus thrombosis

also wtf is it

A

MR venogram

Severe headache with stroke like sx in woman with DVT FHx and COCP

143
Q

Which type of neurofibromatosis has vestibular schwannomas

A

Type 2

144
Q

What is controlled hyperventilation and when is it used

A

In patients with raised ICP

Reduced blood CO2 to induce cerebral vasoconstriction

145
Q

Where is broca’s area

A

Frontal lobe

146
Q

Only opioid appropriate to consider in neuropathic pain

A

Tramadol

147
Q

Pituitary apoplexy management (from pituitary adenoma)

A

Urgent steroids

148
Q

Blood test to differentiate true seizures and pseudoseizure

A

Prolactin

149
Q

Prophylaxis of cluster headaches

A

Verapamil

150
Q

Cause of gait ataxia

A

Lesion in cerebellar vermis

151
Q

Condition associated with subungual fibromatoma

A

Tuberus sclerosis

152
Q

Inheritance of charcot marie tooth

A

autosomal dominant

153
Q

Side effect of triptans

A

Tightness of the throat and chest

154
Q

RTA need to intubate - with what

A

Cuffed endotracheal tube

155
Q

Eye defect in primary open angle glaucoma

A

Unilateral peripheral visual field loss

156
Q

Stroke with right sided hemiplegia, where is the eye defect

A

Right

157
Q

Unilateral deafness or tinnitus

A

Acoustic neuroma

158
Q

What is hyperacusis and what condition is it found in

A

Noises sound louder than usual

Bell’s Palsy

159
Q

Bell’s palsy - is there a sensory deficit

A

NO!

160
Q

When would you perform carotid endardectomy

A

If stenosis greater than 70%

161
Q

Adult seizure - medication at 5 imnutes

A

Rectal diazepam

162
Q

Weakened dorsiflexion, inversion and eversion of the ankle

A

L5 nerve lesion

163
Q

Which nerves are affected in vestibular schwannoma

A

Cranial nerves V, VII, VIII

164
Q

Clinical picture if parkinsons drugs are withheld

A

Stiffness, tachycardia, pyrexia, elevated creatinine kinase

165
Q

4 features of vestibular schwannoma

A

vertigo, hearing loss, tinnitus and an absent corneal reflex

166
Q

Fasciculations in older man

A

Motor neurone

167
Q

Treatment of low phosphate in adults

A

IV infusion

168
Q

Vessel damaged in a subdural haematoma

A

Bridging veins between cortex and venous sinus

169
Q

TIA secondary prevention

A

Clopidogrel only

Aspirin is used as first line treatment and if clopidogrel or other antiplatelets are contraindicated

170
Q

Main feature of syringomyelia

A

Spinothalamic sensory loss (pain and temeprature)

171
Q

Which nerve is most often affected in raised ICP

A

Abducens due to its long course

172
Q

Vessel damaged in an extra dural haematoma

A

Middle meningeal artery

173
Q

Vessel injured in a subarachnoid

A

berry aneurysm

174
Q

RF for subdural haemorrhage

A

Elderly and alcoholics

175
Q

Visual field defects (good luck lol)

A

left homonymous hemianopia means visual field defect to the left, i.e. lesion of right optic tract
homonymous quadrantanopias: PITS (Parietal-Inferior, Temporal-Superior)
incongruous defects = optic tract lesion; congruous defects= optic radiation lesion or occipital cortex

176
Q

When assessing GCS take the best response

A

e.g. left flexes, right extends, take the felxion

177
Q

What does refractory to treatment mean

A

Does not respond to treatment

178
Q

What dementia is associated with MND

A

Frontotemporal

179
Q

Treatment of bells palsy

A

Prescribe prednisolone

180
Q

Forehead spared in….

A

STROKE

181
Q

Parkinsons drugs at increased risk of gambling

A

Dopamine agonists e.g. bromocriptine

182
Q

Xray for assessing degenerative cervical myelopathy?

A

No

183
Q

DVLA guidelines on seizures

A

6 month break after first seizure

5 year ban if bus or lorry driver

184
Q

Management of status epilepticus if patient has a cannula

A

IV lorazepam

185
Q

Brain abscess on CT

A

collection of pus encapsulated by a pyogenic membrane

186
Q

Shingles first line for nerve pain

A

Amitriptyline (or duloxetine, gabapentin or pregabalin)

187
Q

Investigation for myasthenia gravis

A

Antibody screen

188
Q

Extradural haemorrhage shape on CT

A

Biconvex

189
Q

What gait is this?

Wide based gait with loss of heel to toe walking

A

Ataxic gait

190
Q

Isolated rise in protein level in CSF

A

Indicative of GBS

191
Q

Lambert eaton or myasthenia gravis

A

Lambert improves after exercise

Myasthenia worsens

192
Q

Migraine in children

A

Avoid prokinetic agents e.g. metoclopramide

193
Q

What is the typical aura in migraine

A

Spreading scintillating scotoa (jagged crescent)

194
Q

Essential tremor

A

On intention
often in the hands
affects the vocal cords

195
Q

Progressively worsening headache with higher cognitive dysfunction

A

Urgent imaging

196
Q

TIA - specialist review within?

A

24 hours

197
Q

fall soon after a parkinsons diagnosis

A

Assess cranial nerves for other diangosisi e.g. Parkinsons +

198
Q

Medication for chemotherapy induced nausea and vomiting

A

Ondansetron (serotonin receptor antagonist)

199
Q

Treatment of benign essential tremor

A

Propanolol (also alcohol lol)

200
Q

How many drugs for neuropathic pain

A

Monotherapy

201
Q

Assessment tool for stroke v stroke mimic

A

ROSIER

Medicine Year 4 (13 decks)

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