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FLASH FINALS > Neurology > Flashcards

Neurology Flashcards

1
Q

5-HT3 antagonists:

Used in what type of nausea

A

Ondansetron

Chemotherapy induced

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2
Q

Adverse effects 5-HT3 antagonists:

A

Constipation

QT prolongation

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3
Q

Absence seizure tx:

A

ETHOSUXIMIDE

Sodium valproate

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4
Q

Wernicke’s aphasia:

Where is lesion

A

Superior temporal gyrus

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5
Q

Wernicke’s aphasia: what is impaired:

A

Comprehension - ‘word salad’

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6
Q

Broca’s: lesion where is it?

A

Inferior frontal gyrus

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7
Q

Conduction aphasia:
Classically due to:
Deficit:

A

Stroke affecting the arcuate fasiculus
Speech FLUENT but poor repetition
Comprehension normal

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8
Q

Cerebellar hemisphere lesions cause __ ataxia

A

Peripheral

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9
Q

Cerebellar vermis lesions cause ___ ataxia

A

Gait

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10
Q

Autonomic dysreflexia trigger:

A

Faecal impaction or urinary retention

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11
Q

Autonomic dysreflexia symptoms:

A

Extreme hypertension, flushing, sweating above the level of cord lesion

due to prevention of parasympathetic counter response by lesion

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12
Q

Bell’s palsy tx.

A

Oral prednisolone w/in 72 hours of on-set

If no improvement in 3 weeks - urgent referral to ENT

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13
Q

Symptom may precede facial palsy in Bell’s palsy:

A

Post-auricular pain

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14
Q

Erb’s palsy:
Damage to:
Result:

A

Damage to C5,6

Winged scapula

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15
Q

Klumpke’s palsy:

A

Damage to T1

loss of intrinsic hand muscles

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16
Q

Brain abscess antibiotics:

A

3rd generation cephalosporin + metronidazole

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17
Q

Tumours which most commonly metastasise to the brain:

A 
Lung 
Breast 
Bowel 
Skin 
Kidney
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18
Q

Glioblastoma on histology:

A

Pleomorphic tumour cells border necrotic areas

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19
Q

Meningioma on histology:

A

Spindle cells in concentric whirls and calcified psammoma bodies

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20
Q

Pilocytic astrocytoma:
M/c brain tumour in ->
Histology:

A

Children

Rosenthal fibres, corkscrew eosinophillic bundle

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21
Q

Medulloblastoma histology

A

small, blue cells, rosette pattern of cells w/ many mitotic figures

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22
Q

Brain tumour with ‘fried-egg appearance’

A

Oligodendroma

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23
Q

Brown-Sequard syndrome deficits

Lateral hemisection of cord

A

Contralateral loss of pain and temperature sensation
Ipsilateral weakness below lesion
Ipsilateral loss of proprioception and vibration sensation

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24
Q

Carbamazepine binds to _ channels to increase their refractory period

A

Sodium

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25
Q

Carbamazepine adverse effects:

A

Dizziness, drowsiness
Steven-Johnson syndrome
leucopenia and agranulocytosis
hyponatraemia 2ry to SIADH

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26
Q

DANISH

A

D - dysdiadochokinesia, dysmetria (past-pointing), may appear drunk
A - ataxia (truncal)
N - Nystagmus
I - Intention tremor
S - slurred staccato speech, scanning dysarthria
H - hypotonia

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27
Q

Most common hereditary peripheral neuropathy:

Predominantly __ loss

A

Charcot-Marie-Tooth disease

Motor

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28
Q

Cluster headache mx.

A

Acute: 100% oxygen w/ SC TRIPTAN

Prophylaxis = VERAPAMIL

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29
Q

Paroxysmal hemicrania mx.

A

INDOMETHACIN

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30
Q

CNS tumours ix. of choice:

A

MRI

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31
Q

Tibial and common fibular nerves come from which nerve:

A

Sciatic

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32
Q

Sensory loss in common fibular nerve palsy:

A

Dorsum of foot and lower lateral part of the leg

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33
Q

Creutzfeldt Jacob Disease fx.

A

Dementia + Myoclonus

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34
Q

CJD MRI:

A

Hyperintense signals from basal ganglia and thalamus

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35
Q

Degenerative cervical myelopathy symptoms:

A

Pain - affecting the neck, upper or lower limbs
Loss of motor function (loss of digital dexterity)
Loss of sensory function causing numbness
Loss of autonomic function - urinary or faecal incontinence/impotence)

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36
Q

What is Hoffman’s sign:

A

Reflex test to assess for cervical myelopathy - flicking a finger on the pts. hand. A positive test results in reflex twitching of other fingers

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37
Q

Mx. for DCM

A

Urgent referral for assessment due to importance of early treatment.

Decompressive surgery is the only treatment thereafter

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38
Q

Dermatomes: L5

A

Big toe - Largest of the 5 toes

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39
Q

Dermatomes: S1

A

Lateral foot: small toe -> the smallest 1

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40
Q

Dermatomes: C2

A

Posterior half of the skull (cap)

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41
Q

Dermatomes: C3

A

Turtle neck

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42
Q

Dermatomes: C4

A

Low collar shirt

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43
Q

Dermatomes L1

A

Inguinal ligament

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44
Q

Drugs causing peripheral neuropathy

A

MINAV

Metronidazole 
Isoniazid 
Nitrofurantoin 
Amiodarone 
Vincristine
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45
Q

Focal seizures mx.

A

Carbamazepine

or Lamotrigine

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46
Q

Essential tremor
Affects:
Worse if:

A

Both upper limbs

Arms outstretched: Postural tremor

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47
Q

Essential tremor tx.:

A

Propranolol

Primidone sometimes used

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48
Q

Extradural haematoma: bleeding limited by which anatomical structure

A

Limited by the suture lines of the skull

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49
Q

Causes of bilateral facial nerve palsy:

A

Sarcoidosis
Guillain-Barre syndrome
Lyme disease
Bilateral acoustic neuromas (NF2)

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50
Q

Fourth nerve palsy:

A

Vertical diplopia - when reading a or when going downstairs
Head tilt
‘Up and out’ eye

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51
Q

Other features of Guillane-Barre:

A

Respiratory muscle weakness
Cranial nerve involvement - diplopia, b/l facial nerve palsy
Autonomic involvement: urinary retention, diarrhoea

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52
Q

Guillane-Barre: Investigations

A

Lumbar puncture -> rise in protein w/ normal WCC

Nerve conduction studies: decreased motor nerve conduction velocity

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53
Q

Medication overuse headache:
present for _ days/month
Patients taking which medications for pain are more at risk:
Mx:

A

Present for 15 days or more/month

triptans and opioids

W/draw triptans and simple analgesics abruptly
W/draw opioids gradually

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54
Q

Meningitis protein in bacterial/viral CSF

A

Raised in bacterial

Normal in viral

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55
Q

Most common complication of Meningitis:

A

Sensorineural hearing loss.

Others include:
seizures, focal neurological deficit
infective - sepsis, intracerebral abscess

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56
Q

Waterhouse-Friderichsen syndrome ->

A

adrenal insufficiency secondary to adrenal haemorrhage

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57
Q

Migraine prophylaxis:

A

Propranolol or topiramate

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58
Q

Migraine acute treatment:

A

First line = oral TRIPTAN AND NSAID or paracetamol

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59
Q

Migraine acute management if 12-17 yrs:

A

nasal rather than oral TRIPTAN

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60
Q

Migraine if prophylaxis fails ->

A

5-8 weeks of ACUPUNCTURE

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61
Q

Topiramate is contraindicated in ->

A

Pregnant women

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62
Q

Common but niche feature of MND:

A

Wasting of small muscles of the hand/tibialis anterior

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63
Q

MND diagnosis

A

CLINICAL but nerve conduction studies will show normal motor conduction and can help exclude neuropathy
EMG shows reduced number of action potentials with increased amplitude.

64
Q

MND types:

ALS signs

A

LMN in arms and UMN signs in legs

opposite of what would be logical i.e upper and lower

65
Q

PLS signs:

A

UMN signs only

66
Q

Progressive muscular atrophy:

A

LMN signs only

67
Q

Progressive bulbar palsy:

A

Palsy of tongue, muscles of chewing, swallowing.

carries worst prognosis

68
Q

Uhtoff’s phenomenon:

A

Worsening of vision during rise in body temperature (showering etc)

69
Q

Lhermitte’s sign:

A

Paraesthesia of limbs on neck flexion

70
Q

MS MRI:

A

WITH CONTRAST

High signal T2 lesions
Periventricular plaques
Dawson fingers

71
Q

MS acute relapse mx.

A

High dose steroids (oral or IV methylprednisolone) for 5 days

shorten duration of relapse but do not improve degree of recovery

72
Q

Disease modifying drugs: MS

A

Natalizumab - strongest evidence for preventing relapse of disease. Given IV

Fingolimod

b-interferon
Glatirmaer acetate - immune decoy. Given SC

73
Q

MS fatigue tx.

A

Amantadine

74
Q

MS spasticity:

A

Baclofen or Gabapentin

75
Q

MS bladder dysfunction:

A

Get US first
If significant residual volume: ISC
If no significant residual volume: anti-cholinergics improve urinary frequency

76
Q

MS oscillopsia (when visual fields appear to oscillate) tx.

A

Gabapentin

77
Q

Myasthenia Gravis assoc w/ which tumour

and other AI disorders?

A

Thymomas (15%)

AI disorders: pernicious anaemia, thyroid disorders, RA, SLE.

78
Q

MG Ix.

A

Single fibre EMG: High sensitivity

CT thorax to exclude thymoma

79
Q

MG mx.

A

Pyridostigmine

80
Q

Mx. Myasthenic crisis:

A

Plasmapharesis

IV immunoglobulins

81
Q

Drugs which exacerbate MG:

A 
Penicillamine 
Quinidine, procainamide 
B-blockers
Lithium
Phenytoin
Antibiotics: Gentamicin, macrolides, quinolones, tetracyclines
82
Q

Mx. Narcolepsy

A

Modafinil

Night-time sodium oxybate

83
Q

NF1 fx.

A 
Iris hamartomas (>90%) 
Cafe au lait spots
Axillary or groin freckles
Peripheral neurofibromas 
Phaechromocytomas
84
Q

NF2 fx.

A

Bilateral vestibular schwannomas

multiple intracranial schwannomas, meningiomas and ependyomas

85
Q

As well as atypical antipsychotics which neuro drug may also cause neuroleptic malignant syndrome

A

Levodopa

86
Q

Onset of neuroleptic malignant syndrome after starting antipsychotic

A

hours to days

87
Q

NMS other fx.

A

Raised CK in most cases
AKI (2ry to rhabdomyolysis)
Leukocytosis

88
Q

Mx. Neuroleptic malignant syndrome

A

Dantrolene

Bromocriptine may be used

89
Q

Neuropathic pain which is resistant to medication ->

A

referral to pain clinics

90
Q

NP hydrocephalus triad

Mx.

A

Gait abnormality
urinary incontinence
Dementia and bradyphrenia (slowed thinking and processing of information)

VP shunting

91
Q

Refeeding syndrome metabolic consequences:

A

Hypophosphataemia
Hypokalaemia
Hypomagnesaemia

PKM -
please kill me

92
Q

if pt. has not eaten for >5 days what percentage of energy and protein levels should be re-fed:

prescription of feed:

A

50%

start up to 10 calories/kg/day increasing to full needs over 4-7 days

93
Q

Differentiating drug-induced Parkinson’s from idiopathic Parkinson’s

A

Motor symptoms are generally rapid on-set and bilateral

Rigidity and rest tremor are less common

94
Q

Parkinson’s tx. if symptoms NOT affecting QoL:

A 
Dopamine agonist (non-ergot derived) 
MAO-B inhibitor 
Levodopa
95
Q

If pt. still has symptoms despite optimal levodopa tx. or has developed dyskinesia what should be started:

A

Dopamine agonist or
MAO-B or
COMT

96
Q

Dopamine agonist therapy may result in:

A

impulse control disorders

97
Q

Levodopa side effects:

A

Postural hypotension
Psychosis
dry mouth
anorexia

98
Q

If pts. cannot take levodopa orally for a time, what should they be given:

A

Dopamine agonist PATCH

99
Q

What are ergot derived dopamine agonists and what are they known to cause:

A

Bromocriptine, cabergoline

pulmonary, retroperitoneal and cardiac FIBROSIS

100
Q

Drug induced Parkinson’s causes:

A

Antipsychotics

Metoclopramide

101
Q

Pituitary apoplexy treatment.

A

Urgent steroids replacement due to loss of ACTH
Careful fluid balance
Surgery

102
Q

Post-LP headache mx.

A

Supportive initially:

If pain continues past 3 days: Blood patch, epidural saline, IV CAFFEINE

103
Q

Post-LP headache exacerbating factors

A

Worsens with upright position

Improves on lying down

104
Q

Progressive supranuclear palsy fx.

A

VERTICAL GAZE palsy - down gaze worse than up gaze -pts. complain of difficulty reading or descending stairs

Parkinsonism
Cognitive impairment
Postural instability

105
Q

PSP response to levodopa

A

POOR

106
Q

Factors which favour a true epileptic seizure over psychogenic

A

Raised PROLACTIN

tongue biting

107
Q

Weakened supination of prone hand and elbow flexion nerve palsy:

A

Radial nerve

108
Q

Nerve supplying triceps:

A

Radial nerve

109
Q

Normal ICP:

A

7-15 mmHg

110
Q

Mx. Increased ICP:

A

Ix. and treat underlying cause
Head elevation to 30*
IV mannitol
controlled hyperventilation - reduce CO2 to cause cerebral vasoconstriction

111
Q

Restless leg syndrome tx.

A 
Simple measures - walking, stretching 
treat iron deficiency 
First line is DOPAMINE AGONISTS (ropinirole, pramipexole) 
BZPs
Gabapentin
112
Q

Dose of rectal diazepam for seizures in adults:

A

10-20 mg

113
Q

Sodium valproate MoA:

A

Increases GABA activity

114
Q

Which spinal cord disease does Friedrich’s ataxia present similarly to:

A

Subacute degeneration of the cord

115
Q

Anterior spinal artery occlusion spinal tracts affected:

A

Lateral CST - b/l spastic paresis

Lateral STT - b/l loss of pain and temperature

116
Q

Where is the lesion in internuclear ophthalmoplegia:

A

Medial longitudinal fasciculus

117
Q

Features of internuclear ophthalmoplegia:

A

impaired adduction of the eye on the SAME side of lesion

Horizontal nystagmus of the abducting eye on the contralateral side

118
Q

Intracranial venous thrombosis gold standard investigation:

A

MRI venography

119
Q

Management: intracranial venous thrombosis:

A

Anticoagulation w/ LMWH

120
Q

Lambert-Eaton syndrome tx. drug:

A

3.4-diaminopyridine

121
Q

Lateral medullary syndrome artery infarcted:

A

Posterior inferior cerebellar artery

122
Q

Lateral medullary syndrome (Wallenburg syndrome) fx.:

A

Ataxia, Nystagmus

Dysphagia, facial numbness, cranial nerve palsy
Contralateral: limb sensory loss

123
Q

Motor innervation of median nerve:

A 
LOAF muscles:
Lateral 2 lumbricals 
Opponens pollicis 
Abductor pollicis brevis 
Flexor policis brevis
124
Q

Spontaneous intracranial hypotension - CTD assoc.

Worse when:

A

Marfan’s syndrome

Upright (like post-LP headache)

125
Q

Status epilepticus: seizure termination:

A

Pre-hospital: PR diazepam or buccal midazolam

Hospital: IV lorazepam (may be repeated ONCE after 10-20 minutes)

126
Q

If on-going status what second agent may be started:

A

Phenytoin

127
Q

Weber’s syndrome:

A

Ipsilateral CN III palsy

contralateral weakness of upper and lower extremity

128
Q

Middle cerebral artery stroke:

A

Contralateral hemiparesis and sensory loss (Upper > Lower)
Contralateral homonymous hemianopia
Aphasia

129
Q

Basilar artery stroke:

A

Locked in syndrome

130
Q

Lacunar strokes:
Strong assoc. w/
px.

A

Hypertension

Px. w/ isolated hemiparesis, hemi-sensory loss or hemiparesis w. limb ataxia

131
Q

Stroke - issues to manage:

A 
Fluid management
Glycaemic control 
Blood pressure management 
Feeding assessment and management 
Disability scales
132
Q

Features of stroke more common w/ HAEMORRHAGIC causes:

A

Decreased level of consciousness
Headache
Nausea and vomiting
Seizures

133
Q

TIA mx.

A

Immediate aspirin 300mg

Unless bleeding disorder, already on low dose (75mg) Aspirin

134
Q

TIA assessment if:
Suspected in the last 7 days
Suspected more than a week previously:

A

Assessment w/in 24 hours

Assessment w/in 1 week

135
Q

Stroke mx.

A 
Offer THROMBECTOMY (if available) w/in 6 hours of symptoms on-set 
If > 24 hours thrombectomy may still be indicated if there is potential to salvage brain tissue as shown in MRI
136
Q

Consider thrombectomy w/ thrombolysis if:

A

W/in 4.5 hours

posterior circulation stroke and there is potential to salvage brain tissue

137
Q

Stroke 2ry prevention:

A

CLOPIDOGREL (aspirin plus dipyridamole if CI)

138
Q

Subacute combined degeneration of spinal cord deficits:

A

Dorsal columns and lateral CST affected so
Joint position and vibration sense loss first then distal paraesthesia
UMN signs develop in the legs

139
Q

IF chronic subdural haemorrhage found on CT and pt. px. w/ confusion what is mx.

A

Surgical decompression w/ burr holes

140
Q

What syndrome may present alongside syringomyelia

A

Horner’s syndrome - due to compression of sympathetic chain.

141
Q

Tension headache mx.

A

Acute: Aspirin, paracetamol or NSAID = 1st line
Prophylaxis = 10 sessions of acupuncture of 5-8 weeks
low-dose amitriptyline NOT supported by NICE

142
Q

TIA ix. if indicated

Carotid imaging?

A

CT not done unless clinical suspicion of alternative diagnosis
MRI is preferred to determine the territory of ischaemia or detect haemorrhage.

Urgent carotid artery doppler if emboli suspected

143
Q

What are triptan sensations:

A

tingling, heat tightness (chest, throat), heaviness and pressure

144
Q

Contraindications of triptans:

A

Ischaemic heart disease or cerebrovascular disease

145
Q

Damage of ulnar nerve:

A

wasting of intrinsic hand msucles
wasting of hypothenar muscles

Damage at elbow may result in radial deviation of the wrist

Remember ulnar paradox theory

146
Q

Incongruous defects (defect is not the same in both eyes) =>

A

optic tract lesion

At face-value as per the visual tracts, visual loss will be symmetrical (congruous) more in depth, perhaps due to extent of compression, the defect may be incongruous between the two eyes

147
Q

Congruous defect => (defect same in both eyes)

A

Optic radiation lesion or occipital cortex

148
Q

Ix. for Degenerative cervical myelopathy:

A

MRI spine

plain radiographs will not be sufficient

149
Q

Condition which:
Can complicated facial infection, orbital cellulitis, pharyngitis, and other conditions

Presents w/ fever, ophthalmoplegia, and other eye findings such as peri-orbital swelling over an acute/subacute timeframe

A

Cavernous sinus thrombosis

150
Q

Which syndrome may cause waddling gait due to pelvic girdle weakness:

A

Lambert Eaton Syndrome

*May precede a cancer diagnosis by a number of years

151
Q

Well-defined tumour between brain parenchyma and tumour

A

Meningioma

152
Q

Where does Ondansetron work:

A

CTZ - Medulla oblongata

153
Q

Saturday night palsy causes compression of which nerve:

A

Radial nerve

154
Q

Scale that measures disability or dependence in activities of daily living in STROKE patients

A

Barthel index

155
Q

Absent corneal reflex + PROPTOSIS in a pt. w/ pre-existing nasopharyngeal carcinoma

A

Cavernous sinus syndrome

156
Q

What is located in:

inferior FRONTAL gyrus

A

Broca’s area

157
Q

What is located in:

superior temporal gyrus

A

Wernicke’s

FLASH FINALS (34 decks)

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