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PACES - Final Week Revision > Neurology > Flashcards

Neurology Flashcards

(92 cards)

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1
Q

Bilateral upper motor neuron DD:

A

Disc prolapse
SOL or demyelinating lesion
Motor Neuron Disease (mixed picture)

Spine specific —> Syringomyelia, Cervical myelopathy

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2
Q

Proximal Weakness DD:

A

Drugs (statins, steroids)
Endocrine —> Diabetes, Cushing’s, hypo/hyperthyroidism
Neuromuscular —> Myasthenia Gravis, Lambert-Eaton syndrome
Inflammatory —> IBM, dermatomyositis

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3
Q

Unilateral upper motor neuron DD:

A

Stroke
SOL
Multiple Sclerosis
Disc prolapse

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4
Q

Bilateral lower motor neuron DD (normal sensation):

A

Peripheral neuropathy
Motor Neuron disease
Guillaume-Barré syndrome
CIDP
Myotonic dystrophy
Inclusion-body myositis

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5
Q

Bilateral lower motor neuron DD (with sensory deficits):

A

GBS & CIDP
Alcohol
B12 and thiamine deficiencies
Cancer (anti-Hu) + Charcot-Marie-Tooth
Diabetes + Drugs (Amiodarone, Vincristine)
Every autoimmune thing (RA, PAN, SLE) and a
Few infections (HIV, syphilis)

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6
Q

Proximal leg weakness with distal arm weakness

A

Inclusion-body myositis

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7
Q

Causes of Mononeuritis multiplex

A

Diabetes
Infectious (HIV, Lyme’s disease, syphilis)
Vasculitis (PAN, Wegener’s, Goodpasture’s)
Amyloidosis
Autoimmune (RA, SLE, Sjogren)

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8
Q

Causes of Cerebellar syndrome:

A

Acute onset:
Demyelinating lesion
SOL
Stroke

Progressive onset:
Alcohol
Inherited – Friedreich’s ataxia, spinocerebellar ataxia

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9
Q

Causes of Horner’s syndrome:

A

1st order (central) – MS, SOL, stroke
2nd order (pre-ganglionic) – Pancoast tumour, thyroid goitre
3rd order (post-ganglionic) – carotid artery dissection, cavernous sinus thrombosis

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10
Q

Causes of Carpal tunnel syndrome

A

Local extrinsic pressure, e.g. ganglion, lipoma, fracture, haematoma
Diabetes
Hypothyroidism
Acromegaly
Gout
Rheumatoid arthritis

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11
Q

Causes of pale optic disc (optic atrophy)

A

Glaucoma
Optic neuritis
Ischaemic optic neuropathy from GCA or atherosclerosis
Compression from SOL
Thyroid eye disease

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12
Q

Causes of internuclear ophthalmoplegia

A

Stroke
MS
SOL

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13
Q

Diabetic retinopathy

A

Dot and Blot haemorrhages
Macular oedema
Cottonwool spots, hard exudates
Microaneurysms

If proliferative —> neovascularisation around optic disc

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14
Q

Hypertensive retinopathy

A

Silver wiring
AV nipping
Cotton wool spots
Flame haemorrhages
Papilloedema

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15
Q

Retinitis pigmentosa symptoms & treatment

A

Autosomal dominant
Tunnel vision
Night blindness
Hearing loss

Can give Vitamin A palmitate

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16
Q

Unilateral ptosis

A

Horner’s syndrome
3rd nerve palsy
Myasthenia Gravis

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17
Q

Bilateral ptosis

A

Myasthenia gravis
Myotonic dystrophy
Miller-Fisher variant of GBS

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18
Q

Medication for Motor Neuron Disease

A

Riluzole

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19
Q

Management of Parkinson’s disease

A

Selegiline (MAO-B inhibitor)
Ropinirole (dopamine agonist)
Levodopa

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20
Q

Myotonic dystrophy mutation?

A

Autosomal dominant

Type 1 (distal wasting): Triple repeat expansion of DMPK gene on Chrom 19

Type 2 (proximal wasting & weakness)

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21
Q

Extra-neurological complications of myotonic dystrophy?

A

DM
Cataracts
Subfertility in men (testicular atrophy)
Arrhythmias & cardiomyopathies
OSA
Sensitivity to GA

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22
Q

Functions of the Facial nerve?

A

Raising eyebrows, blinking & closing eyes
Smiling
Lacrimation & salivation
Taste in the anterior ⅔rds of tongue
Stapedius muscle in inner ear

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23
Q

Parkinson’s differentials

A

Idiopathic - asymmetric, Anosmia, REM sleep disturbance
MSA - cerebellar + postural hypotension
PSP - gaze palsy + messy tie
Wilson’s disease - young
Corticobasal degeneration - alien limb, myoclonus

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24
Q

Causes of CN3 palsy

A

Eye down & out + ptosis

Diabetes
SOL, MS
Posterior communicating artery aneurysm

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25
Causes of CN 6 palsy
Diabetes Trauma SOL Raises intracranial pressure
26
Argyll Robertson pupil
Small (miotic) irregular pupils Constricts for accommodation but not to light Caused by diabetes and tertiary syphilis
27
Holmes Adie pupil
Unilateral dilated pupil Accommodates easily Sluggish response to light Anhydrous, hyporeflexia Middle-aged woman Caused by viral infection
28
CN3 palsy description
Ptosis Down & out eye If mydriatric --> surgical cause, otherwise medical cause.
29
Causes of Flaccid Paraparesis
LMN signs MND (fasciulations) Post-Polio syndrome (shortened leg) Cauda Equina Syndrome (sensory level) Myasthenia Gravis / Guillain-Barre Synd
30
Anterior Horn diseases
Motor neurone disease - mixed UMN & LMN signs Post-Polio syndrome - monoparesis with limb hypoplasia and wasting Sensation will always be normal
31
Causes of Radiculopathy
Dermatomal sensory loss Disc herniation Degenerative disc disease Osteoarthritis
32
Causes of plexopathy
Trauma Congenital Neoplastic infiltration
33
Unilateral facial nerve palsy
Bell’s palsy Ramsay-Hunt syndrome SOL Lyme disease
34
Bilateral facial nerve palsy
Bell's palsy Guillaume-Barré syndrome Sarcoidosis Lyme disease
35
Myotonic dystrophy differentials
Myasthenia gravis Acquired myopathies (IBM, polymyositis) Muscular dystrophies
36
Differentials for Myasthenia gravis
Lambert-Eaton syndrome Miller-Fisher syndrome Botulism
37
Précipitants of Myasthenic crisis
Infections Stress Non-compliance with treatments Drugs (Verapamil, bisoprolol, tetracyclines)
38
Loss of proprioception
B12 deficiency Syphilis Guillain-Barre syndrome Paraneoplastic / Sjogren syndrome
39
Causes of foot drop with LMN signs
Sciatic nerve palsy Common peroneal nerve palsy (from trauma, surgery, mononeuritis multiplex)
40
Spinocerebellar ataxia genetics
Autosomal dominant Trinucleotide CAG repeats Anticipation phenomenon
41
Miller-Fisher syndrome symptoms and cause
Triad: - Ophthalmoplegia - Ataxia - Hyporeflexia GQ1b antibodies
42
Absent ankle jerks + upgoing plantars
Friedrich’s ataxia SCAD Syphilis MND (But most commonly Peripheral neuropathy combined with a myelo- or myeloradiculopathy)
43
Causes of Miosis
Horner syndrome CN3 palsy Argyll-Robertson syndrome Opiates
44
Differentials ulnar nerve palsy
C8/T1 radiculopathy Cubital tunnel syndrome Guyon’s canal syndrome (cyclist’s wrist)
45
Charcot Marie Tooth syndrome
Autosomal dominant but lots of mutations No disease modifying treatment Type 1 —> demyelinating
46
Pseudoathetosis
Involuntary writhing of the fingers
47
Difference between cerebellar and sensory ataxia
Cerebellar will have eye signs and staccato speech Sensory only have past-pointing with eyes closed Sensory have pseudoathetosis, impaired proprioception & vibration Sensory will have everything worse with eyes closed
48
Causes of sensory ataxia
Central: - dorsal column damage from B12 deficiency or tabes dorsalis - subacute degeneration of the cord - demyelinating lesion Peripheral: - large fibre neuropathy (DM, alcohol, B12 def)
49
Management of non-proliferative diabetic retinopathy
Observation If macular oedema then intravitreal anti-VEGF therapy +/- laser therapy
50
Management of proliferative diabetic retinopathy
Urgent pan-retinal photocoagulation
51
Advanced diabetic retinopathy
Vitreous haemorrhage Retinal detachment Progressive glaucoma
52
Causes of papilloedema
SOL or other causes of intracranial hypertension Optic neuritis Uveitis (from sarcoidosis, TB) Malignant hypertension
53
Causes of optic atrophy
ICING: Ischaemia Compression of the optic nerve ICP increased Neuritis Glaucoma
54
Differentials for motor neurone disease
Cervical myelopathy Syringomyelia Co-existent upper and lower motor neurone pathology
55
Management of MND
MDT approach Neurologist for Riluzole Assess respiratory function as at risk of T2RF requiring NIV Screen for neuropsychiatric symptoms of Lewy Body dementia
56
Brown-Séquard syndrome
Ipsilateral paralysis and loss of proprioception Controlateral loss of pain and temperature
57
Differentials for retinitis pigmentosa
Congenital deafness + ataxia —> Usher syndrome Cardiac arrhythmias + ataxia Kearney-Sayre syndrome Leber’s optic neuropathy
58
Myasthenia Gravis antibody
Anti-Acetylcholine nicotinic receptor antibody at the neuromuscular junction Anti-MuSK antibody
59
Myasthenia Gravis management
MDT approach Pyridostigmine Consider IV Ig, plasmapheresis, steroids Thymectomy Monitor FVC
60
Difference between Lambert-Eaton syndrome and Myasthenia Gravis
Lambert Eaton syndrome: - voltage-gated calcium channel antibody - worse in lower limbs - does not affect eyes/face Symptoms improve after exercice
61
Different forms of motor neuron disease
ALS - mixed UMN/LMN, spastic paraparesis Primary lateral sclerosis - UMN Progressive muscular atrophy - LMN signs
62
Friedrich’s ataxia gene mutation
Autosomal recessive disease Frataxin gene on chromosome 13
63
Criteria for MS
McDonald’a Criteria - dissemination in time & space
64
Classic features of Multiple sclerosis
Uhthoff’s phenomenon - symptoms worse after hot bath/exercise Lhermitte’a sign - lightening pains in spine on neck flexion
65
Examples of drugs for multiple sclerosis
Ocrelizumab Natalizumab Glatiramer acetate
66
Can’t get reflexes so you do a … manoeuvre?
Reinforcement
67
Non-motor symptoms of Parkinson’s disease
Anosmia Cognitive impairment with mood disorders REM sleep disturbance Constipation
68
Side-effects of Levodopa
Nausea On/off phenomenon Dyskinesia
69
Side-effects of Dopamine Agonists
Pramipexole, Ropinirole, Apomorphine pump Nausea, drowsiness Impulsivity, compulsivity
70
Speech examination
Spontaneous Dysarthria: - baby hippopotamus - west register street Dysphasia: - one and two and three step commands - recognise pen & badge - no ifs, ands or buts
71
Mutation causing Huntington's disease
Autosomal dominant CAG triplet repeat expansion on chromosome 4
72
Abnormal movements in Huntington's disease
Chorea (large volume, unpredictable, jerky movements) Hemiballismus (violent, flinging movements) Atethosis (slow, writhing movements)
73
Medications for Huntington's disease
Tetrabenazine (anti-chorectic) Baclofen (anti-spasmodic)
74
Differentials for Huntington's disease
SLE Wilson's disease Vascular cause if unilateral chorea
75
Myasthenia Gravis cranial nerves findings (4)
Fatigable ptosis Complex ophathlamoplegia with restricted eye movements and diplopia Low voice volume, poor swallow Reduced shoulder abduction
76
Drugs to avoid in Myasthenia Gravis
Antibiotics (Cipro, Tetracycline) Beta-blockers Lithium
77
Friedrich's ataxia examination findings
Nystagmus High arched palate Spastis paraparesis (UMN) Cerebellar syndrome Loss of proprioception and vibration
78
Parkinson’s disease - adjuncts to Levodopa
Dopamine agonists (ropinorole) —> reduce motor comps COMT inhibitors (entocapone) —> reduce off time Apomorphine SC—> rescue therapy for off time
79
Muscles supplied by ulnar nerve
Flexor carpi ulnaris Flexors of the distal phalanx of 4th and 5th finger All intrinsic muscles of the hand except the thénar éminence
80
Froment’s sign
Weakness in thumb addiction elicited by failure to grip a piece of paper
81
Muscles supplied by radial nerve
Triceps Brachioradialis Supinator Wrist & finger extensors
82
Causes of radial nerve palsy
Trauma to brachial plexus or radial nerve Saturday night palsy
83
Muscles supplied by median nerve
Lateral two limb rivals Opponens pollicus Abductor pollicus Flexor pollicus brevis
84
Causes of common peroneal nerve palsy
Trauma Fibular fracture Knee surgery Compression (plaster cast, weight loss)
85
Clinical difference between L5 Radiculopathy and common peroneal nerve palsy?
Larger extent of sensory loss
86
Branches of the common peroneal nerve
Superficial Deep
87
Causes of acute peripheral neuropathy
Guillain Barre syndrome Botulism Acute porphyria
88
Carpal tunnel borders
Sup: flexor retinaculum Radial: pisiform, hamate Inf: carpal bones Medial: scaphoid, trapezium
89
Management of carpal tunnel syndrome
Treat associated condition Physio and wrist splint Steroid injection Surgery
90
Causes of ulnar neuropathy
Supra onduler fracture Compression Cubital tunnel syndrome Mononeuritis multiplex
91
Causes of cervical myelopathy (4)
Degenerative (spondylitis) Trauma Tumour TB
92
Differentials for cervical myelopathy
MS MND SACD

PACES - Final Week Revision (7 decks)

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