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PACES - Final Week Revision > Neurology > Flashcards

Neurology Flashcards

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
Q

Causes of CN 6 palsy

A

Diabetes
Trauma
SOL
Raises intracranial pressure

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26
Q

Argyll Robertson pupil

A

Small (miotic) irregular pupils
Constricts for accommodation but not to light
Caused by diabetes and tertiary syphilis

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27
Q

Holmes Adie pupil

A

Unilateral dilated pupil
Accommodates easily
Sluggish response to light
Anhydrous, hyporeflexia
Middle-aged woman
Caused by viral infection

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28
Q

CN3 palsy description

A

Ptosis
Down & out eye
If mydriatric –> surgical cause, otherwise medical cause.

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29
Q

Causes of Flaccid Paraparesis

A

LMN signs

MND (fasciulations)
Post-Polio syndrome (shortened leg)
Cauda Equina Syndrome (sensory level)
Myasthenia Gravis / Guillain-Barre Synd

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30
Q

Anterior Horn diseases

A

Motor neurone disease - mixed UMN & LMN signs
Post-Polio syndrome - monoparesis with limb hypoplasia and wasting

Sensation will always be normal

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31
Q

Causes of Radiculopathy

A

Dermatomal sensory loss

Disc herniation
Degenerative disc disease
Osteoarthritis

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32
Q

Causes of plexopathy

A

Trauma
Congenital
Neoplastic infiltration

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33
Q

Unilateral facial nerve palsy

A

Bell’s palsy
Ramsay-Hunt syndrome
SOL
Lyme disease

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34
Q

Bilateral facial nerve palsy

A

Bell’s palsy
Guillaume-Barré syndrome
Sarcoidosis
Lyme disease

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35
Q

Myotonic dystrophy differentials

A

Myasthenia gravis
Acquired myopathies (IBM, polymyositis)
Muscular dystrophies

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36
Q

Differentials for Myasthenia gravis

A

Lambert-Eaton syndrome
Miller-Fisher syndrome
Botulism

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37
Q

Précipitants of Myasthenic crisis

A

Infections
Stress
Non-compliance with treatments
Drugs (Verapamil, bisoprolol, tetracyclines)

38
Q

Loss of proprioception

A

B12 deficiency
Syphilis
Guillain-Barre syndrome
Paraneoplastic / Sjogren syndrome

39
Q

Causes of foot drop with LMN signs

A

Sciatic nerve palsy
Common peroneal nerve palsy (from trauma, surgery, mononeuritis multiplex)

40
Q

Spinocerebellar ataxia genetics

A

Autosomal dominant
Trinucleotide CAG repeats
Anticipation phenomenon

41
Q

Miller-Fisher syndrome symptoms and cause

A

Triad:
- Ophthalmoplegia
- Ataxia
- Hyporeflexia
GQ1b antibodies

42
Q

Absent ankle jerks + upgoing plantars

A

Friedrich’s ataxia
SCAD
Syphilis
MND
(But most commonly Peripheral neuropathy combined with a myelo- or myeloradiculopathy)

43
Q

Causes of Miosis

A

Horner syndrome
CN3 palsy
Argyll-Robertson syndrome
Opiates

44
Q

Differentials ulnar nerve palsy

A

C8/T1 radiculopathy
Cubital tunnel syndrome
Guyon’s canal syndrome (cyclist’s wrist)

45
Q

Charcot Marie Tooth syndrome

A

Autosomal dominant but lots of mutations
No disease modifying treatment
Type 1 —> demyelinating

46
Q

Pseudoathetosis

A

Involuntary writhing of the fingers

47
Q

Difference between cerebellar and sensory ataxia

A

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
Q

Causes of sensory ataxia

A

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
Q

Management of non-proliferative diabetic retinopathy

A

Observation
If macular oedema then intravitreal anti-VEGF therapy +/- laser therapy

50
Q

Management of proliferative diabetic retinopathy

A

Urgent pan-retinal photocoagulation

51
Q

Advanced diabetic retinopathy

A

Vitreous haemorrhage
Retinal detachment
Progressive glaucoma

52
Q

Causes of papilloedema

A

SOL or other causes of intracranial hypertension
Optic neuritis
Uveitis (from sarcoidosis, TB)
Malignant hypertension

53
Q

Causes of optic atrophy

A

ICING:
Ischaemia
Compression of the optic nerve
ICP increased
Neuritis
Glaucoma

54
Q

Differentials for motor neurone disease

A

Cervical myelopathy
Syringomyelia
Co-existent upper and lower motor neurone pathology

55
Q

Management of MND

A

MDT approach
Neurologist for Riluzole
Assess respiratory function as at risk of T2RF requiring NIV
Screen for neuropsychiatric symptoms of Lewy Body dementia

56
Q

Brown-Séquard syndrome

A

Ipsilateral paralysis and loss of proprioception
Controlateral loss of pain and temperature

57
Q

Differentials for retinitis pigmentosa

A

Congenital deafness + ataxia —> Usher syndrome
Cardiac arrhythmias + ataxia Kearney-Sayre syndrome
Leber’s optic neuropathy

58
Q

Myasthenia Gravis antibody

A

Anti-Acetylcholine nicotinic receptor antibody at the neuromuscular junction
Anti-MuSK antibody

59
Q

Myasthenia Gravis management

A

MDT approach
Pyridostigmine
Consider IV Ig, plasmapheresis, steroids
Thymectomy
Monitor FVC

60
Q

Difference between Lambert-Eaton syndrome and Myasthenia Gravis

A

Lambert Eaton syndrome:
- voltage-gated calcium channel antibody
- worse in lower limbs
- does not affect eyes/face
Symptoms improve after exercice

61
Q

Different forms of motor neuron disease

A

ALS - mixed UMN/LMN, spastic paraparesis
Primary lateral sclerosis - UMN
Progressive muscular atrophy - LMN signs

62
Q

Friedrich’s ataxia gene mutation

A

Autosomal recessive disease
Frataxin gene on chromosome 13

63
Q

Criteria for MS

A

McDonald’a Criteria - dissemination in time & space

64
Q

Classic features of Multiple sclerosis

A

Uhthoff’s phenomenon - symptoms worse after hot bath/exercise

Lhermitte’a sign - lightening pains in spine on neck flexion

65
Q

Examples of drugs for multiple sclerosis

A

Ocrelizumab
Natalizumab
Glatiramer acetate

66
Q

Can’t get reflexes so you do a … manoeuvre?

A

Reinforcement

67
Q

Non-motor symptoms of Parkinson’s disease

A

Anosmia
Cognitive impairment with mood disorders
REM sleep disturbance
Constipation

68
Q

Side-effects of Levodopa

A

Nausea
On/off phenomenon
Dyskinesia

69
Q

Side-effects of Dopamine Agonists

A

Pramipexole, Ropinirole, Apomorphine pump
Nausea, drowsiness
Impulsivity, compulsivity

70
Q

Speech examination

A

Spontaneous
Dysarthria:
- baby hippopotamus
- west register street
Dysphasia:
- one and two and three step commands
- recognise pen & badge
- no ifs, ands or buts

71
Q

Mutation causing Huntington’s disease

A

Autosomal dominant CAG triplet repeat expansion on chromosome 4

72
Q

Abnormal movements in Huntington’s disease

A

Chorea (large volume, unpredictable, jerky movements)
Hemiballismus (violent, flinging movements)
Atethosis (slow, writhing movements)

73
Q

Medications for Huntington’s disease

A

Tetrabenazine (anti-chorectic)
Baclofen (anti-spasmodic)

74
Q

Differentials for Huntington’s disease

A

SLE
Wilson’s disease
Vascular cause if unilateral chorea

75
Q

Myasthenia Gravis cranial nerves findings (4)

A

Fatigable ptosis
Complex ophathlamoplegia with restricted eye movements and diplopia
Low voice volume, poor swallow
Reduced shoulder abduction

76
Q

Drugs to avoid in Myasthenia Gravis

A

Antibiotics (Cipro, Tetracycline)
Beta-blockers
Lithium

77
Q

Friedrich’s ataxia examination findings

A

Nystagmus
High arched palate
Spastis paraparesis (UMN)
Cerebellar syndrome
Loss of proprioception and vibration

78
Q

Parkinson’s disease - adjuncts to Levodopa

A

Dopamine agonists (ropinorole) —> reduce motor comps
COMT inhibitors (entocapone) —> reduce off time
Apomorphine SC—> rescue therapy for off time

79
Q

Muscles supplied by ulnar nerve

A

Flexor carpi ulnaris
Flexors of the distal phalanx of 4th and 5th finger
All intrinsic muscles of the hand except the thénar éminence

80
Q

Froment’s sign

A

Weakness in thumb addiction elicited by failure to grip a piece of paper

81
Q

Muscles supplied by radial nerve

A

Triceps
Brachioradialis
Supinator
Wrist & finger extensors

82
Q

Causes of radial nerve palsy

A

Trauma to brachial plexus or radial nerve
Saturday night palsy

83
Q

Muscles supplied by median nerve

A

Lateral two limb rivals
Opponens pollicus
Abductor pollicus
Flexor pollicus brevis

84
Q

Causes of common peroneal nerve palsy

A

Trauma
Fibular fracture
Knee surgery
Compression (plaster cast, weight loss)

85
Q

Clinical difference between L5 Radiculopathy and common peroneal nerve palsy?

A

Larger extent of sensory loss

86
Q

Branches of the common peroneal nerve

A

Superficial
Deep

87
Q

Causes of acute peripheral neuropathy

A

Guillain Barre syndrome
Botulism
Acute porphyria

88
Q

Carpal tunnel borders

A

Sup: flexor retinaculum
Radial: pisiform, hamate
Inf: carpal bones
Medial: scaphoid, trapezium

89
Q

Management of carpal tunnel syndrome

A

Treat associated condition
Physio and wrist splint
Steroid injection
Surgery

90
Q

Causes of ulnar neuropathy

A

Supra onduler fracture
Compression
Cubital tunnel syndrome
Mononeuritis multiplex

91
Q

Causes of cervical myelopathy (4)

A

Degenerative (spondylitis)
Trauma
Tumour
TB

92
Q

Differentials for cervical myelopathy

A

MS
MND
SACD

PACES - Final Week Revision (7 decks)

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