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Neurology Flashcards

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1
Q

What is the treatment of Ramsay Hunt syndrome?

A

oral aciclovir and oral corticosteroids are usually given if patient is systemically well

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2
Q

Where is the lesion in Bells palsy?

A

lower motor neuron - do not cause forehead sparing

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3
Q

What are the features of Horner’s syndrome?

A

miosis - small/constricted pupil
ptosis - drooping of upper eyelid
endophthlamos (sunken eye)
anhidrosis (loss of sweating one side)

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4
Q

What is the first-line treatment for absence seizures?

A

ethosuximide

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5
Q

What is the first-line treatment for focal seizures?

A

lamotrigine or levetiracetam

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6
Q

What is the gold standard test for diagnosing venous sinus thrombosis?

A

MR venogram

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7
Q

what is the first line treatment for tonic or atonic seizures?

A

males: sodium valproate
females: lamotrigine

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8
Q

At what GCS level should a patient be intubated?

A

Less than 8

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9
Q

What is the ROSIER tool used for?

A

used to differentiate stroke from stroke mimics

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10
Q

What is the ROSIER tool used for?

A

used to differentiate stroke from stroke mimics

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11
Q

What is the treatment of Bell’s Palsy?

A

prednisolone + eye care

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12
Q

What should be given if you suspect meningitis in children?

A

< 3 months: IV amoxicillin + IV cefotaxime
> 3 months: IV cefotaxime or ceftriaxone
NICE advise against corticosteroids in children younger than 3 months

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13
Q

What are the features of Bell’s Palsy?

A

lower motor neuron facial nerve palsy - forehead affected
post-auricular pain, altered taste, dry eyes, hyperacusis

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14
Q

How can you differentiate between Parkinsons disease dementia and dementia with lewby bodies?

A

PDD = parkinsonian symptoms for at least a year then dementia symptoms
DLB = neuropsychiatric + dementia symptoms for a year then parkinsonism

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15
Q

Which nerve/nerve root is tested with triceps reflex?

A

radial nerve - c7

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16
Q

How does lacunar stroke present?

A

one of the following:
- unilateral weakness and/or sensory deficit of face and arm, arm and leg or all three
- pure sensory stroke
- ataxic hemiparesis

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17
Q

What are the effects of Levodopa in patients with Parkinsons?

A
  • more improvement in motor symptoms
  • more improvement in activities of daily living
  • more motor complications
  • fewer specified adverse effects
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18
Q

What are the features of L5 Nerve root decompression?

A

Sensory loss over the dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

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19
Q

What is the NICE guidance on performing a CT scan within 8 hours of injury?

A

Age 65+
Any history of bleeding or clotting disorders including anticoagulants
Dangerous mechanism of injury
More than 30 mins retrograde amnesia of events immediately before the head injury (?)

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20
Q

What invstigation should be done if you suspect takayusu’s arteritis?

A

ct angiography of the large vesels

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21
Q

What anaesthetic agent would people with myasthenia gravis most likely be resistant to?

A

suxamethonium

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22
Q

what are the features of delirium tremens?

A

symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety
peak incidence of seizures at 36 hours
peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

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23
Q

What is the management of spinal cord compression?

A

high dose oral dexamethasone
urgent oncological assessment for consideration of radiotherapy or surgery - radiotherapy may be indicated in older frail patients

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24
Q

what is the most common medical cause of a third nerve palsy?

A

diabetes

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25
What are the features of Broca's aphasia and what causes it?
Expressive aphasia caused by a lesion in the inferior frontal gyrus - typically supplied by the superior division of the left MCA speech is non-fluent, laboured and halting. Repetition is impaired Comprehension is normal
26
What are the features of Wernicke's aphasia and what causes it?
Due to a lesion in the superior temporal gyrus Typically supplied by the interior division of the left MCA This area 'forms' the speech before 'sending it' to Brocas area The lesion results in sentences that make no sense, word substitution and neologisms but speech remains fluent - 'word salad'
27
What are features of a common peroneal nerve lesion?
characteristic feature is foot drop other features include: - weakness of foot dorsiflexion - weakness of foot eversion - weakness of extensor hallucis longus - sensory loss over dorsum of foot and lower lateral part of leg - wasting of anterior tibial and peroneal muscles
28
what are the features of cubital tunnel syndrome and what nerve is affected?
compression of the ulnar nerve as it passes through the cubital tunnel: - tingling and numbness of the 4th and 5th finger which starts off intermittent and then becomes constant - over time patients may also develop weakness and muscle wasting pain worse on leaning on the affected elbow - over a history of osteoarthritis or prior trauma to the area
29
What is the triad of Wernicke's encephalopathy?
confusion ataxia ophthalmoplegia (weakness or paralysis of eye muscles)
30
What are the features of specific focal seizures?
temporal - automatisms (lip-smacking) - deja vu or jamais vu, emotional disturbance (sudden terror), olfactory, gustatory or auditory hallucinations frontal - motor features such as Jacksonian features, dysphasia or Todd's palsy parietal - sensory symptoms such as tingling and numbness, motor symptoms occipital - visual symptoms such as spots and lines in the visual field
31
what are the signs of motor neuron disease?
fasciculations absence of sensory signs/symptoms mixture of lower motor neuron and upper motor neuron signs wasting of the small hand muscles/tibialis anterior is common
32
what is the typical presentation of vascular dementia?
progressive stepwise deterioration in cognition which usually occurs over a period of several months to years
33
What is Weber's syndrome and how does it present?
infarct in branches of posterior cerebral artery that supply the midbrain presents with ipsilateral CN III palsy - diplopia, ptosis, RAPD, and contralateral weakness of the upper and lower extremity
34
What are the pathological changes seen in Alzheimer's Disease?
macroscopic: widened cerebral atrophy, particularly involving the cortex and hippocampus microscopic: cortical plaques due to deposition of type A bets amyloid protein and neurofibrillary tangles caused by abnormal aggregation of the tau protein biochemical: defecit of acetylcholine
35
what is transient global amnesia?
neurological condition characterised by a temporary but total disruption of both short and long term memory. Episodes typically last a matter of hours before resolving, after which patients usually make a full recovery
36
What is the classic Parkinson's triad?
bradykinesia resting tremor rigidity
37
what are other features of parkinson's?
stooped posture mask-like face depression anosmia sleep distrubances autonomic dysfunction
38
what is the management of parkinson's?
- co-careldopa - dopamine with carbidopa or - co-beneldopa - dopamine with benserazide comt inhibitors e.g. entacapone dopamine agonists e.g. carbegoline moa-inhibs e.g. rasegeline
39
what are the features of MSA?
Parkinsonism Autonomic dysfunction - postural hypotension, constipation, abnormal sweating , sexual dysfunction - erectile dysfunction is early sign cerebellar dysfunction - ataxia
40
what are the features of PSP?
parkinsonism postural instability and falls -> broad-based gait impairment of vertical gaze cognitive impairment - frontal lobe dysfunction
41
what can be given for acute attacks of menieres?
prochlorperazine
42
What is pituitary apoplexy and what can precipitate it?
sudden enlargement of a pituitary tumour secondary to haemorrhage or infarction precipitating factors: hypertension, pregnancy, trauma, anticoagulation
43
What are the features of pituitary apoplexy?
Sudden onset headache similar to that seen in subarachnoid haemorrhage vomiting Neck stiffness Visual field defects: classically bitemporal superior quadrantic defect extraocular nerve palsies features of pituitary insufficiency: hypotension/hyponatraemia secondary to hypoadrenalism
44
when can stopping anti-epileptic medication be considered in someone with epilepsy?
can be considered if seizure free for > 2 years with AEDs being stopped over 2-3 months
45
What are the possible features of a posterior circulation stroke?
involves vertebrobasilar arteries and presents with 1 of the following: - cerebellar or brainstem syndromes - loss of consciousness - isolated homonymous hemianopia
46
what is lateral medullary syndrome?
occlusion of posterior inferior cerebellar artery a.k.a wallenberg's syndrome ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner's contralateral;=: limb sensory loss
47
What antibodies can you test for if you suspect myasthenia gravis?
acetylcholine receptor antibodies - 85% of patients muscle-specific kinase antibodies - 10% of patients LRP4 antibodies - less than 5%
48
what test can be performed to aid diagnosis of myasthenia gravis?
edrophonium test/tensilon test - not used commonly due to risk of cardiac arrhythmias single fibre electromyography - high sensitivity - 92-100% ct thorax to exclude thymoma
49
what drugs can exacerbate myasthenia gravis?
penicillamine quinidine, procainamide beta blockers lithium phenytoinn abx - gent, macrolides, quinolones, tetracyclines
50
What are the features of hereditary sensorimotor neuropathy type I (Charcot-Marie-Tooth)?
autosomal dominant due to defect in PMP-22 gene - codes for myelin features often start at puberty motor symptoms predominate distal muscle wasting, pes cavus, clawed toes foot drop, leg weakness are often the first features
51
How is motor neuron disease diagnosed?
it is a clinical diagnosis, but nerve conduction studies will show normal motor conduction and can help exclude a neuropathy Electromyography shows a reduced number of action potentials with increased amplitude MRI is usually performed to exclude the differential diagnosis of cervical cord compression and myelopathy
52
What are the triggers for migraine?
remember the mnemonic "CHOCOLATE" Chocolate Hangovers Orgasms Cheese, caffeine Oral contraceptive pill Lie ins Alcohol Travel Exercise
53
what is the window for thrombolysis in acute stroke?
within 4.5 hrs of onset of stroke symptoms when haemorrhage has been definitively excluded
54
what are absolute contraindications to thrombolysis?
previous intracranial haemorrhage seizure at onset of stroke intracranial neoplasm stroke or traumatic brain injury in preceding 3 months lumbar puncture in preceding 7 days GI haemorrhage in preceding 3 weeks active bleeding pregnancy oesophageal varices uncontrolled hypertension > 200/120
55
what are relative contraindications to thrombolysis in acute stroke?
concurrent anticoagulation (INR > 7.1) haemorrhagic diathesis - susceptibility to bleed active diabetic haemorrhagic retinopathy suspected intracardiac thrombus major surgery/trauma in preceding 2 weeks
56
what cranial nerves can be affected by an acoustic neuroma and what are the associated features?
VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus V: absent corneal reflex VII: facial palsy
57
what is a pontine haemorrhage?
form of intracerebral haemorrhage which can be caused by long standing hypertension
58
how does a pontine haemorrhage present?
reduced GCS paralysis bilateral small or "Pin point" pupils
59
how are cluster headaches treated acutely?
100% oxygen subcutaneous triptan
60
what is the prophylaxis for cluster headaches
verapamil is the drug of choice
61
obstruction of which vessel causes amaurosis fugax?
retinal artery
62
what is the treatment of myasthenic crisis?
plasmapharesis iv immunoglobulins
63
what is lambert eaton syndrome associated with?
small cell lung cancer and to a lesser extent breast and ovarian cancer
64
what is pathophysiology of lambert eaton and how does this compare to myasthenia gravis?
antibodies directed against presynaptic voltage gated calcium channels in the peripheral nervous system myasthenia is antibodies against post-synaptic terminal
65
what are the features of lambert eaton syndrome?
repeated muscle contractions lead to increased muscle strength - in contrast to myasthenia gravis limb girdle weakness - affects lower limbs first hyporeflexia autonomic symptoms - dry mouth, impotence, difficulty micturating ophthalmoplegia and ptosis not commonly a feature (unlike in myasthenia gravis)
66
what drugs are used for spasticity in MS?
baclofen and gabapentin
67
which artery can be affected in temporal arteritis?
posterior ciliary artery - branch of ophthalmic artery - fundoscopy shows a swollen pale disc and blurred margins - anterior ischaemic optic neuropathy
68
what is the investigation of choice for acoustic neuroma?
MRI of cerebellopontine angle
69
what is the treatment of tonic/atonic seizures?
males: sodium valproate females: lamotrigine
70
what medications can worsen myasthenia gravis?
penicillamine quinidine, procainamide beta-blockers lithium phenytoin antibitoics: gent, macrolides, quinolones, tetracyclines
71
what is normal pressure hydrocephalus?
reversible cause of dementia seen in elderly patients - thought to be secondary to reduced CSF absorption at the arachnoid villi - may be 2ndary to head injury, subarachnoid haemorrhage or meningitis
72
what is the triad of normal pressure hydrocephalus?
urinary incontinence dementia and bradyphrenia gait abnormality
73
what are the features of anterior inferior cerebellar artery stroke/lateral pontine syndrome?
symptoms are similar to wallenberg - ipsilateral facial pain and temperature loss contralateral limb/torso pain and temperature loss ataxia, nystagmus and ipsilateral facial paralysis and deafness
74
what does hypoglossal nerve injury cause?
deviation of tongue towards side of lesion
75
what blood test can be used to differentiate a true seizure and a psuedoseizure?
prolactin - raised following true epileptiform seizures
76
what is benign rolandic epilepsy?
childhood epilepsy that typically occurs between age of 4 and 12 seizures characteristically occur at night seizures are typically partial e.g. paraesthesia affecting the face but 2ndary generalisation may occur i.e. parents may report tonic clonic movements eeg characteristically shows centrotemporal spokes prognosis is excellent, with seizures stopping by adolescence

Medicine (20 decks)

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