Neurology Flashcards

1
Q

Differentiate carpal tunnely syndrome from pronatory syndrome

A

Palmar cutaneous branch. Splits off before carpal tunnel and goes above flexor retinaculum

In CTS, lateral pal spared

In pronator syndrome, lateral palm involved

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2
Q

Rapidly progressive dementia associate with myoclonus

A

CJD

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3
Q

Adies pupil

A

Loss of parasympathetic consrictors of pupil

Different from CN III lesion where opthalmoplegia occur

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4
Q

Management of IIH

A

1st line weight loss
2nd - medical (acezetolamide, topiramate)

3rd - surgery

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5
Q

CSF changes in Alzheimer’s

Earliest signs of pre-clinical Alzheimer’s disease

A

Early - Low CSF AB peptide 42

Next - High CSF Tau

High PET amyloid tracer retention

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6
Q

Imaging changes for Alzheimers

  • MRI
A
  • MRI - hippocampal atrophy
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7
Q

Which primary headache type can you use botulinum toxin in?

A

Chronic migraine (16-30 days of headache per month)

Use 2nd line

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8
Q

Most common ongoing outcome of Wernicke’s

A

Amnestic memory loss i.e Korsakoff’s syndrome

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9
Q

DDx of bilateral temporal lobe MRI changes

A

Infection

Inflammation - Limbic encephalitis (paraneoplastic or autoimmune)

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10
Q

Rx of serotonin syndrome

A

Cyproheptadine

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11
Q

Rx of NMS

A

Bromocriptine

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12
Q

Signs and Rx of malignant hyperthermia

A

Fever, hypcarbia, rigidity after volatile induction anaesthetic

Rx - dantrolene (direct muscle relaxant)

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13
Q

Which side of brain are speech centres?

A

Usually L - Left dominance

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14
Q

Another name for essential tremor

A

Benign familial tremor

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15
Q

Management of psychosis in Parkinson’s

A

Withdraw Parkinson’s meds in order of least effective (anticholinergics first)

Rx - quetiapine, clozapine

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16
Q

Treatment of CVST

A

LWMH/heparin

Aim for therapeutic anticoagulation for 3-6 months

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17
Q

Main risk factors for CVST

A

Pregnancy/puepuerium

COCP use

Malignancy

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18
Q

Treatment of eclampsia - features of hypermagnesiaemia

A

Loss of deep tendon refexes –> hypermagnesaemia

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19
Q

Episodic vertigo/ataxia
Interstitial keratitis
Oscilopsia (sensation of unstable vision

A

Cogan syndrome

Treat with pred and DMARDs - MTX

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20
Q

Hemiballismus. Lesion where?

A

Subthalamic nucleus

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21
Q

Components of basal ganglia

A

Striatum - caudata/putamen
Globus pallidus
Subthalamic nucleus
Substantia nigra - pars compact (Da) and parts reticulata (GABA)

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22
Q

Trauma, neck pain, headache, horner’s syndrome

A

Carotid artery dissection

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23
Q

Rhomberg test -positive and negative results intepretation

A

Positive - ataxia due to sensory loss (proprioception)

Negative - ataxia due to cerebellar cause

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24
Q

Endolymphatic hydrops

A

Menierre disease

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25
Q

Rinne and Weber

A

Rinne - tunin fork on mastoid and next to ear. Normal is air > bone

Weber - if Rinne abnormal, can distinguish conductive vs sensironeural. cOnductive localises bad ear, sensironeural localises good ear

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26
Q

Parkinsonism
Postural instability/frequent falls

A

PSP

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27
Q

Parkinsonism
Asymmetric
Alien limb phenomenon
Athetosis, chorea

A

Corticobasal degeneration

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28
Q

Parkinsonism
Predominant autonomic symptoms

A

MSA

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29
Q

Features of prodromal PD

A

RBD
Hyposmia
Anxiety

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30
Q

Significance of RBD

A

50% will develop synucleopathy - iPD, MSA

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31
Q

GBA1 gene
- heterozygous - increased risk?
- homozygous - increased risk?

A

Heterozygous - 10% Parkinsons’

Homozygous - Gaucher disease

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32
Q

A/e of ergot Da agonists (hence not used)

A

Valvulopathy
Raynaud’s
Erythromelalgia
Pulmonary fibrosis
Retroperitoneal fibrosis

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33
Q

COM-T - what is it and benefit of blocking

A

Degrades dopamine

Entacapone blocks COM-T, so reduces rate of breakdown of Da (and therefore L-dopa), potentiating effect (increasing half-life. Good for wearing off periods

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34
Q

Treatment of REM sleep behaviour disorder

A

Clonazepam

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35
Q

Risk of starting Da agonists

A

Impulse control disorders
- Pathological gambling
- Hypersexuality
- Compulsive shopping, bing eating

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36
Q

Repetitive sterotype movements in patient with Parkinson’s on treatment

Name?
Cause?

A

Punding

Feature of dopamine dysregulation syndrome, due to Da agonists

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37
Q

Management of off periods

A

Add entacapone
Add amandatadine
Add Da agonist
Increase L-dopa dose or frequency

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38
Q

Which Parkinson medication has anticholinergic activity

A

Amantadine

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39
Q

Gene for Wilson’s

A

ATP7B
- homozygote - confirms diagnosis
- heterozygote - confirms, most patients are compound heterozygotes

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40
Q

Neurological manifestations in Wilson’s in terms of frequency

A

Dysarthria - most common
Dystonia
Tremor
Parkinsonism

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41
Q

Diagnostic approach to Wilson’s

A

Caeroplasmin low, 24 urinary copper excretion high, Kayser fleischer rings confirm diagnosis

Any one of above not present - obtain liver biopsy or ATP7B gene testing to confirm

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42
Q

Oral disease modifying therapy for MS

A

Fingolimod
Teriflunomide
Dimethyl fumarate

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43
Q

MoA fingolimod

A

Decreases ability of lymphocytes to enter CNS by preventing lymphocytes leaving lymphatic tissue

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44
Q

A/E of fingolimod

A

Bradycardia and heart block
Overwhelming hsv

Downregulates spingosine 1 phosphate receptor subtypes

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45
Q

MoA of teriflunomide

A

Inhibits pyrimidine synthesis

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46
Q

NMOSD
- Name
- Cell involved

A

Neuromyelitis optica spectrum disorder

Astrocytes

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47
Q

APQ4 antibody

A

NMOSD

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48
Q

NMOSD mimicker:
- Classic clinical presentations

A

Bilateral/rapidly sequential optic neuritis

Tranverse myelitis (often > 3 segments)

Area postrema syndrome -Intractabile hiccups, nausea

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49
Q

NMOSD diagnosis

A

Clinical features (3)

APQ4 antibody

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50
Q

MOGAD disease presentation

A

ADEM in children
- Confusion
- Demyelination - weaness, numbness, bladder/bowel changes

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51
Q

MOGAD Ab

A

Myelin oligodendrocyte gylcoprotein associated Ab (MOGAD)

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52
Q

MS in pregnancy

A

Can use GIN
- glatiramer, inteferon, nataluzimab.

Aim for quiscient disease. Pregnancy is protective for MS relapse so can w/h altogether

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53
Q

Oftatumumab

A

Anti-CD20 for MS

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54
Q

Dominant lobe
- Side
- Symptoms

A

Left usually (for R hand people)

Aphasia - Broca’s and Wernicke’s

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55
Q

Non-dominant lobe
- Side
- Symptoms

A

R usually

Neglect, homonomous heminopia

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56
Q

Gerstman syndrome
- Location

A

Inferior angular gyrus parietal lobe dominant side

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57
Q

L PCA syndrome
- Normal
- Gerstmand

A

Normal - Alexia (reading issue), but no agraphia

Gerstman - Agraphia, (issue with writing), acaculia, Agnosia, L-R disorientation

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58
Q

L vs R PCA syndrome
- Similar
- Different

A

Both can have homonomous heminopia with macular sparing

L - Alexia without agraphia, Gerstman

R - more likely to have neglect

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59
Q

Blind but denies blindness
- Name?
- Cause

A

Anton syndrome

Bilateral PCA artery

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60
Q

Decreased conscious state
Gaze palsy
Dilated pupils

A

Top of the basilar stroke

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61
Q

Locked in syndrome - site of lesion?

A

Pons infarction - proximal basilar artery

62
Q

Basilar artery
- Proximal pathology
- Distal pathology

A

Proximal = pons/medullar junction. Get bulbar dysfunction, locked in syndrome, herald weakness

Distal = midbrain pons. Get LoC and gaze palsies. (“top of basilar)

63
Q

Most common residual effect of Wernicke’s encephalopathy

A

Amneistic memory loss - Korsakoff syndrome, memory loss can persist in 80% of patients after recocery

64
Q

Preventative stroke therapy for non-cardioembolic stroke
- Acute stroke NIHSS > 5
- TIA or NIHSS < 5 stroke
- Low ris TIA

A

Acute stroke NIHS > 5 or low risk TIA - aspirin

High RISK TIA or small stroke NIHSS < 5 - DAPT 21 days, clopi monotherapy

65
Q

Pyrodoxine deficiency
- Deficiency causes?
- Common cause

A

Required for GABA synthesis

Deficiency can cause seizures, peripheral neuropathy

Common cause isoniazid use - Give concomittant B6

66
Q

1st line for generalised seizures

A

Valproate

If child-bearing - lamotrigine

67
Q

First line for focal seizures

A

CBZ

68
Q

First line for absence seizures (generalised)

A

Ethosuximide

69
Q

ANti-epileptics acting on GABA

A

PTV B to GABA
Phenobarbitol
Tigabine
Vigabitrin
BZD

70
Q

Ca Channel anti-epileptics

A

Ca Channels - Ethosuximide

Alpha 2 delta subunit - pregabalin, gabapentin

71
Q

Synaptic vesicle 2A

A

leviteracetam

72
Q

NMDA receptor antagonist

A

Perampanel

73
Q

A/E leviteracetam

A

Psychiatric - mood, irritability, suicidality

74
Q

A/E of perampenl

A

Weight gain
Hostility

75
Q

Antiepileptic causing weight loss

A

Topiramte

76
Q

Options for pregnant women epilepsy

A

Lamotrigine, leviteracetam

77
Q

Phenytoin decreased absoprtion with?

A

Enteral feeds

78
Q

Anti-epileptic most likely to cause weight gain

A

Valproate

79
Q

Seizures with CTB showing calcified cysts

A

Neurcysterocosis
- Calcified cysts - late stage, AED only
- Non-calcified cysts - albendazole and praziquantel

80
Q

4 principles of MG therapy

A

Symptomatic - acetylcholinesterase inhibitor (pyridostigmine)

Immunomdulator therapy

Thymemectomy

Rescue for crisis - IVIG, PLEX

81
Q

MusK Ab positive MG - Rx?

A

Rituximab

82
Q

Indications for thymemectomy

A

MG + thymoma
MG + ACHr Ab positive + inadequate response to immunotherapy

83
Q

Pathophys of LEMS

A

VGc Ab

84
Q

EMG difference of LEMS and MG

A

LEMS - repeat high frequency stimulation causes high amplitude

MG - low amplitude with repeated stimulation

85
Q

Management of LEMS

A

3.4 DAP (diaminopyrmidine) - K channel blocker

86
Q

Severe shouder pain, with subsequent weaness/wasting around shoulder girlde

A

Brachial neuritis

Often post inefction/vaccination

87
Q

Pain, numbness, weakness in arm on raising arm above head or repeated exertion
- ?cause
- Common aetiology

A

Neurogenic thoracic outlet syndrome - compression of NV bundle between 1st rib and clavicle.

Common cause - cervical rib

88
Q

Deep tendon reflex - where is sensory receptor

A

Muscle spindle - stretch receptor in muscle that is stimulated with stretching of tendon

89
Q

Pre-ganglionic autonomic nerve fibre type

A

B

90
Q

Post-ganglionic autonomic nerve fibre type

A

C

91
Q

Nerve fibre for warm temperature

A

C - opposite of cold

92
Q

Nerve fibres for motor, proprioception/vibration

A

Aa - large fibre,large myelin
- Motor, vibration/proprioception

93
Q

Ad fibres?

A

Small, minimally myelinated
- Cold temperature, pain

94
Q

What are positive sensory symptoms?
- more common in acquired or hereditary

A

Prickling, paresthesias

More common in acquired peripheral neuropathy

95
Q

CIDP
- Ab’s indicating nodal/paranodopathy
- Rx?

A

Neurofascin AB’s
Contactin 1

Both IgG4

Treat with rituximab

96
Q

Charcot Marie tooth inheritance and gene

A

Autosomal dominant
Type 1 is PMP22

97
Q

Sensory and Motor symptoms
Foot deformities - Pes planus (flat), pes cavus (high arch)

Foot drop, pseudohypertrophy calves

A

Charcot Marie Tooth
= Herediatry and Sensory Motor neuropathy

98
Q

Episodes of isolated peripheral nerve palsy. Usually nerves susceptible to compression
- Cause?
- Genetics

A

Hereditary neuropathy with liability to pressure palsy (HNLPP)

Allele of PMP22 (Charcot Marie Tooth form)

99
Q

Sensory symptoms
- Worsen with closing eyes (sensory ataxia)
- Associatd with pseudoathetoid movements (moving fingers like playing piano)

Cause?
Location of lesion

A

Paraneoplastic sensory neuropathy

Involving DRG

99
Q

Sensory symptoms
- Worsen with closing eyes (sensory ataxia)
- Associatd with pseudoathetoid movements (moving fingers like playing piano)

Cause?
Location of lesion

A

Paraneoplastic sensory neuropathy

Involving DRG

99
Q

Sensory symptoms, usually level
Motor symptoms - paraparesis
Autonomic symptoms - bladder, bowel dysfunction

Acute or Subacute

A

Transverse myelitis

Need MRI-spine to exclude compressive cause

100
Q

Corticospinal tract which part of internal capsule?

A

Posterior limb

101
Q

Where do following pathways decussate?
- Corticospinal
- DCMLN
- ST

A

Corticospinal (pyramid) - medulla

DCMLN - medulla

ST - 1-2 levels above spinal cord exit

102
Q

Differentiate central cord syndrome and anterior cord

Simalarities

A

Anterior cord - has autonomic dysfunction, and preference of upper and lower limb weakness

Central Cord - rarely autonomic dysfunction. UL >LL for weakness. Hyperreflexia below lesion early

Both have preserveation of vibration/proprioception (dorsal columns)

103
Q

Brown Sequard
- Patter of neurological loss - ipsilateral and contralteral?

A

Ipsilateral motor and vibration/proprioception

Contralteral pain/temperature (ST decussates 1-2 levels above)

104
Q

Posterior cord features
Intermittent Shooting pains

A

Tabes Dorsalis - Neurosyphilis

105
Q

LMN findings at spinal level only, no sensory
- type of disease
- cause

A

Anterior horn cell disease

Cause - Polio

106
Q

Complete spinal cord lesion

A

Spasticity and paresis below level of lesion

Loss of all sensory modalities

Loss of autonomic function - bowel, bladder, erectile dysfunction

(similar to transverse myelitis)

107
Q

Radial nerve palsies features
- Arm
- deep forearm (below elbow)
- Superficial forearm

A

Arm = spiral groove. Sensory loss and wrist drop

Splits below elbow:
- Posterior interosseus (deep forearm) - weakness extensors of hand, wrist spared a extensor carpi radialis get inmrvaton at elbow

Superficial radial - sensory only, no motor weakness

108
Q

Weakness of extensors of hands
No sensory changes

A

Posterior interosseus palsy
- Fracture/dislocation radius
- Entrapment arcade of Frohse

109
Q

Loss of sensation dorsum of hand, no wrist extensor weakness

A

Superficial radial nerve injury
- laceration to forearm

110
Q

Median nerve injury at elbow (pronator teres syndrome) vs in forearm (AIN palsy)

A

Elbow - supracondylar fracture. = loss of LOAF muscles, forearm pronation, finger extension, Sensory deficit lateral 3 1/2 digits

AIN - can’t pinch finger/thumb together. No senssory loss.

111
Q

Carpal Tunnel vs laceration above palmar branch division

A

Carpal tunnel - sensory thenareminence spare

Above palmar branch division (wrist) - involves thenar eminence

112
Q

Ulnar paradox

A

Ulnar lesion at elbow - long flexors also affected, so claw is more mild (DIP’s can’t flex due to loss of FDP)

Ulnar at wrist - long flexors preserved, so more pronounced DIP flexion from FDP

113
Q

Cranial nerve 3 palsy
- Pupillary sparing (normal miosis (parasympathetics)

A

Diabetic mononeuritis multiplex

114
Q

Function of trochlear nerve

A

SO
- Downward movement when adducted
- Intorsion when abducted

115
Q

Isolated CN VI palsy - what case to be mindful of?

A

Elevated ICP - can be false localising sign

116
Q

Structures cerebellopontine angle

A

CN V, VI, VII, VIII

CN V in more extensive lesions

117
Q

Cranial nerves cavernous sinus

A

III, IV, V1, V2, VI and sympathetics

118
Q

Cranial nerves foramen magnum

A

CN 9,10,11,12

119
Q

Pons gaze centres
- sequence

A

Contralateral Eye field –> PPRF –> 6 –> crossover via MLF to 3 –> eye

120
Q

Can’t recognise faces

A

Propasognosia

R PCA

121
Q

Apraxia
- What is it
- Which hemisphere

A

Difficulty performing tasks that require some complex planning - e.g constructional, dressing aprexia

Non-dominant

122
Q

Operculum - consists of

A

Frontal, temporal and parietal lobe junction

Covers the insula

123
Q

Prompting to get out of bed, eat:
- Sign?
- Cause?

A

Abulia

Frontal cortical stroke (ACA)

124
Q

Pyramidal weakness

A

Extensors UL
Flexors LL

Think back of body

125
Q

What detects and initaites deep tendon reflex

A

Muscle spindles

126
Q

Treatment options for essential tremor

A

Propanolol

Primidone (antiseizure medication metabolised to phenobarbitol, beware CYP interactions

127
Q

Ab for Miller Fisher syndrome

A

GQ1b

128
Q

GQ1B syndromes - simialr features

Variants and separating features

A

Opthalmoplegia, Ataxia

MFS - areflexia
Bickerstaff encephalitis - encephalopathy
Pharyngeal/cervical - bulbar dysfunction

129
Q

When to treated GQ1b syndromes

A

Lower limb weakness

Bulbar or respiratory involvement

130
Q

Rapid onset vertigo
Nausea/vomitting
Gait instability but can still ambulate

A

Vestibular neuritis

131
Q

Midline cerebellar features

A

Think middle
- Truncal ataxia - swaying of head/trunk when sitting
- Titubation - involuntary nodding of head/neck/trunk
- Gait ataxia with tendency to fall

132
Q

Hemipshere cerebellar features

A

Think peripheral
- Dysdiadochonesis
- Dysmetria UL
- Intention tremor
- Limb ataxia

133
Q

Diagnostic approach to GBS

A

Typical symptoms?
- LP –> high protein, normal WCC –> confirms diagnosis

Atypical symptoms or non-diagnostic LP –> NCS/EMG

134
Q

Cause of lateral medulalry syndrome

A

Vertebral artery infarct

135
Q

Cause of medial medullary syndrome

A

Vertebral artery or basilar artery infarct

136
Q

Headache, vomitting, cerebellar signs
Decreased LoC
Stupor

Which vessel?

A

PICA

causing cerebellar infarction and mass effect

137
Q

PML treatment for natazilumab

A

Stop natazilumab

Steroids if develop IRIS after withdrawal

138
Q

Hummingbird sign MRI

A

PSP

139
Q

A/E of amantadine

A

antichoinergic like activity

140
Q

Moa of triptan release

A

Inhibits CRGP release (associated with migraine)

141
Q

Type 1 muscle fibres

A

Slow, aerobic, fatigue resistance

High mitochondria, capillaries, myoglobin (for O2)

Low gylcogen

142
Q

Type 2 muscle fibres - features

A

Fast

High glyocgen –> anaerobic

143
Q

Dissemination in space for MS

A

2 MRI lesions

144
Q

Dissemination in time for MS

A

MRI
- new lesion
- x2 lesions, one enhancing other note
- Further clinical attack
- Oligoclonal bands

145
Q

Inferior qunadrantopia only

A

Occiptal lobe - cuneus

146
Q

Important mimicker for meningitis involving VZV

A

Herpes opthalmicus - V1 (opthalmic branch of trigeminal)

147
Q

Which radiculopathy are reflexes usually preserved?

A

L5

Most others have hyporeflexia

148
Q

Anti-psychotic with highest risk of seizure

A

Clozapine

149
Q

Findings that a NCS can demonstrate

A

Axonal degeneration

Demyelination

Conduction block