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Med School Finals > Neurology > Flashcards

Neurology Flashcards

1
Q

Deep tendon reflexes and their nerve roots?

A

Ankle (S1-S2)
Knee (L3-L4)
Biceps (C5-C6)
Triceps (C7-C8)

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2
Q

Motor (descending) pathways?

A

Pyramidal tracts
→ corticospinal
Extrapyramidal tracts
→ rubrospinal
→ reticulospinal
→ vestibulospinal
→ tectospinal

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3
Q

Function of the motor (descending) pathways?

A

Pyramidal = conscious movement
Extrapyramidal = unconscious movement
→ rubrospinal = flexors and extensors
→ reticulospinal = eye and respiratory muscles
→ vestibulospinal = posture and balance
→ tectospinal = reflex movements

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4
Q

Sensory (ascending) pathways?

A

DCML
Spinocerebellar tracts
Spinothalamic tracts

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5
Q

Function of the sensory (ascending) pathways?

A

DCML = proprioception, fine touch, pressure, vibration
Spinocerebellar = proprioception
Spinothalamic = pain and temperature

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6
Q

Types of stroke?

A

Ischaemic (85%)
Haemorrhagic (15%)

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7
Q

Features of anterior vs middle vs posterior cerebral artery stroke?

A

Anterior = contralateral hemiparesis and sensory loss, lower limbs > upper limbs
Middle = contralateral hemiparesis and sensory loss, lower limbs < upper limbs, contralateral homonymous hemianopia, aphasia
Posterior = contralateral homonymous hemianopia with macular sparing, visual agnosia

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8
Q

Oxford stroke classification assessment criteria?

A
  1. Hemiparesis +/- hemisensory loss
  2. Homonomyous hemianopia
  3. Higher cognitive dysfunction e.g. dysphasia
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9
Q

Oxford stroke classification features of TACI vs PACI?

A

TACI = all 3 features
PACI = 2 features

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10
Q

FAST stroke campaign?

A

Face = is one side droopy? can they smile?
Arms = can they raise them and keep them there?
Speech = is it slurred?
Time = call 999 if there is any of the above

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11
Q

Investigation for suspected stroke?

A

Non-contrast CT head

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12
Q

Acute management options for ischaemic stroke?

A

Thrombolysis (if < 4.5 hours)
Thrombectomy (if < 6 hours)
Aspirin 300mg daily

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13
Q

Long-term management of ischaemic stroke?

A

1st line = clopidogrel
N.B. add anti-hypertensive, statin etc. if needed

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14
Q

Advice for starting anticoagulants for AF post-stroke?

A

Only commence after haemorrhagic stroke excluded and at least 14 days has passed

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15
Q

Transient ischaemic attack (TIA)?

A

Transient neurological dysfunction without acute infarction
Symptoms typically resolve within 1 hour

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16
Q

Investigations for TIA?

A

MRI
Carotid artery doppler

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17
Q

Dysarthria vs dysphasia vs aphasia?

A

Dysarthria = weakness of muscles involved in speech
Dysphasia = partial loss of language
Aphasia = complete loss of language

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18
Q

Where is Broca’s vs Wernicke’s area?

A

Broca’s = frontal lobe
Wernicke’s = temporal

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19
Q

Cause of Wernicke’s aphasia and features?

A

Lesion of the superior temporal gyrus
→ non-sensical speech
→ remains fluent
→ comprehension/insight impaired

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20
Q

Cause of Broca’s aphasia and features?

A

Lesion of the inferior frontal gyrus
→ laboured and halting speech
→ non-fluent
→ repetition is poor
→ comprehension/insight preserved

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21
Q

Cause of conduction aphasia and features?

A

Lesion of the arcuate fasciculus (connection between Wernicke’s → Broca’s)
→ fluent speech
→ repetition is poor
→ comprehension/insight preserved

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22
Q

Red flags of headache?

A

Immunosuppressed
PMH malignancy
Sudden and severe
Age < 20
Neurological deficit
Worse on coughing, sneezing etc.

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23
Q

Features of a migraine?

A

Unilateral or bilateral throbbing pain
N&V, photophobia, phonophobia
Preceding aura e.g. visual change
Can last up to 72 hours

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24
Q

Acute management of a migraine?

A

Triptan + NSAID or paracetamol

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25
Drug options for migraine prophylaxis?
Propanolol Topiramate Amitriptyline
26
Advice for contraception in women with migraines?
COCP absoutely contraindicated
27
Triptan examples, mechanism of action and side effects?
Examples = sumatriptan, zolmitriptan Mechanism of action = 5-HT1 agonists Side effects = tingling, heat, chest tightness
28
Features and management of tension headaches?
Bilateral, band-like pain No aura or associated symptoms May be related to stress Management = aspirin, paracetamol or NSAID
29
Features and management of cluster headaches?
Sharp, stabbing pain around eye Redness, lacrimation, eyelid swelling Clusters usually last 4-12 weeks Management = oxygen + triptan (acute), verapamil (prophylaxis)
30
Investigation for cluster headaches?
MRI with gadolinium contrast
31
Management of trigeminal neuralgia?
Carbamazepine
32
Seizure vs epilepsy?
Seizure = single episode of abnormal electrical activity with many causes e.g. fever, hypoglycaemia Epilepsy = chronic seizure activity
33
Generalised vs focal seizure subtypes?
Generalised → tonic-clonic (grand mal) → myoclonic → absence (petit mal) → atonic Focal → focal aware → focal impaired awareness
34
Management of focal, tonic-clonic, myoclonic, absence and atonic seizures?
Focal = lamotrigine or levetiracetam Tonic-clonic = lamotrigine (female), sodium valproate (male) Myoclonic = levetiracetam (female), sodium valproate (male) Absence = ethosuximide Atonic = lamotrigine (female), sodium valproate (male)
35
DVLA guidance for epilepsy?
- Must surrender licence if has a seizure - Reapply after 6 months if one-off - Reapply after 12 months if more than one - Established epilepsy may qualify if at least 12 months seizure-free - No driving if withdrawing from medication and for 6 months after last dose
36
Status epilepticus?
Seizure lasting > 5 minutes or ≥ 2 seizures within 5 minutes
37
Pre-hospital mangement of status epilepticus?
Rectal diazepam or buccal midazolam
38
Hospital manegement of status epilepticus?
1st line = IV lorazepam 2nd line = IV phenytoin or phenobarbital
39
Features and management of narcolepsy?
Hypersomnolence Cataplexy Sleep paralysis Management = daytime stimulant + nighttime sodium oxybate
40
UMN vs LMN lesion features?
UMN = spastic paresis, hyperreflexia, hypertonia, Babinski +ve LMN = flaccid paralysis, muscle wasting, fasiculations, hyporeflexia, hypotonia
41
MS subtypes?
Relapsing-remitting (~85%) Secondary progressive Primary progressive
42
Features of MS?
Fatigue Optic neuritis Sensory changes Spastic weakness Urinary incontinence
43
Investigations and findings for MS?
MRI → lesions and plaques Lumbar puncture → oligoclonal bands
44
Acute management of MS?
Methylprednisolone for 5 days
45
Disease-modifying drugs for MS?
Natalizumab (1st line) Ocrelizumab (1st line) Fingolimod Beta-interferon Glatiramer acetate
46
Drug options for spasticity?
Baclofen Gabapentin
47
Features and management of of Gullain-Barre syndrome?
Progressive (ascending) weakness of limbs 1-3 weeks post-infection Back pain, leg pain Reduced or absent reflexes Mild sensory changes Management = IV immunoglobulins (1st line), plasmapharesis (2nd line)
48
Lumbar puncture features of Guillain-Barre syndrome?
Raised protein with normal WCC
49
Features and management of MND?
Mixed UMN and LMN signs Limb atrophy and weakness Wasting of small hand muscles Management = riluzole, respiratory support, nutritional support
50
Features and management of myasthenia gravis?
Muscle fatiguability Diplopia Proximal muscle weakness Management = pyridostigimine
51
Investigations for myasthenia gravis?
EMG studies Antibodies to ACh receptors
52
Management of a myasthenic crisis?
IV immunoglobulins Plasmapharesis
53
Condition associated with myasthenia gravis?
Thymoma (~15%)
54
Cerebellar syndrome features?
DANISH → dysdiadochokinesia → ataxia → nystagmus → intention tremor → scanning dysarthria → hypotonia
55
Clonus vs myoclonus?
Clonus = rhythmic movement in response to muscle stretch e.g. testing a reflex Myoclonus = random, jerky movements
56
Features and management of Parkinson's disease?
Bradykinesia Resting tremor (3-5 Hz) Muscle rigidity Loss of facial expression Mental health problems Management = levodopa (motor symptoms prominent), dopamine agonist or MAO-B inhibitor (fewer motor symptoms)
57
Parkinson's disease vs drug-induced Parkinsonism?
Parkinson's = progressive, unilateral, variable symptoms Drug-induced = rapid, bilateral, rigidity and tremor rare
58
Features and management of essential tremor?
Postural Worse with arms outstretched Improves with alcohol and rest Management = propanolol
59
EMG features of a myopathy vs neuropathy?
Myopathy = ↑ action potential duration and ↑ action potential amplitude Neuropathy = ↓ action potential duration and ↓ action potential amplitude
60
Most common hereditary peripheral neuropathy?
Charcot-Marie-Tooth disease
61
Management of neuropathic pain?
1st line = amitriptyline, duloxetine, gabapentin, pregabalin 2nd line = switch to one of other 3 3rd line = pain management team referral N.B. topical capsaicin can be used for localised pain and tramadol can be used as "rescue" medication
62
Features, investigation and management of degenerative cervical myelopathy?
Neck and arm pain Loss of motor and sensory function Urinary incontinence Investigation = MRI cervical spine Management = surgical decompression
63
Features of ulnar nerve (C8-T1) vs radial nerve (C5-T1) vs median nerve (C6-T1) lesion?
Ulnar = "claw hand," hypothenar wasting, sensory loss over dorsal/palmar medial 1 1/2 digits Radial = "wrist drop," sensory loss over dorsal lateral 2 1/2 digits Median nerve = carpal tunnel syndrome, thenar wasting, sensory loss over palmar 2 1/2 digits
64
Features of common peroneal nerve (L4-S2) lesion?
Foot drop Weak extension of big toe Sensory loss on dorsum of foot and lateral lower leg
65
Glasgow Coma Scale (GCS) criteria?
Motor response: 6. Obeys commands 5. Localises to pain 4. Withdraws from pain 3. Abnormal flexion to pain 2. Extending to pain 1. None Verbal response: 5. Orientated 4. Confused 3. Words 2. Sounds 1. None Eye opening: 4. Spontaneous 3. To speech 2. To pain 1. None
66
Cerebral perfusion pressure (CPP) calculation?
CPP = MAP - ICP
67
Normal ICP?
7-15 mmHg
68
Features and management of raised ICP?
Cushing't triad (bradycardia, wide pulse pressure, irregular breathing) Headache Vomiting Papilloedema Reduced consciousness Management = head elevation, IV mannitol, CSF drainage
69
Cause of communicating vs non-communicating hydrocephalus?
Communicating = increased CSF production or impaired reabsorption via arachnoid granules e.g. meningitis Non-communicating = pathology obstructing the flow of CSF e.g. tumour
70
Features and management of normal pressure hydrocephalus?
Weird, wet and wobbly: → dementia → urinary incontinence → ataxic gait Management = V-P shunt
71
Features and management of meningitis?
Headache Fever Neck stiffness Photophobia Reduced consciousness Purpuric rash (meningococcus) Management = IV ceftriaxone + IV amoxicillin + IV aciclovir (if viral suspected)
72
CSF features of bacterial vs viral meningitis?
Bacterial = cloudy, low glucose, high protein, very raised WCC Viral = clear/cloudy, 60-80% plasma glucose, normal/high protein, raised WCC
73
Management of post-lumbar puncture headache?
Supportive e.g. fluids, caffeine If > 72 hours = blood patch, epidural saline, IV caffeine
74
Investigation for suspected TB meningitis?
PCR
75
Management of a brain abscess?
Craniotomy with debridement + IV cephalosporin + IV metronidazole
76
Most common cause and site of encephalitis?
HSV-1 Temporal lobes
77
Features and management of encephalitis?
Acute headache Meningism e.g. photophobia, seizures Sudden behavioural change Management = IV aciclovir + IV broad-spectrum antibiotic
78
UMN vs LMN facial nerve lesion?
UMN spares upper face LMN affects all facial muscles
79
Features and management of Bell's palsy?
Unilateral facial LMN weakness Sparing of extraocular and mastication muscles Postauricular otlagia Management = prednisolone, eye care e.g. artificial tears
80
First line investigation for head trauma?
Non-contrast CT
81
Criteria for CT head < 1 hour?
- GCS < 13 on initial assessment - GCS < 15 at 2 hours post-injury - Suspected open or depressed skull fracture - Any sign of basal skull fracture - Post-traumatic seizure - More than 1 episode of vomiting - Focal neurological deficit
82
Criteria for CT head < 8 hours?
Those with LoC or amnesia plus: - Age 65 years or older - Bleeding or clotting disorders - Anticoagulant use - Dangerous mechanism of injury - More than 30 minutes retrograde amnesia of events immediately before the head injury
83
Classification of primary brain injuries?
Focal (e.g. haematoma) → subdural → epidural → intracerebral Diffuse (e.g. diffuse axonal injury)
84
Herniation vs coning?
Herniation = displacement of brain structures Coning = specifically displacement of the cerebellar tonsils through the foramen magnum
85
CT feature of a subdural vs epidural haematoma?
Subdural = crescent shape Epidural = biconcave/lentiform shape
86
CT feature of an acute vs chronic subdural haematoma?
Acute = hyperdense lesion Chronic = hypodense lesion
87
Origin and management of a subdural haematoma?
Bridging veins Management = supportive (small), decompression with burr holes (large)
88
Origin and management of an epidural (extradural) haematoma?
Middle meningeal artery Management = supportive (small), craniotomy with evacuation (large)
89
Typical history of an epidural haematoma?
Patient with head injury loses consciousness, regains it ("lucid interval"), then loses it again
90
Features and management of a subarachnoid haemorrhage?
"Thunderclap" occipital headache Photophobia, neck stiffness N&V, seizures, coma Management = nimodipine, aneurysm coil or clipping
91
Investigations for subarachnoid haemorrhage?
Non-contrast CT CT < 6 hours and -ve = alternative diagnosis CT > 6 hours and -ve = lumbar puncture
92
CSF features of subarachnoid haemorrhage?
Xanthochromia Normal or raised LP opening pressure
93
Features of subacute combined degeneration of the spinal cord?
Vitamin B12 deficiency Dorsal column disease → impaired sensation, parasthesia Lateral corticospinal tract disease → UMN signs Spinocerebellar disease → gait abnormalities
94
Features of Brown-Sequard syndrome?
Ipsilateral hemiplegia Ipsilateral loss of proprioception/vibration Contralateral loss of pain/temperature sensation
95
Features and management of neuroleptic malignant syndrome?
Fever Muscle rigidity Hypertension, tachycardia Raised CK and WCC Management = stop antipsychotic, IV fluids, dantrolene

Med School Finals (18 decks)

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