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neurology Flashcards

1
Q

best investigation for VZV?

A

viral PCR - can quickly detect DNA

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2
Q

list the causes of tension headaches

A

depression, lack of sleep, missed meals, stress
- NOT dehydration

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3
Q

what is the treatment for Guillian-Barre syndrome?

A
  • IV immunoglobulins - contains antibodies which help prevent harmful antibodies damage your nerves
  • plasma exchange
  • supportive care
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4
Q

what medication is given to control chorea?

A

risperidone is a dopamine receptor antagonist that helps manage aggression and chorea, it is in the antipsychotic drug class

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5
Q

give 4 signs of upper motor neurone disease

A

babinski reflex, increased muscle tone, muscle weakness, overactive reflexes

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6
Q

give 4 signs of lower motor neurone disease

A

fasciculations, decreased muscle tone, muscle weakness, underactive reflexes

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7
Q

list 4 causative organisms of meningitis

A
  • listeria monocytogenes,
  • neisseria meningitis,
  • strep agalactiae,
  • strep pneumonia - most common
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8
Q

1st line treatment for a migraine?

A

NSAIDs!

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9
Q

an extradural haemorrhage is caused by a rupture of what artery?

A

middle meningeal artery

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10
Q

a subarachnoid haemorrhage is caused by a rupture of what?

A

berry aneurysm not following a head injury

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11
Q

will a subdural haemorrhage have a lucid period?

A

no

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12
Q

what does a subdural haemorrhage look like on a CT?

A

crescent shaped

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13
Q

what does a extradural haemorrhage look like on a CT?

A

lemon shaped

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14
Q

what is the first line investigation of meningitis?

A

blood cultures

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15
Q

what would bacterial cause of meningitis show on CSF?

A

cloudy appearance, increased neutrophils, increased protein levels, decreased glucose

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16
Q

prophylaxis for meningitis?

A

oral ciprofloxacin

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17
Q

What is the medical term for a feeling of a curtain coming down on eyes?

A

amaurosis fugax

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18
Q

what would temporal arteritis show on biopsy?

A

multinucleated giant cells

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19
Q

what danger is possible after sudden stop in taking prednisolone?

A

adrenal crisis

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20
Q

typical history of giant cell arteritis?

A

unilateral headache, tiredness in jaw on eating, pain in scalp, weight loss

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21
Q

typical presentation of a cluster headache?

A

severe unilateral, present around orbits, blood shot eye and ptosis on affected side

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22
Q

5 features on examination of a cluster headache?

A
  • blood shot eye on affected side
  • ptosis
  • rhinorrhoea
  • lid swelling
  • lactrimation
  • miosis
  • sweating
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23
Q

what is the acute treatment of a cluster headache?

A

100% O2 and SC sumatriptan

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24
Q

what is the long term prophylaxis of cluster headaches?

A

CCB e.g. verapamil

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25
Q

define encephalitis

A

inflammation of the brain usually caused by viral infection

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26
Q

What is the most common infective cause of encephalitis in immunocompetent patients?

A

herpes simplex virus

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27
Q

What would be the diagnostic investigation in a patient with encephalitis?

A

LP with CSF viral PCR testing

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28
Q

What would be the route and treatment provided for encephalitis?

A

IV acyclovir

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29
Q

What would your immediate medical management be of a migraine?

A

combination therapy with an oral triptan (sumatriptan) and an NSAID, or an oral triptan and paracetamol

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30
Q

What are 2 risk factors for developing Alzheimer’s disease?

A

family history, depression, loneliness, reduced mental and physical activity, Down’s syndrome

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31
Q

You examine a patient’s CSF, do some bloodwork and an MRI. You see hallmark features of Alzheimer’s. What would you be expecting to see?

A

cortical atrophy, extracellular deposition of beta amyloid plaques, tau neurofibrillary tangles, damaged synapses

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32
Q

what medication is given to Alzheimer’s patients?

A

acetylcholinesterase

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33
Q

state some symptoms of PD

A
  • bradykinesia, rigidity, resting tremor
  • dementia, disordered sleep, depression, urinary frequency and constipation
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34
Q

treatment for PD?

A

levodopa, dopamine agonists, COMT/MAO-B inhibitor

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35
Q

what is the main cause of GBS?

A

campylobacter jejuni infection

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36
Q

What 4 clinical features would you expect to see with GBS?

A

motor weakness, paraesthesia, respiratory and autonomic involvement

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37
Q

how is a diagnosis of GBS made?

A

LP with raised CSF proteins

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38
Q

no sensation in genital area -> What is this phenomenon known as?

A

saddle anaesthesia

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39
Q

why is a PMH of prostate cancer important in a diagnosis of cauda equina syndrome?

A

prostate cancer can metastasise to the spine

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40
Q

what is the treatment for cauda equina syndrome?

A

spinal decompression surgery

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41
Q

how do you differentiate between a stroke and Bell’s palsy?

A

lift eyebrows -> no wrinkles = BP, wrinkles = stroke

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42
Q

if a suspected stroke resolves with no symptoms what is it?

A

TIA

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43
Q

four risk factors for stroke and TIA?

A

increasing age, a. fib, smoking, HTN, obesity, DM, alcohol

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44
Q

what inheritance pattern is duchenne muscular dystrophy?

A

x-linked recessive

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45
Q

Why does Duchenne muscular dystrophy almost exclusively affect boys?

A

Boys only need one copy of the gene for the disease to manifest as they only have one X chromosome, whereas girls need both copies due to the recessive nature of the condition

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46
Q

appears to understand what you are saying, but is struggling to speak and is slurring his words. What type of aphasia is this?

A

Broca’s aphasia

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47
Q

what artery is affected when presenting with amaurosis fugax?

A

anterior cerebral artery

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48
Q

what does an ABCD2 score assess?

A
  • chance of stroke after TIA
    ABCD2 score:
  • Age > 60yrs =1.
  • Blood pressure > 140/90mmHg = 1.
  • Clinical features (Unilateral weakness = 2.
  • Speech disturbance without weakness = 1.
  • Duration of symptoms (>1hr = 2. 10-59min = 1).
  • Diabetes = 1.
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49
Q

what test is used to confirm epilepsy?

A

electroencephalogram (EEG)

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50
Q

3 medications used in tonic-clonic seizures?

A

lamotrigrigine, carbamazepine, levetriacetam

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51
Q

What are the 2 big differentials for epilepsy?

A

syncope, non-ectopic seizures

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52
Q

how do you treat raised ICP?

A

IV mannitol

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53
Q

what nerve is affected in carpal tunnel syndrome?

A

median nerve

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54
Q

Give 2 examination tests for carpal tunnel syndrome.

A

Phalen’s test, Tinel’s test

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55
Q

What are the roots for the median nerve?

A

C6-8, T1

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56
Q

loss of sensation in lateral leg and foot, inversion is weak, eversion is unaffected, what is the cause?

A

L5 radiculopathy

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57
Q

which group of muscles is supplied by the ulnar nerve?

A

hypothenar muscles

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58
Q

what is the first line medication for trigeminal neuralgia?

A

carbamazepine

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59
Q

what can granulomatosis with polyangiitis present with?

A

epistaxis, sinusitis, saddle shaped nose, haemoptysis, glomerulonephritis

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60
Q

what investigations would you do for granulomatosis with polyangitis?

A

c-ANCA lab testing, imaging, biopsy of affected organs

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61
Q

what would biopsy of affected organs show in someone with granulomatosis with polyangiitis?

A

necrotising granulomatous inflammation

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62
Q

what is the treatment for granulomatosis with polyangiitis?

A

immunosuppressive drugs

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63
Q

what 4 investigations can be done in suspected dementia?

A

Mini-Mental State Assessment, MRI, CSF analysis, confusion screen

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64
Q

which type of dementia behaves in a stepwise like progression of deterioration?

A

vascular

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65
Q

ischaemic stroke in the anterior cerebral artery will cause what?

A

contralateral lower limb weakness

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66
Q

ischaemic stroke in the middle cerebral artery will cause what?

A
  • contralateral motor and sensory weakness / loss of upper limbs
  • facedrop
  • aphasia / dysphasia
67
Q

ischaemic stroke in the posterior cerebral artery will cause what?

A

acute vision loss, memory loss

68
Q

ischaemic stroke of which artery causes hemiparesis of the lower contralateral face, speech impairment and contralateral weakness?

A

middle cerebral artery

69
Q

ischaemic stroke of which artery causes contralateral lower limb weakness?

A

anterior cerebral artery

70
Q

ischaemic stroke of which artery causes acute vision loss and memory loss?

A

posterior cerebral artery

71
Q

What brain pathology results from the rupture of berry-aneurysms?

A

subarachnoid haemorrhage

72
Q

describe myasthenia gravis

A
  • autoimmune disease mediated by nicotinic acetylcholine receptor (AChR) antibodies on the post-synaptic side of the neuromuscular junction
  • mainly affects muscles of the eyes and face
73
Q

what are the appropriate treatments for myasthenia gravis?

A

pyridostigmine, prednisolone, thymectomy

74
Q

what symptoms would occur in a temporal lobe seizure?

A

automatisms e.g. lip smacking, chewing and fiddling

75
Q

what symptoms would occur in a frontal lobe seizure?

A

motor features e.g. peddling movements of the leg

76
Q

what is the difference between a complex partial seizure and a simple partial seizure?

A

simple PS do not affect awareness and there are no post-ictal symptoms, unlike complex

77
Q

what are the presentations of progressive bulbar palsy (MND)?

A

LMN involvement of CN 9, 10, 11 12 resulting in:
- dysarthria
- dysphagia
- nasal regurgitation of fluids / choking
- absent jaw jerk reflex
- flaccid and fasciculating tongue
- change in speech

78
Q

what would a cerebellar tumour present with?

A

DASHING
- Dysdiadochokinesis
- Ataxia
- Slurred speech
- Hypotonia
- Intention tremor
- Nystagmus
- Gait abnormality

79
Q

why are lumbar punctures contraindicated in raised ICP?

A

a lumbar puncture would withdraw CSF, and may provoke immediate coning of the brain through the opening where skull meets spinal cord

80
Q

how can a brain tumour increase ICP?

A
  • once the tumour becomes large enough there comes a point where no more CSF can be removed from ventricles by brain -> rapid rise in ICP.
  • This leads to herniation of the brain
81
Q

which nerve is responsible for opening the fist?

A

radial

82
Q

which muscles are involved with opening the fist?

A

BEST
- Brachioradialis
- Extensors
- Supinator
- Triceps

83
Q

what signs suggest ulnar nerve damage?

A

claw hand, good luck sign - unable to cross fingers

84
Q

what does damage to the median nerve look like?

A
  • affects precision grip muscles (LOAF) “can’t open jam jar”
  • wasting of the thenar eminence and sensory loss / weakness of the abductor pollicis brevis
85
Q

what would damage to the axillary nerve look like?

A

weakness in shoulder abduction

86
Q

what do parietal lobe seizures present with?

A

sensory disturbances

87
Q

what do temporal lobe seizures present with?

A

aura

88
Q

what do frontal lobe seizures present with?

A

motor features

89
Q

Which vitamin is deficient in Wernicke encephalopathy?

A

vit b1 (thiamine)

90
Q

what is first line treatment for viral meningitis?

A

analgesia, antipyretics and hydrate

91
Q

give 3 symptoms of Horner’s syndrome

A

anhydrosis, miosis, ptosis

92
Q

what can cause Horner’s syndrome?

A

pancoast tumour

93
Q

presentations of Brown-Sequard Syndrome?

A

Ipsilateral loss of position, vibration sensation and motor control at the level of the lesion

94
Q

what is first line medication used for subarachnoid haemorrhages??

A

nimodipine

95
Q

first line investigation for MS?

A

MRI then LP

96
Q

what is the first line acute treatment for a migraine?

A

sumatriptan

97
Q

which tonic-clonic epilepsy medication is teratogenic?

A

sodium valproate - lamotrigine is next best option

98
Q

what receptors are affected in myasthenia gravis?

A

nicotinic acetylcholine receptors

99
Q

what would compression of the L5 nerve root cause?

A

pain in outer leg, weakness in dorsiflexion of ankle

100
Q

What is the diagnostic criteria for multiple sclerosis?

A

2+ lesions disseminated by time and space AND exclusion of other similarly presenting conditions

101
Q

On CT scan it is found that a patient with MS has a spinal cord lesion – name 2 symptoms that might be present?

A
  • Numb/tingling limbs
  • Leg weakness
  • Bladder/Sexual dysfunction
  • Lhermitte’s sign
102
Q

What affect does heat have on patients with MS and why is this the case?

A

Worsens symptoms – the new myelin is ineffective

103
Q

In a subdural haematoma where does the bleeding come from?

A

bridging veins between cortex and venous sinuses

104
Q

Between which two meningeal layers do subdural haematomas form?

A

internal dural layer and arachnoid mater

105
Q

Alcoholics are at a higher risk of subdural haematomas, why is this?

A

alcohol causes veins to become thin walled making them more susceptible to damage

106
Q

What is the preferred management for subdural haematomas?

A

decompression surgery

107
Q

Give 3 signs of brainstem compression.

A

ipsilateral pupil dilation, coma, bilateral limb weakness, deep/irregular breathing

108
Q

What is the gold standard investigation for an epidural haemorrhage?

A

CT head

109
Q

define an epileptic seizure

A

paroxysmal event that causes change of behaviour / cognitive processes due to hypersynchronous neuronal discharges in the brain

110
Q

name 3 causes of epilepsy

A

idiopathic, cortical scarring due to head injury, brain tumour, dementia, alcohol withdrawal

111
Q

give 3 risk factors for epilepsy

A

family history, premature babies, abnormal blood vessels in brain, dementia, drugs, stroke/tumour/infection

112
Q

what 2 categories can epileptic seizures be classified into?

A

primary generalised, partial/focal

113
Q

Give 2 features that would differentiate Epilepsy from Syncope

A

tongue biting, cyanosis, post ictal symptoms

114
Q

immediate first step in course of action in suspected stroke?

A

CT head

115
Q

name 4 potential clinical features found in brain tumours?

A

coma, dysdiadochokinesis, N/V, seizures

116
Q

what can differentiate compression of spinal cord from cauda equina syndrome?

A
  • additional sensory loss one dermatome below where sensation is already reduced
  • UMN signs below level of compression
117
Q

describe the mechanism of action of the drugs neostigmine and pyridostigmine that are used to treat myasthenia gravis?

A

blocks active site of acetylcholinesterase, increasing amount of Ach available to the post-synaptic membrane

118
Q

Adult patients with acute ischaemic stroke should receive alteplase treatment within what time after onset of their symptoms?

A

< 4.5 hours

119
Q

what would you see on a CT in PD?

A

normal

120
Q

name 2 things seen histologically in PD?

A
  • loss of dopaminergic neurones
  • presence of Lewy-bodies
121
Q

name 4 things seen on a physical exam in PD

A
  • Resting tremor / pill-rolling tremor
  • Rigidity (either smooth/lead-pipe or oscillating/cog-wheel)
  • Bradykinesia / slowness of movement
  • ‘Freezing’ when starting to walk (start-hesitation), when turning or when crossing a
    threshold e.g. a doorway, reduced arm swing
122
Q

what would Huntington’s show on an MRI?

A

atrophy of the caudate nucleus and putamen

123
Q

what is the cause of Huntington’s disease?

A

> 38 repeats of the CAG coding gene for Huntingtin protein

124
Q

what is Lambert-Eaton Myasthenic Syndrome?

A
  • autoantibodies against presynaptic voltage-gated calcium channels
  • typically presents with
    proximal weakness which improves through repetitive use
  • can be secondary to small cell lung cancer
125
Q

what is given for acute flare ups of MS?

A

IV methylprednisolone

126
Q

what is given as long term prophylaxis for MS flare ups?

A

IV beta-interferon

127
Q

how do you determine between idiopathic and vascular PD?

A
  • Vascular -> bilateral onset with lower
    limb predominance, leading to presentation with falls and gait problems
  • Idiopathic -> more likely to have unilateral onset with upper limb predominance, leading to a presentation with Bradykinesia.
128
Q

what is Uhthoff’s phoenomenon?

A

a transient worsening of neurological symptoms related to a demyelinating disorder such as multiple sclerosis when the body becomes overheated

129
Q

how do you determine between left and right anterior cerebral artery stroke presentations?

A
  • RACA - left sided hemiparesis
  • LACA - right sided hemiparesis
130
Q

what is given for prophylaxis for cluster headaches?

A

verapamil

131
Q

what are Jacksonian seizures?

A
  • type of focal partial seizure which originates from the frontal lobe
  • usually begins with a tingling or twitching sensation in a small area
  • followed by jerking movements which move proximally at the same side of the body
132
Q

what is the treatment for malaria?

A

oral quinine / doxycycline

133
Q

what is the term to describe a seizure that affects both hemispheres?

A

generalised

134
Q

Describe the pathophysiology of paroxysmal electrical discharges, give examples of any neurotransmitters or receptors you mention.

A
  • Area of the brain becomes over active.
  • Either too much excitatory e.g. glutamate stimulates NMDA receptors
  • Or lack inhibitory e.g. GABA stimulates GABA receptors
135
Q

give 4 potential causes of a seizure

A

brain tumour, trauma, infection, drugs

136
Q

what type of genetic disorder is Huntington’s?

A

triplet repeat

137
Q

Describe the genetic pathophysiology of Huntington’s disease

A
  • Huntington gene contains triplet repeat of CAG (10-35)
  • CAG codes for glutamine
  • in Huntington’s CAG repeated more than 35 times
  • this leads to too much glutamine which builds up in the caudate and putamen
  • this causes cell death.
138
Q

what is chorea?

A

Jerky involuntary movements involving hips, shoulders and face and parkinsonian features

139
Q

define anticipation

A

signs and symptoms of a genetic condition becoming more severe/appearing earlier as the disorder is passed on from generation to next

140
Q

what structure within the brain is the striatum part of?

A

basal ganglia

141
Q

List 2 symptoms of complicated malaria.

A

shock, cerebral malaria, kidney failure, acute respiratory distress syndrome

142
Q

List the 3 stages of malaria infection.

A
  • exo-erythrocytic stage
  • endo-erythrocytic stage
  • hypnozoite stage
143
Q

How would you treat uncomplicated malaria?

A

quinine, doxycycline

144
Q

name 3 causes of Wernicke’s encephalopathy

A
  • Chronic alcoholism
  • Eating disorders
  • Malnutrition
  • Prolonged vomiting
145
Q

what may Wernicke’s encephalopathy present with?

A

liver disease

146
Q

What is the triad of Wernicke’s encephalopathy?

A

confusion, ataxia, ophthalmoplegia

147
Q

what is delirium tremens?

A

rapid onset of confusion usually caused by withdrawal from alcohol

148
Q

how do you treat delirium tremens?

A

chlordiazepoxide and lorazepam

149
Q

define weakness

A

impaired ability to move a body part at will

150
Q

how do you differentiate MND to myasthenia gravis?

A

MND never affects eye movements

151
Q

What is the only medication shown to improve survival of patients suffering from MND and how does it work?

A
  • riluzole
  • inhibits glutamate release and is an NMDA receptor antagonist
152
Q

what will a cerebellar stroke present with?

A

ataxia, headache, vertigo, vomiting

153
Q

what can speed up presentations of myasthenia gravis?

A

infection

154
Q

what are the nerve roots for carpel tunnel syndrome?

A

C5-T1

155
Q

MND: UMN presentations is damage to what?

A

motor cortex neuronal cell

156
Q

MND: LMN presentations is damage to what?

A

anterior horn cell

157
Q

define stroke

A

Sudden-onset neurological deficit due to ischaemic or haemorrhagic compromise in blood supply / acute onset of focal neurological deficit of vascular origin which lasts over 24 hours

158
Q

best answer for first line management for blindness associated with temporal ateritis?

A

IV methylprednisolone

159
Q

what is advised in regards to driving after TIA?

A

dont notify DVLA but no driving for 1 month

160
Q

prophylaxis for cluster headache?

A

verapamil

161
Q

Myasthenia Gravis is an autoimmune disease. What do the antibodies specifically target in this disease?

A

nicotinic acetylcholine receptors

162
Q

tendon reflexes in MSG?

A

initially normal but fatigable

163
Q

Which serum antibody might you expect to see in a patient with MSG?

A
  • Anti-AChR (acetylcholine receptor) OR
  • anti-MuSK (muscle specific tyrosine kinase)
164
Q

treatment for MSG?

A

anticholinesterase, prednisolone and alendronate for osteoporosis prophylaxis

past questions (11 decks)

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