Neurology Flashcards
1
Q
What tumour is most associated with myasthenia gravis?
A
Thymoma
2
Q
How does an anterior inferior cerebellar artery stroke present? (Lateral pontine syndrome)
A
Ipsilateral: facial pain and paralysis, temperature loss, deafness
Contralateral: facial pain and temp loss
Ataxia, nystagmus
3
Q
What do GBS nerve conduction studies show?
A
Decreased motor nerve conduction velocity
4
Q
What is the management for idiopathic intracranial hypertension?
A
Weight loss (if overweight)
(Specialist): Carbonic anhydrase inhibitors
Topiramate
5
Q
How does MCA stroke present?
A
Contralateral hemiparesis and sensory loss
Upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
6
Q
What is used for spasticity in MS?
A
Baclofen and gabapentin 1st line
PT important
7
Q
How to test if a fluid is CSF in trauma?
A
Check for glucose at bedside
8
Q
Blood tests in neuroleptic malignant syndrome?
A
Raised CK and leukocytosis
9
Q
How does neuroleptic malignant syndrome present?
A
FEVER
Fever
Encephalopathy
Vitals (SNS activity inc)
Elevated CK
Rigidity
10
Q
Initial treatment for PD?
A
Levodopa
11
Q
What is the most common complication of meningitis?
A
Sensorineural hearing loss
12
Q
Which nerve is affected in ‘Saturday night palsy’?
A
Radial nerve
13
Q
What is the management for myasthenia gravis?
A
Long acting acetylcholinesterase inhibitors eg pyridostigmine
14
Q
Medical management in paediatric status epilepticus?
A
- Buccal midazolam
- IV lorazepam
- IV phenytoin, keppra or sodium valproate
- Rapid sequence induction of anaesthesia using thiopental sodium
15
Q
what are the 4 1st line medications for neuropathic pain?
A
duloxetine, amitriptyline, gapapentin and pregabalin
if one doesn’t work, try the others
16
Q
what is the management for an acute myasthenic crisis?
A
IVIg, plasmapheresis
17
Q
what type of brain bleed does fluctuating consciousness suggest?
A
subdural haemorrhage
18
Q
trigger for cluster headaches?
A
alcohol
19
Q
what is the test for carotid stenosis?
A
carotid USS
20
Q
what is the management for carotid stenosis?
A
endarterectomy
21
Q
which blood vessel causes extradural haemorrhage?
A
middle meningeal artery
22
Q
which bone injury is associated with extradural haemorrhage?
A
fracture of temporal bone
23
Q
which vessels cause subdural haemorrhage?
A
bridging veins
24
Q
what is the shape of a subdural haemorrhage on CT?
A
crescent
25
at what GCS should securing the airway be considered?
>/8
26
what illicit drug is associated with SAH?
cocaine
27
what blood condition is associated with SAH?
sickle cell anaemia
28
what kidney condition is associated with SAH?
PKD
29
first line ix for SAH?
CT head
30
next test in SAH if CT head is negative? findings?
LP
- raised red cell count
- xanthochromia
31
medication to prevent vasospasm in SAH?
nimodipine
32
what is the abnormal pupil response in optic neuritis?
relative afferent pupillary defect
33
visual field defect in optic neuritis?
central scotoma
34
what is a single episode of MS called?
clinically isolated syndrome
35
pathophysiology of MS?
demyelination in the CNS
36
3 disease patterns in MS?
relapsing-remitting
secondary progressive
primary progressive
37
ix for MS?
MRI
LP
38
finding in the CSF in MS?
oligoclonal bands
39
tx of relapses in MS?
methylprednisolone
40
most common type of MND?
amylotropic lateral sclerosis
41
how is MND diagnosed?
clinically
42
licensed medication to slow progression of MND?
riluzole
43
tx to support breathing at night in MND?
NIV
44
LMN signs in MND?
fasciculations
muscle wasting
45
UMN signs in MND?
brisk reflexes
spasticity
upgoing plantars
46
classic triad of parkinsons features?
rigidity
bradykinesia
resting tremor
47
name for facial masking in PD?
hypomimia
48
PD plus syndrome with autonomic dysfunction?
multiple system atrophy
49
PD plus syndrome with varying alertness?
lewy body dementia
50
what is levodopa usually combined with in PD tx?
peripheral decarboxylase inhibitor
eg carbidopa and benserazide
51
3 examples of dyskinesias in PD?
dystonia, chorea and athetosis
52
what type of drug is entacapone?
COMT inhibitor
53
what type of drug is bromocriptine?
dopamine agonist
54
what type of drugs are selegiline and rasagiline?
MAO-B inhibitors
55
what type of tremor is 4-6Hz?
PD tremor
56
what type of tremor is worse at rest?
PD
57
what type of tremor improves with alcohol?
essential tremor
58
what type of tremor is asymmetrical?
PD
59
what type of tremor worsens on intentional movements?
essential tremor
60
mgt options for essential tremor?
propranolol
primidone
61
diagnostic tests for epilepsy?
EEG and MRI
62
additional features of tonic-clonic seizures?
tongue biting
incontinence
post ictal period
groaning
63
first line to prevent tonic-clonic seizures?
sodium valproate
64
type of seizure associated with memory flashbacks?
focal seizures
65
type of seizure associated with unresponsive staring?
absence seizures
66
type of seizure associated with 'drop attacks'?
atonic seizure
67
type of seizure associated with muscle jerks?
myoclonic seizure
68
highly teratogenic epilepsy drug?
sodium valproate
69
first line generalised epilepsy medication for women of childbearing potential?
lamotrigine or levetiracetam
70
first line for focal seizures?
lamotrigine or keppra
71
first line for absence seizures?
ethosuximide
72
first line for myoclonic seizures?
sodium valproate (men)
levetiracetam (FCP)
73
drug for status epilepticus in community?
buccal midazolam or rectal diazepam
74
first line for tonic or atonic seizures?
sodium valproate
lamotrigine
75
drug for status epilepticus in hospital?
IV lorazepam
76
treatment options for neuropathic pain?
amitriptyline
duloxetine
gabapentin
pregabalin
77
when would you use carbamazepine for neuropathic pain?
trigeminal neuralgia
78
dx: 59 year old fractured wrist in fall. Noticed pain, skin flushing, swelling and unusual hair growth in area during recovery
complex regional pain syndrome
79
name for experiencing pain from stimuli that are not normally painful?
allodynia
80
is facial nerve palsy an upper or lower MN pathology?
lower
-> forehead is affected
81
idiopathic cause of facial nerve palsy?
bells palsy
82
tx of bells palsy?
prednisolone if within 72h
83
facial nerve palsy with vesicular rash around ear?
ramsay hunt syndrome
84
treatment for ramsay hunt syndrome?
prednisolone
aciclovir
85
key causes of UMN pathology?
stroke
tumour
86
why are lubricating eye drops required in facial nerve palsy?
prevent the eye drying out and exposure keratopathy
87
sign of raised ICP on fundoscopy?
papilloedema
88
location of a brain tumour causing personality changes?
frontal lobe
89
most malignant type of brain tumour?
glioblastoma
90
name for tumour of the membranes around the brain?
meningioma
91
typical sx of acoustic neuroma?
unilateral hearing loss
tinnitus
balance problems
92
which cancers most commonly metastasise to brain?
lung
breast
renal cell carcinoma
melanoma
93
dx: 37 yo lady with uncontrolled movts, falls and difficulty speaking
huntington's chorea
94
inheritance pattern of huntington's?
autosomal dominant
95
what type of genetic disorder is huntingtons?
trinucleotide repeat disorder
96
name for earlier age of onset and inc severity in later generations?
anticipation
97
pathophysiology of myasthenia gravis?
autoantibodies attack ach receptors on postsynaptic membrane
98
most affected muscle groups in MG?
proximal muscles and small muscles of the head and neck
99
most common antibodies in MG?
acetylcholine receptor antibodies
100
tumour associated with myasthenia gravis?
thymoma
101
specific test for myasthenia gravis?
edrophonium test
102
examples of reversible acetylcholinesterase inhibitors (for MG)?
pyridostigmine
neostigmine
103
surgical tx for myasthenia gravis?
thymectomy
104
moab tx for MG?
rituximab
105
pathophysiology of lambert eaton myasthenic syndrome?
autoantibodies attack calcium channels in presynaptic NMJ
106
notable cause of lambert eaton syndrome?
small cell lung cancer
107
key symptom of LAMS?
muscle weakness
108
most affected skeletal muscles in LAMS?
proximal muscles (notably in legs)
109
commonly affected muscle groups in LAMS?
intraocular muscles (diplopia)
levator muscles (ptosis)
oropharyngeal muscles (dysarthria + dysphagia)
110
tendon reflexes in LAMS?
reduced
111
what is post-tetanic potentiation (LAMS)?
reflexes improve after strong contraction of associated muscles
112
medication for LAMS?
amifampridine (cholinergic receptor stimulator)
113
dx: 35 year old with weakness in lower legs and peripheral sensory loss
charcot-marie-tooth disease
114
pattern of inheritance of CMT?
autosomal dominant
115
lower leg/foot signs in CMT?
pes cavus (high foot arches)
distal muscle wasting
116
reflexes in CMT?
reduced
117
7 causes of peripheral neuropathy?
ABCDE
Alcohol
B12 deficiency
Cancer, CKD
Diabetes, drugs (eg isoniazid)
Every vasculitis
118
dx:26 year old presents with weakness and loss of sensation spreading up from her feet. she had an episode of gastroenteritis 3 weeks ago
guillain-barre syndrome
119
type of cell that produces antibodies in GBS?
b-cells
120
key triggering pathogens in GBS?
campylobacter jejuni
CMV
EBV
121
investigations to support GBS diagnosis?
nerve conduction studies
LP
122
finding on CSF in GBS?
raised protein
123
main tx for GBS?
IVig
124
skin signs in neurofibromatosis type 1?
neurofibroma
cafe-au-lait spots
axillary freckling
125
eye sign in neurofibromatosis type 1?
iris hamartomas (lisch nodules)
126
what chromosome is the gene for NFT1 on?
17
127
what protein does the gene for NFT1 code for?
neurofibromin (tumour suppressor gene)
128
inheritance pattern of neurofibromatosis type 1?
autosomal dominant
129
diagnosis associated with schwannomas?
neurofibromatosis type 2
130
bilateral tumours with neurofibromatosis type 2?
bilateral acoustic neuromas
131
skin signs associated with tuberous sclerosis?
poliosis
ash leaf spots
angiofibromas
(shagreen patches, subungual fibromata, cafe-au-lait spots)
132
affected genes in tuberous sclerosis?
TSC1 gene - hamartin
TSC2 gene - tuberin
133
tuberous sclerosis pathology in the heart?
rhabdomyomas
134
tuberous sclerosis pathology in the brain?
gliomas
135
tuberous sclerosis pathology in the kidneys?
polycystic kidneys
136
tuberous sclerosis pathology in the retina?
hamartomas
137
tuberous sclerosis pathology in the lungs?
lymphangioleiomyomatosis
138
key symptom of tuberous sclerosis requiring tx?
seizures
139
first line management for trigeminal neuralgia?
carbamazepine
140
stages of migraine with aura?
prodrome/premonitory
aura
headache
resolution
postdrome/recovery
141
name for migraine with limb weakness?
hemiplegic migraine
142
mechanism of triptans?
5ht receptor agonist
143
options for migraine prophylaxis?
propranolol
topiramate
amitriptyline
144
symptoms associated with cluster headaches?
red swollen watery eye
miosis
ptosis
nasal discharge
facial sweating
145
triggers for cluster headaches?
alcohol, strong smells, exercise
146
acute management for cluster headaches?
triptans
high flow oxygen
147
prophylaxis options for cluster headaches?
verapamil
lithium
prednisolone
148
which drugs worsen myasthenia gravis?
beta blockers
several antibiotics
antimalarials
lithium
149
Patients with a thrombus in which location are more likely to benefit from thrombectomy?
proximal middle cerebral artery
or internal carotid artery
150
what type of speech is associated with myasthenia gravis?
nasal speech
151
features of subacute combined degeneration of the spinal cord?
dorsal column - distal tingling/burning/sensory loss, impaired proprioception and vibration sense
lateral corticospinal - muscle weakness, hyperreflexia, spasticity. UMN signs etc
spinocerebellar - sensory ataxia - gait abnormalities, positive romberg's sign
152
what does 4th nerve palsy cause?
defective downward gaze
vertical diplopia
153
what does 3rd nerve palsy cause?
down and out
154
what does 6th nerve palsy cause?
defective abduction
-> horizontal diplopia
155
what is the major risk with withholding levodopa?
can precipitate neuroleptic malignant syndrome
156
homonymous quadrantanopias mnemonic?
PITS
parietal - inferior
temporal - superior
157
if a patient has a homonymous quadrantanopia, is it ipsilateral or contralateral?
contralateral
eg right parietal = left inferior HQ
158
pathophysiology of huntingtons?
trinucleotide repeat disorder
degeneration of the cholinergic and GABAergic neurones in the striatum of the basal ganglia
defect in huntingtin gene on chromosome 4
159
what type of organism is n. meningitidis?
gram negative diplococci
160
signs of 3rd nerve palsy?
ptosis
down and out eye
dilated, fixed pupil
(unable to adduct)
161
IV nerve palsy?
defective downward gaze
-> vertical diplopia
162
VI nerve palsy?
defective abduction
->> horizontal diplopia
163
dx: patient presents post head injury, is okay then rapidly deteriorates
extradural haematoma
164
MS investigations?
MRI brain with contrast - look for demyelinating lesions
CSF- oligoclonal bands
165
if recent blood levels of normal epilepsy medication is normal for a patient in status who hasn't responded to 2 doses of lorazepam, what do you do?
give a diff 2nd line drug like keppra or phenytoin
166
bitemporal hemianopia with predominantly upper quadrant defect?
pituitary tumour
167
bitemporal hemianopia with predominantly lower quadrant defect?
craniopharyngioma
168
tx for wernicke's encephalopathy????
PABRINEX
169
tx for alcohol withdrawal???
chlordiazepoxide
170
where in the brain should MRI be focussed for acoustic neuroma?
cerebellopontine angle
171
appearance of chronic subdural haematoma on CT?
hypodense (dark)
crescentic collection
around convexity of the brain
172
patient with blood results showing macrocytic anaemia with low b12, next test you do?
intrinsic factor antibodies for pernicious anaemia
173
serious dermatological s/e of lamotrigine?
stevens johnson syndrome
174
medication for IIH?
acetozolamide
175
mgt for brain abscess?
IV ceftriaxone and metronidazole
176
neurological features of GBS?
hyporeflexia
progressive symmetrical weakness of all limbs
mild sensory sx eg distal paraesthesia
177
GBS causative organism?
campylobacter jejuni
178
mgt of acute relapse in MS?
high dose steroids - IV or oral methyprednisolone
179
score that measures disability or dependence in activities of daily living in stroke patients
barthel index
180
damage of what nerve in mid shaft humeral fracture?
radial nerve -> wrist drop
181
is the tremor asymmetrical or symmetrical in parkinsons?
asymmetrical
182
symptoms of autonomic dysreflexia?
severe hypertension and flushing and sweating above the level of injury
183
