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Neurology Flashcards

1
Q

Multiple sclerosis cells affected

A

Oligodendrocytes

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2
Q

3 types of MS

A
  1. relapsing remitting (95%)
  2. primary progressive
  3. secondary progressive
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3
Q

Genetic mutation for MS

A

HLA DRB1

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4
Q

Pathophysiology

A

Astrocytic and macrocytic activation
Causes demyelination

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5
Q

Investigations for MS

A
  1. MRI - demyelination in time and place
  2. CSF oligocloncal bands
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6
Q

Scoring system for MS

A

Kurtzke Expanded disability score

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7
Q

Management of MS

A
  1. DMARD: interferon or glatiramer
    (second line dimethyl fumarate)
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8
Q

Management of primary progressive MS

A

Ocrelizumab in primary progressive

Given IV
Anti CD-20 antibody

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9
Q

Management of secondary progressive MS

A

spionmod

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10
Q

Management of relapse of MS

A

IV Methylprednisolone for 5 days

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11
Q

NPH management

A

Shunt if not suitable for surgery will require frequent CSF taps

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12
Q

Acoustic neuroma symptoms

A
  • unilateral tinnitus
  • hearing loss
  • loss of corneal reflex
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13
Q

Sub acute degeneration of the spinal cord cause

A

Vitamin B12 deficiency

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14
Q

Temporal lobe epilepsy

A

Lip smacking

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15
Q

Frontal lobe epilepsy

A

Jacksonian march

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16
Q

Indications to start DMARDs in MS

A

Relapsing-remitting disease + 2 relapses in past 2 years + able to walk 100m unaided

OR

Secondary progressive disease + 2 relapses in past 2 years + able to walk 10m (aided or unaided)

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17
Q

First line DMARD for MS

A

Natalizumab

(Given IV, recombinant monoclonal antibody against alpha-4 beta-1-integrin found on leucocytes, has the strongest evidence base)

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18
Q

Management of tiredness in MS

A

Amantadine once other causes ruled out

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19
Q

Management of spasticity in MS

A

Baclofen and gabapentin

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20
Q

Management of bladder dysfunction in MS

A

Significant residual volume: self-catheterisation

No significant residual volume: anti-cholinergics

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21
Q

Management of oscillopsia (visual fields oscillating) in MS

A

Gabapentin

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22
Q

Brocas dysphagia (able to comprehend but cannot speak coherently) where in the brain?

A

Inferior frontal gyrus

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23
Q

Imaging for urinary incontinence in MS

A

USS MUST DO BEFORE STARTING MANAGEMENT (anticholinergics may make it worse in some cases)

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24
Q

Good prognostic indicators for MS

A
  • female
  • young age of onset (i.e. 20s or 30s)
  • relapsing-remitting disease
  • sensory symptoms only
  • long interval between first two relapses
  • complete recovery between relapses
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25
MND drug management
Riluzole
26
Riluzole MOA
Prevents stimulation of glutamate receptors
27
Other treatments for MND
Non-invasive ventilation, normally BiPAP (can increase life by 7 months) PEG for feeding
28
GBS pattern of weakness
Ascending
29
Most common cause of GBS
Campylobacter
30
GBS investigations
1. LP - rise in protein but normal WCC 2. Nerve conduction studies
31
GBS nerve conduction findings
1. Decreased motor nerve conduction velocity (due to demyelination) 2. Prolonged distal motor latency 3. Increased F wave latency
32
GBS management
Immunoglobulins, also require regular FVC monitoring
33
anterior cerebral artery presentation
contralateral hemiparesis and sensory loss (legs >arms)
34
middle cerebral artery presentation
contralateral hemiparesis and sensory loss (arms > legs), contralateral homonymous hemianopia and aphasia
35
posterior cerebral artery presentation
contralateral homonymous hemianopia with macular sparing, visual agnosia
36
Webers syndrome
(Posterior cerebral artery that supplies the midbrain): ipsilateral CN III palsy, contralateral weakness of upper and lower extremity
37
Wallenburg syndrome
Lateral medullary syndrome (posterior inferior cerebellar artery) ipsilateral facial pain and temperature loss, contralateral limb/torso pain, ataxia and nystagmus
38
Lateral pontine syndrome
(anterior inferior cerebellar artery): similar to Wallenbergs but also have ipsilateral facial paralysis and deafness
39
Stroke management
1. Rule out haemorrhagic, once ruled out for aspirin 300mg 2. Thrombolysis if within 4.5 hours 3. May have thrombectomy if within 6 hours
40
Indications for a thrombectomy
Confirmed occlusion of the proximal anterior circulation demonstrated by CTA or MRA if within 6 hours of symptoms and if thrombolysis (if within 4.5 hours) As soon as possible to people who were last known to be well between 6 and 24 hours if confirmed occlusion of the proximal anterior circulation demonstrated by CTA or MRA AND if there is the potential to salvage brain tissue as shown by imaging such as CT perfusion or diffusion weighted MRI sequences showing limited infarct core volume
41
Long term management of stroke
Aspirin 75mg and clopidogrel 75mg If cannot tolerate clopidogrel for dipyradimole
42
When to offer carotid artery endarectomy
If carotid stenosis >70% unilaterally or >50% bilaterally
43
Management of a TIA
Aspirin 300mg
44
Long term management of TIA
Clopi (unless AF then for DOAC)
45
Further investigation post TIA
If more than one TIA or suspected cardioembolic source → need for discussion If patient has had a suspected TIA in the last 7 days → seen within 24 hours If has had a suspected TIA more than a week ago → see within 7 days
46
Why is levodopa given with co-careldopa
Prevents the peripheral break down and therefore reduces the risk of side effects
47
Parkinsons, consequences of meds
End of dose weaning off (decline of motor activity) On-off phenomenon Dyskinesia when having the maximum dose
48
Management of restless legs
Ensure treated for iron deficiency Ropinirole/pramipexole
49
First line management for motor symptoms in Parkinsons
levodopa and co-careldopa
50
Neurofibromatosis cause of hypertension
Phaeochromocytoma
51
SAH investigation
CT head, if done <6 hours and normal need to think of other pathology if >6 hours for LP (needs to be done >12 hours) then need to work out why a spontaneous SAH --> CT angiogram
52
SAH management
Oral nimodipine Neurovascular coiling
53
Brain abscess management
IV ceftriaxone and metronidazole
54
Right incongronous homonymous hemianopeia
Incongronous - optic tract Congronous - optic radiation lesion Macula sparing: lesion of occipital cortex
55
Superior bitemporal hemianopeia common cause
Pituitary tumour
56
Inferior bitermoral hemianopeia common cause
Craniopharyngioma
57
Side effect of phenytoin
Folate deficiency Cerebellar symptoms
58
How to distinguish neuromyelitis optica and MS
Neuromyelitis optica is NMO IgG positive
59
Palatal myoclonus lesion
Olivary nucleus
60
Food bourne botulism mx
Heptavelent antitoxin
61
Status epilepticus management
IV/IM loraz 4mg or PR diazepam 10mg
62
Forehead sparing where is the lesion
UMN
63
Forehead not spared where is the lesion
LMN
64
Benign essential tremor management
Propranolol or topimarate (primidone is second line as can cause tiredness)
65
Pontine haemorrhage
Pinpoint pupils, severe headache, reduced GCS, no movement of eyes on turning
66
Transient global amnesia
Amnesia but is aware of who they are. It is a benign condition, no increased risk of vascular events.
67
Warfarin and antiepileptic
Lamotrigine is safe
68
Most common inherited polyneuropathy
Charcot-Marie
69
Largest risk factor for stroke
AF (rheumatic)
70
Drug management of TIC
risperidone
71
Management of a stroke, how long should you take aspirin for
aspirin 75mg for 2 weeks then switch to clopidogrel 75mg. If clopi not tolerated then can switch to aspirin and dipyradimole
72
Miller Fisher syndrome
Descending paralysis Eyes normally affected first
73
HSV encephalitis
Affects the temporal lobes, petechial haemorrhages can be seen on CT
74
Paraneoplastic cerebellar degeneration
Rapidly progressive cerebellar signs + evidence of ovarian carcinoma
75
When to use amantadine in Parkinsons
Used to treat dyskinesia in later stages of the disease
76
When to use COMT in Parkinsons
Can help with motor fluctuations later in the disease course
77
Best diagnostic test for CJD
LP
78
Cavernius sinus thrombosis
CN III, IV, V, VII affected
79
Sagittal sinus thrombosis
Seizures and bilateral motor deficits
80
Dose of pyridostigmine bromide
30mg QDS for 2-4 days if not effective can increase to 60mg qds and if this is ineffective may require oral pred

MRCP (28 decks)

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