neurology Flashcards
1
Q
how can you differentiate surgical and medical 3rd nerve palsy
A
surgical = painful and causes fixed dilated pupil, can be caused by posterior communicating artery aneurysm
medical = pupil sparing, common cause is diabetes
2
Q
describe symptoms of midbrain infarct (weber’s syndrome)
A
n ipsilateral third nerve palsy (due to involvement of oculomotor nerve fibres originating in the midbrain)
and contralateral hemiparesis (due to involvement of corticospinal fibres as they pass through the midbrain)
3
Q
what is chemosis
A
swelling of the tissue that lines the eyelids and surface of the eye
4
Q
describe symptoms of cavernous sinus thrombosis
A
unilateral ptosis and chemosis
oedema
headache
photophobia
5
Q
what does the triad of urinary incontinence, dementia and gait abnormality indicate
A
normal pressure hydrocephalus
6
Q
what is the definitive management for normal pressure hydrocephalus
A
Ventriculo-peritoneal shunting
7
Q
what does bilateral medial temporal lobe involvement on an MRI indicate
A
encephalitis
8
Q
what mediation is given to reduce the long term neurological symptoms of meningitis
A
IV dexamethasone
9
Q
what mediation is given to relatives/close contacts to a pt with meningitis
A
oral ciprofloxacin or rifampicin
10
Q
what bacteria does an India ink stain show
A
Cryptococcal meningitis
11
Q
likely cause of meningitis in an immunocompromised pt eg with HIV, who has fibrin web CSF, high protein, normal glucose ad high lymphocytes, but normal CXR and no haemoptysis
A
Cryptococcal meningoencephalitis
(normal CXR and no haemoptysis indicate that its not TB)
12
Q
Tx for meningitis in a pt with penicillin allergy
A
IV Chloramphenicol
(cefriaxoen is C/I due to cross-reactivity between cephalosporins and penicillin)
13
Q
what is the common gram positive rod shaped bacteria that causes meningitis
A
listeria monocytogenes
14
Q
what type of encephalitis do IgM or IgG antibodies in the CSF suggest
A
tick-borne encephalitis
15
Q
what can be given for status epileptics in the community if IV route can’t be established
A
PR diazepam or Bucal midazolam
16
Q
pt had stomach upset 2 weeks ago and now has rapidly progressing ascending weakness
diagnosis?
A
guillain barre syndrome
17
Q
what is used to monitor respiratory muscle involvement in Guillain barre syndrome
A
FVC
18
Q
which anti epileptic causes gingival hypertrophy, hirsutism and coarsening facial features
A
phenytoin
19
Q
side effects of levetiracetam
A
drowsiness
headaches
irritation
nausea and vomiting
20
Q
side effects of carbamazepine
A
drowsiness
ataxia
headache
hyponatraemia
rarely, Stevens-Johnson syndrome
21
Q
how can temporal lobe epilepsy cause long term memory loss
A
can cause damage to medial temporal lobe structures eg hippocampus - causes long term memory loss
22
Q
what is west syndrome
A
infantile spasms, which usually start between 4-8 months of age and involve myoclonic jerking (or ‘jack-knife’ spasms) that occur in clusters
23
Q
preceded by an aura followed by automatisms, including fidgeting of the hands, chewing, lip smacking or swallowing
These episodes would usually be accompanied with altered awareness and subsequent amnesia.
which type of focal epilepsy is this
A
temporal lobe epilepsy
24
Q
which juvenile epilepsy occurs exclusively in sleep
A
benign Rolandic seizures
25
cause of tremor on movement but nothing at rest
essential tremor
26
facial weakness, unilateral ear pain and vesicles seen in the ear canal
diagnosis?
Ramsay hunt syndrome due to VZV infection (causes inflammation of the geniculate ganglion of the facial nerve)
27
Tx for Ramsay hunt syndrome due to VZV infection
oral antiviral and steroids
28
first line tx for GBS
Iv immunoglobulin and supportive treatment
29
what is the most important thing to monitor regarding pt prognosis in a pt with GBS
FVC
30
what does an isolated rise in CSF protein indicate
GBS
31
name 5 drugs which cause idiopathic inter cranial HTN
Oral contraceptive pill
Steroids
Tetracycline
Vitamin A
Lithium
32
first line Tx for atonic seizures in women of reproductive age
lamotrigine (or levetiracetam)
(sodium valproate is first line for generalised seizures but not for women of reproductive age)
33
what type of hydrocephalus is caused by problems in the subarachnoid space, often stemming from complications like subarachnoid haemorrhage and infective meningitis.
communicating hydrocephalus
34
where are the common causes of obstruction in obstructive hydrocephalus
foramen of Monro (e.g. due to colloid cysts), cerebral aqueduct (e.g. due to aqueduct stenosis), or fourth ventricle (e.g. due to posterior fossa tumour).
35
dilated lateral ventricles and third ventricle
normal fourth ventricles
headache, no other history
diagnosis?
obstructive hydrocephalus due to lesion/obstruction in cerebral aqueduct (aqueduct stenosis)
(obstructive hydrocephalus can affect all the ventricles)
but communicating hydrocephalus would be after meningitis or subarachnoid haemorrhage
36
what is a secondary generalised seizure
secondary to preceding focal seizure
37
tx for Ramsey hunt syndrome
prednisolone and oral acyclovir
38
LMN facial nerve palsy
ringing noise
vesicles in ear
diagnosis?
ramsay hunt syndrome
39
what is scintillating scotoma
visual phenomenon described in patients suffering from migrainous headache
visual hallucination of zigzags starting in centre and moving out to peripheries of vision
40
what type of lesion does babinskis sign suggest
UMN lesion
41
what is the difference between the movements of the foot that are impaired in peroneal/common fibular nerve palsy and L5 root lesion
peroneal/common fibular nerve palsy
= loss of
ankle eversion
ankle dorsiflexion
L5 root lesion
= loss of
ankle eversion
ankle dorsiflexion
ankle inversion
(also causes weakness of hip abduction)
42
which disorder causes an ascending pattern of weakness that improves on exertion/repetition
LEMS (Lambert-eaton syndrome)
43
which disorder causes descending weakness that fatigues on repletion/sustained action
myasthenia gravis
44
effects of autonomic neuropathy
postural hypotension
gastroparesis
45
effects of spinothalamic tract damage
contralateral loss of coarse touch/pain and temperature sensation
46
effects of peripheral sensory neuropathy
glove-and-stocking distribution of sensory loss or paraesthesiae
47
effects of dorsal column damage
ipsilateral loss of fine touch, vibration sense, and proprioception
48
effects of corticospinal tract damage
ipsilateral weakness below the level of the medulla
contralateral weakness above the level of the medulla
49
what is raised on bloods in an epileptic seizure
prolactin
50
what is the difference between a true epileptic seizure and non epileptic attack disorder
true epileptic seizure
- caused by abnormal brain activity
- head remains fixed
- eyes remain open
- post octal confusion / tongue biting / incontinence
- raised prolactin
non epileptic attack disorder
- caused by psychological stress
- pelvic thrusting
- head movements
- eyes closed
- Postictal crying
- normal prolactin
51
pelvic thrusting, head movements, eyes closed, postictal crying
what kind of seizure/disorder is this
non epileptic attack disorder
52
what is Todds paresis/palsy
when there is persistent weakness or paralysis in a part of the body following a seizure
53
what medication can be given through a cannula for a patient who is in status epilepticus
lorazepam
(lorazepam given IV, diazepam given PR)
54
which nerve is often damaged in fractures of head of fibula
common fibular/peroneal nerve
55
which seizure involves crazy movements and jerking of limbs but no loss consciousness
myoclonic
56
what does reflex anoxic seizure involve
faint, causing a brief twitching episode
57
tx for GBS
IV Ig
or plasma exhcnage if they have vit A deficiciency or renal failure
58
which epilepsy is seen in children 1-2 hours after waking up, triggered by lack of sleep, and which is seen in children during sleep
juvenile myoclonic epilepsy
- after waking up
- triggered by lack of sleep
- myoclonic
benign Rolandic seizures
- during sleep
- tonic clonic
59
what is the cause of a fine bilateral tremor associated with anxiety, hair loss, palpitations and breathlessness
thyrotoxicosis
60
cause of intention tremor, reduced coordination and dysarthria
cerebellar ataxia
61
which tremor starts following a stressful life event
psychogenic tremor
62
what is vital to monitor in GBS and why
FVC, the ascending muscle weakness could affect diaphragm which could then cause resp arrest
63
what is a coryzal illness
inflammation of mucous membranes of nasal cavities
64
what is the triad for normal pressure hydrocephalus
urinary incontinence
dementia
gait abnormality
65
what medication can be given through cannula for status epilepticus
IV lorazepam
(diazepam given PR)
66
which nerve is damaged in a neck of fibula fracture
Common fibular nerve (common peroneal nerve)
67
which seizure is a faint followed by twitching
reflex anoxic seizure
68
describe consciousness in a myoclonic seizure
not affected
69
which child epilepsy occurs after waking up, and which one occurs during sleep
juvenile myoclonic epilepsy
- after waking up
- triggered by lack of sleep
- myoclonic
benign Rolandic seizures
- during sleep
- tonic clonic
70
what is the cause of a bine bilateral tremor associated with anxiety, hair loss, palpitations, breathlessness
thyrotoxicosis
71
what is the cause of an intention tremor, associated with reduced coordination and dysarthria
cerebellar ataxia
72
which tremor starts after stressful life event
psychogenic tremor
73
why should FVC be monitored in GBS
the weakness may spread to diaphragm which causes resp arrest
74
first line manager t for idiopathic inter cranial hypertension
weight loss and close monitoring
75
how do LMN and UMN lessons affect forehead
UMN - forehead sparing
LMN - non forehead sparing
76
is bells palsy UMN or LMN lesion
LMN
77
give a cause of acute onset unilateral facial drooping with forehead sparing
acute stroke
78
cause of unilateral facial weakness with hypersensitivity to loud sounds
Ramsay hunt syndrome
79
what is the cause of foot drop that involves loss of foot inversion as well as eversion
L5 radiculopathy
80
what is the cause of foot drop that involves loss of sensation over the big toe
L5 radiculopathy
81
what is the cause of foot drop that involves loss of sensation over the lateral calf
common perineal nerve palsy
82
LMN facial palsy with ear pain, hearing loss and vertigo
diagnosis?
Ramsay hunt syndrome
83
what is the likely diagnosis of a hiker that had illness (fever, fatigue muscle/joint pain) and later developed monoarthiritis or facial nerve palsy or neuropathic pain or palpitations
Lyme disease
84
what is the diagnostic sign for GBS
albumin-cytologic dissociation
ie raised protein, normal white cell count
(raised WCC would indicate infection, but GBS is usually para-infectious)
85
pt has urinary incontinence, dementia and gait abnormality
diagnosis?
normal pressure hydrocephalus
86
tx for normal pressure hydrocephalus
ventriculo-peritoneal shunting
87
ix for cauda equina due to metatstases
spine MRI (cauda equina due to all causes)
do whole spine MRI rather than just lumbar spine MRI if you think the cause is metastases as you can check the whole spine and pick up multiple lesions if there are some
88
which seizure involves
Swearing / screaming / laughing
Urinary incontinence
Weakness after the seizure
frontal lobe seizure
89
pt has a seizure which involves repetitively pulling at his shirt
what kind of seizure is this
temporal lobe
90
what is this feature and what type of seizure does it present in
twitching in one area of body, that progresses to involve another area of the body as well
Jacksonian march
frontal lobe seizure
91
CSF: very high proton. normal WCC, normal glucose, normal appearance
diagnosis
GBS
92
pt was complaining of numbness in his fingers and arm, before he lost consciousness and his arms and legs starting jerking.
type of seizure ?
Generalised seizure secondary to parietal lobe seizure
92
tx for Ramsay hunt syndrome
acyclovir
93
what is todds paresis
focal unilateral weakness after a seizure - usually frontal lobe seizure
94
which antiepileptic can cause hepatic dysfunction
sodium valproate
95
which condition can the Tensilon Test diagnose
myasthenia gravis
96
which test confirms Idiopathic inter cranial hypertsenion
lumbar puncture - will have high opening pressure
(do imaging of brain first to rule out a space occupying lesion ads that would contraindicate lumbar puncture)
97
management of pt with IIH that has new onset visual loss
optic nerve fenestrations - try to relieve the pressure and improve sight
98
which type of hydrocephalus is after subarachnoid haemorrhage
communicating hydrocephalus
99
which type of hydrocephalus results from problems with the arachnoid granulations
communicating hydrocephalus
(CSF can exit the ventricular system but there is a problem with CSF absorption at the arachnoid granulations)
100
what is opthalmoplegia
paralysis of eye muscles
101
which condition has a prodrome pf gastroenteritis and presents with a triad of ataxia, areflexia and opthalmoplegia
miller fisher syndrome
(Remember that Guillain-Barre starts distally (polyneuropathy) and makes it way up. Miller-Fisher starts proximally i.e. with the eyes)
102
which antiepileptic can cause renal stones
topiramate
103
which anti epileptic can cause skin rash, ataxia, dysarthria and nystagmus
carbamezapine
104
which anti epileptic can cause Acne, anorexia, constipation, dizziness, gingival hypertrophy, hirsutism, insomnia, rash, tremor.
phenytoin
105
proteinuria
oedema
enlarged kidneys
palpitations
cardiomegaly
carpal tunnel syndrome
likely diagnosis?
Amyloidosis
106
what is the cause of "violet wide-amplitude flinging movements of the proximal limb" after a stroke
Hemiballismus due to stroke in the contralateral side of the brain
107
which lobe is affected in receptive aphasia
left temporal lobe
- wernickes area is in the the left temporal lobe
108
which lobe is affected in expressive aphasia
left frontal lobe
- broca's area is in the left frontal lobe
109
pt has stroke and CT head is normal
what does that mean
it is a thrombotic stroke not hemorrhagic
110
which syndrome presents with
hoarse voice
difficulty swallowing
changes in taste
ipsilateral constructed pupil and drooping eyelid
ipsilateral loss of pain and temp sensation on face
contralateral loss of pain and temp sensation on limbs
Wallenbergs syndrome - infarct/ischaemia of the posterior inferior cerebellar artery (PICA)
111
which 3 features constitute a TACI (Total Anterior Circulation Infarct
Contralateral hemiparesis and / or sensory loss
Contralateral homonymous hemianopia that is non-macular sparing
Higher cerebral dysfunction (eg aphasia, neglect)
( If only 2 of these features are present (or there is higher cortical dysfunction alone) the stroke is called a PACI-)
112
aphasia vs dysarthria
Aphasia occurs due to brain damage that affects the ability to express and understand speech.
Dysarthria, on the other hand, is a condition that affects the muscles necessary for speech
113
is the basilar artery anterior or posterior circulation
posterior
114
symptoms of basillar artery stroke
prodromal symptoms 2 weeks before: vertigo, nausea, headaches
115
what is hypocusis
partial or total loss of hearing acuity (clarity/clearness)
116
symptoms of basilar artery stroke
hemiparesis or quadriparesis, and facial palsies, dizziness, headache, and speech abnormalities
locked in syndrome
117
what is bruising over the mastoid process known as, and what does it indicate
Battle sign
suggestive of a skull fracture
118
what is a hemotympanum and what does it indicate
presence of blood in the middle ear
clinical feature of a skull fracture
118
what is CSF otorrhea and what does it indicate
leakage of CSF from the ear (seen as clear fluid)
clinical feature of a skull fracture.
119
head injury causing an initial loss of consciousness, followed by a lucid interval where the patient appears to have recovered which is then followed by a deterioration in GCS
what type of stroke is this
extradural
120
which vessel is the most common cause of an extradural haemorrhage
middle meningeal artery
121
what scoring system can be used in someone with AF to assess their risk of a stroke
CHA2DS2VASc
122
what scoring system can be used in someone who had a TIA to assess their risk of stroke
ABCD2
123
what hereditary condition causes recurrent sprains and joint dislocations and which stroke does it increase the risk of
Ehlers dances syndrome
increases risk of Subarachnoid haemorrhage
124
what type of visual loss does a left parietal lobe lesion cause
right sided inferior homonymous quadrantanopia
125
what type of visual loss does a left occipital lobe lesion cause
right sided homonymous hemianopia with macular sparing
126
what type of visual loss does a left temporal lobe lesion cause
right sided superior homonymous hemianopia
127
what should be given to a pt on warfarin after a hemorrhagic stroke
stop warfarin
give
IV vitamin K
and
Prothrombin complex concentrate
128
what type of stroke causes
ipsilateral cranial nerve three palsy
and contralateral weakness
webers syndrome - midbrain stroke syndrome
129
what are the symptoms of Wallenberg syndrome (lateral medullary syndrome)
"DANVAH"
Dysphagia,
ipsilateral Ataxia,
ipsilateral Nystagmus,
Vertigo,
Anaesthesia (Ipsilateral facial numbness and contralateral pain loss on the body)
ipsilateral Horner's syndrome
130
pt had severe headache and CT head was normal, had LP 12 hours later which showed xanthochromia. what's the next step
CT angiogram
131
what is the difference in symptoms between anterior inferior cerebellar artery stroke and posterior inferior cerebellar artery stroke
posterior inferior cerebellar artery stroke (Wallenberg's ie lateral medullary syndrome)
-"DANVAH"
Dysphagia,
ipsilateral Ataxia,
ipsilateral Nystagmus,
Vertigo,
Anaesthesia (Ipsilateral facial numbness and contralateral pain loss on the body)
ipsilateral Horner's syndrome
anterior inferior cerebellar artery syndrome
- same as Wallenbergs with the addition of
- ipsilateral facial paralysis
- hearing loss
132
which stroke is almost always due to trauma
extradural haemorrhage
133
what is the characteristic clinical course of an extradural haemorrhage
Initial brief loss of consciousness following the trauma
A period of regained consciousness and apparent recovery (the lucid interval)
Subsequent deterioration of consciousness and the onset of a headache
134
are extradural haematomas arterial or venous
arterial
135
are subdural haematomas arterial or venous
venous
136
which vessel is the typical source of bleeding for an extradural haematoma
middle meningeal artery
137
are extradural haematomas infratentorial or supratentorial
supratentorial
138
typical presentation of subarachnoid haemorrhage on CT scan
white area in the centre of the brain that expands bilaterally
139
typical presentation of subdural haemorrhage on CT scan
crescent shaped haematoma - not limited by sutures of the skull
140
typical presentation of subarachnoid haemorrhage on CT scan
biconvex haematoma which is limited to the skull sutures where the dura adheres to the skull.
141
contrast subarachnoid haemorrhage and intracerebral haemorrhage symptoms
Subarachnoid haemorrhage: Characterised by a sudden, severe headache (often described as a 'thunderclap' headache), nausea, vomiting, and neck stiffness
(severe headache + meningism)
Intracerebral haemorrhage: Presents with sudden onset severe headache, vomiting, high blood pressure, and signs of increased intracranial pressure
(severe headaches + raised ICP)
142
which surgical procedure can be done for extradural haemorrhage
ligation of the bleeding artery
143
what is a lentiform shape and which type of haemtaoma is shaped like this
like a lens - convex
extradural haematoma
144
what level do you want co2 to be at during raised ICP
normal, so if try to get pt to hyperventilate
bc high Co2 causes vasodilation in the cerebral vessels which increases blood flow to the brain and therefore further increases ICP, you don't want that
145
what colour is CSf from LP 12 hours after a confirm subarachnoid haemorrhage
yellow (or sometime pink)
146
what is a Amaurosis fugax
temporary painless loss if vision in eye which returns to normal after - its like a TIA in the eye
147
ipsilateral cranial nerve 3 palsy
and contralateral weakness
diagnosis
webers syndrome
148
which scoring system is used to recognise stroke in the acute setting of the emergency department
ROSIER
149
what is conductive aphasia
there is an isolated inability to repeat
different from Broca or wernicke aphasia
150
what is nominal aphasia
inability to correctly name objects
151
what is mannitol used for
raised ICP
152
what is contrast vs non contrast Ct head scans used for
contrast enhanced CT head
- intracerebral infections
- tumours
non-contrast CT scan
- haemorrhage (stroke)
153
what does tetraplegic mean
paralysed in the upper and lower body
154
lesion in which artery can cause tetraplegia with preserved consciousness and only preserved vertical eye movements
basillar artery (locked in syndrome)
155
mechanical thrombectomy id most beneficial in thrombi in which 2 arteries
proximal middle cerebral artery thrombus
or
internal carotid artery thrombus
156
what is enoxaparin
anticoagulant
157
what should the target bp be in a haemorrhagic stroke
<140 mmHg
158
when do you start aspirin 300mg in a pt who has been thrombolysed with Iv atleplase
24 hrs after thrombolysis
159
when do you start aspirin 300mg in a pt who has presented >4.5 hrs from stroke onset
immediately
160
what type os stroke is cerebral amyloid antipathy associated with
hemorrhagic stroke
161
what scoring system can be used to assess functional independence of patients after a stroke
Barthel Index
162
what is the modified SOAR score used for
looks at the short-term mortality of patients after an ischaemic stroke and is measured on a scale of 0–9
162
what is the NIH stroke scale used for
to measure the severity of neurology after a stroke. It can be used when patients first present to establish the extent and severity of focal neurology with higher scores indicating higher levels of neurological impairment. It is often used to help clinicians decide whether the severity of the stroke outweighs the risks of giving a patient thrombolysis.
163
what is the DRAGON score used for
is used for patients with ischaemic stroke to predict their 3-month prognosis if they are to be thrombolysed with alteplase
164
pt is unable to abduct their right eye
where is the lesion
unable to abduct right eye --> lateral rectus muscle doesn't work --> damage to the abducens nerve which innervates it --> abducens nucleus come out of pons --> lesion in right pons
(Cranial nerve lesions are ipsilateral, except trochlear)
165
which CN come out of midbrain, pons and medulla
mid brain: CN 3, 4
pons: CN 5, 6, 7, 8
medulla: CN 9, 10, 11, 12
166
what does loss of grey-white matter differentiation on a CT scan indicate
'loss of grey-white matter differentiation' = cytotoxic oedema = ischaemia --> ischaemeic stroke
167
best ix for MS
MRI brain and spine
168
what phenomena of MS can checking visual evoked potentials reveal
optic neuritis
169
which Parkinson's meds are c/I in pts with impulse control disorders eg gambling addiction
dopmine agonists eg ropinerole, pramipexole, apomorphine
170
weakness in legs, patches of sensory loss that come and go, middle aged female pt
likely diagnosis
MS
171
progressive weakness with mixed UMN and LMN signs
diagnosis
MND
172
what is the parkinsonian triad of symptoms
tremor
hypertonia
bradykinesia
173
tremor
hypertonia
bradykinesia
vertical gaze palsy
progressive supra nuclear palsy
174
tremor
hypertonia
bradykinesia
fluctuating cognitive impairment and hallucinations
Lewy body dementia
175
describe the gait in parkinsons
festinating and shuffling gait
176
causes of unilateral and bilateral high stepping gait
LMN lesions
Bilateral
- cauda equina
- peripheral neuropathy
- Guillain barre / charocot-maire-tooth
Unilateral
- radiculopathy of L5 root
- neuropathy of the sciatic nerve or common peroneal nerve
- polio at the anterior horn
177
causes of Spastic and circumducting gait
MS
space occupying lesions
tumours
178
causes of Spastic and scissoring gait
Cord lesions
- due to trauma, compression, syringomyelia or transverse myelitis
Bihemispheric brain lesions
- due to cerebral palsy or multiple sclerosis
179
what type of tremor is worse of resting, and reduced on action, can be assymetrical
parksions tremor
(essential tremor is usually bilateral/symmetrical, worse on resting, associated with family history, received by alcohol consumption)
180
which medication for MS can reduce duration and severity of attacks
IV methylprednisolone
181
what medication for MS can reduce relapse rate in the long term
IV beta interferon
182
what do periventricular lesions on MRI indicate
MS
183
factors associated with worse prognosis in MS
Older, male, motor signs at onset, early relapses, many MRI lesions and axonal loss
184
which condition is micrographia (abnormally small cramped handwriting) associated with
parkinsons
185
tremor
hypertonia
bradykinesia
spontaneous activity or akinetic rigidity of a limb
diagnosis
Parkinson plus syndrome --> cortico-basal degeneration
186
what is sporadic MND
occurs with no family history
187
what do SOD1mutations cause
familial ALS --> MND
188
what is hyperemesis gravidarum
persistent severe vomiting leading to weight loss and dehydration, as a condition occurring during pregnancy
189
what could be the cause of wernickes encephalopathy in a pregnant woman
hyperemesis gravidarum
190
what should be prescribed to a parksinons pt on levodopa who is experiencing on-off symptoms (motor fluctuations)
MAO-B inhibitor eg rasagiline
or OCMT inhibitor
or dopamine agonist eg ropinerole, pramipexole, apomorphine
191
classic cause of raised CSF protein
GBS
192
worsening unilateral neck pain
constricted pupil
ptosis
diagnosis?
internal carotid dissection, causing horners syndrome
193
which medications can cause acute dystonic reactions
dopamine antagonists eg metoclopramide
194
how does lesion in the primary visual cortex affect vision
contralateral homonymous hemianopia with macular sparing
195
how does lesion in the lateral geniculate nucleus affect vision
contralateral homonymous hemianopia
196
how does lesion in the optic tract affect vision
incongruous homonymous hemianopia
eg lesion in left optic tract causes right homonymous hemianopia
197
where is the lesion in optic neuritis
optic nerve
198
what is the gene and inheritance pattern of Huntingtons
autosomal dominant, defect in HTT gene
199
triad of Huntingtons
movement disorder
psychiatric features
depression
200
what is an oculogyric crisis (OGC), common causes and treatment
acute dystonic reaction - upward deviation of eyes, sometimes neck extended backwards and mouth fixed in open wide position
commonly caused by use of metoclopramide or haloperidol
tx = procyclidine, benzatropine
201
what is malingering
the deliberate faking of symptoms in order to obtain secondary gain
202
pt has difficulty hearing for 6 months, vertigo, reduced sensation of the opthalmic, maxillary, and mandibular divisions of the left trigeminal nerve, reduced taste sensation of the posterior left side of the tongue; and deviation of the uvula to the right
diagnosis?
acoustic neuroma
203
back pain associated with leg or buttock pain
relieved by flexion and worse with extension
may have weakness or reduced sensation in certain areas
diagnosis
spinal stenosis (which causes spinal claudication)
204
describe onset fo cluster headache vs migraine
cluster - sudden onset
migraine - gradual onset
205
where is the lesion in left upper quadrantinopia
right temporal lobe
206
where is the lesion in left homonymous hemianopia with macular sparing
right occipital lobe
207
sudden intense headache pain when shaving / brushing teeth / touching face / eating ice cream
diagnosis?
trigeminal neuralgia
208
unilateral sudden headache pain around eye
profuse eye watering and nasal secretions
diagnosis?
cluster headache
209
which conditions is sumatriptan (migraine med) C/I in
ischaemic heart disease, hypertension, peripheral vascular disease, previous strokes, and previous myocardial infarctions
(bc sumatriptan causes vasoconstriction)
210
which medications are used first line for neuropathic pain
Gabapentin, Pregabalin, Amitriptyline and Duloxetine
211
most common cause of LEMS
Small cell lung cancer
212
what is LEMS
autoimmune, usually due to underlying malignancy eg SCLC
limb weakness
worse in mornings
dry mouth / impotence / orthostatic hypotension
reduced / absent reflexes
213
what med can be used as symptoms management for LEMS
amifampridine
214
LEMS investigations
serology for anti-voltage-gated calcium channel antibodies
nerve condition studies - show a doubling of muscle action potential amplitude following exercise
imaging for SCLC
215
LEMS vs myasthenia gravis
LEMS
- weakness worse in mornings
- limb weakness
- absent or reduced reflexes
- small response to edrophonium
myasthenia gravis
- fatiguable mucles weakness
- starts with ocular muscle weakness
- persevered reflexes
- proper repose to edrophonium (improves in repose to acetylecholinsterase inhibitors)
216
when exactly should sumatriptan be taken for a migraine
should be taken once the headache starts, but not during the aura phase
217
pt presents with severe sudden onset headache and has history of recurrent sprains and shoulder dislocations like her father
diagnosis and explain what's going on
she has Ehlers danlos syndrome
and is experiencing a subarachnoid haemorrhage due to rupture of a berry aneuryrsm (Ehlers danlos causes aneurysms)
218
diminished vibration sensation and proprioception
symmetrical sensory symptoms
some exaggerated and some diminished reflexes
diagnosis
subacute combined degeneration of the spinal cord
219
cause of subacute combined degeneration of the spinal cord
vit B12 deficiency
220
which tracts are degenerated in subacute combined degeneration of the spinal cord
degeneration of the dorsal column and the corticospinal tract
221
tx for subacute combined degeneration of the spinal cord
vt b12 replacement
222
function of spinothalamic tract
only sensory
- Pain
- Temp
sPinoThalamic
223
function of corticospinal tracts
sensory
- proprioception
light touch
vibration
motor
- lateral corticocpinal tract
voluntary movement of contralateral limbs
- anterior corticospinal tract
voluntary movement of the trunk
224
function of the dorsal column
only sensory
- fine touch
- 2 point discrimination
- proprioception
- vibration
225
what do Kayser-Fleischer rings in eye suggest
Wilsons disease
226
which condition is the ATP7B gene linked to
Wilsons disease
227
what is Wilsons disease, what are the signs an symptoms, investigations and treatments
defective copper metabolism
leads to copper accumulation esp in liver and brain
ATP7B gene mutation
signs/symptoms
- psychiatric / neurological symptoms
- hepatic dysfunction
- kayser-fleischer rings in the eye
investigations
- serum ceruloplasmin (low)
- serum copper levels (low)
- 24hr urinary copper collection (high)
- genetic testing
treatment
- chelators
--> D-penicillamine
--> Trientine
--> Zinc salts
228
crampy leg pain that radiates down the back of legs, is brought on by exercise but improves on bending over our walking uphill
diagnosis
spinal claudication
229
what are the antibodies against in LEMS
Autoantibodies against presynaptic voltage-gated calcium channel
230
in which condition are Anti-acetylcholine receptor antibodies found
myasthenia gravis
231
first line prophylaxis in migraine
propanolol
(if asthmatic give topiramate - but don't give to pregnant or child brawling age)
232
first line prophylaxis for cluster headaches
verapamil
233
tx for cluster headaches
high flow oxygen or sumatriptan (subcut or intranasal)
234
tx for migraine
sumatriptan (oral) + NSAIDs
235
tiredness
weakness in limbs
numbness
increased tone and spasticity in legs
absent angle jerks
macrocytic megaloblastic anaemia
diagnosis
subacute combine degeneration of the spinal cord
236
what is a classic cause of surgical third nerve palsy
posterior communicating artery aneurysm
237
pt: suddenly feeling very dizzy, losing her sense of balance and has been choking on her food. On examination there is reduced left facial sensation, absent pain sensation throughout the right arms and legs, a droopy left eyelid and a constricted left pupil
diagnosis
Lateral medullary syndrome aka Wallenberg syndrome
("DANVAH" - Dysphagia, ipsilateral Ataxia, ipsilateral Nystagmus, Vertigo, Anaesthesia, ipsilateral Horners syndrome)
238
sudden onset of vertigo
recent viral illness
vertigo not triggered by head movements
no hearing loss or tinnitus
diagnosis
vestibular neuritis
239
what are the paraneoplastic syndromes of small cell lung cancer
can be remembered by the "SCLC" mnemonic which stands for
SIADH,
Cushing's,
LEMS
Cerebellar degeneration.
240
contrast horners syndrome caused by pan coats tumour vs carotid artery dissection
pancoast tumour
- miosis, ptosis, anhidrosis
- also shoulder pain, cough etc
carotid artery dissection
- miosis, ptosis
- no anhidrosis
- neck pain
241
patient is unable to adduct her left eye and nystagmus is noted in the right eye on abduction
diagnosis
left intranuclear opthalmoplegia (caused by lesion affecting left medial longitdinal fasciculus)
242
features of cerebellar dysfunction
DANISH:
Dysdiadochokinesia (inability to perform rapid alternating movements)
Ataxia
Nystagmus (typically multidirectional)
Intention tremor (tremor during voluntary movement illustrated by the finger-nose test)
Slurred speech
Hypotonia
243
which can best visualises spinal claudication
non contrast spine MRI
244
when can you use dexamethasone for raised ICP
only used for raised ICP resulting from malignancy
if have raised ICP due to cerebral oedema give mannitol
245
which medication can be used for raised ICP due to cerebral oedema
mannitol
246
which headache is COCP C/I in
migraine with aura
247
right-sided inferior quandrantanopia
where is the lesion
left parietal lobe
248
which medication can be used to manage choreoathetosis
tetrabenazine
249
what is sensory ataxia
ataxia due to impairment of sensory feedback signals eg when vision is removed -> rombergs test
250
what type of visual loss is most common due to optic neuritis
central scotoma
251
instability
night time falls
jeans no longer fit
pmh of diabetes
diagnosis
diabetic amyotrophy (symmetric wasting of the thighs in diabetes)
252
pt has infectious signs, siezure, and lateralising signs eg right sided increases tone and hypereflexia
diagnosis?
cerebral abscess - meningitis would not present with focal neurological signs
253
what does a ring enhancing lesion indicate on CT
abscess
254
which medication can be given for migraine prophylaxis to an asthmatic young woman
amytriptyline
255
MRI shows atrophy of the caudate nucleus and putamen
which condition has this
huntigntons
256
which genetic condition causes choreoathetosis and dementia
Huntingtons
257
confused, nausea, headache, non contrast CT shows hyper density in a sinus
diagnosis and first lien tx
intracranial venous thrombosis
LMWH
258
medical vs surgical 3rd nerve palsy, and causes
medical
- doesn't affect pupil
- problem from inside of nerve: ischaemia of the nerve
surgical
- does affect pupil: dilation
- problem from outside of nerve compressing on it and the parasympathetic fibres which runs along its surface (parasympathetic constructs the pupil): PCA aneurysm - in circle of willis
