Neurology Flashcards
1
Q
What triad of symptoms is associated with normal pressure hydrocephalus?
A
Urinary incontinence
Dementia
Gait abnormality
KNOWN AS HAKIM TRIAD
2
Q
What is the result of a third nerve palsy?
A
Down and out eye
Diplopia
Ptosis
Fixed dilated pupil (mydriasis)
3
Q
What is the result of a fourth nerve palsy?
A
Defective downward gaze (vertical diplopia)
4
Q
What is the result of a sixth nerve palsy?
A
Defective abduction (horizontal diplopia)
5
Q
What is the management of neuropathic pain?
A
Monotheraphy with Amitryptiline, pregabalin, gabapentin, or duloxetine
If doesnt work then switch medication
6
Q
Triad for wernickes encephalopathy?
A
Gait ataxia
Ophthalmoplegia/Nystagmus
Confusion
7
Q
What is the result of a common peroneal nerve palsy?
A
Weakness of foot Doris flexion and foot eversion
8
Q
What marker can be used to differentiate a seizure form a pseudo seizure?
A
Prolactin
9
Q
What is the mainstay treatment for a TIA?
A
Aspirin 300mg for 2 weeks followed by long term use of clopidogrel 75mg
10
Q
What is the acute management of a cluster headache?
A
High flow oxygen + SC/intra nasal triptan
11
Q
Prophylaxis mix of cluster headache?
A
Verapamil
12
Q
What is the management of an acute relapse of ms?
A
High dose steroids
13
Q
What medication/s reduce risk of relapse in MS
A
Natalizumab
Fingolimod
Beta interferon
14
Q
What is the medical management of myasthenia gravis
A
Acetylycholinesterase inhibitors- Pyradistigmine
15
Q
What is the 1st line Ix for MG?
A
Acetylcholine receptor antibodies
16
Q
What is syringomeylia?
A
Collection of CSF in spinal cord
17
Q
What are the key features of syringomyelia/
A
Cape like distribution loss of sensation to temperature and pain but preservation of light touch, proprioception and vibration classic- burn hands and don’t notice
Upgoing plantars
Autonomic features e.g. Horner’s
Spastic weakness (predominantly Lower limbs)
18
Q
What does syringomyelia have a strong association with?
A
Arnold-Chiari malformations
19
Q
What is the ix and management for syringomyelia?
A
Ix- full spine and brain MRI
Ms- dependent on cause - possibly a shunt
20
Q
What is a fixed dilated pupil and indication of?
A
Cn 3
21
Q
What would be the result of Neuro imaging in NPH?
A
Ventriculomegaly w/o sulcal enlargement
22
Q
What is the inheritance pattern of neurofibromatosis?
A
Autosomal dominance
23
Q
What chr is affected in NF1 and list 3 features?
A
Chr 17
> =6, 15mm cafe au lair spots
Axillary/groin freckles
Iris hamatomas (Lisch Nodules)
Scoliosis
Phaechromocytoma
24
Q
What chr is affected in NF2 and list prominent feature?
A
Chr 22
Bilateral vestibular schwannomas
25
List 3 Sx of. An acoustic neuroma?
Unilateral hearing loss
Reduced facial sensation
Balance problems
26
What is the 1st line and GS Ix for acoustic neuromas? Also what sign will be present on GS to be diagnostic?
1st line- Audio gram
GS- gadolinium enhanced MRI scan- will show 'absence of dural tail'
27
What is the Rx for prophylaxis of migraines?
Propranolol
Topiramate- avoid in girls of bearing age
Amitryptiline
28
What nerve is affected in a mid shaft humerus fracture and what happens?
Radial nerve --> Wrist drop and loss of grip strength
29
What is the mode of inheritance of charcot marie tooth syndrome?
autosomal dominant
30
What nerve and blood vessel is affected in amurosis fugax?
Optic nerve
retinal/opthalmic artery (branch of ICA)
31
What is the key diagnostic test in GBS and what does it show?
Lumbar puncture (raised protein, with normal wcc)
32
How long can a person who suffered from their first unprovoked/isolated seizure with no evidence in imaging/EEG not drive for?
6 months
33
What is the associated effects of an anterior cerebral artery infarct?
Contralateral hemiparesis
sesnoryt loss lower extremity > upper
34
What are the associated effects of a middle cerebral artery infarct?
Contralateral hemiparesis
sensory loss greater in upper extremity
contralateral homonymous heminanopia
aphasia
35
What are the associated effects of a posterior cerebral artery infarct?
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
36
What is webers syndrome?
Weber's syndrome is a form of midbrain stroke (posterior cerebral artery) characterised by the an ipsilateral CN III palsy and contralateral hemiparesis
37
Wha are the characteristics of Progressive supranuclear palsy (PSP)?
postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction
38
What is the tx of choice for an essential tremor?
Propranolol or Primidone
39
What are sx and features of an acoustic neuroma?
vertigo
sensorineural hearing loss
unilateral tinnitus
absent corneal reflex
facial palsy
40
What classification can be used for an acute ischaemic stroke?
The Oxford stroke (Bamford) classification.
41
What medication should you give to someone within 4.5 hours of having an ischaemic stroke?
Thrombolysis - Alteplase (IV).
42
What are the contraindications for alteplase?
Haemorrhage.
Suspected SAH.
Active bleeding.
Recent GI infection or UTI.
Recent surgery.
Malignancy.
43
List the signs of a ACA infarct?
LL weakness and loss of sensation
Gait apraxia
Incontinence
Drowsiness
Decrease in spontaneous speech
44
List the signs of a MCA infarct?
UL and LL weakness
Contralteral homonymous hemianopia
Aphasia
Dysphasia
Facial droop
45
List the signs of PCA infarct?
Speech impairment + dysphagaia
Cerebellar dysfunction
Visual disturbances (contralateral homonymous hemianopia with macular sparing)
visual agnosia
prospagnosia
46
What are the signs of Weber's syndrome and what artery is affected?
Branches of posterior cerebral artery that supply midbrian
Ipsilaterla CN3 Palsy
contralkaterla weakness of UL and LL
47
What is the signs of Wallenberg syndrome/lateral medulalry syndrome and what aretry is affected?
Posterior inferior cerebellar artery
Ipsilateral facial pain and temp loss and Horner's
Contralateral limb/torso pain and temp loss
Ataxia, Nystagmus
48
Give 4 signs of UMN weakness.
Increased muscle tone.
Hyperreflexia.
Spasticity.
Minimal muscle atrophy.
49
Give 5 signs of LMN weakness.
Decreased muscle tone.
Hyporeflexia.
Flaccid.
Muscle atrophy.
Fasciculations.
50
Give 3 signs of Myasthenia Gravis.
Generalised fatiguability:
Proximal limbs.
Neck/face - head drop, ptosis.
Extra-occular - diplopia.
Speech and swallowing problems.
Risk of other auto-immune disorders.
51
Peripheral Neuropathy: describe mononeuritis multiplex.
A patchy process where individual nerves are picked off randomly. Often it has an inflammatory or immune mediated cause. Chronic, slow progression.
52
What are the 3 main components of the Glasgow Coma scale?
Best motor response.
Best vocal response.
Best eye-opening response.
53
What spinal tract is responsible for motor response?
Corticospianl tract
54
What signals does the spinothalamic tract carry?
Anterior- Crude touch, light touch, vibration.
Lateral- pain, temperature,
55
Give 2 population groups who may be at increased risk of a subdural haematoma.
Elderly and alcoholics - due to cerebral atrophy.
56
Give 3 symptoms of a subarachnoid haemorrhage.
Thunderclap, maximum severity headache within seconds.
Photophobia.
Neck stiffness.
Nausea and vomiting.
57
What investigations might you do in someone who you suspect has a subarachnoid haemorrhage?
CT head (star shaped).
Cerebral angiography.
Lumbar puncture - xanthochromia.
58
How do you manage and treat a patient who has had a subarachnoid haemorrhage?
Nimodipine (CCB).
Early intervention, support and close monitoring is essential.
59
Give 3 symptoms of Cauda Equina syndrome.
Bilateral sciatica - pain radiates down leg to foot.
Saddle anaesthesia.
Bladder/bowel dysfunction.
Erectile dysfunction.
Leg weakness.
60
Define frailty.
A state of increased vulnerability resulting from an ageing associated decline in function across multiple physiologic systems; the ability to cope with everyday stressors is therefore compromised.
61
What is relative afferent pupillary defect (RAPD)?
It is observed during the swinging light test. The patient's pupils constrict when the light is swung from the unaffected to the affected eye. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced.
62
What is another name for RAPD?
Marcus Gunn pupil.
63
In what conditions might you see RAPD?
MS.
Glaucoma.
Severe retinal disease.
Optic nerve lesion.
64
List 5 RF for stroke?
Smoking
Alcohol
HTN
Hyperlipidaemia
obeisty
DM
AF
65
What is syncope?
A transient loss of conciousness, loss of postural tone
66
List 5 differentials for blackouts?
Vasovagal syncope
cardiac syncope
migraine w/ aura
Hypoglycaemia
TIAs
non-epileptic seizures
Intermittent hydrocephalus
67
What ix couold be done for blackouts
12 lead ECG
Brain imaging
EEG
Video telemtery
Tilt Table Test
68
List 3 features of Multi System Atrophy?
- parkinsonism
- autonomic disturbance
- cerebellar signs
classical history of poor response to levodopa, impotence, urinary retention and age group.
69
List features of PSP?
impaired balance and therefore being prone to many falls.
vertical gaze palsy.
symmetrical onset and is poorly responsive to levodopa
70
what should be suspected with a Painful third nerve palsy
Posterior communictaion artery aneurysm
71
What diagnosis should be suspected in a Obese, young female with headaches / blurred vision
Idiopathic intracranial hypertension
72
which of the muscles are typically spared in MND
Ocular muscles
73
What is Brown-Sequard syndrome a result of and list the main feature
BSS is a result of lateral hemisection of the spinal cord
ipsilateral weakness below lesion
ipsilateral loss of proprioception and vibration sensation
contralateral loss of pain and temperature sensation
74
What is the GS ix for suspected stroke?
Non contrast CT head
75
List 5 triggers for a migraine?
Chocolate
Hangovers
Orgasms
Cheese
Oral contraceptives
Lie ins
Alcohol
Tumult
Exercise
76
List the triad associated with Horners syndrome
Ptosis, Miosis and Anhidrosis
77
What is GCA and list 3 fetaures?
GCA is agrnaulamatous vasuclitis of medium sized arteries
Temporal headaches
Jaw claudication
Sclap tenderness
Amurosis fugax
Aching and stiffness
78
What is the firts line and GS Ix of GCA?
1st line- Infammmatory markers- Raised ESR
GS- Temporal artery biopsy- granulamatous inflammation
79
What is the 1st line medication for focal seizures
Lamotrigine or Leviteracetam
80
What is Charcots Neurological triad and list the 3 features?
Charcot's neurological triad refers to a set of three classic clinical features associated with the progression of multiple sclerosis (MS)
1) Nystagmus
2) Dysarthria
3) Intention tremor
81
What is MS?
A chronic cell mediated autoimmune disorder charcterised by demyelination of the CNS (a type 4 hsr)
82
What cells are reponsible for myelination in
a) CNS
B) PNS
A) Oligodendrocytes
B) Schwann cells
83
What criteria is used to make a diagnosis of MS
McDonalds criteria of MRI imaging
84
List 2 signs/phenemenoms found in MS?
Lhermittes phenemenom- Parsatehesia in limbs following neck flexion
Uhertoffs phenemenom- Increase in temp causes worsening of sx (often visual)
85
List 2 findings in someone with MS
White matter plaques disseminaated in space and time
CSF- oligoclonal bands
86
What type of lesion if bells palsy
LMN lesion
87
list the clincial features in Parkinson's disease
Bradykinesia
Pill rolling resting tremor
Postural instability
Rigidity
Reduced facial expression (hypomimia)
88
What is Parkinson's disease?
A neurodegenerative disorder characterised by the loss of dopiminergic neurons in the substantia nigra
89
Give 2 histopathological signs of Parkinson's disease.
Lewy bodies.
Loss of dopaminergic neurones in the substantia nigra.
90
What class of medications are used to treat PD?
Levodopa
Dopmaine agonist e.g. Bromocriptine, ropinerole, Cabergoline
MAO-B Inhibitors- seleglline
COMT inhibitors- entacapone
91
What lobe of the brain is affected in Alzheimer's disease?
Temporal lobe
92
Give histopathological signs of Alzheimer's disease
Excess intraneuronal Amyloid plaques
Aggregates of TAU proteins-- neurofibliray tangles
93
What medication can be used to manage the sx of alzheimers dementia
Acetylcholinesterase inhibitors e.g Donepezil, Rivastigmine
or Memnatine (NMDA antagonist)
94
Frontotemporal dementia is characterised by what?
Pick bodies
95
What is the tx for GBS?
IV Immunoglobulins 5 days and plasma exchange
96
What is MG?
(T2 Hypersensitivity reaction)
Automimmune disorder resulting in insufficient functioning acetylcholine receptors
97
What antibodies are associated with MG?
Acetylchloline receptor antibodies
MUSK antibodies
98
What is the mx of a myasthenic crisis?
Plasmapharesis and IVIG
99
What other conditions is LEMS asscoaited with?
Small cell lung cancer **
breast and ovarian cancer to a lesser extent
100
What is LEMS?
Lambert-Eaton myasthenic syndrome is caused by an antibody directed against presynaptic voltage-gated calcium channel in the peripheral nervous system.
101
What antibody is associated with LEMS
Anti P/Q voltage gated calcium channel
102
What is the mx of LEMS?
3,4 Diaminopyridine (Amifampridine)
103
What are the subtypes of MND and list their key sx?
1) Amyotrophic Lateral Sclerosis
UMN and LMN affected
Babinski +ve, Fasiculations on tongue, Dysphagia, Dysarthria
2) Progressive Bulbar plasy
(Bulbar)-> Medulla so CN 9,10,11,12 affected
Carries the WORST PROGNOSIS
3) Progressive Muscle atrophy
4) Primary lateral Sclerosis
104
What is the 1st line tx for MND?
Riluzole
Then just symptom management: Respiratory care, Nutrition
105
List the RF for carpal tunnel syndrome and what nerve is repsonsible?
OPRAH
Obesity
Pregnancy
RA
Acromegaly
Hypothyroidism
Median nerve
106
What is the mx of carpal tunnel?
moderate
1st line- wrist splint
2nd line- corticosteroid injection
severe
1st line- surgical release
107
What is the GS ix for carpal tunnel?
EMG
108
List the causes of Cauda equina syndrome
Lumbar disc hernaition (L4/5 AND L5/S1)- Most common cause
Neoplasm
Abscess
Iatrogenic causes
109
List 5 sx of Cauda equina?
Back pain
Saddle anaesthesia
Loss of senstaion in bladder and rectum
Bilateral sciatica
Bilateral LMN weakness
Sexual dysfunction
Reduced anal tone on PR exam
Absent ankle reflex
110
GS ix of cauda equina
urgent MRI of spine
111
WHat is the mx of cauda equina syndrome
Surgical decompression ideally witthin 48 hours
if malignancy- give dexamethasone
112
What tracts are repsonsible for
a) Temp and pain
b) crude touch
c) sensory info of lower limbs
d) Sensory info of upper limbs
a) Lateral spinothalamic tract
b) Anterior spinothalamic tract
c) DCML- Fasiculus Gracillis (Medial)
d) DCML- Fasiculus Cuneatus (Lateral)
113
What is Subacute combined degeneration of the spinal cord
A neurological complication associated with vit b12 deficiency
114
List the causes of vit b12 deficiency that can cause SCDC
prenicious anemia
malabsorbtion syndromes
Dietary deficiencies
Misuse of nitrous oxide (functional rather than true)
115
list the importance of vit b12 and how a deficiency of b12 may lead to sx of SCDC?
- B12 is essential to the syntheisis of myelin therefore in b12 deificiency the synthesis is compromised and leading to demyelination of nerve fibres
- in the absence of b12, the metabolism of certain amino acids and fatty acids is disrupted thus leading to an acucmulation of HOMOCYSTEINE and METHYLYMALONIC ACID --> toxic metabolites lead to neuro sx of SCDC
116
What ix can be done for a diagnosis of SCDC?
Folate and B12 levels
Homocysteine levels- rasied level despite normal B12 levels may indicated functional deficiency
MRI of spine to exclude cervical myelopahy
EMG
117
What is the managemnt of a brain abscess
surgery- abscess cavity is debrided
Abx- 3rd gen cephalosporin + metronidazole
Intracranial pressure mx- dexamethasone
118
What may be seen on imaging for brain abscess?
Ring enhancing lesion on CT
119
When should a refferal for Bells Palsy be made to ENT?
If no signs of improvement in 3 weeks
120
List sx of idiopathic intracranial htn
Blurred vision
Headaches
Papillooedema
Enlarged blind spots
may ahve 6th nerve palsy
121
What is the tx for trigeminal neuralgia?
1st line- Carbamazepine
other include- Phenytoin Lamotrigine, Gabapentin
122
What is pituitary apoplexy?
Sudden enlargement of a pituitary tumour (usually non-functioning macroadenoma) secondary to haemorrhage or infarction.
123
What is the ix and mx of choice for pituitary apoplexy?
ix- MRI is diagnostic
mx- urgent steroid replacement due to loss of ACTH
surgery
124
What is wernickes aphasia and what lobe is compromised?
receptive aphasia- speech fluent, comprehension abnormal, repetition impaired
Temporal lobe
125
What is Brocas aphasia and what lope in compromised?
Expressive aphasia- difficulty speaking fluently, and their speech may be limited to a few words at a time. Speech is halting or effortful.
126
What is the most common complication of meningitis?
Sensorineural Hearing loss
127
What are the signs of pontine haemorrhage?
Low GCS
Paralysis (quadriplegia)
Bilateral pinpoint pupils (small reactive pupils)
128
What class of medication should be avoided in myasthenia gravis
Beta blockers
129
Where do secondary brain tumours arise from?
Lung
Colorectal
Melanoma
Breast
Kidney
130
If clopidogrel is CI in the secondary managemnt of an ischaemic stroke what is the mx?
Aspirin 75mg
131
What is the mx of cervical myelopathy?
Surgery
132
If brain imaging is required in a TIA, what is the best modality to use?
MRI Brain w/ diffuse weighted imaging
133
List 3 sx of Bells Plasy
Facial nerve palsy --> FOREHEAD AFFECTED
Hyperacuisis
Aletred taste
Dry eyes
Post-auricular pain (may precede paralysis)
134
What is the management of Bells Palsy
Oral prednisalone + eyecare
135
What is the inheritance pattern of Friedreich's ataxia
Autosomal recessive- trinucleotide repeat of GAA
136
From which cancers do secondary brain tumours arise from
Lung
Breast
Kidney
Melanoma
Colorectal
137
What medication can be used to treat Idiopathic Intracranial Hypertension (IIH)
Acetazolamide- a carbonic anhydrase inhibitor
138
What is the most common complication following meningitis infection
Sensorineural hearing loss
139
List 3 CI for a lumbar puncture?
Coagulopathy/bleeding disoreder
Signs of raised ICP
Sings of brain hernaition
Skin infection of puncture site
Focal neurology
140
What is the mos common caustive agent of encephalitis?
HSV1 - Herpes Simplex
141
List the rf for alzheimers
Downs syndrome
Lonliness
Depression
142
What is the ABCD2 score and list the contents?
Stratifes the risk ofstroke following a TIA
Age >60
BP- >140/90
Clinical features-
- unilateral wekaness- 2
- Speech, no wekaness- 1
Duration
->60 mins- 2
-10-59 mins- 1
Diabetes- 1
143
List 3 factors that favour pseduseizures compared to true epileptic seizures?
Gradual onset
Doesnt occur when alone
Pelvic thrusting
More common in females
Crying after seizures
Family member with epeilepsy
144
List 5 RF of isachaemic stroke
Smoking
HTN
Obesity
Diabetes
Afib
hypercholestraemia
Male, Age
145
What is the difference between strokes and epileptical events?
Strokes present with negative sx and obey the vascular territory whereas epileptic events present with positive sx and do not obey vascualr territory
146
What ix can be done post acutely following an ischaemic stroke?
Carotid USS
Echocardiogram
CT/MRI angiogrpahy
147
What is the chronic mx of a ischaemic stroke?
HALTSS
HTN
Antiplatelet- clopidogrel 75mg
Lipid lowering theraphy
Tobacco cessation
Sugar- get diabets under control
Surgery- carotid endarectomy if stenosis >70% (can be 50%- varies according to orgs)
148
What is the main risk associated with thrombolysis
bleeding
149
List 4 causes of painelss monocular vision loss
Amurosis fugax
retinal dettachemnt
vitreous haemorrhage
Anterior ischaemic optic neuritis
150
List 2 complications of epilepsy?
Status epilepticus
depression
suicide
Sudden unexpected death in Epilepsy (SUDEP)
151
WHat is the GS Ix for carotid sinus thrombosis?
MR venogram
152
List 3 triggers of epilepsy?
Poor sleep
drugs and alcohol
stroke
Intracranial haemorrhage
153
List 2 differential sof essential tremors
Parkinsons
Hyperthyroidism
Drug induced tremor
154
What is the rules of driving following a TIA
do not drive for a month- no need to inform DVLA
155
What is the MOA of triptans and list its CI for usage?
5HT Agonist
CI- In ischaemic heart disease and cerebrovascular disease
156
What are the side effects associated with triptans?
Flushing, Tingling, Chest and throat tightness (may mimic angina)
157
What is Brudzinkis sign?
passive neck flexion elicits hip and knee flexion
158
What is kernigs sign?
Knee and hip flexed at 90. Extension of the knee is painful or limited in extension.
159
Definition of seizures?
Transient occurunces of symptoms due to abnormal excessive neuronal activiy in the brain
160
What is the definition of epilepsy?
Neurological disorder characterised by the recurrence of seizures
161
What is cushings triad for raised ICP?
HTN/wide pulse pressure
Bradycardia
Irregular breathing
162
List the 3 tracts that are affected in SCDC?
1. Dorsal Columns- distal tingling/numbness. Impaired propioception and vibration
2. Lateral corticospinal tracts- Muscle weakness, hypereflexia, UMN sigsn
3. Spinocerebellar tract- ataxia and romberg +ve
163
'hot potato' speech is indicative of what?
Pseudobulbar palsy
164
List sx of anterior inferior cerebellar artery leison?
SImilar to wallenburh but ipsilateral facial paralysis and deafness
165
List the sx of thoracic outlet syndrome?
Painless muscle wasting of hand--> weakness in grasping
Numbness and tingling
Cold hands
Swelling
166
In cn 3 palsy, what isn the sataus of the light and consensual reflex?
Absent light reflex
Intact consensual reflex
167
What EEG findings are present in infantile spasms?
Hypsarrythmia - Poor prognosis
Infantile spasms/west syndrome- characterised by salam attacks
168
What EEG findings are concurrent with Benign rolandic epilepsy?
Centerotemporal spikes
169
What nerve root correspond to the ankle reflex?
S1-S2
170
What nerve root correspond to the knee reflex?
L3-L4
171
What nerve root correspond to the biceps reflex?
C5-C6
172
What nerve root correspond to the triceps reflex?
C7-C8
173
What parts of the spinal cord is affected in subacute combined degeneration of the spinal cord?
Loss of myelin in dorsal and lateral columns of the spinal cord and the spinocerebellar tracts
JUST REMEMBER: SCD
Spinocerebellar, Corticospinal, Dorsal
174
Describe features of subacute combined degeneration of the spinal cord?
Distal sensory loss, tingling (paraesthesia)
Babinski Sign - absent ankle jerks/extensor plantars
Gaits abnormalities
Romberg's positive
175
What is the NEW Definition of TIA?
Tissue based not time-based. A TIA is caused by focal brain, spinal cord or retinal ischaemia without acute infarction
176
What tool is recommended by NICE to assess stroke symptoms?
ROSIER - Recognition of Stroke In The Emergency Room
177
What clinical syndrome occurs in spinal injury at, or above T6 spinal level?
Autonomic dysreflexia
178
What are the features of autonomic dysreflexia?
- Unbalanced physiological response - Extreme hypertension
- Flushing and sweating above level of lesion
- Agitation
179
What is the radiological feature of a subdural haemorrhage?
Isodense (hypodense) crescent-shaped collection
180
What are features of cataplexy?
Sudden transient episode of muscle weakness after strong emotions such as laughter, anger or surprise
181
What is first line treatment for males with Myoclonic seizures?
Sodium valproate
182
What are the 6 options for motor response in GCS?
6. Obeys commands
5. Localises to pain
4. Withdraws from pain
3. Abnormal flexion to pain (decorticate posture)
2. Extending to pain
1. None
183
What are the 5 options for verbal response in GCS?
5. Orientated
4. Confused
3. Words
2. Sounds
1. None
184
What are the 4 options for Eye response in GCS?
4. Spontaneous
3. To speech
2. To pain
1. None
185
What are adverse effects of sodium valproate?
Teratogenic, Nausea, Weight gain, Alopecia
186
What is the management of myasthenic crisis?
Supportive care and IV immunoglobulins or Plasma exchange
187
Name some clinical features of raised ICP?
Headache
Vomiting
Reduced consciousness
Papilloedema
Cushing's Triad
188
What is the Mx of raised ICP?
Head elevation to 30 degrees
IV Mannitol
Controlled Hyperventilation
Removal of CSF
189
When starting a phenytoin infusion what must be monitored?
Cardiac monitoring due to pro-arrhythmogenic effects
190
Describe the Mx of an Acute Seizure episode?
ABCDE
Maintain airway
- Benzodiazepines e.g. Lorazepam IV. Repeat after 10-20 mins if seizure continues
- Phenytoin infusion
191
What are clinical features and Ix of Intracranial venous thrombosis?
Headache, Nausea, Vomiting, Reduced Consciousness
MRI Venography - GS
Non-contrast CT is normal in 70%
192
What is the Mx of Encephalitis?
IV Aciclovir
193
What is the Ix for encephalitis?
CSF Analysis - Lymphocytosis, Elevated protein
194
What Ix must all TIA patients have?
Carotid doppler
195
What is the duration of each cluster headache episodes?
15 minutes - 2 hours
196
In terms of visual field defects, how does a parietal and temporal lobe lesion manifest?
Homonymous quadrantanopias
Parietal - Inferior
Temporal - Superior
197
What is a Lacunar stroke?
Arteries to deep structures such as Thalamus or Basal Ganglia are affected
198
What are the Sx of a Lacunar Stroke?
- Unilateral weakness and/or
- Sensory deficits of the face and arm, arm and leg
or
- All 3, a pure sensory stroke
or
- Ataxic hemiparesis.
199
What is a total anterior circulation stroke?
Affects middle and anterior cerebral arteries
Presents with Unilateral hemiparesis and/or hemisensory loss, homonymous hemianopia and higher cognitive dysfunction
200
What is the MOA and adverse effects of Lamotrigine?
MOA - Sodium channel blocker
Adverse effect - Stevens-Johnson Syndrome & Toxic epidermal necrolysis
201
In terms of Bitemporal Hemianopia. What are the common lesion sites for a upper and lower quadrant defect?
Upper - Pituitary tumour
Lower - Craniopharyngioma
202
What two causes of status epilepticus must be ruled out first?
Hypoxia
Hypoglycaemia
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Name and function of CN 1
Olfactory nerve
Function - Smell
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Name and function of CN 2
Optic Nerve
Function - Sight
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Name and function of CN 3
Oculomotor Nerve
Function - Eye Movement, Pupil constriction, Accommodation, Eyelid opening
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What does palsy of CN3 result in?
Ptosis
Down and Out eye
Dilated, Fixed Pupil
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Name and function of CN 4?
Trochlear Nerve
Function - Eye movement
208
What does palsy of CN 4 result in?
Defective downward gaze aka Vertical diplopia
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Name and function of CN 5
Trigeminal nerve
Function - Facial sensation and Mastication
210
What does lesion of CN 5 result in?
Trigeminal neuralgia
Loss of corneal reflex
Loss of facial sensation
Paralysis of mastication muscles
Deviation of jaw to weak side
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Name and function of CN 6
Abducens
Function - Eye movement
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What does palsy of CN 6 result in?
Defective abduction aka Horizontal diplopia
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Name and function of CN 7
Facial nerve
Function - Facial movement, Taste (2/3rd of tongue), Lacrimation, Salivation
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What does a lesion of CN 7 result in?
Flaccid paralysis of upper and lower face
Loss of corneal reflex
Loss of taste
Hyperacusis
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Name and function of CN 8
Vestibulocochlear Nerve
Function - Hearing and Balance
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What does lesion of CN 8 result in?
Hearing loss, Vertigo, Nystagmus
217
Name and function of CN 9
Glossopharyngeal Nerve
Function - Taste (1/3rd of tongue), Salivation, Swallowing, Mediates input from carotid body and sinus
218
What does lesion of CN 9 result in?
Hypersensitive carotid sinus reflex
Loss of gag reflex
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Name and function of CN 10
Vagus Nerve
Function - Phonation, Swallowing, Innervates viscera
220
What does lesion of CN 10 result in?
Uvula deviates away from site of lesion
Loss of gag reflex
221
Name and function of CN 11?
Accessory nerve
Function - Head and Shoulder Movement
222
What does lesion of CN 11 result in?
Weakness turning head to contralateral side
223
Name and function of CN 12
Hypoglossal nerve
Function - Tongue movement
224
What does lesion of CN 12 result in
Tongue deviates towards side of lesion
225
What do the lumbar puncture findings show for autoimmune encephalitis?
Lymphocytosis
226
What is the first line treatment for autoimmune encephalitis?
Steroids and IV Immunoglobulins
227
In refeeding syndrome, what electrolyte change is most likely?
Hypophosphataemia
228
What type of drugs should be avoided in Lewy body dementia?
Antipsychotics
229
How is Lewy body dementia differentiated from idiopathic Parkinson's disease dementia?
Time of onset of dementia compared to motor symptoms
230
What is the quick and easy bedside test to confirm a fluid is CSF?
Check for glucose
GS is test for Beta-2-transferrin
231
What differential to cluster headaches, last minutes and can occur up to 20 times a day
Paroxysmal hemicrania
232
What is the Mx for Acute subdural haemorrhage?
Decompressive craniectomy
233
What is the Mx for Chronic subdural haemorrhage?
Burr hole evacuation
234
What injuries or syndromes would impact the median nerve?
Supracondylar fracture of humerus
Carpel tunnel
Wrist laceration
235
What would proximal damage to the median nerve manifest with?
Cant make a fist with thumb, index and middle finger
236
What would distal damage to the median nerve manifest with?
Median claw
Can't extend with thumb, index and middle finger
Atrophy of thenar eminence
237
What nerve would a fracture of the medial epicondyle impact and manifest with?
Ulnar nerve
Can't make fist with with ring and pinky
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What nerve would a fracture of the hook of hamate impact and manifest with?
Ulnar nerve
Can't extend with ring and pinky
Atrophy of hypothenar eminence
239
What is Uhthoff's phenomenon?
Neurological symptoms exacerbated by increase in body temperature typically associated with MS
240
How does weakness differ between Lambert-Eaton syndrome and Myasthenia gravis?
Weakness improves after exercise or repetitive movement in LE and not MG
241
When is a carotid endarterectomy considered in a patient who had a TIA?
Carotid artery stenosis exceeding 50% on the side contralateral to the symptoms
NASCET CRITERIA
242
How is Wernicke's encephalopathy managed?
IV Pabrinex (B and C vitamins)
For thiamine replishing
243
What is Juvenile myoclonic epilepsy and its Mx
Infrequency seziures often in morning after sleep deprivation
Daytime absensces
Sudden shock like myoclonic seizures
Treatment is Sodium valproate
244
What would a CT head show for herpes simplex encephalitis?
temporal lobe hypodensities
MRI is better, CT can be normal
245
Name 4 causes of Bilateral facial nerve palsy?
Sarcoidosis
GBS
Lyme disease
Bilateral acoustic neuromas
Bell's palsy
246
Name 4 causes of unilateral facial nerve palsy?
Bell's palsy
Ramsay-Hunt Syndrome
Acoustic neuroma
Parotid tumours
HIV
MS
Diabetes
247
What is the criteria assessed for the Oxford Stroke Classification?
1. Unilateral hemiparesis and/or hemisensory loss of face, arm and leg
2. Homonymous hemianopia
3. Higher cognitive dysfunction e.g. Dysphasia
248
What is a total anterior circulation infarct (TACI)
Involves middle and cerebral arteries
All 3 Oxford Stroke Criterion met
249
What is a Partial anterior circulation infarct (PACI)?
Involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
2 criterion of Oxford Stroke met
250
What is a Lacunar infarct (LACI)?
Involves perforating arteries around internal capsule, thalamus and basal ganglia
Presents with 1 of:
- Unilateral weakness and/or sensory deficit of face, arm leg
- Pure sensory stroke
- Ataxic hemiparesis
251
What is a Posterior circulation infarct (POCI)?
Involves vertebrobasilar arteries
Present with 1:
- Cerebellar or brainstem syndromes
- Loss of consciousness
- Isolated homonymous hemianopia
252
Where would a lesion cause Wernicke's aphasia?
Superior temporal gyrus
253
Where would a lesion cause Broca's aphasia?
Inferior frontal gyrus
254
What is a conduction aphasia due to?
Stroke affecting the arcuate fasiculus
255
What is Korsakoff's syndrome?
Complication of Wernicke's encephalopathy. Features: anterograde amnesia, retrograde amnesia and confabulation
256
What anti-emetic is recommended for patients with Parkinson's?
Domperidone because it doesnt cross blood brain barrier
257
What drugs are associated with Steven-Johnson syndrome?
Carbamazepine
Lamotrigine
Allopurinol
Sulfonimine
Phenobarbital
258
What muscle groups would be affected in myasthenia but not MND?
Eye muscles and Facial muscles
259
In myasthenia gravis would you expect proximal or distal muscle weakness first?
Proximal
260
What investigations would you do for suspected MND?
Nerve conduction studies
MRI head and spine
EMG
261
What is the preferred method to support nutrition for those with MND?
Percutaneous gastrotomy tube (PEG)
262
What is the preferred method for respiratory support for those with MND?
Non-invasive ventilation usually BIPAP
263
What is the most common cause of meningitis in pregnant women?
Listeria monocytogenes
264
In the UK, what are the most common causative bacteria of meningitis in people over 3 years old?
Neisseria meningitidis
Strep pneumoniae (most common)
Haemophilus influenza type B
265
What is the most common cause of meningitis in neonates (under 1 month old)?
Strep agalactiae
E. coli
Strep pneumoniae
Listeria monocytogenes
266
What is the most common cause of meningitis in children 3 months or older?
N. meningitidis
S. pneumoniae
Haemophilus influenza type B
267
Name contraindication to doing a lumbar puncture?
Signs of raised ICP
Coagulopathy
Focal neurological signs
Decreased GCS (<12)
Papilledema
Sepsis
268
What is the management for close contacts of those with bacterial meningitis?
Oral Ciprofloxacin to all in close contact within past 7 days
269
What is the management of bacterial meningitis caused by Listeria monocytogenes?
IV Amoxicillin + Gentamicin
270
Describe a positive Kernig's sign?
Patient is supine
Flex hip to 90 degree
Extension of knees elicit pain or there is resistance to extension
271
Describe a positive Brudzinski's sign?
When the neck is flexed, the hips and knees flex involuntarily
272
Describe the gram stain and shape of S. pneumoniae?
Gram positive diplococci
273
Describe the gram stain and shape of E. coli?
Gram negative bacilli
274
Describe the gram stain and shape of H. influenzae?
Gram negative coccobacilli
275
Describe the gram stain and shape of L. monocytogenes?
Gram positive rod
276
What are the most common causes of viral meningitis?
Enteroviruses such as Coxsackie virus or Echovirus
277
What is the Mx in primary care for suspected Meningococcal disease in children?
IM Benzylpenicillin
278
What is the Mx of bacterial meningitis?
3 months - 50 years old - IV Cefotaxime (or Ceftriaxone)
Over 50 years old - IV Cefotaxime + Amoxicillin
279
What are the complications following meningitis?
Sensorineural hearing loss (most common)
Seizures
Focal neurological deficiit
280
What is the management of autoimmune encephalitis?
IV Methylprednisolone and IV Immunoglobulins
281
What is the Mx of a migraine?
Sumatriptan oral
NSAID or Paracetamol
282
In terms of Sumatriptan use for a migraine, When should it be used?
Taken once the headache starts but not during the aura phase
283
Can you give Donepazil to someone with asthma
No. Its contraidicated
284
What drug is useful for managing tremor in drug-induced parkinsonism?
Procyclidine
285
Fracture of the surgical neck of the humerus, puts what nerve at risk?
Axillary nerve
286
Damage to C8-T1 causes what?
This is the lower aspect of the Brachial plexus causing Klumpe's paralysis it presents with Horner's syndrome
287
Damage to C5-C6 causes what?
Erbs Palsy
288
What anaesthetic agent are those with Myasthenia gravis resistant to?
Suxamethonium
is a depolarising NMBD - it acts by binding to and activating the receptor, at first causing muscle contraction, then paralysis. Again, due to a decreased number of available receptors, MG patients are typically resistant to depolarising NMBDs and may require significantly higher doses.
289
What is the management of post-lumbar puncture headache/
Analgesia, Rest, Caffeine, Blood patch, Epidural saline
290
What is cubital tunnel syndrome?
Ulnar nerve neuropathy
291
Describe Wernicke's aphasia (receptive aphasia)? and common site of lesion
Lesion of superior temporal gyrus
- Typically inferior division of left MCA
Sentences make no sense, word substitution and neologisms but speech remains fluent 'word salad'
292
Describe Broca's aphasia (expressive aphasia)? and common site of lesion
Lesion of inferior frontal gyrus
- Typically superior division of left MCA
Speech is non-fluent, laboured and halting, repetition is impaired
But Comprehension is normal
293
Describe conduction aphasia? and common site of lesion
Due to stroke affecting arcuate fasciculus - Connection between Wernicke's and Broca's area
Speech is fluent but repetition is poor. Aware of the error they are making
Comprehension is normal
294
Describe global aphasia? and common site of lesion
Large lesion affecting all 3 of the above areas resulting in severe expressive and receptive aphasia
May still be able to communicate using gestures
