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2MRCP Part 2 > Neurology > Flashcards

Neurology Flashcards

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1
Q

Multifocal motor neuropathy vs MND

A

Like MND although MND usually involves bulbar signs

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2
Q

Differential
- thunderclap headache + normal CTH + normal LP

A

Reversible cerebrovascular vasoconstrictor syndrome

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2
Q

CADASIL
- presentation
- genetics

A

Usually migraine with aura by 30s, TIAs in 40s and dementia in 50s

NOTCH3, Ch 19

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3
Q

What is a scissoring gait?
What can it be a sign of?

A

= legs crossing over each other as walk
= UMN
e.g. cervical myelopathy

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4
Q

Prophylaxis in cluster headache

A

Verapamil

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5
Q

Management of Parkinson’s Dementia

A

Rivastagmine
- has been shown to be of some benefit

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6
Q

Hyperviscosity syndrome + intra-cranial mass

A

Haemangioblastoma
- can secrete epo = hyperviscosity syndrome

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7
Q

Management of ophthalmic shingles

A

PO aciclovir
No role for topical treatments

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8
Q

Dysarthria
Poor coordination
Ataxia
New T2DM
Young
- additional signs that may be present
- diagnosis
- confirmation?

A

Upgoing plantars
Absent ankle jerk

= Frederich’s ataxia
Genetic testing

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9
Q

Areas of brain vulnerable during sustained hypotension

A

Posterior parietal lobes
= watershed area between middle and posterior cerebral artery territories

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10
Q

Cluster headache VS paroxysmal hemicrania

A

Cluster = attacks are longer, less frequent
May also have a circadian rhythm

Paroxysmal hemicrania = shorter duration, ipsilateral autonomic features

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11
Q

Management of cluster headache

A

Oxygen
Nasal/SC triptan

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12
Q

Management of paroxysmal hemicrania

A

Indomethacin

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13
Q

Myasthenic crisis - what do you need to assess?

A

FVC
- allows both inspiratory and expiratory mechanisms to be assessed

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14
Q

TIA - is there loss of consciousness?

A

NO THERE IS NOT

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15
Q

Haemorrhagic stroke
+ free thrombus
- management?

A

Usually IV heparin - easier to reverse

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16
Q

Essential tremor features (4)

A

Isolated tremor
Worse on posture
Head bobbing
No cerebellar symptoms

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17
Q

Management of acute sickle cell infarct

A

Exchange transfusion

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18
Q

Multiple infarcts inconsistent with territory
Seizures
Early onset dementia
Focal weakness

A

MELAS = mitochondrial encephalopathic lactic acidosis syndrome

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19
Q

CNS lymphoma
- appearance
- management

A

= homogenous mass in frontal lobe
Mx: steroids, methotrexate

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20
Q

Bilateral tremor

A

Drug-induced parkinsonism

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21
Q

Anterior uveitis management

A

Topical steroids
Topical cycloplegic drops

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22
Q

Drug-induced Parkinson’s

A

Rapid onset
Bilateral
Rigidity unusual as a feature

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23
Q

Management of motor symptoms in Parkinson’s Disease

A

Can add in adjuncts to improve symptoms
e.g. selegiline (MAO), bromocriptine/cabergoline (dopamine agonist)

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24
Cabergoline - drug class - side effects
Dopamine agonist Associated with fibrosis e.g. cardiac, respiratory
25
Contralateral hemiparesis - lower > upper
Anterior cerebral infarct
26
Contralateral hemiparesis Contralateral homonymous hemianopia Aphasia
Middle cerebral infarction
27
Macula sparing contralateral homonymous hemianopia Visual agnosia
Posterior cerebral infarction
28
Visual agnosia =
= cannot recognise faces/people/objects
29
Ipsilateral CN III palsy Contralateral weakness
Weber's Syndrome - branches of posterior cerebral artery that supply midbrain
30
Criteria for thrombolysis (3)
Within 4.5 hours if haemorrhage excluded Consider if can be started 4.5-9 hours within known onset + radiological evidence of salvageable tissue BP should be <185/110
31
Contra-indications to thrombolysis (7)
Haemorrhage previously Seizure at onset of stroke Brain tumour Uncontrolled HTN Varices GI bleeding <3 weeks LP within 7 days
32
Thrombectomy - status - criteria (3)
Status = must have Rankin <3 and >5 on NIHSS - Within 6 hours and thrombolysis to proximal anterior - 6-24 hours and salvageability to proximal anterior - Consider with thrombolysis up to 24 hours + salvageability to proximal posterior
33
Pseudo lumen of carotid artery
= carotid artery dissection - A cause of Horner's syndrome - May need an anti-platelet
34
What is neuromyelitis optica? - criteria - management
= relapsing and remitting demyelinating disorder Criteria = spinal cord lesion >= 3 levels, normal MRI brain, aquaporin 4 antibody positive Treat with IV methylprednisolone
35
NMDA encephalitis - features (4)
Female, viral prodrome, memory complaint, catatonia
36
Sodium valproate overdose - result - management
= hyperammoneic encephalopathy = give L-cartinine (activates the enzyme which metabolises ammonia into urea)
37
Mechanism of Huntington's chorea - management
excess of dopamine, use dopamine depleting agents e.g. reserpine/tetrabenazine (can cause depression)
38
Features of sporadic CJD (5)
Ataxia, Dementia, Myoclonus, elevated 14-3-3 protein, periodic sharp waves
39
Management of severe Alzheimer's
Memantine
40
Central retinal vein occlusion appearance
Cheese and tomato pizza
41
Temporal field corresponds to what part of retina
Nasal field
42
Status epilepticus not responding to benzo or 2nd line treatment
GA with thiopentone (barbituate)
43
Trigeminal neuralgia vs SOL
No sensory loss in trigeminal neuralgia Need to check for SOL or demyelinating disorder
44
Superior sagittal sinus thrombosis - presentation - radiological sign
Sudden onset headache Empty delta sign (on contrast scan, superior sagittal sinus should be opaque with contrast, if thrombus there, cannot fill with contrast = empty)
45
Miller-Fisher
anti-GQ1 antibodies
46
Investigating recurrent laryngeal nerve injury
Laryngoscope
47
Modality of choice in acute stroke
DWI MRI (FLAIR better for looking for chronic ischaemia)
48
Starting SSRI in <25 year old - immediate follow up
See after 1 week - increased risk of suicidal ideation
49
Management of tremor predominant PD
Anticholinergic e.g. procyclidine, oprphenadrine
50
Causes of peripheral neuropathy - investigation findings
Either axonal degeneration or demyelination Axonal = diabetes, B12 deficiency, uraemia. HIV, inherited Normal velocity, reduced amplitude in NCS Demyelination = autoimmune, paraproteinaemia Reduced velocity, normal amplitude in NCS
51
Papilloedema Normal visual acuity - suspected IIH, management
Acetazolamide Normal visual testing despite papilloedema
52
VTE prophylaxis - stroke + high risk of haemorrhagic transformation
Intermittent pneumatic compression
53
Progressive neurological symptoms Evidence of demyelination on imagine
Consider progressive multifocal leukoencephalopathy Need to determine HIV status
54
What is ischaemic penumbra?
Salvageable ischaemic tissue
55
Dopamine agonist + increased spending
Impulse control disorder
56
Headache with maximal intensity in minutes Postural element - diagnosis? - investigation of choice?
= spontaneous idiopathic hypotension Contrast MRI
57
Management of lewy body dementia
Rivastigmine Donepezil
58
Carotid artery stenosis identified in context of stroke - when endarectomy?
Within 14 days
59
Management - if BP too high for thrombolysis
Aim to reduced BP <185/110 to allow for thrombolysis (rather than just treat suboptimal with aspirin)
60
Contralateral hemiparesis Ipsilateral CN III - diagnosis - blood supply
Weber's syndrome Posterior cerebral artery
61
Personality change Dementia Hyperintense lesions on MRI
CJD
62
Management of acute isolated optic neuritis
IV methylprednisolone Demonstrated superior to PO prednisolone
63
Personality change and strange behaviour Hypodense lesions predominantly in medial temporal region
Encephalitis
64
Weakness Nil sensory symptoms Muscle wasting Demyelination NCS = f waves and H-reflexes - diagnosis - management
Multifocal motor neuropathy IVIg as management
65
Side effect associated with ropinrole
Psychosis
66
Management of CIDP
High dose steroids - remember similar presentation to GBS but chronic/more indolent
67
Antibodies present in some myaesthenia gravis cases
Muscle specific kinase antibodies (MUSK antibodies)
68
Cheese tomato pizza retina Immunosuppressed
CMV retinitis
69
Lateral medullary syndrome - pathophysiology - cause
Caused by interrupted blood supply to posterior inferior cerebellar artery Can be as a result of vertebral artery dissection e.g. hyperextension injury = need CTA to diagnose dissection
70
Hereditary neuropathy with liability to pressure palsy - gene implicated - pattern
PMP22 gene Usually neuropathy after extended pressure e.g. sleeping on arm
71
What can you use for acute confusion in Parkinson's Disease?
Quetiapine
72
Investigation of choice in TIA
Diffusion weighted MRI
73
Chronic paroxysmal hemicrania
Multiple (>20) short (minutes) headaches Cluster tends to be fewer and longer
74
Management of stroke in sickle cell
Exchange transfusion
75
Basal CN palsy Malaise CSF - lymphocytosis, raised protein, low glucose - diagnosis
TB meningitis
76
Drugs to avoid in myaesthenia gravis (8)
Pencillamine Quinine Procainamide BB Lithium Magnesium Gentamicin Macrolide antibiotics
77
Early postural symptoms Falls Swallowing issues Personality change - diagnosis?
Progressive Supranuclear Palsy
78
Progressive Supranuclear Palsy - features (4)
Early postural symptoms Falls Swallowing issues Personality change - diagnosis?
79
Driving and transient global amnesia
No restrictions on driving if investigated
80
Dysarthria Hearing loss Headache Less than 1 hour duration - diagnosis
Basilar migraine (migraine with brainstem aura)
81
Immunocompromised Retinal necrosis
Toxoplasmosis
82
Regression in development Seizures Myoclonic jerks Wolff Parkinson White Syndrome Optic Atrophy - inheritance - diagnosis
MERRF = myoclonic epilepsy with ragged red fibres Mitochondrial inheritance Muscle biopsy
83
Upgoing plantars Absent ankle jerks - differential
Subacute degeneration of the cord Syphillis Frederich's ataxia Motor neurone disease
84
Upgoing plantars Hyperreflexic
Tropical spastic paraparesis
85
Poor prognosis in intracranial haemorrhage
Low GCS
86
Key feature of Miller Fisher syndrome
Abnormal eye movements
87
Multiple cord level involvement Streak of demyelination Optic nerve involvement - diagnosis - alternative name
Neuromyelitis optica Delvic's disease

2MRCP Part 2 (14 decks)

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