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Neurology 2 Flashcards

1
Q

Motor neuron disease
Upper/lower
Age of onset

Features (4)

A

Both upper and lower motor neuron signs
>40yo

Fasciculations
Absence of sensory signs
Mixture of upper and lower signs
Wasting of small hand muscles

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2
Q

Features NOT seen in motor neuron disease (3)

A

No cerebellar signs
Doesn’t impact external ocular muscles
No sensory signs

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3
Q

Examples of motor neuron disease (3)

A

Amyotrophic lateral sclerosis
Progressive muscular atrophy
Bulbar palsy

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4
Q

Diagnosis of MS

A

Two or more relapses
OR
Two or more lesions
OR
One lesion with reasonable historical evidence of prev relapse

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5
Q

What is Uhthoff’s phenomenon

A

Worsening of vision following a rise in body temperature

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5
Q

Acute relapse of MS mx

A

High dose steroids 5/7 (PO or IV methylpred)

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6
Q

Mx for reducing the risk of relapse in MS (1)
Give five examples

A

DMARDS
1. natalizumab
2. ocrelizumab
3. fingolimod
4. beta-interferon
5. glatiramer acetate

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7
Q

MS symptomatic management
Fatigue (2)

A
  1. Amantadine
  2. CBT/ mindfulness
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8
Q

MS symptomatic management
Spasticity
1st line (2)
2nd line (3)
3rd line (1)

A
  1. Baclofen/ gabapentin
  2. Diazepam/ dantrolene/ tizanidine
  3. PT
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9
Q

MS symptomatic management
Bladder dysfunction
Ix (1)
If sig residual volume (1)
If not (1)

A

US
If significant residual volume –> intermittent self catheterisation
If no significant residual volume –> anticholinergics

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10
Q

MS symptomatic management
Oscillopsia
Mx (1)

A

Gabapentin

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11
Q

Good prognosis features for MS (6)

A

Female
Young age of onset
Relapsing remitting
Sensory sx only
Long interval between first two relapses
Complete recovery between relapses

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12
Q

Multiple system atrophy
Features (3)

A

Parkinsonism
Autonomic dysfunction e.g erectile dysfunction, postural hypotension, atonic bladder
Cerebellar signs

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13
Q

Myasthenia gravis
What is it?

A

Autoimmune disorder resulting in antibodies to acetylcholine receptors

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14
Q

Myasthenia gravis features (4)

A
  1. Extraocular + proximal muscle weakness
  2. Ptosis
  3. Dysphagia
  4. Diplopia
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14
Q

Myasthenia gravis
Associations (3)

A

Thymomas
Pernicious anaemia
Autoimmune thyroid disorders

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15
Q

Myasthenia gravis
Ix (4)

A

EMG
CT thorax to exclude thymoma
CK normal
Autoantibodies

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16
Q

Myasthenia gravis mx (3)

A
  1. Pyridostigmine
  2. Prednisolone, AZT, cyclosporin
  3. Thymectomy
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17
Q

Myasthenia crisis mx (2)

A

Plasmapheresis
IV immunoglobulins

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18
Q

Drugs that can exacerbate myasthenia gravis (4)

A

BB
Lithium
Phenytoin
Gent, macrolides, tetracyclines, quinolones, penicillamine

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19
Q

Triad for Wernicke’s encephalopathy

A

Ataxia
Encephalopathy
Ophthalmoplegia/nystagmus

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20
Q

Korsakoff’s extra symptoms (2)

A

Antero+retrograde amnesia
Confabulation

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21
Q

What is Von Hippel Lindau syndrome?

A

AD condition characterised by cysts/ benign tumours with potential for malignant transformation

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22
Q

Cerebellar haemangiomas
Extra-renal cysts
Retinal haemorrhages
Renal cysts
Phaeo
= which condition?

A

Von Hippel Lindau

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23
Restless legs Associations (4)
IDA Uraemia DM Pregnancy
24
Restless legs mx (4)
1. Walking/stretching/massaging 2. Pramipexole/ ropinirole (dopamine agonists) 3. Benzos 4. Gabapentin
25
What is Reye's syndrome? Age Features (4)
Severe, progressive encephalopathy affecting children 2yo Preceding viral illness Encephalopathy Fatty infiltration of liver, kidney, pancreas Hypoglycaemia
26
Management of acute seizures 1 month-1year 2year-11year 12-17years Adult Elderly When can you repeat?
Rectal diazepam 1 month-1year 5mg 2year-11year 5-10mg 12-17years 10mg Adult 10-20mg Elderly 10mg Once more, after 10-15 minutes IV benzo if in hospital
27
Adverse effects of sodium valproate (5)
Teratogenic Alopecia Hepatotoxicity Pancreatitis Hyponatraemia
28
Define status epilepticus
Seizure lasting >5 minutes OR >= 2 seizures within a 5 minute period without the person returning to normal in between
29
Acute subdural haematoma is most commonly caused by? What will the CT show? (2)
High impact trauma Crescentic collection, not limited by suture lines Hyperdense +/- midline shift
30
Chronic subdural haematoma Who is at risk? (2) How will the patient present? CT
Elderly and alcoholics Several week to month progressive history of confusion and reduced consciousness or neurological deficit Crescentic shape not limited by suture lines but appear hypodense
31
Syringomyelia what is it? Features (5) Ix
Collection of CSF within the spinal cord 1. Cape like (neck, shoulder arms) loss of sensation to temperature e.g pt burns hands without realising 2. Spastic weakness 3. Neuropathic pain 4. Upgoing plantars 5. Horner's syndrome MRI spine + brain
32
Causes of syringomyelia (3)
Trauma Tumours Chiari malformation (strong association)
33
Tension type headache First line mx (3) Prophylaxis (1)
First line: aspirin, paracetamol, NSAID Prophylaxis 10 sessions of acupuncture over 5-8 weeks
34
Down and out, ptosis + dilated pupil = Causes (4)
Third nerve palsy 1. DM 2. Vasculitis 3. Cavernous sinus thrombosis 4. Weber's syndrome
35
What is Weber's syndrome?
Ipsilateral third nerve palsy, contralateral hemiplegia (caused by midbrain strokes)
36
Thoracic outlet syndrome what is it? Typical patient Age Usually precipitated by?
Disorder involving compression of brachial plexus, subclavian artery or vein Thin, young woman, long neck and drooping shoulders 30-40 Trauma
37
Features of neurogenic thoracic outlet syndrome (3)
1. Painless muscle wasting of hand 2. Nubmness and tingling of arm 3. Cold hands, blanching or swellling
38
Features of vascular TOS (2)
1. Diffuse arm swelling with distended veins 2. Painful arm secondary to artery compression (claudication), ulceration, gangrene
39
Thoracic outlet syndrome Ix (6)
XR cervical spine/ CXR CT/MR Venography/ angiography
40
Neurofibromatosis NF1 chrm? NF2 chrm?
NF1 chrm 17 NF2 chrm 22
41
NF1 features (5)
Cafe au lai spots Axillary groin freckles Iris haematomas (lisch nodules) Scoliosis Pheochromo
42
NF2 features (2)
Bilateral vestibular schwannomas Multiple intracranial schwannomas
43
Ash leaf spots Shagreen patches Epilepsy Developmental problems + intellectual impairment Adenoma sebaceum (angiofibromas) butterfly distribution over nose = which condition?
Tuberous sclerosis
44
Myotonic dystrophy what is it? Age Distal or proximal weakness more prominent in each? DM1 chrm? DM2 chrm?
Inherited myopathy affecting skeletal, cardiac and smooth muscle 20-30yo DM1 chrm 19 distal weakness more prominent DM2 chrm 3 proximal weakness more prominent
45
Myotonic dystrophy features (5)
Myotonic facies (long haggard appearance) Frontal balding Bilateral ptosis Cataracts Dysarthria
45
Long haggard appearance Frontal balding Bilateral ptosis Cataracts Dysarthria = which condition?
Myotonic dystrophy
46
Mild mental impairment DM Testicular atrophy Heart block/ cardiomyopathy Dysphagia = which condition
Myotonic dystrophy
47
Neuroleptic malignant syndrome Occurs when? Features (4)
Hours to days of starting an antipsychotic Pryexia Muscle rigidity Autonomic lability (HTN, tachycardia, tachypnoea) Delirium
48
Neuroleptic malignant syndrome Ix (3) (all bloods findings)
Raised CK AKI Leukocytosis
49
Neuroleptic malignant syndrome Mx (2)
Stop antipsychotic IVF
50
Differences between neuroleptic malignant syndrome and serotonin syndrome Reflexes Pupils Onset Other feature
Serotonin syndrome Increased reflexes Clonus Dilated pupils Faster onset (hours) Neuroleptic malignant syndrome Reduced reflexes Lead pipe rigidity Normal pupils Hours to days onset
51
Neuropathic pain mx 1st line (4)
1. Amitriptyline 2. Duloxetine 3. Gabapentin 4. Pregabalin
52
Neuropathic pain Rescue therapy (1) Localised neuropathic pain (1)
Tramadol Topical capsaicin
53
Normal pressure hydrocephalus Triad of symptoms Mx (1)
Urinary incontinence Dementia Gait abnormality Mx shunting
54
Parkinson's disease classic triad of features Drug induced parkinsonism features (2) Which two of the triad are not usually present?
Bradykinesia Tremor Rigidity Motor symptoms are generally rapid onset and bilateral Rigidity and rest tremor are uncommon
55
Parkinson's mx 1st line management (2)
If motor sx are affecting the patient's QOL = levodopa Otherwise DA, levodopa or MAO-B inhib
56
Levodopa should always be combined with? SE (5)
Decarboxylase inhibitor Dry mouth Anorexia Palpitations Postural hypotension Psychosis
57
Dopamine agonists Examples (2) SE (4)
Bromocriptine Cabergoline SE Pulmonary/ retroperitoneal/ cardiac fibrosis Excessive daytime somnolence Hallucinations Nasal congestion
58
MAO-B inhibitors Example (1)
Selegiline
59
Amantadine SE (4)
Ataxia Slurred speech Confusion Livedo reticularis
60
COMT inhibitors Examples (2) When is it used?
Entacapone, tolcapone In conjunction with levodopa
61
Mx of drug induced Parkinsonism (2)
Anti-muscarinics e.g procyclidine & benzotropine
62
Mx of drooling in PD?
Glycopyronium
63
Orthostatic hypotension in PD mx (1)
Midodrine
64
Causes of peripheral neuropathy sensory (4)
Alcoholism B12 deficiency DM Uraemia
65
Peripheral neuropathy motor loss causes (4)
Guillian Barre Porphyria Lead poisoning Charcot Marie Tooth
66
When to check trough levels of phenytoin? ignore
Dose change Suspected toxicity Detection of non adherence
67
Phenytoin SE (6)
1. Teratogenic (cleft palate, congenital heart disease) 2. Diplopia 3. Nystagmus 4. Gingival hyperplasia 5. Megaloblastic anaemia 6. Peripheral neuropathy
68
Reflexes nerve roots Ankle Knee Biceps Triceps
S1-S2 L3-L4 C5-C6 C7-C8
68
Reflexes nerve roots Ankle Knee Biceps Triceps
S1-S2 L3-L4 C5-C6 Ct-C8
69
Topiramate COCP UKMEC Implant UKMEC Depot IUS
3 2 Depot + IUS not affected by topiramate
70
Topiramate SE (4)
Acute myopia/ secondary angle closure glaucoma Reduced appetite and weight loss Paraesthesia Foetal malformations
71
TIA Who should get a specialist review? When to admit (1) When to get an assessment within 24 hours When to get an assessment within 7 days
>1 TIA (e.g crescendo TIA) - admit If suspected TIA in the last 7 days - arrange urgent assessment within 24 hours If >1 week ago for specialist assessment within 7 days
72
TIA mx (2)
1. Aspirin 300mg immediately + clopi OR 2. Aspirin + dipyridamole (if clopi not tolerated)
73
Trigeminal neuralgia mx (2)
1. Carbamazepine If not effective - refer to neurology
74
Features of acoustic neuromas (4) Mx (2)
Vertigo Tinnitus Hearing loss Absent corneal reflex Urgent referral to ENT Surgery/ RT
75
Left hemianopia means visual field defect to the left which means a lesion where?
Right optic tract
76
Homonymous quadrantanopias
PITS Parietal - inferior Temporal - superior

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