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Flashcards in Neurology Deck (61):
1

Where do the majority of intracerebral haemorrhages occur?

Basal ganglia

2

Which nerve roots are being tested by the cremasteric reflex?

L1-2

3

Which nerve roots are being tested by the epigastric reflex?

T7-9

4

Which nerve roots are being tested by brachioradialis reflex?

C5-6

5

Which nerve roots are being tested by the ankle jerk?

S1-3

6

Which nerve roots are being tested by the anal reflex?

S4-5

7

What is the normal pH of CSF?

7.31

8

Describe the electrolyte levels in CSF compared to plasma

CSF: lower K, Ca and protein
Higher Na, Cl, bicarbonate and magnesium

9

What is a normal white cell value in CSF?

Less than 4/ml

10

What is a normal opening pressure of CSF?

Less than 20cm of water

11

What is a normal glucose concentration in the CSF?

Approximately 2/3 of plasma
3.3-4 mmol/L

12

What is mononeuritis multiplex?

Neuropathy where individual nerves are affected, especially linked with CNIII and VI

13

What is the diagnostic criteria for delirium?

Disturbance of consciousness: reduced clarity of awareness of environment, reduced ability to focus, sustain or shift attention
Change in cognition: memory deficit, disorientation, language disturbance, perceptual disturbance
Disturbance develops over a short period: hours or days
Fluctuation over the course of the day

14

What is the diagnostic criteria for delirium?

Disturbance of consciousness: reduced clarity of awareness of environment, reduced ability to focus, sustain or shift attention
Change in cognition: memory deficit, disorientation, language disturbance, perceptual disturbance
Disturbance develops over a short period: hours or days
Fluctuation over the course of the day

15

In which patient group should bupropion be used with caution as a smoking cessation aid?

History of epilepsy or other seizure disorders such as excessive alcohol consumption

16

In which patient group should varenicline be used with caution as a smoking cessation aid?

Psychiatric conditions with suicidal ideation or attempts

17

The foot processes of which cell type support the blood brain barrier?

Astrocytes
Wrap around every capillary in the brain, important for movement of water and glucose between circulation and brain

18

Which are the cells of the choroid plexus which produce CSF?

Ependymal cells

19

What neuropathies can be associated with B12 deficiency?

Glove and stocking anaesthesia
Optic atrophy
Psychosis
Sensory ataxia
Spastic paraparesis

20

What signs would you expect in a patient with Parkinson's disease?

Bradykinesia: slow festinant gait with difficulty changing direction or arm swinging
Rigidity: stiff, lead pipe rigidity during elbow flexion, cog wheel rigidity at the wrist with superimposition of tremor
Tremor: pill rolling tremor of fingers

21

What symptoms might you get with cervical spondylosis?

Tingling, numbness, weakness and wasting in upper limbs

22

How is neurofibromatosis inherited?

Autosomal dominant

23

What is the NIH consensus criteria for diagnosis of neurofibromatosis?

2 or more of the following:
Six or more cafe au lait spots over 5mm diameter in pre pubertal individual
Two or more plexiform neurofibromas
Freckling in the axillary or inguinal regions
Optic glioma
Two or more lisch nodules (iris hamartomas)
Distinctive osseous lesion such as sphenoid dysplasia
First degree relative with NF1

24

A 70 year old man complains of a 6 month headache, visual disturbances and weight loss. On examination he is sensitive on palpation of the scalp which is tender, what is the likely diagnosis?

Giant cell arteritis

25

A 22 year old male student presents with a 6 hour history of deteriorating headache. On examination he has a faint purpuric rash over his knees, a temperature of 39 degrees and neck rigidity. What is the likely diagnosis?

Meningitis

26

What diagnostic markers would you use for giant cell arteritis?

ESR markedly elevated
Temporal artery biopsy show histological inflammation

27

72 year old female presents with 6 month history of headaches which are worse in the morning, associated with nausea and generally ease as the day progresses. On examination there is blurring of the disc margin in the right eye. What is the likely diagnosis?

Cerebral tumour

28

What is dementia?

Acquired loss of higher mental function affecting 2 or more domains
Of sufficient severity to significantly cause social or occupational impairment
Occurring in clear consciousness (distinguish from delirium)

29

Give 3 examples of cholinesterase inhibitors which can be used to treat dementia

Donepezil
Rivastigmine
Galantamine

30

What is memantine?

NMDA antagonist used in moderate to severe AD where cholinesterase inhibitors are not tolerated

31

What are symptoms of wernicke Korsakoff's encephalopathy?

Eye signs: nystagmus, lateral rectus palsy, conjugate gaze palsy
Ataxia: wide based gait, cerebellar signs, vestibular paralysis
Cognitive change: stupor, coma, amnesic syndrome, confabulation

32

What is mild cognitive impairment?

Memory problems in patients who do not fit a diagnosis of dementia as they are not functionally impaired/ not severe enough to interfere with normal activities of daily living

33

What regions are involved in episodic memory?

Hippocampus and limbic circuits

34

What brain areas are involved in working memory?

Prefrontal cortex
Angular gyrus

35

What brain areas are involved in semantic memory?

Inferolateral temporal lobes

36

What brain areas are involved in procedural memory?

Basal ganglia
Cerebellum
Supplementary motor area

37

What is the classic triad of normal pressure hydrocephalus symptoms?

Memory loss
Gait disorder
Urinary incontinence

38

What are risk factors for haemorrhagic stroke?

HTN
Amyloid angiopathy
Venous sinus thrombosis
Haemorrhagic tumour
Arteriovenous malformation

39

How do you diagnose a subarachnoid haemorrhage?

CT head
Lumbar puncture

40

A 26 year old female presents with two month Hx of severe headaches that are relieved by standing. On examination it is noted that she is obese. She has no neurological abnormalities or visual disturbances. What is the likely diagnosis?

Idiopathic intracranial hypertension

41

What are clinical features of giant cell arteritis?

Tender scalp
Jaw claudication
Headache
Malaise
Thickened temporal arteries
Optic neuropathy

42

What is frailty?

Loss of metabolic reserve

43

What is Uhthoff's phenomenon?

Worsening of neurologic symptoms in multiple sclerosis (MS) and other neurological, demyelinating conditions when the body gets overheated from hot weather, exercise, fever, or saunas and hot tubs

44

What is L'Hermitte's sign?

Barber chair phenomenon, is an electrical sensation that runs down the back and into the limbs when neck is flexed

45

Give 3 features of the headache in migraine

Usually Unilateral
Throbbing/pulsating
Moderate - severe
Worse on movement

46

Give 3 associated features of a headache in migraine

Nausea vomiting
Photophobia
Phonophobia
Aura

47

In a younger patient with a trigeminal neuralgia, what causes might you want to rule out?

MS
Cerebellopontine angle tumour

48

What is the emergency treatment for meningococcal meningitis?

Benzylpenicillin slow IV injection or IM
Cefotaxime if penicillin allergy

49

Give 3 examination findings of a temporal arteritis

Scalp tenderness
Thickened temporal artery
Reduced temporal pulse
Fever
Upper limb stiffness
Visual disturbance
Mono/polyneuropathy
Cranial nerve palsy

50

A child with suspected meningitis is in GP. Whilst waiting for the ambulance what should you do?

Give IM penicillin

51

What are features of progressive supranuclear palsy?

Supranuclear ophthalmoplegia
Dysarthria
Gait impairment
Balance impairment
Dysphagia

52

What are some viral causes of encephalitis?

Herpes simplex
HIV
Chlamydia
Measles
Mumps
Epstein Barr
Rabies

53

What are some causes of delirium?

Hypoxia
Hypoglycaemia
Hyperthermia
Anticholinergic toxicity
Alcohol withdrawal
Infections
Metabolic abnormalities
Brain lesions
Medication adverse effects
Post operative state

54

Which vitamin deficiencies maybe associated with psychosis?

Folate
Vit B12
Niacin
Chronic thiamine

55

What are features of B12 deficiency?

Anaemia
Peripheral neuropathy
Weakness
Decreased positional and vibration sense
Psychosis
Delirium
Slowed thinking
Mood/personality changes

56

What are some symptoms of Korsakoff's psychosis?

Memory loss
Confusion
Amnesia
Personality change
Confabulation

57

What are symptoms of wernickes encephalopathy?

Psychomotor slowing
Nystagmus
Ataxia
Ophthalmoplegia

58

What are some endocrine causes of psychosis?

Thyroid dysfunction
Cushing's syndrome
Thymoma
Hyperparathryoidism

59

What are some features of encephalitis?

Aphasia
Hemianopia
Hemiparesis
Ataxia
Brisk tendon reflexes
Babinskis sign
Cranial nerve deficits
Tremors
Myoclonus
Paresthesia
Neuropathy
Raised ICP signs

60

What is Holmes adie syndrome?

Pupils large and irregular due to parasympathetic denervation
Reduction in reflexes

61

Who should be considered for decompressive hemicraniectomy after ishchaemic stroke?

Patients under 60 with a large (>50%) cerebral infarction arising in MCA territory