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Neurology Flashcards

1
Q

Diagnostic criteria for encephalitis.

A

Major Criteria - acute onset of behavioural disturbance <24 hours

Minor Criteria

  • Documented fever
  • Seizures not related to pre-existing disorder
  • New onset focal neurology
  • CSF WBC >5
  • Brain imaging changes
  • EEG changes
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2
Q

What activates NMDA receptors?

A

Glutamate

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3
Q

Which part of the internal capsule does the corticospinal tract run through?

A

Posterior limb

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4
Q

When are electrophysiologic studies useful?

A

Peripheral neuropathy
Entrapment neuropathy
Radiculopathies
Muscle disorders

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5
Q

What are the expected EMG findings in neuropathy?

A

Denervation
Fibrillations
Fasciculations
Positive sharp waves

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6
Q

What are the expected EMG findings in myopathies?

A

Decreased amplitudes

Small polyphasic MUAPs

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7
Q

What is the most sensitive test for myasthenia gravis?

A

Single fibre EMG

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8
Q

What is the argyle Robertson pupil? And what is the differential diagnosis?

A

Bilateral small pupils that accomodate but do not react.

Neurosyphilis
Diabetic neuropathy

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9
Q

What is the diagnostic criteria for MELAS?

A
  1. Stroke like episodes before 40
  2. Encephalopathy (seizures or dementia)
  3. Lactic acidosis OR “ragged red fibres” on skeletal muscle biopsy
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10
Q

What is the treatment of MELAS patients with an acute stroke like episode?

A

Intravenous followed by oral arginine hydrochloride

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11
Q

What are the 2 core clinical criteria for MMN?

A
  1. Stepwise progressive asymmetric limb weakness for more than a month
  2. No objective sensory change (apart from mild vibration sense changes)
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12
Q

What are the exclusion criteria for MMN?

A

Upper motor neuron signs
Marked bulbar involvement
Sensory impairment
Diffuse symmetrical weakness at the start

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13
Q

What is the treatment of MMN?

A

IVIG

Not responsive to plasma exchange or steroids

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14
Q

What is the classical presentation of CJD? And what is the median survival?

A

Rapidly progressive dementia with myoclonus. Median survival 4-5 months.

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15
Q

What is variant CJD and what is the prognosis?

A

Bovine to human transmission of CJD resulting in similar clinical phenotype (dementia and myoclonus)

Median survival 11 months

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16
Q

Type 1 myotonic dystrophy results from an expansion of which trinucleotide repeat?

A

CTG

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17
Q

How does having a malignancy influence the prognosis of NMDA encephalitis?

A

Improved prognosis with malignancy.

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18
Q

What protein is associated with duchennes muscular dystrophy?

A

Dystrophin

19
Q

What is the ABCD2 score?

A 
Age - >60
BP - >140/90
Clinical - unilateral weak (2), speech (1) 
Duration - 10-59mins (1), >60 (2)
Diabetes - 1
20
Q

What are the common residual deficits after Wernickes?

A
  1. Horizontal nystagmus (60%)
  2. Ataxia (60%)
  3. Memory deficit (80%)
21
Q

What is the treatment of Ramsay Hunt Syndrome?

A

Valacyclovir 10 days

Prednisone 5 days

22
Q

What lesion causes Alexia without agraphia?

A

Dominant PCA infarction

23
Q

Describe fragile X syndrome.

A

X linked dominant condition from CGG trinucleotide repeats (>200) (FMR1) which results in intellectual disability, ataxia, tremor and Parkinsonism.

24
Q

Type 1 muscle fibres description.

A 
Red colour 
High mitochondria 
Slow twitch fibre 
Slow conduction velocity 
Fatigue resistant 
Aerobic metabolism
25
Where is Broca’s area?
Inferior frontal gyrus
26
What are the features of a 4th nerve palsy?
Vertical diplopia | Eyes that turn up and out
27
Anti Hu antibody Disease association? Presentation?
Small cell lung cancer Encephalomyelitis or cerebellar Syndrome
28
Anti Yo antibodies Disease association? Presentation?
Ovarian and breast cancer Cerebellar Syndrome
29
Anti GAD antibodies Disease association? Presentation?
Small cell/ breast/ colorectal cancer Stiff person syndrome
30
Anti Ri antibodies Disease association Presentation?
Small cell and breast cancer Ocular opsoclonus myoclonus
31
Mechanism of riluzole?
Unknown really but ?sodium channel blockade ?Glutamate antagonist
32
What features of Parkinson’s are uncommon in drug induced Parkinsonism?
Rigidity and rest tremor
33
How does phenytoin cause anemia?
Folate deficiency
34
What medication is first line in the prevention of cluster headaches?
Verapamil
35
What percentage of children with absence seizures will be free of seizures by 15 years?
95%
36
``` Wernickes aphasia Type of aphasia? Lesion location? Fluent or non fluent? Comprehension normal or abnormal? Repetition normal or impaired? ```
``` Receptive aphasia Superior temporal gyrus Fluent speech Abnormal comprehension Normal repetition ```
37
``` Conduction aphasia Type of aphasia? Lesion location? Fluent or non fluent? Comprehension normal or abnormal? Repetition normal or impaired? ```
``` Dissociative aphasia Actuate fasiculus Fluent aphasia Abnormal comprehension Poor repetition ```
38
``` Brocas aphasia Type of aphasia? Lesion location? Fluent or non fluent? Comprehension normal or abnormal? Repetition normal or impaired? ```
``` Expressive dysphasia Inferior frontal gyrus Non fluent speech Normal comprehension Poor repetition ```
39
A lesion of which artery results in a lateral medullary syndrome?
PICA
40
What is the Wallenberg Syndrome?
Lateral medullary syndrome from PICA stroke Vertigo Ipsilateral horners Ipsilateral bulbar muscle weakness Loss of pain and temperature on contralateral side
41
What is Dejerine Syndrome?
Small perforating branch occlusion Contralateral Hemiplegia Contralateral sensory loss Contralateral limb ataxia
42
What are the features of a AICA infarct?
Vertigo Ataxia Facial palsy Hypoacusis
43
What are the features of myotonic dystrophy?
Distal weakness Dominant (autosomal) Diabetes Dysarthria

RACP (16 decks)

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