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Neurology Flashcards

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1
Q

Treatment for tension headaches (acute, chronic)

A

Acute
1. Paracetamol/ ibuprofen/ aspirin

Chronic
1. Acupuncture

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2
Q

Features of a migraine with aura (4) and without (4,2)

A 
Migraine with aura
At least x2 episodes between 5 ad 60 minutes 
1. Visual sx
2. Change in speech 
3. Sensory sx
4. Fully reversible

Without 
At least x5 attacks lasting 4-72 hours
1. Unilateral
2. Unable to do day to day activities 
3. Throbbing/pulsatile 
4. Mod/severe pain 
AND
At least x1 of:
1. N&V
2. Phonophobia/ photophobia
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3
Q

Management of migraines (acute 2, prophylaxis 4)

A

Acute

  1. Triptan PO +/- paracetamol/ ibuprofen/ aspirin
  2. Metoclopramide/ prochlorperazine

Prophylaxis

  1. Propranalol OR topiramate OR amitryptilline
  2. Behavioural interventions OR riboflavin
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4
Q 
Features of temporal arteritis (6)
Management (1)
Where is it tender?
One or two sides?
Age?
Onset speed
Blood finding
Other symptom
A 
Features
1. Tender/ palpable temporal artery 
2. Unliateral
3. >60yo 
4. Rapid onset <1 month
5. Jaw claudication
6. Raised ESR
Management
Emergency 
1. Prednisolone 60mg PO tapering over 1-2 years
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5
Q

Features (4) and management of trigeminal neuralgia (1)

A 
Features
1. Worse on chewing/ brushing hair/ light touch
2. Lasts a few seconds to minutes
3. Unilateral
4. Severe electric shock like pains
Treatment 
1. Carbamezapine
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6
Q

Features of MS

visual (3), sensory (2), motor (2), cerebellar (2), other (2)?

A 
Visual
1. Optic neuritis 
2. Optic atrophy
3. Uhthoff's phenomenon (worsening of vision on neck flexion)
Sensory
4. Pins and needles 
5. Lhermitte's syndrome (parasthesia in limbs on neck flexion)
Motor
6. Spasticity
7. Weakness 
Cerebellar
8. Ataxia 
9. Tremor 
Other
10. Urinary incontinence
11. Sexual dysfunction
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7
Q 
Name three types of MS 
Diagnosis definition 
Management acute (1), chronic (4)
A

Types

  1. Relapsing-remitting (RR)
  2. Primary progressive - deteriorate from onset
  3. Secondary progressive - deteriorating on BG of RR

Diagnosis
1. x2 relapses with x2 objective clinical evidence
OR
2. x1 objective clinical evidence of lesion with x1 reasonable evidence of prev relapse

Mx
Acute
1. High dose steroids - methylpred for 5/7 (to reduce duration)

Chronic

  1. Beta interferon
  2. Glatiremer acitate
  3. Natalizumab
  4. Fingolimod
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8
Q

Menstrual migraine management (2)

A
  1. Frovatriptan OR

2. Zolmitriptan

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9
Q

Features (6) and treatment acute (2) and prophylaxis (2) of cluster headaches

A 
Features 
1. M>F
2. Smokers
3. Unilateral (always same side), periorbital 
4. Ptosis and miosis
5. Lacrimation/ redness
6. Nasal congestion 
Management 
Acute
1. 100% oxygen
2. SC triptan (sumo)
Prophylaxis
1. Verapamil
2. +/- Prednisolone tapering dose
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10
Q

Symptomatic management of MS
Fatigue (2)
Spasticity (3)
Oscillopsia (1)

A

Fatigue

  1. Amantadine
  2. CBT

Spasticity

  1. Baclofen OR gabapentin
  2. Diazepam/ dantrolene/ tizanidine
  3. Physio

Oscillopsia
1. Gapapentin

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11
Q

Sx of anterior cerebral infarct (1)

A

Contralateral hemiparesis and sensory loss of lower extremities > upper

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12
Q

Sx of middle cerebral artery infarct (3)

A

Contralateral hemiparesis and sensory loss upper extremities > lower
Contralateral homonomous hemianopia
Aphasia

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13
Q

Posterior cerebral artery infarct (2)

A

Contralateral homonomous hemianopia with macular sparing

Visual agnosia

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14
Q

Basilar artery infarct (pons) (1)

A

Locked in syndrome

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15
Q

Weber’s syndrome (branches of PCA that supply the midbrain) (2)

A

Ipsilateral CN III palsy

Contralateral hemiparesis of upper and lower extremity

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16
Q

Posterior inferior cerebellar artery (lateral medullary syndrome) (4)

A
  1. Ipsilateral face pain and temperature loss
  2. Contralateral torso and trunk pain and temperature loss
  3. Ataxia
  4. Nystagmus
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17
Q

Anterior inferior cerebellar artery (lateral pontine syndrome) (4)

A
  1. Ipsilateral facial paralysis deafness
  2. Contralateral torse/ trunk pain and temperature loss
  3. Nystagmus
  4. Ataxia
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18
Q

Lacunar (2)

A
  1. Isolated hemiparesis/ hemisensory loss/ hemiparesis with limb ataxia
  2. Strong assoc HTN
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19
Q

Retinal/ Ophthalmic Artery

A

Amaurosis fugax (painless total loss of vision)

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20
Q

Oxford Stroke Classification/ Bamford (3)

A
  1. Hemiparesis/ hemisensory loss
  2. Homonomous hemianopia
  3. Congnitive dysfunction

TACI, PACI, POCI, LACI

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21
Q

TACI - total anterior circulation infarct

A

Involves MCA + ACA (all 3)

  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
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22
Q

PACI - partial anterior circulation infarct

A

Small arteries of anterior circulation (MCA+ACA)
2 of 3 criteria
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

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23
Q

LACI lacunar infarcts

A

Involves perforating arteries around internal capsule, thalamus, basal ganglia
1 of below
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

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24
Q

POCI posterior circulation infarct
Which artery?
Features (3)

A 
Vertebrobasilar artery
1 of following
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia
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25
Features of haemorrhagic stroke (4)
1. Decreased level of consciousness 2. Headache 3. N+V 4. Seizures
26
Criteria for thrombolysis for ischaemic stroke (2)
1. Within 4.5hrs of onset of symptoms | 2. Nil hx of preeclampsia/ pregnancy/ intracranial haemorrhage
27
``` Acute stroke investigation and management If ischaemic --> If secondary to AF --> If cholesterol raised --> Offer thrombectomy --> ```
CT to rule out haemorrhagic stroke If ischaemic - 300mg aspirin If secondary to AF - anticoagulation not to be started for 2 weeks, 300mg aspirin in the interim If cholesterol >3.5 start on statin Offer thrombectomy if: 1. confirmed occlusion of the proximal anterior circulation demonstrated by CTA/MR within 6 hours of onset OR 2. confirmed occlusion of the proximal anterior circulation demonstrated by CTA/ MR AND potential to salvage brain tissue if within 24 hours of onset For all other locations consider if within 24 hours
28
Stroke | Secondary prevention treatment (4)
1. Clopidogrel 75mg OD If contrainidicated 1. MR dipyridamole + aspirin PLUS 3. Statin 4. Antihypertensives
29
Criteria for carotid artery endarterectomy for stroke treatment (2)
1. Not severely disabled | 2. Carotid stenosis must be >70% (or 50% in different source)
30
TIA management Acute (1) TIA <1 week TIA >1 week
1. Aspirin 300mg 2. If has had TIA within 1 week, refer for urgent specialist assessment within 24 hours 3. If has had TIA >1 week ago, refer for specialist assessment within a week
31
Blood supply to cranial nerves Midbrain Pons Medulla
Midbrain III, IV Pons V, VI, VII, VIII Medulla IX, X, XI, XII
32
Management of epilepsy Generalised tonic clonic 1. (1) 2. (2)
1. Sodium valproate 2. Lamotrogine/ carbamezapine TLC
33
Management of epilepsy Absence seizures 1. (2)
1. Sodium valproate/ ethosuximide | AbScencE
34
Management of epilepsy Myoclonic 1. (1) 2. (2)
1. Sodium valproate 2. Clonazepam, lamotrogine MyoCLonic
35
Management of epilepsy Focal seizures 1. (2) 2. (3)
1. carbamazepine/ lamotrigine | 2. levetiracetam/ oxcarbazepine/ sodium valproate
36
Carbamazepine can exacerbate which two types of seizures
1. Myoclonic | 2. Abscence
37
Myoclonic and abscence seizures are exacerbated by which antiepileptic?
Carbamazepine
38
Commonest causes/type of dementia (3)
1. Alzheimers 2. Vascular 3. Lew body
39
Creutzfeldt-Jakob disease Symptoms (4) Caused by build up of ____ (1) Variant caused by ______ (1)
1. loss of intellect and memory 2. changes in personality 3. loss of balance and co-ordination 4. progressive loss of brain function and mobility Caused by build up of prions Variant CJD - caused by contamination of meat
40
``` Vascular dementia Sub types (3) ```
1. Stroke related VD - multi or single infarct 2. Subcorticol VD - small vessel disease 3. Mixed (AD +VD)
41
Vascular dementia | Features (8)
1. Stepwise deterioration 2. Seizures 3. Mood changes 4. Reduced attention/ concentration 5. Motor/ sensory loss 6. Memory disturbance 7. Speech disturbance 8. Gait disturbance
42
Diagnosis for VD using NINDS-AIREN criteria (3)
1. Cognitive decline - using clinical examination and neuropsychological testing 2. CVD - through neuro exam OR - imaging (MRI) 3. Association between the above two - onset of symptoms within three months following stroke - stepwise progression - abrupt deterioration in cognitive functions
43
Management of VD Non pharmacological (1) Pharmacological (1)
Non pharma 1. Musical/ art therapy Pharma 1. Memantine or ACE inhibitors if mixed with AD, PD or Lewy body dementia
44
``` Lewy Body Dementia Features (4) Diagnosis (2) Mx (2) What drugs to avoid? (1) ```
Features 1. Cognitive impairment, fluctuating 2. Attention and executive function seen early 3. Parkinsonism 4. Visual hallucinations Dx 1. Clinical 2. SPECT Mx 1. As AD, donepezil/ / galantamine/ rivastigmine (AChEi) mild to mod 2. Memantine severe (NMDA antag) Avoid 1. Antipsychotics - risk of irreversible Parkinsonism
45
``` Alzheimer's disease Management Mild-moderate (3) Mod-severe (1) Severe (1) ```
``` Mild-mod 1. Donepazil (AChEin) (CI if bradycardia) 2. Rivastigmine 3. Galantamine Mod-severe 1. Combi Severe 1. Memantine (NMDA) ```
46
Normal pressure hydrocephalus Triad (3) Imaging findings (2) Management (1)
Triad 1. Shuffling gait/ gait abnormality 2. Urinary incontinence 3. Dementia + bradyphenia (slowness of thought) Imaging CT/MRI 1. Hydrocephalus with ventriculomegaly 2. Absence of sulcal atrophy Management 1. Ventriculoperitoneal shunt
47
``` Parkinson's disease Triad Gender, age Other features (6) Drug induced features (3) Ix (2) ```
``` Triad 1. Bradykinesia (slowness of movement) 2. Tremor (resting, pill rolling) 3. Rigidity (cog wheel+lead pipe) M>F, median age 65yo ``` Features 1. Mask like face 2. Depression/ psychosis 3. Asymmetrical 4. Micrographia 5. Salivation 6. Flexed position Drug induced features 1. Bilateral 2. Rapid onset 3. Rigidity and tremor not present Ix 1. Clinical 2. SPECT
48
Parkinson's Disease Mx First line (3) Second line (3)
First line, given in early PD with sx impacting daily lives 1. Levodopa with dopa decarboxylase inhibitor (co-beneldopa) 2. Dopamine agonist 3. MAO-B inhib Second line 1. COMT inhibitors 2. Amantadine 3. Deep brain stimulation
49
Investigations needed prior to starting dopamine agonists (4)
1. CXR 2. ECHO 3. ESR 4. Creatinine
50
Name 8 causes of Parkinsonism
1. Drug induced (antipsychotics + antiemetics) 2. Parkinson's disease 3. Wilson's disease 4. Dementia pugillistica (boxers dementia) 5. Post encephalitis 6. Progressive supranuclear palsy 7. Multiple system atrophy 8. Toxins e.g CO, MPTP
51
Acoustic neuroma (aka vestibular schwannoma) Features (4) Bilateral vestibular schwannomas are seen in _______ Ix (1) Mx (4)
1. Vertigo 2. Tinnitus 3. Absent corneal reflex 4. Hearing loss Bilateral vestibular schwannomas are seen in: Neurofibromatosis type 2 Ix MRI Mx 1. Refer to ENT 2. Surgery 3. RT 4. Observation
52
Parietal lobe lesions (4)
Integrating sensory information, including touch, temperature, pressure and pain 1. Apraxia (difficulty with the motor planning to perform tasks or movements when asked) 2. Sensory inattention (neglect) 3. Astereognosis (unable to recognise object in hand with eyes closed) 4. Inferior homonomous quadrantanopia
53
Cerebellum lesions (5)
1. Dysdiadokinesis 2. Past pointing 3. Intention tremor 4. Nystagmus 5. Gait and truncal ataxia
54
Temporal lobe lesions (4)
1. Wernicke's receptive aphasia 2. Superior homonymous quadrantanopia 3. Prosopagnosia (face blindness) 4. Auditory agnosia
55
Frontal lobe lesion (5)
1. Personality change 2. Expressive (Broca's) aphasia 3. Perseveration 4. Anosmia 5. Disinhibition
56
Kluver-Bucy syndrome Lesion in which location (1) Name 3 features
1. Amygdala Features 1. Hypersexuality 2. Hyperorality (excessive chewing, lip smacking) 3. Hyperphagia (excessive eating/ desire of food)
57
Bell's Palsy - facial nerve paralysis Age range Features (2) Rx (3)
``` Age range 20-40yo Features 1. LMN 2. Affects forehead Mx 1. If within 72 hours of onset, for prednisolone 50mg 2. +/- acyclovir 3. Eye lubrication ```
58
``` Syringomelia What is it? Causes (4) Symptoms (3) Ix (1) Mx (2) ```
``` Increased CSF at segmental level (in the spinal cord) Causes 1. Trauma 2. Tumour 3. Chiari malformation 4. Idiopathic Sx 1. Bilateral loss of pain and temp 2. Cape like distribution (neck, back and arms) 3. Spastic weakness of upper limbs (due to impact on corticospinal) 4. Horners Ix 1. MRI Mx 1. Treat underlying cause 2. Shunt ```
59
Neuroanatomy | Name three tracts and features
1. Corticospinal - motor, muscles weakness 2. Spinothalamic - sensory, pain and temperature, crosses at the level of the spinal cord 3. DCML - sensory, light touch
60
Brainstem Strokes (3)
1. Midbrain - Weber's 2. Pons - Locked in 3. Medullary - Wallenburg/ lateral medullary
61
What is cataplexy?
Sudden and transient loss of muscular tone caused by strong emotion. Common in narcoplexy E.g ranging from buckling kness to collapsing
62
Idiopathic intracranial hypertension | RF (4, 4 -5)
RF 1. Female 2. Obese 3. Pregnancy 4. Drugs e.g COCP, steroids, tetracycline, lithium, vit A
63
Idiopathic intracranial hypertension Features (5) Mx (5)
Features 1. Papilloedema 2. Large blind spot 3. Headache 4. Blurred vision 5. CN V1 palsy Mx 1. Weight loss 2. Acetozolamide 3. Topiramate 4. Repeat LP 5. Surgery optic nerve sheath decompression and fenestration or shunt
64
``` Mononeuropathies Ulnar nerve Nerve Roots Sensory (1) Motor (3) Damage ```
C8, T1 Medial 1.5 fingers Adductors, interossei, hypothenar Claw hand
65
``` Mononeuropathies Radial nerve Nerve Roots Sensory Motor Damage ```
C5-T1, lateral epicondyle Proximal phalanges on the dorsal aspect of the hand Extensors, abductor pollicis longus, supinator Wrist drop
66
``` Mononeuropathies Median Nerve Roots Sensory Motor Damage ```
C6, C8, T1 Fingers 1-3.5 LOAF muscles, lumbricals, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis, pronation Carpal tunnel
67
Carpal Tunnel Signs (4) Treatment (3)
Features 1. Phalens (prayer) 2. Tillens (tapping over median causes sx) 3. Thenar wasting 4. Weakness of thumb adduction Treatment 1. Steroid injection 2. Wrist splint 3. Surgical decompression
68
Carpal Tunnel | Causes
``` Causes MEDIAN TRAPS Myxoedema Enforced flexion (Colle's fracture) Diabetic neuropathy Idiopathic Acromegaly Neoplasms Tumour (benign) Rheumatoid arthritis Amyloidosis Pregnancy Sarcoidosis ```
69
Meralgia paraesthetica which nerve? Nerve roots Is it more common in men or women? Average age group
Lateral cutaneous nerve of the thigh L2 L3 Men 30-40
70
``` Meralgia paraesthetica Features (4) Type of pain (3) Aggravated by? Relieved by? ``` Ix (1)
Features 1. Aggravated by standing, and relieved by sitting 2. Burning, tingling, coldness, or shooting pain 3. Numbness 4. Deep muscle ache Ix 1. Pelvic compression test
71
1. Foot drop is caused by what nerve? 2. Name two muscles that are weakened in foot drop 3. What is the sensory loss? 4. Nerve roots
1. Sciatic nerve 2. Hamstrings, calf muscles 3. Reduced sensation below knee 4. L4-S3
72
Wernicke's encephalopathy Triad of symptoms (3) Treatment (1) Korsakoff's features (2)
1. Ophthalmoplegia (paralysis of eye muscles)/ nystagmus 2. Ataxia 3. Confusional state Rx - thiamine 1. Antero + retrograde amnesia 2. Confabulation
73
1. Cafe au lait spots 2. Axillary and groin freckles 3. Iris haematomas (Lisch nodules) = which condition? Type 1 --> common in, chrm Type 2 --> common in, chrm
Neurofibromatosis NF1 von Recklinghausen's syndrome, chrm 17 NF2 bilateral vestibular schwannomas (acoustic neuromas), chrm 22
74
1. Epilepsy 2. Ash leaf spots 3. Shagreen patches 4. Angiofibromas - butterfly distribution on nose 5. Developmental delay + intellectual impairment
Tuberous Sclerosis
75
Huntington's Age Chrm Features (4)
>35yo AD, chrm 4 Features 1. Chorea 2. Dystonia (muscles contract uncontrollably) 3. Saccadic eye movements 4. Personality changes
76
MND - what is it? | Name three types
Causes upper or lower motor neuron signs, nil sensory symptoms. 1. Amyotrophic lateral sclerosis 2. Progressive muscular atrophy 3. Bulbar palsy
77
MND Features (4) Treatment for amyotrophic lateral sclerosis
Features 1. Upper and lower motor neuron signs 2. Fasciculations 3. Nil sensory signs 4. Wasting of lumbricals, interossei and tibialis anterior Tx 1. Riluzole 2. BIPAP
78
What is bulbar disease? What cranial nerves does it affect? What is corticobulbar palsy? UMN or LMN signs?
An MND that affects CN IX-XII and causes LMN signs An MND that affects CN IX-XII and causes UMN signs
79
What is progressive muscular atrophy
A type of MND Anterior horn lesion Nil UMN signs
80
Myasthenia Gravis What is it? Antibodies against? Features (4)
Autoimmune disease, antibodies against acetylcholinesterase receptors Features 1. Muscle fatigueability (worse over day) 2. Proximal muscle weakness: face, neck, limb girdle 3. Dysphagia 4. Ptosis
81
An inherited myopathy affecting skeletal, cardiac and smooth muscle. Average age 20-30 Features 1. Haggard, long face 2. Dysarthria 3. Frontal balding 4. Bilateral ptosis 5. Cataracts
Myotonic dystrophy
82
Myasthenia Gravis | Treatment (3)
1. AchR inhib - pyridostigmine 2. Prednisolone 3. Thymectomy
83
Guillian Barre What is it? What is it normally caused by?
Immune mediated demyelination Progressive, symmetrical weakness of all the limbs ascending in nature Campylobacter jejuni
84
Third nerve palsy features (3)
1. Down and out 2. Ptosis 3. Dilated pupil
85
Subdural haemorrhage on CT findings | Chronic subdural haemorrhage more common in? (2)
Crescenteric | Chronic subdural haematoma common in elderly and ETOH excess
86
Reye's syndrome features (5)
1. Age 2 2. Progressive encephalopathy 3. Fatty infiltration of liver, kidneys and pancreas 4. Following viral infection 5. Low glucose
87
``` Reflexes nerve roots Ankle Knee Biceps Triceps ```
Ankle S1-S2 Knee L3-L4 Biceps C5-C6 Triceps C7-C8
88
Neuroleptic malignant syndrome features (4)
Following antipsychotics 1. Fever 2. Autonomic lability (tachy, HTN, high RR) 3. Muscle rigidity 4. Confusion
89
Multiple system atrophy features (5)
1. Parkinsonism 2. Cerebellar signs 3. Atonic bladder 4. Erectile dysfunction 5. Postural hypotension
90
Degenerative cervical myelopathy Ix What sign can be seen O/E
MRI of the cervical spine is the gold standard test Hoffman's Flicking one finger on a patient's hand +ve if results in reflex twitching of the other fingers on the same hand in response
91
Duchenne Muscular Dystrophy | Features (4)
1. Gower's sign 2. Progressive proximal muscle weakness from 5 years 3. Calf pseudohypertrophy 4. Intelectual disability 5. X linked
92
Becker muscular dystrophy (2)
1. develops after the age of 10 years | 2. intellectual impairment much less common
93
1. absent ankle jerks/extensor plantars 2. cerebellar ataxia 3. optic atrophy 4. spinocerebellar tract degeneration 5. cardiomyopathy AD/AR Age
Friedreich's ataxia 1. Autosomal recessive 2. 10-15yo
94
1. cerebellar symptoms 2. spider angiomas 3. IgA deficiency resulting in recurrent chest infections 4. risk of developing malignancy, lymphoma or leukaemia, but also non-lymphoid tumours AD or AR Age of onset
AR 1-5yo Ataxia telangiectasia
95
GCS
Motor response 6. Obeys commands 5. Localises to pain 4. Withdraws from pain 3. Abnormal flexion to pain (decorticate posture) 2. Extending to pain 1. None Verbal response 5. Orientated 4. Confused 3. Words 2. Sounds 1. None Eye opening 4. Spontaneous 3. To speech 2. To pain 1. None
96
Sodium valproate SE
``` WHATT PLANT Weight gain Hepatotoxicity Alopecia Teratogenic Tremor Pancreatitis Low sodium Ataxia Nausea Thrombocytopenia ```
97
CN3 palsy
down and out ptosis four extraocular muscles
98
CN6 palsy finding
horizontal diplopia
99
CN 4 palsy finding
vertical diplopia
100
Name 4 DA Name 2 MAOB Name 2 COMT
DA: Bromocriptine Ropinerole Apomorphine Cabergoline Pramipexole MAOB: selegilene, rasigiline COMT: entacapone, tolcapone
101
Name x3 drugs should not be used as first-line treatment in epilepsy due to the risk of cardiac fibrosis, what type of drug are they
bromocriptine, cabergoline and pergolide | DA
102
Ergot derived DA name three | Non ergot derived DA name three
bromocriptine, cabergoline, pergolide | ropinerole, pramipexole, rotogotine
103
infantile spasms, three-eight months, drawing up of the legs (Salaam attacks)
West syndrome
104
Janz syndrome AKA Triad
aka juvenile myoclonic epilepsy 1. Infrequent generalised seizures 2. Absence 3. Myclonic jerks
105
What is Kernig's sign? | Which two diseases is it positive in?
positive when the thigh is flexed at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful SAH + meningitis

MSRA (22 decks)

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