Neurology MSRA passmed Flashcards

1
Q

Jacksonian movement (clonic movements travelling proximally

A

Frontal lobe seizures

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2
Q

seizures with sensory abnormalities?

A

PArietal lobe

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3
Q

seziures with aura - lip smacking/ clothes plucking, rising epigastric sensation?

A

Temporal lobe seizures

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4
Q

Absolute CI to thrombolysis in stroke?

A

ICH, seizures, cancer sus, SAH, stroke/ injury in 3 months before, LP 7 days before, GI bleed 3 weeks before, Oesophageal varices, HTN>200/120mmHg

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4
Q

Relative CI to thrombolysis?

A
  • Pregnancy
  • Concurrent anticoagulation (INR >1.7)
  • Haemorrhagic diathesis
  • Active diabetic haemorrhagic retinopathy
  • Suspected intracardiac thrombus
  • Major surgery / trauma in the preceding 2 weeks
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5
Q

Lacunar stroke features?

A

purely motor/
purely sensory
ataxic hemiparesis
ipsilateral weakness and limb ataxia that is out of proportion to the motor deficit
dysarthria-clumsy hand syndrome
affect: internal capsule, thalamus and basal ganglia.

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6
Q

Bilateral median N Dysfunction and twitches in elderly “fibrillation” think?/ hx of carpal tunne/ new imbalance/ sensnory/motor dysfunction

A

Degenerative cervical myelopathy.
MRI: gold standardL

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7
Q

fever, headache, malaise focal neurology, seizures, immunocompromised. what does CT show? dx?

A

CT: temporal lobe/ frontal changes (hypodensities). CSF: lymphocytosis and raised protein.
HSV encephalitis

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8
Q

asymmetric limb weakness, fasciculations, tibialis anterior wasting, small hand muscle wasting

A

ALS MND. risk frontotemporal dementia

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9
Q

Features of tuberus sclerosis?

A

AD, epilepsy, retinal haematoma, ash leaf spots, shagreen patches, sublingual fibromata, adenoma sebaceum, angiofibromas, poliosis

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10
Q

Neurofibromatosis features?
CRABBing?
Risks?

A

lisch nodules, AD, cafe au lait spots, phaechromocytomas, axillary/ groinfreckles,
CRABBING: cafe au lait, renal A stensosi (HTN/ relative), axillary nodules/ inguinal, Bone dysplasia/ bowing scapula, iris nodules, neurpfibroma, glioma eyes
NF2: acoustic neuroma, cns tumours

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11
Q

pyramidal tract lesions?

A

Upper limb - flexors>extensors
lower: extensores >flexors
pronator drift
acute;y flaccid paralysis then becoming spastic and increased tone over weeks with clonus/ brisk reflexes

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12
Q

Variation of gbs with descending demyelination?

A

miller fischer syndrome
ophthalmoplegia, areflexia and ataxia. The eye muscles are typically affected first
Anti GQ1B antibodies present

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13
Q

32 year-old female 3 day history of altered sensation of her left foot and right forearm. She had an episode of visual loss/ nystagmus?

A

Multiple sclerosos. ON with female <50 YO.

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14
Q

60 YO male with clumsy hand, dropping cups, struggles to use phone, worse over months?

A

degenerative cervical meylopathy (UMN signs with loss of dexterity, hoffman’s)

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15
Q

trigeminal neuralgia tx?

A

carbemazepine. if fail to respond and atypical features eg <50 - refer to neuro. preceded by pain in ear

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16
Q

red flag features of trigeminal neuralgia?

A

Sensory changes
Deafness or other ear problems
History of skin or oral lesions that could spread perineurally
Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally
Optic neuritis
A family history of multiple sclerosis
Age of onset before 40 years

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17
Q

Migraine tx?
menstrual migraine tx?

A

acute: triptan + nsaid/ paracetamol
child@ nasal triptan,
Others: non oral metoclopramide, domperidone
proph: propanolol/ topiramatee (teratogenic)/ amitryptiline/ riboflavin (for some),

predictable menstrual migraine: frovatriptan (2.5 mg twice a day) or zolmitriptan (2.5 mg twice or three times a day) as a type of ‘mini-prophylaxis’

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18
Q

differentiate between PD and essential tremour?

A

SPECT
features: essential: improves with alcohol, worse with intention, symmetrical

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19
Q

Parkinson’s symptoms?

tx?

A

features: resting tremour, bradykinesia, rigidity, shuffling gait, arm swinging, stooped,

tx: levodopa with peripheral decarboxylase inhibitors Co-beneldopa (levodopa and benserazide), with the trade name Madopa
Co-careldopa (levodopa and carbidopa), with the trade name Sinemet

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20
Q

parkinson plus syndome?

A

Multiple system atrophy: autonomic dysfunction (sweating, ED, postural hypotension), ataxia

Normal pressure hydrocephalus (wet, wobbly, wacky - incontinence, falls, dementia)

Lewy body dementia

progressive supranuclear palsy (virtical gaze palsy, speech/ swallowing issues)

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21
Q

levodopa SE?

A

dyskinesia :excessive motor activity, chorea, dystonia, athetosis.
MX: amantadine

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22
Q

PD drugs:
COMT inhibitors?
dop agonists?
MOBI?monoamine oxidase-B enzymes

A

COMT - entacapone, slows breakdown to levodopa in brain

dopamine agonist: bromocriptine/ cabergoline/ pergolide. SE: pulmonary fibrosis. less effective but delays need for levodopa and then combined to reduce necessary dose

MOBi: selegiline, rasagiline
(slow breakdown)

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23
Q

cx of brain abscess?

A

extension of sepsis from middle ear or sinuses, trauma or surgery to the scalp, penetrating head injuries and embolic events from endocarditis

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24
Q

15 min headache 5 weeks men, smoker, alcohol, crying around eye. tx?

A

cluster headache. get advice from specialist, imaging and acute: 02, sc triptan, prophylaxis: verapamil

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25
Q

features favouring epileptic seziure?

A

tongue biting, raised serum prolactin

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26
Q

wernicke’s encephalopathy triad?

A

Confusion, gait ataxia, nystagmus + opthalmoplegia. thiamine deficinecy

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27
Q

32 YO, F, altered sensation left foot and right forearm. B/L clonus in legs, and hyperreflexia in all limbs.

A

Multiple sclerosis

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28
Q

carbemazepine se?

A

dizziness, ataxia, and diplopiap

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29
Q

phenytoin se?

A

peripheral neuropathy, (numbness and reduced sensation in a glove-and-stocking distribution). gingival hyperplasia, bleeding gums, osteomalacia, p450 inducer, megaloblastic anaemia, Lymphadenopathy. check trough level (before dose) if dose change/ tox suspicion/ compliance doubt

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30
Q

lumbar spondylosis and chronic back pain presents with gradually worsening bilateral upper limb paraesthesias and leg stiffness

A

degenerative cervical myelopathy. do MRI c spine

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31
Q

Huntington’s disease features?

A

35 +, chromosome 4 (H, 4 arms), chorea
personality changes (e.g. irritability, apathy, depression) and intellectual impairment
dystonia
saccadic eye movements

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32
Q

stroke of: Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)

A

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

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33
Q

stroke: ipsilateral facial paralysis and deafness?

A

anterior inferior cerebellar artery

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34
Q

stroke: Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

A

Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)

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35
Q

site of lacunar stroke?

A

isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
AF: hypertension
common sites: basal ganglia, thalamus and internal capsule

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36
Q

Cushing triad?

A

bradycardia, irregular breathing, wide pulse pressure, systolic HTN (response to raised ICP). also dilated poorly reactive pupils, gcs low, CN6 palsy, pappiloedema

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37
Q

Tx of stroke?

A

CT, if ischaemic stroke - give aspirin 300mg 2/52 then lifelong chlopi
-TIA: aspirin 75mg +chlopi 75mg 3 weeks, then lifelong chlopi.
-if PACS and <4.5hrs do both thrombolysis and thrombectomy (ensure BP 185/110)
thrombolysis if within 4.5 - 9 hrs or 9 hrs of mid point sleep in wake up stroke
- thrombectomy if within 6 hrs. 6-24 hrs if salvagable brain tissue evidence
- clopidogrel and MR dipyramdioleafter aspirin.
- carotid endartectomy wihtin 7 days if 50% + stenosis
-statin if cholesterol 3.5+ (usually delayed 48 hrs due to risk of haemorrhagic transformation)

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38
Q

(CN8)vertigo, hearing loss, tinnitus and an absent corneal reflex (CN5)? and facial nerve palsy (CN7)

A

acoustic neuroma/ vestibular schwannoma

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39
Q

seratonin syndrome?

NMS?

A

presents hours rather than days, sweating, myoclonus, diarrhoea and hyperreflexia. TX: chlorpromazine, cryptoheptadine

NMS: pyrexia
muscle rigidity, reduced reflexes, HTN, hgih HR/ RR, delerium, raised CK/ WCC. over days. TX: dantrolene

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40
Q

Weber lateralises to?

A

contralasteral SN HL
ipsilateral conductive HL

41
Q

valporate SE?

A

Teratogenic (harmful in pregnancy)
Liver damage and hepatitis
Hair loss
Tremor
Reduce fertility
now not recced in men or women <55YO, unless no alternative

42
Q

1st line for focal seizures?

A

lamotrigine/ keppra

43
Q

abscent seizures tx first line ?

A

ethoxusimide. made worse by carbemazepine

44
Q

Myoclonic seizures first line?

A

valporate/ then keppra

45
Q

starting IV phenytoin, what to monitor?

A

cardiac monitoring

46
Q

Amantidine SE?

A

ataxia, slurred speech, confusion, dizziness and livedo reticularis

47
Q

SE dopamine agonists?

A

cabergoline/ bromocriptine: pulmonary fibrosis, retroperitoneal/ cardaic. do CXR, echo, ESR, raised hallucinations, postural hypotension, nasal congestion

48
Q

tx of drug induced parkinsonions?

A

procyclidine (antimuscarinics),

49
Q

TIa and informing DVLA?

A

1 month no neuro deficit, 3 months if multiple TIA and inform DVLA,
craniotomy for meningioma : 1 yr, for pit adenoma craniotomy - 6 months (if vision clear)

50
Q

laughter/ fear triggering loss of msucle tone?

A

cataplexy

51
Q

Stokes-adams attack?

A

LOC/ collapse without warning, 10-30 secs with pallor, flushing on recovery. AF: complete heartblock/ eCG changes, IHD

52
Q

MS ix?

A

MRI with contrast

53
Q

PAtient on DOAC/ anticoagulant and has sx of TIA even if resolved. tx?

A

admit to ED to exclude haemorrhagic stroke

54
Q

Raised protein/ lymphocytes CSF with swelling on CT, fever,

A

HSV enceph

55
Q

Seizures like a ‘‘dream’’, lip smacking without remembering?

A

focal impaired awareness

56
Q

most common initial sx of posterior circulation stroke?

A

dizziness

57
Q

70 year-old man has pain and weakness in both legs on walking. It settles with rest

A

Lumbar spinal stenosis (PVD)

58
Q

Types of aphasia? Speech is fluent but repetition is poor. Aware of the errors they are making. normal comprehension

A

conduction aphasia (connection between broca’s and wernicke’s)

59
Q

Speech is non-fluent, laboured, and halting. Repetition is impaired
Comprehension is normal, type of aphasia?

A

broca’s aphasia - superior left MCA, inferior frontal gyrus (frontal lobe)

60
Q

type of aphasia - speech fluent but comprehension is impaired?

A

expressive. superior temporal gyrus supplies by inferior left CMA

61
Q

impairement of all 3 areas of aphasia: broca’s, wernicke’s and conductive?

A

global aphasia. can communicate with signs

62
Q

CI of triptans?

A

cardiovascular disease,

63
Q

the delusion that a friend or partner has been replaced by an identical-looking impostor

A

capgras syndrome

64
Q

Fregoli’s syndrome?

A

delusional idea that the various people that the patient meets are in fact the same person.

65
Q

cotard’s syndrome?

A

belief they are dead

66
Q

Types of MS that have deteriorated sx between relapses?

A

secondary progressive. gait and baldder disorders also seen

67
Q

bell’s nerve is also seen with?

A

hyperacusis (CN7 palsy, supplies stapes), post auricular pain, dry eyes, altered taste

68
Q

double vision, right eye fails to adduct, left eye has nystagmus on abduction

A

Right sided intranuclear opthalmoplegia (can be feature in MS)

69
Q

visual symptoms preceding the headache. B/L ‘wavy’ and ‘shimmering’ lines in his vision (scintillating scotoma)

A

migraine with aura

70
Q

LEft inferior homonymous hemianopia. where is lesion?

A

right parietal lobe

71
Q

Exacerbate myasthenic crisis?

A

penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines

72
Q

causes of flapping tremour?

A

encephalopathies
phenytoin
CO2 retention
Wilson’s disease

73
Q

pit adenoma visual field defect?

A

Bitemporal hemianopia, upper quadrant defect

74
Q

Visual field defect with primary open angle glaucoma?

A

unilateral peripheral VL

75
Q

bitemporal hemianopia - with worse VL in lower quadrants?

A

craniopharyngioma

76
Q

headache with greying out vision worse in morning and at night. better when standing, double vision,

A

Raised ICP

77
Q

Tx for TV - with and wihtout cns

A

RIPE - 2months
without CNS - RI for 4 months, wiht CNS - RI for 10 furthe rmonths

78
Q

reduced visual acuity, eye pain worse with exercise, swollen optic disc?

A

optic neuritis (uhtoff’s phenomenon - worse with exercise/ heat), lines appear striaght o wavey

79
Q

Bacterial Meng CSF?
TB CSF?

A

high protein, glucose <50% of serum glucose, low
TB: protein ++, glucose low

80
Q

CTH within 1 hr?

A

GCS<15 initially, or GCS <13 within 2 hrs, suspected basal skull #, post traumatic seizure, 1 vomit, neurology

81
Q

CTH within 2 hrs?

A

LOC/ amnesia with 65+/bleeding disorder, mechanism dangerous, retrograde amnesia 30 mins+

82
Q

CTH within 8 hrs?

A

any patient on warfarin

83
Q

CTH for children within 1 hr?

A

non accidental injury, post truamatic seizure (not known epileptic), intial GCS <14/ 15 paeds, GCS<15 2 hrs after, tense fontanelle, basal skull #, neuro sx, <1YO with laceration/swelling/bruise 5cm+

or 2 factors of: LOC 5mins, 3+vomit, dangerous mechanism, amnesia 5 mins+. if only 1, then observe and CTH if GCS<15, vomiting, drowsiness

84
Q

When to tx if first T-C seizure?

A

EEG chasnges, unacceptable risk of reoccurance, known cerebral structual issue, previous myoclonic/ abscence/ focal seziures

85
Q

8YO boy staring into space/ daydreaming?

A

Abscent seizure

86
Q

60YO F, derranged LFTs, acutely confused, ataxic gait, B/Lhorizontal nystagmus. CTH petechial haemorrhages

A

Glucose infusion with chronic thiamine deficiency precipitating wernickes

87
Q

10YO east asian, gait issues, slurred speech, scoliosis, diabetes weak arms and legs?

A

freidrich’s ataxia. autosomal recessive.
risk: cardiomyopathies and DM

88
Q

PD sx, urine dysfunction, postural hypotension, cerebellar ataxia?

A

multiple system atrophy

89
Q

Diagnosis of normal pressure hydrocephalus?

A

LP and evaluation post CSF removal. cT - enlarged ventricles without convolusional atrophy)

90
Q

when to tx tension headaches prophylactically?

A

if more than 2 days a week, trial amitryptiline first line

91
Q

13 YO girl progressive difficulty whistling/ sucking through straw?

A

facioscapulohumeral muscular dystrophy:

92
Q

76 YO man with dementia, painful resteless legs, cant turn in bed, presents with sleep difficulty?

A

parkinsons

93
Q

13YO boy, pulls legs up to walk upstairs, milestones delayed by 18 months, big calves?

A

duchenne muscular dystrophy

94
Q

extrapyramidal SE present 1 yr then cognitive decline?

A

parkinsons disease with dementia

dementia with Lewy bodies - in cortical neurones. the motor SX and cognitive decline present within a year

95
Q

45YO M, BL cataracts, worsening stiffness muscles of shoulders and hips 3 months

A

myotonic dystrophy - Autosomal dom. facila weakness, ptosis, frotnal balding, weakness in grip and shoulder, hallowed temples, hypernasal speech,

PMR - 50YO+

96
Q

headache associated with sexual activity? type 1/ type2? mx?

A

coital cephalgia
t1 - B/L occipital, increases with sexual excitement
type 2- thunderclap like at point of orgasm

acute: BB (pre-emptive)/triptan,
proph:Indomethacin, propanolol/metoprolol,CCB diltiazem

97
Q

charcot’s neurological triad?

A

AF MS but not pathognomonic.
nystagmus, intention tremour, staccato speech

98
Q

When is mirtazipine/ trazadone/ reboxetine best to start in depression with chronic illness?

A

if patient is on NSAID/ warfarin/ aspirin, triptans, selegiline/ rasagiline (MAO-B)

99
Q

best antidepressant for patient on anti-epileptics?

A

sertraline

100
Q
A