Neurology questions Flashcards
(45 cards)
1
Q
What medication is used in Lambert Eaton Myasthenic syndrome and how does it work?
A
Amifampridine
- it blocks the voltage gated potassium channels in the pre synaptic membrance, prolonging depolarisation of the cell and allowing the calcium channels to carry out their function
2
Q
what medication is used in Huntington’s chorea and for what symptom?
A
Tetrabenazine
- used for chorea by reducing the amount of dopamine
3
Q
what medications can be used for an essential tremor?
A
Propanolol
Primidone
4
Q
what are some associated features/signs of temporal arteritis?
A
- The temporal artery may be tender and thickened to palpation, with reduced or absent pulsation
- Symptoms of polymyalgia rheumatica (e.g shoulder and pelvic girdle pain and stiffness)
- Systemic symptoms (e.g., weight loss, fatigue and low-grade fever)
5
Q
what would a duplex USS show in temporal arteritis?
A
hyperechoic ‘halo’ sign and stenosis of the temporal artery
6
Q
what is alzhemiers dementia?
A
- most common type
- loss of white matter causing gyrus atrophy and wide sulci + ventricular dilation (mainly lateral and 3rd)
- due to presence of amyloid beta plaques and neurofibrillary tau tangles
- underlying pathophysiology involves brain atrophy, amyloid plaques, reduced cholinergic activity and neuroinflammation
7
Q
what are some early symptoms of dementia?
A
- forgetting names
- forgetting events
- difficulty remembering words
- repeating the same question
- impaired decision making
- reduced flexibility
8
Q
what are some features of advanced dementia?
A
- aphasia (inability to speak or understand speech)
- dysphagia (can lead to aspiration and pneumonia)
- incontinence
- loss of appetite and weight loss
9
Q
what are triptans and what is their MOA?
A
- 5-HT receptor agonists (bind and stimulate serotonin receptors)
- cranial vasoconstriction
- inhibiting the transmission of pain signals
- inhibiting the release of inflammatory neuropeptides
10
Q
5 stages of a migraine?
A
- prodromal stage
- aura
- headache stage
- resolution stage (headache may fade away or be relieved abruptly by vomiting or sleeping)
- recovery phase
11
Q
- what medication can be used for menstrual migraines?
A
- prophylactic triptans such as frovatriptan or zolmitriptan
12
Q
tuberous scleoriss is caused by mutations in what gene?
A
- TSC1 gene on chromosome 9, which codes for hamartin
- TSC2 gene on chromosome 16, which codes for tuberin
13
Q
what is the role of hamartin and tuberin?
A
- They interact with each other to control the size and growth of cells
- Abnormalities in one of these proteins lead to abnormal cell size and growth
14
Q
management of tuberous sclerosis?
A
- no treatment for underlying gene defect
- Supportive management, monitoring and treating complications esp epilepsy
- specific circumstances, mTOR inhibitors (eg, everolimus or sirolimus) can be used to suppress the growth of brain, lung or kidney tumours
15
Q
what are some of the characteristic features of GBS?
A
- acute
- symmetrical
- ascending weakness
- reduced/absent reflexes
- neuropathic pain
- distal paraesthesia/mild sensory symptoms
- autonomic dysfunction: urinary retention, facial weakness
- cranial nerve involvement
16
Q
what criteria is used to diagnose GBS?
A
- Brighton criteria
17
Q
what is the edrophonium test used for and how does it work?
A
- used to test for myasthenia gravis
- patients are given IV edrophonium chloride
- edrophonium blocks cholinesterase enzymes, reducing the breakdown of ACh
- so the level of ACh at the level of the NMJ increases
- this temporarily relieves the weakness
- a positive result suggests a diagnosis of MG
18
Q
what medication can be used to slow the progression of MND?
A
- Riluzole
- can increase life expectancy by 3 months
19
Q
what else is used for symptom control in MND?
A
- baclofen for muscle spasticity
- antimuscarinic for excessive saliva
- benzodiazepines for breathlessness worsened by anxiety
20
Q
what is the first line treatment for trigeminal neuralgia?
A
carbamazepine
21
Q
what is oscillopsia?
A
the visual sensation of the environment moving and being unable to create a stable image
22
Q
what are they key features of optic neuritis?
A
- unilateral reduced vison
- central scotoma (enlarged central blind spot)
- pain with eye movement
- impaired colour vision
- RAPD
23
Q
what is the medial longitudinal fasciculis & what would a lesion here cause?
A
- the nerve fibres of the MLF connect the cranial nerve nuclei (internuclear) that control eye movements (3rd, 4th and 6th cranial nerves)
- the fibres ensure coordination of the eye movements
- a lesion in the MLF causes internuclear opthalmoplegia
24
Q
what is Ihermitte’s sign?
A
- electrical shock sensation that travels down the spine into the limbs when flexing the neck
- indicates disease in the cervical spinal cord in the dorsal column
- it’s caused by stretching the demyelinated dorsal column
25
what investigations are carried out in MS?
- MRI: typical lesions
- LP: oligoclonal bands in the CSF
26
what is the role of myelin?
- covers the axons of neurones and helps electrical impulses travel faster
27
what is the cause of a subarachnoid haemorrhage?
usually result of a ruptured cerebral aneurysm
28
what is the main side effect of levodopa?
Dyskinesia = abnormal movements associated with excessive motor activity
- dystonia (abnormal posture or exaggerated movements due to excessive muscle contraction
- chorea (abnormal involuntary movements that can be jerking and random)
- athetosis
29
what medication can be used to treat dyskinesia?
Amantadine (glutamate antagonist)
30
how can bradykinesia present?
- micrographic: handwriting gets smaller and smaller
- shuffling gait
- festinating gait: rapid frequency of steps to compensate for the small steps and avoid falling
- difficulty initiating movement
- difficulty turning around when standing and having to take lots of small steps to turn
- hypomimia: reduced facial movements and expressions
31
what is multiple systems atrophy?
a rare condition where the neurones in multiple systems in the brain degenerate including the basal ganglia (this leads to parkinson's presentation)
32
what are infantile spasms an what is the EEG finding?
Also known as West syndrome, where there are clusters of full body spasms.
On EEG - hypsarrhythmia
33
what are myoclonic seizures?
sudden, brief muscle contractions (like a sudden jump) but they remain awake
34
treatment of generalised tonic clonic seizures?
- males: sodium valporate
- females: lamotrigine or levetiracetam
35
treatment of focal seizures?
lamotrigine or levetiracetam
36
treatment of absence seizures?
ethosuximude
37
treatment of myoclonic seizures?
sodium valporate (males) levetiracetam (females)
38
treatment of tonic or atonic seizures?
sodium valporate (males) lamotrigine (females)
39
what are tonic seizures?
sudden increase in muscle tone where the entire body stiffness, so they can fall
- will only last a few seconds
40
what are some signs and symptoms of CP?
- failure to meet milestones
- increased or decreased tone
- hand preference below 18 months
- problems with coordination, speech or walking
- feeding or swallowing difficulties
- learning difficulties
41
perinatal and postnatal causes of cerebral palsy?
- Perinatal: birth asphyxia, preterm birth & trauma
- Postnatal: intraventricular haemorrhage, brain injury, meningitis, severe neonatal injury
42
what are the symptoms of TIA?
- rapid onset
- unilateral weakness or sensory loss
- aphasia or dysarthria
- ataxia, vertigo, loss of balance
- visual problems: amaurosis fugax, diplopia, homonymous hemianopia
43
symptoms of stroke?
- sudden onset of neurological symptoms
- asymmetrical symptoms
- limb weakness
- facial weakness
- dysphagia (sleep disturbance)
- visual field defects
- sensory loss
- ataxia and vertigo
44
what are some prophylactic options for cluster headaches (first line and others)
- verapamil (1st line)
- lithium
- prednisolone
- occipital nerve block
45
what are some metabolic causes of seizures?
- hypoglycaemia
- hyponatraemia
- uraemia
- hypernatraemia
- hypocalcaemia
