Neurosciences Flashcards

Question

List the presentations by cerebellar vermis lesions

Answer 1

Truncal ataxia (difficulty standing and sitting unsupported) Broad-based, ataxic gait

Answer 2

Vertigo and vomiting Gait ataxia

Answer 3

Thrombus (atherosclerosis) Embolus (atrial fibrillation, atherosclerosis of the carotid arteries) Intra/extracranial vessels diseases: * Carotid artery dissection * Vasculitis * Cerebral venous thrombosis Haematological condition: * Sickle cell anaemia * Antiphospholipid syndrome

Answer 4

Intracerebral haemorrhage - Hypertension Subarachnoid haemorrhage * Intracranial aneurysm rupture * Arteriovenous malformations * Arterial dissections * Anticoagulant use

Answer 5

Hemorrhagic transformation of ischaemic stroke Cerebral oedema Delirium Seizures Pulmonary embolism Cardiac complications * Myocardial ischemia * Congestive heart failure * Atrial fibrillation * Arrhythmias Infection * Aspiration pneumonia * Urinary tract infection * Cellulitis from infected pressure sores

Answer 6

Neurological dysfunction < 24 hours Unilateral weakness/sensory loss Dysphasia Ataxia, vertigo, loss of balance Syncope Amaurosis fugax, diplopia, homonymous hemianopia Cranial nerve deficits

Answer 7

Lifestyle factors * Smoking. * Alcohol misuse and drug abuse (cocaine, methamphetamine). * Physical inactivity. * Poor diet. Cardiovascular diseases: * Hypertension * Atrial fibrillation * Infective endocarditis * Valvular disease * Carotid artery disease * Congestive heart failure * History of myocardial infarction * Congenital / structural heart disease Other medical conditions: * Migraine. * Hyperlipidaemia. * Diabetes mellitus. * Sickle cell disease. * Haemophilia. * Antiphospholipid syndrome and other hypercoagulable disorders. * Chronic kidney disease. * Ehlers-Danlos syndrome. * Marfan syndrome. * Pseudoxanthoma elasticum. * Polycystic kidney disease. * Neurofibromatosis type I. * Obstructive sleep apnoea. * Vascular malformations Other factors: * Older age * Gender Male sex - more likely to have a stroke at a younger age Female sex * Anticoagulation * Previous TIA/stroke, family history of stroke

Answer 8

Combined oral contraceptives Immediate postpartum period Pre-eclampsia

Answer 9

Pregnancy Infection Dehydration Malignancy

Answer 10

Best motor response 6 - obeys commands 5 - localising pain 4 - withdrawal from pain 3 - flexion to pain 2- extension to pain 1 - no motor response Best verbal response 5 - oriented 4 - confused 3 - inappropriate words 2 - incomprehensible sounds 1 - no verbal response Best eye response 4 - open spontaneously 3 - open to verbal command 2 - open to pain 1 - no eye opening

Answer 11

The level of consciousness using Glasgow Coma Scale Airway, breathing, and circulation Vital signs * Blood pressure * Heart rate * Respiratory rate * Oxygen saturation * Temperature Focused neurological examination - Face Arm Speech Test (FAST) The cardiovascular system * Arrhythmia (atrial fibrillation) * Murmurs * Pulmonary oedema * Heart failure

Answer 12

Aspirin 300 mg immediately * PPI cover if dyspepsia * Clopidogrel if aspirin contraindicated

Answer 13

No AF - Antiplatelet therapy * clopidogrel 75 mg * Intolerance - Aspirin 75 mg daily with modified-release dipyridamole 200 mg twice daily AF - Anticoagulant drugs * Valvular AF - Adjusted-dose warfarin * Non-valvular AF - Direct thrombin (Dabigatran) / factor Xa inhibitor (Apixaban, Betrixaban, Edoxaban, Rivaroxaban) High-intensity statin - Atorvastatin 20-80 mg daily Antihypertensive drugs

Answer 14

To exclude intracranial haemorrhage: Indicated for thrombolysis or thrombectomy On anticoagulant treatment Known bleeding tendency Depressed level of consciousness (GCS scale score <13) Unexplained progressive / fluctuating symptoms Papilloedema, neck stiffness, fever Severe headache at onset of stroke symptoms Uncertain diagnosis

Answer 15

hypoattenuation (darkness) of the brain parenchyma loss of grey-white matter differentiation, sulcal effacement hyperattenuation (brightness) in an artery indicates clot

Answer 16

Serum glucose - hypo/hyperglycaemia (before thrombolysis) Serum electrolytes - electrolyte disturbance Serum urea and creatinine - renal failure Cardiac enzymes - concomitant myocardial infarction ECG - cardiac arrhythmia/ischaemia FBC - anaemia/thrombocytopenia before thrombolysis, anticoagulants, or antithrombotics. PT and aPTT (with INR) - coagulopathy.

Answer 17

IV alteplase / tenecteplase within 4.5 hours of known onset Manage ABC * Endotracheal intubation if unable to protect their airway or GCS score ≤8 * Supplemental oxygen if sat < 93% Mechanical thrombectomy if confirmed occlusion of the proximal anterior circulation (ICA/M1) or the proximal posterior circulation (basilar/PCA).

Answer 18

Chronic hypertension resulting in * Rupture of microaneurysms (Charcot–Bouchard aneurysms) * Degeneration of small, deep, penetrating arteries

Answer 19

Cerebral amyloid angiopathy Vascular malformations * Saccular/mycotic aneurysms * Arteriovenous malformations * Cavernous angiomas * Moyamoya disease Intracranial tumours Bleeding disorders, anticoagulant and fibrinolytic treatment Vasculitides * Granulomatous angiitis of the central nervous system * Polyarteritis nodosa Sympathomimetic agents * Amphetamine * Cocaine Hemorrhagic infarction Head trauma Septic emboli/arteritis in the setting of infective endocarditis

Answer 20

hyperattenuation (brightness), suggesting acute blood, often with surrounding hypoattenuation (darkness) due to oedema

Answer 21

Aneurysm rupture (80%) Arteriovenous malformations Arterial dissections Anticoagulant use

Answer 22

Thunderclap headache Neck stiffness Nausea and Vomiting Photophobia Loss of consciousness Seizures (7%) Diplopia (CN VI), eyelid drooping, mydriasis, orbital pain (CN III) Visual loss (Intraocular haemorrhage from increased ICP) Agitation Focal neurological deficits * Unilateral loss of motor function * Loss of visual field * Aphasia

Answer 23

Presence of hyperdense appearance of blood in the subarachnoid space / basal cisterns

Answer 24

cerebral venous sinus thrombosis idiopathic intracranial hypertension

Answer 25

low pressure headache

Answer 26

Left ventricular subendocardial injury Takotsubo cardiomyopathy

Answer 27

Full blood count - Leukocytosis (independent risk factor for cerebral vasospasm) Serum electrolytes - Hyponatremia (associated with SIADH) Serum glucose - Hyperglycemia (Present in ⅓. Feature of any acute brain injury) Clotting profile - coagulopathy (elevated INR, prolonged PTT) Serum troponin I - Elevated (acute myocardial injury due to autonomic dysregulation with sympathetic stimulation) ECG * Arrhythmias and ischaemic changes * Prolonged QT * ST segment / T wave abnormalities

Answer 28

Oral nimodipine

Answer 29

IV mannitol - reduce ICP Stop / reverse anticoagulation BP control < 140 mmHg systolic Surgical eg. EVD

Answer 30

Sudden drop in conscious level Spike in blood pressure Tonic/extensor posturing Pupillary changes

Answer 31

Early aneurysm repair Short-term Tranexamic acid

Answer 32

Rebleeding Acute hydrocephalus Seizures Vasospasm and delayed cerebral ischaemia

Answer 33

A gradually worsening level of arousal with relative preservation of deliberate motor responses Severe headache/vomiting/agitation

Answer 34

CSF drainage or diversion

Answer 35

≥ 2 drop in GCS score New focal neurological deficit (e.g., unilateral motor or sensory loss, speech disturbance, visual field loss)

Answer 36

Triple-H (uses hypertension, hypervolaemia, and haemodilution) Endovascular strategies (balloon angioplasty / intra-arterial vasodilators)

Answer 37

Hereditary connective tissue diseases: * ADPKD * Neurofibromatosis type 1 * Ehlers-Danlos syndrome type IV * Marfan’s syndrome Hypertension Arteriovenous malformations/fistulas Smoking, Alcohol, Drug abuse

Answer 38

Trauma (most common) Rupture of a cerebral aneurysm Vascular malformation * AVM * Dural fistula

Answer 39

torsional / shear forces causing disruption of bridging cortical veins

Answer 40

Acute - <3 days old, diffusely hyperdense Subacute - 3~21 days old, heterogeneously hyperdense/isodense Chronic - >21 days old, diffusely hypodense Acute-on-chronic - areas of hyperdensity within hypodense haematoma

Answer 41

Raccoon eyes CSF rhinorrhea CSF otorrhea Haemotympanum

Answer 42

Head injury with a brief duration of unconsciousness Followed by improvement (lucid interval) Then becomes stuporose * Ipsilateral dilated pupil * Contralateral hemiparesis * Transtentorial coning Followed by * Bilateral fixed, dilated pupils * Tetraplegia * Respiratory arrest

Answer 43

Normal-age related memory changes Mild cognitive impairment Depression Delirium Thiamine deficiency (Wernicke-Korsakoff’s syndrome) Hypothyroidism Normal pressure hydrocephalus

Answer 44

Age Mild cognitive impairment (MCI) Learning disability Genetics Cardiovascular disease Cerebrovascular disease Parkinson's disease (PD)

Answer 45

Alzheimer’s disease (50–75% of cases) Vascular dementia (up to 20% of cases) Dementia with Lewy bodies (DLB) (10–15% of cases) Frontotemporal dementia (FTD) (2% of cases) Other causes of dementia: Parkinson’s disease (PD) dementia Progressive supranuclear palsy Huntington’s disease Cretzfeldt-Jakob disease (Prion disease) Normal pressure hydrocephalus Chronic subdural haematoma Benign tumours Metabolic and endocrine disorders * Chronic hypothyroidism * Addison's disease * Hypopituitarism Vitamin deficiencies (B12, thiamine) Infections (HIV, syphilis) Inflammatory and autoimmune disorders Transient epileptic amnesia

Answer 46

extracellular plaques composed primarily of amyloid intraneuronal neurofibrillary tangles composed primarily of hyperphosphorylated tau

Answer 47

Loss of recent memory first Difficulty with executive function / nominal dysphasia Loss of episodic memory Cognitive deficits - aphasia, apraxia, agnosia

Answer 48

Acetylcholinesterase (AChE) inhibitors - mild to moderate AD * Donepezil * Rivastigmine * Galantamine Memantine (N-methyl-D-aspartic acid receptor antagonist) - moderate to severe AD

Answer 49

Large / multiple small infarcts Haemorrhage Cerebral amyloid angiopathy Subcortical leukoencephalopathy

Answer 50

Stepwise increase in severity of symptoms Focal neurological signs eg. hemiparesis / visual field defects

Answer 51

REM sleep behaviour disorder Fluctuating cognition Recurrent visual hallucinations One or more symptoms of Parkinsonism - bradykinesia, rest tremor, rigidity, postural instability Memory impairment in later stages

Answer 52

donepezil or rivastigmine

Answer 53

Amyotrophic lateral sclerosis (ALS) Parkinsonism Corticobasal degeneration Progressive supranuclear palsy

Answer 54

AChEi Memantine

Answer 55

Evident disturbance in attention Cognitive change Develops over a short period of time Evident physiological disturbance

Answer 56

Hyperactive Hypoactive Mixed

Answer 57

PINCHME: Pain Infection Nutrition Constipation deHydration Medication Environment

Answer 58

Headache of migraine results from neurogenic inflammation of CNV1 sensory neurons (Innervates the large vessels and meninges of the brain) CNV neurons release substances that cause dilation of the meningeal blood vessels, leakage of plasma proteins into surrounding tissues, and platelet activation. This peripheral sensitisation results in increased nociceptive inputs into CNV sensory nucleus and ultimately central sensitisation. Therefore, non-painful stimuli (eg. light touch) are interpreted as pain.

Answer 59

Intermittent Headache Visual disturbance Nausea and vomiting Photophobia and phonophobia Reduced ability to function

Answer 60

aspirin (900 mg) sumatriptan

Answer 61

propanolol

Answer 62

Psychological stress (most common) Disturbed sleep patterns (episodic) Insomnia and other sleep disorders (chronic)

Answer 63

Dull, non-pulsatile pain (typically expressed as being a 'tight band' around the head)

Answer 64

Alcohol Volatile smells Warm temperatures Sleep

Answer 65

Trigeminal distribution of the pain Ipsilateral cranial autonomic symptoms Circadian/circannual pattern of attacks

Answer 66

Severe unilateral orbital, supra-orbital, and/or temporal pain lasting 15 to 180 minutes At least one of the following symptoms or signs, ipsilateral to the headache: * Conjunctival injection, lacrimation * Nasal congestion, Rhinorrhoea * Eyelid oedema, Facial and forehead sweating * Miosis, Ptosis * Sense of restlessness or agitation.

Answer 67

subcutaneous sumatriptan / nasal zolmitriptan High flow oxygen

Answer 68

Unilateral paroxysms of facial pain lasting seconds to minutes in a distribution along ≥1 divisions of the CNV

Answer 69

Neuropathic pain due to focal demyelination and resultant conduction aberration

Answer 70

Tooth brushing Eating Cold Touch

Answer 71

Carbamazepine Oxcarbazepine

Answer 72

irreversible vision loss due to optic nerve ischaemia

Answer 73

Age >50 yrs New onset headache Limb, jaw, tongue claudication Scalp tenderness Acute visual symptoms (amaurosis fugax) Unexplained raised ESR/CRP Constitutional symptoms: * Fever * Fatigue * Night sweats * Weight loss

Answer 74

IV high-dose methylprednisolone

Answer 75

Granulomatous inflammation of the intima and media Breaking up of the internal elastic lamina Giant cells, lymphocytes and plasma cells in the internal elastic lamina

Answer 76

S1-2 Ankle L3-4 Knee jerk C5-6 Biceps C7-8 Triceps

Answer 77

(A) Thalamic - sensory loss throughout the opposite side. (B) Brainstem - contralateral sensory loss below face and ipsilateral loss on face. (C) Central cord - ‘suspended’ areas of loss, often asymmetrical and ‘dissociated’: i.e. pain and temperature lost but light touch intact. syrinx (D) Hemisection of cord/unilateral cord lesion - Brown–Séquard syndrome: contralateral spinothalamic (pain and temperature) loss with ipsilateral weakness and dorsal column loss below lesion. (E) Transverse cord - loss of all modalities, including motor, below lesion. (F) Dorsal column - loss of proprioception, vibration and light touch. (multiple sclerosis) (G) Individual sensory root lesions, e.g. C6, T5, L4. (H) Polyneuropathy - distal sensory loss. UMN, upper motor neuron.

Answer 78

Weakness in the upper extremities greater than the lower Pain and temperature loss 2/3 levels caudal to the lesion Loss of bladder control If lesion expands: * bilateral spastic paraparesis of the lower extremities * asymmetric upper extremity paraparesis

Answer 79

(Involve the anterior two-thirds of the spinal cord) Pain, temperature, and motor function below the level of the lesion lost Vibration, proprioception, and fine touch sensation intact

Answer 80

Loss of vibration and proprioception Spastic paraparesis and brisk reflexes Urgency and incontinence Retained pain and temperature sensation

Answer 81

‘Suspended’ area of dissociated sensory loss (cape like distribution) Loss of upper limb reflexes Hand and forearm muscle wasting Spastic paraparesis (initially mild) Brainstem signs (syringobulbia) * Tongue atrophy and fasciculation * Bulbar palsy * Horner’s syndrome * Impairment of facial sensation

Answer 82

Spinal cord tumours * Extramedullary - meningioma, neurofibroma * Intramedullary - ependymoma, glioma Bony metastases (vertebral body destruction) Disc and vertebral lesions: * Chronic degenerative * Acute central disc prolapse * Trauma Inflammatory: * Epidural abscess * Tuberculosis * Granulomatous Epidural haemorrhage / haematoma

Answer 83

Radiating arm pain Mild weakness in the muscles Reflex changes

Answer 84

Loss of hand coordination Hand intrinsic muscles weakness eg. interossei Mild gait ataxia (impaired position sense) Bowel and bladder difficulties in severe cases

Answer 85

Prostate Breast Lung Renal Thyroid

Answer 86

serum calcium levels - hypercalcaemia serum ALP - elevated cancer-specific laboratory testing * prostate specific antigen (PSA) * breast cancer genes 1 and 2 (BRCA1 and 2) * carcinoembryonic antigen (CEA) * serum and urine protein electrophoresis

Answer 87

Afferent pathway: 1. Light activates optic nerve axons. 2. Axons (some decussating at the chiasm) pass through each lateral geniculate body 3. Synapse at pretectal nuclei. Efferent pathway: 4. Action potentials pass to Edinger–Westphal nuclei of the CN III 5. Via parasympathetic neurons in CN III to cause 6. Pupil constriction

Answer 88

Absent direct and consensual reflex Intact consensual reflex of the right eye

Answer 89

Relative afferent pupillary defect

Answer 90

lesion of the medial longitudinal fasciculus

Answer 91

Multiple sclerosis

Answer 92

Ipsilesional adduction deficit Contralateral, horizontal abducting nystagmus on attempted gaze to the contralesional side

Answer 93

Headache CN5 compression * Hemifacial hypo/paraesthesia * Trigeminal neuralgia CN7 compression - Facial spasm/weakness 4th ventricle compression - Obstructive hydrocephalus Cerebellar displacement * Nystagmus * Ataxia

Answer 94

Peripheral * Benign paroxysmal positional vertigo * Meniere's disease * Labyrinthitis * Labyrinthine concussion * Vestibular neuronitis * Vestibular ototoxicity * Perilymphatic fistula * Semicircular canal dehiscence syndrome * Syphilis Central * Migraine * Stroke * Cerebellar tumour * Vestibular schwannoma * Multiple sclerosis

Answer 95

vertigo visual disorders occipital pressure nausea and vomiting

Answer 96

Canalithiasis

Answer 97

Cupulolithiasis

Answer 98

Head trauma Labyrinthitis Vestibular neuronitis Meniere's disease (endolymphatic hydrops) Migraines Ischaemia Iatrogenic

Answer 99

Posterior canal Lateral canal Superior canal

Answer 100

Sensation that the environment is spinning around relative to oneself Sudden onset and intense vertigo Precipitated by head movements Short duration Episodic and recurrent

Answer 101

Posterior canal BPPV

Answer 102

1. The patient sits on the examination table 2. their head is turned 45° to one side 3. then they are laid back into a supine position, with the head hanging back but supported by the examiner and the neck extended by about 30°

Answer 103

Eyes rotate in an anticlockwise manner during the fast phase of nystagmus With a slight up-beating vertical component (towards the forehead)

Answer 104

Eyes rotate in a clockwise manner during the fast phase of nystagmus With a slight up-beating vertical component (towards the forehead)

Answer 105

lateral canal BPPV

Answer 106

pure horizontal nystagmus without a torsional (rotatory) component

Answer 107

horizontal nystagmus with the fast phase beating towards the ground (geotropic) the side with the stronger response is the affected side

Answer 108

the fast phase beats away from the ground (apogeotropic) the side with the weaker response is the affected side

Answer 109

Particle repositioning manoeuvre

Answer 110

Endolymphatic hydrops - overproduction or impaired absorption of endolymph

Answer 111

Episodic sudden onset of vertigo, hearing loss, tinnitus, and sensation of fullness in the affected ear.

Answer 112

Positive Romberg’s test Inability to walk tandem (heel to toe) in a straight line Fukuda stepping test (march in place with eyes closed) - unable to maintain position and turn towards the affected side

Answer 113

Salt restriction to 1500~2300 mg/day - prevent Na+ related water retention and re-distribution into the endolymphatic system Thiazide diuretics Lifestyle: * Limit caffeine * Reduce alcohol * Ceasing smoking * Managing stress

Answer 114

Inflammation of the otic capsule: * Cochlea * Three orthogonal semi-circular canals * Otolith organs (utricle, saccule)

Answer 115

severe to profound hearing loss (typically irreversible) and vertigo

Answer 116

(Direct microbial invasion of the inner ear) Acute/chronic otitis media Cholesteatoma Meningitis

Answer 117

Treponema pallidum Haemophilus influenzae Streptococcus species Staphylococcus species Neisseria meningitidis

Answer 118

less severe hearing loss (often reversible) and vertigo than suppurative labyrinthitis.

Answer 119

Preceding URTI Autoimmune inner ear disease * Cogan's syndrome * Behçet’s disease

Answer 120

Varicella zoster virus Cytomegalovirus Mumps, measles, rubella HIV

Answer 121

Unilateral sensorineural hearing loss Tinnitus Vertigo with nausea and vomiting

Answer 122

Spontaneous horizontal-rotary nystagmus - fast phase beating towards the normal ear Significant difficulty walking Unable to perform tandem gait Fall with Romberg’s testing

Answer 123

Inflammation of the vestibular nerve (after a viral infection) Secondary to ischaemia of the anterior vestibular artery

Answer 124

hearing is not affected in vestibular neuronitis.

Answer 125

BPPV Persistent postural perceptual dizziness (PPPD) Oscilloposia

Answer 126

Spontaneous vertigo * Exacerbated by changes of head position * Acute symptoms settle in a few days and recovery over 2–6 weeks. Imbalance (veer to the affected side) Nausea and vomiting Autonomic symptoms * Malaise * Pallor * Sweating

Answer 127

Nystagmus with the fast phase away from the affected ear

Answer 128

Buccal prochlorperazine Intramuscular prochlorperazine / cyclizine

Answer 129

Bradykinesia Tremor Rigidity Postural instability

Answer 130

Parkinson's disease Vascular Parkinsonism Drug induced Parkinson-plus syndromes * Lewy body dementia * Multiple system atrophy * Progressive supranuclear palsy * Corticobasal degeneration Wilson's disease Repeated head injury

Answer 131

First generation antipsychotics (fluphenazine, trifluoperazine, haloperidol, chlorpromazine, flupentixol, zuclopenthixol) Antiemetics (prochlorperazine, metoclopramide)

Answer 132

Parkinsonism Severe early autonomic dysfunction: * Symptomatic hypotension * Constipation / Urinary retention * Faecal / Urinary urge incontinence * Persistent erectile dysfunction Speech/bulbar dysfunction Pyramidal/cerebellar dysfunction Poor response to levodopa

Answer 133

Parkinsonism Early dysphagia Vertical gaze palsy Recurrent falls (postural instability)

Answer 134

Parkinsonism Asymmetric rigidity and dystonia Cortical sensory loss Progressive aphasia Apraxia Cognitive impairment Alien limb phenomenon

Answer 135

Kayser-Fleischer rings Variable neurological signs including tremor, ataxia, dystonia Non-specific liver disease

Answer 136

Tremor at rest Rigidity Bradykinesia Postural instability Autonomic dysfunction * Orthostatic hypotension * Swallowing problems * Excessive salivation * Weight loss * Urinary symptoms * Constipation * Sexual problems Non-motor symptoms * Depression, anxiety, and fatigue * Anosmia * Cognitive impairment * REM sleep behaviour disorder * Pain

Answer 137

Selective loss of nigrostriatal dopaminergic neurons in the substantia nigra pars compacta (SNc) Intracytoplasmic eosinophilic inclusions (Lewy bodies) and neurites, composed of alpha-synuclein

Answer 138

1. Decreased activity of the direct pathway and increased activity of the indirect pathway 2. Increased inhibitory activity from the GPi/SNr to the thalamus 3. Reduced output to the cortex

Answer 139

Levodopa Monoamine oxidase-B (MAO-B) inhibitors * Selegiline * Rasagiline * Safinamide Dopamine agonists * Pramipexole (oral) * Ropinirole (oral) * Rotigotine (transdermal)

Answer 140

Dyskinesia Excessive sleepiness Hallucinations Impulse control disorders

Answer 141

Essential tremor Postural and action tremor * Dystonic tremor * Hyperthyroidism * Drugs eg. beta2-agonists Intention tremor - cerebellar disorder

Answer 142

Postural tremor - worse if arms outstretched Bilateral and symmetrical Involves the head, neck, voice, and limbs Worsen with * stress * caffeine * sleep deprivation Improves * alcohol * beta-blockers

Answer 143

Chorea Incoordination Cognitive decline Personality changes Psychiatric symptoms

Answer 144

Systemic disease * Thyrotoxicosis * SLE * Antiphospholipid syndrome * Polycythaemia vera Genetics * Huntington’s disease * Neuroacanthocytosis * Benign hereditary chorea Structural and vascular disorders of the basal ganglia Drugs * Levodopa * Oral contraceptives Post-infectious (Sydenham’s chorea) Pregnancy

Answer 145

Fluoxetine (SSRI) Buspirone Benzodiazepines

Answer 146

Autosomal dominant disorder Mutation in ε-sarcoglycan gene

Answer 147

Childhood onset Motor and vocal tics Psychiatric disorders (OCD, ADHD)

Answer 148

Comprehensive behavioural intervention for tics

Answer 149

Alpha-2 agonist (monotherapy at minimal dosage) * Clonidine * Guanfacine Antipsychotics * Aripiprazole * Risperidone * Ziprasidone Botulinum toxin

Answer 150

Dystonia may improve with simple 'sensory tricks' such as lightly touching the affected body part

Answer 151

Axial * Blepharospasm * Cervical torticollis Limb * Task related (writer’s cramp) * Foot * Orofacial/mandibular

Answer 152

TOR1A gene mutations

Answer 153

Levodopa Trihexyphenidyl (anticholinergic) Pallidal deep brain stimulation

Answer 154

Amyotrophic lateral sclerosis Progressive muscular atrophy Progressive bulbar and pseudobulbar palsy Primary lateral sclerosis

Answer 155

Pure LMN presentation Weakness Muscle wasting Fasciculations Usually starting in one limb and gradually spreading to involve other adjacent spinal segments

Answer 156

UMN disorder Slowly progressive tetraparesis and pseudobulbar palsy

Answer 157

Mild weakness Spasticity Hyperreflexia and clonus Pathological reflexes: * Babinski * Hoffmann sign * Loss of abdominal reflexes

Answer 158

Moderate to severe weakness Atrophy Hyporeflexia Flaccidity Fasciculations

Answer 159

Sporadic (mostly) Genetic * free radical scavenging enzyme superoxide dismutase (SOD-1) - missense mutations * C9orf72 * TDP-43 * FUS

Answer 160

Isolated dysarthria Hand weakness Foot drop Gait changes Shortness of breath

Answer 161

Typical UMN findings: Loss of coordinated movement Spasticity Muscle spasms Pronator drift Hyperreflexia * Babinski's sign * Hoffmann's reflex * Crossed adductors * Exaggerated jaw jerk * Primitive reflexes: palmomental/snout reflex Typical LMN findings: Weakness Atrophy Fasciculations Split-hand phenomenon - severe changes in the thenar eminence but relative sparing of the hypothenar eminence

Answer 162

(El Escorial Diagnostic Criteria) Definite ALS - UMN and LMN signs in at least 3 regions Probable ALS - UMN and LMN signs in 2 regions, with some UMN signs rostral to LMN signs

Answer 163

Nerve conduction studies * Diminished CMAP * Normal sensory nerve conduction study Electromyography * Fasciculation potentials * Acute (positive sharp waves and fibrillation potentials) + chronic (reduced neurogenic firing pattern, polyphasic motor unit potentials) changes

Answer 164

Nerve conduction studies - Rule out peripheral nerve disease mimicking ALS eg. multifocal motor neuropathy If NCS suggests possible peripheral nerve disease, blood tests to assess: * Vitamin B₁₂ level * Specific antibodies (anti-GM1, acetylcholine receptor, muscle-specific tyrosine kinase, voltage-gated calcium-channel antibodies) Neuroimaging - Exclude structural, inflammatory, or infiltrative disorders Lumbar puncture - Exclude infectious diseases

Answer 165

1st line: Riluzole Edaravone (antioxidant) Sodium phenylbutyrate / tauroursodeoxycholic acid

Answer 166

Glutamate inhibitor, reduces excitotoxicity

Answer 167

Hepatotoxicity and neutropenia (rare) LFT and FBC monthly for first 3 months, then every 3 months

Answer 168

Dystrophin - exon deletions

Answer 169

X-linked recessive

Answer 170

Nuclear envelope proteins * Emerin (X-linked recessive) * Lamin A/C (autosomal dominant)

Answer 171

Small deletion on chromosome 4 affecting D4Z4 region in FSHD1 (95%) SMCHD1 region in FSHD2

Answer 172

Autosomal dominant Spontaneous mutations (up to 30%)

Answer 173

CTG triplet repeat expansion in the 3' non-coding region of DMPK

Answer 174

10~20 years

Answer 175

10–40 years

Answer 176

Proximal: shoulders, pelvic girdle

Answer 177

Face, shoulders, scapular winging, upper arms, foot drop. Typically asymmetric

Answer 178

deafness and retinal abnormalities

Answer 179

Severe disability <25 years

Answer 180

Life expectancy normal, slow progression

Answer 181

Xp21 defect / deletion results in the absence of dystrophin (sarcolemma-associated protein) Provides structural stability to the dystroglycan complex in cell membranes Results in ongoing cell membrane depolarisation due to calcium entering the cell Causes ongoing degeneration and regeneration of muscle fibres Degeneration is faster than regeneration, and muscle fibres undergo necrosis Muscle fibres are replaced by adipose and connective tissue, causing the muscles to progressively weaken

Answer 182

Toddler with * Delayed motor milestones * Calf hypertrophy * Proximal hip girdle muscle weakness * Marked elevation of serum creatine kinase

Answer 183

Imbalance of strength at all lower extremity pivots Relatively weaker hip extensors, knee extensors, and ankle dorsiflexors Physical signs: * Gowers' sign * Musculotendinous contractures - imbalance of lower body strength * Increased lumbar lordosis and heel cord contractures

Answer 184

Corticosteroid therapy - Preserve muscle strength Prevention/reduction of musculotendinous contractures Physiotherapy

Answer 185

Apixaban Betrixaban Edoxaban Rivaroxaban

Answer 186

Dabigatran

Answer 187

Contralateral hemiparesis and sensory loss of lower limbs Anosmia Anterior corpus callosum involvement - alien hand syndrome Pericallosal branch involvement - apraxia, agraphia, tactile anomia of the left hand

Answer 188

Contralateral homonymous hemianopia or upper quadrant anopsia Receptive aphasia (Wernicke)

Answer 189

Contralateral weakness (affects the lower face and arm more than the leg) Contralateral sensory loss (including the face) Contralateral hemineglect Expressive aphasia (Broca)

Answer 190

(Gerstmann syndrome) Agraphia, Acalculia, Finger agnosia Right-left disorientation Contralateral weakness, sensory loss Contralateral hemineglect Contralateral homonymous hemianopia Global aphasia (receptive and expressive)

Answer 191

Reducing level of consciousness Severe headache Nausea/vomiting Sudden increase in blood pressure

Answer 192

Weber syndrome (Ventromedial midbrain) * Ipsilateral oculomotor nerve palsy * Contralateral hemiplegia

Answer 193

(Lateral pontine syndrome (Marie-Foix Syndrome)) Ipsilateral cerebellar ataxia (arm and leg) Ipsilateral facial weakness Ipsilateral deafness, vertigo, nystagmus (CN VIII palsy) Contralateral weakness (corticospinal tract) Contralateral pain and temperature loss (spinothalamic tract)

Answer 194

(Lateral medullary syndrome (Wallenberg Syndrome)) Ipsilateral * Loss of gag reflex * Facial sensory loss * Horner's syndrome * Nystagmus * Ataxia Contralateral - Pain and temperature sensory loss in the extremities Generally * Vertigo * Nausea * Dysphagia

Answer 195

Prednisolone IV dihydroergotamine (Contraindicated in patients with CV risk factors (CAD, HTN)) Greater occipital nerve block

Answer 196

Mild TBI: GCS 13-15; mortality 0.1% Moderate TBI: GCS 9-12; mortality 10% Severe TBI: GCS <9; mortality 40%

Answer 197

Blunt TBI * Falls (48%) * Motor vehicle-related injury (17%) * Crush injuries * Physical altercations Penetrating TBI * Gunshot * Stabbing Blast TBI - combination of contact and inertial forces, overpressure, and acoustic waves

Answer 198

Rapid rotational/deceleration force that causes stretching and tearing of neurons, followed by focal areas of haemorrhage and oedema.

Answer 199

Petechial haemorrhages and oedema located at the: Grey-white matter junction (Grade 1) Corpus callosum (Grade 2) Brainstem (Grade 3)

Answer 200

Raising the head of the bed to 30° Analgesics and sedation - reduce metabolic demands Inducing hypocapnia by hyperventilation - reduces pCO₂, which provokes cerebral vasoconstriction, and lowers ICP * Hyperventilation should be limited to <30 minutes to treat acute cerebral herniation.

Answer 201

Osmosis: hypertonic saline, mannitol High-dose barbiturate ICP monitoring Decompressive hemicraniectomy

Answer 202

attention executive function memory and learning language perceptual motor social cognition

Answer 203

Significant cognitive decline in one or more cognitive domains, based on: 1. Concern about significant decline, expressed by individual/reliable informant/observed by clinician. 2. Substantial impairment, documented by objective cognitive assessment. Interference with independence in everyday activities. Not exclusively during delirium. Not better explained by another mental disorder. Specify one or more etiologic subtypes

Answer 204

Increased intracranial pressure in an alert and oriented patient

Answer 205

overweight women of childbearing years, often in the setting of weight gain.

Answer 206

CSF absorption occurs both via the arachnoid granulations and along nerve root sheaths, especially along the olfactory nerve through the cribriform plate. Abnormalities of the absorption pathways. Papilloedema and loss of vision are usually due to intraneuronal ischaemia related to increased CSF pressure transmitted along the optic nerve sheath.

Answer 207

Symptoms * Headaches * Pulse-synchronous tinnitus * Transient visual obscurations, visual loss, diplopia * Neck and back pain Signs * Papilloedema * CN6 paresis * Sensory visual disturbances

Answer 208

Decreased flow through arachnoid granulations due to scarring from previous inflammation * Meningitis * Sequel to subarachnoid haemorrhage Obstruction to venous drainage * Venous sinus thrombosis * Bilateral radical neck dissection * Superior vena cava syndrome * Increased right heart pressure Endocrine disorders * Addison's disease * Hypoparathyroidism * Corticosteroid withdrawal Hypervitaminosis A (vitamin, liver, or isotretinoin intake) Arteriovenous malformations and dural shunts

Answer 209

Lumbar puncture - opening pressure >250 mm H2O MRI * Transverse sinus stenosis * Empty sella * Posterior globe flattening * Pituitary stalk displacement * Meningoceles * Abnormalities of the optic nerve * Slit like ventricles * Tight subarachnoid spaces Inferior position of cerebellar tonsils

Answer 210

Weight-reduction Low-sodium diet

Answer 211

Acetazolamide Furosemide Topiramate

Answer 212

Inhibit carbonic anhydrase, reduces sodium ion transport across the choroid plexus epithelium Acetazolamide decreases CSF production in humans by 6~50%

Answer 213

CN III, IV, V1, V2, VI Internal carotid artery

Answer 214

Superior and Inferior ophthalmic vein Superficial middle cerebral vein Middle meningeal vein Hypophyseal veins

Answer 215

Superior and inferior petrosal sinuses

Answer 216

Sinusitis Facial infection (folliculitis) Periorbital infection. Mucormycosis (highly invasive fungal infection, usually occurs in immunocompromised) Otitis media, mastoiditis Petrous apicitis (infection of the medial portion of the temporal bone at the base of the skull) Odontogenic infection Bacterial meningitis

Answer 217

Trauma Post-surgery Hypercoagulable states Malignancy * Rhabdomyosarcoma * Nasopharyngeal carcinoma Vascular abnormalities

Answer 218

Polycythaemia vera Sickle cell disease Acute lymphocytic leukaemia Deficiencies of antithrombin III, protein C, or protein S Resistance to activated protein C Antiphospholipid syndrome Thrombocytosis Elevated IgM Nephrotic syndrome Oral contraceptives

Answer 219

Staphylococcus aureus

Answer 220

Staphylococcus aureus (most common) Fusobacterium necrophorum Streptococci

Answer 221

Headache - unilateral, V1/2 regions (retro-orbital or frontal areas) Fever (septic CST) Ocular manifestations * Chemosis (conjunctival oedema) * Periorbital oedema * Proptosis. * Painful ophthalmoplegia * Ptosis * Mydriasis * External ophthalmoplegia (restriction of extraocular muscles)

Answer 222

CT with contrast - abnormal filling defects with lateral convexity of the cavernous sinuses

Answer 223

Empirical antibiotics: vancomycin with/without rifampicin Linezolid Trimethoprim/sulfamethoxazole

Answer 224

Bulbar - LMN Pseudobulbar - UMN

Answer 225

Tongue - wasted, fasciculations Absent palatal movement Absent gag reflex Absent jaw jerk Nasal speech (flaccid dysarthria) Normal emotions

Answer 226

Motor neurone disease Syringobulbia Guillain-Barre syndrome Poliomyelitis Subacute menignitis (carcinoma, lymphoma) Neurosyphilis Brainstem cerebrovascular accident

Answer 227

Bilateral cerebrovascular accidents affecting the internal capsule

Answer 228

Cerebrovascular accidents Multiple sclerosis Motor neurone disease High brainstem tumours Head injury

Answer 229

Spastic tongue, slow moving Absent palatal movement Increased gag reflex Increased jaw jerk Spastic speech, ‘Donald Duck’ dysarthria Labile emotions

Answer 230

Stooped posture Shuffling (reduced stride length) Loss of arm swing Postural instability Freezing

Answer 231

(Myopathic gait) Waddling (proximal weakness) Bilateral Trendelenburg signs

Answer 232

(Central ataxia) Wide-based, ‘drunken’ Tandem gait poor

Answer 233

Wide-based Positive Romberg sign

Answer 234

Sensory ataxia Bilateral vestibular failure

Answer 235

The foot on the affected side is plantar flexed and describes a semicircle as the patient walks The upper limb may be flexed

Answer 236

Scissor-like gait (spasticity)

Answer 237

Sodium valproate Glucocorticoids Lithium

Answer 238

slow (3 to 7 Hz), coarse, ‘pill-rolling’ tremor, worse at rest but reduced with voluntary movement

Answer 239

fine (low-amplitude), fast (high-frequency, 3 to 30 Hz) postural tremor

Answer 240

0 - No muscle contraction visible 1 - Flicker of contraction but no movement 2 - Joint movement when effect of gravity eliminated 3 - Movement against gravity but not against resistance 4 - Movement against resistance but weaker than normal 5 - Normal power

Answer 241

Deltoid - Axillary C5

Answer 242

Elbow flexion * Biceps - Musculocutaneous C5/6 * Brachioradialis (supinator reflex) - Radial C6 Elbow extension * Triceps - Radial C7

Answer 243

Extensor carpi radialis longus - Radial (posterior interosseous branch) C6

Answer 244

Finger extension * Extensor digitorum communis - Radial (posterior interosseous branch) C7 Finger flexion * Flexor pollicis longus/Flexor digitorum profundus - Median (anterior interosseous branch) C8 * Flexor digitorum profundus - Ulnar C8

Answer 245

Finger abduction * First dorsal interosseous - Ulnar T1 Thumb abduction * Abductor pollicis brevis - Median T1

Answer 246

Hip flexion * Iliopsoas - Iliofemoral nerve L1/2 Hip extension * Gluteus maximus - Sciatic L5/S1

Answer 247

Knee flexion * Hamstrings - Sciatic S1 Knee extension * Quadriceps - Femoral L3/4

Answer 248

Ankle dorsiflexion * Tibialis anterior - Common peroneal L4/5 Ankle plantar flexion * Gastrocnemius and soleus - Tibial S1/2

Answer 249

Extensor hallucis longus - Common peroneal L5

Answer 250

Ankle eversion * Peronei - Common peroneal L5/S1 Ankle inversion * Tibialis posterior - Tibial nerve L4/5

Answer 251

mononeuropathy radiculopathy

Answer 252

Contralateral frontal lobe pathology

Answer 253

Ramsay Hunt syndrome (herpes zoster infection of the geniculate (facial) ganglion) Vestibular schwannoma (cerebellopontine angle compression) Parotid tumours Trauma

Answer 254

(LMN CN7 paralysis) Weakness of both upper and lower facial muscles Taste impairment Hyperacusis

Answer 255

Anterior vertebral artery injury eg. flexion injury

Answer 256

Mechanical compression/chemical irritation of a specific nerve root by * degenerative disc * degenerative joint changes, narrowing the root exit at the foraminal level

Answer 257

Posterior disc protrusion Congenital spinal canal narrowing Osteophytic bars Ligamentous thickening Ischaemia

Answer 258

Corticosteroid - dexamethasone sodium phosphate Radiotherapy Surgery

Answer 259

CES (LMN involvement) * Usually bilateral, severe radicular pain * Saddle anaesthesia * Asymmetric motor weakness * Hypo/areflexia * Late-onset bowel/bladder dysfunction CMS (Mixed UMN and LMN involvement) * Sudden-onset severe back pain * Perianal anaesthesia * Symmetric motor weakness * Hyperreflexia * Early-onset bowel/bladder dysfunction

Answer 260

Low back pain Bilateral / unilateral sciatica Saddle anaesthesia / paraesthesia Sexual dysfunction Bladder dysfunction * Difficulty starting/stopping urination * Impaired sensation of urinary flow * Urgency * Urinary retention with overflow urinary incontinence Bowel dysfunction * Loss of sensation of rectal fullness * Faecal incontinence * Laxity of the anal sphincter

Answer 261

MRI lumbar spine without IV contrast

Answer 262

Anterior poliomyelitis Motor neuron disease

Answer 263

Systemic metabolic disorders Toxin exposure Vasculitis Inherited neuropathies

Answer 264

Stocking and glove sensory loss Muscle weakness and atrophy Loss of distal limb myotatic reflexes

Answer 265

Focal weakness without sensory loss

Answer 266

Sensory ataxia Sensory loss Diffuse areflexia

Answer 267

Toxins * organic mercury compounds * doxorubicin * high-dose pyridoxine Vitamin E deficiency Immune-mediated * paraneoplastic sensory neuronopathy * Sjögren syndrome

Answer 268

Sensory - large myelinated Motor - small myelinated Autonomic - small unmyelinated

Answer 269

Foot drop Weak ankle inversion

Answer 270

Paralysis of knee flexion and all movements below knee Sensory loss below knee Reflexes * ankle and plantar reflex lost * knee jerk intact

Answer 271

Inability to * Stand on tiptoe (plantar flexion) * Invert the foot * Flex the toe * Sensory loss over the sole

Answer 272

Hypothyroidism Pregnancy (third trimester) Rheumatoid disease Acromegaly Amyloidosis, including dialysis

Answer 273

variations in the anatomy of the carpal tunnel age over 30 years high BMI pregnancy occupations involving repetitive movements of the wrist

Answer 274

Gradual onset, intermittent, bilateral hand numbness and pain Numbness typically confined to the palmar aspect of the thumb and radial fingers Sensory loss in the radial 3.5 fingers. Thenar muscle wasting Waking up at night-time Difficulty finger extension / flexion on awakening Relived by shaking or flicking the wrist

Answer 275

Electromyography * conduction velocity slowing in the median sensory nerves across the carpal tunnel * median distal motor latency prolongation * decreased amplitude of median sensory/motor nerves

Answer 276

Ulnar nerve root = C8-T1 Claw hand Wasting of interossei and hypothenar muscles Weakness of interossei and medial two lumbricals Sensory loss in the little finger and splitting of the ring finger

Answer 277

Radial nerve root = C5-T1 Wrist drop Weakness of brachioradialis and finger extension

Answer 278

Compression of the lateral femoral cutaneous nerve (L2-3) Anterio-lateral burning thigh pain

Answer 279

Common peroneal nerve root = L4-S2 Foot drop Intact ankle jerk (S1) Weakness of * ankle eversion * foot dorsiflexion Sensory loss over the dorsum of the foot and the lower lateral part of the leg Wasting of the anterior tibial and peroneal muscles

Answer 280

Divides into tibial and common peroneal nerves

Answer 281

Vasculitis Diabetes mellitus Malignancy Neurofibromatosis HIV and hepatitis C infection Leprosy Multifocal motor neuropathy with conduction block.

Answer 282

Painful, acute to subacute sensory and motor deficits that may be limited to one nerve or multifocal.

Answer 283

Symmetric numbness, paraesthesias, and dysesthesias in the feet and distal lower extremities. Stocking-glove sensory symptoms in severe cases

Answer 284

Guillain–Barré syndrome Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) Monoclonal gammopathies Hereditary neuropathies

Answer 285

Acute * Acute pandysautonomic neuropathy (autoimmune, paraneoplastic) * Guillain-Barré syndrome * Porphyria * Toxic: vincristine Chronic * Diabetes mellitus * Amyloid neuropathy * Paraneoplastic sensory neuronopathy (malignant inflammatory sensory polyganglionopathy) * HIV-related autonomic neuropathy * Hereditary sensory and autonomic neuropathy

Answer 286

Infections in the 6 weeks before symptom onset Campylobacter jejuni Cytomegalovirus Epstein–Barr virus Mycoplasma pneumoniae

Answer 287

Paraesthesias in hands and feet Pain (typically begins in the back and legs) Hyporeflexia/areflexia Facial, oropharyngeal, and extraocular weakness (cranial nerve deficits) Dysautonomia * Sinus tachycardia, Cardiac arrhythmias * Hypertension, postural hypotension * Urinary retention, Ileus Respiratory muscle weakness * Dyspnoea on exertion * Shortness of breath

Answer 288

Lumbar puncture - Increased CSF albumin with a normal cell count (albuminocytological dissociation) Nerve conduction studies * Prolonged distal and F-wave latencies * Reduced conduction velocities LFT - Elevated AST, ALT Spirometry - reduced: * Vital capacity * Maximal inspiratory/expiratory pressure

Answer 289

high-dose intravenous immunoglobulin (IVIG) plasma exchange

Answer 290

(Thiamine (vitamin B1) deficiency) Alcohol (most common) Anorexia nervosa Vomiting of pregnancy

Answer 291

Sensory ataxia Reduced strength in the distal muscles with associated atrophy and weakened foot eversion Reduction in pinprick and vibration sensation, more pronounced distally than proximally Areflexia/hyporeflexia High-arched feet and hammer toes (pes cavus) Steppage gait

Answer 292

Eye signs * Nystagmus * Bilateral lateral rectus palsies * Conjugate gaze palsies Ataxia * Broad-gait based gait * Cerebellar signs * Vestibular paralysis Cognitive change * Stupor and coma (acute) * Amnestic syndrome with confabulation (chronic)

Answer 293

Clumsiness as a child Weak ankles Steppage gait Pes cavus (high foot arches with hammer toes) Distal atrophy of the hands and legs (inverted champagne bottle legs) Abnormal sensations typically begin distally and proceed proximally over time Kyphoscoliosis Symmetrical nerve conduction changes

Answer 294

CMT 1A - most common Autosomal dominant PMP22 gene duplication

Answer 295

CMT type 1 (CMT1) - demyelinating conductions and dominant inheritance CMT2 - axonal conductions and dominant inheritance

Answer 296

beriberi * Polyneuropathy * Cardiac failure

Answer 297

limb numbness developing during anti-tuberculosis therapy with slow isoniazid acetylators

Answer 298

Prophylactic pyridoxine 10 mg daily is given with isoniazid

Answer 299

Subacute combined degeneration of the cord (SACD) * spastic paraparesis * loss of vibration sense, proprioception, and two-point discrimination * ataxic gait * reduced sensation

Answer 300

Plaques of demyelination 2~10mm in size, commonly in * Optic nerves * Periventricular region * Corpus callosum * Brainstem and cerebellar connections * Cervical cord (corticospinal tracts and posterior columns)

Answer 301

Relapsing-remitting MS * Onset over days and typically recovery (partial/complete) over weeks. * Average one relapse per year. * May accumulate disability over time if they do not recover fully after relapses. Secondary progressive MS * Late stage MS * Gradually worsening disability progressing slowly over years * ~75% of patients with relapsing–remitting MS will eventually evolve into a secondary progressive phase by 35 years after onset. Primary progressive MS * Gradually worsening disability without relapses or remissions * Typically presents later * Associated with fewer inflammatory changes on MRI Relapsing–progressive MS * Similar to PPMS but with occasional supra-added relapses on a background of progressive disability from the outset.

Answer 302

Optic neuritis * Partial / total unilateral visual loss * Pain behind the eye * Loss of colour discrimination (particularly reds) * Relative afferent pupillary defect - paradoxical dilation of the pupil when light is rapidly shifted from the unaffected eye to the affected eye Transverse myelitis * Paresthesia * Weakness (initial flaccid paralysis, followed by spastic paralysis with hyperreflexia) * Tight band sensation around the trunk at the level of the inflammation * Lhermittes’ phenomenon - Shock-like sensation radiating radiating down the spine induced by neck flexion Cerebellar syndromes - Ataxia, Vertigo, Clumsiness, Dysmetria Brainstem syndromes * Ataxia * Eye movement abnormalities- Diplopia, Oscillopsia, Nystagmus, Internuclear ophthalmoplegia Bilateral trigeminal neuralgia Uhthoff phenomenon: symptoms worsening with increased body temperature Urinary frequency Bowel dysfunction (constipation)

Answer 303

Internuclear ophthalmoplegia - nystagmus of the abducting eye with absent adduction of the other eye UMN signs * Spasticity * Hyperreflexia Gait * Mild dragging of the foot * Spasticity * Balance problems

Answer 304

MRI brain (high field magnet with IV gadolinium contrast) * Hyperintensities in the periventricular white matter * Demyelinating lesions in the spinal cord, particularly cervical

Answer 305

Oligoclonal bands CSF IgG

Answer 306

Oral methylprednisolone 0.5 g for 5 days Plasma exchange

Answer 307

1st line: Siponimod or IV methylprednisolone 2nd line: Cladribine

Answer 308

Ocrelizumab

Answer 309

Anti-aquaporin 4 Anti-myelin oligodendrocyte glycoprotein

Answer 310

Optic neuritis Acute myelitis Area postrema syndrome (unexplained hiccups, nausea, or vomiting) Acute brainstem syndrome Symptomatic narcolepsy Symptomatic cerebral syndrome with NMOSD-typical brain lesions

Answer 311

Typically bilateral Progressive paraparesis/quadriparesis Sensory loss/paraesthesias below the lesion Autonomic (bowel and bladder) dysfunction Evolution of signs over several days. Radicular or segmental pain at the level of the spinal lesion Back pain L'hermitte's sign Paroxysmal tonic spasms

Answer 312

IV methylprednisolone

Answer 313

Demyelinating disease preferentially affecting the CNS Areas commonly involved * subcortical white matter * periventricular areas * cerebellar peduncles In most cases, the optic nerve and the spinal cord are unaffected.

Answer 314

Reactivation of John Cunningham virus (JC virus) infecting oligodendrocytes in patients with compromised immune systems. * AIDS * Post solid organ/bone marrow transplant recipients * Malignancies * Chronic inflammatory conditions (Progressive and fatal disease)

Answer 315

New-onset neurological symptoms in a patient with immunosuppression Cognitive impairment Limb, gait ataxia Hemiparesis Hemianopia Aphasia

Answer 316

hypodense confluent lesions without mass effect

Answer 317

Ageing Genetics Environmental toxins * Organochlorine pesticides * Lead * Mercury * Beta-carboline alkaloids (harmane, harmaline)

Answer 318

Propranolol Primidone Small amounts of alcohol Benzodiazepines - clonazepam DBS * ventralis intermedius nucleus (VIM) of the thalamus * caudal zona incerta (posterior subthalamic area) Ultrasound thalamotomy * refractory ET ineligible for DBS

Answer 319

Autosomal dominant Expanded CAG repeats at the N-terminus of the HTT gene that codes for huntingtin protein. Individuals with ≥40 CAG repeats are certain to develop Huntingon’s disease. Reduced penetrance is observed in those with 36 to 39 repeats.

Answer 320

Degeneration of cholinergic and GABAergic neurons in the striatum of the basal ganglia

Answer 321

A form of secondary myoclonus following cardiac arrest, divided into acute and chronic Myoclonus status epilepticus - acute, within 24 hrs * Generalised myoclonus * Intermittent eye opening, upward gaze deviation, swallowing movements Lance-Adams syndrome - chronic, days to weeks * Focal in nature and exacerbated by action * Negative (relaxation) myoclonus also occurs - drop objects or fall

Answer 322

Primary * Physiological * Myoclonic dystonia * Epilepsy Secondary * Metabolic disorders (hepatic and renal failure, asterixis) * Alzheimer’s * Encephalitis

Answer 323

Symptoms typically begin in childhood, peak prior to puberty, attenuate later in adolescence

Answer 324

Primary - familial, autosomal dominant Secondary * Iron deficiency * Pregnancy (26%, third trimester) * Uraemia * Renal dialysis/ESRD (20%)

Answer 325

Obesity Diabetes Multiple sclerosis Parkinson's disease Neuropathy

Answer 326

TCAs, SSRIs Sedating antihistamines Metoclopramide (DPA antagonist) Neuroleptics

Answer 327

Symptoms are nocturnal The urge to move with dysaesthesia symptoms (creeping, crawling, tingling, cramping, aching) Symptoms worse at rest, relieved temporarily with movement Lower extremities are more commonly affected

Answer 328

(Dissemination in both time and space) 2 or more attacks + 2 or more lesions on MRI

Answer 329

White women aged between 20 and 40 years.

Answer 330

EBV infection Female, caucasian, HLA-DRB1 Environmental factors * Location (USA, europe) * Cold climate Low vitamin D Smoking

Answer 331

Thyroid disease Vitamin B12 deficiency Diabetes mellitus

Answer 332

Anti-AChR (80-90%) Anti-muscle-specific tyrosine kinase (MuSK) (3-7%)

Answer 333

Circulating antibodies against the nicotinic acetylcholine receptor (AChR) or associated proteins impair neuromuscular transmission.

Answer 334

Muscle weakness that increases with exercise (fatigue) and improves on rest. * Ptosis, Diplopia * Dysarthria, Dysphagia * Facial paresis * Proximal limb weakness * Shortness of breath

Answer 335

An MG exacerbation requiring mechanical ventilation * forced vital capacity ≤ 15 (normal ≥60 mL/kg) * negative inspiratory force ≤ 20 (normal ≥70 cm H₂O)

Answer 336

Infections (particularly respiratory infections) Aspiration Medicines including high-dose corticosteroids Medications that are contraindicated in MG Failure to adhere to medications Administration of immune checkpoint inhibitors eg cancer therapy Surgery Trauma

Answer 337

Intubation and mechanical ventilation Plasma exchange / IVIG

Answer 338

1st line: Pyridostigmine (cholinesterase inhibitor) Prednisolone Azathioprine Rituximab (MuSK-MG) Thymectomy

Answer 339

Early in disease course for aged 18~50 to minimise the need for immunosuppressants Ocular AChR-MG with insufficient response to cholinesterase inhibitors Severe disease

Answer 340

Small cell lung cancer Autoimmune thyroid disease Vitamin B12 deficiency Rheumatoid arthritis Inflammatory myopathy Systemic vasculitis

Answer 341

Small cell lung cancer (CA-LEMS) Autoimmune (NCA-LEMS) * Autoimmune thyroid disease * Vitamin B12 deficiency * Rheumatoid arthritis * Inflammatory myopathy * Systemic vasculitis

Answer 342

MG * Antibody against AChR Antibody * Associated with thymic tumour * Weakness worsen on prolonged exercise * Normal deep tendon reflex * Autonomic dysfunction absent * On repeated nerve stimulation, there is decremental response LEMS * Antibody against voltage gated calcium channel * Associated with small cell lung cancer * Weakness improves on prolonged exercise * Decreased/absent deep tendon reflex * Autonomic dysfunction present * On repeated nerve stimulation, there is incremental response

Answer 343

Disruption of neurotransmission due to depletion of voltage-gated calcium channels (VGCCs) In normal neurotransmission, depolarisation of the presynaptic nerve terminal triggers calcium influx at VGCC that ultimately results in quantal release of ACh into the synaptic cleft. This produces localised depolarisation of the adjacent peri-endplate muscle membrane.

Answer 344

Generalised fatigue Proximal leg weakness Dry mouth (xerostomia), Dysarthria, Dysphagia Prominent ocular weakness with ptosis and binocular diplopia Autonomic features * Pupillary dilation * Orthostatic hypotension

Answer 345

Proximal muscle weakness in hip girdle and thigh muscles Absent/reduced tendon reflexes Dilated, poorly reactive pupils

Answer 346

Auto-antibody serology - serum P/Q-type VGCC antibodies +ve NCS * Typically low initial CMAP * Decremental responses to low-frequency repetitive nerve stimulation

Answer 347

Treat malignancy Symptomatic * Amifampridine * Pyridostigmine

Answer 348

Progressive dementia and motor dysfunction

Answer 349

Sporadic Creutzfeldt-Jakob disease (sCJD) Genetic prion diseases * Familial CJD * Gerstmann-Straussler-Scheinker * Fatal familial insomnia Acquired prion diseases * Iatrogenic CJD * Variant CJD

Answer 350

MRI (FLAIR) * hyperintensity in the cerebral cortex grey matter gyri, basal ganglia, thalamus * bilateral pulvinar hyperintensity (vCJD) EEG - generalised slowing, focal or diffuse, and periodic polyspike-wave complexes and sharp waves CSF testing

Answer 351

Lung Breast Melanoma Kidney Stomach Prostate Thyroid

Answer 352

Astrocytoma Oligodendroglioma Oligoastrocytoma Ependymoma Lymphoma Medulloblastoma

Answer 353

Meningioma Neurofibroma

Answer 354

Ionising radiation Genetic syndromes * Neurofibromatosis type 1 * Tuberous sclerosis complex * Li-Fraumeni syndrome * Turcot syndrome

Answer 355

MRI head/spine with/without contrast * Contrast-enhancing tumour * Surrounding cerebral oedema * Enhancing dural tail CT head/spine * Bony changes (hyperostosis) * Calcification (25%) (slower growing tumour) * Contrast-enhancing tumour * Surrounding oedema, enhancing dural tail

Answer 356

Neonates * E. coli * Group B streptococcus (S. agalactiae) * L. monocytogenes Infant * N. meningitidis * H. influenzae * S. pneumoniae Young adult * N. meningitidis * S. pneumoniae Elderly * S. pneumoniae * N. meningitidis * L. monocytogenes

Answer 357

Meningothelial cells of the arachnoid layer (arachnoid-cap cells)

Answer 358

Bacterial * Opening pressure: raised * Appearance: turbid, cloudy, purulent * CSF WBC count: raised (typically >100) * Predominant cell type: neutrophils * CSF protein: raised * CSF glucose: very low * CSF/plasma glucose ratio: very low Viral * Opening pressure: normal/mildly raised * Appearance: clear * CSF WBC count: raised (typically 5 to 1000) * Predominant cell type: lymphocytes * CSF protein: normal/mildly raised * CSF glucose: normal * CSF/plasma glucose ratio: normal

Answer 359

oral ciprofloxacin single dose

Answer 360

Headache Neck stiffness Photophobia Fever Altered consciousness Rash Seizures Shock

Answer 361

Kernig’s sign (present in only 11%) Pain in the lower back or back of thigh on extension of knee when hip is flexed to a 90° right angle Brudzinski’s sign (present in only 9%) Forced flexion of the neck elicits a reflex flexion of the hip

Answer 362

Blood culture

Answer 363

Acidosis Hypokalaemia Hypocalcaemia Hypomagnesaemia Low sodium (TB meningitis)

Answer 364

Signs suggesting raised ICP Shock Extensive or spreading purpura After convulsions, until stabilised Coagulation abnormalities Local infection at the lumbar puncture site Respiratory insufficiency

Answer 365

IM/IV benzylpenicillin (children, adults) IV ceftriaxone/cefotaxime (adults)

Answer 366

(Viruses) Herpes viruses * Herpes simplex virus * Varicella zoster virus * Cytomegalovirus * Epstein-Barr virus West Nile virus Picornaviridae / enteroviruses * Coxsackievirus * Poliovirus Bacterial * Neisseria meningitidis (meningoencephalitis) * Syphilis * Listeria * Bartonella (cat-scratch disease) * Borrelia burgdorferi (Lyme disease) Autoimmune * Anti-NMDA encephalitis * Acute hemorrhagic leukoencephalitis

Answer 367

Acute/subacute onset of a febrile illness Altered mental status Focal neurological abnormalities Seizures

Answer 368

Major criteria (required): Altered mental status lasting ≥24 hours with no alternative cause identified * Altered level of consciousness * Lethargy * Personality change Minor criteria (2 required for possible, ≥3 required for probable/confirmed encephalitis) * Documented fever ≥38°C within the 72 hours before/after presentation * Generalised/partial seizures not fully attributable to a pre-existing seizure disorder * New onset of focal neurological findings * CSF WBC count ≥5/mm³ * Abnormality of brain parenchyma on neuroimaging suggestive of encephalitis * Abnormality on EEG consistent with encephalitis and not attributable to another cause.

Answer 369

Immunocompetent - Aciclovir Immunocompromised - Aciclovir AND ganciclovir AND foscarnet

Answer 370

Symptoms * Recent unexplained fever with neurological deficit * Headache * Fever * New-onset neurological deficits Signs * Nuchal rigidity, and Kernig and Brudzinski signs in the presence of neurological deficits * Increased intracranial pressure and impending cerebral herniation: * CN3 / 6 palsies * Anisocoria * Papilloedema

Answer 371

Neonates - Proteus mirabilis and Citrobacter species Children - Streptococcus species in combination with cyanotic heart disease Adults - Streptococcus and Staphylococcus species

Answer 372

Vancomycin + Metronidazole/clindamycin + third generation cephalosporin (ceftriaxone, cefotaxime)

Answer 373

1 or more ring-enhancing lesions

Answer 374

Clinical features of hydrocephalus without significantly elevated CSF * levodopa-unresponsive gait apraxia * urinary incontinence * cognitive impairment

Answer 375

A slow, cautious gait Gait initiation failure Unsteadiness Reduced stride length Shuffling gait Falls Freezing

Answer 376

MRI/CT without contrast * May be normal * Moderate dilation of the ventricles and periventricular leukomalacia * Disproportionate central atrophy, resulting in larger ventricles with relative preservation of cortical sulci Levodopa challenge - unresponsive Lumbar puncture - Normal CSF pressure

Answer 377

Ventriculoperitoneal shunt surgery

Answer 378

subdural haematoma mechanical obstruction infection

Answer 379

Nausea, vomiting and abdominal pain

Answer 380

Baclofen and gabapentin

Answer 381

Focal Neurology - Cerebral Abscess Cranial Nerve Palsy, Ophthalmoplegia - Cavernous Sinus Thrombosis Neck Stiffness, Photophobia, Kernig's/Brudzinski's positive - Meningitis Painful Ophthalmoplegia, Proptosis, Eye swelling - Orbital Cellulitis Staph. Aureus - Frontal bone osteomyelitis

Answer 382

Cardiovascular disease

Answer 383

Stevens-Johnson syndrome and toxic epidermal necrolysis Drug reaction with eosinophilia and systemic symptoms (DRESS)

Answer 384

Develops up to 2 months after starting an anti-convulsant. Usually prodromal illness which resembles a viral upper respiratory tract infection Followed by rapid onset of painful red skin rash which starts on the trunks and extends abruptly onto the face and limbs. Rash rarely affects the scalp, palms or soles.

Answer 385

carotid artery stenosis >50% (NASCET criteria) on the side contralateral to the symptoms

Answer 386

The person with epilepsy may qualify for a driving licence if they have been free from any seizure for 1 year.

Answer 387

Nimodipine

Answer 388

5-HT1 antagonist

Answer 389

IV hydrocortisone

Answer 390

1. Buccal midazolam/IV lorazepam 2. IV lorazepam 3. IV phenytoin/levetiracetam/sodium valproate 4. Rapid sequence induction of anaesthesia using thiopental sodium

Answer 391

Elevated serum prolactin 10 to 20 minutes after an episode

Answer 392

amitriptyline, duloxetine, gabapentin, pregabalin

Answer 393

diabetic neuropathy post-herpetic neuralgia trigeminal neuralgia prolapsed intervertebral disc

Neurosciences Flashcards

USMLE (428 cards)