Year 4 Neuro document

Question 1

Exposure to which chemicals is associated with Parkinson’s disease

Answer 1

Pesticide

Question 2

Which lifestyle habit is thought to be protective for Parkinson’s

Answer 2

Smoking??

Question 3

Which neurones degenerate in Parkinsons disease

Answer 3

Dopaminergic neurones of the pars compacta substantia nigra

Question 4

Is an idiopathic Parkinsons tremor typically symmetrical or asymmetrical

Answer 4

Asymmetrical

Suspect drug-induced parkinsonism if bilateral tremor

Question 5

What is an expression to describe the facial expression of someone with Parkinsons disease

Answer 5

Mask-like face

Question 6

What kind of sleep disorders are seen in Parksinson’s

Answer 6

REM sleep disorders

Question 7

Which reduced special sense can be an early sign of Parkinson’s

Answer 7

Hyposmia

Reduced sense of smell

Question 8

What is the Glabella tap and how will it present in Parkinson’s

Answer 8

Tapping on the forehead makes people stop blinking. Blinking will persist in Parkinson’s - Myerson’s sign of frontal release

Question 9

What is the gold standard treatment of Parkinson’s

Answer 9

Levodopa + Carbidopa

Question 10

Why might different classes of drugs be used in Parkinson’s

Answer 10

To delay the use of Levodopa until significant disability

Question 11

What type of drug is Rasagiline

Answer 11

MAO-B inhibitor

Question 12

What drug should you give for Levodopa associated nausea and why not use metoclopramide

Answer 12

Domperidone
Selective to peripheral dopamine receptors so wont prevent activity of levodopa in the brain (metoclopramide isn’t selective)

Question 13

Which Parkinsons Plus Syndrome has a lack of a tremor and how does it present

Answer 13

Progressive supranuclear palsy
Vertical gaze palsy.
Early postural instability and falls. 
Speech and swallowing problems. 
Symmetrical trunkal rigidity

Question 14

What is the triad of Multi-System Atrophy

Answer 14

Parkinsonism
Autonomic Dysfunction
Cerebellar Dysfunction

Question 15

What sign is seen on MRI in Multi-System Atrophy

Answer 15

Hot Cross Bun sign

Question 16

Which disease affects the Nucleus Basilis of Meynert

Answer 16

Alzheimer’s Disease

Question 17

Which genetic disease increases your chances of developing Alzheimer’s in the future

Answer 17

Down’s Syndrome

Question 18

Hemiballism as a symptom suggests a lesion where in the brain

Answer 18

Subthalamic lesion

Question 19

Which anti-epileptic drug can cause hyponatraemia

Answer 19

Carbamazepine

Question 20

Which drug can be given for treatment of fatigue in MS

Answer 20

Amantidine

Question 21

A defect in which artery will cause full paralysis except blinking and eye movement

Answer 21

Basilar artery

Question 22

Anti-Musk and Anti-AchR antibodies are associated with which condition

Answer 22

Myasthenia Gravis

Question 23

Which disease can present with renal and hepatic failure as well as Parkinsonism

Answer 23

Wilson’s Disease

Question 24

How is a postural tremor different from a resting tremor

Answer 24

postural tremor is a tremor that is absent at rest, present on maintained posture such as holding arms out

Question 25

What diseases can cause an intention tremor

Answer 25

``` Cerebellar disease (MS, stroke, hemorrhage) Wilsons disease ```

Question 26

What is dystonia

Answer 26

Involuntary, sustained muscle spasms that result in abnormal posturing and repetitive movements in the context of an associated tremor

Question 27

What is chorea

Answer 27

Non rhythmical irregular purposeless movements that flit and flow from one body part to another

Question 28

Huntington's disease shows acceleration- what does this mean

Answer 28

Gets worse as it is passed down though the generations

Question 29

Syndeman's chorea can develop after what

Answer 29

Rheumatic fever | Strep throat infection

Question 30

What is Myoclonus

Answer 30

Sudden, involuntary focal or generalised muscle jerks. | Myoclonus can be normal, with abnormal being defined by over 5 of these jerky movements

Question 31

What is the median age of onset of MND

Answer 31

60

Question 32

Which form of dementia does MND have a link to

Answer 32

Frontotemporal Dementia

Question 33

How can the presentation of MND be differentiated from Myasthenia gravis

Answer 33

Doesn't affect the eyes | Cogan Lid Twitch

Question 34

What is the mechanism of action of Riluzole

Answer 34

Blocks glutamatergic neurotransmission in the CNS

Question 35

Which connective tissue disease is Myasthenia associated with

Answer 35

SLE

Question 36

Which common cardioprotective drug can worsen Myasthenia symptoms

Answer 36

Beta-Blockers

Question 37

What is the mainstay of treatment for Myasthenia Gravis

Answer 37

Pyridostigmine | Anti-Cholinesterase

Question 38

What is the mainstay of treatment for Lambert Eaton syndrome

Answer 38

3,4 - diaminopyridine

Question 39

What is a Stokes Adams Attack

Answer 39

Transient arrhythmias causing reduced cardiac output and loss of consciousness.

Question 40

What is a Jacksonian march

Answer 40

A frontal lobe seizure only occurs on one side of the body; it progresses in a predictable pattern from twitching or a tingling sensation or weakness in a finger, a big toe or the corner of the mouth, then marches over a few seconds to the entire hand, foot or facial muscles

Question 41

A spike and wave pattern at 3HZ on an EEG suggest which type of seizure

Answer 41

Absence seizure

Question 42

Name a newer anti-convulsant which has the adverse effects of mood swings and depression

Answer 42

Levetiracetam

Question 43

Which anti-epileptic drug can cause Leucopenia

Answer 43

Carbamazepine

Question 44

What is non-epileptic attack disorder

Answer 44

Functional seizures that are largely mediated at the subconscious level and have a strong association with past trauma

Question 45

What is an unusual part of the MS epidemiology

Answer 45

More common in locations which are higher above sea level

Question 46

What is the diagnostic criteria for MS

Answer 46

Two episodes of symptoms suggestive of MS that last at least 1 hour and are at least 30 days apart as this shows dissemination in time and place

Question 47

Name 3 disease modifying drugs used 1st line for MS

Answer 47

Beta-interferon Techfidera Copaxone

Question 48

What is Mononeuritis Multiplex

Answer 48

When two mononeuropathies in distinct locations develop at the same time

Question 49

Which type of fungal meningitis is seen in HIV patients

Answer 49

Cryptococcal

Question 50

What is Kernig's sign

Answer 50

Pain and resistance on passive extension of the knee with a flexed hip

Question 51

Which cells will be seen in CSF in Viral, Bacterial and Tb meningitis respectively

Answer 51

Viral and TB - Lymphocytes | Bacterial - Neutrophils

Question 52

What is the contact prophylaxis regime for meningitis

Answer 52

Rifampicin 4 doses | Ciprofloxacin 1 dose

Question 53

Bilateral temporal lobe oedema or bilateral temporal focal enhancement on MRI suggests what

Answer 53

Herpes Simplex encephalitis

Question 54

What causes Progressive multifocal leukoencephalopathy

Answer 54

JC virus infection

Question 55

The use of which drug increases risk of JC virus activation

Answer 55

Tysabari (MS 2nd line)

Question 56

What is the mechanism of action of triptans

Answer 56

5HT (serotonin) agonists

Question 57

How many times should triptan use be limited to, per week, and why

Answer 57

Shouldn’t be taken more than twice a week as patient can become dependent and experience rebound headaches.

Question 58

Which gender is Trigeminal Neuralgia more common in and what is the 1st line treatment

Answer 58

More common in Men | Carbamazepine

Question 59

What are the two peak ages on onset of Narcolepsy

Answer 59

15 and 36??

Question 60

Which arteries are affected in Total Anterior Circulation Syndrome

Answer 60

Blockage of both anterior and middle cerebral arteries

Question 61

Which arteries are affected in Partial Anterior Circulation Syndrome

Answer 61

Blockage of one of anterior or middle cerebral arteries

Question 62

Which arteries are affected in Posterior Circulation Syndrome

Answer 62

Posterior circulation stroke involving vertebral basilar arteries

Question 63

Which arteries are affected in Lacunar Stroke

Answer 63

Multiple small vessel infarcts in basal ganglia and thalamus.

Question 64

What is the timescale within which you can offer thrombolysis to a stroke patient

Answer 64

<4.5 hours

Question 65

What should you do if someone presents with a stroke after 4.5hours of onset

Answer 65

300mg aspirin | continued for at least 14 days

Question 66

What is the most common cause of Sub-Arachnoid Hemorrhage

Answer 66

Rupture of berry aneurysms

Question 67

When do berry aneurysms rupture

Answer 67

When they grow greater than 6mm

Question 68

Which 3 disease are associated with the development of berry aneurysms

Answer 68

Polycystic Kidney Disease Coarction of aorta Ehlers Danlos syndrome

Question 69

What are Charcot-Bouchard aneurysms

Answer 69

Micro-aneursyms associated with chronic hypertension | Most commonly occur within basal ganglia

Question 70

Rupture of Charcot-Bouchard aneurysms leads to what

Answer 70

Intracerebral haemorrhage

Question 71

Which chemical imbalance can occur after a sub-arachnoid haemorrhage

Answer 71

Hyponatraemia

Question 72

Which drug is given to patients following a sub-arachnoid haemorrhage to prevent Delayed Ischaemic Neurological Deficits

Answer 72

Nimodipine

Question 73

What type of haemorrhage is associated with fluctuating consciousness and insidious mental/physical slowing

Answer 73

Subdural

Question 74

What type of haemorrhage is associated with a head injury followed by a lucid period

Answer 74

Extradural

Question 75

What is the most common cause of an extradural haemorrhage

Answer 75

Temporal bone fracture

Question 76

What is the most common type of primary brain tumour

Answer 76

Astrocytoma (glioma)

Question 77

What is another name for a grade 4 astrocytoma

Answer 77

Glioblastoma Multiforme

Question 78

Which tumour is described as having a toothpaste-like morphology

Answer 78

Oligodendroma

Question 79

Which malignant tumour of the cerebellum is almost exclusively seen in children

Answer 79

Medulloblastoma

Question 80

Which therapy are oligodendromas very sensitive to

Answer 80

Chemotherapy

Question 81

Glioblastoma multiforme is sensitive to which drug

Answer 81

Temozolomide

Question 82

How is cerebral perfusion pressure calculated

Answer 82

MAP - ICP

Question 83

Which type of herniation will present as lower limb weakness

Answer 83

Subfalcine | frontal lobe under falx cerebri

Question 84

Which type of herniation will present as ipsilateral 3rd nerve palsy

Answer 84

Uncal | Temporal lobe under tentorium cerebelli

Question 85

What is the most common cause of painful 3rd nerve palsy

Answer 85

Posterior communicating artery aneurysm

Question 86

Which type of herniation will present as ataxia, 6th nerve palsy and UMN sign

Answer 86

Tonsillar | Herniation of the cerebellar tonsils through the foramen magnum

Question 87

What is the triad of normal pressure hydrocephalus

Answer 87

Ataxia Dementia Urinary incontinence

Question 88

Which spinal tracts are affected in Central Cord Syndrome

Answer 88

Corticospinal --> as it lies medially | Spinothalamic --> as the fibres have to cross the ischaemic zone

Question 89

Which gene is associated with MS

Answer 89

HLA-DR2

Question 90

How does internuclear ophthalmoplegia present

Answer 90

Failure to adduct with nystagmus in other eye

Question 91

Which neural cells undergo gliosis

Answer 91

Astrocytes | hyperplasia and hypertrophy

Question 92

What colour are acute MS plaques

Answer 92

Yellow/brown

Question 93

What colour are chronic inactive MS plaques

Answer 93

Grey

Question 94

What are the two ages in which incidences of Myasthenia Gravis peak

Answer 94

Females in the 3rd decade | Males in the 6/7th decade

Question 95

Alzeheimer's disease causes a loss of cholinergic neurons where in the brain in particular

Answer 95

Nucleus basalis of Meynert

Question 96

Which two proteins make up Lewy bodies and which one can be detected by immunochemical staining

Answer 96

Alpha- synuclein | Ubiquitin (staining)

Question 97

What is the greatest risk factor for Parkinson's

Answer 97

Age

Question 98

Which drug treatment for Parkinon's can cause pathological gambling and hyper-sexuality

Answer 98

Dopamine Agonists

Question 99

Which chromosome has the abnormality leading to Huntington's

Answer 99

Chromosome 4

Question 100

Which basal ganglion atrophies in Huntington's

Answer 100

Caudate Nucleus

Question 101

What causes xanthochromia in the context of sub-arachnoid haemorrhage

Answer 101

Yellow discolouration of CSF indicating presence of bilirubin breakdown

Question 102

Asides from giving Nimodipine, how else can you prevent Delayed Ischaemic Deficit following sub-arachnoid haemorrhage

Answer 102

triple H therapy – hypervolaemia, hypertension, haemodilution