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Flashcards in 4th Year Neurology Deck (114)
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1
Q

What % of sub arachnoid haemorrhages are seen on CT?

A

95%

2
Q

Where is SAH seen in CT?

A

Centrally between ventricles

3
Q

What other investigations could be in suspected SAH, except CT?

A

Lumbar puncture after 12 hours to look for xanthanchrcomia

4
Q

What is the cause of most SAH?

A

Berry aneurysms

5
Q

Which infection commonly precedes guillan barre?

A

Campylobactor jejuni - diarrhoea

Other - CMV and EBV

6
Q

Where does GBS typically begin?

A

In the legs, proximal muscles first

7
Q

What happens to reflexes in GBS?

A

May be present at first but disappear as weakness progresses

8
Q

Where are the antibodies directed in myasthenia gravis?

A

At the acetylcholine receptor

9
Q

What is the cardinal symptom of myasthenia gravis?

A

Fatiguable muscle weakness

10
Q

What is the most common type of MND?

A

ALS

11
Q

What type of MND has the worst prognosis?

A

Progressive bulbar palsy

12
Q

What type of MND has the best prognosis?

A

Progressive muscular atrophy.

13
Q

ALS - UMN or LMN?

A

UMN - signs

LMN - wasting

14
Q

Progressive muscular atrophy - LMN or UMN?

A

LMN

15
Q

Primary lateral sclerosis - UMN or LMN?

A

UMN

16
Q

Which nerves does progressive bulbar palsy typically affect?

A

Cranial nerves IX - XII

17
Q

When should you give give Aspirin 300mg in a stroke?

A

After a haemorrhage stroke has been ruled out

18
Q

What is the triad of normal pressure hydrocephalus?

A

Gait disturbance, sphincter dysfunction and dementia

19
Q

What radiological sign is seen on normal pressure hydrocephalus?

A

Dilated ventricles

20
Q

Features of alcoholic neuropathy?

A

Symmetrical motor and sensory symptoms

Deranged liver enzymes

21
Q

3 causes of normal pressure hydrocephalus?

A

Head injury, meningitis, SAH

22
Q

GBS - motor or sensory peripheral neuropathy?

A

motor

23
Q

Diabetes - motor or sensory peripheral neuropathy?

A

Sensory

24
Q

Alcoholic neuropathy - motor or sensory?

A

Sensory

25
Q

Position of eye in 3rd nerve palsy?

A

Down and out + ptosis

26
Q

Pneumonic for orbital muscles?

A

LR6 SO4 AO3

27
Q

Clinical signs in intranuclear ophthalmoplegia?

A

Impairment of adduction of ipsilateral eye, and nystagmus on abduction of contralateral eye.

28
Q

What is intranuclear ophthalmoplegia?

A

Lesion on the medial longitudinal fasiculus

29
Q

Causes of INO?

A

MS and vascular disease

30
Q

What is mononeuritis multiplex?

A

Sensory and motor loss in individual non contiguous nerves

31
Q

What are the 3 branches of the trigeminal nerve?

A

V1 - Ophthalmic
V2 - Maxillary
V3 - Mandibular

32
Q

What is the main treatment for trigeminal neuralgia?

A

Carbemazepine - titrate up

33
Q

What are the 5 branches of the facial nerve?

A
Temporal
Zygomatic 
Buccal 
Mandibular (marginal)
Cervical
34
Q

What are the features of the CH2DS2VAS score and what is it used for?

A
C - CHF - 1 
H - HTN -1 
A2 - Age>75 - 2
D - diabetes - 1
S2 - Stroke, TIA, DVT -2 
V - vascular disease -2 
Age - 65-74 -1
S - Female - 1
To calculate AF risk of stroke and management
35
Q

What are the features of the ABCD2 score and what is it used for?

A
A - Age >60 - 1
B - HTN - 1
C - Weakness -2, Speech 1
D2 - Duration >60mins 2, 10-59 -1
D2 - Diabetes - 1
Risk of stroke in people with a previous TIA
36
Q

What is the NIHSS score used for?

A

To quantify impairment caused by stroke

37
Q

What is the ROSIER score used for?

A

To differentiate between stroke and mimics

38
Q

3 Drug causes of idiopathic intracranial hypertension?

A

Isotretonin (vit a derivatives)
Tetracyclines
Oral contraceptive

39
Q

What condition is fasciculation typical of?

A

Motor neuron disease

40
Q

Which signs are absent in motor neurone disease?

A

Sensory signs

41
Q

When should thrombolysis be given in a ischaemic stroke?

A

Within 4.5 hours

42
Q

When aspirin regime should be followed in ischaemic stroke?

A

300mg OD for 14 days (clopidogrel if intolerant)

43
Q

When should Warfarin be given in new diagnosis AF causing a stroke?

A

After 14 days of aspirin

44
Q

What is the management of idiopathic intracranial hypertension?

A

Therapeutic lumbar punctures and Acetalzolomide

45
Q

What drugs cause neuroleptic malignant syndrome?

A

Typical anti psychotics, can also occur with atypical

46
Q

When does neuroleptic malignant syndrome usually present?

A

Within 10 days of treatment starting

47
Q

What are 3 signs of Neuroleptic malignant syndrome?

A

Pyrexia, rigidity and tachycardia

48
Q

Management of neuroleptic malignant syndrome?

A

Stop antipsychotic, IV fluids to prevent renal failure, bromocriptine

49
Q

Folic acid dose in pregnancy - normal vs epilepsy

A

Normal - 400mcg

Epilepsy - 5mg

50
Q

In central cord syndrome which limbs are most weak?

A

Lower limbs

51
Q

Which nerve is at risk from a fibular fracture or compression from cast? and what signs would this cause?

A

Common peroneal

Foot drop

52
Q

What type of protein is seen in CJD?

A

Proteinaceous beta sheets

53
Q

Definition of status epilepticus?

A

Single or serial seizures lasting more than 5 minutes, o 2 of more seizures without a return to consciousness between

54
Q

First line and second treatment of status in in-patients?

A

Lorazepam IV

2nd - Midazoloam bucally

55
Q

What other drug should be given within 30 minutes of status if not responding to benzodiazepines?

A

Phenytoin

56
Q

First and 2nd line treatment of status in the community?

A

Midazolam bucally

2nd diazepam PR

57
Q

Which vessels are affected in TACS?

A

Middle and anterior cerebral arteries

58
Q

Which vessels are affected in PACS?

A

Smaller arteries of anterior circulation

59
Q

Which vessels are affects in LACS?

A

Perforating arteries around the internal capsule, thalamus and basal ganglia

60
Q

Which vessels are affected POCS?

A

Vertebrobasillar arteries

61
Q

What 2 drugs are used for status epilepticus in the community?

A

Bucal midazolam

PR diazepam

62
Q

What are the 3 options in treating status epilepticus?

A
  1. Lorazepam IV
  2. Midazolam - buccal
  3. Diazepam - IV
    Repeat dose after 5 mins if no response
63
Q

Dorsal column - modalities, decusates, ascending or descending?

A

Ascending
Fine touch and proprioception
Decusates in the medulla

64
Q

Spinothalamic trace - modalities, decusates, ascending or descending?

A

Pain temp and deep pressure
Decussates segmentally
Ascending

65
Q

Corticospinal (pyramidal tract) modalities, decusates, ascending or descending?

A

fine movement
85% cross at pyramid, 15% segmentally
Descending

66
Q

Function of tectospinal tract?

A

Mediates reflex of head and neck movement

67
Q

Features of brown sequard syndrome?

A

Ipsilateral paralysis
Ipsilateral loss of fine touch and proprioception
Contralateral loss of pain and them
Ipsilateral hyperreflexia

68
Q

Myelin producing cells, CNS and PNS??

A

CNS - oligodendrocytes

PNS - Schwann cells

69
Q

3 layers of the meninges?

A

Dura, arachnoid, pia

70
Q

Where is CSF absorbed?

A

By arachnoid granulations

71
Q

4 drug classes in Parkinson’s management?

A

Levodopa - increases dopamine
Decarboxylase inhibitor (benserazide)
Dopamine agonists - bromocriptine
Catechol - o - methyltransferase inhibitor

72
Q

4 types of MND?

A

Amyotrophic lateral sclerosis - UMN and LMN
Progressive bulbar palsy -
Progressive muscular atrophy - LMN signs
Primary lateral sclerosis - UMN

73
Q

Benign essential tremor , mode of inheritance?

A

Autosomal dominant

74
Q

First line treatment of benign essential tremor?

A

Bisoprolol

75
Q

What two special tests are positive in carpal tunnel syndrome?

A

Tinnels - tapping causing parasthesia

Phalens - flexion of wrist causes symptoms

76
Q

What is the surgical option for carpal tunnel syndrome?

A

Flexor retinaculum division

77
Q

Triad of normal pressure hydrocephalus?

A

Gait disturbance, urinary incontinence, dementia

78
Q

What is wernickes encephalopathy?

A

Thiamine deficiency (B1), ophthalmoplegia, ataxia and confusion. Reversible with thiamine - IV (pabrinex) then oral -

79
Q

What is korsakoffs?

A

Decreased ability for form new memories and confabulating - as a result of wernickes - irreversible

80
Q

What is Picks disease?

A

Frontotemporal dementia

81
Q

Broca and wernickes area - expressive or receptive dysphasia?

A

broca - expressive

wernicke - receptive

82
Q

Management of focal seizures?

A

Carbemazepine or lamotrigine

83
Q

Management of absence seizures?

A

Ethosuximide or sodium valproate

84
Q

Management of tonic clonic seizures?

A
  1. Sodium valproate

2. Lamotrigine

85
Q

Management of myoclonic seizures?

A
  1. Sodium valproate

2. Levetricitam

86
Q

Management of atone seizures?

A

sodium valproate

87
Q

When should treatment be commenced in Parkinson disease?

A

At the onset of disabling symptoms

88
Q

What type of intra cerebral haemorrhage had a lucid interval?

A

Extra dural haematoma

89
Q

How long much an epileptic patient remain fit free before they can drive?

A

12 months

90
Q

How long must you wait to drive after a new seizure?

A

6 month

91
Q

Features of TACS?

A

All 3 of

  1. Unilateral hemiparesis andor hemisensory loss of face, arm or leg
  2. Homonymous hemianopia
  3. Higher cognitive function loss e.g. dysphasia
92
Q

Features of PACS?

A

2 of

  1. Unilateral hemiparesis andor hemisensory loss of face, arm or leg
  2. Homonymous hemianopia
  3. Higher cognitive function loss e.g. dysphasia
93
Q

Features of a lacunar stroke?

A
1 of the following
1. Unilateral weakness
2. Pure sensory stroke
3. ataxic hemiparesis 
Can be pure motor or sensory
94
Q

Features of POCS?

A

1 of following

  1. Cerebellar or brainstem symptoms
  2. Loss of consciousness
  3. Isolated homonymous hemianopia
95
Q

What is the difference between simple partial seizures and complex partial seizures?

A

Simple - no loss of awareness

Complex - loss of awareness

96
Q

2 features of progressive supranuclear palsy?

A

Dysarthria and vertical gaze palsy

97
Q

What effect does exertion have in Lambert eaton myasthenia syndrome?

A

Improves the weakness

98
Q

What heart condition are triptans contraindicated in?

A

IHD

99
Q

2 features of tuberous sclerosis?

A

Ash leaf spots, subungual fibromas

100
Q

What is cataplexy?

A

Loss of muscle tone caused by strong emotion

101
Q

What may happen to the hearing in bells palsy?

A

Hyeracusis

102
Q

What is syringiomyelia?

A

Fluid filled cavities in spinal cord, loss of pain and temp sensation are lost

103
Q

3 features of multi system atrophy?

A

Parkinsonism
Autonomic disturbance
Cerebellar signs

104
Q

What is levodopa usually combined with?

A

Decarboxylase inhibitor (carbidopa)

105
Q

Acute drugs for migraine?

A

Triptan, NSAID and paracetamol

106
Q

Prohpylactic drugs for migraine?

A

Topiramate and propanolol

107
Q

Drug to give in SAH?

A

Nimodipine

108
Q

How quickly should a patient be seen with a TIA?

A

Withint 24 hours

109
Q

What to give for spascicity in MS?

A

Baclofen

110
Q

Investigation for myasthenia gravis?

A

Nerve conduction studies

111
Q

What nerve might be injured during childbirth or pregnancy?

A

Lateral femoral cutaneous nerve

112
Q

Indian ink?

A

HIV meningitis

113
Q

How is Huntington’s inherited?

A

Autosomal dominant

114
Q

What nerve is affected in carpal tunnel syndrome?

A

Median