MRCP Part 1 > Neuro > Flashcards

Neuro Flashcards

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1
Q

Features and inheritence of Charcot Marie Tooth?

A

Autosomal dominant
distal muscle wasting and weakness - thinner ankles
Sensorimotor neuropathy of peripheral nerves - develops in puberty

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2
Q

What is astereognosis? Lesions in which lobe may cause this?

A

the inability to identify an object by active touch of the hands without other sensory input, such as visual or sensory information. (astereoGNosis - no nose)
Parietal lobe
Dominant parietal lobe = bilateral astereognosis
Non-dominant = contralateral astersognosis

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3
Q

What is perseveration? It can be caused by lesions in which lobe?

A

Repetitive and involuntary continuation of a response in the absence of original stimulus
Frontal lobe

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4
Q

What is Acalculia? Lesions in which lobe can cause this?

A

Impairment in numerical and calculation abilities
Parietal lobe (dominant side - usually left)

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5
Q

Which part of the brain is associated with huntingtons + chorea in general?

A

Striatum (caudate nucleus) of the basal ganglia

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6
Q

What is hemiballism?
ipsilateral or contralateral side to lesion

A

A type of chorea caused by decreased activity in the subthalamic nucleus of the basal ganglia
Sx on contralateral side

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7
Q

What is Parinaud Syndrome?

A

Result of a lesion in the dorsal midrain.
Causes
1) vertical gaze palsy
2) Pupillary light-near dissociation (do not accommodate to light - Pseudo-Argyll Roberyson pupils)
3) Mild eyelid retraction

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8
Q

Palatal myoclonus is evidence of a lesion where

A

Olivary nucleus

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9
Q

What is Gerstmann’s syndrome? A lesion in which lobe is indicated?

A

Parietal lobe
1) agraphia/dysgraphia (difficulty with writing)
2) acalculia/dyscalculia (difficulty with mathematical tasks)
3) finger agnosia (inability to distinguish fingers on the hand)
4) left-right disorientation.
way to remember: men are stupid, cant read, write or distinguish fingers on hand

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10
Q

Alexia (inability to read) without agraphia (inability to write) =

A

Lesion at corpus callosum

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11
Q

MOA of triptans

A

Specific 5-HT1 agonist

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12
Q

First line medications (2) for restless legs

A

Pregabalin or gabapentin

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13
Q

Presentation of brocas vs wernickes aphasia

A

Brocas - non-fluent speech, normal comprehension, and impaired repetition
Wernickes - speech fluent, comprehension abnormal, repetition impaired

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14
Q

MS pt with bladder dysfunction - investigation?

A

US bladder to assess emptying

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15
Q

First and second line for essential tremor

A

first line = propranolol
second line = primidone

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16
Q

What is myotonic dystrophy? Features?

A

Autosomal dominant myopathy -presents around 20-30 years old
Features
- myotonic facies (long, haggard appearance)
- frontal balding
- bilateral ptosis
- cataracts
- dysarthria

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17
Q

Facial droop +/- forehead sparing causes

A

No forehead sparing = LMN - bells/ ramsey hunt
Forehead sparing = UMN - stroke, tumours

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18
Q

With which antiepleptic medication might you see seizure recurrence 3-4 weeks after starting, why + how do you combat this?

A

Carbamazepine - metabolised by autoinduction - The half-life of carbamazepine decreases considerably as auto-induction takes place.
dose should be increased every 2 weeks

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19
Q

What is anti-NMDA receptor encephalitis

A

Paraneoplastic syndrome associated with ovarian teratoma.
Presents with psychiatric features - agitation, hallucinations, delusions, seizures

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20
Q

Which anti-epileptic causes visual defects?

A

Vigabatrin (V +V)

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21
Q

Common trigger for cluster headache

A

Alcohol

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22
Q

Which renal condition can develop secondary to tuberous sclerosis? risk?

A

renal angiomyolipomata - prone to haemorrhage

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23
Q

Bilateral acoustic neuromas is assocociated with what? Gene mutation on what gene?

A

NF2 - gene mutation on chromosome 22
(bilateral - NF2 and 22 - all 2s)

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24
Q

Progressive supranuclear palsy specific feature

A

Vertical gaze dysfunction

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25
Parkinsons + ataxic gait + autonomic features =
Multiple system atrophy
26
Good prognostic features in MS
Classical patient - female, young, relapsing remitting, sensory features present at presentation
27
viral labrynthitis vs vestibular neuronitis
Vestibular neuronitis - no auditory symptoms viral labyrinthitis - hearing loss and /or tinnitus
28
Which antibodies are associated with sensory neuropathy in patients with small cell lung cancer
Anti-Hu - specific paraneoplastic neurological syndrome
29
Bilateral spastic paresis and loss of pain and temperature sensation in lower limbs
Anterior spinal artery syndrome (occlusion)
30
What is transient global amnesia
Acute onset of anterograde amnesia, patent may keep asking the same questions, resolves within 24 hours. with an absence of other cognitive or neurological impairments. Nil management required
31
Best way of artificially feeding patients with MND
PEG tube
32
Complications of SAH
1) Re-bleeding - most common in first 12 hours. Repeat CTH. 2) hydrocephalus - treated with external ventricular drain 3) vasospasm (7-14 days) - ensure euvolaemia, consider vasopressers 4) hyponatramiea (SIADH) 5) seizures
33
Features of juvenile myoclonic epilepsy
typically in teenage girls 1) infrequent generalized seizures, often in morning//following sleep deprivation 2) daytime absences 3) sudden, shock-like myoclonic seizure (these may develop before seizures)
34
Features of conduction aphasia, what causes it?
Speech is fluent but repetition is poor. Aware of the errors they are making Normal comprehension. Due to a stroke affecting arcuate fasiculus (connection between Wernicke's and Broca's area)
35
Cerebellar haemangiomas retinal haemangiomas + pheochromocytomas + renal cell cancer are associated with which syndrome Inheritance?
Von Hippel-Lindau (VHL) syndrome Autosomal dominant
36
Presentation of Facioscapulohumeral muscular dystrophy (FSHMD)
Presents by age 20 Weakness of face, scapula and upper arms first Shoulder blade prominence (winging) lower limb: hip girdle weakness, foot drop
37
What is Uhthoff 's phenomenon
Neurological symptoms are exacerbated by increase in body temperature in MS (e.g getting into hot bath)
38
Causes of gingival hyperplasia
PANIC Phenytoin AML Nifedipine Ciclosporin Calcium channel blockers
39
Nerves affected by acoustic neuroma and therefore symptoms
CN III - vertigo, unilateral sensorineural hearing loss, unilateral tinnitus CN V - absent corneal reflex CN VII - facial palsy
40
What is Spastic paraparesis?
upper motor neuron pattern of weakness in the lower limbs
41
What does the trochlear nerve innervate? sx in palsy
Innervates superior oblique muscle get vertical diplopia upward deviation of the eye at rest clue: vision worse on going down the stairs
42
Most common early symptom in MS
Lethargy (can present with non specific symptoms)
43
Presentation of brachial neuritis
Acute onset of unilateral (occasionally bilateral) severe pain, followed by shoulder and scapular weakness several days later.
44
Artery causing extradural haemorrhage
Middle meningeal artery
45
SAH suspected and CTH within 6 hrs is normal =
consider other diagnosis do not do LP
46
Drugs causing myaesthesic crisis
MP supports LGBTQ Macrolides(Azithromycin, erythromycin,clarithromycin ) Procainamide, penicillamine, phenytoin Lithium Gentamicin Beta blockers Tetracycline (Doxycycline, minocycline) Quinoline, Quinidine
47
When can you consider stopping anti-epileptic drugs? over how long do you stop thm?
Consider after 2 yrs of seizure free wean over 2-3 months
48
Features of craniopharyngioma Which part of the hypothalamus is often affected
Brain tumour that presents in children - get bitemporal hemianopia (mimics acoustic neuroma) ventromedial area of the hypothalamus
49
Leg crossing, squatting or kneeling may cause what neuropatht
Common peroneal neurpathy -> foot drop
50
Causes of parkinsonism
drug-induced e.g. antipsychotics, metoclopramide* progressive supranuclear palsy multiple system atrophy Wilson's disease post-encephalitis dementia pugilistica (secondary to chronic head trauma e.g. boxing) toxins: carbon monoxide, MPTP
51
Anti-Ri are associated with which paraneoplastic syndrome? Which cancers are implicated
Ocular opsoclonus-myoclonus breast and small cell lung cancer
52
What is Neuromyelitis optica? Features?
relapsing-remitting demyelinating CNS disorder (used to be put under umbrella of MS) Bilateral optic neuritis Transverse myelitis Area postrema syndrome: intractable hiccups, nausea, or vomiting (due to medullary involvement)
53
Diagnosis of Neuromyelitis optica
Diagnosis requires bilateral optic neuritis, myelitis and 2 of the following 3 criteria: 1. Spinal cord lesion involving 3 or more spinal levels 2. Initially normal MRI brain 3. Aquaporin 4 positive serum antibody
54
MOA of baclofen
GABA receptor agonist
55
What anti-epileptic medication may exacerbate absence seizures?
Carbamazepine
56
Most common psychiatric condition associated with parkinsons
Depression
57
CKD + neuropathy = feature of neuropathy
Uraemic neuropathy - predominantly sensory
58
Which chromosome is affected in Von Hippel-Lindau syndrome
Chromosome 3p
59
Most important ix for restless leg syndrome
Ferritin - can be caused by iron deficiency
60
MOA pyridostigmine
long-acting acetylcholinesterase inhibitor
61
EEG findings = Unilateral or bilateral periodic sharp-and-slow-wave complexes at 2–3 Hz over the temporal lobes
Herpes Simplex Encephalitis
62
Management of Juvenile myoclonic epilepsy
Sodium Valporate
63
Causes of raised lymphocytes in CSF
viral meningitis/encephalitis TB meningitis partially treated bacterial meningitis Lyme disease Behcet's, SLE lymphoma, leukaemia
64
Causes of high protein in CSF
Guillain-Barre syndrome tuberculous, fungal and bacterial meningitis Froin's syndrome* viral encephalitis
65
Which spinal tracts are affected in subacute degeneration of spinal chord
the dorsal columns and lateral corticospinal tracts are affected - UMN signs - reduced proprioception and vibration sense
66
Which antiepileptic medication is associated with peripheral neuropathy
Phenytoin
67
Bells palsy associated features (4)
post-auricular pain (may precede paralysis) altered taste dry eyes hyperacusis - heightened sensitivity to noise
68
Natalizumab tx for MS can cause what neurological condition
Progressive multifocal leukoencephalopathy (PML)
69
Severe persistent pain affecting one limb after recovery from injury?
Complex regional pain syndrome
70
Features of otosclerosis
conductive hearing loss, tinnitus and positive family history
71
Differences in presentation between NMS and serotonin syndrome
NMS: rigidity (antipsychotics) Serotonin syndrome: myoclonus (SSRIs, MAOIs)
72
Abrupt withdrawal of PD meds Tx
Parkinsonian malignant syndrome (presents like NMS) Treat with re-initiation of PD therapy
73
Laughter + collapse =
Cataplexy -> key symptom of narcolepsy
74
Most common symptom of migraine
Phonophobia, insensitivity to sounds
75
First line for myoclonic seizures, what are myoclonic seizures
Levetiracetam Shock-like muscle jerks
76
Which opioid is the best at managing neuropathic pain? Why?
Tramadol Dual action as weak opioid agonist and a reuptake inhibitor of serotonin and norepinephrin
77
Where is the chemoreceptor trigger zone location (site of ondansetron)
Medulla Oblongata
78
Drug causes of tinnitus
Aspirin/NSAIDs Aminoglycosides Loop diuretics Quinine
79
What is miller fisher syndrome? antibodies?
Variant of Guillian barre ophthalmoplegia, areflexia and ataxia anti-GQ1b antibodies
80
Homonymous hemianopia optic tract lesion vs optic radiation lesion
Optic tract - incongruous homonymous hemianopia (slighty different between two eyes) Optic radiation (behind optic tract - between thalamus and visual cortex)- congruous
81
SE of ondansetron
Constipation
82
Axonal vs demyelinating peripheral neuropathy
Axonal - metabolic causes - diabetes, vasculitis, B12, alcohol Demyelinating - Guillian barre, amiodarone
83
MRI finding in wernickes
Enhancement on mamillary bodies
84
Migraine tx in pregnancy
First line: paracetamol NSAIDs until third trimester Avoid triptans, avoid aspirin and opioids
85
What is Kluver-Bucy syndrome
Can follow herpes simplex encephalitis with bilateral temporal lobe involvement - emotional blunting, hypersexuality
MRCP Part 1
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