1
Q
Which scoring system can be utilised to determine if this is a likely large vessel occlusion stroke
A
Los angles motor score
2
Q
What does Aphasia mean?
A
loss of speech and language function
3
Q
What does Avolition mean?
A
loss of motivation
4
Q
What does Anhedonia mean?
A
inability to derive pleasure
5
Q
What does Apraxia mean?
A
inability to carry out skilled motor function, despite normal motor function
6
Q
What does Agnosia mean?
A
inability to recognise people, objects or places that were once known to a person
7
Q
A 2-week-old neonate has been diagnosed with hydrocephalus secondary to congenital spina bifida. Where is the site of cerebrospinal fluid (CSF) production?
A
Choroid plexuses
8
Q
A 22-year-old man is undergoing a wedge excision of his great toenail. As the surgeon passes a needle into the area to administer local anaesthetic, the patient notices a sharp pain.
By which pathway will this sensation be conveyed to the central nervous system?
A
Spinothalamic tract- Pain and temperature
9
Q
All intrinsic larynx muscles are supplied by the recurrent laryngeal nerve except which muscle?
A
Cricothyroid
10
Q
The recurrent laryngeal nerve is a branch of which nerve?
A
vagus
11
Q
What is the visual loss seen with occipital nerve lesions?
A
Homonymous hemianopia with macular sparing
12
Q
What causes a bitemporal hemianopia?
A
Lesions of the optic chiasm
13
Q
Which patients are most likely to have a subdural haematoma?
A
(1) Elderly
(2) Patients on anti-coagulants
eg, warfarin, heparin
(3) Epileptic patients
(4) Alcoholic patients
14
Q
What are the symptoms of low intracranial pressure?
A
Headache is worse on standing, better with lying down.
= Caused by dural tears
15
Q
What does the CT head of a subdural haematoma show?
A
Crescent shaped (concave) bleed
16
Q
What is the appropriate treatment for a medication overuse headache?
A
withdraw paracetamol and ibropren
17
Q
Which nerve artery is affected in giant cell arteritis?
A
Temporal artery
18
Q
How long must someone stop driving after a one-off seizure (car or motorbike licence)?
A
6 months
19
Q
How long must someone stop driving after more than one seizure (car or motorbike licence)?
A
1 year
20
Q
How long must someone stop driving after a one-off seizure if they hold a lorry or bus licence?
A
5 years
21
Q
How long must someone stop driving after more than one seizure if they hold a lorry or bus licence?
A
10 years
22
Q
Which brain lobe causes numbness and tingling if affected by a seizure?
A
Parietal lobe
23
Q
Which brain lobe causes limb jerks during a seizure?
A
Frontal lobe
24
Q
Which brain lobe causes automatisms, déjà vu, or olfactory hallucinations during seizures?
A
Temporal lobe
25
Which anti-epileptic can cause Stevens–Johnson syndrome?
Lamotrigine
26
Which anti-epileptic can cause weight loss, kidney stones, and cognitive issues?
Topiramate
27
What is non-epileptic attack disorder (pseudoseizure)?
Seizure-like episodes not caused by abnormal brain activity but by psychological stress
28
Name one key feature that suggests a pseudoseizure rather than a true epileptic seizure
Eyes closed during episode (true seizures often have eyes open)
29
What defines a secondary generalised tonic-clonic seizure with temporal focus?
A partial temporal seizure that spreads to become tonic–clonic
30
What should be checked during status epilepticus before increasing the drug dose?
Plasma phenytoin level.
31
What is the triad of juvenile myoclonic epilepsy?
1. Myoclonic jerks
2. Absence seizures
3. Generalised tonic–clonic seizures
32
Which neurological sign pattern (sparing the forehead) suggests an upper motor neuron lesion, such as a stroke?
Facial weakness sparing forehead movement
33
What movement is lost in L5 radiculopathy?
Inversion of the foot
34
What movement is lost in common peroneal nerve palsy?
Eversion of the foot
35
Which brain structure is responsible for the “fight or flight” response?
The amygdala
36
'slowness of movement' term name
Bradykinesia
37
'involuntary, uncontrolled muscle movements' term name
Dyskinesia
38
What does Cerebellar ataxia mean?
loss of muscle coordination that results from damage to the cerebellum, the part of the brain responsible for balance and coordination
39
What do you call "blood pressure that drops when you stand up, causing dizziness or faintness"?
Postural hypotension
40
Which medicines should not be stopped on acute admissions and must be delivered on time?
Levodopa and other antiparkinsons drugs (eg, Ropinirole) are 'critical' medicines
41
Multiple sclerosis patient with bladder dysfunction - history of urinary frequency and incontinence. What should be the correct next step?
Ultrasound kidneys, ureters and urinary bladder
42
What is a percutaneous gastrostomy tube?
a feeding tube placed through the skin directly into the stomach so someone can receive nutrition when they can’t eat safely by mouth
43
Lower motor neurons only are what subtype of motor neuron disease?
Progressive multiple atrophy
44
Primary Lateral Sclerosis signs
upper motor neuron signs ONLY
45
Polymorph infiltration meaning
lots of neutrophils (polymorphs) in the CSF, which points to bacterial meningitis
46
What does a positive Kernig’s sign mean/ look like?
The patient’s hip is flexed at 90°, and when you try to extend the knee, the hamstrings cause pain or resistance. This indicates meningeal irritation
47
Explain what global aphasia is?
A patient is noted to have no speech and appears to understand little of what is said to him
48
Explain what Wernicke's aphasia is?
A patient is noted to speak fluently but makes little sense with multiple word substitutions and neologisms.
He also has difficulty understanding what people are saying to him
49
Pure motor stroke feeling
weakness only in posterior limb of internal capsule,
50
Pure sensory stroke
numbness only in the ventral posterolateral (VPL) thalamus
51
Where is Broca's area located?
frontal
52
A 60-year-old man with a background of hypertension presented to the emergency department complaining of visual disturbance. He noticed the symptoms as soon as he woke up in the morning at around 7 am. He was otherwise well on the previous night with no neurological symptoms.
Examination shows right homonymous hemianopia with reduced sensation on the right side of the body. Urgent computed tomography (CT) scan of the head showed a left occipital infarct. He was not suitable for thrombolysis as the onset of his symptoms was unclear. Under the current recommendation, the standard target time for thrombectomy is within 6 hours.
An extended target time of up to 24 hours may be considered in which of the following circumstances?
Advanced brain imaging (such as CT perfusion or diffusion-weighted MRI sequences) indicates that substantial salvageable brain tissue is still present
53
The definition of a TIA is now what?
tissue-based, not time-based
= Stroke due to the presence of an acute infarction on imaging
54
A 19-year-old presents as she would like to start a combined oral contraceptive pill. Throughout her history, she states that in the past she has had migraine with aura. She asks why the combined oral contraceptive pill is contraindicated.
What is the most appropriate response?
Significantly increased risk of ischaemic stroke
55
In a lumbar puncture, where is a raised opening pressure seen?
idiopathic intracranial hypertension
56
In a lumbar puncture, where is xanthochromia seen?
subarachnoid haemorrhage
57
In a lumbar puncture, where is reduced glucose seen?
bacterial meningitis
58
In a lumbar puncture, where is an elevated lymphocyte count seen?
viral meningitis
59
A 28-year-old man presents with a severe, intermittent, piercing left-sided frontotemporal headache over the past few days. It seems to occur early in the morning, around the same time each day and lasts between 15 minutes and 2 hours. He feels sick at the time and is unable to lie still. He had a similar episode last year.
A full neurological examination, whilst headache-free, is entirely normal.
What is the most likely underlying diagnosis?
Cluster headache
= lasts 15mins-2hrs
60
A 36-year-old woman presents to her GP complaining of a debilitating headache on the left side of her head that is throbbing in nature. She has had these headache 'attacks' on and off for the past 2 weeks. The headache is made worse when doing her daily walk to work in the morning, and recently she has had to take days off work due to the debilitating pain. The patient also describes visual disturbances such as flashing lights and general discomfort with bright lights. She has a past medical history of eczema and is on no medications.
What is the most likely diagnosis for this patient?
Migraine
61
A 50-year-old man has a history of recurrent mechanical falls with no loss of consciousness. He is seen in the neurology clinic by the registrar following an MRI scan. On examination, he has an intention tremor and an ataxic gait, but only very minimal past-pointing. The MRI brain has revealed a lesion.
Where is the most likely location of the lesion?
Gait ataxia is caused by cerebellar vermis lesions
62
A wide-based gait with loss of heel-to-toe walking is called what?
ataxic gait
63
"Middle-aged, personality changes, involuntary movements"
This suggests what?
Huntington's disease
64
A 69-year-old man presents with a 2-year history of progressive short-term memory loss, intermittent confusion and wandering around the house at night. His family reports that he has been seeing objects around the house. His chest is clear, and his urine dip is unremarkable. In the last few months, he has developed a unilateral resting tremor that resolves with purposeful movement.
What is the most likely diagnosis?
Lewy body dementia
= seeing visual hallucinations
65
A 23-year-old man is brought into the emergency department with nausea and vomiting. He is given metoclopramide by an F1; however, 20 minutes later, he complains that his eyes are trapped in a strange position, and he is unable to move them.
What has happened to this man?
Acute dystonia
66
A 75-year-old man is referred to the neurology clinic after a history of dropping objects. He was noted to have weakness and fasciculations in his arms, and a diagnosis of motor neurone disease was suspected.
What would this patient be at increased risk of if he were to be diagnosed with this condition?
Frontotemporal dementia
67
A 75-year-old lady is admitted in an acute confusional state secondary to a urinary tract infection. Despite antibiotic therapy, reassurance and environmental modification, she remains agitated. You are considering prescribing haloperidol.
What condition may be significantly worsened if haloperidol is prescribed?
Parkinson's disease
68
Sleep disturbance, stress triggers and a normal mini-mental test score with global memory loss suggest what?
Depression
69
This person has a brain abscess
“You arrange an urgent CT head that shows a frontal ring-enhancing lesion”
What is the most appropriate first-line treatment for this patient?
IV 3rd-generation cephalosporin + metronidazole
= Intravenous ceftriaxone and metronidazole
70
A 32-year-old woman visited her GP two weeks ago, complaining of thick green nasal secretions, a fever and facial pain. There is tenderness on palpation of the maxillary and frontal sinuses. The patient was reassured that she was suffering from acute sinusitis, which should resolve itself in 2-3 weeks without antibiotic therapy.
She now has a frontal headache with nausea. She is also having increasing difficulty lifting her right arm and leg. She presents herself to the emergency department with these new symptoms, whilst in the department, she has a seizure.
Which complication of acute sinusitis has she developed?
Cerebral abscess
= brain abscess
71
An 81-year-old woman is brought to her general practitioner by her concerned son, who reports that she has been unable to cope at home following an acute ischaemic stroke she suffered 8 weeks ago. The son supplies the general practitioner with a CT brain report that confirms a lesion was identified within the M1 segment of the left middle cerebral artery.
During the consultation, the general practitioner performs a mini-mental state examination (MMSE). The woman appears to understand all of the instructions and performs well. She speaks fluently but has difficulty repeating 'apple, table, penny' immediately after hearing the phrase.
What is the most accurate description of the woman's language deficit?
Conduction dysphasia
72
What is a form of stroke that affects the retinal/ophthalmic artery?
Amaurosis fugax
= Atherosclerosis of the internal carotid
73
An 84-year-old is seen on the stroke ward, and a test entitled the aphasia rapid test (ART) is conducted. His family are concerned that he is getting frustrated because he cannot get his words out.
The patient is asked to follow two simple orders: to open his eyes and raise his left hand, and then subsequently touch his left hand to his right ear, which he does with ease. Next, he is asked to repeat three single words, which he can only do for one of the three words. Then, when asked to repeat one sentence, he cannot do so in a fluent manner and eventually gives up. Naming three common objects, a pen, a watch and a tie takes 5 minutes, but is done correctly. Finally, the patient is asked to name as many animals as possible in a minute, and names 3 animals.
What is this type of dysphasia?
Broca's dysphasia
= Conductive dysphasia is characterised by word-finding difficulties and difficulty in repeating phrases. Comprehension is still there
74
A 22-year-old man consults you as he and his housemate have been feeling generally unwell for the past few weeks.
What is the most common feature of carbon monoxide poisoning?
Headache
75
A 10-year-old boy has had 3 months of recurrent headaches. Each day last week, his mother tried giving him ibuprofen, but worried about frequent analgesic use, prompting their visit. The headaches last for 6 hours and often occur after school. He describes the pain as throbbing and on the right side of his head, around the right eye. During these episodes, he finds that loud noises aggravate the headaches. He has no visual disturbances and has no past medical history.
His vital signs are normal, and a neurological examination is unremarkable.
Which diagnosis is most likely?
Migraine without aura
76
A 22-year-old student presents to the emergency department with a 2-day history of feeling generally unwell. She shares a rented house with 3 others who have similar symptoms. She reports feeling tired and nauseous. Examination reveals a heart rate of 98 bpm and blood pressure of 118/76 mmHg. Pulse oximetry shows oxygen saturation of 99% on room air.
What is the most likely additional symptom she is experiencing?
Carbon monoxide poisoning
= headache
77
Subarachnoid haemorrhages can lead to communicating hydrocephalus by causing impaired CSF absorption where?
Arachnoid granulations
78
Idiopathic intracranial hypertension usually presents as what in questions?
1. headache
2. transient visual disturbances
3. papilledema
79
The most common cause of a surgical third nerve palsy is what and where is it located?
posterior communicating artery aneurysm, located in the circle of Willis
80
A 45-year-old man notices he has double vision, worse in the vertical plane. He struggles to walk down the staircase in his house, and his wife has noticed he walks with a tilted head.
What is the most likely cause of this patient’s presentation?
Diabetes Mellitus
81
You are the FY1 on a neurosurgical ward with a patient recently admitted following a head injury. A nurse alerts you that the patient is displaying irregular breathing and is concerned that he is displaying other signs of raised intracranial pressure. You look at the observation chart before reviewing the patient.
Given the above, what would be most concerning?
Patients with raised ICP may exhibit Cushing's triad:
1. Widening pulse pressure
2. Bradycardia
3. Irregular breathing
YOU FUCKING DUMB CUNT
82
Horner syndrome
ptosis - drooping of the upper eyelid
miosis - constriction of the pupil
anhidrosis - lack of sweating
83
A patient has Horner syndrome + severe shoulder pain. Cause?
Pancoast tumour
= chest XRAY
84
Sudden painful Horner syndrome + neck pain → cause?
Carotid artery dissection
85
Key distinguishing feature of Horner syndrome in carotid dissection?
NO anhidrosis
86
Why is there no anhidrosis in carotid dissection?
Sweat fibres run with the external carotid, not the internal
87
Horner syndrome + arm weakness/wasting suggests what?
Pancoast tumour (brachial plexus involvement)
88
Horner syndrome + smoker + weight loss → likely cause?
Pancoast tumour
89
Painful Horner syndrome = ?
Think Carotid artery dissection
90
A 40-year-old patient with Ehler's Danlos syndrome was found to have a constricted left pupil and ptosis of the left lid. The pupil is reactive to light, and the accommodation reflex is intact. His vision is 6/6 in both eyes. He has also been experiencing headaches and pain on the left side of his neck that has been getting worse over the last few days. He mentions he has just started practising yoga and sweats profusely during classes.
What is the most likely cause for this presentation?
Internal Carotid Dissection = cause of sweating
91
A 68-year-old man presents to A&E due to a 2-day history of a “droopy” left eyelid. On examination, there is marked left-eye ptosis with pupillary constriction. Visual acuity and visual fields are unaffected.
He denies any trauma to the area or any medication use. He is currently undergoing investigation for new-onset hoarseness of his voice. He has smoked for 40 years.
What is the most likely underlying cause of his clinical signs?
Loss of innervation of the sympathetic chain
92
A 73-year-old female presents to her GP with left shoulder and arm pain, which came on quite suddenly a week ago and has been worsening. The pain is now unmanageable with regular co-codamol. The GP also notes that the patient's left pupil is smaller than the right side and the eyelid is lagging slightly.
Which question would most likely aid in diagnosing this lady?
Smoking history
93
As well as Horner's syndrome, Pancoast tumours may also present with what?
shoulder pain and upper limb neurological signs due to local extension of the tumour
94
Horner's syndrome - anhydrosis determines the site of the lesion:
Check for glucose
head, arm, trunk = A
just face = B
absent = C
A. central lesion: stroke, syringomyelia
B. pre-ganglionic lesion: Pancoast's, cervical rib
C. postganglionic lesion: carotid artery
95
A 23-year-old man is admitted to the emergency department following an altercation. He was hit in the face using considerable force with a cricket bat. He has a Glasgow Coma Scale score of 13. On examination, there is extensive bruising around the left eye; you can see bruising behind the left mastoid. He has clear fluid dripping down his nose.
What is a quick and easy bedside test to perform to confirm that the fluid is CSF?
Check for glucose = cause most of the CSF is made up of glucose
96
The use of what reduces the risk of post-lumbar puncture headache?
pencil point (atraumatic) needles
97
"Prominent weakness of ankle dorsiflexion, inversion and eversion"
This suggests what?
L5 radiculopathy
98
The lingual nerve, a branch of the mandibular division (V3), carries general sensation from the anterior two-thirds of the tongue. This involves what?
touch, pain, and temperature
taste = chorda tympani (CN VII). Facial nerve palsy can cause loss of taste rather than sensory loss of the anterior two-thirds of the tongue
99
Intracranial venous thrombosis symptoms
1. Risk factors for thrombosis
2. Headache
3. Reduced consciousness
4. Vomiting
= MR venogram
100
Headache and focal neurological signs in a postpartum woman suggest what?
cavernous sinus thrombosis
101
Neuroleptic malignant syndrome often presents with raised what?
Raised creatine kinase and raised white cell count
102
A 55-year-old woman has complained of neck and right arm pain for the past two months. The pain is often triggered by flexing her neck. Her past medical history includes osteoarthritis of her knee, obesity and depression. On examination, there is no obvious muscle atrophy or weakness of the right arm. There is, however, some sensory loss over the middle finger and palm of the hand.
Which nerve root is most likely to be affected by the impingement?
C7
103
A 61-year-old man complains of a four-month history of neck and arm pain. The pain is described as being like 'electric shocks' and is worse when he turns his head. There is no history of trauma and no other obvious trigger. He is otherwise fit and well and takes no other medication. On examination, he has decreased sensation on the dorsal aspect of the thumb and index finger.
What is the most likely underlying diagnosis?
C6 radiculopathy
104
A young man presents with an acute headache associated with unilateral periorbital oedema. On examination, there is a lateral gaze palsy
What is the most likely diagnosis?
cavernous sinus thrombosis
105
A 58-year-old gentleman presents with left-sided paraesthesias affecting his thumb and first finger. He complains of grip weakness and dropping objects unintentionally. On examination, there is wasting over the thenar eminence. Which of the following signs would suggest a diagnosis other than carpal tunnel syndrome?
Positive Hoffmann's sign
106
A 60-year-old man presents with a prolonged history of altered sensation. He informs you that many weeks ago, he burned both of his shoulders after leaning against a radiator. His wife was bemused that he did not realise how hot the radiator was at the time.
The burn has since been assessed and has healed fully; the patient has been increasingly confused as to why he cannot feel pain or heat over either of his shoulders. He is usually fit and well, and takes no regular medication.
What is the most likely cause of his symptoms?
Syringomyelia
107
Where are the bleeds located in extradural and subdural haematomas?
Extradural haematomas = arterial bleed
Subdural haematomas = venous bleed
Year 3 - Neurology
flashcards
Decks in class (51)
# Cards
-
Foundations Year 3131
-
Medicine for the Elderly173
-
`Random107
-
Pharm42
-
Anatomy89
-
Ascending Tracts37
-
Descending Tracts54
-
Cranial and Peripheral Nerves27
-
Cranial Nerves106
-
Cranial Nerve Palsies67
-
Eye anatomy93
-
Spinal and Named Nerves82
-
Physiology49
-
Acute Cognitive Disorders35
-
Concussion11
-
Parkinson's Disease67
-
Parkinson - plus syndromes27
-
Multiple sclerosis69
-
Neurodegenerative Diseases83
-
Meningitis86
-
Encephalitis33
-
Epilepsy (+seizures)105
-
Loss of Consciousness44
-
Chronic Complications of Diabetes68
-
Congenital Disorders30
-
Sleep Disorders32
-
Ischaemic Stroke219
-
Cerebrovascular Event (Stroke)26
-
Other stroke symptoms29
-
Transient Ischaemic Attack58
-
Polymyositis and Dermatomyositis54
-
Neuromuscular Junction Disorders72
-
Peripheral nerve disease - Polyneuropathies78
-
Peripheral Nerve Disease - Mononeuropathies51
-
Migraine36
-
Headache + Tension Headache32
-
Cluster Headaches24
-
ICP and Hydrocephalus46
-
Trigeminal Autonomic Cephalgias16
-
Trigeminal Neuralgia28
-
Neuro-opthalmic Disease48
-
Spinal Cord Suppression73
-
Back Pain67
-
Cauda Equina Syndrome20
-
Comparison table - Haemorrhage36
-
Intracerebral (Intraparenchymal) Haemorrhage13
-
Subarachnoid Haemorrhage56
-
Subdural Haematoma32
-
Extradural Haemorrhage23
-
Haemorrhagic stroke30
