Y3 Cms

Front 1

Typical age of presentation of MS

Back 1

Typically presents between 20 and 50

Average = 30

Front 2

Risk factors of MS

Back 2

Low vitamin D

Smoking

Early life obesity

Infections eg EBV

Family history

Front 3

MS is more prevalent in women or men?

Back 3

Women (3:1)

Front 4

Geographical variation of MS. More common where?

Back 4

US, Canada, Europe, Australia

Front 5

MS is an upper or lower motor neurone disorder

Back 5

Upper

Front 6

MS is an autoimmune disorder. Which immune cells are involved?

Back 6

All of them

Both innate and adaptive immunity

Front 7

What does internuclear ophthalmoplegia look like

Back 7

When looking to the unaffected side the affected eye's movement lags behind the unaffected eye's movement

Gives diplopia on looking to unaffected side

Front 8

Likely cause of internuclear ophthalmoplegia in 30year old

Back 8

MS

Front 9

Likely cause of internuclear ophthalmoplegia in 75 year old

Back 9

Stroke

Front 10

Site of damage with internuclear ophthalmoplegia

Back 10

Medial longitudinal fasciculus (in brain stem)

Front 11

What is Lhermitte's sign

Back 11

Uncomfortable sensation (shooting down spine or legs or arms) when putting head down, chin to chest

Front 12

Lhermitte's sign suggests..

Back 12

High cervical posterior cord lesion

Front 13

Scale used in MS to assess disability

Back 13

EDSS (Expanded Disability Status Scale)

Front 14

Upper motor neurone disorders cause...

Back 14

Weakness

Spasticity

Brisk reflexes

Front 15

Lower motor neurone disorders cause...

Back 15

Weakness

Wasting

Fasciculations

Loss of reflexes

Front 16

Ubiquitinated proteins called 'inclusions' are found in motor neurones of 98% of people with MND. What protein does the ubiquitin bind to?

Back 16

TDP-43

Front 17

Which type of dementia has an overlap with MND?

Back 17

Fronto-temporal Dementia (FTD)

Front 18

Typical age of presentation of MND

Back 18

Elderly

60 and above

(although can present from late 30s)

Front 19

Life expectancy after diagnosis of MND

Back 19

3-5 years

Front 20

Increased risk of MND in males or females?

Back 20

Males

Front 21

Cause of death from MND

Back 21

Respiratory failure or infection

Front 22

Typical presentation of brain tumours

Back 22

Progressive neurological deficit

AND/OR

Headaches (usually tension-like, worse in the morning)

AND/OR

Seizures (usually focal, can be generalised)

Front 23

Why are steroids given to those with brain tumour? What must you give alongside steroids?

Back 23

Decrease swelling of the brain surrounding the tumour

Must give proton pump inhibitor (eg omeprazole) for gastro protection

Front 24

Subarachnoid haemorrhage most commonly caused by

Back 24

Trauma

Front 25

Spontaneous subarachnoid haemorrhage most commonly caused by

Back 25

Aneurysm

Front 26

If ruptured brain aneurysm left untreated there is a __% chance of rebleeding

Back 26

50%

Front 27

Risk factors for brain aneurysm

Back 27

HTN

Smoking

Family Hx

ADPKD (Autosomal Dominant Polycystic Kidney Disease)

FMD (Fibro-Muscular Dysplasia)

Marfan's Syndrome

Front 28

Brown-Sequard (hemi-cord) Syndrome presents with

Back 28

Ipsilateral loss of motor, vibration sensation and proprioception

Contralateral loss of pain and temperature sensation

Front 29

Name the three meningeal layers, from outside in

Back 29

Dura mater (lining skull bone)

Arachnoid mater

Pia mater (coating brain parenchyma)

Front 30

Main method of pathogen entry to CNS

Back 30

Hematogeneous spread (embolic bacteria or infected thrombi)

Front 31

Three most common bacteria causing meningitis

Back 31

Streptococcus pneumoniae (53%)

Neisseria meningitidis (29%)

Haemophilus influenzae (5%)

Front 32

Most common cause of meningitis

Back 32

Viral infection (36%)

Front 33

Three most common viral causes of meningitis

Back 33

Enteroviruses (54%)

Herpes simplex 2 (23%)

Varicella zoster (19%)

Front 34

What is Kernig's sign and what does it show

Back 34

Patient lying supine, flexed hip and knee to right angles. Knee slowly extended. Resistance or pain during extension > 135° = positive result, indicating meningeal irritation.

NEGATIVE RESULT DOES NOT EXCLUDE MENINGITIS

Front 35

What is Brudzinski's sign and what does it show

Back 35

Patient lying supine, neck is passively flexed (chin to chest). Positive sign = when neck is flexed, hips and knees flex involuntarily. Shows meningeal irritation

NEGATIVE RESULT DOES NOT EXCLUDE MENINGITIS

Front 36

LP is diagnostic for meningitis and needs to be done ASAP unless...

Back 36

There is evidence of raised intercranial pressure, such as:

- focal neurological signs

- papillodema

- continuous or uncontrolled seizures

- GCS < 13

In these circumstances, do brain imaging first

Inability to perform fundoscopy is not a contraindicator for LP

Front 37

Which pathogen that causes meningitis has vaccination

Back 37

Meningococcal meningitis caused by Neisseria meningitidis

There are lots of strains and different vaccines for each strain

Front 38

What causes NAION?

Back 38

Occlusion of the short posterior ciliary arteries, leading to infarction of the optic nerve head

Front 39

NAION typically presents with...

Back 39

Painless, monocular, sudden loss of vision

Front 40

NAION on examination

Back 40

- Moderate to severely reduced visual acuity in affected eye

- Optic nerve may be partially or fully swollen, with splinter or flame haemorrhages

- RAPD

- Visual field defect corresponding to the area of optic disc swelling (most common inferior altitudinal defect)

Front 41

Typical presentation of giant cell arteritis

Back 41

- Painful, sudden loss of vision (Typically is initially one eye, second eye can develop within a few hours)

- Headache

- Scalp tenderness

- Jaw claudication

- Loss of appetite

Front 42

Giant cell arteritis is associated with which condition

Back 42

Polymyalgia rheumatica

Front 43

Mechanism of giant cell arteritis

Back 43

Systemic inflammatory vasculitis of the medium and large arteries, often around the temple, scalp, head and neck. Optic nerve head blood supply compromised, giving anterior ischemic optic neuropathy

Front 44

On examination giant cell arteritis

Back 44

Significantly reduced visual acuity (counting fingers)

Non-pulsatile tender temporal arteries

Swollen optic disc

RAPD

May have flame haemorrhages and cotton wool spots

Front 45

When someone presents with sudden loss of vision in one eye it is important to refer to ophthalmology to assess for which emergency?

Back 45

Giant cell arteritis

Front 46

Branch retinal artery occlusion (BRAO) on fundoscopy looks like...

Back 46

Retina appears white in the area supplied by the affected artery

Front 47

Central retinal artery occlusion (CRAO) on fundoscopy looks like...

Back 47

Retina is oedematous and pale

'Cherry red spot' where the macula appears red against pale retina

Front 48

Signs of retinal vein occlusion on fundoscopy

Back 48

Extensive retinal haemorrhage (if is BRVO will map the area of the retinal vein, if CRVO will cover whole retina)

Cotton wool spots may be present

Front 49

Visual pathway starting with the retina

Back 49

Retinal ganglion axons

Optic disc

Optic nerves

Optic chiasm

Optic tracts

Lateral geniculate nuclei

Meyer's loop

Optic radiations

Primary visual cortex

Front 50

A lesion in the right optic nerve leads to...

Back 50

Monocular vision loss (right eye)

Front 51

A lesion in the optic chiasm leads to...

Back 51

Bitemporal hemianopia

Front 52

A lesion in the right optic tract leads to...

Back 52

Contralateral (left sided) homonymous hemianopia

Front 53

A lesion in the right upper bank of the calcarine fissure (primary visual area of occipital lobe) leads to...

Back 53

Contralateral (left sided) inferior quadrantinopia

Front 54

A lesion in the right lower bank of the calcarine fissure (primary visual area of the occipital lobe) leads to...

Back 54

Contralateral (left sided) superior quadrantinopia

Front 55

A lesion affecting the whole (upper and lower) of the right calcarine fissure (primary visual area of the occipital lobe) leads to...

Back 55

Contralateral (left sided) homonymous hemianopia

Front 56

Two most common causes of bitemporal hemianopia

Back 56

Pituitary tumour (superior quadrants first because compresses from below)

Craniopharyngioma (inferior quads first, compresses from above)

Front 57

A painful unilateral third nerve palsy with pupil dilation suggests what?

Back 57

Posterior communicating artery aneurysm

Requires URGENT neuro assessment

Front 58

One eye has ptosis, points downwards and outwards at rest, limited movement in all other directions. Problem with which nerve and therefore which muscle(s)?

Back 58

Third nerve palsy (occulomotor)

Levator palpebrae superioris, inferior oblique, superior rectus, medial rectus, inferior rectus muscles

Front 59

One eye deviates upward and slightly inward. Diplopia on looking down. Problem with which nerve and therefore which muscle(s)?

Back 59

Fourth nerve palsy (trochlear)

Superior oblique muscle

Front 60

Gaze normal at rest, diplopia when looking to one side. One eye has decreased abduction. Problem with which nerve and therefore which muscle(s)?

Back 60

Sixth nerve palsy (abducens)

Lateral rectus muscle

Front 61

What is monocular diplopia?

Back 61

Double vision which persists when one eye is covered

Front 62

What is anisocoria?

Back 62

Difference in the size of pupils

Front 63

What amount of anisocoria is considered physiological?

Back 63

0.5mm

Front 64

Which muscle constricts the pupil

Back 64

Sphincter pupillae

Front 65

Which muscle dilates the pupil

Back 65

Dilator pupillae

Front 66

Is pupil constriction under parasympathetic or sympathetic control?

Back 66

Parasympathetic (division of third nerve - occulomotor)

Front 67

Is pupil dilation under parasympathetic or sympathetic control?

Back 67

Sympathetic

Front 68

What does a RAPD show?

Back 68

Asymmetric (affects one eye but not the other) optic nerve disease. Efferent signals work in both eyes (because they both are able to constrict), but the afferent signal in one eye is defective.

Front 69

What is Horner's syndrome?

Back 69

Lack of sympathetic stimulation to one eye.

Typical presents with the triad:

- Ptosis

- Pupil miosis (pupil constriction)

- Anhydrosis (lack of sweating - distribution determined by site of lesion)

Front 70

What is the name of the constricting eye drops ?

Back 70

Pilocarpine

Front 71

Name two dilating eye drops

Back 71

Phenylephrine

Tropicamide

Front 72

What is a tonic pupil? What is Holmes-Aide syndrome?

Back 72

A tonic pupil is a pupil that is abnormally dilated and has slow reactions to light, with better reactions to accommodation.

Holmes-Aide syndrome has features including tonic pupil, diminished deep tendon reflexes and orthostatic hypotension

Front 73

Why do strokes not typically affect the muscles of the forehead?

Back 73

Because the ophthalmic branch of the facial nerve has presynaptic nerve fibres from both the contralateral motor cortex (like normal) but also the ipsilateral motor cortex (only ophthalmic branch). As a stroke typically affects one area of the brain it is unusual for it to affect both the right and left motor cortices.

Front 74

What is amyblopia?

Back 74

Under-development of the visual system. If the brain fails to receive a clear image in the first 7 years of life it does not develop the neuronal capacity to see clearly, such that even if the ocular cause of blurred vision is treated, the vision never recovers. Most commonly it occurs in one eye, due to underlying refractive error or squint. Sometimes, the better eye is patched, forcing the brain to use the image from the worse seeing eye.

Front 75

What is the name for the lack of accommodating capacity (long-sightedness) that often is symptomatic in people over the age of 40?

Back 75

Presbyopia

Front 76

Name for long-sightedness (not age-related)

Back 76

Hypermetropia

Front 77

Name for short-sightedness

Back 77

Myopia

Front 78

Condition in which the "cornea is shaped like a rugby ball"

Back 78

Astigmatism

Front 79

Bilateral acquired corneal collagen disorder in which the corneas become distorted into more of a cone-like shape

Back 79

Keratoconus

Front 80

When the ciliary muscles contract...

Back 80

The suspensory ligaments relax, and the lens becomes more convex. This helps to focus things that are close-up. (=accommodation)

Front 81

When the ciliary muscles relax...

Back 81

The suspensory liagaments become taut, and pull the lens flatter. This allows for the focusing of distant objects

Front 82

Percentage of people diagnosed with Parkinsons Disease under the age of 40

Back 82

10%

Front 83

Most common cause of coma

Back 83

Na abnormalities

Front 84

What is brain stem death

Back 84

When a person no longer has any brain stem function and has permanently lost the potential for consciousness and the capacity to breathe

Front 85

Five brainstem reflexes that must be absent to determine brain stem death (other criteria also need to be met)

Back 85

Pupillary reflexes (fixed pupils, no response to light)

Corneal reflexes

Oculovestibular reflex (infuse cold water into ear canal, no nystagmus)

Oculocephalic reflex (dolls eyes present)

Gag and cough reflex

Front 86

Describe the spino-thalamic pathway

Back 86

Sensory pathway for pain, temperature and imprecise touch

Synapse 1: in spinal cord

Synapse 2: in thalamus (lateral ventro-posterior nucleus, VPL)

Synapse 3: somatosensory cortex (post-central gyrus)

Decussates: in the spinal cord ventrally

Front 87

Describe the dorsal column-medial lemniscus pathway

Back 87

Sensory for discriminative touch, proprioception and vibration

Synapse 1: medulla

Synapse 2: thalamus (lateral ventro-posterior nucleus, VPL)

Synapse 3: somatosensory cortex (post-central gyrus)

Decussates: in brainstem

NOTE: there are two tracts in spinal cord - medial (gracile) tract for lower body, lateral (cuneate) tract for upper body

Front 88

Describe the cortico-spinal pathway

Back 88

Motor pathway (voluntary and spinal reflexes)

Neurones start in the primary motor cortex (pre-central gyrus)

Decussate: in medulla (85% of neurones decussate)

Synapse 1: in spinal cord near site of spinal nerve

Synapse 2: neuromuscular junction

Front 89

Which cells are responsible for myelination in the CNS

Back 89

Oligodendrocytes

Front 90

Which cells are responsible for myelination in the PNS

Back 90

Schwann cells

Front 91

Which two cranial nerves do not exit from the brainstem

Back 91

I - olfactory

II - optic

Front 92

Which two cranial nerves exit from the midbrain

Back 92

III - occulomotor

IV - trochlear

Front 93

Which four cranial nerves exit from the pons

Back 93

V - trigeminal

VI - abducens

VII - facial

VIII - vestibulocochlear

Front 94

Which four cranial nerves exit from the medulla

Back 94

IX - glossopharyngeal

X - vagus

XI - accessory

XII - hypoglossal

Front 95

Which four cranial nerves run in the midline of the brainstem (others run down the lateral aspect of the brainstem)

Back 95

The ones that are factors of 12

III - occulomotor

IV - trochlear

VI - abducens

XII - hypoglossal

Front 96

Pyramidal tracts control...

Back 96

Voluntary movement

Front 97

Extrapyramidal tracts control...

Back 97

Involuntary movement

Front 98

Normal IOP (interocular pressure)

Back 98

Between 12 and 24 mmHg

Difference between eyes <4