Neurology

Question 1

Syncope

Answer 1

Transient loss of consciousness due to Hypoperfusion of brain

Cause: decreased cardiac output/ fall in peripheral resistance

Key Qs: triggers, history, medications, previous episodes, witness, jerks

Red flags: >65 years, short prodrome, new breathlessness, palpitation, chest/ abdominal pain, ECG abnormality, family h/o death due to heart disease <40 years, chest pain, murmur, syncope when supine, GI bleed, short prodrome, Systolic BP <90, heart rate<40

Ix: 12 lead ECG, standing test
D/d: Epilepsy, pseudo psychogenic syncope (PPS)

Mx: look for cause, rule out heart, GI, neurology condition

Question 2

Multiple Sclerosis Types

Answer 2

✓ Relapsing- Remitting MS (RRMS) is the most common type - episodic relapses and remissions can be complete or partial.
✓ Progressive-Relapsing MS (PRMS) is rare and is when the disease worsens from the onset and has no remissions, just relapses.
✓ Primary-Progressive MS (PPMS) is when the disease slowly worsens from the onset and has no relapse or remissions.
✓ Secondary-Progressive MS (SPMS) occurs in around two thirds of those patients who initially have RRMS and is when the disability slowly worsens unrelated to relapses.

Question 3

Carotid Body Tumour

Answer 3

✓Paraganglionoma - benign neuroendocrine tumour of parasympathetic ganglion.
✓ Slow-growing but can become invasive and metastasise over time.
✓ Situated at bifurcation of Common Carotid Artery
✓ Pulsatile, painless lump in posterior triangle -can be moved from side to side
✓Symptoms: dizziness, hoarseness, shoulder drop, Horner’s syndrome
✓ A MRA - carotid angiogram is diagnostic - ‘salt & pepper’
✓ Treatment is usually surgical excision.
✓ Recurrence 10%

Question 4

Management of Amyotrophic Lateral Sclerosis

Answer 4

Riluzole - extends life and time to ventilation