7/2

Question 1

Ascending spinal = sensory info going up to the brain

Descending spinal = motor info going out to the limbs

What are the two types of ascending spinal tract and how do you remember them?

Answer 1

Dorsal - back - fine touch on back (aware that its there) feels so good -> straight up to the medulla

Dorsal = propricopetion and fine touch and crosses at medulla

Spinothalamic - scene in Spirit - DEEP PRESSURE pushes HOT brand into side and causes PAIN - pressure pushes straight through to other side

Spinothalamic = deep pressure, temp, pain and crosses at spinal level

Question 2

Overview of PD
- What
- Who
- Present
- Invx
- manage

What drugs should be avoided?

Answer 2

What
- lewy body depositions in brain lead to degneration of dopamine producing neurons in substantia nigra

Who
>65
0.3% population

Presentation
1. resting tremor (pill-rolling)
2. rigidity
3. bradykinesia
4. postural instability

(non-motor = sleep disorders, constipation, depression, dementia, visual hallucinations)

Invx
- clinical diagnosis

Manage - meds MUST be given at same time
1. levodopa + carbidopa (levodopa = dopamine agonist that can cross BBB)
- important to counsel patients of the on-off phenomenum - might work better at times compared to others

2.

AVOID
Antiemetics that are Dopamine anatgonists e.g. metroclopramide, Chlorpromazine

anti-psychotics such as haloperidol and -done drugs

Note: these meds should be avoided if the patient has lewy-body dementia - either manage brain or body can’t mediciate for both

Question 3

How do you tell the difference between cortical and brainstem strokes?

How can you localise brainstem strokes?

Answer 3

Cortical (particular artery) = focal

Brainstem = diffuse

Brainstem - Motor = MIDLINE brain
Sensory = (side) = LATERAL

Rule of 4s (CN divisible into 12 = midline)

Midbrain - CN 1-4
Pons - CN 5-8
Medulla CN 9-12

Question 4

Management of status epilepctus

Answer 4

1. give rectal (midozolam) or IV benzo (lorazepam)

WAIT 5-10 mins

2. repeat step 1

WAIT 5-10mins

3. repeat with 2nd line - phenytonin or sodium valporate

Question 5

Seizure rules for driving

Answer 5

One-off - 6 months off
More than one/one-off with abnormal CT head/EEG - 1 year off

Question 6

Pathology of alzehimer’s

Answer 6

Amyloid plaques and neurofibrillary tangles composed of tau proteins

Question 7

Breast-feeding with anti-epilitics?

Answer 7

Acceptable with basically them all

Question 8

Bone profile in osteoporosis?

Management

Answer 8

Normal bone profile

Calcium and vit D supplements + bisopsphonates

Question 9

Who has to take more folic acid from BEFORE pregnancy till 12 weeks?

Answer 9

MORE

Metabolic disease (coeliac and diabetes)
Obesity
Relative or personal Hx of Neural tube defects
Epilepsy (taking meds)

+ sickle cell and thalassemia