Amadex 2020

Question 1

70yo man, TIA , BP 180/110mmhg
Carotid bruit heard and Doppler shows 50% and 60% stenosis on right and left carotid arteries, what’s the most appropriate for prevention of thromboembolism

Answer 1

1. Aspirin- long term antiplatelet therapy significantly prevents further strokes, MI or vascular deaths. (By preventing coagulation)
2. Hypertension control has significant effects of further CVA prevention
3. Carotid endarterectomy(CEA) is done in patients with ipsilateral stenosis of 70-99% if surgery can be performed by a specialized surgeon. If 50-69% stenosis CEA performed in selected patients considering age, gender and comorbidities.
4. Clopidogrel can be added if coexisting IHD or has recently undergone coronary artery stenting.
5. Regular exercises
6. Statins
7. Glycemic control if diabetic
8. Warfarin is the standard care in patients with CVA in setting of atrial fibrillation and preferred over aspirin and other antiplatelet agents

Question 2

What are meningiomas

Answer 2

Non-cancerous CNS tumors that arise from meningeal lining of brain or spinal cord.
Symptoms caused by irritation of underlying brain or spinal tissue.
Headache is a common feature.
Of all CPA tumors meningiomas are 20% and 80% of meningiomas are acoustic neuromas. Their symptoms progressively worsens but doesn’t have periodic symptoms.

Question 3

In an episode of transient alteration or absence of consciousness. What’s the first step

Answer 3

If patient is stable firstly should evaluate such situations to diagnose epileptic seizures, organic encephalopathies, psychogenic non epileptic seizures or sometimes malingering.
A WITNESS is a valuable source to assess the episode properly.

Question 4

What’s the special feature of diabetic third nerve palsy

Answer 4

Intact pupillary reflex

Question 5

In ischemic CVAs what has the most significant effect on recovery of the patient

Answer 5

If presents within 4.5 hours of onset, in carefully selected patients , if not contraindicated , fibrinolytic/Thrombolytic therapy is the treatment of choice.
It shown to be significantly reduce death and disability.
Recombinant tissue plasminogen activator(rTPA) approved in Australia.

Acute lowering of BP in stroke is has risk of hypoperfusion. Only indication is extreme hypertension ( SBP >22mmHg or DBP >11mmHg )

CEA prevents further episodes but doesn’t change the outcome of this attack.

Aspirin is the most commonly given antiplatelet drug for ischemic stroke( CI in hemorrhagic stroke) if thrombolysis is done aspirin should be delayed for 24hrs.

Question 6

GBS ( acute inflammatory polyradiculoneuropathy) features and diagnosis confirmation

Answer 6

Cardinal features-
1.progressive and symmetrical muscle weakness
2. Absent for depressed deep tendon reflexes
3. Intact sensory
Some cases shows preceding infection (eg gastroenteritis with campylobacter)

Initial diagnosis by clinical picture.
To confirm diagnosis -
1. CSF ( typical finding is known as albuminocytogenic dissociation) finding starts after 48hrs and present in 50-65% within first week.
2. NCS( shows a typical demyelinating pattern) and Electromyography(EMG) for confirmation and to assess prognosis

Question 7

Sciatic nerve injury manifestations

Answer 7

1.paralysis of hamstring muscles ( knee flexion impatient) and all muscles below knee.
2. All sensation of the leg except medial aspect is impaired.
3. Absent or weak ankle reflex.

Foot drop is not specific bcos it occurs in common perineal nerve injury as well

Question 8

Hip flexion nerve roots

Answer 8

L1- L2 nerve roots

Question 9

Sciatic nerve formed of

Answer 9

L4, L5, S1, S2, S3 nerve roots

Question 10

Femoral nerve

Answer 10

Sensory of anterior thigh and medial leg.
Supply anterior thigh muscles and works in hip flexion and knee joint extension

Question 11

What are DDs for new focal neurological deficits

Answer 11

UMN bulbar signs- brainstem lesions including syrinx, mass, stroke and demyelinating forms of other degenerative diseases

LMN Bulbar signs - cranial nerve palsies

Limb UMN signs - cervical myelopathy, cord tumor, Hereditory spastic paraparesis, Transverse myelopathy, HIV related myelopathy, Syrinx

Limb LMN signs - Radiculopathy, plexipathy, neuropathy

Question 12

What’s multifocal motor neuropathy

Answer 12

LMN type( no UMN features) weakness in hands with different features on one side compared to the other.
Believed to be caused by an abnormal response to the immune system.

Both ALS and MMN has progressive pure motor weakness but in absence of UMN and also not affecting respiratory muscles differentiate MMN form ALS.