BPT Neurology

Question 1

Benign intracranial hypertension

Answer 1

Tinnitus
Headache worse on bending forward
Obese middle aged lady

Raised opening pressure on LP

Question 2

Normal pressure hydrocephalus triad

Answer 2

Urinary incontinence
Gait apraxia
Dementia

Elderly

Imaging: enlarged ventricles without convolutional atrophy

Question 3

CJD - the gold standard diagnosis is by brain biopsy. What other investigations support the diagnosis?

Answer 3

MRI with T1/T2 and FLAIR sequences - high signal uptake in caudate and putamen
EEG - periodic sharp wave complexes
LP - 14-3-3 protein in otherwise bland CSF

Question 4

Carbamazepine: indications, side effects

Answer 4

Focal seizures (first line). Ataxia, dizziness, diplopia. Myelosuppression - aplastic anaemia, leukopenia. Hepatotoxicity. Hyponatraemia. SJS/TEN (HLAB1502), DRESS (HLAB3101).

Question 5

Gabapentin: indications, side effects

Answer 5

Focal seizures (add in). Sedation, dizziness, ataxia, fatigue; GI upset, weight gain, oedema.

Question 6

Lamotrigine: indications, side effects

Answer 6

Focal, GTCS (onset/early), myoclonic, LG. Dizziness, diplopia, sedation, ataxia. Skin rash, Steven’s Johnsons syndrome**. OCP decreases levels, valproate increases levels.

Question 7

Levetiracetam: indications, side effects

Answer 7

Focal / GTCS. Sedation, fatigue, incoordination, mood changes; anaemia, leukopaenia

Question 8

Phenytoin: indications, side effects, safety in pregnancy

Answer 8

Focal, GTCS. Dizziness, diplopia, ataxia. Gingival hyperplasia, hirsutism, osteomalacia, rash (CYP2C9*3 - DRESS). Craniofacial / cleft palate in pregnancy.

Question 9

Topiramate: indications, side effects

Answer 9

Focal, GTCS, LG. Psychomotor slowing, speech or language issues. Renal stones, glaucoma, hypohidrosis. Weight loss

Question 10

Valproate: indications, side effects, safety in pregnancy

Answer 10

GTCS (first-line) - all other seizure types. Ataxia, tremor, hepatotoxicity, thrombocytopenia, GI upset, weight gain**, alopecia. Neural tube defects in pregnancy.

Question 11

Notable side effects of carbamazepine, lamotrigine, valproate, topiramate, phenytoin, levetiracetam

Answer 11

CBZ: myelosuppression, SJS/TEN, DRESS
LAM: SJS/TEN
VAL: weight gain, hepatotoxicity, thrombocytopenia
TOP: renal stones, wt loss
PHENY: gingival hyperplasia, hirsutism 
LEV: psychosis

Question 12

Foot drop: causes and distinguishing features

Answer 12

• L5 root: inversion and eversion affected; normal NCS, neurogenic EMG (spontaneous activity - denervation)
• Common peroneal: eversion affected, EMG changes only below knee, often compression at fib neck
• Sciatic: EMG abnormal above knee; often post-hip dislocation / surgery

Question 13

Features of lumbar canal stenosis

Answer 13

“Spinal claudication” - leg / buttock pain, weakness after walking. Better walking uphill, relieved by stopping and sitting down.

Question 14

MS therapeutics: fingolimod

Answer 14

PO sphingosine receptor modulator, retains lymphocytes in LN. Efficacy > IFN-B1a. Risks: first dose bradycardia, macular oedema, lymphopaenia, zoster risk.

Question 15

MS therapeutics: teriflunamide

Answer 15

PO de novo pyrimidine synthesis inhibitor; similar efficacy to IFN-B1a. Risks: possibly peripheral neuropathy, LFT derangement. Pregnancy cat X.

Question 16

MS therapeutics: fumarate

Answer 16

PO, activates Nrf2 antioxidant response; efficacy similar to glatiramer. Risks: flushing, GI upset.

Question 17

Drugs that may precipitate myasthenia crisis

Answer 17

Aminoglycosides, macrolides, tetracyclines, beta blockers, procainamide, IFN-alpha, magnesium sulfate, penicillamine, quinine; iodinated contrast, morphine, pethidine