Data - neurology

Question 1

CSF interpretation
Appearance: Cloudy/turbid
Opening pressure: Elevated
WBC: Elevated
Glucose: Low
Protein: Elevated

Answer 1

Bacterial meningitis

Question 2

CSF interpretation:
Appearance: Clear
Opening pressure: Normal/elevated
WBC: Elevated
Glucose: Normal
Protein: Elevated

Answer 2

Viral meningitis

Question 3

CSF interpretation:
Appearance: Clear or cloudy
Opening pressure: Elevated
WBC: Elevated
Glucose: Low
Protein: Elevated

Answer 3

Fungal meningitis

Question 4

CSF interpretation:
Appearance:  Opaque
Opening pressure: Elevated
WBC: Elevated
Glucose: Low
Protein: very elevated

Answer 4

Tuberculosis meningitis

Question 5

CSF interpretation:
Appearance: blood-stained/xanthochromia
Opening pressure: Elevated
WBC: Elevated
Glucose: Normal
Protein: Elevated

Answer 5

Subarachnoid haemorrhage

Question 6

Difference in WBC between viral and bacterial meningitis?

Answer 6

In bacterial meningitis:
Primarily polymorphonuclear leukocytes (>90%)
In viral meningitis:
Primarily lymphocytes (PMN early on)

Question 7

Olfactory nerve controls what?

Answer 7

CNI sense of smell

Question 8

Optic nerve?

Answer 8

CNII - vision!

Question 9

Oculomotor nerve?

Answer 9

CNIII - Eye movements - sup. inf. med. rectus muscles. Inf oblique muscle.
Levator palpabrae superioris

Question 10

Trochlear nerve?

Answer 10

CNIV - Eye movements - superior oblique

Question 11

Trigeminal nerve?

Answer 11

CNV - split into three nerves, supplying sensation to face.

Only mandibular division has motor function

Question 12

Ophthalmic nerve?

Answer 12

CNV1
Sensation to upper face
Parasymp to lacrimal gland

Question 13

Maxillary nerve?

Answer 13

CNV2
Sensation to mid face
Parasymp to lacrimal gland and nasal glands

Question 14

Mandibular nerve?

Answer 14

CNV3
Sensation to lower face, mucous membranes, tongue
Parasymp to submandibular, sublingual and parotid glands
Motor muscles of mastication - temporalis, masseter, pterygoids. And also tensor veli palatini and tensor tympani

Question 15

Abducens nerve?

Answer 15

CNVI -

Motor to lateral rectus

Question 16

Facial nerve?

Answer 16

CNVII
Motor to muscles of facial expression
Anterior 2/3 tongue TASTE (chorda tympani)

Question 17

Branches of facial nerve?

Answer 17

Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical

Question 18

Vestibulocochlear nerve?

Answer 18

CNVIII

hearing and balance

Question 19

Glossopharyngeal nerve?

Answer 19

CNIX 
Motor to stylopharyngeus
Parasymp - parotid gland
Posterior 1/3 tongue TASTE
Sensory - oropharynx

Question 20

Vagus nerve?

Answer 20

CNX
Motor - muscles of pharynx
Parasymp - trachea smooth muscle, bronchi, GI tract, heart

Question 21

Accessory nerve?

Answer 21

CNXI

Motor - trapezius and SCM

Question 22

Hypoglossal nerve?

Answer 22

CNXII

Motor to muscles of tongue (except palatoglossus CNX)

Question 23

Where is the lesion

Uvula deviated toward the right?

Answer 23

Left glossopharyngeal nerve lesion

Question 24

Where is the lesion

Bovine cough, dysphonia?

Answer 24

Recurrent laryngeal nerve - Vagus nerve

Question 25

Where is the lesion

Tongue deviated to left, some wasting on left side?

Answer 25

Left hypoglossal nerve

Question 26

Patient with:

• hemiparesis, affecting face and arm worse than lower limb
• anaethesia

Answer 26

MCA stroke - contralateral side to hemiparesis

Question 27

Patient with:

- lower limb weakness unilaterally

Answer 27

ACA stroke - contralateral side to hemiparesis

Question 28

Patient with:
homonymous hemianopia
ataxia
diplopia
nystagmus
facial weakness/numbness

Answer 28

PCA stroke - ipsilateral to weakness/numbness

Question 29

Pattern of tonic clonic seizure?

Answer 29

Focal onset - aura (not always)
Tonic phase - LOC + body stiffness
Clonic phase - rhythmical jerking
Postictal phase

Question 30

Kernig’s sign?

Answer 30

Patient lying on back
Flexed knee and hip
Resisted knee extension
Positive for meningitis

Question 31

Features of UMN lesion?

Answer 31

Increased tone (spasticity)
Weakness but not wasting
\+ve Babinski's sign
Clonus
Brisk reflexes

Question 32

Features of LMN lesion?

Answer 32

Weakness and wasting
Reduced tone (flaccidity)
Fasciculations
Reduced reflexes (may be absent)

Question 33

Predictive features of SAH?

Answer 33

Age >40
Onset with exertion
Next stiffness/pain
Raised BP
Loss of consciousness 
Vomiting

Question 34

What is dysarthria?

Answer 34

Slurred speech caused by articulation problems due to motor deficit

Question 35

What is dysphonia?

Answer 35

Loss of volume caused by laryngeal disorders

Question 36

What is dysphasia?

Answer 36

Disturbance of language resulting in abnormalities of speech production

Question 37

Common causative vessel of extradural haematoma?

Answer 37

Middle meningeal artery

Question 38

Hemisection of spinal cord?

Answer 38

Brown-Sequard syndrome
Contralateral loss of pain and temp
Ipsilateral loss of touch, vibration, proprioception

Question 39

Four causes of CVA?

Answer 39

Embolism - Most common
Thrombosis
Hypoperfusion (eg shock)
Haemorrhage

Question 40

How to score GCS?

Answer 40

Eyes:
Not opening = 1
To pain = 2
To speech = 3
Spontaneously = 4

Verbal response
None = 1
Incomprehensible sounds = 
Inappropriate words = 3
Patient confused = 4
Patient oriented = 5

Motor response
None = 1
Extends to pain = 2
Flexion to pain = 3
Withdraws from pain = 4
Localized to pain = 5
Obeys commands = 6

Question 41

Where does lumbar puncture go?

Answer 41

L2/3 or L3/4

Question 42

Layers met in lumbar puncture

Answer 42

Trying to get to subarachnoid space

Skin
Subcutaneous tissue
Interspinous ligament
Ligamentum flavum
Epidural space
Dura and arachnoid mater
Subarachnoid space