DPD: Amir Sam cases

Question 1

Which sites may a lesion causing a neurological pathology be found?

Answer 1

Brain
Spinal cord
Nerve roots
Peripheral nerves
Neuromuscular junction

Question 2

What may cause neurological pathology broadly speaking?

Answer 2

Vascular
Infection
Inflammation/ AI
Toxic/ Metabolic
Tumour/ malignancy

Question 3

State what would be affected by pathology of each of the cranial nerves

Answer 3

I: sense of smell
II: VA, VF, pupils, fundoscopy
III, IV, VI: diplopia
V: sensation, corneal reflex
VII: facial palsy
VIII: hearing
IX, X: Speech, swallowing
XI: Sternocleidomastoid, trapezius
XII: tongue movements

Question 4

Describe the tone, power and reflexes seen in upper motor neurone lesions

Answer 4

Tone: Increased (spasticity)
Power: Decreased
Reflexes: Increased (brisk), upgoing plantar

Question 5

Describe the tone, power and reflexes seen in lower motor neurone lesions

Answer 5

Tone: Decreased (flaccid)
Power: Decreased
Reflexes: Diminished

Question 6

List 3 examples of UMN conditions

Answer 6

Stroke
Multiple sclerosis
Huntingtons disease

Question 7

Using the acronym, list the cerebellar signs

Answer 7

Dysdiadochokinesa
Ataxia
Nystagmus
Intention tremor
Slurred/ staccato speech
Hypotonia

Question 8

How would you locate the lesion based on the distribution of abnormal sensation?

Answer 8

Cerebral cortex: Hemisensory loss
Spinal cord: reduced up to certain Level
Nerve roots (Radiculopathy): Dermatome
Mononeuropathy: Specific area
Polyneuropathy: Glove + stocking

Question 9

Considering the broad causes of pathology, what can cause peripheral neuropathy?

Answer 9

Vascular: No.
Infection: HIV
Inflammation/ AI: Vasculitis, CTD, inflammatory demyelinating neuropathy
Toxic/ Metabolic: DM, Alcohol, B12 deficiency
Tumour/ Malignancy: Paraneoplastic feature

Question 10

Give 3 symptoms of papillitis (optic neuritis at head of optic nerve)

Answer 10

Blurred vision
Blurred optic disc margins
Pain on eye movement

Question 11

What features are suggestive of MS?

Answer 11

2 lesions

Separated in time + space

Question 12

Give 4 differentials for apparent confusion and decreased AMTS

Answer 12

Post-ictal (post seizure)
Dysphasia
Dementia
Depressive pseudo dementia

Question 13

Describe the GCS

Answer 13

Eyes
4 = Spontaneous 
3 = Opens in response to voice
2 = Opens in response to painful stimuli
1 = Does not open 

Verbal response
5 = Oriented
4 = Confused
3 = Words
2 = Sounds
1 = No sounds

Motor response
6 = Obeys commands
5 = Localizes pain
4 = Withdraws to painful stimuli
3 = Abnormal flexion
2 = Extension
1 = No movements

Question 14

List the 10 components of AMTS

Answer 14

DOB
Age
Time
Year
Place
Recall (West Register Street)
Recognize doctor + nurse
PM/ Monarch
Date of 2nd WW
Count backwards from 20 to 1

Question 15

Give 3 signs of meningitis

Answer 15

Fever
Neck stiffness
Kernig’s sign (lying on back, pain on straightening knee)

Question 16

Give 4 signs of a migraine

Answer 16

Throbbing headache
Vomiting
Photo/ photophobia
Aura

Question 17

What indicates SAH? What should yo do?

Answer 17

Sudden onset headache
CT
LP (xanthochromia)

Question 18

What makes you suspect GCA as cause of headache? What measurement may be found? What should you do?

Answer 18

> 50s
High ESR
Urgent steroids e.g. prednisolone
Biopsy

Question 19

How do you manage a patient presenting with stroke within 4.5 hours of onset?

Answer 19

CT

If no haemorrhage- Thrombolysis

Question 20

How do you manage a patient presenting with stroke after 4.5 hours of onset?

Answer 20

CT head (exclude haemorrhage)
Aspirin (300mg, swallow assessment)
Maintain hydration, oxygenation

Question 21

How do you manage a patient presenting with TIA?

Answer 21

Aspirin
Don't treat BP acutely (unless >220/120)
ECG
Echo
Carotid doppler
Risk factor modification