Exam 2

Question 1

Drugs which can cause parkinsonism(2)

Answer 1

Anti-emetics e.g. metoclopramide

anti-psychotics

Question 2

Four cardinal symptoms of Parkinsons disease

Answer 2

Resting tremor
Rigitidy
Bradykinesia
Postural/gait impairment

Question 3

Non-motor symptoms of Parkinsons disease (4)

Answer 3

Depression
Constipation
Hyposmia
Dementia

Question 4

Poor levodopa response suggests..

Answer 4

Vascular parkinsonism

Question 5

Postural tremor, symmetrical which improves with alcohol

Answer 5

Essential tremor

Question 6

Causes of a flapping tremor (3)

Answer 6

Liver disease
Renal failure (uraemia)
Hypercapnia

Question 7

Aetiology of an intention tremor

Answer 7

Cerebellar lesion/alcohol

Question 8

Causes of chorea (2)

Answer 8

Huntingtons disease
Sydenhams chorea (post-strep)

Question 9

First-line management of Parkinsons disease (2)

Answer 9

Levodopa+ decarboxylase inhibitor e.g. carbidopa to reduce peripheral metabolism of dopamine

Question 10

Adverse effects of levodopa (3)

Answer 10

On-off effect
Reduced effectiveness with time
Dyskinesia

Question 11

Bromocriptine is an example of what? Give two other drugs in the same class

Answer 11

Dopamine agonist. Cabergoline, ropinorole

Question 12

Adverse effects of dopamine agonists (3)

Answer 12

Excessive daytime somnolence
Impulse control disorders
Fibrosis

Question 13

Inflammatory demyelinating disease of the CNS presenting with focal neurological deficit

Answer 13

Multiple sclerosis

Question 14

Demyelination of the medial longitudinal fasciculus causes…

Answer 14

Internuclear opthalmoplegia- failure of adduction of contralateral eye during lateral gaze with nystagmus in abducting eye

Question 15

Investigations in MS:

a) LP
b) MRI
c) evoked potentials

Answer 15

a) oligoclonal bands in CSF- represents IgG reponse in the CNS
b) high-signal plaques
c) delayed

Question 16

Management of acute exacerbations of MS

Answer 16

Steroids- if severe, admit and give IV

Question 17

In MS, what is a) amantadine and b) modafinil indicated for?

Answer 17

a) fatigue

b) daytime somnolence

Question 18

Disease modifying treatment in MS? (2) What is the aim of this?

Answer 18

Interferon beta
Glitiramer acetate.
Reduce relapse rate in relapsing-remitting MS.

Question 19

Electric-shock like sensation caused by neck flexion? What other conditions is this caused by?

Answer 19

Lhermitte’s phenomenon

Cervical spondylosis, SCDC, cord tumours

Question 20

Symptoms/signs of optic neuritis (4)

Answer 20

Blurred vision
Washed-out colours
Eye pain
Relative afferent pupillary defect

Question 21

Commonest brain region affected in stroke and symptoms of this (3)

Answer 21

Middle cerebral artery
Contralateral hemiparesis and sensory loss (upper>lower)
Contralateral homonymous hemianopia
Aphasia

Question 22

How does the hemiparesis/sensory loss in anterior cerebral artery strokes differ from middle?

Answer 22

Affects more the lower limb than the upper

Question 23

Ataxia + disorders of gaze and vision/other cranial nerve lesions: stroke location?

Answer 23

Posterior circulation

Question 24

Indications for thrombolysis (2)

Answer 24

Haemorrhagic stroke excluded on CT

Patient is within 4.5 hours of symptoms

Question 25

Secondary prevention of stroke

Answer 25

Control of blood pressure, cholesterol, diabetes
Clopidogrel as an antiplatelet
Warfarin for cardio-embolic stroke

Question 26

Agent and dose used for thrombolysis

Answer 26

Recombinant tissue plasminogen activator, 0.9mg/kg/hour