Exam 5

Question 1

Severe unilateral pain + lacrimation

Answer 1

Cluster headache

Question 2

Management of cluster headache

a) acute
b) prophylactic

Answer 2

a) 100% oxygen, triptan (nasal or subcut)

b) verapamil, prednisolone

Question 3

Treatment for migraine:

a) abortive
b) prophylactic

Answer 3

a) triptan + simple analgesia

b) propanolol, pizotifen, TCA

Question 4

Pain in trigeminal distribution, unilateral, triggered by light touch

Answer 4

Trigeminal neurlagia

Question 5

Throbbing temple pain + jaw claudication + visual loss

Answer 5

Temporal arteritis

Question 6

Features suggesting raised ICP (4)

Answer 6

Worse in the morning and with coughing/bending
Visual disturbance
Papilloedema
Abducens palsy

Question 7

Treatment of raised ICP (2)

Answer 7

Treat the cause

Mannitol IV

Question 8

Intense unilateral eye pain + mid-dilated pupil

Answer 8

Acute angle closure glaucoma

Question 9

Treatment of acute angle closure glaucoma

Answer 9

Miosis with pilocarpine

Question 10

Commonest cause of a stroke in young people

Answer 10

Carotid or vertebral artery dissection

Question 11

Key features in a seizure history?

Answer 11

BEFORE- what was happening, prodrome?
DURING- aura, onset, duration, loss of consciousness, tongue biting, incontinence
AFTER- recovery, any residual weakness

Question 12

Main classification of seizures

Answer 12

Partial (with a focal onset- 2/3 go on to become generalized)
Generalised

Question 13

Seizures:

a) loss of consciousness, limbs stiffen and then jerk
b) brief pauses of around 10 seconds,usually present in childhood
c) seizures provoked by fever in otherwise healthy children; usually brief and tonic/tonic-clonic
d) generalised seizure with brief, rapid muscle jerks
e) focal features + DISTURBANCE OF CONSCIOUSNESS/AWARENESS

Answer 13

a) tonic-clonic seizures
b) absence seizures
c) febrile convulsions
d) myoclonic seizures
e) complex partial seizures

Question 14

First-line prophylactic treatment for

a) generalised seizures
b) partial seizures
c) absence seizures

Answer 14

a) sodium valproate
b) carbamezapine
c) sodium valproate, ethosixumide

Question 15

What is lamotrigine used for in seizure prophylaxis?

Answer 15

2nd line for tonic-clonic, myoclonic, partial seizures

Question 16

Management of status (3)

Answer 16

Airway and breathing
Lorazepam/diazepam
Second line- phenytoin, valproate

Question 17

Definition of status epilepticus?

Answer 17

Seizures lasting more than 30 mins, or repeated seizures without intervening consciousness

Question 18

Side-effects of sodium valproate (5)

Answer 18

Teratogenic-neural tube defects, avoid in pregnancy
Alopecia
Weight gain
Fatigue
Nausea

Question 19

How does sodium valproate work?

Answer 19

Increases GABA activity

Question 20

What dose of folic acid should women taking AEDs be given in pregnancy?

Answer 20

5mg per day starting well before pregnancy