Extra neuro questions

Question 1

Absolute CI to thrombolysis x11

Answer 1

Previous haemorrhagic stroke 
Suspected SAH 
LP in the last 7 days 
Stroke or traumatic brain injury last 3 months
Seizure at onset of stroke 
Intracranial neoplasm 
Active bleeding
GI haemorrhage last 3 weeks
Oesophageal varices
Pregnancy 
Uncontrolled HTN >200/120

Question 2

Relative CI to thrombolysis

Answer 2

Major surgery or trauma last 2 weeks
Concurrent anticoagulation with INR >1.7
Bleeding diathesis (predisposition to bleeding)
Suspected intracardiac thrombus
Active diabetic haemorrhagic retinopathy

Question 3

Features of normal pressure hydrocephalus

Answer 3

Dementia, urinary incontinence and gait abnormalities

Question 4

Diagnosis of normal pressure hydrocephalus

Answer 4

Diagnostic CSF removal (draining lumbar puncture etc)

Will cause improvement in symptoms

Question 5

Management of normal pressure hydrocephalus

Answer 5

Surgical CSF shunting

Question 6

First line for neuropathic pain

Answer 6

Amitryptilline
Gabapentin
Pregabalin
Duloxetine

Question 7

First line for trigeminal neuralgia

Answer 7

Carbamazepine

Question 8

What is intranuclear opthalmoplegia

Answer 8

Cause of horizontal disconjugate eye movement
Due to lesion in medial longitudinal fasciculus
Impaired adduction of eye on same side as lesion
Nystagmus of abduction of eye on other side

Question 9

Causes of intranuclear opthalmoplegia

Answer 9

MS

Vascular disease

Question 10

Antibodies in GBS

Answer 10

Anti-ganglioside - present in MIller-Fischer

25% of GBS

Question 11

Infective agent in GBS

Answer 11

Commonly campylobacter jejuni

Question 12

What causes huntington disease

Answer 12

Trinucleotide repeat expansion (CAG) in huntingin gene on chromosome 4p- autosominal dominant inheritance - exhibits anticipation

Question 13

Initial features of HTD

Answer 13

Insidious onset in middle-age, fidgeting and clumsiness
Develops into involuntary, jerky, dyskinetic movements
Grunting and dysarthria

Question 14

Late disease features of HTD

Answer 14

Rigid

Akinetic and bed-bound

Question 15

Cognitive abilities in HTD

Answer 15

Early cognitive, emotional and behavioural changes - lability, dysphoria, anxiety and then dementia

Question 16

Examination signs of HTD

Answer 16

Chorea, dysarthria
Slow voluntary saccades and supranuclear gaze restriction
Parkinsonism and dystonia ( especially juvenile onset)

Question 17

How many repeats needed for HTD diagnosis

Answer 17

> 39 CAG repeats

27-39 exist with reduced penetrance

Question 18

What is seen on CT/MRI in HTD

Answer 18

Symmetrical atrophy of striatum (esp, caudate nuclei)

Butterfly dilation of lateral ventricles

Question 19

Treatment of chorea in HTD

Answer 19

Dopamine-depleting drugs (reserpine, tertabenazine)

Benzo’s

Question 20

Prognosis of HTD

Answer 20

Most die 15-20years after first onset of symptoms - usually from resp infection

Question 21

How does inclusion body myositis differ from other inflammatory myopathies (dermato and polymyositis)

Answer 21

Can cause neck droop (affects erector spinae muscles) and dysphagia
Insidious onset over months-years
Most common in >50 yr old

Question 22

Distinguishing features of CSF on varying meningitis

Answer 22

Bacterial - cloudy, high neutrophils, high protein and low glucose
Viral - high lymphocytes and protein and normal glucose
TB - fibrinous CSF, high lymphocytes and protein and low glucose

Question 23

Treatment of meningitis

Answer 23

Cefotaxime
Benzylpenicllin good for meningococcus
Amox + gent for listeria
Chloramphenicol if penicillin allergic

Also dexamethasone IV (QDS for 4 days)

Question 24

Prevalence of migraines in men and women

Answer 24

Men 6% and women 18% therefore 3x more common in women

Question 25

What is Alport syndrome

Answer 25

Genetic condition with sensorineural hearing loss, kidney dysfunction (haematuria and proteinuria) and vision problems

Question 26

What is pendred syndrome

Answer 26

Genetic disorder leading to bilateral sensorineural hearing loss and goitre with euthyroid or slightly hypothyroid