Facial paralysis

Question 1

What is Ramsay Hunt syndrome?

Answer 1

Facial nerve palsy, vertigo and hearinb loss

Question 2

How do you treat Ramsay Hunt syndrome?

Answer 2

Aciclovir

Question 3

How is meningitis treated?

Answer 3

IM benzylpenicillin - only if doesnt delay hospital transfer

Question 4

What is the gold diagnostic for Subarrachnoid harmorrhage?

Answer 4

Lumbar puncture
CSF

Question 5

Treatment for acute migraine

Answer 5

Analgesia: Aspirin, ibuprofen or sumatriptan

Naproxen
Tolfenamic acid
Dclofenac potassium
Paracetemol if unable to have others

Antiemetics:
Metaclopramide, prochlorperazine

Question 6

What does a ruptured berry aneurysm cause?

Answer 6

Sub arrachnoid haemorrhage

Question 7

How do you treat bells palsy? What is the caveat?

Answer 7

Steroids eg prednisone, have to present in 72 hours of symptom onset, for 10 days

Question 8

Symptoms of normal pressure hydrocephalus

Answer 8

Wet, wobbly and weird

Question 9

What is metaclopramide and why is it contraindicated in parkinsons?

Answer 9

Antiemetic, dopamine/5HT3 antagonist, prokinetic

Question 10

Cardiac effect of ondenestron

Answer 10

Increase QT interval + risk of torsades de pointes

Question 11

What is ondestron used for?

Answer 11

anti-emetic 5HT3/serotonin antagonist

Question 12

Treatment for haemorrhagic stroke

Answer 12

Take off anticoagulation
Aggressive BP control - <140 systolic within an hour of admission

Question 13

What is interferon beta used in?

Answer 13

Relapsing remitting MS when able to walk unaided

Question 14

How to treat status epilepticus?

Answer 14

4g IV lorezapam

Question 15

How can isoniazid cause polyneuropathy?

Answer 15

Via B6 deficiency

Question 16

What symptoms does a corticobulbal tract lesion cause?

Answer 16

Pseudobulbar palsy

Question 17

Preventative treatment for migraines

Answer 17

Propanolol
MetoprololBisoprolol esp if cardiac indications
Teratogenic:
Topirimate
Sodium valproate - episodic or chronic migraine

Question 18

How long does Bells palsy take to improve?

Answer 18

3-4 months
Refer if more than 5 months of symptoms

Question 19

When emergency referral for bells palsy

Answer 19

Worsening of existing neurologic findings, or new neurologic findings.
Features suggestive of an upper motor neurone cause (for example limb paresis, facial paraesthesia, other cranial nerve involvement, postural imbalance).
Features suggestive of cancer (for example, gradual onset of symptoms, persistent facial paralysis for more than 6 months, pain in the distribution of the facial nerve, head or neck lesion suggestive of cancer, history of head and neck cancer, hearing loss on the affected side).
Systemic or severe local infection.
Trauma.

Question 20

Ramsay hunt vs bells palsy

Answer 20

Ramsay hunt has a rash and is more paingul, caused by herpes zoster virus

Question 21

What rhythm is a person with a TIA most likely to have?

Answer 21

Atrial fibrillation

Question 22

When consider blood pressure lowering medication in haemorrhagic stroke

Answer 22

Consider rapid blood pressure lowering for patients who present within 6 hours of symptom onset with a systolic blood pressure between 150 and 220 mmHg and who do not fit any exclusion criteria.

Question 23

Treatment for Multiple scleroisis relapse

Answer 23

Oral methylprednisolone as early as possible