FRACP questions

Question 1

Meniere disease

Answer 1

Question 2

HINTS test in ongoing vertigo

Answer 2

Question 3

DBS in PD

Answer 3

Question 4

Stroke vs stroke mimic

Answer 4

Question 5

Thrombectomy in acute stroke mgt

Answer 5

Question 6

Tenecteplase vs alteplase for best outcome prior to performing endovascular thrombectomy

Answer 6

Question 7

Brown Sequard syndrome

Answer 7

Hemisection of the spinal cord

Extent of symptoms depend on level of injury but hey always include:

• contralateral loss of pain and temperature sensation
• ipsilateral loss of fine touch and vibratory sensation
• ipsilateral loss of motor function

Pure brown-sequard syndrome is rare

Common causes are trauma, tumor, ischaemic/infarction and MS

Question 8

Rubrospinal tract

Answer 8

Question 9

Transverse myelitis

Answer 9

Question 10

Optic neuritis

Answer 10

Question 11

Multiple Sclerosis features

Answer 11

Question 12

CLIPPERS

Answer 12

Question 13

Progressive multifocal leukoencephalopathy

Answer 13

Question 14

Ocrelizumab used in which MS?

Answer 14

Question 15

BPPV

Answer 15

Question 16

Essential tremor

Answer 16

Question 17

Tremor in PD

Answer 17

Question 18

Right parietal infarct

Answer 18

hemiparesis + homonymous quadrantopia and hemispatial neglect

Lesion in occipital lobe - also homonomous hemianopia but with macular sparing

Question 19

pneumonic PITS for quadrant hemianopias location

Answer 19

Parietal - inferior

Temporal - superior

Question 20

PRES

Answer 20

Posterior reversible encephalopathy syndrome

• Assoc with HTN, kidney disease, malignancy, dialsyis dpendency

Refers to a syndrome of reversible subcortical vasogenic oedema in patients with acute neurological symptoms.

Early brain MRI usually demonstrates ivasogenic oedema in the parieto-occipital regions of both cerebral hemispheres.

Common presentations:

• seizure (85% of cases), headachee, amaurosis, altered mental status, N+V, transient motor deficits.

If recognized and treated promptly (aggresive BP management by 20% of MAP and seizure management and supportive care) - rapid onset symptoms and radiological features usually resolve within days to weeks.

Question 21

Normal pressure hydrocephalus

Answer 21

Normal pressure hydrocephalus charterized by 3 things:

1. gait impairment (gait apraxia)
2. dementia
3. urinary incontiennce

Treatment = CSF drainage, surgical placement of VP shunt

Question 22

Question 23

Wallenbergs syndrome

Answer 23

• *_Posterior inferior cerebellar artery (vertebral)
• Lateral med_ullary (Wallenberg) syndrome** (PICA or vertebral artery occlusion)
• vertigo, diplopia (due to vestibular nuclear involevemtnet)
• hoarseness, dysarthria (involvement of nucleus ambiguus)
• numbness of ipsilateral face (trigeminal spinal nucleus) and contralateral limb loss of pain and temp (due to spinothalamic tract)
• ipsilateral horner’s

Question 24

Cluster headache

Answer 24

strictly unilateral phonophobia and photophobia

same side as cluster ehadache

Question 25

**When to CT prior to LP?**

Answer 25

1. presence of papilloedema 2. recent ehad trauma on hx 3. konwn or suspected intracranial lesions 4. focal neurological fidnings 5. depresed level of consciousness

Question 26

IIH treatment options

Answer 26

WEIGHT loss, acetazolamide, frusemide, topirmate in the past Corticosteroids - more harm then benefit

Question 27

Gene mutation linked with FALS

Answer 27

SOD1 mutation

Question 28

Which ix is most useful in making the diagnosis of motor neuron disease?

Answer 28

EMG - electromyogram! Denervation is afeature in all forms of MND except primary lateral scleorosis us confirmed on EMG. Chronic partial denervation with preserved motor conduction velocity is characteristic,

Question 29

Kennedys syndrome

Answer 29

X-linked disorder No UMN signs Assoc with gynomastia and infertility LMN disease - progressive weakness and wasting limb and bulbar muscles begins in malesin mid-adult life and is conjoined with androgen insensitivity and manifested by gynaecomastia and reduced fertility. Two distiingushin features from ALS are the **absence of signs of pyramidial tract disease (spasticity) and the presence of a subtle sensory neuropathy in some patients**

Question 30

In MND which intervention most likely to prolong survival?

Answer 30

NIV

Question 31

Riluzole

Answer 31

**sodium channel blocker that inhibits glutamate release**

Question 32

Primary muscular atrophy vs primary lateral sclerosis

Answer 32

Primary muscular atrophy = LMN signs OINLY Primary lateral sclerosis = UMN signs ONLY

Question 33

Amytrophic lateral sclerosis

Answer 33

LAS = UMN + LMN + bulbar dysfunction + respiratory failure. Also cramps and fasciulations

Question 34

Most common cause of death in MND?

Answer 34

Respiratory failure

Question 35

Carnazepine pharmacology

Answer 35

Question 36

Phenytoin side effects

Answer 36

* osteoporosis * ataxia * nystagmus * gingival hyperplasia * coursenung f facial features * loss of libido * hormone dysfunction * bone marroe hypoplasia

Question 37

Which AED has the most teratogenic effect in pregnancy?

Answer 37

VALPROATE (VERY bad) major malformations - congenital heart disease, neural tube defects, urogenital defects and cleft lips or palates

Question 38

Vigabatrin side effects

Answer 38

Drowsiness (most common), neuropsych symptoms, weigth gain, visual field changes

Question 39

Topiramate

Answer 39

Weight loss

Question 40

AED choice in combination with OCP?

Answer 40

Sodium valproate

Question 41

Which drug should be avoided in Juvenile myoclonic epilepsy?

Answer 41

Carmabazepine - may aggravate JME, so it is important to uncover any history of jerking, especially in the morning

Question 42

What is the **most common** symptom of excess levodopa?

Answer 42

Nausea and vomiting