Functional / Radiology / Drugs / DVLA

Question 1

What are functioning neurological symptoms

Answer 1

Change in function of brain rather than structure causing Sx
Blackout
Paralysis
Abnormal movement

Question 2

How do you investigate

Answer 2

EEG
MRI
All normal

Question 3

What are positive functional signs

Answer 3

Hoover +ve
Inverted pyramidal weakness
Functional sensory disturbance down midline
Tremor disappears if distracted

Question 4

What is Hoover

Answer 4

Hip extension weak if tested directly

Normal when opposite hip is flexed

Question 5

What is inverted pyramidal weakness

Answer 5

Normally extensor weaker in arm if lesion

But flexor weaker

Question 6

How do you Rx

Answer 6

Refer psych
Rehab
CBT
Support

Question 7

When are MRI useful for Dx

Answer 7

Epilepsy
MS 
Neuro Sx from back 
Degeneration of spine
Malignancy 
Paeds neuro

Question 8

When can you not perform MRI

Answer 8

Electronic / metal implants
Programmable shunts
Insulin pumps
Claustrophobia
Pregnancy

Question 9

When are CT’s indicated

Answer 9

Stroke 
Head trauma
Headache
Malignancy
Post surgery of hydrocephalus and haemorrhage

Question 10

When should you not perform

Answer 10

Minor head trauma

Seizure - do MRI

Question 11

What is SPECT

Answer 11

Useful in Alzheimer’s

Question 12

When is DAT useful

Answer 12

Parkinson’s

Don’t take up as much tracer

Question 13

What is carbamazepine useful for

Answer 13

1st line partial seizure
1st line trigeminal neuralgia
Neuropathic pain
Bipolar disorder

Question 14

What are AE

Answer 14

P450 inhibitor 
Ataxia
Dizzy
Headache 
Diplopia
SJS 
Leucopenia
Agranulocytosis
Hyponatraemia due to 2 ADH

Question 15

SE of lamotrigdine (Na blocker)

Answer 15

SJS

Similar to SV

Question 16

What does phenytoin do

Answer 16

Binds to Na channel
Increases refractory
p450 inducer

Question 17

What are acute SE

Answer 17

Dizzy
Diplopia
Slurred speech
Nystagmus
Ataxia
Confusion
Seizures

Question 18

What are chronic SE

Answer 18

Gingival hyperplasia
Hirsutism
Coarse facial features
Drowsy
Metagloblastic anaemia due to folate
Peripheral neuropathy
LN 
Dyskinesia
Drug induced lupus

Question 19

Other SE

Answer 19

Rash
Fever
Hepatitis
Dupytrens
Anaemia
Lupus

Question 20

Teratogenic causing

Answer 20

Cleft

Congenital heart disease

Question 21

How do you monitor

Answer 21

Trough levels before each dose

Question 22

What is sodium valproate used for

Answer 22

1st line generalised seizures

Question 23

How does it work

Answer 23

Increased GABA

P450 inhibitor

Question 24

What are the SE

How do you monitor

Answer 24

Increased appetite and weight gain
Nausea 
Alopecia 
Ataxia
Tremor
Hepatotoxicity
Pancreatitis
Thrombocytopenia
Hyponatraemia
Teratogenic

FBC + LFT prior
LFT throughout Rx

Question 25

If stroke / TIA

Answer 25

1 month of driving

No need to inform DVLA

Question 26

If multiple TIA’s over a short period of time

Answer 26

3 months of driving

Inform DVLA

Question 27

Craniotomy

Answer 27

1 year of driving

Question 28

Narcoplexy / cataplexy

Answer 28

Cease driving

Can start when satisfactory control of symptoms

Question 29

Chronic neuro disorders e.g. MS / motor neuron

Answer 29

Inform DVLA

Complete PK1

Question 30

Seizure

Answer 30

6 months if isolated

1 year epilepsy free if known epilepsy

Question 31

Narcolepsy

Answer 31

Dx = Sleep EEG
Rx = modafinil in day or Na oxybute at night