General

Question 1

What are two clinical signs of meningism?

Answer 1

Kernig’s sign (knee flexion + extension elicits pain) + Brudzinski sign (passive flexion of neck illicits flexion of knee). Both are signs of meningism. Observed in SAH

Question 2

New acute back pain + bilateral weakness + cancer.

a. osteomalacia
b. prolapsed disc
c. spinal cord compression
d. vertebral fracture

Answer 2

spinal cord compression

Question 3

Which drug should be used for the secondary prevention of stroke in a patient with AF?

Answer 3

DOAC e.g. apixaban

Question 4

Which drug is first line in the secondary prevention of stroke?

Answer 4

clopidogrel

Question 5

Which spinal tract mediates fine touch, vibration, and proprioception?

Answer 5

dorsal column

Question 6

Which spinal tract mediates pain and temp?

Answer 6

lateral spinothalamic tract

Question 7

Which is the motor tract of the spinal cord?

Answer 7

lateral corticospinal tract

Question 8

Which nerves are parasympathetic?

Answer 8

Cranial 3, 7, 9, 10

S2-S4

Question 9

Which nerves are sympathetic?

Answer 9

T1-L2 cell bodies

Question 10

List three signs of UMN lesion

Answer 10

Hyperreflexia
Up-going plantars/positive babinski
spasticity: tone +- clonus
pyramidal weakness: extensors in UL and flexors in LL
no wasting

Question 11

List three signs of LMN lesion

Answer 11

wasting
fasiculation
flaccidity: reduced tone
hyporeflexia
down-going plantars

Question 12

What is the pattern of Brown-Sequard syndrome?

Answer 12

ipsilateral loss of proprioception/vibration and motor weakness with contralateral loss of pain

Question 13

Which spinal tract mediates crude touch?

Answer 13

anterior spinothalamic tract

Question 14

What are the two divisions of the dorsal columns?

Answer 14

fasciculus gracilis- lower trunk and legs

fasciculus cuneatus- upper trunk and limbs

Question 15

Differentials for brown sequard syndrome?

Answer 15

penetrating trauma to neck or back
ischaemia
infectious of inflammatory process e.g. MS, TB

Question 16

Name three signs of cerebellar syndrome

Answer 16

DANISHP
Dysdiadochokinesia
Ataxia
Nystagmus- horizontal 
Intention tremor
Speech
Hypotonia
Past pointing

Question 17

State three causes of cerebellar syndrome

Answer 17

Alcohol- B12 and thiamine deficiency
Sclerosis
Tumour
Stroke- vertebrobasilar
Paraneoplastic

Question 18

Differentials for black out?

Answer 18

CRASH
Cardiac: brady, tachy, structural (LVF, AS, tamponade, PE)

Reflexes: vagal over-activity (vasovagal) and sympathetic under-activity

Arterial: shock, HTN, migraine, TIA, CVA

Systemic: metabolic (hypoglycaemia), anaemia, hypoxia

Head: epilepsy, drop attacks?

Question 19

Patient with vertigo, hearing loss in right ear, tinnitus, and absent corneal reflex. What is the diagnosis?

Answer 19

acoustic neuroma= vestibular schwannoma

Question 20

Name a special test for MS?

Answer 20

Hoffman’s sign- use to assess for UMN conditions
Hoffmans sign is elicited by flicking the distal phalaynx of the middle finger to cause momentary flexion. A positive result is exaggerated flexion of the terminal phalanyx of the thumb.