General Neuro

Question 1

Chrom Tuberous sclerosis

Answer 1

AD: chromosome 9 & 16

Question 2

Sx. Tuberous sclerosis

Answer 2

• depigmented ‘ash-leaf’ spots which fluoresce under UV light
• Shagreen patches -roughened patches of skin over lumbar spine
• angiofibromas adenoma sebaceum butterfly distribution over nose
• subungual fibromata -fibromata beneath nails
  café-au-lait spots*
• retinal hamartomas: dense white areas on retina (phakomata)
• rhabdomyomas of the heart
• gliomatous changes can occur in the brain lesions
• polycystic kidneys, renal angiomyolipomata
• lymphangioleiomyomatosis: multiple lung cysts

Question 3

Neuro sx of friedreichs ataxia

Answer 3

Absent ankle jerks
Cerebellar ataxia
Optic atrophy
Spinocerebeller degen

Question 4

3rd nerve palsy causes

Answer 4

Dm
Vasculities
Icp
Pica
Cavernous sinus thrombosis
Webber’s

Question 5

Sx of otosclerosis

Answer 5

Family Hx
Conductive hearloss
Flamingo tinged tympanic
Tinnitus

Question 6

Lesion C6

Answer 6

Bicep & lat aspect of arm
Weakness in elbow flexion

Question 7

Nerve root damage C5

Answer 7

Weakness of shoulder Abduction

Question 8

Nerve root damage C7

Answer 8

Supplies triceps,
sensation middle 3 fingers
Weakness of elbow extension

Question 9

Nerve root damage C8

Answer 9

Wrist flexion
Little finger sensation

Question 10

Nerve root damage T1

Answer 10

Finger Abduction

Question 11

Blood storm on fundoscopy
And Rx

Answer 11

retinal vein occlusion
Rx VEGF

Question 12

What Nerve causes Wasting of thenar eminence diminish sensation over tip of finger 2 &3?

Answer 12

Distal median
Like carpal tunnel sny.

Question 13

What Nerve causes loss of sensation to the dorsum of the hand

Answer 13

Distal radian nerve

Question 14

What Nerve causes wrist drop, & weakness in extension of thumb and fingers

Answer 14

Proximal radial nerve

Question 15

Loss of sensation to little finger, wasting of the hypothenar

Answer 15

Ulnar

Question 16

Painless loss of vision + cario hx and pale retina
Rx

Answer 16

Central artery occlusion
rx acetazolamide

Question 17

Fluctuating confusion/consciousness? -

Answer 17

subdural haematoma

Question 18

single brain lesions with homogenous enhancement

Answer 18

• CNS lymphoma

Question 19

usually single or multiple ring enhancing lesions, mass effect may be seen

Answer 19

Toxoplasmosis

Question 20

RX Toxoplasmosis

Answer 20

sulfadiazine and pyrimethamine

Question 21

CNS lymphoma
-associated virus
-Rx

Answer 21

EBV
-steroids (may significantly reduce tumour size),
- chemotherapy (e.g. methotrexate) + with or without whole brain irradiation.
Surgical may be considered for lower grade tumours

Question 22

CT: oedematous brain +HIV

Answer 22

Encephalitis

Question 23

CSF in Cryptococcus
-Special test
- CT

Answer 23

high opening pressure
elevated protein
reduced glucose
normally a lymphocyte predominance but in HIV white cell count many be normal
India ink test positive
CT: meningeal enhancement, cerebral oedema

Question 24

CT: single or multiple lesions, no mass effect, don’t usually enhance. MRI is better - high-signal demyelinating white matter lesions are seen

Answer 24

pogressive multifocal leukoencephalopathy (PML)
widespread demyelination
due to infection of oligodendrocytes by JC virus (a polyoma DNA virus)

Question 25

CT: single enhancing lesion

Answer 25

Tuberculosis
much less common than toxoplasmosis or primary CNS lymphoma

Question 26

Isoniazid effect on P450 system

Answer 26

inhibits
INR has increased

Question 27

Cerebellar tonsillar herniation sx

Answer 27

medulla oblongata and is often a terminal event in an unconscious patient resulting in asystolic cardio-respiratory arrest.

Question 28

trans-tentorial, or uncal, herniation sx

Answer 28

combination of a fixed and dilated pupil with an eye deviated inferiorly and laterally (‘down and out’) is indicative of a third nerve palsy. In the context of a decreasing conscious level and an intracranial mass (the haematoma)

Question 29

SE Isoniazid- (3) and preventative measure

Answer 29

this is a CYP450 enzyme inhibitor
-drug-induced lupus
- peripheral neuropathy.
Therefore pyridoxine is given which is a vitamin B6 and this reduces the risk of neuropathies.

Question 30

Cushing reflex

Answer 30

is a physiological nervous system response to increased intracranial pressure (ICP)
- hypertension
- bradycardia

Question 31

paralysis of all intrinsic hand muscles

Answer 31

C8-T1 nerve root damage i.e. Klumpke’s paralysis.

Question 32

Erb’s palsy is

Answer 32

damage to the C5-6 nerve root.
-loss of sensation in the arm
-paralysis of the deltoid, biceps, and brachialis muscles

Question 33

facial and contralateral body loss of pain sensation along with nystagmus and ataxia

Answer 33

lateral medullary syndrome.
-
posterior inferior cerebellar artery (PICA)

An anterior inferior cerebellar artery infarct would present in the same way but with the additional symptoms of a same-sided facial weakness and loss of hearing

Question 34

Cause of distal muscle wasting

Answer 34

Charcot-Marie-Tooth
Features:
There may be a history of frequently sprained ankles
Foot drop
High-arched feet (pes cavus)
Hammer toes
Distal muscle weakness
Distal muscle atrophy
Hyporeflexia
Stork leg deformity

Question 35

Painful third nerve palsy

Answer 35

posterior communicating artery aneurysm

Question 36

Nimodipine use

Answer 36

prevent vasospasm in aneurysmal SAH

Question 37

Ataxia, ophthalmoplegia , areflexia

Answer 37

Miller fisher

Question 38

Ptosis, widen mediastinum

Answer 38

thyroma mysina

Question 39

Swollen pale optic disk

Answer 39

GCA

Question 40

CSF :
very High Proteins
Low glucose & Lymph

Answer 40

TB
Differential: listeria

Question 41

CSF :
High Proteins
Low glucose & Lymph

Answer 41

listeria

Question 42

Tingling medial aspect of hand

Answer 42

Medial epicondyle