Head, Neck And Neuro

Question 1

How would you manage a patient with a pinna haematoma?

Answer 1

Prompt drainage and measures to prevent re-accumulation.

Question 2

How would you manage a patient with otitis media with effusion?

Answer 2

Grommet if doesn’t resolve spontaneously within 2-3 months.

Question 3

How would you manage a patient with a septal haematoma?

Answer 3

Aspirate and pack.

Question 4

How would you manage a patient with a head or neck cancer?

Answer 4

Medical - chemotherapy and radiotherapy.
Surgical - assessment, biopsy, excision, reconstruction.
Supportive - swallowing, assisted feeding, voice rehab, pain relief, supportive care.

Question 5

How would you manage a patient with hydrocephalus as a result of spina bifida?

Answer 5

Shunt

Question 6

How would you manage a patient with Parkinson’s disease?

Answer 6

Levodopa (with carbidopa, can be given in a combination).
Dopamine receptor agonists eg bromocriptine which is ergot derived, or ropinirole which is non-ergot derived. Apomorphine for patients with severe motor fluctuations.
COMT inhibitor eg entacapone.
MAOI Type B inhibitors eg selegiline.
Anticholinergics eg orphenadrine.
Amantidine.
Surgery eg lesion (thalamus for tremor, globus pallidus interna for dyskinesia) or deep brain stimulation of the subthalamic nucleus.

Question 7

How would you manage a patient with depression?

Answer 7

First line -SSRI eg citalopram, fluoxetine.
Tricyclics antidepressants eg amitriptyline.
Serotonin/noradrenergic reuptake inhibitor eg venlafaxine.
Monoamine oxidase inhibitor.
Antipsychotics - typical eg haloperidol or atypical eg risperidone.
Anxiolytics - benzodiazepines eg lorazepam, diazepam, midazolam.
CBT/counsellor.
Social - carry on working etc.

Question 8

How would you manage a patient with epilepsy with primary generalised tonic-clonic seizures?

Answer 8

Sodium valproate.

Lamotrigine (least teratogenic for women of child bearing age).

Question 9

How would you manage a patient with epilepsy with partial seizures?

Answer 9

Sodium channel blocker - Carbamazepine or Lamotrigine (least teratogenic for women of child bearing age).

Question 10

How would you manage a patient with status epilepticus or an acute seizure that has not terminated in 5 minutes?

Answer 10

Benzodiazepines eg lorazepam IV, midazolam buccal, diazepam rectally.
Phenytoin (sodium channel blocker).

Question 11

How would you manage a patient with myasthenia gravis?

Answer 11

Acetylcholinesterase inhibitors eg pyridostigmine.
Corticosteroids.
Steroid sparing treatments eg azathioprine.
IV immunoglobulin in an acute decline or crisis.
Plasmapheresis.
Antimuscarinics eg pyridostigmine.

Question 12

How would you manage a patient with anxiety?

Answer 12

Non pharmacological eg CBT.
Antidepressants eg SSRIs.
GABA analogue - pregabalin.
Anxiolytics - benzodiazepines eg diazepam, lorazepam (not long term).
Antipsychotics.

Question 13

How would you manage a patient with paranoid schizophrenia?

Answer 13

Typical antipsychotics eg haloperidol.
Atypical antipsychotics eg risperidone.
Clozapine.

Question 14

How would you manage a patient with bipolar disorder?

Answer 14

Mood stabilisers eg lithium, sodium valproate, carbamazepine, lamotrigine, antipsychotics.

Question 15

How would you treat toxicity from lithium?

Answer 15

Supportive measures.
Anticonvulsants.
Increased fluid intake/IV fluids.
Haemodialysis may be necessary.

Question 16

How would you treat benzodiazepine overdose?

Answer 16

Support.

Flumazenil.

Question 17

How would you manage a patient with dementia?

Answer 17

Acetyl cholinesterase inhibitors eg donepezil, galantamine, rivastigmine.
NMDA antagonist eg memantine.
Social care eg risk assessment and mental capacity act.
Memory aids eg orientation boards and remembrance therapy.
Therapies eg babies and pets.

Question 18

How would you manage a seizure in an emergency setting?

Answer 18

ABCDE approach.

Give benzodiazepines eg lorazepam or midazolam either PR or buccal pre-hospital, or IV in hospital.

Question 19

How would you manage a patient with idiopathic intracranial hypertension?

Answer 19

Weight loss.
Medical management using drugs eg carbonic anhydrase inhibitors.
CSF drainage (therapeutic lumbar puncture) and shunts.

Question 20

How would you manage a patient with raised ICP due to increased cerebral blood volume?

Answer 20

Anticoagulantion.

Tenting of venous sinuses.

Question 21

How would you manage a patient with raised ICP due to cerebral oedema?

Answer 21

Mannitol (osmotic agent).

Hypertonic saline.

Question 22

How would you manage a patient with raised ICP due to increased CSF?

Answer 22

Ventriculoperitoneal shunts.
Tumour resection.
Diuretics whilst awaiting intervention eg furosemide, carbonic anhydrase inhibitors.

Question 23

How would you manage a patient with raised ICP due to an expanding mass?

Answer 23

Surgical resection eg craniotomy.

Steroids for brain tumours.

Question 24

How would you manage a patient with a basilar skull fracture?

Answer 24

Traumatic brain injury management including ICP control.
Seek and treat complications.
Elevation of depressed skull fractures.
Surgery for persistent CSF leak.

Question 25

How would you manage a patient with an extradural haemorrhage?

Answer 25

ABCDE approach.
Small EDH observe and manage conservatively with neurological follow up.
Large EDH requires referral to neurosurgery for craniotomy and clot evaluation.

Question 26

How would you manage a patient with a subdural haemorrhage?

Answer 26

Small chronic haematomas monitored with serial imaging.
Acute SDH needs immediate neurosurgical intervention (burr hole or craniotomy).
Symptomatic subacute/chronic SDH often treated with one or more burr holes.

Question 27

How would you manage a patient with a subarachnoid haemorrhage?

Answer 27

Stabilise patien - ITU.
Prevent rebleeding.
Treat cerebral vasospasm.
Correct hyponatraemia.
Neurosurgical intervention if large bleed.

Question 28

How would you manage a patient with OCD?

Answer 28

CBT.
Exposure response prevention.
High dose long term SSRIs.
Augmentation with antipsychotics.
TCA - clomipramine.
For treatment resistance OCD - deep brain stimulation (subthalamic nucleus).

Question 29

How would you manage a patient with post traumatic stress disorder?

Answer 29

Medical treatment eg SSRIs.
CBT.
Eye movement desensitisation.
Reprocessing (EMDR).

Question 30

How would you manage a patient with a spinal cord injury?

Answer 30

Consider intubation (if C5 or above).
ICU admission.
Early immobilisation of the C-spine.
Retain C-spine restriction for 6 weeks.
PT/OT.
Surgical if progressive neurological deficits or an unstable spine fracture.