Meeran Book Neuro

Question 1

What is Brown-Sequard syndrome?

Answer 1

A hemisection in the spinal cord leading to contralateral loss of pain and temperature and ipsilateral loss of fine touch, vibration, proprioception and movement

Question 2

What is the management of MS?

Answer 2

A course of oral prednisolone

Question 3

What is the main risk factor for stroke?

Answer 3

Hypertension

Question 4

Do jerky movements during a collapse indicate seizure?

Answer 4

No, any cause of collapse can cause some limb jerking

Question 5

What are the signs on opthalmoscopy of retinal artery occlusion?

Answer 5

Cherry red fovea and oedema

Question 6

What are the absolute contraindications for thrombolysis?

Answer 6

• Bleeding disorder
• Recent haemorrhage
• Trauma
• Surgery
• Acute cerebrovascular event

Question 7

What is most affected in diabetic neuropathy?

Answer 7

Vibration and proprioception

Question 8

What is the Parkinsonian gait?

Answer 8

Narrow based shuffling gait

Question 9

How often should headache patients take analgesia?

Answer 9

No more than two days per week, to avoid medication overuse headaches

Question 10

What is the management of migraines?

Answer 10

• Conservative
• Sumatriptan (IV in an acute setting)
• Beta blockers, prophylactically

Question 11

What is a complex partial seizure?

Answer 11

A seizure confined to one area of the brain however the patient is unable to recall the events

Automatisms commonly characterise a partial seizure

Question 12

What is the difference between a complex partial seizure and a simple partial seizure?

Answer 12

Both will originate from a focal area in the brain, however patients with simple seizures will be able to recall the events

Question 13

What are absence seizures?

Answer 13

They commonly occur in children and typically last seconds with the patients being unable to recall the events

Question 14

What are the first line medications for complex partial seizures?

Answer 14

Carbamazepine, lamotrigine and sodium valproate

Question 15

Where would the lesion be if a patient had left sided facial weakness and right sided hemiparesis?

Answer 15

The brainstem

Question 16

What are the afferent and efferent limbs of the pupillary reflex?

Answer 16

Afferent: optic nerve

Efferent: oculomotor nerve

Question 17

What is a relative afferent pupillary defect?

Answer 17

An impairment in the afferent part of the pupillary reflex

Eg. if the lesion is on the left side

• Right pupil constricts when light is shone into pupil
• Left consensual reflex is in tact
• Both pupils dilate as light is removed
• Left pupil does not constrict when light is shone
• Right consensual reflex is not initiated

Question 18

What is the most indicitive sign of myaesthenia gravis?

Answer 18

Fatiguability

Question 19

What are the key diagnostic tests for Lambert Eaton Myaesthenic Syndrome?

Answer 19

• Anti-VGCC
• EMG

Question 20

Why is a neck CT/ ultrasound obtained in patients with Myaesthenia Gravis?

Answer 20

Because it’s associated with thymoma formation

Question 21

What is forehead sparing?

Answer 21

The eyes and above are not paralysed, indicating upper motor neuron pathology

Question 22

What is the management of Bell’s palsy?

Answer 22

• Presenting <72 hours, oral prednisolone
• Presenting >72 hours, conservative management

Question 23

Where is the lesion in intranuclear opthalmoplegia?

Answer 23

In the medial longitudinal fasciculus between cranial nerves 3 and 6 in the brainstem

Question 24

What is a positive Hoffman’s reflex?

Answer 24

Securing the middle finger, flicking the nail and observing the thumb contract indicating pathology in the upper region of the spinal cord

Question 25

What is the glabellar tap?

Answer 25

Positive in patients with Parkinson’s, tapping on the bridge of the nose causing the patient to blink after the tapping has ceased

Question 26

What is Tinsel’s sign?

Answer 26

Tapping on a trapped nerve, causing electric shock distributions along the neuronal pathway

Question 27

How can Alzheimer’s and Frontotemporal dementia be distinguished?

Answer 27

Alzheimers will predominantly present with aphasia and memory impairment

Question 28

What is a hemiplegic gait?

Answer 28

Gait where the leg is swung round due to a lesion in the CNS, causing weakness and spasticity in the leg

Question 29

What would cause a spastic gait?

Answer 29

Upper motor neuron injury

Question 30

What is a scissoring gait?

Answer 30

Commonly seen in cerebral palsy and MS

Bilateral spasticity of the legs

Question 31

What are stomping gaits?

Answer 31

Hard steps due to decreased fine touch, vibration and proprioception sensation, commonly in patients with diabetic nephropathy

Increased vibrations will eventually reach in tact nerves

Question 32

What is Meniere’s?

Answer 32

Episodes of vertigo lasting 2-3 hours accompanied by tinnitus, hearing impairments and sensation of increased ear pressure

Question 33

What is the difference between Mernier’s and Vestibular Neuronitis?

Answer 33

Vestibular neuronitis presents almost identically, however is not accompanied by hearing loss

Question 34

How does subarachnoid haemorrhage present on CT?

Answer 34

Bleeding between the fissures and sulci

Question 35

Where is Broca’s area located?

Answer 35

Left frontal/ parietal lobe

Question 36

Where is Wernicke’s area located?

Answer 36

Left parietal/ temporal lobes