mock questions Flashcards
what is the most common cause of meningitis in children under 8?
strep pneumonia
are fasiculations UMN or LMN?
LMN
what would not being able to distiguish between shades of red indicate?
MS
what would the prescence of a face droop in a stroke indicate?
middle cerebral artery - even if the legs are affected more than the arms
what is a prognostically beneficial drug for MND?
riluzole
what is the gene affected in huntingtons?
on chromosome 4, CAG trinucleotide repeat
what is pain and temperature transported in?
lateral spinothalamic tract
what is pain and crude touch transported in?
anterior spinothalamic tract
what receptors are in the sympathetic nervous system?
nicotinic and adrenergic
what is the first line treatments for migraines?
triptans, ibuprofen, paracetamol
what is the prophylaxis treatments for migraines?
1st line acute - triptans
1st line chronic - Propranolol, Topiramate or Amitriptyline
what is the scoring system for weather someone will have a stroke after a TIA?
ABCD2 score
what is the ABCD2 score?
A: Age > 60 years = 1 point
- B: BP >140/90 at initial evaluation = 1 point
- C: Clinical features
- Speech disturbance without weakness = 1 point
- OR unilateral weakness = 2 points
- D: Duration
- Symptoms 10-59 minutes = 1 point
- Symptoms >60 minutes = 2 points
- D: Diabetes mellitus in patient history = 1 point
how long after the start of symptoms can thrombolysis with alteplase be used in a stroke patient with a rules out haemorrhage ?
within 4.5 hours
Trevor returns to A+E after having a similar episode with more significant and
longer lasting symptoms. His symptoms were: hemiparesis with sensory deficit in his chin
and arm, homonymous hemianopia, and dysphasia. Trevor was brought in within 3 hours of
onset of symptoms and haemorrhage was ruled out.
what treatment would be used?
thrombolysis with alteplase within 1.5 hours
what is the first line prophylaxis treatment for migranes?
triptans - sumatriptan / almotriptan
what is the most common causative pathogen for kids with meningitis?
strep pneumoniae
what is the treatment for raynaud’s?
nifedipine
who would you expect to have meningitis caused by listeria monocytogenes?
pregnant women
which causative agent has the worst prognosis for meningitis?
neisseria meningitis
which causative agent is most likely to cause meningitis in neonates?
strep agalactiae
what are the signs of MS?
D - diploplia E - eye movements M - motor weakness and spasticity Y - nYstagmus E - elevated temperature L - lhermitte's pnenomenon (electric shock?) N- neuropathic pain A - ataxia T - talking slurred I - impotence O - overactive bladder N - numbness
what does risperidone do?
used to reduce jerky movement, mange aggression and chorea.
given in huntingtons
what is the most common cause of meningitis?
strep pneumonia
what is the difference between a common peroneal nerve palsy and L5 radiculopathy?
both present with foot drop and weakness of the toe extenders
in CPNP - ankle eversion is affected
L5 - weeknes in ankle inversion
what would suggest ulnar nerve damage?
claw hand and pain in elbow
what is the first line treatment for trigeminal neuralgia?
carbamazepine
what investigations would be carried out when diagnosing dementia?
MMSE, MRI, CSF analysis, confusion screen to rule out reversible causes
what type of dementia has step wise progression?
vascular
which nerve opens the fist?
radial
what are risk factors for alzheimer’s?
down’s syndrome, reduced physical or congenitive activity, depression, loneliness
what would been seen on the MRI scan of someone with alzheimer’s?
Extracellular deposition of beta amyloid plaques Tau neurofibrillary tangles Damaged synapses Cortical atrophy (hippocampus)
what treatment can be given for alzheimer’s?
Acetylcholinesterase e.g., donepezil, galantine, rivastigmine, memantine
what causes guilliene barre syndrome?
recent campylobacter infection, CMV, EBV, mycoplasma infection
what are the signs of guillene barre syndrome?
motor weakness starting distally, Paraesthesia Respiratory involvement Autonomic involvement – HR changes, BP changes, urinary control symptoms
how is GB syndrome diagnosed?
Lumbar puncture with raised CSF proteins
how is GB syndrome treated?
IV immunoglobulins plasma exchange, supportive care in HDU/ITU
what is it called when sensation is lost in the genitals?
Saddle anaesthesia
how does prostate cancer lead to cauda equina?
Prostate cancer can metastasize to the spine via the venous blood flow in this area. Compression of the spinal cord by metastatic tumours (below L1 level, where the cauda equina begins)
how is cauda equina treated?
Decompressive surgery of the spine e.g., lumbar laminectomy
what does an ABCD2 score of over 6 mean?
calculates risk of stroke after TIA, score of 6 or more strongly predicts a stroke and should be referred to a specialist immediately
what are the important differentials for epilepsy?
Syncope, non-ectopic seizure
what does a CT scan look like of an extradural haemorrhage?
hyperdense mass that is biconvex shaped and adjacent to the skull
how is high ICP treated?
IV mannitol - osmotic diuretic
what are the tests that can be done for carpal tunnel syndrome?
Phalen’s test, Tinel’s test
what nerve roots are affected in carpal tunnel syndrome?
C6, C&, C8, T1
what is the treatment of viral meningtis?
give analgesic, antipyretic and hydration
what is horner’s syndrome?
anhidrosis (reduced sweating), miosis (pupil constriction), ptosis (eyelid droop). Damage to the sympathetic nerves., can be caused by a pancoast tumour
what would brown sequard syndrome cause?
proprioceptive, vibration and motor loss on the ipsilateral side and pain and temperature loss on the contralateral side 2 levels below the lesion.
what is given in SAH?
nimodipine - CCB
what is the 1st line acute treatment of migraines?
triptans (more effective than paracetamol and no risk of overdose)
what would champagne bottle weakness suggest?
Charcot-marie tooth
what would meningitis caused by a gram negative diplococci be suggestive of?
neisseria meningitidis
what is the treatment for bacterial meningitis caused by NM?
Urgent antibiotics Cefotaxime IV Consider Amoxicillin if ptx. Immunocompromised / over 55
what is the pathology of parkinsons?
Degeneration of dopaminergic neurons resulting in reduced dopaminergic output in the substantia nigra (in the basal ganglia) Normally dopamine stimulates movement from the basal ganglia since it inhibits the inhibitory pathway of the striatum therefore allowing movement. In Parkinson’s the amount of dopamine is reduced therefore there is less inhibition of the inhibitory pathway therefore less movement.
what are the red flags of headaches?
New Headache with Hx of Cancer Cluster Headache Seizure Altered: consciousness / memory / confusion/ coordination Papilloedema
what are the signs of LMN lesions?
Decreased tone/ flaccid
Decreased Reflexes,
Muscle wasting,
Fasciculations
what are the signs of UMN leisons?
Increased tone/ Spasticity,
Brisk reflexes,
Minimal muscle atrophy- weakness,
Babinski’s sign
which antiemetic is contraindicated in parkinson’s?
metoclopramide - D2 receptor antagonist. crosses the blood brain barrier, can cause extrapyramidal side effects and parkinsonism
what are the driving rules for a TIA?
no need to inform DVLA, but don’t drive for 1 month
what is the prophylaxis for cluster headaches?
verapamil
where does the medulla develop from?
myelencephalon
what are the prophylaxis medications for migranes?
propranolol, amitriptyline, acupuncture, topiramate
what is the ABCD2 score?
1 point - Age>60, BP >140mmHg systolic or >90mmHg diastolic, speech disturbance without weakness, TIA duration 10-59 minutes, history of diabetes mellitus. 2 points - unilateral weakness and TIA duration 60 minutes
- Score 6+ should be assessed immediately by a specialist
- Score >4 should be assessed within 24 hours by a specialist
- All patients with suspected TIA should be seen by a specialist within 7 days
is the tremor in parkinsons symmetrical or asymmetrical?
asymmetrical, usually worse on one side
what is brudzinski’s test?
Lying the patient supine and flexing their neck a positive test involves the patient involuntarily flexing their hip and knee - suggests meningitis
what tract is damaged ipsilaterally to the lesion in brown sequard syndrome?
DCML pathway
what can cause cauda equina?
tumours, spinal metastases, spiondylolisthesis, abscess, trauma, slipped disk
how is cauda equina treated?
Immediate hospital admission (1), emergency MRI scan (1), lumbar decompression surgery
when does the non blanching rash form in meningitis?
in meningitis septicaemia
what is given when meningitis is suspected?
IM, benzylpenicillin
what are the best antibiotics for treating meningitis?
Cefotaxime or ceftriaxone, 3rd generation Cephalosporin.
