Neuro

Question 1

Seizure: sudden loss muscle tone

Answer 1

Atonic

Question 2

Sudden jerk seizure

Answer 2

Myoclonic
Generalised
Aware

Question 3

Seizure: crying out, loss of awareness, muscle stiffness, then convulsion and jerking

Answer 3

Tonic clonic

Generalised

Question 4

Seizure: blank stare 10seconds

Answer 4

Absence

Impaired awareness

Question 5

Seizure: remains aware and awake
Depends on where is the brain-
Motor Sx: lip smacking, picking, jerking, cry
Non motor: rising feeling, unusual smell, hallucinations

Answer 5

Focal aware seizure
Focal is Most common seizure in brain tumours
Can go to bilateral

Question 6

Seizure that starts in one area

Unaware or unconscious

Answer 6

Affect a bigger part of one hemisphere
Focal impaired awareness seizure
Previously called complex partial seizure

Question 7

Migraine Tx
Throbbing usually one sided
Sometimes visual disturbances

Answer 7

Triptans - change blood flow in brain :
Sumatriptan , rizatriptan 
Prevention meds:
Propranolol 
Topiramate
 Amitriptyline

Question 8

Meningitis causes

Answer 8

Viral - enterovirus
Bacterial: strept pneumonia, niesseria meningococcal , HIB, , herpes virus , listeria
LP: high protein indicates bacterial with decreased glucose. Viral has normal glucose and normal or decreased protein.

Question 9

35 yo female with Numbness in left leg 
Electric shock sensations on neck bending 
Unsteady gait 
Partial vision loss 
Fatigue

Answer 9

MS - autoimmune 
1 Relapse and remitting 
2. Primary progressive 
3. Secondary progressive 
4. Progressive relapsing  
Improve partially or completely between episodes 
Tx: corticosteroids, plasmapheresis

Question 10

60 yo female with severe shooting pain in obs of face to jaw

Starts when eating

Answer 10

Trigeminal neuralgia 
Contact between vessel and nerve 
Can be related to MS or ageing or tumour 
Tx: no Tx, carbamazepine (AC)
Muscle relaxant- baclofen 
Botox injections 
Surgical - decompression

Question 11

40 yo women with fatigue, fever, rash on face, SoB, headaches, skin lesion which get worse with sun exposure, raynauds

Answer 11

Lupus

Complications : kidney damage, CNS changes, lungs, heart

Question 12

Miosis- constricted pupils
Ptosis- droopy eyelid
Anhidrosis- failure to sweat

Answer 12

Horner’s syndrome
Trauma to the brachial plexus during birth
New onset in children can be possible neuroblastoma
Cervical sympathetic nerve compression - malignancy (lung apex)

Question 13

When patient asked to smile and raise both eyebrows:

Whole left side of face palsy

Answer 13

Left side facial lower motor neuron lesion

Question 14

Pateint asked to smile and raise eyebrows:

Lip droop on right side but eyebrows both raised

Answer 14

Left sided upper motor neuron lesion

Question 15

Facial nerve palsy
Rash over outside ear on same side of face - red, vesicular, painful.
May have tinnitus

Answer 15

Ramsey hunt syndrome
Rare neuro disorder - caused by varicella zoster virus (VZV) same as chicken pox and shingles
Tx - antivirals - acyclovir , prednisolone

Question 16

40 yo women wakes with LHS facial fullness and feeling of face and tongue numbness without objective hypoaesthesia.
Later that day develops ear and face pain and hyperacusis
Then left side face palsy with weakness, asymmetry, Incompete eye closure.

Answer 16

Bell’s palsy 
Acute sudden onset facial palsy - viral aetiology 
Sx fully Evolve within 72 hours 
Complete recover in 70% cases 
Eye protection important 
Tx : prednisolone ASAP 
In severe cases - add in valaciclovir

Question 17

Dementia type
Effects emotion control, behaviour and language
More Tau proteins

Answer 17

Picks disease
Fronto-temporal dementia - behaviour personality and speech
Sx: aggressive, mood swings, uninterested, no empathy, inappropriate behaviour or speech, trouble recalling names, understanding written words, copying shapes

Vs Alzheimers :
Early in life 
No hallucinations 
Don’t have as much memory loss
Don’t get loss of familiar places