Neuro

Question 1

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

Answer 1

L3

Question 2

Sensory loss over anterior knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

Answer 2

L4

Question 3

Sensory loss over dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

Answer 3

L5

Question 4

Sensory loss over posterolateral aspect of leg and lateral foot
Weakness of plantarflexion
Reduced ankle reflex
Positive sciatic nerve stretch test

Answer 4

S1

Question 5

Controlled hypo/hyper-ventilation in raised ICP?

Answer 5

Hyper - lower pCO2 causes cerebral vasoconstriction

Question 6

When to refer to ENT for bell’s palsy?

Answer 6

If no improvement after 3 weeks - refer urgently

Question 7

4 Parkinson’s plus syndromes?

Answer 7

MSA

Lewy Body

Progressive supranuclear palsy - impairment of vertical gaze

Corticobasal degeneration - alien limb

Question 8

For each of these where is the lesion and describe the aphasia:

• Wernicke’s?
• Broca’s?
• Conduction?
• Global?

Answer 8

Wernicke’s (Receptive):
- Comprehension impaired, speech fluent but makes no sense - ‘word salad’

Global:
- Severe receptive and expressive aphasia - can communicate using gestures

Broca’s (Expressive):

• Inferior frontal gyrus (MCA)
• Comprehension normal, speech is non-fluent and halting

Conduction:
- speech fluent, comprehension normal, but repetition is poor - aware of errors they are making

Question 9

MS management:

• acute relapse?
• for fatigue?
• for spasticity?
• bladder dysfunction?
• oscillopsia (visual field oscillation)?

Answer 9

Relapse: IV methylpred 5 days - shortens relapse but no effect on recovery

Fatigue:

1. Rule out anaemia, thyroid, depression
2. Amantadine
3. Mindfulness, CBT

Spasticity:

1. Baclofen
2. Gabapentin
3. Diazepam, Dantrolene or Tinzadine

Bladder - urgency, frequency, overflow, incontinence etc:
1. bladder USS to assess residual volume
2. If normal residual volume, anticholinergics may help frequency
3. If significant residual volume - intermittent self-catheterisation
(be aware anticholinergics may worsen symptoms)

Oscillopsia:
- Gabapentin

Question 10

Hoarseness and uvula deviating to left?

Answer 10

Right vagus lesion

uvulAWAY from lesion

Question 11

Cerebral venous thrombus Ix

Answer 11

MRI venogram

Question 12

1st line management of absence seizures?

Answer 12

Sodium valproate or ethosuxomide

Question 13

ACA stroke?
MCA stroke?
PCA stroke?
Basilar stroke?

Answer 13

ACA:

• contralateral hemiparesis/sensory
• lower extremity worse

MCA:

• contralateral hemiparesis/sensory
• upper worse then lower
• contralateral homonymous hemianopia
• Aphasia

PCA:

• contralateral homonymous hemianopia with macular sparing
• visual agnosia

Basilar:
- locked in syndrome

Question 14

1st line and 2nd line options for generalised tonic clonic seizures?

Answer 14

1st - valproate

2nd line - lamotrigine, carbamazepine

Question 15

1st line and 2nd line options for focal seizures?

Answer 15

1st line - carbamazepine or lamotrigine

2nd line - levetiracetam, oxcarbazepine, valproate

Question 16

MND linked with which dementia?

Answer 16

Frontotemporal

Question 17

Antibodies in MG?

Answer 17

anti-AChR

anti-MuSK

Question 18

Treatment of LEMS?

Answer 18

3,4-diaminopyradine

Question 19

SE valproate?

Answer 19

Reversible hair loss
Weight gain
Tremor
Thrombocytopaenia
Oedema
Liver stuff

Question 20

SE lamotrigine

Answer 20

Rash

SJS

Question 21

SE levetiracetam?

Answer 21

Mood swings

Question 22

SE carbamazepine?

Answer 22

Impaired balance

Blurred/double vision

Question 23

What anti-epileptics are P450 inducers and inhibitors?

Answer 23

Inducer: carbamazepine and phenytoin

Inhibitor: valproate

Question 24

CI triptans?

Answer 24

IHD

Question 25

Commonest brain tumour in kids? | Infratentorial brain tumour in kids?

Answer 25

Pilocytic astrocytoma Medulloblastoma

Question 26

Tabes dorsalis?

Answer 26

Neurosyphilis Loss of DCML only

Question 27

Anterior cord syndrome?

Answer 27

Bilateral spastic paresis and loss of pain/temperature DCML normal

Question 28

Central cord syndrome?

Answer 28

Due to whiplash etc Corticospinal - upper limbs more than lower Spinothalamic lost as fibres decussate

Question 29

Pituitary apoplexy - what is it? - presentation? - Ix? - management?

Answer 29

Sudden enlargement of a pituitary tumour secondary to haemorrhage/infarction 'thunderclap' pain behind eye Vomiting, neck stiffness bitemporal hemianopia MRI Urgent steroid replacement Surgery

Question 30

Loss of finger abduction and thumb adduction?

Answer 30

T1

Question 31

Head injury: - criteria for immediate CT? (6) - criteria for CT within 8 hours? (4)

Answer 31

Immediate: - GCS <13 initially - GCS <15 2 hours post-injury - suspected skull fracture - post-traumatic seizure - focal neurological deficit - >1 episode of vomiting 8 hours: - age 65+ - Hx of bleeding/clotting disorders - dangerous mechanism of injury - >30 mins retrograde amnesia before event

Question 32

Diplopia and difficulty opening mouth after facial injury?

Answer 32

Zygoma fracture

Question 33

Foot drop, loss of hip abduction, all reflexes intact?

Answer 33

L5

Question 34

Initial steps in haemorrhage stroke/haemorrhagic transformation?

Answer 34

Stop/reverse any anti platelet/anticoagulant drugs | Maintain BP to a target 140mmHg systolic