Neuro

Question 1

Tension headache management

Answer 1

Patient education and counseling 
Relaxation therapy 
Lifestyle modification - stop smoking 
Coping strategies 
Psychotherapy 
Aspirin/PCM 
Short term diazepam

Question 2

Diagnosing migraine

Answer 2

Pulsatile quality 
One day duration
Unilateral headache 
Nausea-vomiting
Disabling intensity 

Also photo & phonophobia

Question 3

Managing migraines

Answer 3

Mild to moderate: NSAIDS 
Moderate to severe: 
- triptans 
- NSAIDs 
- intranasal dihydroergotamine 
- antiemetic 
Severe 
- triptans 
- ergots 
- antiemetics like metoclopramide 
Prophylaxis: beta blockers, amitryptiline, pizotifen 
Avoid wine, chocolate, MSG, estrogen

Question 4

Cluster headache management

Answer 4

Acute: 100% oxygen 10L/min for 15 min + sumatriptan + metoclopramide

Prophylaxis:

• prednisolone 50mg a day for 10 days
• verapamil
• indomethacin
• valproate
• deep brain stimulation

Question 5

Cluster headache features

Answer 5

• paroxysmal clusters of unilateral headache
• deep stabbing pain, burning, Lancinating
• typically at night, early hours of morning
• rhinorrhea
• lacrimation

Question 6

Meningitis investigations

Answer 6

FBC, ESR/CRP, blood culture, HIV/EBV serology
LP, CSF micro culture/PCR
CT scan

Question 7

Meningitis features in > 3 (for less, go to paeds section)

Answer 7

Fever, photophobia, neck stiffness

Vomiting, delirium, laterr consciousness

Question 8

Treatment for suspected meningitis

Answer 8

Oxygen and IV access
Take blood for culture within 30 minutes of assessment
For child give bolus 10-20ml NS with added bolus up to 60 if hypoperfused
Admit to hospital for LP
Dexamethosone 0.15mg/kg
Ceftriaxone 2g IV stat then 12 hourly for 4 days

Question 9

Treatment for meningococcemia all ages (petechial/purpuric)

Answer 9

Must treat before reach hospital!

Benpen 2.4g (child 60mg/kg IV) stat and continue for 5 days
OR Ceftriaxone 2g IV/IM 12 hrly for 5 days

If h influenza, cephalosporin

Question 10

Tests for stroke

Answer 10

FBC, UEC, lipids, clotting
Echo
CT/MRI !!
Carotid doppler

Question 11

Acute management for stroke

Answer 11

Protect airway, screen swallowing
Exclude head trauma
URGENT CT/MRI
Treat seizure/hypoglycemia

Admit 
Investigate
Treat hypertension
IV fluids, electrolytes, nutrition
Antiplatelet agent: Aspirin 300mg if cerebral hemorrhage excluded (unless thrombolysis with TPA then withhold one day)
Physio 
Rehab 
2 weeks of just aspirin, then DAPT

Question 12

Extradural hematoma features and management

Answer 12

Short lucid interval followed by LOC
Restless, confused, irritable, headaches, seizures, ipsilateral pupil dilation and facial weakness

Skull X-ray, CT scan, urgent decompression of hematoma

Question 13

Subdural hematoma features and management

Answer 13

Acute/subacute/chronic
After an injury
Personality change, slowness and unsteadiness of movement, headache, fluctuating consciousness, irritability

Urgent neuro referral, CT and MRI