Neuro

Question 1

GCS - M6 V5 E4

Answer 1

obeying commands; orientated; spontaneous eyes opening

Question 2

GCS Motor

Answer 2

6 points
6 - obeying commands
5 - localising to pain
4 - withdrawing from pain
3 - flexing
2 - extending
1 - no response

Question 3

GCS Voice

Answer 3

5 points
5 - orientated
4 - confused
3 - words
2 - sounds
1 - no response

Question 4

GCS Eyes

Answer 4

4 points
4 - spontaneous opening
3 - open to voice
2 - open to pain
1 - no response

Question 5

Lumbar puncture - bacterial meningitis

Answer 5

Mostly neutrophil
Cloudy
High protein
Low glucose (<1/2 plasma glucose)

Question 6

Lumbar puncture - viral meningitis

Answer 6

mostly lymphocyte
clear
normal / raised protein
slightly low glucose

Question 7

Lumbar puncture - tuberculous meningitis

Answer 7

Mostly lymphocyte
slightly cloudy
high protein
low glucose (<1/2 plasma glucose)

Question 8

meningitis bacterial and tuberculous organisms

Answer 8

Explaining Big Hot Neck Stiffness
0-1mo: E.coli, Group B strep
1mo-6y: H. influenza, Neisseria meningitidis, Strep. pneumoniae
6y+: N. meningitidis, Strep. pneumoniae
60+/immunocompromised: N. meningitidis, Strep. pneumoniae, Listeria monocytogenes

Question 9

meningitis viral organisms

Answer 9

enterovirus (coxsackievirus)
herpes simplex
cytomegalovirus
EBV
adenovirus

Question 10

criteria for a CT head in 1h

Answer 10

GCS<13 at time of injury
GCS<15 2h post injury
depressed/open skull fracture
basal skull fracture signs
focal neurological deficit
post-traumatic seizures
>1 episode of vomiting

Question 11

basal skull fracture signs

Answer 11

haemotypanum (blood in middle ear)
CSF rhinnorhea (from nose)
Battle sign (mastoid bruising)
panda eyes

Question 12

LP contraindications

Answer 12

raised ICP signs
purpura fulminans (skin necrosis)
shock
seizure activity
local infection
respiratory distress
coagulopathy

Question 13

raised ICP signs

Answer 13

headache
blurred vision
less alert, lethargy
vomiting
blurring of disc margins on fundoscopy

Question 14

UMN / LMN signs

Answer 14

UMN = things go up (e.g. stroke, brain trauma)
hypertonia; hyperreflexia; spasticity; pathological reflexes; clonus; loss of fine hand movements

LMN = things go down (e.g. MND, peripheral neuropathy, spine cord injury)
flaccidity; hyporeflexia; wasting; hypotonia; fasiscuations

Question 15

ataxic gait

Answer 15

unsteady, staggering gait

Question 16

triad of symptoms in normal pressure hydrocephalus

Answer 16

urinary incontinence
dementia
gait abnormality

Question 17

tardive dyskinesia

Answer 17

involuntary movements (grimacing, sticking tongue out, lip smacking)
(extrapyramidal SE -> of typical antipsychotics like haloperidol)
treat with tetrabenazine

Question 18

acute dystonic reaction

Answer 18

torticollis (painful contractions of head/neck)
(extrapyramidal SE -> of typical antipsychotics like haloperidol)
treat with procyclidine / benztropine

Question 19

akathisia

Answer 19

restless
(extrapyramidal SE -> of typical antipsychotics like haloperidol)
treat with propranolol

Question 20

where’s the lesion? contralateral hemiparesis and sensory loss, lower extremity > upper

Answer 20

anterior cerebral artery

Question 21

where’s the lesion? contralateral hemiparesis and sensory loss, lower extremity > upper, contralateral homonymous hemianopia, aphasia

Answer 21

middle cerebral artery (most common)

Question 22

where’s the lesion? contralateral homonymous hemianopia with macular sparing, visual agnosia

Answer 22

posterior cerebral artery

Question 23

where’s the lesion? Ipsilateral CN III palsy, contralateral weakness upper and lower extremity

Answer 23

Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)

Question 24

where’s the lesion? Ipsilateral: facial pain and temp loss, contralateral: limb/torso pain and temp loss, ataxia, nystagmus

Answer 24

posterior inferior cerebellar artery

Question 25

where’s the lesion? Ipsilateral: facial paralysis and deafness, contralateral: limb/torso pain and temp loss, ataxia, nystagmus

Answer 25

anterior inferior cerebellar artery

Question 26

where’s the lesion? amaurosis fugax

Answer 26

retinal/opthalmic artery

Question 27

where’s the lesion? ‘locked-in’ syndrome

Answer 27

basilar artery