Neuro

Question 1

Management of cluster headaches

Answer 1

Acute: 100% O2, sc triptan

prophylaxis: verapamil

Question 2

Thrombolysis with alteplase for acute ischemic stroke

Answer 2

Administered within 4.5 hours of onset of stroke symptoms

Haemorrhage has been definitively excluded

Question 3

Lambert-Eaton syndrome or myasthenia gravis?

Answer 3

Weakness in Lambert Eaton improves after exercise, unlike myasthenia gravis; which worsens after exercise

Question 4

Acute relapse of MS tx

Answer 4

High-dose steroids (e.g. oral or IV methylprednisolone) for 5 days

Question 5

Classification system for strokes

Answer 5

The Oxford Stroke Classification (also known as the Bamford Classification)

Question 6

Oxford Stroke Classification

Answer 6

The following criteria should be assessed:

1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

Question 7

Migraine acute attack tx vs prophylaxis

Answer 7

• acute: triptan + NSAID or triptan + paracetamol
• prophylaxis: topiramate or propranolol

Question 8

What scoring system measures disability or dependence in activities of daily living in stroke patients

Answer 8

The Barthel index

Question 9

Anterior cerebral artery

Answer 9

Contralateral hemiparesis and sensory loss

lower extremity > upper

Question 10

Middle cerebral artery

Answer 10

Contralateral hemiparesis and sensory loss, upper extremity > lower

Contralateral homonymous hemianopia
Aphasia

Question 11

Posterior cerebral artery

Answer 11

Contralateral homonymous hemianopia with macular sparing

Visual agnosia

Question 12

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

Answer 12

Ipsilateral CN III palsy

Contralateral weakness of upper and lower extremity

Question 13

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)

Answer 13

Ipsilateral: facial pain and temperature loss

Contralateral: limb/torso pain and temperature loss

Ataxia, nystagmus

Question 14

Anterior inferior cerebellar artery (lateral pontine syndrome)

Answer 14

Symptoms are similar to Wallenberg’s (see above), but: Ipsilateral: facial paralysis and deafness

Question 15

Retinal/ophthalmic artery

Answer 15

Amaurosis fugax

Question 16

Basilar artery

Answer 16

‘Locked-in’ syndrome

Question 17

Lacunar strokes

Answer 17

• present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
• strong association with hypertension
• common sites include the basal ganglia, thalamus and internal capsule

Question 18

Most common cancers which metastise to the brain

Answer 18

lung, breast, kidney, melanoma and colorectal

Question 19

Glasgow Coma Scale

Answer 19

Question 20

How to to differentiate between a true seizure and a pseudoseizure

Answer 20

Raised serum prolactin = true epileptic seizure

Question 21

Normal pressure hydrocephalus triad

Answer 21

• urinary incontinence
• dementia and bradyphrenia
• gait abnormality (may be similar to Parkinson’s disease)

Question 22

MRC power score

Answer 22

0 No contraction
1 Flicker or trace of contraction
2 Active movement, with gravity eliminated
3 Active movement against gravity
4 Active movement against gravity and resistance
5 Normal power

Question 23

‘What?’ as the patient doesn’t understand a command

Wernicke’s aphasia

Answer 23

speech fluent, comprehension abnormal, repetition impaired

(lesion in superior temporal gyrus)

Question 24

Broca sounds like ‘broken’ as the patient’s word-flow is broken

Broca’s aphasia

Answer 24

Broca’s is an expressive aphasia

Comprehension normal but speech is non-fluent, repetition is impaired

(lesion in left inferior frontal gyrus)

Question 25

Brown-Sequard syndrome

Answer 25

Question 26

Cushing reflex

Answer 26

Widening pulse pressure, bradycardia and irregular breathing late sign indicating impending brain herniation

Question 27

Investigation for Vestibular schwannomas

Answer 27

* MRI of the cerebellopontine angle * Audiometry

Question 28

Optic neuritis features

Answer 28

* Central scotoma (enlarged blind spot) * Pain on eye movement * Impaired colour vision * RAPD

Question 29

First-line for spasticity in multiple sclerosis

Answer 29

Baclofen and gabapentin

Question 30

Medication for oscillopsia in MS

Answer 30

gabapentin

Answer 31

Dopamine receptor agonists

Question 32

common adverse effects of levodopa

Answer 32

* dry mouth * anorexia * palpitations * postural hypotension * psychosis

Question 33

Levodopa - end-of-dose wearing off

Answer 33

symptoms often worsen towards the end of dosage interval. This results in a decline of motor activity

Question 34

Levodopa 'on-off' phenomenon'

Answer 34

large variations in motor performance, with normal function during the ‘on’ period, and weakness and restricted mobility during the ‘off’ period

Question 35

Levodopa - dyskinesias at peak dose

Answer 35

dystonia, chorea and athetosis (involuntary writhing movements)

Question 36

Levodopa in patient admitted to hospital or vomiting

Answer 36

Do NOT stop if admitted to hospital If cannot take orally: give dopamine agonist patch as rescue medication to prevent acute dystonia

Question 37

Assessment tools for dementia in the non-specialist setting

Answer 37

* 10-point cognitive screener (10-CS) * 6-Item cognitive impairment test (6CIT)

Question 38

Stevens-Johnson syndrome

Answer 38

Maculopapular, erythematous, diffuse rash with mucosal involvement and skin sloughing and blistering when rubbing the skin (Nikolsy's sign)

Question 39

Which area of the brain affects Alzheimer's

Answer 39

Widespread cerebral atrophy mainly involving the cortex and hippocampus

Question 40

Investigating a suspected SAH

Answer 40

Non-contrast CT head * Positive CT → confirmed SAH * If CT head is done >6hrs after onset and normal → do LP * If done within 6 hours of onset and normal → consider alt dx (do NOT do LP)

Question 41

Within what time frame should a LP be done in suspected SAH and why

Answer 41

At least 12 hours AFTER onset of symptoms To allow development of xanthochromia

Question 42

Role of Xanthochromia in SAH diagnosis

Answer 42

Xanthochromia helps to distinguish true SAH from a ‘traumatic tap’ (blood introduced by LP procedure)

Question 43

Investigating cause of pathology once SAH confirmed

Answer 43

* CT intracranial angiogram (to identify a vascular lesion e.g. aneurysm or AVM) * +/- digital subtraction angiogram (catheter angiogram)