Neuro

Question 1

What type of headache typically occurs on one side of the head and pounding or throbbing in nature?

Answer 1

Migraine without aura

Question 2

Other than paracetamol/NSAIDS, what drug can be used to treat migraine?

Answer 2

sumatriptan 50mg
(first line as paracetamol can lead to medication overuse headaches)

Question 3

What two investigations can you use to investigate meningitis by lying the patient down?

Answer 3

Question 4

A patient has meningitis caused by neisseria mengitidis and has reduced GCS + fever. What’s the diagnosis?

Answer 4

Meningococcal septicaemia

Question 5

GP / hospital antibiotics to give for meningitis?

Answer 5

Question 6

If a patient with meningitis is immunocompromised/over 55 years what antibiotic should you consider?

Answer 6

Amoxicillin

Question 7

Give four cardinal signs of Parkinson’s?

Answer 7

Question 8

How does dopamine stimulate movement?

Answer 8

Dopamine inhibits the indirect pathway and excites the direct pathway within the basal ganglia.

Question 9

What four types of drugs can be given in Parkinson’s?

Answer 9

Question 10

What is co-benyldopa made up of?

Answer 10

levodopa + benserazide

Question 11

Give 3 symptoms specific to a MCA stroke patient.

Answer 11

• Contralateral loss of motor skills + sensation in upper limbs
• Contralateral face drop
• Hemianopia

Question 12

Give five red flag symptoms associated with headaches.

Answer 12

Question 13

What drug can be given to reduce intracranial pressure?

Answer 13

Question 14

What three signs/symptoms make up Cushing’s triad?

Answer 14

Question 15

Give five differences between upper and lower motor neurone lesions.

Answer 15

Question 16

L5 radiculopathy and common peroneal nerve damage both result in foot drop and toe extensor weakness. What differentiates them?

Answer 16

Common peroneal damage = ankle EVERSION affected
L5 radiculopathy = ankle INVERSION affected

Question 17

Damage to the deep peroneal nerve results in loss of sensation where?
(deep peroneal = branch of the common peroneal)

Answer 17

First dorsal webspace

Question 18

What group of muscles do you expect wastage of with claw hand?

Answer 18

Hypothenar muscles (flexors in forearm also supplied by ulnar but you’d see less wastage in these)

Question 19

What’s the ulnar paradox?

Answer 19

“closer to the paw, the worse the claw”
- more distal damage of the ulnar nerve leads to a great exaggeration of claw hand.

(ulnar nerve supplies the medial aspect of flexor digitorum profundus, and damage leads to damage in flexion - less flexion power in medial digits = less claw hand)

Question 20

First line treatment for trigeminal neuralgia?

Answer 20

Question 21

What’s the medical term for a nosebleed?

Answer 21

Epistaxis

Question 22

Medical term for coughing up blood?

Answer 22

Haemoptysis

Question 23

Granulomatosis with polyangiitis commonly presents with what shaped nose? Why does this happen?

Answer 23

Saddle shaped nose
Due to perforation of the septum

Question 24

Which antibody can be tested for to investigate potential granulomatosis with polyangiitis?

Answer 24

c-ANCA

Question 25

Four drugs that can be used for prophylaxis of migraines?

Answer 25

Question 26

What scan is not routinely used to diagnose dementia?

Answer 26

CT (MRI produces clearer images of soft tissue and doesn't expose patient to radiation)

Question 27

What's the medical term for a fever?

Answer 27

pyrexia

Question 28

Which type of dementia exhibits a stepwise deterioration pattern?

Answer 28

Question 29

What are the signs of fronto-temporal dementia?

Answer 29

Question 30

What are the signs of Lewy Body dementia?

Answer 30

Question 31

Give four signs of Alzheimer's dementia

Answer 31

Question 32

What's the medical term for speech difficulties?

Answer 32

Dysarthria

Question 33

What's the medical term for swallowing difficulties?

Answer 33

Dysphagia

Question 34

Huntington's disease displays anticipation. What is anticipation?

Answer 34

Question 35

What gene on which chromosome is mutated in Huntington's?

Answer 35

Question 36

What does ACA stroke cause?

Answer 36

Contralateral lower limb weakness

Question 37

In which meningeal space is CSF contained?

Answer 37

Question 38

Which type of haemorrhage is caused by a berry aneurysm bursting? What does it look like on CT?

Answer 38

Question 39

What two things is a subarachnoid haemorrhage associated with?

Answer 39

Question 40

What's the source of subdural haemorrhages and what does it look like on CT?

Answer 40

Question 41

What artery usually causes an epidural haemorrhage? How does it appear on CT?

Answer 41

Question 42

What is myasthenia gravis?

Answer 42

- Autoimmune condition - AChR antibodies - Attack acetylcholine receptors on post-synaptic membranes.

Question 43

What disease is myasthenia gravis linked with?

Answer 43

Question 44

What cells are affected by MS?

Answer 44

Question 45

Four disease patterns of MS?

Answer 45

Question 46

Two diagnostic tests for MS?

Answer 46

- MRI (1st line) - LP ("oligoclonal bands" can be detected - bands of immunoglobulins)

Question 47

Most common presenting complaint of MS?

Answer 47

unilateral optic neuritis

Question 48

What symptoms are typical with frontal lobe focal seizures? (2)

Answer 48

Question 49

What symptoms are typical with temporal lobe focal seizures? (2)

Answer 49

Question 50

What symptoms are typical with parietal lobe focal seizures? (2)

Answer 50

Question 51

What symptoms are typical with occipital lobe focal seizures? (2)

Answer 51

Question 52

What's the difference between simple and complex seizures?

Answer 52

Question 53

What cranial nerves are affected in bulbar palsy?

Answer 53

Question 54

How do you distinguish pseudobulbar palsy from bulbar palsy?

Answer 54

Question 55

Symptoms of cerebellar damage?

Answer 55

Question 56

When are LPs contraindicated?

Answer 56

- infected skin over the puncture site - increased ICP from any space-occupying lesion (mass, abscess), can cause coning - trauma or mass in lumbar vertebrae.

Question 57

Which muscles are supplied by the radial nerve?

Answer 57

Question 58

Muscles supplied by the median nerve?

Answer 58

Question 59

What does damage to the axillary nerve cause?

Answer 59

Question 60

Bells palsy affects what cranial nerve?

Answer 60

CN VII - Facial nerve

Question 61

What are found on a temporal artery biopsy in giant cell arteritis?

Answer 61

Multinucleated giant cells

Question 62

What three things are used to diagnose giant cell arteritis?

Answer 62

Question 63

What's the major complication that a person with giant cell arteritis is at risk of?

Answer 63

Blindness

Question 64

Deficiency in which vitamin can lead to Wernicke's encephalopathy?

Answer 64

Question 65

Three symptoms of Wernicke's encephalopathy?

Answer 65

Question 66

Two symptoms of Korsakoff's syndrome?

Answer 66

Question 67

What is Uhthoff's phenomena?

Answer 67

- transient worsening of neurological symptoms related to a demyelinating disorder (such as multiple sclerosis) - when the body becomes overheated in hot weather, exercise, fever, saunas, or hot tubs.

Question 68

What virus causes infectious mononucleosis and what neurological condition is this associated with?

Answer 68

- EBV - MS (infection causes a 32x increased risk)

Question 69

What two features would you see in the LP fluid in viral meningitis?

Answer 69

Question 70

What happens to glucose levels of the CSF in bacterial meningitis?

Answer 70

CSF is cloudy and CSF glucose is low due to bacteria using it up

Question 71

What's the cause of Horner's syndrome and what are the three symptoms of it?

Answer 71

Question 72

What type of lung tumour can cause Horner's?

Answer 72

Pancoast tumour of the apex of lung.

Question 73

What does Brown-Sequard syndrome cause?

Answer 73

- Contralateral loss of pain and temperature 2 levels below lesion - Ipsilateral loss of motor skills and proprioception + vibration sensation at level of the lesions

Question 74

When can mannitol be given in a sub-arachnoid haemorrhage?

Answer 74

- reduced GCS - focal neurological signs (indicate a raised ICP)

Question 75

What drug is given to all patients with a SAH and what does it do?

Answer 75

Nimodipine = CCB - prevents vasospasm and therefore brain ischaemia

Question 76

MC cause of GBS?

Answer 76

Question 77

Which headaches have an association with family history and have a daily occurrence pattern?

Answer 77

Question 78

Good description of MS presentation?

Answer 78

Neurological symptoms disseminated in time and space

Question 79

Three main differences between myasthenia gravis and Lambert-Eaton syndrome?

Answer 79

Question 80

What drug can combat Lambert-Eaton syndrome?

Answer 80

Question 81

Lesions to which cranial nerve causes "down and out'?

Answer 81

Question 82

Which nerve palsy would cause this?

Answer 82

Abducens

Question 83

What nerve palsy would cause an eye to rotate inwards and upwards?

Answer 83

Trochlear (controls superior oblique which helps to move eye down and out)

Question 84

What urinary symptom can be present in Parkinson's?

Answer 84

Urinary urgency (think of David running to the loo)

Question 85

What drug can be used against MND?

Answer 85

Riluzole

Question 86

Three classic features of Charcot-Marie-Tooth syndrome?

Answer 86

- weakness in lower legs - distal muscle wasting (inverted champagne bottle) - pes cavus

Question 87

A 20 year old female has a tonic-clonic seizure, what is first line treatment?

Answer 87

Lamotrigene

Question 88

What two tests can be used to test for Carpal tunnel syndrome?

Answer 88

Question 89

In myasthenia gravis, are muscurinic or nicotinic ACh receptors targeted?

Answer 89

Nicotinic

Question 90

What's the mnemonic for remembering which reflexes are supplied by which vertebrae?

Answer 90

S1-S2 tie my shoe L3-L4 kick the door C5-C6 pick up sticks C7-C8 shut the gate

Question 91

What does compression of C6 nerve cause?

Answer 91

- Pain in forearm - Elbow flexion weakness

Question 92

What does compression of C7 nerve cause?

Answer 92

- Pain in hand - Elbow extension weakness

Question 93

Where would you get pain with an L2-L3 nerve compression?

Answer 93

- Upper leg interior - Upper leg anterior

Question 94

Compression of which nerve vertebrae would cause bladder and bowel dysfunction?

Answer 94

S4

Question 95

What's the mnemonic for remembering which reflexes are supplied by which vertebrae?

Answer 95

S1-S2 tie my shoe L3-L4 kick the door C5-C6 pick up sticks C7-C8 shut the gate

Question 96

How does myasthenia gravis present?

Answer 96

- muscle weakness (especially in face) - diplopia + ptosis - improves w rest

Question 97

What test can be done to assess a patient's proprioception?

Answer 97

Question 98

What test can be done to assess vestibulocochlear pathology?

Answer 98

Question 99

Give two causes of cauda equina syndrome other than a tumour.

Answer 99

Question 100

Give five symptoms of cauda equina syndrome.

Answer 100

Question 101

MC trigger of Guillain-Barré syndrome?

Answer 101

Question 102

Damage to which nerve causes wrist drop?

Answer 102

Radial nerve

Question 103

Damage to which nerve causes wrist drop?

Answer 103

Radial nerve

Question 104

Give a differential of meningitis

Answer 104

Subarachnoid haemorrhage

Question 105

Give three bacteria that can cause meningitis.

Answer 105

Question 106

What is a non-blanching rash a sign of in meningitis?

Answer 106

DIC caused by meningococcal meningitis

Question 107

Difference in WBC in CSF in meningitis between bacterial and viral?

Answer 107

Bacterial = neutrophilia Viral = Lymphocytosis

Question 108

What's the pathophysiology behind a pancoast tumour of the apex of the lung causing Horner's syndrome?

Answer 108

Tumour presses on: - Intercostal nerves - Brachial plexus - Sympathetic chain (causing Horner's

Question 109

What drug is given for prophylactic treatment in meningitis?

Answer 109

Question 110

What's the most common causative bacteria of meningitis in pregnant women?

Answer 110

Question 111

What's the technical term for a patient having blood vision and a feeling of a curtain coming down over their vision.

Answer 111

Question 112

Acute management for a cluster headache?

Answer 112

Question 113

Prophylactic treatment for cluster headaches?

Answer 113

Question 114

Definition of encephalitis?

Answer 114

Question 115

MC cause of encepahilits?

Answer 115

Question 116

Diagnosis method for encephalitis?

Answer 116

Question 117

Treatment of encephalitis?

Answer 117

Question 118

What treatment is given to manage Alzheimer's? Give two examples of the type of drug.

Answer 118

Question 119

Give two acetylcholinesterase inhibitors used to treat myasthenia gravis.

Answer 119

Question 120

Management of Guillain Barre?

Answer 120

Question 121

Give 4 presenting symptoms of Guillain Barre

Answer 121

Question 122

Give a test that can be used to help diagnose Guillain Barre

Answer 122

Question 123

What cranial nerve is affected in Bell's palsy?

Answer 123

Question 124

Do you get forehead sparing in Bell's palsy?

Answer 124

Question 125

Do you get forehead sparing in UMN or LMN lesions?

Answer 125

Question 126

Management after a TIA?

Answer 126

Antiplatelet e.g aspirin or clopidogrel

Question 127

Inheritance of Duchenne's muscular dystrophy?

Answer 127

Question 128

What scoring system is used to assess the risk of stroke after a TIA?

Answer 128

(>4 = referral to specialist)

Question 129

What are the categories and values for ABCD2?

Answer 129

Question 130

Two differentials for generalised tonic-clonic seizure?

Answer 130

- Syncope - Non-epileptic seizure

Question 131

What neurotransmitter supplies sympathetic innervation to the skin?

Answer 131

Acetylcholine

Question 132

Two causes of asterixis?

Answer 132

Question 133

Diagnosis of rhabdomyolysis?

Answer 133

Question 134

What tract carries pain and temperature sensation from 2 levels below where it enters the spinal cord?

Answer 134

Spinothalamic

Question 135

What's the diagnostic criteria for MS?

Answer 135

McDonald criteria. 2 or more neurological attacks disseminated in time and space.