Neuro

Question 1

5-HT3 antagonists? MoA & exams;e

Answer 1

ct in the chemoreceptor trigger zone area of the medulla oblongata.

chemotherapy-related nausea

ondansetron

prolonged QT interval

Question 2

Types of aphasia

Answer 2

Wernicke’s (receptive) aphasia - superior temporal gyrus. Comprehension is impaired

Broca’s (expressive) aphasia- inferior frontal gyrus. comprehension intact. speech = non-fluent and halting. Repetition is impaired

Conduction aphasia. arcuate fasiculus - the connection. comprehension intact. speech = fluent. Repetition is impaired

Question 3

Ataxia telangiectasia features

Answer 3

Autosomal recessive - DNA repair enzyme defect

an inherited combined immunodeficiency disorder - IgA deficiency resulting in recurrent chest infections

presents in childhood (1-2) w abnormal movements. Cerebellar ataxia.

Telangectasia

increased risk of haematological malignancy

Question 4

Frederick’s ataxia features

Answer 4

autosomal recessive, trinucleotide repeat disorder (but unusually no anticipation)
Late childhood presentation (10-15)

spinocerebellar tract degeneration
Gait ataxia - cerebellar ataxia

kyphoscoliosis

Neurological features
absent ankle jerks/extensor plantars

optic atrophy
HOCM
DM

Question 5

Bell’s palsy tx

Answer 5

oral prednisolone within 72 hours of onset

eye care

if the paralysis shows no sign of improvement after 3 weeks, refer urgently to ENT

Question 6

Brachial plexus injuries

Answer 6

Erb-Duchenne paralysis
- damage to C5,6 roots
- winged scapula
- waiter dip deformity
- may be caused by a breech presentation

Klumpke’s paralysis
- damage to T1
- loss of intrinsic hand muscles - claw hand
- due to traction

Question 7

Brain abscesses mx

Answer 7

CT scanning

IV antibiotics: IV 3rd-generation cephalosporin + metronidazole

surgery
a craniotomy & cavity debrided

intracranial pressure management: e.g. dexamethasone

Question 8

Brown-Sequard syndrome features

Answer 8

lateral hemisection of the spinal cord

ipsilateral weakness below lesion

ipsilateral loss of proprioception and vibration sensation

contralateral loss of pain and temperature sensation

Question 9

Cluster headache mx

Answer 9

acute
- 100% oxygen (80% response rate within 15 minutes)
- subcutaneous triptan (75% response rate within 15 minutes)

prophylaxis
- verapamil
- potentially tapering dose of prednisolone

Question 9

Cerebellar syndrome symptoms

Answer 9

D - Dysdiadochokinesia, Dysmetria (past-pointing), patients may appear ‘Drunk’
A - Ataxia (limb, truncal)
N - Nystamus (horizontal = ipsilateral hemisphere)
I - Intention tremour
S - Slurred staccato speech, Scanning dysarthria
H - Hypotonia

Question 10

common peroneal nerve lesion

Answer 10

foot drop.

weakness
- foot dorsiflexion
- foot eversion
- extensor hallucis longus

(TIPPED
Tibial - inversion - plantarflex
Peroneal - eversion - dorsalflex)

• sensory loss - dorsum of the foot and the lower lateral part of the leg

wasting of the anterior tibial and peroneal muscles

(weakness of hip abduction is suggestive of a L5 radiculopathy)

Question 11

DVLA neuro

Answer 11

first unprovoked/isolated seizure: 6 months off if no structural/ EEG abnormalities, otherwise 12mo

established epilepsy- 12 mo, after 5 years - till 70 license

withdrawing epilepsy meds - 6 mo after last dose

stroke or TIA: 1 month off driving, may not need to inform DVLA if no residual neurological deficit

multiple TIAs over short period of times: 3 months off driving and inform DVLA

Question 12

Dystrophinopathies
inheritance

Answer 12

X-linked recessive

Duchenne - more sever due to frameshift mutation
Becker

Question 13

Encephalitis Ix & mx

Answer 13

(HSV-1 )

Ix

CSF - lymphocytosis, elevated protein, PCR for HSV, VZV and enteroviruses

MRI
medial temporal and inferior frontal changes (e.g. petechial haemorrhages)

EEG

intravenous aciclovir

Question 14

Epilepsy tx

Answer 14

Generalised tonic-clonic
males: sodium valproate
females: lamotrigine or levetiracetam

Absence seizures (Petit mal)
first line: ethosuximide
second line: as per tonic clonic

Myoclonic seizures
males: sodium valproate
females: levetiracetam

Tonic or atonic seizures
males: sodium valproate
females: lamotrigine

Focal seizures
first line: lamotrigine or levetiracetam
second line: carbamazepine

Question 15

Idiopathic intracranial hypertension

Answer 15

weight loss!!
1. acetazolamide
2. topiramate

Question 16

Intracranial venous thrombosis ix & mx

Answer 16

MRI venography is the gold standard
- Sagittal sinus thrombosis - ‘empty delta sign’

anticoagulation
typically with low molecular weight heparin acutely (warfarin usually for long term)

Question 17

Medication overuse headache mx

Answer 17

simple analgesics and triptans should be withdrawn abruptly (may initially worsen headaches)

opioid analgesics should be gradually withdrawn

Question 18

Migraine: management

Answer 18

Acute treatment
first-line: offer combination therapy with
an oral triptan and an NSAID/paracetamol
( 12-17 years -nasal triptan)
(no triptan or NSAID in pregnancy)

Prophylaxis
1. propranolol / topiramate (CI in women) / amitriptylin
2. 10 sessions of acupuncture over 5-8 weeks’

( 5-HT receptor agonists are used in the acute treatment of migraine whilst 5-HT receptor antagonists are used in prophylaxis)

Question 19

MS mx

Answer 19

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

Prevention of relapse
natalizumab

Fatigue - amantadine, CBT
Spasticity - baclofen and gabapentin

Oscillopsia -

Bladder dysfunction - ultrasound first to assess bladder emptying, if significant residual volume → intermittent self-catheterisation
if no significant residual volume → anticholinergics may improve urinary frequency

Question 20

Myasthenia gravis mx

Answer 20

Mx
- long-acting acetylcholinesterase inhibitors - pyridostigmine is first-line

Management of myasthenic crisis
- plasmapheresis
- intravenous immunoglobulins

Question 21

neurofibromatosis features

Answer 21

AD

NF1
- chromosome 17
Café-au-lait spots
Axillary/groin freckles
Iris hamatomas (Lisch nodules)
Pheochromocytomas

NF2
- chromosome 22
Bilateral vestibular schwannomas

Question 22

Neuroleptic malignant syndrome features & mx

Answer 22

antipsychotic medication or dopaminergic drugs (such as levodopa) stopping

pyrexia
muscle rigidity
decreased reflexes
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion

raised CK, AKI, leukocytosis

Mx
- stop antipsychotic
- dantrolene, IV fluids to prevent renal failure
- bromocriptine, dopamine agonist, may also be used

Question 23

Neuropathic pain

Answer 23

first-line treatment*: amitriptyline, duloxetine, gabapentin or pregabalin
if the first-line drug

treatment does not work try one of the other 3 drugs
switched, not added

tramadol may be used as ‘rescue therapy’ for exacerbations of neuropathic pain

Question 24

Radial nerve damage

Answer 24

Triceps - Loss of elbow extension

forarm muscles (supinator, brachioradialis, etc..) - Weakening of supination

Wrist drop

Question 25

raised ICP mx

Answer 25

underlying cause
head elevation to 30º
IV mannitol may be used as an osmotic diuretic

controlled hyperventilation-> reduce pCO2 → vasoconstriction of the cerebral arteries → reduced ICP

removal of CSF,

Question 26

reflex & nerve roots?

Answer 26

ankle - s1 & 2
knee - L3 & 4
biceps - c5 & 6
triceps - c7&8

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

Question 27

Restless legs syndrome (RLS) mx

Answer 27

bloods such as ferritin to exclude iron deficiency anaemia

dopamine agonists are first-line treatment (e.g. Pramipexole, ropinirole)

Question 28

Subacute combined degeneration of the spinal cord features

Answer 28

(vitamin B12 & E deficiency)

1. Bilateral spastic paresis
2. Bilateral loss of proprioception and vibration sensation
3. Bilateral limb ataxia

Question 29

Anterior spinal artery occlusion px

Answer 29

1. Bilateral spastic paresis
2. Bilateral loss of pain and temperature sensation

Question 30

Syringomyelia px

Answer 30

1. Flacid paresis (typically affecting the intrinsic hand muscles)
2. Loss of pain and temperature sensation

Question 31

Neurosyphilis (tabes dorsalis) neuro px

Answer 31

Loss of proprioception and vibration sensation

Question 32

Ischemic stroke mx

Answer 32

non-contrast CT head scan - low density/ ‘hyperdense artery’

aspirin 300mg orally or rectally

thrombolysis- patients present with 4.5 hours of onset of stroke symptoms

thrombectomy asap w/in 6 hours of symptom onset, together with intravenous thrombolysis (if within 4.5 hours)
- proximal anterior circulation

thrombectomy between 6 & 24 hrs:
- proximal anterior circulation & potential to salvage brain tissue

AF anticoagulant - 2 weeks after onset

secondary prevention
- 1. clopidogrel (2.aspirin plus MR dipyridamole)

Question 33

TIA mx

Answer 33

aspirin 300 mg

more than 1 TIA (‘crescendo TIA’) or has a suspected cardioembolic source or severe carotid stenosis:
discuss the need for admission or observation urgently with a stroke specialist

suspected TIA in the last 7 days:
arrange urgent assessment (within 24 hours)

TIA which occurred more than a week previously:
refer for specialist assessment as soon as possible within 7 days

carotid artery endarterectomy:
- carotid stenosis > 70%

Question 34

Tuberous sclerosis (TS) features

Answer 34

depigmented ‘ash-leaf’ spots

roughened patches of skin over
lumbar spine (Shagreen patches)

adenoma sebaceum (angiofibromas)

fibromata beneath nails (subungual fibromata)

café-au-lait spots

Neuro: developmental delay, epilepsy (infantile spasms or partial), intellectual impairment,

retinal hamartomas,
rhabdomyomas of the heart