Neuro

Question 1

Triad of episodic vertigo, tinnitus and hearing loss

Answer 1

Meniere’s Disease

Question 2

Treatment steps for Menieres (3)

Answer 2

Lifestyle + Diet - salt restriction, limiting caffeine + ETOH, and any other triggers
Pharmacotherapy - Hydrochlorothiazide
Vestibular rehab - for symptoms in-between attacks

Question 3

1st and 2nd line treatment for medication overuse headache

Answer 3

1 - naproxen MR 750mg orally. OD for 5days in week1, then 3-4days per week for 2 wks
2 - prednislone 50mg oral, OD for 3days, decrease gradually over 7-10days

Question 4

Migraine prophylaxis with current/PMHx of depression (3, avoid 2)

Answer 4

Good - SSRI, SNRI, TCA
Avoid - Topiramate, b-blockers

Question 5

Migraine propylaxis with obesity +- diabetes

Answer 5

Good - candesartan, topiramate
Avoid - Sodium valproate, pizotifen

Question 6

Migraine prophylaxis in untreated menopausal symptoms

Answer 6

Propanolol, gabapentin or SSRI

Question 7

Mixed upper and lower motor neuron signs

Answer 7

Most likely Motor neuron disease

Question 8

Clinical features of trigeminal neuralgia (4)

Answer 8

1. Trigeminal distribution
2. Paroxysmal electric/stabbing pain
3. Trigger zones by light touch
4. Autonomic symptoms (conjuctival injection, ptosis)

Question 9

KFP: Pharma Mx of trigeminal neuralgia

Answer 9

Oral Carbamazepine MR 100mg BD

Question 10

KFP: DDx for bilateral burning pain in the feet, other than diabetes (5)

Answer 10

1. Bilateral PVD or PAD or bilateral claudication
2. Vit B12 deficiency
3. Raynauds phenomenon
4. Erythromelagia
5. Hypothyroidism

Question 11

KFP: DDx for peripheral vertigo +- hearing loss (6)

Answer 11

1. Labrynthitis
2. Vestibular neuronitis
3. Vestibular Migraine
4. Menieres
5. Ramsay Hunt syndrome
6. Cholesteatoma

Question 12

KFP: History points to ask in patient with vertigo (6)
Hint: 1 general + 5 DDx

Answer 12

1.Duration of the symptoms
2. ANy facial droop/slurred speech (tia/stroke)
3. Any concurrent headache (vestib migraine)
4. Any associated tinnitus (Menieres)
5. Any recent URTI/illnss (vestib neuronitis)
6. ?Precipitated by head movement (BPPV)

Question 13

Non Pharma treatment of migraines (7)

Answer 13

1. Regular sleep/avoid deprivation
2. Limit caffeine
3. Adequate hydration
4. Minimal variation in BGL - avoid fasting and/or excessive imple carbs
5. Regular exercise
6. Regular use of relaxation exercises
7. Avoid known triggers - alcohol, MSG, chocolate