Neuro

Question 1

on a head CT is ischaemic events
1)hypodense
2)hyperdense?

Answer 1

cortical hypodensity shows ischaemia

Question 2

carotid artery stenosis is imaged?

Answer 2

duplex ultrasound - uses sound waves and combines both below USS technology

Traditional ultrasound: Uses sound waves to create pictures of blood vessels

Doppler ultrasound: Records sound waves reflecting off moving objects, like blood, to measure their speed and flow

Question 3

management of TIA?

Answer 3

aspirin 300mg immediately except for contraindications

assessment by a stroke specialist in 24hours

clopidogrel 300mg followed by 75mg +aspiririn

followed by clopidogrel monotherapy

Question 4

myasthenia gravis is associated with?

Answer 4

thymoma
autoimmune disorders - PA
SLE, Rheumatoid

Question 5

how to investigate Myasthenia gravis?

Answer 5

single fibre electromyography
CT thorax thymoma
CK normal

tensilon test - iV edrophonium

Question 6

mx of myasthenia gravis?

Answer 6

long acting acetylcholinesterase inhibitors
pyridostigmine

immunosuppresion can be achieved with prednisolone
azathiopirine

Question 7

mx of myasthenic crisis?

Answer 7

plasmapheresis
IV immunoglobulins

Question 8

where does the posterior cerebral artery supply?

Answer 8

occipital cortex ; situated posteriorly to the optic tract

Question 9

A 67-year-old woman attends the emergency department complaining of a disturbance to her vision. She explains that her symptoms developed suddenly around 20 minutes ago, and adds that she struggles to identify objects on her right side.

PMHx: DM2, HTN

Answer 9

this is a contralateral homonymous hemianopia with macular sparing and visual agnosia - characteristic of PCA infarct

Question 10

Lacunar strokes

Answer 10

isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

Question 11

mononeuritis multiplex

Answer 11

sporadic
non consistent nerve trunks

both sensory
and motor

has a systemic cause
WARDS PLC

wegener’s, amyloidosis, Rheumatoid arthritids, Diabetes, Sarcoid, PAN, leprosy

Question 12

seizure types

Answer 12

generalised tonic clonic > sodium Valproate
lamotrigine
levetricetam

focal
lamotrigine

myoclonic
M: SV
F: Levetiracetam

tonic / atonic seizure
M: Sodium valproate
F: lamotrigine

Question 13

when should you start antiepileptic

Answer 13

pt has neurological deficit
brain imaging shows structural abnormality

EEG unequivocal epileptic activity

Question 14

myasthenia exarcebated by LAB-QT-MG

Answer 14

lithium
abx
betablockers
quinolones
tetracyclines
macrolides
gentamycin

Question 15

guillain barre sydnrome

Answer 15

peripheral neuropathy
nerves outside fo CNS (the brain and spinal cord)

= LMN signs: hyporeflexia

Question 16

Aphasia
supplied by superiro division of left MCA

comprehension is normal

Answer 16

expressive - BROCA
inferior frontal gyrus

Question 17

comprehension is impaired but speech remains fluent?

Answer 17

receptive aphasia

WERNICKE

Question 18

conduction aphasia?

Answer 18

speech is fluent but repetition is poor
aware of errors

Question 19

what comes first? korsakoff or wernickes

Answer 19

Wernicke’s encephalopathy
Trid of
nystagmus, ataxi,encephalopathy

MRI
replace thiamine

Korsakoff- antero-retrograde amnesia

Question 20

lateral medullary syndrome

Answer 20

cerebeller signs
contraletral sensory loss
same side Horner’s

posterior inferior cerebellar artery infarct

Question 21

GCS

M?

Answer 21

M6
6. Obeys commands
5. Localises to pain
4. Withdraws from pain
3. Abnormal flexion to pain (decorticate posture)
2. Extending to pain
1. None

Question 22

GCS
verbal?

Answer 22

5. Orientated
6. Confused
7. Words
8. Sounds
9. None

Question 23

degenerative cervical myelopathy

Answer 23

smoking
pain
los of motor function

Question 24

The most characteristic feature of a common peroneal nerve lesion is

Answer 24

foot drop.

Question 25

Intubate if the GCS is less than 8

Answer 25

This patient’s GCS = 7 (E1, V2, M4). Therefore he requires emergency intubation by a suitably trained clinician to secure his airway, as his GCS is less than 8. This is the most immediate action that needs to be taken as he is otherwise at risk of losing his airway and deteriorating rapidly within seconds to minutes.

Question 26

what is a PEG

Answer 26

Percutaneous gastrostomy tube (PEG) is the preferred way to support nutrition in patents with motor neuron disease
MND

Question 27

location of seizures?
aura
> rising sinking feeling in tummy
>deja vu
> hallucinations

seizure
>lip smacking

Answer 27

temporal lobe

Question 28

frontal lobe seizure?

Answer 28

head/leg movement
psoturing
post ictal weakness

Question 29

pareital lobe seizures?

Answer 29

parastehsia

Question 30

most common primary brain tumour kids?

Answer 30

pilocytic astrocytoma
rosenthal fibres/ corkscrew

Question 31

arise from arachnoid cao cells?

symptoms are compressive

spindle cell in concenteric whorls and calcified psamomma bodies?

Answer 31

meningioma

Question 32

what is subacute combined degeneration of the spinal cord ?

Answer 32

Dorsal columns and lateral corticospinal tracts are affected
from a b12 deficiency

Question 33

proprioception and vibration sense comes from?

Answer 33

dorsal columns

Question 34

lateral corticospinal tract involvemen

Question 36

Bells Palsy

Answer 36

Forehead affected is bells / LMN sign
Sometimes associ w HSV

mx prednisoalome

Question 37

Management of Parkinson’s?

Answer 37

Levodopa

Dopamine agonist

Question 38

Stroke management

Answer 38

Fluid management
Hydration status

Isotonic saline wi dextrose

Glycaemic control

Question 39

Normal pressure hydrocephalus

Answer 39

Urinary incontinence
Gait abnormality
Dementia