Neuro

Question 1

first-line treatemnt for spasticity in multiple sclerosis

Answer 1

Baclofen and gabapentin

Question 2

Rules about stopping
anti epileptic drugs

Answer 2

can be considered if been seizure free for 2 years. AEDs to be stopped over 2-3 months

Question 3

A 45-year-old female with multiple sclerosis complains of tingling in her hands which comes on when she flexes her neck. What is this an example of?

Answer 3

This is a classic description of Lhermitte’s sign which indicates disease near the dorsal column nuclei of the cervical cord. It is also seen in subacute combined degeneration of the cord and in cervical stenosis

seen in MS

Question 4

what is Uhthoff’s phenomenon?

Answer 4

Uhthoff’s phenomenon: worsening of vision following rise in body temperature
MS

Question 5

Lewy body dementia typically presents with…in contrast to other forms of dementia

Answer 5

Lewy body dementia typically presents with fluctuating cognition in contrast to other forms of dementia

Question 6

most common complication following meningitis

Answer 6

Sensorineural hearing loss is the most common complication following meningitis

Question 7

Lip smacking would indicate which type of seizure

Answer 7

Lip smacking would indicate a temporal lobe seizure.

Question 8

Paraesthesia is a feature of… seizures

Answer 8

Paraesthesia is a feature of parietal lobe seizures

Question 9

A Jacksonian march is a feature of… seizures.

Answer 9

A Jacksonian march is a feature of frontal seizures.

Question 10

Plucking of clothes is typically seen in…seizures

Answer 10

Plucking of clothes is typically seen in temporal lobe seizures

Question 11

brain abscess causes

Answer 11

extension of sepsis from middle ear or sinuses, trauma or surgery to the scalp, penetrating head injuries and embolic events from endocarditis

Question 12

brain abscess features and investigations

Answer 12

You arrange an urgent CT head that shows a frontal ring enhancing lesion.

Question 13

management of brain abscess

Answer 13

surgery
* a craniotomy is performed and the abscess cavity debrided
* the abscess may reform because the head is closed following abscess drainage.

IV antibiotics: IV 3rd-generation cephalosporin + metronidazole

intracranial pressure management: e.g. dexamethasone

Question 14

triad in wernick’s encelopathy

Answer 14

oculomotor dysfunction
* nystagmus (the most common ocular sign)
* ophthalmoplegia: lateral rectus palsy, conjugate gaze palsy
gait ataxia
encephalopathy: confusion, disorientation, indifference, and inattentiveness

peripheral sensory neuropathy

Question 15

wernick’s encelopathy management

Answer 15

give Pabrinex (IV B/C vitamins) as they have thiamine deficiency

Question 16

Suspected optic neuritis investigation of choice

Answer 16

MRI of the brain and orbits with gadolinium contrast is the investigation of choice

Question 17

parietal lobe seizure would typically present with

Answer 17

Parietal lobe is incorrect. A parietal lobe seizure would typically present with sensory disturbances, such as paraesthesia, electric shock type sensations, hallucinations, or dizziness.

Question 18

A temporal lobe seizure usually presents with

Answer 18

A temporal lobe seizure usually presents with automatisms, such as lip-smacking, grabbing, or plucking at clothes, along with sudden emotional disturbance or a feeling of deja vu

Question 19

Seizures originating in the occipital lobe typically present as

Answer 19

Seizures originating in the occipital lobe are typically visual, presenting with flashers and floaters, or lines in the vision

Question 20

cerebellar damage symptoms

Answer 20

While the cerebellum can indirectly cause epileptic seizures, they are unlikely to originate in the cerebellum itself. Symptoms of cerebellar damage include gait disturbance, jerky movements, and speech disturbance, which are similar to those seen here. However, a frontal lobe seizure is more likely.

Question 21

frontal lobe seizure presents as

Answer 21

The history of clonic movements starting in one extremity and moving proximally through the body is typical of a Jacksonian March. This, combined with post-ictal weakness usually indicates a frontal lobe origin.

Question 22

A 65-year-old woman presents with fatigue, paraesthesia in her hands and feet, and mild gait unsteadiness. She reports that her symptoms have developed over several months. Her diet is limited, and she admits to rarely consuming meat or dairy products. On examination, you notice reduced vibration and proprioception in the lower limbs.

Blood tests show:

Hb 90 g/L (115 - 160)
Mean cell volume 110 fL (80 - 100)
Vitamin B12 34 ng/L (200 - 900)
Folate 1.5 nmol/L (> 3.0)

What is the most appropriate next step?

Answer 22

Administer IM B12 followed by oral folic acid

In patients with both vitamin B12 and folate deficiencies, the vitamin B12 deficiency must be treated first to avoid subacute combined degeneration of spinal cord

Question 23

what is used to prevent vasospasm in aneurysmal subarachnoid haemorrhages

Answer 23

Nimodipine is used to prevent vasospasm in aneurysmal subarachnoid haemorrhages

Question 24

Of the antiparkinson drugs…associated with the greatest improvement in symptoms and activities of daily living

Answer 24

Of the antiparkinson drugs, levodopa (co-carledopa) is associated with the greatest improvement in symptoms and activities of daily living

Question 25

Which vitamin, present in Pabrinex, can prevent progression of symptoms to Wernicke’s encephalopathy?

Answer 25

B1

Question 26

First line treatment in diabetic neuropathy is with

Answer 26

First line treatment in diabetic neuropathy is with amitriptyline, duloxetine, gabapentin or pregabalin

Question 27

Drug-induced parkinsonism compared to Parkinson’s disease:

Answer 27

motor symptoms are generally rapid onset and bilateral
rigidity and rest tremor are uncommon

Question 28

S1 lesion features

Answer 28

S1 lesion features = Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test

Question 29

migraine attack prevention in asthmatics

Answer 29

topiramate

Question 30

syncope vs seizures

Answer 30

Syncopal episodes are associated with a rapid recovery and short post-ictal period. Seizures are associated with a far greater post-ictal period