neuro 2

Question 1

MG treatment
(3)

Answer 1

temporary symptom relief
- long acting acetylcholinesterase inhibitor= Pyridostigmine (1st line)

myasthenic crisis (resp muscles)
- Plasmapheresis and IV immunoglobulin

immune suppression to prevent relapses
- prednisolone

Question 2

cluster headache
- prophylaxis
- acute rescue

Answer 2

Verapamil

sumitriptan + oxygen

Question 3

migraine
- prophylaxis
- acute rescue

Answer 3

propanolol / topirimate / riboflavin / triptan / acupuncture

triptan and NSAID/ paracetemol

Question 4

stroke in Anterior cerebral artery ACA

Answer 4

Contralateral hemiparesis and sensory loss, lower extremity > upper

Question 5

Stroke in middle cerebral artery MCA

Answer 5

Contralateral hemiparesis and sensory loss, upper extremity > lower

Contralateral homonymous hemianopia

aphasia

Question 6

Stroke in posterior cerebral artery PCA

Answer 6

Contralateral homonymous hemianopia with macular sparing (central vision ok)

Visual agnosia (can’t recognise objects, faces fine)

+/- Webers syndrome (branch off PCA to midbrain)
- Ipsilateral CN III palsy
- Contralateral weakness of upper and lower extremity

Question 7

basilar artery stroke

Answer 7

locked in syndrome

Question 8

stroke in Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)

Answer 8

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

Question 9

stroke in Anterior inferior cerebellar artery (lateral pontine syndrome)

Answer 9

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

Ipsilateral: facial paralysis and deafness

Question 9

how to distinguish idiopathic vs iatrogenic PD

Answer 9

idiopathic - asymmetrical
iatrogenic - symmetrical

Question 10

suspected TIA
- what next

Answer 10

aspirin 300mg asap
(unless already on asprin low dose, just continue, if patient has a bleeding disorder/ is taking an anticoagulant)

if patient has bleeding disorder/ is taking an anticoagulant –> urgent CT to exclude haemorrhage

referal to TIA clinic
(because TIA is imaging based, not time based, all need scan/ follow up)
- within 24h if suspected TIA in last week
- within 7d if suspected TIA over a week ago

if crescendo TIA (more than 1) –> urgent admission and specialist review

possible carotid doppler/ ECG later on

long term - clopidogrel 1st line. (aspirin + dipyridamole if not)

carotid endartectomy if 70% carotid stenosis and not severly disabled

Question 11

lacunar infarct

Answer 11

1 of the following:

1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

Question 12

total anterior circulation infarct

partical anterior circulation infarct

Answer 12

anterior and middle cerebral arteries

(Total) - 3 of

1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

2 of them (partial)

Question 13

posterior circulation infarct

Answer 13

vertebrobasilar arteries

1 of

1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia

Question 14

alcohol withdrawal timeframe
- symtpoms
- seizures
- delerium tremens

Answer 14

• symtpoms 6-12h
• seizures 36h
• delerium tremens 72h

Question 15

A painful 3rd nerve palsy is what until proven otherwise

Answer 15

posterior communicating artery aneurysm

would also give meningism

Question 16

pontine stroke

Answer 16

reduced GCS,
paralysis- often all limbs
bilateral pin point pupils (miosis)
absent horizontal eye mvmts

Question 17

normal pressure hydrocephalus

• triad
• imaging

Answer 17

urinary incontinence
gait issue/ ataxia
declining cognition

wobbly, whacky, wet

ventricles englarged, without or not proportionate to sulcal enlargement

Question 18

ramsay hunt syndrome
- cause
- features
- tx

Answer 18

VZV in CN7

like bells palsy but also ear pain/ hearing symptoms (vertigo, tinnitus)/ ear rash

tx: steroids and aciclovir

Question 19

what type of stroke is fluctuating conciousness/ confusion typical of

Answer 19

subdural

Question 20

korsakoff triad
wernickes triad

Answer 20

korsakoff
1. confabulation
2. anterograde amnesia
3. retrogreade amnesia

wernickes
1. encephalopathy (confusion)
2. ataxia
3. opthalmoplegia ( nystagmus, eye palsy)

Question 21

prolactinoma triad

Answer 21

headaches
amenorrhea
visual defects

Question 22

labyrinthitis vs vestibular neuronitis

Answer 22

both
- vertigo
- n/v
- recent infection

labyrinthitis
- hearing loss
- tinnitus

vestibular neuronitis
- nystagmus