Neuro

Question 1

Ascending tracts (2) - where do they decussate and what modalities?

Answer 1

Dorsal column (fasciculus gracilis [medial] and cuneatus) - decussation brainstem - light touch, vibration and proprioception

Spinothalamic tract - cross over segmentally - pain, temperature, deep pressure

Question 2

Levels of reflexes:

Answer 2

biceps and brachioradialis - C5,6
triceps - C7

quads - L3, 4
gastrocnemius - S1

Question 3

Important descending tracts - what they do? where cross? - describe one most important
mention others (3)

Answer 3

Corticospinal - fine movement - pyramidal tract - 85% cross at decussation of the pyramds in medulla

Tectospinal tract
Reticulospinal tract
Vestibulospinal tract

Question 4

Duchenne muscular dystrophy is the deficiency of which protein?

Answer 4

dystrophin

Question 5

Pathology of Alzheimer (3)

- loss of what? -what intracellular? -what extracellular?

Answer 5

Loss of cortical neurones
Neurofibrillary tangles (intracellular)
Senile plaques (extracellular) - amyloid beta protein

Question 6

Age and most common organisms for bacterial meningitis?

Answer 6

Neonates: listeria, group B streptococci, E. coli
Children: H. influenza
10 to 21: meningococcal
21 onward: pneumococcal >meningococcal
Elderly: pneumococcal>listeria

Question 7

Treatment for TB meningitis?
Treatment of listeria meningitis?
Treat bacterial in general?
Treat viral?

What other medication for bacterial?

Answer 7

isonizid + rifampicin (add pyrazinamid + ethambutol)
IV ampicillin/amoxicillin (if pen allergic: cotrimoxazole)
Ceftriaxone (chloramphenicol+ vancomycin)
Aciclovir

Steroids

Question 8

Meningitis - blanching or non-blanching?

Answer 8

Non-blanching

Question 9

What kind of meningitis?

Lymphocytes, -ve Gram stain, -ve antigen detection, normal or slightly high protein, normal glucose?

Answer 9

Viral

Question 10

What kind of meningitis?

Polymorphs, +ve Gram stain, +ve antigen detection, high protein, less than 70% glucose?

Answer 10

Bacterial

Question 11

What kind of meningitis?

Lymphocytes, +ve or -ve Gram stain, -ve antigen detection, high or v high protein, less than 60% glucose?

Answer 11

Tuberculous

Question 12

Types of MS (4)

Answer 12

Relapsing-remitting (most)
Primary progressive (don't get relapses)
Secondary progressive (get relapses and stuff, then becomes progressive)
Progressive relapsing (is progressive from beginning but also have flare ups)

Question 13

Oligoclonal bands present or absent in MS?

Answer 13

Present

Question 14

Which steroid in MS?

Answer 14

Methylprednisolone

Question 15

What is baclofen used to treat?

Is it an NSAID?

Answer 15

It’s not an NSAID

Muscle relaxant for spasticity

Question 16

First line in relapsing remitting MS?

Answer 16

tecfidera

Question 17

Treatment for myasthenia gravis

Answer 17

Pyridostigmine (ACh-ase inhibitor)
thymectomy
Emergency - plasma exchange or Ig

Question 18

Heliotrope rash on the face is which disease?

Answer 18

Dermatomyositis

Question 19

Acute renal failure (or DIC) and muscle disease (anya), which one?
Triad of symptoms?

Answer 19

Rhabdomyolysis

myalgia, muscle weakness, myoglobinuria (black urine)

Question 20

UMN signs

Answer 20

Pseudobulbar (UMN of IX-XII CN)
Moderate weakness
Spasticity
Hyperreflexia
Babiński

Question 21

LMN signs

Answer 21

Severe weakess
Fasciculations (excited denervated muscle)
Muscle cramps
Hypotonia
Muscle atrophy
Hyporeflexia

Question 22

Headache that is wakes you up, worse on leaning forward and coughing, and may be associated with vomiting?
Can also be new neurological deficit or seizure

Answer 22

BRAIN TUMOUR

may have raised ICP

Question 23

Increased ICP (or suspicion) - do a lumbar puncture or not?

Answer 23

NO

Question 24

Cabergoline is used for?

Answer 24

Pituitary tumours

Question 25

Headache red flags?

Answer 25

New onset headache >55
•Known/previous malignancy
•Immuno-suppressed
•Early morning headache
•Exacerbation by valsalva (coughing, sneezing etc)

Question 26

Migraine: where, what kind of pain
duration
worse by?
(which substance contributes?)
aura?

Answer 26

unilateral, throbing
44-72 hours
worse on movement, light, noise
(substance P)
visual, sensory, motor or language; before or during headache

Question 27

Treatment of migraine

Answer 27

Abortive - NSAID, triptans
aspirin, naproxen, ibuprofen (+- antiemetic)
prophylaxis: propranolol, topiramate, amitriptyline

Question 28

Cluster headache: where
when?
severity, duration

Answer 28

Unilateral
circadian and seasonal variation
severe, 45-90 mis, 1-8 days

Question 29

Treat cluster headache

Answer 29

100% O2
SC sumatriptan
steroids
verapamil for prophylaxis

Question 30

Paroxysmal hemicrania
who?
where?
duration?
frequency
treat

Answer 30

elderly, women
unilateral, severe, unilateral autonomic
10-30 mins (shorter and more frequent than cluster)
1 to 40 day
Ix: indomethicin

Question 31

Treat trigeminal neuralgia

Answer 31

carbamazepine, gabapentine, phenytoin

Question 32

Treat partial seizures

Answer 32

Carbamazepine, lamotrigine

Question 33

Treat generalized seizures

Answer 33

Sodium valproate

Question 34

Treat delayed ischaemia (as a complication of SAH)

Answer 34

Nimodipine (Ca channel blocker so no vasospasm)

Triple H therapy - hypertension, hypervolaemia, hemodilution

Question 35

Charcot-Bouchard microaneurysms associated with what?

Answer 35

Hypertensive Intracerebral Haemorrhage

haematoma can be present too

Question 36

Brown Sequard syndrome - what is (not) felt/moved and which side?

Answer 36

motor - ipsilatera
dorsal column - ipsilateral (fine touch, proprioception, vibration)
spinothalamic - contralateral (pain, temp, crude touch)

Question 37

treat epilepsy - prolonged seizures treated by carers at home

Answer 37

rectal diazepam
(buccal midazolam)
immediate control - also lorazepam, drugs above as IV

Question 38

Management of status epilepticus

Answer 38

Give glucose (hypoglycaemia?) with thiamine (esp if suspicion of nutritional deficiency)
Phenytoin
ITU, EEG (within 1 hour of admission)