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1
Q

Criteria for a Total Anterior circulation Stroke?

A

All three of :

Unilateral weakness or sensory deficit

Homonymous hemianopia

Higher cerebral dysfunction (dysphasia or visuospatial)

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2
Q

Criteria for Partial anterior circulation stroke?

A

Two of:

Unilateral weakness or sensory deficit

Homonymous hemianopia

Higher cerebral dysfunction (dysphasia or visuospatial)

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3
Q

Lacunar syndrome stroke criteria?

A

One of:

Pure sensory

Pure motor

Sensori-motor

Ataxic hemiparesis

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4
Q

Posterior circulation syndrome (stroke)?

A

One of:

Cranial nerve palsy

Bilat motor/sensory deficit

Congate eye movement

Cerebellar dysfunction

Isolated homonymous hemianopia

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5
Q

Person presents with unilateral weakness and dysphasia what stroke?

A

Partial anterior

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6
Q

Person presents with isolate homonymous hemianopia, stroke type?

A

Posterior syndrome

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7
Q

Unilateral weakness, Homonymous hemianopia and dysphasia?

A

TACS

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8
Q

TACS stroke involves which arteries?

A

Middle and anterior cerebral arteries

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9
Q

Scoring system after TIA?

A

ABCD2

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10
Q

High risk ABCD2 score?

A

4 or greater

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11
Q

What classifies as a crescendo TIA?

A

Two or more TIAs in a week treat as high risk

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12
Q

Initial treatment of TIA?

A

Give aspirin 300mg unless already taking if so continue normal dose. Unless on anticoagulation or bleeding problem

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13
Q

Suspected TIA within last week? When to refer?

A

Urgently within 24hrs

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14
Q

What is ABCD2 score?

A 
Age >60
BP >140/90
Clinical presentation Weakness retinal or speech
Duration >60mins (2) 10-59 mins) 1
Diabetes
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15
Q

If TIA occured >1 week ago referral time?

A

Within a week

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16
Q

Antiplatelets in TIA and stroke ?

A

The standard treatment is clopidogrel 75mg daily- off licence in TIA

or if cannot tolerate clopidogrel and have dipy and aspirin

or dipyridamole alone if clopidogrel and aspirin contraindicated

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17
Q

Target systolic BP in pts after stroke or TIA?

A

130mmHg

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18
Q

Initiation of anticoagulation in stroke/TIA? When started

A

If AF or atrial flutter once haemorrhage ruled out.

Immediately in TIA

after 14 days in Stroke(disabling) use aspirin 300mg

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19
Q

DVLA rules for TIA/Stroke?

A

Don’t need to tell DVLA if no complications and recovered. Only if >1 TIA or disabling stroke.

Stop driving for 1 months

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20
Q

DVLA rules for heart attack?

A

Don’t need to tell but stop driving for 1 week after angioplasty
or 4 weeks if no angioplasty or unsuccessful angioplasty

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21
Q

Score for ruling in strokes in A&E?

A

ROSIER

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22
Q

When is thrombolysis indicated in stroke?

A

Within 4.5 hrs and only if imaging has ruled out haemorrhage

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23
Q

Absolute contraindications to thrombolysis?

A

Previous haemorrhage, Seizure at onset
Stroke in previous 3 months
GI haemorrhage
Active bleeding

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24
Q

Relative contraindication for thrombolysis?

A

Major surgery in previous 2 weeks, anticoagulated already

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25
Q

When is carotid endarterectomy recommended?

A

TIA or non disabling stroke in carotid territory

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26
Q

USS of carotids for surgery?

A

50-99% for north american

>70% european system

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27
Q

If brain imaging needed in TIA what used?

A

MRI

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28
Q

Which arteries involved in lacunar stroke?

A

Perforating arteries

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29
Q

What is ataxic hemiparesis?

A

Hemiparesis usually worse in lower extremity, and hemiataxia (loss of muscle control

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30
Q

Posterior stroke involves which arteries?

A

Vertebrobasilar

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31
Q

Most common cause of SAH?

A

Berry aneurysm ~85% Polycystic kidneys associated

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32
Q

Classic SAH questions?

A

Thunderclap’ or ‘baseball bat’), severe (‘worst of my life’) and occipital

Nausea and vomiting
Meningism (photophobia, neck stiffness)

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33
Q

Imaging in SAH?

A

CT- brights on CT basal cisterns and sulci severe cases ventricular

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34
Q

CT negative in SAH now what?

A

> 12hrs laters Lumbar puncture to confirm xanthochromia(differentiate from traumatic tap)

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35
Q

Confirm SAH then?

A

Refer to neurosurgery immediately

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36
Q

Investigation to find cause of SAH?

A

CT intracranial angio

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37
Q

Vasospasm in SAh use what?

A

Nimodipine

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38
Q

SAH complications?

A

Re-bleed, vasospasm, hyponatremia (SIADH)

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39
Q

What nerve may be damaged in colles fracture?

A

Median

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40
Q

Fasciculations think?

A

MND

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41
Q

Big toe nerve root?

A

L5

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42
Q

Subdural haemorrhage results from what?

A

Bridging veins

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43
Q

Essential tremor presentation? Risk factors?

A

A bilateral upper limb action tremor, with absence of other neurological signs, such as dystonia, ataxia, or parkinsonism is the core sign of essential tremor

No resting tremor

Family history

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44
Q

Essential tremor is stopped by consumption of what ?

A

Alcohol

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45
Q

Ptosis plus dilated pupil =

A

Third nerve palsy

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46
Q

Ptosis plus constricted pupil =

A

Horners syndrome

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47
Q

Clonic movements travelling proximally? Which lobe?

A

Jacksonian frontal lobe

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48
Q

Loss of corneal reflex which cranial nerve?

A

CN V trigeminal

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49
Q

Weakness in myasthenia gravis characteristics?

A

Gets worse with exercise

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50
Q

Plucking at clothes and lip smacking often seen in which lobe seizure?

A

Temporal

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51
Q

Deviation of Jaw to or away from lesion? WHich Cn?

A

CN V toward lesion

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52
Q

Loss of facial sensation which CN?

A

Cranial never V

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53
Q

Nystagmus feature of which CN lesion?

A

CNVIII

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54
Q

A man loses consciousness then is seen to have rapid jerks of his facial and limb muscles?

A

Tonic-Clonic seizure

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55
Q

Confusion, ataxia, nystagmus/ophthalmoplegia?

A

Wernickes- give IV pabrinex

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56
Q

Frontotemporal dementia feature?

A

Disinhibition- often family history

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57
Q

Which drugs can cause problem gambling etc in parkinsons?

A

Dopamine agonists biggest risks

58
Q

Differentiate between pseudo and true seizure?

59
Q

ocular myasthenia gravis?

A

Looks like CN3 lesion but pupil is normal

60
Q

Urinary incontinence + gait abnormality + dementia?

A

normal pressure hydrocephalus

61
Q

Pre-renal AKI urea vs creatinine?

A

Urea a lot higher than creatinine

62
Q

Intrinsic and post renal AKI Creat and Urea?

A

Urea lower in contrast to creatinine

63
Q

General screen for stroke?

64
Q

Investigations for TIA ?

A

Peripheral nerves, Pulse and BP is this AF?

65
Q

Aspiring for how long before clopidogrel in stroke?

66
Q

DANISH mnemonic?

A 
dysdiadochokinesis.
ataxia.
nystagmus.
intention tremor.
scanning dysarthria slurred
heel-shin test positivity.
67
Q

CSF results in Bactrial meningitis?

A

Cloudy, Low glucose, High protein and neuts

68
Q

CSF in Viral?

A

Clear usually, Glucose 60-80% plasma, Protein normal usually, lymphs predominant

69
Q

CSF TB?

A

FIBRIN web, slightly cloudy,Low glucose but HIGH protein and lymphs

70
Q

Wegeners ganulomatosis antibody?

71
Q

Churg strauss (Eosinophillic) antibody?

72
Q

Status epilepticus treatment?

A

Initially up to 4mg lorazepam IV repeated after 5-10 mins if necessary

or buccal midaz 10mg or rectal diazepam 10mg

Consider phenytoin 20mg/kg - get senior help if not responding after 5 mins

73
Q

Definition of status epilepticus?

A

> 5mins seizure or seizures that stop very briefly and restart

74
Q

Management of status epilepticus?

A

A-E Protect airway (adjuncts)
Oxygen blood FBC, U&E, calcium magnesium glucose

Consider anaesthetic support

75
Q

Most important investigation in Meningitis?

A

Lumbar puncture

76
Q

When to give Ben pen?

A

If non blanching rash

77
Q

Most common causes of meningitis in adults?

A

S. pneumoniae, H. influenzae type b, N. meningitidis

78
Q

Extra-dural haematoma ct sign?

A

Lentiform extra lentils

79
Q

Subdural Haematoma CT signs?

A

Crescent shaped

80
Q

Risks for subdural haematoma?

A

Trauma or anticoagulants >65years

81
Q

Classic history for extradural?

A

Trauma LOC and then lucid interval. Can then rapidly go down hill third nerve palsy and a fixed dilated pupil

82
Q

Definitive management of extradural?

A

Craniotomy and clot evacuation

83
Q

Acute subdural haematoma mechanism of injury?

A

High speed injuries often

84
Q

Subdural haematoma treatment?

A

Craniectomy

85
Q

SAH treatment?

A

Directed at bleed cause

86
Q

Most common complication meningitis?

87
Q

Criteria for CT head in 1 hr ?

A

CS <13 on initial assessment
GCS <15 at 2h post-injury
Suspected open/ depressed skull fracture
Sign basal skull fracture – panda eyes, Battle’s sign,
Focal neuro deficit
Post-traumatic seizure
>1 episode vom

88
Q

On warfarin head injury no other signs? When to CT?

A

Within 8 hrs

89
Q

LP contraindications?

A

ICp pappiloedema, Cardiorespiratory unstable, Coagulopathy, DIC, FOCAL neurology

90
Q

Post ictal confusion focal unaware which lobe?

91
Q

Rapid recovery from focal unaware? Lobe?

92
Q

Focal aware?postictal?

A

No post ictal symptoms

93
Q

First investigations after possible epilepsy ?

A

Bloods and ECG

94
Q

How long seizure free for driving normal car and how long bus?

A

1 year 10 years

95
Q

Remission of MS symptoms must be present for at least?

96
Q

Relapse of MS how long between symptoms?

A

30days and symptoms must be >24hr in length

97
Q

MS features?

A

Optic neuritis
Pins and needles trigeminal neuralgia and numbness
Spasticity of legs
Ataxia

98
Q

Unilateral pain behind eye and scotoma?

A

Optic neuritis

99
Q

MS give what nutrient?

100
Q

MS lifestyle?

A

Smoking stop exercise etc

101
Q

Parkinsons triad?

A

Increased tone or rigidity, slow to move and tremor(pill rolling)

102
Q

Median nerve palsy symptoms?

A

Abduct and oppose thumb, and lumbrical problems.

103
Q

Ulnar nerve palsy ?

A

Claw hand, inability to flex and abduct fingers

104
Q

Radial nerve palsy?

A

Wrist drop and anatomical snuff box loss of sensation

105
Q

Erbs palsy?

A

Waiters tip upper brachial

106
Q

Klumpsies ? assoc with what? Lower brachial plexus

A

Horners, claw hand

107
Q

Axillary nerve damage by what and causes what?

A

Humeral head damage or dislocation anterior, regimental badge and no abduction first 15degrees

108
Q

Sciatic nerve problems, what happens?

109
Q

Foot drop and loss of dorsiflexion nerve and eversion?

A

Common peroneal

110
Q

Tibial nerve palsy?

A

Plantarflexion cant stand on toes sole of foot loss

111
Q

Management of alzheimers pharmacological?

A

Acetycholinesterase inhibitors are options for mild to moderate alzheimers

112
Q

Moderate alzheimers and intolerent to acetylcholinesterses? Use what?

113
Q

When to use memantine as monotherapy in alzheimers?

A

Severe disease

114
Q

Moderate severe alzheimers which drugs?

A

ACetyl inhib and can add on memantine

115
Q

Depression in alzheimers?

A

Nice dose not recommend anti-deps in mild to severe depression

116
Q

Patient with bradycardia which alzheimers drug to avoid? What other side effect can it cause?

A

Donepazil

Can cause insomnia

117
Q

What features point more towards a vascular dementia?

A

Stepwise progression, significant atheroma history,, can be sudden onset, neurological deficits present, gait disturbances early on. Memory not impaired hugely initially.

118
Q

Potentially treatable causes of dementia?

A

Addisons Hypothyroid, B12/folate/thiamine deficinet
Brain tumour
Hydrocepahlus
Depression

119
Q

Pellagra what is it signs and symptoms?

A

Pellagra is a caused by nicotinic acid (niacin) deficiency

3 D’s - dermatitis, diarrhoea and dementia.

120
Q

Initial areas of change in MRI alzheimers?

A

Temporal lobe initially and then parietal

121
Q

Vascular dementia treatment?

A

Underlying causes- do not offer meds unless co-morbid alzheimers

122
Q

Frontotemporal dementia and AChE?

A

Do not offer, can make worse

123
Q

Frontal temporal dementia symptoms?

A

Disinhibition, personality change. Often younger than other dementias mid 50s

124
Q

Fronto temporal dementia treatment?

A

None as such supportive can use benzos or antipsychotics for aggression and agitation. If parkinsonism use quetiapine

125
Q

Depression vs dementia?

A

short history, rapid onset
Biological symptoms- weight loss
Worried about memory

126
Q

Focal and tonic clonic seizures treatment?

A

Carbamazepine

127
Q

Tonic or atonic seizures treatment?

A

Sodium valproate

128
Q

Myoclonic seizures treatment?

129
Q

Absence seizures treatment?

A

Lomotrigine or ethosuximide

130
Q

Diagnosis of MS clinically?

A

episodic neurological dysfunction in at least two areas of the central nervous system (brain, spinal cord, and optic nerves) separated in time and space

131
Q

Specificity of MRi spine for MS?

132
Q

Primary options for relapsing remitting MS?

A

Interferon

133
Q

Myasthenia gravis signs/symptoms?

A

Dysphagia, diplopia, ptosis, dysarthria

proximal limb weakness worsens with activity (better in morning)

often autoimmune disorder

134
Q

Most specific test for Myasthenia gravis?

A

serum acetylcholine receptor antibody

135
Q

FVC useful in which neuro disorder?

A

Myasthenia gravis

136
Q

Pyridostigmine treats what?

A

Myasthenia gravis

137
Q

Severe myasthenia treatment?

A

intubate plasma exchange and immunoglobulin

138
Q

Clinical diagnosis of ALS?

A

presence of upper and lower motor neuron signs fasciculations present

Wasting of small hand muscles

Absent sensory signs

139
Q

Mix of signs in ALS where?

A

UMN -Arms Hyperreflexia

LMN-Legs fasciculations

140
Q

Treatments of ALS pharmacological and supportive?

A

Riluzole and Bi-pap

141
Q

Motor neurone progressive bulbar?

A

Facial problems chewing and swallowing

Finals (16 decks)

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