Neuro

Question 1

list the types of MS

Answer 1

relapsing-remitting, primary progressive, secondary progressive

Question 2

which areas are most commonly affected by MS

Answer 2

optic nerve, cervical cord, periventricular areas

Question 3

2 signs in MS

Answer 3

Lhermitte’s - neck flexion = paresthesia

uthoff’s - worse in heat

Question 4

investigations in MS

Answer 4

MRI - demyelinating plaques
LP - oligoclonal bands
evoked potentials

Question 5

diagnosis of anterior stroke (ie symptoms) and arteries affected

Answer 5

need 3/3 for total and 2/3 for partial
unilateral hemiparesis, hemianopia, dysphasia
middle cerebral (arm), anterior cerebral (leg)

Question 6

diagnosis of poterior stroke (ie symptoms) and arteries affected

Answer 6

one of;
homonymous hemianopia
loss of consciousness
cerebellar syndrome 
vertebrobasilar arteries

Question 7

diagnosis of lacunar stroke (ie symptoms) and arteries affected

Answer 7

1 of; 
unilateral weakness
ataxic hemiparesis
sensory change 
perforating arteries

Question 8

long term management of stroke

Answer 8

aspirin for 2/52 then clopidogrel

Question 9

management of TIA

Answer 9

do ABCDE2

warfarin if AF or clopidogrel if no AF

Question 10

explain CHADS2Vasc

Answer 10

risk of stroke in AF

give warfarin

Question 11

describe the presentation and CT findings of an extradural and vessel affected

Answer 11

lucid period then reduced LOC following temporal bone fracture
fixed dilated pupil due to CN III compression
biconvex lesion with midline shift
middle meningeal

Question 12

describe the presentation and CT findings of a sub dural

Answer 12

fluctuating consciousness. can be chronic.
crescent shaped not limited by suture lines (bright/hyperdense in acute, dark/hypodense in chronic)
bridging veins

Question 13

describe the presentation and CT findings of subarachnoid

Answer 13

sudden onset thunder clap headache, meningism, N&V
star sign, follows suture lines
circle of willis

Question 14

investigations and management in subarachnoid

Answer 14

CT
Lp 12 hrs after onset - xanthochromia
nimodipine

Question 15

presentation of parkinsons

Answer 15

rigidity, bradykinesia (slow intention, shuffling gait), tremor (resting, pill rolling, unilateral)

Question 16

name the parkinson’s plus syndromes

Answer 16

multiple system atrophy - autonomic dysfunction
progressive supranuclear palsy - vertical gaze palsy, postural instability
lewey body dementia - visual hallucinations
vascular - risk factors
corticobasal degeneration - alien limb, sensory loss

trial of levodopa doesn’t help

Question 17

what drugs are used in parkinsons

Answer 17

MAOi's (selegiline)
dopamine agonists (ropinirole) - domperidone as antiemetic is nausea and vomiting
l-dopa and madopar (decarboxylase inhibitor)

Question 18

acute and chronic treatment of tension headache

Answer 18

short term analgesia/ amitriptyline

10 sessions acupuncture over 5-8 weeks

Question 19

acute and chronic treatment of cluster headache

Answer 19

100% oxygen and SC/sublingual triptan

verapimil

Question 20

acute and chronic treatment of migraine

Answer 20

oral triptan and analgesia

if get >2 attacks a month give topiramate (can give propranolol)

Question 21

investigations in seizures

Answer 21

EEG, CT, glucose , U&E’s

Question 22

management of epilepsy

Answer 22

sodium valproate (generalised)
carbamazepine (focal)

Question 23

driving advice in seizures

Answer 23

cant drive for 6 months after seizure and cant drive for 1 year seizure free in epilepsy

Question 24

driving advice in TIA

Answer 24

at least 1 month off driving

Question 25

management of status epilepticus

Answer 25

buccal midaz , repeat benzo, phenytoin, phenobarbital

Question 26

signs in spinal cord compression

Answer 26

UMN signs BELOW level LMN signs at level of lesion contralateral loss of pain and temperature sensation sphincter disturbance

Question 27

neuro deficits in brown sequard

Answer 27

ipsilateral loss of vibration, proprioception, and fine touch (dorsal columns) and motor function at the level of lesion contralateral loss of pain and temperature 1-2 levels below the lesion

Question 28

management of MS

Answer 28

alemtuzumab beta interferon methylpred in flare up

Question 29

criteria for MND

Answer 29

El escorial criteria UMN and LMN signs no sensory signs progressive course

Question 30

investigations and management of MND

Answer 30

EMG creatinine kinase high riluzole and baclofen for spacisity

Question 31

presentation of myasthenia gravis

Answer 31

``` diplopia/ptosis speech change peek sign snarl swallowing and breathing difficulties ```

Question 32

investigations in myasthenia gravis

Answer 32

Ab's: anti Ach, anti-musk CT thorax for thymus hyperplasia EMG

Question 33

management of myasthenia gravis (chronic and acute)

Answer 33

pyridostigmine, immunosuppression, thymectomy acute: plasma exchange and IVIg

Question 34

triad in normal pressure hydrocephalus

Answer 34

gait abnormality dementia urinary incontinence

Question 35

signs in a c5/6 radiculopathy

Answer 35

loss of biceps reflex (6 letters) | altered thumb sensation

Question 36

signs in C7 radiculopathy

Answer 36

loss of triceps reflex (7 letters) | middle finger sensation

Question 37

signs in L5 radiculopathy

Answer 37

cant stand on heels (dorsiflexion) | big toe sensation

Question 38

signs in s1 radiculopathy

Answer 38

cant stand on toes | absent ankle reflex

Question 39

what does a negative rinne's test mean

Answer 39

bone conduction = better than air conduction | conductive deafness

Question 40

weber's test lateralized to left ear means?

Answer 40

conductive problem in left ear (if rinnes negative) | or sensorineural deafness in right ear (if rinnes positive .- ie. normal rinne's)

Question 41

describe grading of muscle weakness (MRC)

Answer 41

0: no contraction 1: flicker 2: some active movement 3: active movement against gravity 4: active movement against some resistance 5: normal power

Question 42

investigations in memory loss

Answer 42

AMT (out of 10) MMSE (out of 30. <24 = demantia) bloods: B12/folate, FBC, ESR, U&E, calcium, syphilis CT

Question 43

management in dementia

Answer 43

psychosocial | anticholinesterase i's : donepezil, rivastigmine, memantine

Question 44

causes of facial nerve palsy

Answer 44

``` bells (diagnosis of exclusion) ramsay hunt infection stroke tumour diabetes GBS parotid tumour ```

Question 45

what is bells palsy

Answer 45

one half of face paralysed (LMN) CN VII palsy give prednisilone

Question 46

what mononeuropathy gives you foot drop?

Answer 46

common peroneal

Question 47

causes of polyneuropathy

Answer 47

``` diabetes Gbs b12/folate deficiency RA polyarteritis nodosa GPA polycythaemia HIV syphilis lymes disease charcot marie tooth drugs (alcohol, isoniazid, phenytoin, metronidazole, nitrofurantoin) ```