Neuro

Question 1

Name three characteristics of myopathic facies and when you would find it

Answer 1

1. bilateral ptosis
2. sunken cheeks due to wasting of masseter muscle
3. poor ability to smile due to muscle weakness

Congenital myopthies

Question 2

What are three invesigations for MS

Answer 2

1. MRI brain showing white matter lesions
2. CSF showing oligoclonal bands
3. Visual evoked potential

Question 3

Investigations for myasthenia gravis

Answer 3

1. Anti AChR antibody
2. Tensilon test (administration of short acting acetyl-cholinesterase inhibitor improves symptoms)
3. INCREASED evoked potentials on nerve stimulation of motor neurone

Question 4

What is internuclear ophthalmoplegia and when is it seen?

Answer 4

When an attempt is made to gaze contralaterally (relative to the affected eye), the affected eye adducts minimally, if at all. The contralateral eye abducts, however with nystagmus

Lesion of medial longitudinal fasciculus commonly by MS or a brainstem infarction

Question 5

Red flags for headache - 5

Answer 5

1. meningism (neck stiffness, photophobia)
2. cough brings on headache, worse in mornings
3. decline in conciousness
4. first episode of ‘worst headache of life’/thunderclap
5. persisting headache + scalp tenderness in over 50/s (think GCA)

Question 6

Carbemezapine - 3 uses

Answer 6

Generalised & partial siezures (not absence)
Trigeminal neuralgia
Prophylaxis in bipolar disorder

Question 7

What are two eponymous names of signs related to meningism and what are they?

Answer 7

Kernig’s sign (flexion of hips and knees with flexion of neck)
Brudzinski’s sign (inability to straight leg raise due to nexh pain/can’t straighten legs with hips flexed due to neck pain)