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1
Q

Describe hallmarks of Horners syndrome and causative pathologies

A

Ptosis (drooping eyelid), miosis (constriction pupil) and anhidrosis (decreased sweating on affected side)

May result from carotid artery dissection, tumour in neck, pancoast tumour, brain lesion, trauma.

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2
Q

Symptoms associated with central cord syndrome and cause

A

When at cervical region, Cape like distribution of pain and temp loss, weakness in upper limbs and hand wasting. Decussating fibres at that level are effected, so ventral corticospinal and spinothalamic tracts.

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3
Q

Symptoms of anterior cord syndrome

A

Spinothalamic and corticospinal tracts are affected, and dorsal column is spared. This causes variable sensory and motor presentations including loss of pain, temperature and autonomic function below level of lesion.
SPARING of vibration, proprioception and coarse touch.

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4
Q

Symptoms of posterior cord syndrome

A

Posterior column is affect (only decussate in medulla) so ipsilateral loss of fine touch, vibration, and proprioception.

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5
Q

Symptoms of Brown squared syndrome and what it is

A

Half of the spinal cord is damaged (sagitally), leading to ipsilateral loss of fine touch, vibration and proprioception, and contralateral loss of pain and temp and coarse touch.

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6
Q

Saddle, anaesthesia, fecal and urinary incontinence and neurogenic bladder are symptoms of… (spinal level too pls)

A

Cauda equina syndrome (often L4/5 or L5/S1)

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7
Q

spinothalamic tracts function, location on cord, where decussation of fibres occurs

A

Lateral: pain and temperature
Ventral: coarse touch and pressure
They cross at the level of the cord

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8
Q

Dorsal column location, function and decussation location

A

Fine touch, proprioception, vibration
Posterior location
Cross at the craniocervical junction

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9
Q

Lateral and ventral corticospinal tract location, function, decussation

A

Lateral: motor function located laterally at cord and decussates in brain
Ventral: motor function located anteriorly and decussates at the level of the spinal cord

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10
Q

General pattern of decussation in the spinal cord

A

Anterior tracts; decussate at the level of the cord

Posterior + lateral corticospinal; decussate higher up

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11
Q

Myeloradiculopathy what it is and causes

A

A compression causing damage of spinal nerve roots and spinal cord in the cervical vertebrae. It is often caused by facet osteophytes, disc herniation, ossification if ligaments etc…

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12
Q

Periodic rhythmic ocular oscillation is called

A

Nystagmus

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13
Q

Key features of vestibular nystagmus

A

Horizontal, maximal in direction of gaze, suppresses with fixation

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14
Q

Patient presents with dizziness and vertigo. They have no associated hearing loss, but have been vomiting and are unable to get out of bed. Had a sore throat few days ago. Diagnosis and management?

A

Labyrinthitis. Anti-emetics, vestibular suppressants (for short time) and wait it out.

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15
Q

Patient presents with diziness and vertigo. Episodes last about 1 min, especially when getting out of bed in the morning. They have no other significant history. Investigation and management?

A

Dix-hall pike manoeuvre to investigate. If positive, treat for BPPV by epley manoeuvre

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16
Q

Patient with diziness and vertigo. They have been getting frequent episodes lasting 30min-1h. they know it will come on because feel pressure in side the ear, and feel exhausted afterwards. Also have been suffering from gradual hearing loss, especially low frequencies. Diagnosis and management.

A

Ménière’s disease. To prevent attacks, low salt diet and diuretics. To stop attacks, vestibular suppressant.

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17
Q

Patient presents with dizziness and vertigo. These episodes are associated with certain trigger. she had a hex of migraine but her headaches are not related to episodes of dizziness

A

Vestibular migraine

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18
Q

Sodium valproate use and main side effects

A

First line for generalised seizures. P450 enzyme inducer so beware of interactions, very teratogenic, increased appetite and weight gain.

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19
Q

Carbamazepine use and main side effects

A

first line for focal seizures. P450 inducer, visual disturbance SIADH.

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20
Q

Lamotrigine use

A

Second line for variety of generalised and partial seizures. Can cause stevens Johnson syndrome

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21
Q

Management of status epilepticus

A

IV lorazepam 4mg repeated after 10 min if needed. then phenobarbital or phenytoin. IN community, buccal midazolam/ rectal diazepam

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22
Q

First line investigation in a TIA

A

Carotid Doppler US - required. MRI and CT up to specialist opinion

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23
Q

What to do if suspected TIA

A

Urgent (24h) referral to specialist Center

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24
Q

Post stroke medical management

A

Aspirin 75mg 2 weeks, followed by clopidogrel 75mg and Astor a statin 80mg pn.

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25
Acute stroke management
If within 4.5h since onset, give altepase (unless INR>1.7, unknown onset of symptoms, haemorrhagic stroke). And consider mechanical thrombectomy If altepase contraindicated or >4.5h, give aspirin 300mg and consider mechanical thrombectomy
26
Contralateral hemiparesis, sensory loss of lower > upper extremities is a stroke involving...
The anterior cerebral artery
27
Contralateral hemiparesis, sensory loss, upper > lower limb involvement, aphasia, contralateral homonymous hemianopia is a stroke involving the...
Middle cerebral artery
28
Contralateral homonymous hemianopia with macular sparing and visual agnosia is a stroke involving the...
Posterior cerebral artery
29
Aphasia due to a lesion of the superior temporal gurus. Fluent speech but sentences make no sense (word substitution and neologisms). Impaired comprehension. What is this and affected artery
Wernicke’s (receptive) aphasia. Supplied by inferior division of the left MCA
30
Non-fluent, laboured and halting speech, normal comprehension
Broca’s (expressive) aphasia, due to a lesion to the inferior frontal gyrus, supplied by the superior division of the left MCA.
31
Fluent speech with poor repition, patient aware of the errors they are making. Normal comprehension
Conduction aphasia - classically due to a stroke affecting the connection between wernickes and broca (accurate fascicles).
32
Severe expressive and receptive aphasia
Global aphasia caused by a large lesion affecting broca’s, wernicke’s and arcuate fasciculus.
33
Difference in CT scans between subdural and extraldural haemorrhage
Subdural: banana shaped hyper dense extra axial collection Extradural: bi-convex shape lemon limited by cranial sutures,
34
Typical duration of a migraine headache
4-72h
35
First line management of moderate and severe migraine. And what to do if pregnant.
Moderate: NSAID 1st line + metoclopramide (anti-emetic) if needed. Severe: Triptan + metoclopramide If pregnant, try to avoid triptan and NSAIS, opt for paracetamol instead. + antiemetic.
36
Preventive management of migraines
Topiramate (anti-epileptic, teratogenic), reducing triggers, triptans, propranolol
37
Tension headache symptoms and cause
Ache in the forehead in a band-like patter to back of head. Can be due to facial or skull muscle tension.
38
45 y old make smoker presents with unbearable unilateral headache 10/10. Focalised around eye. He has eye tearing and nasal congestion. It comes in waves between headache-free periods. Diagnosis and management
Cluster headache - high flow 100% O2 for 15-20 min. Consider triptan injection subcutaneous.
39
Low frequency, rest tremor, unilateral
Parkinson’s tremor
40
Bilateral action tremor, worst with outstretched arms and may get better with alcohol.
Essential tremor
41
Jerky tremor associated with painful, prolonged muscle contractions resulting in abnormal posture (usually arms or head)
Dystonic tremor
42
Tremor with sleep issue and visual hallucinations
Lewy body dementia
43
Enhanced physiologic tremor
Tremor worst in situation of stress, anxiety or excessive caffeine use.. can also be thyrotoxicosis, alcohol withdrawal, phaechromocytoma.
44
Asymmetrical rest tremor, disorder of skilled, learned, purposeful movement, dystonic limb posturing. Family hx
Cortical degeneration tremor
45
How to manage extraocular foreign body
Topical anaesthetic, remove with needle attached to cotton-tipped applicator. Visualise under slit lamp. Follow up with chloramphenicol.
46
INvestigation in intraocular foreign body
1. CT scan head and orbits. Ophthal can do fluorescein staining. NO MRI.
47
Commonest presentation of painful red eye. Investigation and management
Corneal abrasion. Fluorescein stain for best view of abrasion. If <50% SA, send home with chloramphenicol ointment. If >50% of SA affected, mydriatic (tropicamide).
48
Chemical ocular injury management
copious irrigation >30min. Check pH.
49
Commonest orbital fracture
Blowout fracture involving the orbital floor.
50
Optic neuritis signs
Painful vision loss with central scotoma, colour desaturation, RAPD.
51
Investigation of optic neuritis and considerations
``` MRI: could be a presentation of MS. And do in any case to confirm. FBC/ CRP: infection ESR: giant cell arthritis Serum ACE: elevated in sarcoidosis ANA: positive in SLE ```
52
Typical presentation of acute angle closure glaucoma
Unilateral vision loss in hypermetropic person, painful eye, headache, mid dilated pupils.
53
First line investigation in angle closure glaucoma
Gonioscopy (trabecular meshwork not visible)
54
Primary open angle glaucoma mechanism
Due to a progressive ineffectiveness of the trabecular meshwork, causing a progressive increased in IOP and damage to the optic nerve.
55
Symptoms of primary open angle glaucoma. And findings on ophthalmoscope
Bilateral progressive loss of peripheral visual field. Shows a cupped optic nerve head with increased cup-disk ratio.
56
First line management of acute retinal vascular occlusion.
Ocular massage (15 seconds pressure, then release).
57
2 things that predispose to central retinal vein occlusion
Diuretics and oral contraceptives.
58
Painless unilateral incomplete vision loss (usually inferior half of visual field cause)
Non-arthritic anterior ischemic optic neuropathy (caused by an occlusion of the short posterior ciliary ateries)
59
Retinal detachment signs
Classically floaters, photopsia (flashing lights), partial visual field loss.
60
Investigation for retinal detachement
Dilate pupils and perform ophthalmoscopy.
61
Cataract mechanism and symptom
Loss of transparency of the crystalline lens over time (related to age quite strongly) leading to a gradual reduction in visual acuity with blurred vision.
62
Age related macular degeneration two presentations and treatments
Dry AMD: gradual loss of central vision. No treatment Wet AMD: acute or semi-acute loss of vision, distorted central vision. More serious and treated with anti-VEGF injections.
63
Oculomotor palsy signs and urgent considerations
Down and out gaze, ptosis, mydriasis. Urgent consideration is posterior communicating artery aneurysm (painful unilateral palsy)
64
Conjunctivitis differential between viral and bacteria
Viral: usually bilateral, rapid resolution Bacterial: mucopurulent discharge, unilateral, eyelids stuck together in the morning.
65
Bacteria and virus causing conjunctivitis
Bacterial causes include staph aureus, strep pneumo. | Viral causes are usually adenovirus type 3.
66
Keratitis what is it and association
A microbial invasion of the cornea. Can progress to blindness, so emergency. Commonly a contact lense user
67
Anterior uveitis associations
HLA B27 ankylosis spondylitis, psoriatic arthritis, IBD, reiter syndrome. Chronic disease with idiopathic cause and attacks that can last some time.
68
Management of open angle glaucoma
Protaglandin eye drops | Beta blocker eye drops. Important to exclude contraindications to it (asthma, COPD...)
69
4 causes of swollen optic disc
Papilloedema (high ICP), raised blood pressure, optic neuritis (e..g MS), anterior ischaemic optic neuropathy (including temporal or giant cell arthritis)
70
Pathophysiology of MS
Inflammatory process and immune response to oligodendrocytes and myelin, slowing down nerve conduction.
71
Explain Lhermitte’s and Uhtoff sign And what pathology
Lhermitte’s : electrical sensation going down spine, especially when head is flexed. Uhtoff’s: worsening of symptoms when body gets overheated or during exercise Multiple sclerosis
72
Mechanism proposed for guillian barre syndrome
Molecular mimicry - antibodies against pathogen also match proteins on nerve cells so they are attacked.
73
Guillian Barre presentation
Acute onset symmetrical ascending weakness with a recent infection (gastroenteritis, campylobacter jejuni, CMV, EBV)
74
Signs of an upper motor neuron lesion
Up going plantar reflex, hyperreflexia, increased tone, no fasciculations or muscle waisting
75
Signs of lower motor neuron lesion
Hyporeflexia, down going plantar reflex, decreased tone, muscle wasting, fasciculations
76
Associated condition with myesthenia gravis,
Thymoma - look for thymectomy scar
77
Pathophysiology behind myesthenia gravis
ACh receptor antibodies produced which block ACh singnallkng ag neuromuscular junction.
78
Investigations in myesthenia gravis
Antibodies test (ACh receptor, musk antibody, LRP4). Tensilon test, lung function test (if low FVC and NIF, indicates myasthenia crisis and consider ventilation)
79
Presentation of keratoconus
Late teen/ 20s with astigmatism and myopia, bulging of the lower lid on down gaze
80
Keratocunjlunctivitis main causes
Keratoconjunctivitis sicca: inflammation due to dryness Vernal keratoconjunctivitis: usually due to allergens Epidemic keratoconjunctivitis: due to adenoviruses
81
Keratitis cause
Usually staph aureus, although commonly pseudomonas aeruginosa in contact lense wearers.
82
What does a pancoast tumour cause
Hand wasting, weakness in the hand muscles, horners syndrome, sensory loss
83
Nerve affected in foot drop
Common perineal nerve
84
Cause of trachoma and treatment
Chlamydia trachomatis. Single high dose azithromycin
85
One thing vit a deficiency causes
Night blindness
86
Diff between scleritis and episcleritis
Episcleritis is usually idiopathic, while scleritis often has a systemic cause. Scleritis presents with deep severe pain and is more serious.
87
Dendritic ulcer treatment
Topical acyclovir (herpes simplex)
88
Parietal lobe lesion
Inferior homonymous quadrantanopia, sensory in attention, apraxia
89
Occipital lobe lesion
Homonymous hemianopia with macula sparing Cortical blindness Visual agnosia Vision things
90
Temporal lobe lesion
Wernickes (receptive) aphasia Superior homonymous quadrantanopia Auditory issues
91
Frontal lobe lesion
``` Expressive aphasia (broca’s) Disinhibition (personality changes) Anosmia ```
92
Sciatic nerve damage Sx
Foot drop, loss of power be,ow knee, loss of knee flexion,
93
Webber test
Unilateral sensorineural hearing loss or unilateral conductive hearing loss through tuning fork on forehead
94
Rinne test
Rines test is looking for conductive hearing loss by vibrating next to ear
95
Intention tremor when finger to nose test
Cerebellar tremor
96
Retinoblastoma inheritance
Autosomal dominant, .8 pénétrante
97
Headache, hypertension, rhinorrhoea
Empty sella syndrome
98
Patient with lung cancer, proximal muscle weakness, gets better with movement. Diagnosis and pathophysiology
Antibodies against voltage gated calcium channels - lambert Eaton syndrome
99
Posterior communicating artery aneurysm Sx
Third nerve palsy, vision loss?
100
Orange halo and grittiness
Iron containing corneal foreign body
101
Superior Homonymous quadrantanopia caused by
A lesion of inferior optic chiasm in the temporal lobe
102
Inferior Homonymous quadrantanopia is caused by
Lesion in superior optic radiation’s of parietal lobe

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