neuro DPD

Question 1

Bacterial meningitis causative organisms in neonates

Answer 1

Group B strep
E.coli
Listeria

Question 2

Bacterial meningitis causative organisms in children

Answer 2

Haemophilus influenzae
Neisseria meningitis
Strep pneumoniae

Question 3

Bacterial meningitis causative organisms in adults

Answer 3

Neisseria meningitis
Strep pneumoniae
TB

Question 4

Bacterial meningitis causative organisms in elderly

Answer 4

Strep pneumoniae

Listeria

Question 5

Viral meningitis causative organisms

Answer 5

Enteroviruses
Mumps
HSV
VZV
HIV

Question 6

Cryptococcus meningitis

Answer 6

Fungal cause of meningitis

aseptic meningitis is another cause

Question 7

AMTS score

Answer 7

1. DOB
2. Age
3. Time
4. Year
5. Place
6. Recall address (42 west st)
7. Recognise doctor/nurse
8. WW2 end date (1945)
9. Prime minister
10. Count back from 20 to 1

Question 8

Bacterial lumbar puncture for meningitis

Answer 8

Cloudy CSF
High neutrophils
High protein
Low glucose

Question 9

Viral lumbar puncture for meningitis

Answer 9

High lymphocytes
High protein
Normal glucose

Question 10

TB meningitis lumbar puncture

Answer 10

Fibrinous CSF
High lymphocytes
High protein
Low glucose

Question 11

Where is the lesion if there is abnormal sensation in distribution of:
hemisensory loss

Answer 11

Cerebral cortex

Question 12

Where is the lesion if there is abnormal sensation in distribution of:
dermatomes

Answer 12

Nerve roots (radiculopathy)

Question 13

Where is the lesion if there is abnormal sensation in distribution of:
glove and stocking

Answer 13

peripheral nerves

polyneuropathy

Question 14

Where is the lesion if there is abnormal sensation in distribution of:
level e.g. of umbilicus

Answer 14

spinal cord lesion

Question 15

Where is the lesion if there is abnormal sensation in distribution of:
specific area e.g. first 3.5 fingers

Answer 15

peripheral nerves
mononeuropathy

e.g. median nerve in carpal tunnel syndrome

Question 16

What to prescribe for peripheral neuropathy for diabetic patient?

Answer 16

Duloxetin
Pregabalin
These treat neuropathic pain

Question 17

What is hydroxocobalamin

Answer 17

Vit B12 injection

Question 18

Metabolic causes of peripheral neuropathy

Answer 18

Alcohol
Vit B12 deficiency
Diabetes
Hypothyroidism
Uraemia
Drugs
Amyloidosis

Question 19

Non-metabolic causes of peripheral neuropathy

Answer 19

Infection - HIV
Inflammation/AI - vasculitis, connective tissue disease
Malignancy - paraneoplastia, paraproteinaemia
Hereditary sensory motor neuropathy

Question 20

Papillitis (optic neuritis) signs and symptoms

• optic nerve pathology

Answer 20

Blurred optic disc margins on fundoscopy
Reduced pressure
Blurred vision
Painful on eye movement

Feature of MS

Question 21

Corticospinal tracts determine

Answer 21

Voluntary motor control

Lesions result in spastic paraparesis

Question 22

Meralgia paraesthetica definition

Answer 22

Lateral femoral cutaenous nerve compression
Mononeuropathy sensory loss
Rx: reassure, avoid tight garments, lose weight.
If persistent give carbamazepine and gabapentin

Question 23

Causes of radiculopathy/ nerve root compression

Answer 23

Disc herniation

Spinal canal stenosis

Question 24

Stroke Rx <4.5hours

Answer 24

CT - haemorrhage excluded

Thrombolysis

Question 25

Stroke Rx >4.5hours

Answer 25

CT - haemorrhage excluded
Aspirin 300mg
Swallow assessment
Maintain hydration, O2 and monitor glucose

Question 26

TIA Rx

Answer 26

Aspirin
Only treat BP >220/110
ECG, echo, carotid doppler USS, modify RFs

Question 27

34 yr presented with a fit. He has no PMH, takes no drugs. He is originally from Somalia but worked in UK for 10 yrs. What blood test do you want to perform?

Answer 27

Test for all possible electrolyte fitting causes:

• hypoCa2+
• hypoNa+
• hypoK+
• hypoglycaemia

and do CT head.

Question 28

What colour is CSF on CT scan?

Answer 28

Black

Question 29

What drug to give for space occupying lesion causing cerebral oedema and midline shift?

Answer 29

Dexamethasone

Allows for oedema to decrease a few days before surgical intervention

Question 30

Commonest brain tumours

Answer 30

Glioblastoma
Meningioma
Haemangioblastoma
Craniopharyngioma

(mets)

Question 31

Commonest causative organism in encephalitis

Answer 31

HSV

Question 32

A patient presents with SAH signs and symptoms. CT head is normal. Next appropriate investigation?

Answer 32

Lumbar puncture to check CSF

This will present with xanthochromasia

Question 33

A 29yr old man presents with 2 mobile fusiform-shaped lumps on the forearm. Each feels like firm rubber and causes tingling in the hand on pressure.

Answer 33

Neurofibromas
Often multiple, at any age - usually in adults. Autosomal dominant. Forearm is frequently affected. Multiple neurofibromas = neurofibromatosis (n.b. cafe-au-lait spots, Lisch nodules in eyes, acoustic neuromas etc).