Neuro PassMed

Question 1

treatment of idiopathic inter cranial hypertension

Answer 1

acetazolamide (carbonic anhydrase inhibitor)

Question 2

which antiemetic can be prescribed to Parkinson’s patients and why is it favoured

Answer 2

domperidone - doesn’t cross the BBB so doesn’t cause EP side effects

Question 3

is a resting parkinsons tremor bilateral or unilateral

Answer 3

unilateral

Question 4

bells palsy treatment

Answer 4

prednisolone for 10 days - prescribed within 72hrs of onset

Question 5

encephalitis treatment

Answer 5

IV acyclovir to cover HSV1

Question 6

essential tremor- what is its inheritance, when is it worst and how do you treat

Answer 6

AD
worst when arms outstretched
tx = propranolol

Question 7

what medication is used in thrombolysis if patient presents within 4.5hrs

Answer 7

alteplase

Question 8

what is used in secondary prevention of stroke

Answer 8

clopidogrel is now preferred over aspirin

Question 9

name one contraindication to triptan use in migraine management

Answer 9

a history of CVD

Question 10

name the acute management of migrane

Answer 10

triptan+NSAID+ paracetamol

Question 11

name the prophylactic management of migrane

Answer 11

topiramate or propranolol

Question 12

what neurocutaneous syndrome are bilateral vestibuloschwannomas associated with

Answer 12

NFB2

Question 13

what does the presence of thymoma on CT in a tired girl suggest

Answer 13

myasthenia gravis

Question 14

which antiepileptic has peripheral neuropathy as a side effect

Answer 14

phenytoin

Question 15

describe the mechanism of action of phenytoin

Answer 15

binds to Na channels to increase the refractory period

Question 16

how is the weakness in Lambert eaton syndrome different from MG

Answer 16

weakness in Lambert eaton IMPROVES after exercise

weakness in MG WORSENS after exercise

Question 17

which antibodies are associated with MG

Answer 17

ACh receptor antibodies

Question 18

which antibodies are associated with lamber eaton syndrome

Answer 18

voltage gated calcium channel antibodies

Question 19

what visual field defect will occur if there is a L temporal lobe infarct?

Answer 19

R superior quadranopia (remember PITS)

Question 20

what visual field defect will occur if there is a L parietal lobe infarct?

Answer 20

R inferior quadranopia (PITS!)

Question 21

which type of stroke affects the upper limb more than the lower limb

Answer 21

middle cerebral artery infarct

Question 22

which type of stroke affects the lower limb more than the upper limb

Answer 22

anterior cerebral artery infarct

Question 23

which stroke presents with 2 of:

1. contralateral hemiparesis and sensory loss
2. homonyms hemianopia
3. aphasia

Answer 23

partial anterior circulation infarct

Question 24

which type of stroke has all 3 of:

1. contralateral hemiparesis +/- sensory loss
2. aphasia
3. contralateral homonymous hemianopia

Answer 24

total anterior circulation infarcts

Question 25

what is used for long term prophylaxis of cluster headaches

Answer 25

verapamil

Question 26

what is used as acute therapy for cluster headaches

Answer 26

sumatriptan and high flow oxygen

Question 27

what would be signs of a problem in the basal ganglia

Answer 27

hypERkinetic (Huntington's) or hyPOkinetic (Parkinson's)

Question 28

what is the acute treatment and prophylactic treatment of an ischaemic stroke

Answer 28

acute- 300mg aspirin. if present within 4.5hrs of symptom onset, thrombolysis (using alteplase) prophylactic - clopidogrel

Question 29

what is the Cushing reflex in response to

Answer 29

a physiological response to ICP

Question 30

what is the Cushing reflex

Answer 30

hypertension and bradycardia

Question 31

what should you orescribe to patients with N&V associated with chemotherapy

Answer 31

ondansetron (5HT antagonist)

Question 32

what is required before starting phenytoin and why

Answer 32

cardiac monitoring- it has pro-arrhythmogenic side effects

Question 33

what is the most common hereditary sensorimotor neuropathy? which nerves does it affect

Answer 33

Charcot-marie-tooth disease peripheral nerves

Question 34

name 4 features of Charcot Marie tooth disease

Answer 34

foot drop high arched feet distal muscle weakness and atrophy hyporeflexia

Question 35

what is the 1st line investigation for suspected stroke

Answer 35

non-contrast CT head

Question 36

what are contrast-enhanced CT scans more useful for

Answer 36

detecting cerebral mets and abscesses

Question 37

in detecting ismchaemic changes, is T1 or T2 imaging more sensitive

Answer 37

T2 weighted imaging is more sensitive

Question 38

where is Broca's speech area located

Answer 38

inferior frontal gyrus

Question 39

describe the characteristics of Broca's aphasia

Answer 39

expressive aphasia non fluent, laboured and halting speech comprehension normal

Question 40

where is wernicke's area located

Answer 40

superior temporal gyrus

Question 41

describe the characteristics of wernicke's aphasia

Answer 41

receptive aphasia speech remains fluent but sentences make no sense comprehension is impaired

Question 42

where does the facial nerve supply sensation to on the tongue

Answer 42

the anterior 2/3

Question 43

name one of the signs of bulbar onset MND

Answer 43

tongue fasciculations

Question 44

name 3 areas that are NOT affected in MND

Answer 44

1. external ocular muscles (no nystagmus or diplopia) (allows it to be differentiated from MG) 2. No cerebellar signs 3. sphincter function preserved

Question 45

when a patient presents with mixed UMN and LMN signs, what else must you consider other than MND?

Answer 45

subacute combined degeneration of the cord occurs due to vit B12 deficiency can be precipitated if patients are given folate supplements without B12

Question 46

which drug is used to manage tremor in drug induced parkisnson's

Answer 46

procyclizine

Question 47

which Parkinson's drug has been associated with pulmonary fibrosis

Answer 47

cabergoline

Question 48

why is compliance so important in Parkinson's medication

Answer 48

risk of acute akinesia or neuroleptic malignant syndrome if medication isn't taken

Question 49

what is dystonia

Answer 49

involuntary muscle spasms and sustained muscle contractions

Question 50

name 2 drugs that can cause drug induced dystonia

Answer 50

levodopa and other dopamine agonists used in Parkinson's treatment typical antipsychotics - dystonia is one of the EP side effects they can cause

Question 51

how do you treat drug induced dystonia

Answer 51

procyclidine

Question 52

treatment for neuroleptic malignant syndrome

Answer 52

bromocriptine

Question 53

which arteries does a lacunar infarct affects

Answer 53

the perforating arteries around the internal capsule, thalamus and basal ganglia

Question 54

which arteries does a posterior circulation infarct affect

Answer 54

vertebrobasilar arteries

Question 55

what are the 3 features of normal pressure hydrocephalus

Answer 55

walking wet, wacky ataxia urinary incontinence dementia

Question 56

what is the 1st line treatment for neuropathic pain

Answer 56

amitriptyline (TCA) duloxetine (SNRI) gabapentin (anticonvulsant)

Question 57

pathology of Parkinson's

Answer 57

loss of dopaminergic neurones in substantia nigra

Question 58

what disorder do antiaprkinsonian medications have a risk of

Answer 58

impulse control disorders dopamine agonists are the worst for it

Question 59

a stroke in what area of the brain would cause quadriplegia and 'locked in' syndrome

Answer 59

brainstem stroke

Question 60

which brachial plexus palsy causes a 'waiters tip' appearance

Answer 60

erb's palsy

Question 61

which nerve roots are damaged in erb's palsy - how does it present?

Answer 61

C5, C6 internally rotated shoulder with extended elbow

Question 62

which brachial nerve palsy causes a 'claw hand'

Answer 62

klumpke's palsy

Question 63

which nerve roots are damaged in klumpke's palsy

Answer 63

C8, T1