Neuro Summary Q's

Question 1

Cranial nerve exam, forehead raised but everything else weak. What does this mean and why?

Answer 1

Must be a lower motor neuron as all branches of facial nerve are blocked.

Question 2

STORM BABy

Answer 2

Strength Tone Other (clonus, etc) Reflexs Musc mass Babinski In LOWER, all go down // UPPER all up except for strength

Question 3

what mustnt be given to MG patient?

Answer 3

gent / B blocker / Mg2+

Question 4

post seizure what investigations?

Answer 4

ECG and CT/MRI // then 24hr bloods, LP, EEG +/- CT Brain and advise no driving, swimming, heights

Question 5

what nerve is damaged if winged scapula?

Answer 5

long thoracic nerve

Question 6

what nerve innervates Radial, Median and Ulnar, and what might be seen in nerve palsy of these:

Answer 6

Radial - C5 Ulnar - C6 Median - C7 Radial - sat night palsy / tennis backhand movements Ulnar - claw hand / Median - pincer grip / LOAF muscs

Question 7

causes of unconsciousness

Answer 7

Neuro - epilepsy, CVA, encephalitis, meningitis, head trauma Non-neuro - hypoxia, hypogly, drug OD,

Question 8

management of status epilepticus

Answer 8

Serum CA / U+E’s / BM then give IV lorazepam +/- phenytoin + ECG

Question 9

??SAH investigation plan

Answer 9

if red flags, CT within 48 hours + LP

Question 10

treatment of MS (relapses)

Answer 10

Methylpred / IFN-1 / monoclonal ABs

Question 11

drug causes of parkinsonian

Answer 11

metaclop + haloperidol

Question 12

MG main CF and Investigation

Answer 12

Voice fades, extra ocular muscs, ptosis, limbs, swallowing problems, droopy face I - anti - acetylcholineserase AB’s + nerve conduction be aware of myasthenic crisis

Question 13

RED FLAGs for headache

Answer 13

SNOOC Systemic (weight loss or fever) Neuro defecit Onset sudden Older person Ca hx

Question 14

treating a SAH

Answer 14

coiling/clipping or nimodipine (prevents vasospasm)

Question 15

MS key facts

Answer 15

??

Question 16

stroke in young people causes

Answer 16

??tumor

Question 17

causes of delerium

Answer 17

infections, dehydration, metabolic disturbance, psychiatric, drugs, withdrawls

Question 18

managing a stroke in acute setting

Answer 18

Airway maintainance do ECG, BP, HR (clues to whether embolus) BM (aim for 4-11) Urgent CT/MRi to exclude haemo cause if ischaemic confirmed, thrombolyse if <4.5 hours

Question 19

DDx of stroke

Answer 19

Migraine, sub-dural haem, head injury, hypoglyc, drug OD

Question 20

CI to thrombolysing

Answer 20

haem, past CNS bleed, seizures at presentation, INR >1.7, BP >220/130

Question 21

examples of axonal and demyelinating periph neurop

Answer 21

Axonal - HIV, DM, Nutritional, alcohol = more sensory defecit glove and stocking Demyelinating - Guillan Barre, CMV/EBV = ascending motor weakness over days

Question 22

Basilar Stroke

Answer 22

??

Question 23

CI to lumbar puncture (4)

Answer 23

GCS decrease/focal defecit wound infection over site cardio-resp decrease coag disorder

Question 24

define GCS

Answer 24

Question 25

what is common sign of extra dural haematoma?

Answer 25

CN3 - pupil changes

agitation

gcs decrease

N+V

papiloedoma

Question 26

what are common causes of GCS deterirotation in alcohol/assault cases etc

Answer 26

hypoglycaemia

encephalopathy

substance abuse (alcohol)

DT’s

benzo’s toxicitiy (if given)

Question 27

CI to giving entonox

Answer 27

decreased GCS / head injury

pneumothorax

abdo injury

Question 28

what indicators of raised intra cranial pressure

Answer 28

cushings triad:

bradycardia

widening BP (rising systolic, declining diastolic)

irregular respiration

Question 29

what treatment of meningitis is used?

Answer 29

ben pen (if menigococ suspected)

dexamethasone

IV ceftriaxone

Question 30

what might these symptoms in the acute setting point towards?

dizziness, difficulty breathing, difficulty or inability to swallow, loss of coordination, double vision and nausea.

Answer 30

brainstem stroke