Neuro - Useful facts

Question 1

What motor deficiency effects do you see in common peroneal nerve lesion and tibial nerve palsy?

Answer 1

TIPPED

Tibial Inversion Plantarflexion

Peroneal Eversion Dorsiflexion

So inversion, plantarflexion affected in tibial nerve palsy, and eversion and dorsiflexion in common peroneal nerve lesion

Question 2

What indicates a L5 nerve lesion and not a common peroneal nerve lesion?

Answer 2

Weakened dorsiflexion, eversion, AND INVERSION of the ankle indicates an L5 nerve lesion not a common peroneal nerve lesion

Question 3

Broca’s and Wernicke’s aphasia, way to remember

Answer 3

Broca’s = broken speech (can’t articulate words), also frontal lobe

Wernicke’s = wer de ficke are you talking about (doesn’t make sense), also temporal lobe

Question 4

What is the management for patients with raised ICP?

Answer 4

• investigate and treat the underlying cause
• head elevation to 30º
• IV mannitol may be used as an osmotic diuretic
• controlled hyperventilation

Question 5

Mnemonic to help remember Wernicke and Korsakoff’s clinical features

Answer 5

COAT RACK
Wernicke’s:
Confusion
Opthamoplegia
Ataxia
Thiamine Deficiency

Also nystagmus in Wernicke’s

Korsakoff’s:

• *R**etrograde amnesia
• *A**nterograde amnesia
• *C**onfabulation =
• *K**orsakoff’s

Also Psychosis in Korsakoff’s

Question 6

Why are extradural haematomas limited by suture lines whereas subdural haematomas are not limited?

Answer 6

Extradural haematomas are between the skull and the dura mater, therefore they can move anywhere within those planes of section

However, at suture lines this is where the dura attaches to the skull, therefore they cannot cross it.

Question 7

Meningitis complications SHAPED mnemonic

Answer 7

Meningitis complications = ‘SHAPED’

Sepsis
Hydrocephalus; Herniation of brain
Abscess (intracerebral)
Paralysis
Epilepsy
Deafness

Question 8

Drugs for nausea in which scenario

Answer 8

• Ondansetron for chemotherapy-induced nausea
• Haloperidol for intracranial causes (raised ICP, direct effect of tumour)
• Prochlorperazine for vestibular causes
• Metoclopramide for gastrointestinal causes

OR, good way to help remember

• Ondansetron**from youO***ncologist
• Haloperidol**for causes in yourH***ead
• Prochlorperazine**for when you feelP***eculiar (i.e. dizzy)
• Metoclopramide**for things attached to theM***esentry

Question 9

What component in a blood test would help differentiate between a true seizure and a pseudoseizure?

Answer 9

Prolactin can be used to differentiate between a true seizure and a pseudoseizure

Question 10

What are the features of a 3rd nerve palsy?

Answer 10

• eye is deviated ‘down and out’
• ptosis
• pupil may be dilated (sometimes called a ‘surgical’ third nerve palsy)

If there was ptosis + constricted pupil, then Horner’s

Question 11

What is the best anti-emetic to prescribe in Parkinson’s to someone who is nauseous on co-careldopa? Which two anti-emetic drugs should you not give in Parkinson’s for nausea?

Answer 11

Give Domperidone

Cyclizine is an antihistamine which, like prochlorperazine, may exacerbate Parkinson’s disease, so don’t prescribe

Question 12

Bitemporal hemianopia UP LOC

Answer 12

UP LOC
Upper - Pitiutary (upper quadrant defect)
LOwer - Craniopharyngioma (lower quadrant defect)

Question 13

Key complication of meningitis once a patient has recovered (zerotofinals)

Answer 13

Hearing loss is a key complication of meningitis

All patients with meningitis are offered audiology assessment as soon as they are recovered to assess for hearing impairment.

This complication comes up often in exams and is worth remembering

Question 14

What is discitis?

Answer 14

Discitis is an infection in the intervertebral disc space

It can lead to serious complications such as sepsis or an epidural abscess

Assess the patient for endocarditis e.g. with transthoracic echo or transesophageal echo

Question 15

Antiplatelets you give for TIA and Ischameic stroke?

Answer 15

Clopidogrel for both

Question 16

Tretament of acute subdural and chronic subdural?

Answer 16

Acute - decompressive craniectomy

Chronic - surgical decompression with burr holes if they’re confused of symptomatic

Question 17

Drugs that increase the risk of Idiopathic Intracranial HTN?

Answer 17

COMAAR – ciclosporin, oral contraceptives, mineralocorticoids, amiodarone, antibiotics (tetracyclines, sulphonamides), retinoic acid

Question 18

4 features of a vestibular schwannoma (acoustic neuroma)

Answer 18

The classical history of vestibular schwannoma includes a combination of vertigo, hearing loss, tinnitus and an absent corneal reflex

Question 19

Which antiepileptic drug is most associated with weight gain?

Answer 19

Sodium Valproate

Question 20

Causes of cerebellar injury? PASTRIES

Answer 20

P - Posterior fossa tumour
A - Alcohol
S - Multiple sclerosis
T - Trauma
R - Rare causes
I - Inherited (e.g. Friedreich’s ataxia)
E - Epilepsy treatments
S - Stroke

Question 21

Involvement fo which spinal level could give a patient Horner’s syndrome?

Answer 21

Horner’s makes it harder to see playing golf, you’d never be able to get it in on the first shot.

You can’t Tee 1 (T1)

Question 22

Nerve root for ankle, knee, biceps, triceps reflexes?

Answer 22

S1-S2 button my shoe
L3-L4 kick the door
C5-C6 pick up sticks
C7-C8 open the gate

OR

biceps = 6 letters so c5-6
triceps = 7 letters so c7-8
knee = 4 letters so l3-4

OR

S1-S2 Put on my shoe,
L3-L4 My knee’s on the floor,
C5-C6 Impress the chicks,
C7-C8 Arm is straight

Reflex Root

Ankle S1-S2

Knee L3-L4

Biceps C5-C6

Triceps C7-C8

Question 23

Hypersensitivity reactions

Answer 23

Hypersensitivity reactions - ACID

Type 1 Allergic - IgE-mediated (e.g. bee stings, latex, meds)
Type 2 Cytotoxic/antibody-mediated (e.g. hyperacute graft reaction, haemolytic reaction)
Type 3 Immune-complex deposition (e.g. SLE, polyarteritis nodosa)
Type 4 Delayed/cell mediated (e.g. chronic graft reactions, poison ivy, nickel)

Question 24

Mnemonic for motor nerves that supply the hand?

Answer 24

try the mnemonic: Rock, Paper, Scissors –> Median, Radial, Ulnar (both in alphabetical order)

• Rock –> Clenching your fist in rock formation. The median nerve supplies muscles of finger flexion
• Paper –> Stretching out your hand. The radial nerve supplies muscles of finger extension
• Scissors –> Pretend you’re using scissors made out of ring and index fingers. The ulnar nerve supplies the small muscles of finger abduction and adduction.

(Extra: Anterior interosseous (AIN) nerve supply) –> Make an OK sign with your fingers. Thumb flexion at IP joint and finger flexion of index finger at DIP joint)