Neurological

Question 1

symptoms of a cerebral hemisphere infarct?

Answer 1

contralateral hemiplegia, then spasticity
contralateral sensory loss
homonymous hemianopia
dysphasia

Question 2

symptoms of brainstem/posterior circulation infarct

Answer 2

locked in syndrome
quadriplegia
visual disturbances

Question 3

symptoms of lacunar infarct?

Answer 3

motor, sensory, mixed effects - ataxia

cognition + consciousness intact

Question 4

in what situations should CT scan be performed as soon as possible

Answer 4

anticoagulated, known bleeding tendency, GCS <13, papilloedema, neck stiffness, severe headache at onset of symptoms

Question 5

Management of ischaemic stroke

Answer 5

Alteplase thrombolysis

Aspirin, switch to clopidogrel after 2 weeks

Question 6

management for haemorrhagic stroke

Answer 6

surgical
maintain oxygen and fluids
monitor but don’t treat BP as may impair cerebral perfusion

Question 7

management of a TIA?

Answer 7

immediate aspirin /clopidogrel

novel anticoagulant - Rivaroxaban

Question 8

presentation of a subarachnoid haemorrhage

Answer 8

thunderclap headache, worst they’ve ever had

vomiting, collapse, coma

Question 9

how is subarachnoid haemorrhage investigated

Answer 9

CT head

lumbar puncture - bilirubin in CSF confirms SAH

Question 10

difference between focal and generalised seizure?

Answer 10

Focal (partial) - limited to one hemisphere

Generalised - +/- convulsions, with bilateral discharges, patient usually loses consciousness and memory of seizure

Question 11

different types of focal seizures and their symptoms?

Answer 11

Temporal - tastes, smells, Deja vu
Frontal - twitching, feel a wave going through head
Parietal - numbness, abnormal limb sensation
Occipital - visuals
Complex - multi lobe

Question 12

types of generalised seizure?

Answer 12

Absence
Myoclonic - muscle jerk, pt conscious
Clonic - convulsive, pt goes stiff
Tonic - muscles stiffen
Tonic-clonic - body stiff, convulsive
Atonic - muscle relax, go floppy

Question 13

preferred medication for focal and generalised seizures

Answer 13

Focal - carbamazepine, lamotrigine

Generalised - sodium valproate

Question 14

common viral causes of meningitis?

Answer 14

enteroviruses, HSV, mumps, varicella zoster

Question 15

Common bacterial causes of meningitis

Answer 15

Neisseria meningitides, strep pneumonia, staph aureus

Question 16

What are Kernig’s and Brudzinki’s sign?

Answer 16

Kernig’s = pain on passive knee extension with hips fully flexed
Brudzinki’s - hips flex on bending head forward

Question 17

how is meningitis investigates?

Answer 17

Bloods, blood culture, throat swabs

Lumbar puncture - in early stages may be negative so repeat if symptoms persist

Question 18

Broad spectrum antibiotic of choice for meningitis until cause can be cultured?

Answer 18

Cefotaxime IV

Question 19

risk factors for migraine?

Answer 19

CHOCOLATE
CH - cheese
O - oral contraceptive
C - Caffeine
Ol - alcohol
A - anxiety
T -travel
E - exercise

Question 20

what classifies as chronic migraines

Answer 20

Headaches on at least 15 days of the month, with at least 8 days being a migraine

Question 21

common signs of PD?

Answer 21

resting tremor, rigidity, bradykinesia
pill rolling tremor
slow, shuffling steps, Festinant gait
cog wheel rigidity

Question 22

how does multiple sclerosis typically progress

Answer 22

relapsing and remitting

Question 23

what conditions may suggest multiple sclerosis?

Answer 23

Optic neuritis - acute painful loss of vision

transverse myelitis