Neurological

Question 1

What is the 3rd most common cause of death in the UK?

Answer 1

Stroke

Question 2

Fraction of Ischaemic Vs Hemorrhagic

Answer 2

87% Ischaemic

Question 3

2 types of Ischaemic Stroke

2 types of Haemorrhagic Stoke

Answer 3

Thrombotic and Embolic

Intracerebral and SAH

Question 4

Carotid Symptoms

Answer 4

Amaruosis Fugax and Hemisensory loss, transient loss of vision

Question 5

Vertebrobasilar symptoms

Answer 5

Diplopia, Vertigo, Vomiting, Dysarthria, Ataxia and Visual loss

Question 6

Treatment for Ischaemic and Haemorrhagic

Answer 6

Ischaemic = Altepase withing 4.5 hrs, mechanical clot clearance
Haemorrhagic = Reverse anticoagulation with prothrombin concentrate and possible surgical intervention

Question 7

Risk factors for SAH

Answer 7

50 yrs old, Female, afro-carribbean, smoking, HTN, cocaine and alcohol

Question 8

Most common site of SAH

Answer 8

Berry Aneurysm in circle of willis

Question 9

Symptoms of SAH

Answer 9

Thunderclap headache, may be sentinel bleeds - small leaks from aneurysm gives some symptoms but resolve themselves
Decreases level of consciousness, neck stiffness, loss of pupillary light reflex

Question 10

Investigations of SAH

Answer 10

CT head and the LP if negative

Question 11

Treatment of SAH

Answer 11

Prevent further bleeding/ re-bleeding

70% die before leaving hospital

Question 12

Define Epilepsy

Answer 12

Transient occurrence of signs and symptoms due to abnormal electrical activity in the brain

Question 13

When is a diagnosis of epilepsy made?

Answer 13

1) > 1 unprovoked seizure > 24 hrs apart
2) 1 unprovoked seizure + 60% probability of another
3) Diagnosis of an epilepsy syndrome

Question 14

Focal/Partial Seizures

Answer 14

Activity is limited to one part of one brain hemisphere -

Question 15

Generalised

Answer 15

Widespread seizure activity with many different subtypes

Question 16

Absence

Answer 16

Activity throughout the whole brain - causes unconsciousness without convulsions - 2 to 10 seconds

Question 17

Tonic-clonic

Answer 17

1 to 3 minutes, loss of consciousness. Tonic phase of muscle stiffness, incontinence and tongue biting. Clonic phase - extremities jerk rhythmically with breathing irregularities. Usually followed by post-ictal phase of reduced consciousness.

Question 18

What is the leading cause of early childhood death in the UK?

Answer 18

Bacterial Meningitis

Question 19

What is inflammed in Meningitis?

Answer 19

Leptomeninges and CSF

Question 20

Bacterial vs Viral

Answer 20

Bacterial is less common but more severe

Question 21

Risk factors of meningitis

Answer 21

Low birth weight, CSF shunts or dural defects

Question 22

Causative organisms

Answer 22

Infants - GBstrep, Listeria Monocytogenes, E.coli, H.flu, N.men
Adults - S. pneu, H.flu, N.men + gram neg bacilli

Question 23

Who is given prophylactic antibiotics

Answer 23

Pregnant women at risk of GBstrep

Question 24

What is aseptic meningitis?

Answer 24

Cells in CSF but no gram stain or culture

Question 25

Symptoms of meningitis

Answer 25

Fever, headache, neck stiffness, LoC, Non-blanching rash, Kernigs and Brudzinski’s sign

Question 26

Investigations of meningitis

Answer 26

Lumbar Pucture and CT head if neuro signs

Question 27

Meningitis Treatment

Answer 27

Benzylpenicillin for meningococcal septicaemia
Blind therapy = Ceftriaxone n+/- Amoxicillin
Corticosteroids and Dexamethasone

Question 28

Is migraine more common in men or women?

Answer 28

3x more common in women

Question 29

What classifies a chronic migraine?

Answer 29

Having a migraine at least every other day

Question 30

Different Types of migraine (3)

Answer 30

1) Headache with aura
2) Headache without aura
3) Aura but no headache1

Question 31

Symptoms of migraine

Answer 31

Paroxysmal, severe, unilateral headache

30% have premonitory phase (Vomiting/visual loss)

Question 32

Treatment of migraine - mild, severe and prophylaxis.

Answer 32

Mild = Analgesia, Anti-emetics, fluid and rest
Severe = Triptans (Serotonin agonists)
Prophylaxis if > 2 attacks / month and unresponsive to treatment once they begin - Pizotifen/ B-blockers

Question 33

Is parkinsons more common in men or women?

Answer 33

1.5 x more common in men

Question 34

Parkinsonism vs Parkinson’s Disease

Answer 34

Parkinsonism = Syndrome involving bradykinesia, rigidity, tremor and postural immobility
Parkinson’s Disease = Most common cause of Parkinsonism

Question 35

Pathophysiology of Parkinson’s Disease

Answer 35

Depletion of dopamine secreting cells in the substantia nigra

Question 36

Symptoms of parkinsons

Answer 36

Unilateral to begin with and become bilateral

Bradykinesia, Tremor, slow shuffling gait, trouble turning and initiating movement, depression, anxiety

Question 37

Treatment of parkinsons

Answer 37

L-dopa - can cross the BBB but dopamine can’t

Dopamine agonists - Ropinorole or Pramipexole

Question 38

What is the most common form of chronic recurring head pain?

Answer 38

Tension headache

Question 39

Who are tension headaches most common in?

Answer 39

Females, young adults

Question 40

Presentation of tension headaches

Answer 40

Featureless, generalised headache - tightness around head

Gradual onset and less severe, non-pulsatile

Question 41

Episodic vs Chronic TH

Answer 41

Episodic = Occur on less than 15 days of a month
Chronic = More than 15 days of a month

Question 42

TH Treatment

Answer 42

Episodic = Analgesia, lifestyle modification, acupuncture, massage
Chronic = The above + antidepressants (Amitriptyline)