Neurology

Question 1

Thrombolysis absolute CI

Answer 1

previous haemorrhagic stroke
ischaemic stroke in last 3m
CNS damage/neoplasm
major surgery/HI/major trauma in last 3wks, active internal bleeding
GI bleed in last 1 month
aortic dissection
known bleeding disorder
proliferative diabetic retinopathy

Question 2

Nausea
Vertigo
Nystagmus

MOA: otolith detachment into the semicircular canals of the inner ear

Answer 2

BPPV

Question 3

subacute or acute onset of pain in the eye 
/headache
pain with eye movements
loss of vision
central scotoma

Answer 3

optic neuritis

Question 4

80M
difficulty moving and memory problems

tremor + bradykinetic
Unable to look down falls
not orthostatic

Answer 4

Progressive supranuclear palsy
(parkinson’s plus)
- UNABLE TO LOOK DOWN

Question 5

diarhoeal illness, then

drowsiness
double vision
ataxia
BRISK reflexes

Answer 5

Bickerstaff’s encephalitis

NB in GBS DON’T get drowsiness + have absent reflexes

Question 6

postural hypotension and urinary retention
parkinsonism

Dx?

Answer 6

multi-system atrophy

autonomic dysfunction

Question 7

12 months cognitive impairment, parkinsonism, confusion, generalised myoclonus

started on L dopa

then visual hallucinations

Dx?

Answer 7

diffuse lewy body disease
- early cognitive impairment

(no hallucinations in PSP or MSA)

Question 8

diffuse disease of small arteries

recurrent ischaemic events

may present with migraine

severe mood disorders, dementia

leukoencephalopathy on MRI

Answer 8

CADASIL

(cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)

Question 9

dysphagia 
absent gag reflex
nasal voice/dysarthria
difficulty chewing
tongue wasting/fasciculations

Answer 9

Bulbar palsy

LMN affects CN 9 - 12

Cause = brainstem stroke, GBS

Question 10

hot potato voice
inc jaw jerk/gag reflex
UMN signs in UL
uncontrollable laughter

Answer 10

psudobulbar palsy

UMN

Question 11

can you get CN III palsy in migraine?

Answer 11

Yes

ophthalmoplegic migraine

Question 12

orogenital ulceration
iritis
pathergy (xs skin injury post minor trauma)

Answer 12

Behcets

Question 13

weakness of dorsiflexion of the left foot

sensory loss Dorsum of foot

Answer 13

L5 radiculopathy

Question 14

ataxia
encephalopathy
ophthalmoplegia

Answer 14

Wernicke’s encephalopathy

Question 15

homonomous hemianopia
    (often upper quadrantic)
Cortical blindness
Hemivisual neglect
Visual hallucinations 
verbal dyslexia

Answer 15

posterior cerebral artery stroke

supplies occipital lobe

Question 16

Coarse tremor

drug cause

Answer 16

cyclosporin

dose dependent manner

Question 17

R wRist drop

sensory loss dorsum of hand

nerve affected

Answer 17

Radial nerve

Question 18

supplies serratus anterior
winging of the scapula

nerve affected

Answer 18

long thoracic nerve

Question 19

cannot abduct and oppose the thumb weakness in forearm pronation + finger flexion
sensory loss plantar thumb + 1st two fingers

nerve affected

Answer 19

median nerve

Question 20

elbow injury
numbness in the 5th finger/ lateral aspect hand
+/- claw hand

Answer 20

ulnar nerve

Question 21

70M
L sided weakness resolves in 2 hours

Next step?

Answer 21

next day TIA clinic

CT/MRI head and carotid duplex within 1 wk.

If carotid endarterectomy indicated - within 2 weeks necessary

Question 22

phenytoin toxicity gait

Answer 22

broad based gait

cerebelalr syndrome

Question 23

suspected TIA

which scoring system?

Answer 23

ABCD score

Question 24

suspected TIA
ABCD >/= 4 9high risk stroke)

Mx?

Answer 24

aspirin 300 mg OD

next day TIA clinic

Question 25

which anti HTN

dry mouth and dizziness on standing

Answer 25

doxazosin

alpha blocker

Question 26

horizontal gaze palsy
impaired adduction ipsilateral to the lesion
abduction nystagmus contralateral to lesion

Answer 26

INO
Internuclear ophthalmoplegia
lesion at the medial longitudinal fasciculus

Question 27

Causes Internuclear ophthalmoplegia

Answer 27

MS
brainstem infarction
syphilis and Lyme disease

Question 28

drooling, tongue and lip swelling and tachypnoea

which drug can cause?

Answer 28

ACEi
ARB
does not necessarily occur as soon as the medication is started

Question 29

cortisol level in hypoglycaemia

Answer 29

cortisol should increase

Question 30

sodium valproate risk to foetus

Answer 30

neural tube defects

Question 31

sodium valproate
carbamazepine

p450 effect

Answer 31

sodium valproate - INHIBITOR

carbamazepine - INDUCER

Question 32

proximal lower limb weakness
areflexia (reflexes normalise with repetitive muscle contraction)
no wasting or fasciculations
sensory examination is normal

which Abs test for

Answer 32

VG Ca channel Abs

lambert-eaton syndrome

Question 33

Pt started on carbamazepine
2 weeks later have to increase dose to maintain therapeutic range
whuch?

Answer 33

auto induction carbamazepine

carbamazepine p450 inducer therefore metabolism increases so need more for same therapeutic effect

Question 34

Vertigo
Vomiting
Pressure within the ear
Deafness

Answer 34

Ménière’s disease

Question 35

URTI

then acute disabling vertigo

Answer 35

Labyrinthitis

Question 36

Nausea
Vertigo
Nystagmus

Answer 36

BPPV

Question 37

Sudden onset of painless monocular visual loss in patients aged 50 or more is commonly due to ischaemic optic neuropathy

Answer 37

Nonarteritic ischaemic optic neuropathy

arteritic ION = GCA

Question 38

carotid endarterectomy in dense stroke?

Answer 38

no

Question 39

dengue fever initial Mx

Answer 39

normal saline

Question 40

right sided weakness

Leg >arms

Answer 40

anterior cerebral artery stroke

MCA = UL > LL weakness

Question 41

foot drop

nerve affected

Answer 41

common peroneal nerve palsy