Neurology

Question 1

Guillain-Barré syndrome

Answer 1

GBS is an acute paralytic polyneuropathy that effects the peripheral nervous system.

Risk factors include a recent infection mainly gastroenteritis caused by campylobacter, EBV and cytomegalovirus

Question 2

Guillain-Barré syndrome presentation

Answer 2

Quick onset 
Symmetrical 
Ascending weakness 
Reduced reflexes 
Neuropathic pain 
Peripheral loss of sensation 
Facial nerve weakness

Question 3

Guillain-Barré syndrome diagnosis

Answer 3

Clinically made using the Brighton criteria supported by

Nerve conduction studies and Lumbar puncture

Question 4

GB Management

Answer 4

IV immunoglobulins
Plasma exchange
Supportive care
VTE prophylaxis

Question 5

Cluster headaches

Answer 5

Severe and unbearable unilateral headaches usually around the eye. They are called cluster headaches as they come in clusters of attacks. Typically last 15 minutes to 3 hours

Risk factors
Strong smells
Alcohol
Exercise

Question 6

Cluster headache presentation

Answer 6

Severe pain 
Unilateral 
Red, swollen and teary eye 
Pupil constriction 
Eyelid drooping 
Nasal discharge 
Facial sweating

Question 7

Cluster headache treatment

Answer 7

Acute: Triptans and high flow oxygen 100%
Prophylaxis: verapamil, lithium, prednisolone

Question 8

Delirium what it is and RF’s

Answer 8

Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness. It is of rapid onset.

Risk factors:
Increased age 
Hospital admission 
Multiple co-morbidities 
Sensory impairment 
Post surgery 
Excess alcohol

Question 9

Causes of delirium CHIMPSPHONED

Answer 9

Constipation 
Hypoxia 
Infection 
Metabolic disturbances 
Pain 
Sleeplessness 
Prescriptions 
Hypothermia 
Organ dysfunction 
Nutrition 
Environmental changes 
Drugs

Question 10

Delirium presentation

Answer 10

Hyperactive:
Agitated/aggressive 
Incoherent speech 
Disorganised thoughts 
Delusions 
Hallucinations 
Disorientation 

Hypoactive:
Sluggish
Less reactive
Looks withdrawn

Question 11

Myasthenia gravis Pathophysiology and RF

Answer 11

MG is an autoimmune condition where acetylcholine receptor antibodies bind to the post synaptic membrane receptors blocking the action of Ach.

RF
Woman under 40
Men over 60

Question 12

MG presentation and examination findings

Answer 12

>Mild to life threatening 
>Weakness - worse with use and better with rest which is minimal in the morning and worst at the end of the day
>Mainly effects proximal and small muscles of the head and neck 
> Diplopia 
>Ptosis 
>facial weakness 
>Dysphagia 
>slurred speech 
>Fatigue in jaw 

Exam:
Repeated blinking causes fatigue
Upward gazing
Repeated abduction of shoulder

Question 13

MG diagnosis

Answer 13

Bloods: Ach receptor antibodies
MUSK antibodies
CT/MRI of thymus LF thymoma

Question 14

MG treatment

Answer 14

Achesterase inhibitors: Pyridostigmine, neostigmine MOA= increases amount of Ach at the neuromuscular junction
Immunosuppression
Thymectomy