Neurology

Question 1

If a patient has a homonomous quadrantopia WITH macula sparing, where is the lesion?

Answer 1

Occipital lobe

Question 2

A tumour (e.g. craniopharygioma) in which part of the hypothalamus causes bitemporal hemianopia?

Answer 2

Ventromedial area

Question 3

Side effects of sodium valproate?

Answer 3

Vomiting
Alopecia
Liver toxicity
Pancreatitis/ Pancytopenia
Retention of fats (weight gain)
Oedema (peripheral oedema)
Anorexia/Ataxia
Tremor
Enzyme inhibition

Question 4

What is the rule for neuropathic pain drugs?

Answer 4

Drugs for neuropathic pain are typically used as monotherapy, i.e. if not working then drugs should be switched, not added

Question 5

SE’s of phenytoin?

Answer 5

P- Pseudolymphoma
pancytopenia
P450 interaction

H-Hirsutism,Acne

E-Enlarged gums

N-Nystagmus-cerebellar syndrome

Y-Yellow browning of skin

T-teratogenic

O-Osteomalacia

I-Interference with folic acid absorption

Idiosyncracy

N-Neuropathies

Question 6

What is the chance of absence seizures resolving by adulthood?

Answer 6

90-95%

Question 7

What is the risk if you don’t replace vitamin B12 before folate?

Answer 7

Subacute combined degeneration of the spinal cord - affects dorsal columbs + lateral corticospinal tracts

Mixed UMN/LMN signs

Damage to the posterior columns - loss of proprioception, light touch and vibration sense (sensory ataxia and a positive Romberg’s test).

Damage to lateral columns - spastic weakness and upgoing plantars (UMN signs).

Damage to peripheral nerves - absent ankle and knee jerks (LMN signs).

Question 8

What should you consider in sudden onset sensorineural hearing loss?

Answer 8

Acoustic neuroma

Question 9

What is the management of bladder dysfunction in MS?

Answer 9

do an ULTRASOUND first

If significant residual volume –> intermittent self catheterisation

If no significant residual volume –> anticholinergics (improves frequency

Question 10

What is the management of spasticity in MS?

Answer 10

First line: gabapentin + baclofen

and PT

Question 11

Where is the lesion in intranuclear ophthalmoplegia + what are the signs?

Answer 11

Medial longitudinal fasciculus

Signs:

1. impaired adduction of the eye on the same side as the lesion
2. horizontal nystagmus of the abducting eye on the contralateral side

Question 12

Secondary prevention for stroke?

Answer 12

Aspirin, clopidogrel, dipyridamole

Question 13

What type of stroke should you offer thrombectomy to?

Answer 13

Proximal anterior circulation stroke

Aneterior circulation = MCA+ACA

Question 14

Drugs that exacerbate MG?

Answer 14

penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines

Question 15

Drug used in drug induced parkinsons e.g. from antipsychotics?

Answer 15

Benzhexol (trihexyphenidyl)