Neurology

Question 1

Management of cluster headache

Answer 1

Subcut sumatriptan 6mg

High flow 100% Oxygen

Question 2

40yo women presents with fatigue/weakness occurring at the end of each day.

1) Likely diagnosis
2) Antibodies involved (3)
3) Muscle most commonly affected and signs you might see.
4) Associated cancer
5) Management

Answer 2

1) Myasthenia Gravis
2) Anti-acetylcholine-receptor abds. Muscle specific kinase antibodies. LRP4 antibodies.
3) Proximal muscles and those of neck and face. Ptosis, eye droop.
4) Thymoma
5) Pyridostigmine. Neostigmine

Question 3

Patient presents as their partner is concerned. They are spending more money, gambling. Chatting shit.

where is the likely lesion?

Answer 3

Lesions in the frontal lobe can cause disinhibition.

Question 4

Overweight women presents with headaches. Worse in the morning and when doing a poo.

1) Likely diagnosis
2) Two drugs which can cause this
3) First line medical management

Answer 4

1) Idiopathic intracranial hypertension
2) Tetracyclines. Vitamine A supplements
3) Acetazolamide

Question 5

Side effects of lamotrigine

Answer 5

Leukopenia

Steven-Johnson syndrome

Question 6

1) Which anticonvulsant causes vitamin D deficiency, and peripheral neuropathy
2) What 1 other side effect is associated with this drug?

Answer 6

Phenytoin

Mesoblastic anaemia

Question 7

1) What advice should female patients started on valproate be given.
2) What other side affects are there
3) What is the second line mx of tonic-clonic seizures

Answer 7

1) Teratogenic to don’t have babies
2) Liver damage/hepatitis. Hair loss. Tremors
3) Carbamazepine

Question 8

Side effects of carbamazepine

Answer 8

P450 inducer
Agranulocytosis
Aplastic Anaemia

Question 9

1) Criteria for status epilepticus (2)

2) Management of Status epileptics inc dosage and times

Answer 9

1) >5 min seizure. Or 3 in 1 hour

2) 4mg IV lorazepam. PR diazepam. Buccal midazolam.

Question 10

Most common type of MS

Answer 10

Relapsing-remitting

Question 11

Patient presents with increasing tunnel vision. They have a positive FH of early blindness.

1) Diagnosis
2) What is seen on fundoscopy

Answer 11

1) Retinitis Pignmentosa

2) Extensive pigmentation of the retina

Question 12

1) How might a brain abscess present (2 features)

2) How to differentiate between abscess and high grade tumour

Answer 12

1) Fever + neurological signs think abscess.

2) Diffusion weighted scan will show restricted diffusion on abscess.

Question 13

1) Pathophysiology of MS
2) 4 causes/RF of MS
3) Gold standard diagnostic test and what is seen on lumbar puncture.
4) Management of relapses

Answer 13

1) Demyelination of CNS - antibodies destroy oligodendrocytes cells
2) EBV, Smoking, vit D deficiency, fatties.
3) MRI shows lesions. Oligodendrocytes on LP
4) Methylpred - 500mg OD 5 days PO

Question 14

1) Presentation sensation in syringomyelia

2) Causes of syringomyelia

Answer 14

1) cape-like loss of sensation to pain/temp

2) Chiari formation, trauma, tumours, idiopathic

Question 15

1) 4 symptoms of posterior stroke
2) Brainstem syndrome
3) Haemorrhagic stroke symptoms

Answer 15

1 - dizziness, diplopia, aphasia, dysarthia, ataxia
2 - ipsilateral cranial nerves palsy, contralateral peripheral nerve palsy.
3) altered mental state, nausea/vom, raised BP, Seizures

Question 16

1) Initial inx of suspected stroke
2) Initial management of suspected stroke
3) management of ischemic stroke and timing.

Answer 16

1) CT head
2) Aspirin 300mg for 2 weeks ten clopidogrel 75m onwards
3) Thrombolysis (alteplase) within 4.5 h of symptoms presenting

Question 17

How long can a patient not drive for post stroke

Answer 17

1 month - if still having symptoms tell DVLA. Lorry drivers must tell DVLA

Question 18

Complications of major MCA infarct

Answer 18

Malignant MCA infarct syndrome - cerebral oedema causing rapid neurological deterioration. Mx is decompressive hemi-craniotomy.

Question 19

Causes of SAH

1) Most common cause
2) Common spontaneous cause

Answer 19

1) Trauma

2) Cerebral aneurysm rupture. Berry aneurysm and PCKD

Question 20

1) Nerve palsy associated with berry aneurysms
2) Symptoms
3) How to differentiate between metabolic and structural cause of symptoms.

Answer 20

1) Third nerve palsy
2) enlarged fixed pupil. Down and out gaze. ptosis, diplopia
3) pupil changed likely aneurysm fibres on the periphery. Motor palsy likely to be vasculitis or diabetes as nerves are deeper

Question 21

1) 2 inx for SAH and timings

2) ECG changes in SAH

Answer 21

1) CT < 6 hours from symptoms onset.

2) ST depression, T wave inversion, QTc elongation.

Question 22

1) medical management of SAH

2) Surgical management of SAH

Answer 22

1) nimodipine 60mg every 4 h

2) Coiling or clipping of the bleed

Question 23

Complications of SAH

Answer 23

siadh
Hyponatraemia
Infection
DVT/PE

Question 24

4 different syndromes of MS

Answer 24

Relapsing remitting
Primary progressive
Secondary progressive
Singular event

Question 25

Sensory presentation of MS

Answer 25

Paraesthesia
Pain
Heat sensitivity 
sexual dysfunction 
Bladder/bowel dysfunction

Question 26

Patient presents with constipation. Weakness in both legs and decreased co-ordination in both legs. They have a PMH of optic neuritis.

1) What is the most likely cause
2) What is the main differential(s) of concern
3) What is the most important inx to do first

Answer 26

1) Transverse myelitis
2) Spinal cord compression, or spinal stroke
3) MRI spine to rule out the two above.

Question 27

1) Management of flares of MS
2) Type of drugs used to manage MS long term, 3 examples
3) Management of spasticity in MS
4) Management of bladder incontinence

Answer 27

1) Mehtylpred - IV or PO
2) Disease modifying therapies (DMTs) - Interferon B, Glactiramer acetate, Teriflunomide
3) Baclofen
4) Oxybutin then botulin injections

Question 28

1) Initial presentation of MND

2) Symptoms of bulbar onset disease

Answer 28

1) Weakness/loss of dexterity in one hand
asymmetrical
foot or wrist drop
2) Dysarthia and dysphagia

Question 29

Cognitive decline associated with ALS

Answer 29

Fronto-temporal dementia

Question 30

1) Infection that causes GBS

2) Presentation of GBS

Answer 30

1) Campylobacter - gastroenteritis

2) glove and stocking distribution of weakness. Ascending

Question 31

Management fo GBS

Answer 31

Supportive

IV Ig

Question 32

Causes of tremor

Answer 32

Parkinsons
huntintons 
hyperthyroid 
fever
drugs - antipsych, lithium, digoxin

Question 33

1) Benign essential tremor key symptoms

2) Management of BET

Answer 33

1) Bilateral. Worse when tired, with caffiene, with movement.
2) Propranolol. Primidone

Question 34

Cancer associated with lambert eaton syndrome

Answer 34

Small cell lung cancer