Neurology

Question 1

What are the diagnostic criteria for Parkinson’s disease?

Answer 1

Presence of bradykinesia with either rest tremor, rigidity or both

Question 2

What are the three research criteria for PD?

Answer 2

Preclinical - Neurodegeneration without symptoms/signs
Prodromal - Symptoms/signs present but insufficient for diagnosis
Clinical - Diagnostic criteria met

Question 3

What are the early symptoms/signs of PD?

Answer 3

REM behaviour disorder
Hyposmia
Constipation
Early motor impairment
Depression/anxiety
Executive dysfunction

Question 4

What is the biggest risk factor for PD development?

Answer 4

Sibling with PD <50yo at diagnosis (LR+ 7.5)

Question 5

What is the most protective factor against PD development?

Answer 5

Smoking (LR- 0.45)

Question 6

What are the key histopathological findings of PD?

Answer 6

Lewy bodies (intracytoplasmic inclusions) and Lewy neurites (intra-axonal neurites) comprised of ubiquitin and alpha-synuclein

Question 7

What is the biggest prodromal risk factor for PD?

Answer 7

RBD (LR+ 130)

Question 8

What are the two most important genetic variations contributing to PD?

Answer 8

Glucocerebrodase (GBA) 10%
LRRK2 1-2%

Question 9

What is the primary/concerning adverse effect of ergot-based dopamine agonists?

Answer 9

Cardiac, pulmonary and retroperitoneal fibrosis

Question 10

Quetiapine is often used for confusion/hallucinations in PD. What important interaction needs to be considered when using quetiapine?

Answer 10

Long QT with used with domperidone (for nausea)

Question 11

What adverse effect is more commonly seen with dopamine agonists than with levodopa?

Answer 11

Impulse control disorder

Question 12

What adverse effect is more commonly seen with levodopa when compared to other PD treatments?

Answer 12

Dyskinesia

Question 13

What are the features of peak-dose dyskinesia?

Answer 13

Onset 30-60 minutes post-dose, upper body chorea, patient often unaware

Question 14

What are the features of end-dose dyskinesia?

Answer 14

Onset 3-4 hours post-dose, dystonic reactions of feet (most often), painful

Question 15

What is the average time to onset of dementia in PD patients?

Answer 15

10 years

Question 16

What red flags in a PD patient warrant review of the diagnosis?

Answer 16

Absence of tremor
Symmetrical signs
Falls within the first year of diagnosis
Marked speech/dysphagia
Early urinary incontinence
Early dementia within first two years

Question 17

What are the four classic signs of PSP (Richardson’s syndrome)?

Answer 17

Early falls
Supranuclear down gaze palsy
Postural instability
Frontal dementia

Question 18

What are the classic features of PSP-Parkinson’s?

Answer 18

Asymmetric onset
Tremor
Response to levodopa
Better prognosis

Question 19

What is the most common presentation of corticobasal syndrome?

Answer 19

Useless, rigid, jerking arm

Question 20

What causes are there of corticobasal syndrome?

Answer 20

Corticobasal degeneration
PSP
Pick disease
Alzheimers
DLB
CJD

Question 21

What feature distinguishes the bradykinesia of PD from other causes?

Answer 21

Fatiguing

Question 22

King Penguin sign on MRI is indicative of what?

Answer 22

PSP

Question 23

Normal midbrain with pons atrophy is indicative of what on MRI?

Answer 23

MSA

Question 24

What age and gender are predominantly affected by MS?

Answer 24

Females aged 20-40

Question 25

Which five characteristic signs of MS are there?

Answer 25

Internuclear ophthalmoplegia Optic neuritis Acute partial myelopathy Lhermitte's symptoms Uhtoff's symptoms

Question 26

What is the difference between relapsing remitting MS and progressive MS?

Answer 26

RRMS - Complete resolution of symptoms between attacks PPMS - Progressive deterioration without resolution from time of disease onset SPMS - Progressive deterioration without resolution after previous post-attack resolution

Question 27

What level of the spinal cord are MS lesions most commonly seen?

Answer 27

Cervical

Question 28

What proportion of patients with CIS and an abnormal MRI will develop MS?

Answer 28

70-90%

Question 29

What CSF findings are seen with MS?

Answer 29

Normal CSF profile +/- mildly elevated lymphocytes Oligoclonal bands + IgG levels Normal serum oligoclonal bands

Question 30

What relapse rates are seen with pregnant women with MS?

Answer 30

Increased relapse rates in first and second trimester (2-3 fold), decreased risk in third trimester

Question 31

What are the three most important risk factors for ischaemic strokes?

Answer 31

Age, hypertension, atrial fibrilation

Question 32

What are the two most important risk factors for haemorrhagic strokes?

Answer 32

Hypertension, cerebral amyloid angiopathy

Question 33

What is the most common foetal abnormality seen with anti-epileptics?

Answer 33

Cardiac malformations

Question 34

What is the typical age of onset for myasthenia gravis?

Answer 34

75 years

Question 35

What is the test diagnostic of MG in 80% of cases?

Answer 35

Acetylcholinesterase antibodies

Question 36

What is the secondary receptor to which antibodies are formed in MG?

Answer 36

Muscle Specific Kinase

Question 37

Which HLA is MUSK MG associated with?

Answer 37

HLA DR14-DQ5

Question 38

What is the primary treatment for MG?

Answer 38

Acetylcholinesterase inhibitors

Question 39

What secondary means of treatment are there for MG?

Answer 39

Steroids, steroid-sparing (AZA, MTX), rituximab/eculizumab

Question 40

What is the life-threatening complication of myasthenic crisis?

Answer 40

Diaphragmatic/intercostal involvement

Question 41

What proportion of LEMS is paraneoplastic?

Answer 41

50% (usually SCLC)

Question 42

What HLA class is associated with LEMS?

Answer 42

HLA B8-DR3

Question 43

What antibodies are the cause of LEMS?

Answer 43

Anti-voltage gated calcium channel antibodies

Question 44

What is the primary treatment of LEMS?

Answer 44

3-4 diaminopyridine (potassium channel blocker)

Question 45

What is the most sensitive test for MG?

Answer 45

EMG

Question 46

What is the most common pattern of peripheral neuropathy?

Answer 46

Distal symmetrical neuropathy