Neurology

Question 1

What is an epileptic seizure? Is it the same as epilepsy?

Answer 1

a paroxysmal event in which changes of behaviour, sensation or cognitive processes are caused by excessive, hypersynchronous neuronal discharges in the brain

epilepsy is a chronic condition, an epileptic seizure is an acute event, so they are not the same

Question 2

How are epileptic seizures characterised?

Answer 2

usually 30-120 seconds
‘positive’ ictal symptoms
‘negative’ postictal symptoms
stereotypical seizure type
may occur from sleep
may be associated with other brain dysfunction

Question 3

What are the phases of a seizure?

Answer 3

beginning (prodrome and aura)
middle (ictal)
end (post-ictal)

Question 4

What is the likely diagnosis if a patient is having seizures during sleep?

Answer 4

epilepsy- seizures while asleep is common for epileptic patients

Question 5

What is hemiparesis?

Answer 5

weakness/ inability to move on one side of the body

Question 6

What is the main triad of meningitis symptoms?

Answer 6

fever
headache
neck stiffness

Question 7

What is the mortality of bacterial meningitis?

Answer 7

5% with treatment

Question 8

What is measured in the Glasgow coma scale?

Answer 8

best eye response
best verbal response
best motor response

Question 9

What are the main organisms responsible for encephalitis?

Answer 9

virus’:
herpes simplex
varicella zoster

Question 10

What are the types of strokes?

Answer 10

ischaemic- blood vessel in brain is blocked
hemorrhagic- bleeding from a blood vessel within the brain

Question 11

How do you assess TIA risk?

Answer 11

ABCD^2 assessment

Question 12

What is IAPT?

Answer 12

improving access to psychological therapies

Question 13

What are the three cardinal features of Parkinson’s?

Answer 13

bradykinesia/ askinesia:
- problems with buttons, typing on keyboard, etc
- writing smaller
- small steps, dragging one foot

tremor:
- at rest
- may be unilateral

rigidity:
- pain
- problems turning in bed

Question 14

What is bradykinesia?

Answer 14

slowness of movement

Question 15

What happens anatomically in Parkinson’s?

Answer 15

loss of dopaminergic neurons in substantia nigra
presence of lewy bodies

Question 16

What is the most powerful Parkinson’s drug?

Answer 16

L-Dopa

Question 17

Why aren’t anticholinergics used to treat Parkinson’s?

Answer 17

• we have more powerful medications for Parkinson’s
• they affect cognition and cause confusion

Question 18

What is the commonest cause of dementia?

Answer 18

alzheimer’s disease

Question 19

What is the first cognitive marker of Alzheimer’s?

Answer 19

memory impairment

Question 20

What will vitamin abnormalities on a blood test in a patient with dementia suggest?

Answer 20

that the cause of dementia is reversible

Question 21

What is the limitations of structural brain scans to diagnose Alzheimers?

Answer 21

atrophy is a late presentation
some people just have small brains

Question 22

How is dementia managed?

Answer 22

socially active
cognitively active
control vascular risk factors
treat mood and anxiety

drugs:
- acetyl choline esterase inhibitors
- memantine (anti-glutamate)

Question 23

Do dementia drugs modify disease progression?

Answer 23

not disease modifying, but give a longer period of stability before deterioration

Question 23

Do dementia drugs modify disease progression?

Answer 23

not disease modifying, but give a longer period of stability before deterioration

Question 24

What is a ‘spider sign’?

Answer 24

blood in the csf on a CT scan- subarachnoid haemorrhage

Question 25

What are the signs of a lower motor neurone disorder?

Answer 25

weakness
reduced tone
muscle wasting
fasciculation
absent deep tendon reflex

Question 26

What are the causes of lower motor neuron injury?

Answer 26

motor neuron: MND, spinal muscular atrophy, polio

motor nerve roots: radiculopathy, Guillain barre syndrome

motor nerves: neuropathies, radiculopathies

neuromuscular junction disorder: myasthenia gravis

muscle disorders: myositis, myopathies

Question 27

What is the primary cause of spinal muscular atrophy?

Answer 27

SMN1 gene mutation