Neurology

Question 1

Wernicke’s Encephalopathy triad

Answer 1

ophthalmoplegia: nystagmus/ lta rectus palsy, conjugate gaze palsy

ataxia, encephalopathy

Question 2

Korsakoff’s syndrome

Answer 2

IRREVERSIBLE

ophthalmoplegia, ataxa, encephalopathy, antero/retrograde amnesia, confabulation

Question 3

Mx Generalised Toni-clonic

Answer 3

M: sodium valporate
F: lamotrigine/levetiracetam

Question 4

Focal seizure 1st line

Answer 4

lamotrigine/ levetiracetam

Question 5

Focal seizure 2nd line

Answer 5

cabamazepine/ oxcarbazepine/ zonisamide

Question 6

abscence seizure 1 st line

Answer 6

ethosuxide

Question 7

abscence seizure 2nd line

Answer 7

M: sodium valporate
F: lamotrigine/ levetiracetam

Question 8

myoclonic seizure Tx

Answer 8

M: sodium valporate
F: levetiracetam

Question 9

Tonic/ Atonic seizures Tx

Answer 9

M: sodium valporate
F: lamotrigine

Question 10

migraine prophylaxis

Answer 10

propranolol
topiramate avoid in women of childbearing ge
amitriptyline

Question 11

Acute mx cluster headache

Answer 11

O2 100%
sc triptan

Question 12

TIA mx

Answer 12

300mg aspirin stat unless taking low dose aspirin already

If more than 1 episode tia/ suspected cardio emboli’s or severe stenosis- referral for admission

If 1 tia within 7 days assessment within 24 hours

If tia >7d days refer r/v within 7d

Question 13

Ix Parkinsons

Answer 13

I123-FP-CIT-SPECT=> DatScan

Question 14

1st line Parkinsons tx

Answer 14

Levodopa

Question 15

Parkinsons mx

Answer 15

1st line: Levodopa

2nd line: Levodopa + Dopamine AG/ MAO-Bi/ COMTi

DA-R AG: bromocriptine, ropinirole, cabergoline, apomorphine: younger pt/ mild sx

MAOB-i: selegiline

COMTi: entacapone, tolcapone

Question 16

SE Dopamine R AG

Answer 16

ergot- derived DA-R AG: bromocriptine, cabergoline-> pulmonary/ retroperitoneal/ cardiac fibrosis

elderly pt: increased risk hallucinations

Question 17

TACI (total anterior circulation infarcts)

Answer 17

involves middle and ant cerebral arteries
unilat hemiparesis +/- hemisensory loss face, arm, leg. Homonymous hemianopia, increased cognitive dysfunction

Question 18

PACI (partial naterior circulation infarcts)

Answer 18

2 of the criteria
unilat hemiparesis +/- hemisensoryloss face/ arm/ leg. homonymous hemianopia. increased cognitive dysunfctionction

Question 19

LACI (lcunar infarcts)

Answer 19

involves perforating arteries around internal capsule, thalamus and basal ganglia. 1 of follwing present. Unilateral weekness +/- sensory deficit of face and arm, arm and leg or all three. Pure sensory stroke. Ataxic hemiparesis

Question 20

Posterior circulation infarcts (POCI)

Answer 20

vertebrobasilar arteries. Presens with 1 of following. Cerebellar or brainstem syndromes. Loss of consciousness. Isolated homonymous hemianopia. (Lateral medullary stndrome aka Wallenberg’s syndrome)

Question 21

Ischaemic stroke timing of thrombolysis + Mx
Mx stroke related to AFib when to start DOAC

Answer 21

4.5 hr
Aspirin 300mg ASAP
if DOAC- not started until r/o haemorrhage not until 14d passed from onset of ischaemicc stroke

Question 22

When to consider thrombectomy

Answer 22

Pre stroke functional status <3, modified rakin scale and score >5 NIHSS

Offer thrombectomy ASAP within 6hrs of onset with iv thrombolysis 4.5hr to pts with acute ischaemia.

Thrombectomy ASAP last known to be well 6-24hrs previously

Question 23

how long to give aspirin or clopidogrel in stroke

Answer 23

life long

Question 24

GCS

Answer 24

EVM

E: spontaneous, command, pain, nil
V: orientate, confused, words non sense, incomprehensible sound

M: command, localises pain, withdraw from pain, flexion, extension, no motor response

Question 25

Cranial nerve: which Sensory, motor, both

Answer 25

Some say marry money but my brother says big brain matters most

Question 26

Central vs peripheral VII nerve palsy

Answer 26

Central contralateral droop of lower half of mouth to lesion as other half also innervated by ontralateral side Peripheral inability to wrinkle forehead and drop of half mouth on ipsilateral side of lesion

Question 27

Hand position when damage to ulnar & radial nerve

Answer 27

Radial nerve: wrist drop Ulnar: claw hand

Question 28

AFib related stroke when to start DoAC

Answer 28

14 days passed from ischaemic stroke due to high risk of haemorrhage

Question 29

Timing of thombolysis and thrombectomy

Answer 29

Thrombolysis 4.5 hrs Thrombectomy 6hrs

Question 30

Causes of SAH

Answer 30

Traumatic cause Spontaneous

Question 31

Dx of SAH timing of LP

Answer 31

CT head within 6 hours of sx onset: if negative then Lp not needed If more than 6 hours sx onset & normal: do LP, needs to be perform at least 12 hours following sx onset as checking for xanthochromia. Norma, or high opening pressure

Question 32

Mx of SAH

Answer 32

Supportive Vasospasm: po nifedipine Intracranial aneurysm: coil Can develop hyponatraemia: due to SIaDH

Question 33

Acute to of migraine

Answer 33

Po triptan and NSAIDS or po triptan and paracetamol

Question 34

Cluster headache mx and prophylactic

Answer 34

Acute oxygen 100% Subcutaneous triptan Prophylactic:verapamil , tapering dose of prednisone

Question 35

Inheritance of essential tremor and mx

Answer 35

AD Propranolol 1st line Primidone sometimes used

Question 36

Motor neuron investigation

Answer 36

Clinical but nerve conduction can help exclude neuropathy EMG: decreased number of action potential with increased amplitude MRI: exclude diff dx of cervical cord compression and myelopathy

Question 37

Motor neuron disease mx

Answer 37

riluzol: prevents activation of glutamate receptor n-invasive bipap

Question 38

GBS cause, Ix, is it ascending or descending

Answer 38

Peripheral nervous system demyelination, ascending paralysis. Campylobacter jejuni LP: increased protein with normal WBC Nerve conduction decreased motor nerve conduction velocity due to demyelination, prolonged distal motor latency, f wave latency increased

Question 39

Miller fisher syndrome

Answer 39

Ophthalmoplegia, areflexia, ataxia: eye muscle affected first. Variant of GBS Anti GQ1b Ab

Question 40

Huntington genetics

Answer 40

AD triculeitide repeat disorder CaG on chromosome 4 Anticipatory

Question 41

Neuropathic pain mx

Answer 41

1St line: amitriptyline, duloxetine, gabapentin, pregabalin Reduce: tramadol- rescue tx

Question 42

Causes of neuroleptic malignant syndrome

Answer 42

Pt taking antipsychotics Slower onset- hours to days

Question 43

Mx of neuroleptic malignant syndrome

Answer 43

Stop antipsychotics Ivi Dantrolene decreases excitation contraction skim binding to ryanodine receptor. Decreases release of calcium from sarcoplasmic reticulum

Question 44

Multiple sclerosis classification

Answer 44

1. Relapsing remitting 2. Secondary progressive 3. Primary progressive

Question 45

Uhthoff’s phenomenon, most common findings in MS, Lhermitles syndrome, what kind of muscle weakness

Answer 45

Uhthoff: worsening vision after increased body temp in Ms Lhermitles : paraesthesia in limbs on neck flexion Most common eye signs: optic neuritis Motor spastic weakness due to demyelination along nerves of brain and spine

Question 46

Dx of Ms

Answer 46

Demonstration of lesion disseminated in time and space MRI: initial test- increased signal T2 lesion, periventricular plaque, Dawson fingers often seen on FLAIR images hyperintense lesion perpendicular to corpus callous. 2. csf: oligoclonal bands and not in serum , increased intrathecal synthesis of IgG Visual field: visual evoked potential delayed but well preserved waveform

Question 47

Dystrophies types, inheritance, classic findings

Answer 47

XR dystrophin xp21 Duchenne frameshit, severe form- calf pseudohypertrophy, growers sign Becker insertion less severe form

Question 48

Herpes simplex encephalitis ix

Answer 48

CSF: lymphocytosis, increased protein Pcr for hsv Ct: medial temporal and inferior frontal changes MRI

Question 49

Mx of migraine in children and adults and prophylaxis

Answer 49

Children: acute mx- ibuprofen more effective than paracetamol. >12 years triptan may be used but follow up needed. Sumatriptan nasal spray is the only proven triptan. Prophylaxis pizotifen + propranolol 1st line. 2nd line- valporate/ topiramate/ amitriptyline Adult: 1st line- oral triptan + nsaid OR po triptan + paracetamol If not effective than offer n-oral pre metoclopramide/ prochooperazine with or without n-oral nsaids. Triptan Prophylaxis- propranolol, topiramate not in female in childbearing age, amitriptyline