Neurology

Question 1

What may exacerbate myasthenia gravis

Answer 1

BETA BLOCKERS
penicillamine
quinidine, procainamide
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines

Question 2

What does subacute combined degeneration of the spinal cord affect

Answer 2

dorsal columns (proprioception, vibration sense and tactile discrimination).

Question 3

What cause subacute combined degeneration of the spinal cord

Answer 3

B12 Deficiency

Question 4

Why should B12 levels be checked before folate supplementation

Answer 4

Folate supplementation can precipitate subacute combined degeneration of the spinal cord if B12 levels are already low

Question 5

What are the features of Weber’s syndrome

Answer 5

ipsilateral CN III palsy and contralateral hemiparesis

Question 6

How is myasthenia gravis managed

Answer 6

long-acting acetylcholinesterase inhibitors
pyridostigmine is first-line

immunosuppression is usually not started at diagnosis, but the majority of patients eventually require it in addition to long-acting acetylcholinesterase inhibitors:
1) prednisolone initially
2) azathioprine, cyclosporine, mycophenolate mofetil may also be used

Question 7

How is myasthenic crisis managed

Answer 7

plasmapheresis
intravenous immunoglobulins

Question 8

Describe Syringomyelia

Answer 8

Classically presents with cape-like loss of pain and temperature sensation due to compression of the spinothalamic tract fibres decussating in the anterior white commissure of the spine

Question 9

Drug options for reducing the risk of relapse in MS

Answer 9

natalizumab (IV) - 1st line
ocrelizumab (IV) - 1st line

Question 10

How to manage Spasticity in MS

Answer 10

baclofen and gabapentin

Question 11

What can be used in the management of acute relapse of MS

Answer 11

high dose steroids (methylprednisolone)

Question 12

What are some risk factors for idiopathic intracranial hypertension

Answer 12

obesity
female sex
pregnancy

drugs:
combined oral contraceptive pill
steroids
tetracyclines
retinoids (isotretinoin, tretinoin) / vitamin A
lithium

Question 13

How does Thoracic outlet syndrome present

Answer 13

Painless muscle wasting of hand muscles, with patients complaining of hand weakness e.g. grasping

sensory symptoms such as numbness and tingling may be present

if autonomic nerves are involved, the patient may experience cold hands, blanching or swelling

Question 14

What may precede thoracic outlet syndrome

Answer 14

There is usually a history of neck trauma preceding TOS

neck trauma can either be a single acute incident or repeated stresses

anatomical anomalies can either be in the form of soft tissue (70%) or osseous structures (30%)

a well-known osseous anomaly is the presence of cervical rib

Question 15

What can be used to differentiate between a true seizure and a pseudoseizure

Answer 15

Prolactin

Question 16

What is a positive hoffman’s sign and what does it indicate

Answer 16

A positive Hoffmans sign is a sign of upper motor neuron dysfunction and points to a disease of the central nervous system

To elicit it, the examiner should flick the patients distal phalanx (usually of the middle finger) to cause momentary flexion. A positive sign is exaggerated flexion of the thumb.