Neurology

Question 1

Neuropathic pain Mx

Answer 1

1st - amitriptyline, duloxetine, gabapentin or pregabalin. If one of these agents don’t work next line is to try one of the other remaining three drugs

Tramadol may also be useful

Question 2

DVLA rules
Epilepsy/ seizures
first seizure
chronic epilepsy
withdrawal of medication

Answer 2

Epilepsy/ seizures - No driving, inform DVLA
- first seizure - 6 months
- must be seizure free for 12 months to start again
- withdrawal of medication - 6 months after last dose

Question 3

DVLA rules syncope
simple faint
single episode, explained
single episode, unexplained
two or more episodes

Answer 3

simple faint - no restriction
single episode, explained - 4 weeks
single episode, unexplained - 6 months
two or more episodes - 12 months

Question 4

DVLA rules
stroke/ TIA
Multiple TIAs
narcolepsy/ cataplexy

Answer 4

Stroke/ TIA - 1 month
Multiple TIA - 3 months, inform DVLA
Narco - stop driving, start again when symptoms under control

Question 5

Cabergoline (for Parkinsons) main side effect

Answer 5

Pulmonary fibrosis

Question 6

Anti platelet Mx of Stroke

Answer 6

1st - clopidogrel
2nd - Aspirin + Dipyridamol lifelong
3rd - Aspirin OR Dipyridamol monotherapy

Question 7

Trigeminal neuralgia Mx

Answer 7

1st - Carbemazepine#
2nd - refer Neuro

Question 8

Neurogenic thoracic outlet syndrome Fx

Answer 8

muscle wasting of hands
numbness and tingling
worse when raising arm above head

Question 9

Tension-type headaches Mx
Prophylaxis
Mx

Answer 9

Prophylaxis - acupuncture, low dose amitriptyline
Mx - Aspirin, paracetamol, nsaid

Question 10

Bells palsy mx

Answer 10

Prednisolone
>3 weeks no improvement = ENT Urgent refer
>6 months no improvement = Plastics refer

Question 11

TIA Acute Mx

Answer 11

300mg Aspirin
- unless:
- known bleeding disorder or on anticoagulant
- already taking aspirin (then continue low dose)
- aspirin contraindicated - need specialist input

Specialist review
- more than 1 TIA
- TIA <7 days - admission <24 hrs
- TIA > 7 days - admission <7 days

CT Head - exclude other pathology
Carotid doppler

Not to drive until specialist review

Question 12

TIA secondary prevention Mx

Answer 12

Clopidogrel (or Aspirin + Dipyridamole)
Statin - aim reduce non-HDL >40%

Question 13

Phenytoin side effects

Answer 13

Peripheral neuropathy
bleeding gums (gingival hyperplasia)
lymphadenopathy
osteomalacia
hirsutism
hepatitis

Question 14

Reye’s syndrome Fx

Answer 14

rash
fever
vomiting
can lead to encephalopathy

this is why aspirin is contraindicated in children

Question 15

Acoustic neuroma (vestibular schwannoma) Fx

Answer 15

CN VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus

CN V: absent corneal reflex

CN VII: facial palsy

Question 16

Cluster headaches Mx

Answer 16

first episode - neurology review

acute - 100% O2, Subcut Triptan + admission

Prophylaxis - verapamil

Question 17

essential tremor mx

Answer 17

propranolol

Question 18

Migraine prophylaxis

Answer 18

Riboflavin (vit B2)
1st Topiramate or propranolol
If menstrual migraine - Frovatriptan/ zolmitriptan
3rd Acupuncture

Question 19

Stopping anti epileptic medication criteria

Answer 19

seizure free >2 years
AEDs stopped over 2-3 months

Question 20

Lamotrigine serious side effects (rare)

Answer 20

Steven johnson syndrome

Question 21

Degenerative cervical myolopathy Fx

Answer 21

Upper motor neuron signs
Hoffmans positive - flick distal phalynx causes momentary flexion (positive sign)

Question 22

Acute Seizure management
Neonate
1 month - 1 yo
2 - 11 yo
12 - 17 yo
adult
elderly

Answer 22

• Rectal Diazepam
  Neonate 1.25 - 2.5 mg
  Child 1 month - 1 year 5 mg
  Child 2 years - 11 years 5 - 10 mg
  Child 12 years - 17 years 10 mg
  Adult 10 - 20 mg (max. 30 mg)
  Elderly 10 mg (max. 15 mg)

Question 23

Parkinsons related dementia Mx

Answer 23

Rivastigmine

Question 24

Common peroneal nerve lesion Fx

Answer 24

weakness of foot dorsiflexion
weakness of foot eversion
weakness of extensor hallucis longus
sensory loss over the dorsum of the foot and the lower lateral part of the leg
wasting of the anterior tibial and peroneal muscles

Question 25

Complex regional pain syndrome Mx

Answer 25

Amitriptyline + Physiotherapy

Question 26

Focal Seizure Mx

Answer 26

Lamotrigine or levetiracetam

Question 27

Normal pressure hydrocephalus Fx

Answer 27

Urinary incontinence + gait abnormality + dementia

Question 28

Drugs causing peripheral neuropathy

Answer 28

Amiodarone
Isoniazid
Vincristine
Metronidazole
Nitrofurantoin

Question 29

Absence seizure Mx

Answer 29

Ethosuximide

Question 30

Triptans common side effect

Answer 30

tightness of throat and chest

Question 31

Restless legs syndrome Mx

Answer 31

1st - Ropinirole/ Pramipexole
2nd - Pregabalin/ Gabapentin

Question 32

Restless legs syndrome ix

Answer 32

Ferritin - most commonly associated with iron deficiency

Question 33

Syringomyelia Fx

Answer 33

Cape like (neck, shoulders, arm) - loss of sensation and temperature
fine touch is normal

associated with chiari malformation

Question 34

Focal seizure Mx

Answer 34

Lamotrigine or levetiracetam

Question 35

Motor neuron disease - Amyotrophic lateral sclerosis Mx

Answer 35

Riluzole - prolongs life by roughly 3 months
Respiratory care - Bipap at night
Nutrition - PEG feeding

Question 36

Third nerve palsy Fx

Answer 36

“down and out” eye
ptosis
dilated pupil