Neurology

Question 1

Cranial nerves

Answer 1

CN1 - Olfactory - smell in each nostril
CN2 - Optic - visual acuity, fields, pupils, ophthalmology
CN3 - Oculomotor - palsy: ptosis, large pupil, pupil down & out
CN4 - Trochlear - diplopia on looking down & in
CN5 - Trigeminal - Motor (ask to open mouth), Sensory (ophthalmic (V1), maxillary (V2), and mandibular (V3) & corneal reflex)
CN

Question 7

UMN v LMN

Answer 7

UMN:
* Hypertonia
* Hyperflexia
* Spastic paralysis
* No muscle atrophy

LMN:
* Hypotonia
* Diminished/absent reflexes
* Flaccid paralysis
* Lots of muscle atrophy

Question 8

Migraine

Question 9

Topiramate: Adverse effects

Answer 9

• Risk of foetal malformations
• Reduced appetite and weight loss
• Dizziness
• Paraesthesia
• Lethargy and poor concentration
• Rare but important: Acute myopia and secondary angle-closure glaucoma

Question 10

Tension Headache - what do you know?

Answer 10

• Usually bilateral
• 30 minutes to 7 days
• No N&V
• Acute: paracetamol, aspirin (not if <16) or NSAID (not opiods)
• Prophylaxis: Acupuncture (up to 10 sessions), amiptriptyline 10-75mg Od (off-label)

Question 11

Cluster headache - what do you know?

Answer 11

• Unilateral
• 15 minutes - 3 hours
• Recurrent, severe, eye symptoms (e.g. watering/red)
• Acute: O2 & sumatriptan 6mg SC (can also give nasally 10-20mg)
• Prophylaxis: Verapamil (off-label)

Question 12

Medication overuse headache

Answer 12

● Opiates most common (e.g. codeine), triptans, NSAIDs (less common)
● Almost daily headache with almost daily analgesia
● Usually tension-type headaches, worse in morning
● Mgt:
* Education
* Withdrawal (detox) for at least 1 month (advise rebound headaches likely to occur)
* Prophylactic treatment e.g. prednisolone

Question 13

Temoral arteritis (GCA)

Answer 13

● Systemic immune-mediated vasculitis affecting medium/large
● Cause unknown, strong link with PMR
● Temoral headache, fever, malaise, myalgia, jaw claudication, scalp tenderness
● Risks include
* Permanent vision loss
* Large Artery complications, e.g. aortic aneurysm
* CVD, e.g. stroke
● ACR (American College of Rhematology) diagnosis: 3 from 5 features needed
* >50, new headache, temp A abnormaility, ESR >50, positive biopsy

● Management:
* Use of pred 40-60mg without eye symptoms (admit if possible, max within 3 days)
* Use of pred 60-100mg one off dose with eye symptoms (admit same day)
* Routine use of antiplatelets is not recommended (previous guidance suggested Aspirin 75mg od is needed)

Question 14

Head injury

Question 18

Stroke

Answer 18

Rapidly developing neurological deficit (focal or global) deficit lasting for