Neurology

Question 1

patient with a stroke AND ecg showing they have atrial fibrilliation

already on aspirin and simvastatin since stroke.

most appropriate long term plan for secondary stroke prevention?

Answer 1

Apixaban!!! (an xa-inhbitor)

or warfarin

as anticoagulation

Question 2

woman has severe neck chest and back pain after a fall

cxr clear with left sided rib fracture
CT head is clear except orbital fracture

most appropriate next investigation?

Answer 2

CT scan of neck!!!!

history and exam suggests cervical spine fracture

Question 3

when would a CT scan of head be indicated after a fall?

Answer 3

LOC
OR amnesia

Question 4

sudden severe headache 4 hours ago. autosomal dominant polycystic kidney disease

neuro exam and CT scan head normal

next step in management?

Answer 4

lumbar puncture!!!

patient most likely had a subarrachnoid hemorrhage

negative CT scan must be followed up with lumbar puncture

Question 5

Question describing A focal Siezure affecting patients right hemisphere as a result of a previous stroke

Question 6

spinal stenosis presentation?

Answer 6

neurogenic claudication - eg numbeness and weakness of legs that come on with walking that improve with leaning forward

Question 7

A 17 year old boy has repeated episodes characterised by a funny ‘racing’
sensation in his abdomen, followed by loss of awareness. His girlfriend
describes that he has a vacant stare and waves his left arm around in a
writhing manner during these attacks.

what is the most likely site origin of these episodes?

Answer 7

right temporal lobe

He has focal onset impaired awareness
seizures, the aura implicates one of the temporal lobes. In the seizure
itself he waves his left arm, suggesting spread to the right frontal lobe (though
the origin is elsewhere).

Question 8

A 46 year old woman attends the Emergency Department with fever,
headache and confusion, which developed over several hours. She finds it
impossible to lift her head from the pillow and resists the doctor’s attempts to
feel her neck.
Her temperature is 38.1°C, pulse rate 105 bpm and BP 110/60
mmHg. Her GCS score is 14.
A CT scan of her head is normal. A lumbar puncture is performed

Answer 8

High pressure, raised protein, excess neutrophils

Question 9

TIA management?

management if patient on anticoagulants or has bleeding disorder?

Answer 9

300mg aspirin + specialist review within 24hrs

anticoagulants = immediate non contrast CT to rule out hemorrhage

TIA may present as amurosis fugax

Question 10

bells palsy management?

Answer 10

oral prednisolone and artificial tears

aciclovir is not given!!

if the paralysis shows no sign of improvement after 3 weeks, refer urgently to ENT

Question 11

baclofen not helping enough for patient with muscle stiffness in with MS. other first line option?

acute relapse treatment?

Answer 11

gabapentin

oral or IV methylprednisolone