Neurology

Question 1

Peripheral neuropathy causes

Answer 1

Diabetes
Alcohol
B12/folate defciency
CKD
HIV
Shingles
Rheumatoid arthritis
Lyme disease
Sjögren’s syndrome
Amyloidosis
Uraemia
Guillain–Barré syndrome/chronic infammatory demyelinating polyneuropathy (CIDP)
Porphyria
Charcot–Marie–Tooth disease
Malignancy or paraneoplastic syndrome
Vasculitic neuropathy
Side effects of chemotherapy including drugs used to treat HIV and more.

could it be causa equina?

Question 2

Normal Pressure Hydrocephalus Fx (3)

Answer 2

Cognitive impairment
Gait disturbance (apraxia)
urinary incontinence

Question 3

migraine red flags

Answer 3

Neurological or raised intracranial pressure symptoms or seizures.
Changes in behaviour, memory or skills.
Unilateral deafness or pulse synchronous tinnitus.
Drowsiness or loss of consciousness.
Ataxia.
Sudden visual loss.
Migraine with aura using OCP.

Question 4

headache DDX

Answer 4

Tension headache.
Trigeminal autonomic cephalgias, e.g. cluster headache.
trauma to head or neck.
Subarachnoid haemorrhage: ‘thunder-clap headache’ – severe, sudden onset.
Subdural haemorrhage: risk factors include alcohol, being elderly and falls.
Temporal arteritis: >50 years + pain on chewing or combing your hair? Temporal artery:
‘absent pulse, beaded, tender or enlarged’.
Exposure to, or withdrawal from, substances: carbon monoxide, cocaine, alcohol. Also
medication overuse headache.
Infections, e.g. ear, sinuses, meningitis, encephalitis, cerebral abscess.
Hypoxia/hypertension – including pre-eclampsia and eclampsia.
Head/neck problems such as angle closure glaucoma or temporomandibular joint
dysfunction.

Question 5

Migraine Mx

Answer 5

Acute
- Ibuprofen, aspirin
- Metoclopramide, prochlorperazine
- triptans (avoid in uncontrolled HTN, vascular disease, >60s or children)

Prednisolone 20mg OD 5/7

Prophylaxis
- Propranolol, amitriptylin, gabapentin, pregabalin , topiramate (teratogenic)

Question 6

TIA Fx

Answer 6

Face - unilateral droop, not including forehead
Arms unilateral weakness or sensation loss
Speech slurred
Time! Call 999

Question 7

TIA Mx

Answer 7

Aspirin 300mg (unless contraindicated)
if on anticoagulation or bleeding disorder to admit to hospital

if <7 days ago symptoms - needs TIA clinic assessment within 24hrs

Question 8

Stroke Mx

Answer 8

999
do not give aspirin

Question 9

CVD secondary prevention

Answer 9

BP - aim <130/80
Atorvastatin 20mg
Antiplatelet
lifestyles - smoking, diet

Question 10

Multiple sclerosis Fx

Answer 10

Visual changes, e.g. acuity, colour vision, visual felds (optic neuritis).
Reduced vision, loss of vision or double vision.
Hearing loss.
Facial weakness.
Altered sensations.
Limb weakness, gait problems.
Bladder and bowel control may be affected.
Altered temperature regulation, e.g. sweating.
Altered sexual function/impotence.
Lhermitte’s phenomenon: the feeling of electricity down the spine on neck flexion.
Cerebellar symptoms: ataxia, nystagmus, dysarthria and vertigo.
Cognitive dysfunction (late symptoms).

Question 11

If signs of confusion/ muddled what to ask?

Answer 11

AMT

1. What is your age?
2. What is the time to the nearest hour?
3. Give the patient an address, and ask him or her to repeat it at the end of the test
   e.g. 42 West Street
4. What is the year?
5. What is the name of the hospital or number of the residence where the patient is
   situated?
6. Can the patient recognize two persons (the doctor, nurse, home help, etc.)?
7. What is your date of birth? (day and month sufficient)
8. In what year did World War 1 begin?
9. Name the present monarch/prime minister/president.
10. Count backwards from 20 down to 1.

6 or less = delirium/ dementia