Neurology

Question 1

Which of the following anti-epileptic drug may cause osteoporosis?
Which one is safest in pregnancy?
Phenytoin
Gabapentin
Carbamazepine
Lamotrigine
Vigabatrin

Answer 1

Osteoporosis = Phenytoin
Pregnancy = Lamotrigine

Question 2

What does CADASIL stand for?
What gene is implicated in its disease process?
How and what age does it present?
Treatment?

Answer 2

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
Gene = NOTCH3
Presentation = Progressive dementia developing in the fifth to seventh decades in multiple family members
Treatment = nil

Question 3

What does Valproate do to Lamotrigine levels?
What does Carbemazepine do?
What about pregnancy? and how?

Answer 3

Valproate = increases
Carbemazepine = decreases
Pregnancy = Decreases
How = Metabolism increased secondary to increased oestrogen levels

Question 4

Apart from seizure control, what are two other indications for Topiramate use?

Answer 4

Migraine headaches
Weight loss (binge eating disorders)

Question 5

The following treatments are useful in essential tremor except?
And what is first line?
Levodopa
Propranolol
Primidone
Alprazolam
Alcohol

Answer 5

Levodopa
1st line = Propranolol

Question 6

How does Levodopa potential cause nausea and vomiting?

Answer 6

Levodopa converted to dopamine -> excessive levels can overstimulate the dopamine receptors in the area postrema of the brain -> chemoreceptor trigger zone for vomiting.

Question 7

What is the mechanism of action of Carbidopa?

Answer 7

Reduce peripheral conversion of levodopa to dopamine

Question 8

Which of the following drugs enhances dopamine release?
Carbidopa
Amantidine
Entacapone

Answer 8

Amantidine

Question 9

What type of ineurological mpairment is a hallmark finding in Botulism?

Answer 9

Multiple Cranial nerve palsy with progressive descending muscle weakness

Question 10

A patient with Parkinson’s disease presents with gambling problem,compulsive shopping and hypersexuality.
Which medication is likely to have caused this?
Selegiline
Entecapone
Amantadine
Levodopa
Pramipexole

Answer 10

Pramipexole

Question 11

Which of the following medications are ergot and non-ergot dopamine agonists?
And what does this mean for side effect profile? Bromocriptine
Pramipexole
Rotigotine

Answer 11

Ergot = Bromocriptine
Non = Pramipexole, Rotigotine
Non-ergot bind specifically to Dopamine D1 and D2 receptors = less side effects

Question 12

Which of the following feature is least consistent with the diagnosis of progressive supranuclear palsy?
Pseudobulbar palsy
Frequent falls in the first year
Supranuclear gaze palsy
Akinetic-rigid syndrome
Excellent response to levodopa

Answer 12

Excellent response to Levodopa
This occurs in Parkinsons

Question 13

What neurology is found in Weber’s syndrome?
Where is the lesion?
What about Gerstmann’s Syndrome?
Where is the lesion?

Answer 13

Weber’s syndrome: ipsilateral third nerve palsy with contralateral hemiplegia
Lesion = medial midbrain
Gerstmann’s syndrome: Finger agnosia, left-right disorientation, agraphia, acalculia
Lesion = posterior parietal lobe in the dominant hemisphere

Question 14

What chromosome is Huntington disease on?
What nucleosides are repeated?
How many is needed for full penetrance?

Answer 14

4q
CAG repeat
>40 for full penetrance

Question 15

What gene links Frontotemporal dementia and Motor Neuron Disease?
What gene is linked to the ALS form of MND?

Answer 15

C9ORF72 “Chromosome 9 open reading frame 72”
ALS = SOD1

Question 16

What does protein 14-3-3 in CSF indicate?
What about neuron specific anolase?

Answer 16

14-3-3 = CJD
NSE = Neuronal damage or neuroendocrine tumours (small cell lung cancer)

Question 17

Mechanism of action:
Natalizumab?
Ocrelizumab?
Alemtuzumab?

Answer 17

Nat = α4β1inhibitor
Ocre = CD20
Alem = CD52

Question 18

Which of the following feature is least consistent with the diagnosis of pseudotumor cerebri (Idiopathic intracranial hypertension)?
- Reduced level of consciousness
- Symptoms of raised intracranial pressure
- No localising signs with the exception of abducens (sixth) nerve palsy
- Normal MRI findings
- LP opening pressure of >25 cmH2O

Answer 18

Reduced level of consciousness

Question 19

What are the genetic mutations/deletions to the DMD gene for each disorder;
(promotor vs frameshift vs in-frame)
Duchenne
Beckers
X-linked cardiomyopathy

Answer 19

Duchenne = Frameshift deletion
Becker = In-frame deletion
X-linked = promotor deletion

Question 20

Parkinsons inheritance rate?
Which genes cause early onset?
Specific histopathology in the brain?
MRI sign that is specific?

Answer 20

Inheritance: 5%
Gene = PARK 1 and PARK 4 cause early onset
Histo = alpha-Synuclein
MRI = swallow tail sign

Question 21

What is the risk of seiure recurrence after stopping seizure medication?
What implication does this have on young female patients with regards to pre-conception advice?

Answer 21

The frequency of seizure recurrence within six and twelve months of discontinuing therapy is approximately 15 and 30 percent, respectively. The risk may vary according to the specific epilepsy syndrome and other factors though these estimates should be individualised.

If a woman has been seizure-free for a satisfactory period and the decision is made to discontinue anti-seizure drugs, this should be performed for at least six to twelve months prior to becoming pregnant, as the risk of seizure recurrence after withdrawal is highest during this period.

Question 22

Altered metabolism of Amyloid precursor protein is involved in amyloid plaques and tau tagnles.
Which chromosome is this protein found on?
What is the clinical link to this?

Answer 22

Chromosome 21
Mutation causes Alzheimers, also links Down’s to Alzheimers

Question 23

What are the 5 frailty criteria?

Answer 23

Fatigue
Slow walking speed
Weakness
Unintentional weight loss
Low physical activity

Question 24

What is the most supported window for thrombolysis?
When can this time frame be doubled?

Answer 24

4.5 hours

9hrs if;
- core infarct is small (less than 70 mL)
- significant penumbra (ratio of penumbra:core greater than 1.2)
- significant delay to clot retrieval (presenting to rural hospital)