Neurology

Question 1

Patient with stroke symptoms since less than 4.5 hours, imaging confirms blockage of proximal anterior or posterior circulation, treatment:

Answer 1

Thrombolysis with alteplase and thrombectomy.

Question 2

Aphasia characterised by fluent but incoherent speech, comprehension and repetition are abnormal:

Answer 2

Wernicke’s aphasia.

Question 3

Aphasia characterised by non-fluent and effortful speech, reading comprehension is okay:

Answer 3

Broca’s aphasia.

Question 4

Sodium valproate adverse effects:

Answer 4

Teratogenic, neural tube defects
P450 inhibitor
gastrointestinal: nausea
increased appetite and weight gain
alopecia: regrowth may be curly
ataxia
tremor
hepatotoxicity
pancreatitis
thrombocytopaenia
hyponatraemia
hyperammonemic encephalopathy: L-carnitine may be used as treatment if this develops

Question 5

Crescent shaped haemorrhage on CT head, diagnosis and damaged vessel:

Answer 5

Subdural haemorrhage, bridging veins.

Question 6

Phenytoin side effects:

Answer 6

Gingival hyperplasia, hirsutism, coarsening, megalblastic anaemia, peripheral neuropathy, etc.

Question 7

Status epilepticus patient, not responding after 2 doses of IV lorazepam:

Answer 7

Levetiracetam, phenytoin, sodium valproate.

Question 8

Main difference between MND and myasthenia gravis:

Answer 8

MND spares eye movements.

Question 9

Triptan contraindications

Answer 9

Ischaemic heart disease or cerebrovascular disease.

Question 10

Parkinson’s drugs that may cause pulmonary, retroperitoneal or cardiac fibrosis:

Answer 10

Ergot-derived dopamine receptor agonists (bromocriptine, cabergoline).

Question 11

Treatment for drug-induced parkinsonism:

Answer 11

Antimuscarinics: procyclidine, benzotropine, trihexyphenidyl (benzhexol).

Question 12

Stroke patient intolerant of clopidogrel, secondary prevention:

Answer 12

Aspirin + dipyridamole lifelong.

Question 13

First line treatment for trigeminal neuralgia:

Answer 13

Carbamazepine

Question 14

Patient with brain abscess, ejection systolic murmur, diagnosis:

Answer 14

Infective embolism frominfective endocarditis

Question 15

Obese, young female with headache and blurred vision, diagnosis and treatment:

Answer 15

Idiopatic intracranial hypertension. Weight loss, topiramate, acetazolamide.

Question 16

TIA that resolved completely before 24h treatment:

Answer 16

300 mg aspirin and urgent stroke review.

Question 17

Prevention treatment for luster headache:

Answer 17

Verapamil

Question 18

Initial management for patients with suspected TIA who are taking anticoagulants or have bleeding disorders:

Answer 18

Urgent imaging

Question 19

Impaired adduction of one eye and nystagmus on abduction on the other eye, diagnosis:

Answer 19

Internuclear ophthalmoplegia

Question 20

Parkinson’s group of drugs that cause more adverse events like sleepiness, hallucinations and impulse disorders:

Answer 20

Dopamine agonists: bromocriptine, cabergoline, ropirinole.

Question 21

In what lobe is Broca’s and Wernicke’s areas located?

Answer 21

Inferior frontal gyrus and superior temporal gyrus.

Question 22

Ipsilateral CN III paralysis and contralateral hemiparesis, diagnosis, occluded branch and area of infarction:

Answer 22

Weber’s syndrome, posterior cerebral artery, midbrain.

Question 23

Neuropathic pain 1st line (4 meds).

Answer 23

Amitriptyline, gabapentin, duloxetine, pregabalin. All as monotherapy.

Question 24

Pain in neck or extremities, loss of motor or sensory function or autonomic function, may have been diagnosed with resistant carpal tunnel syndrome, diagnosis:

Answer 24

Degenerative cervical myelopathy

Question 25

Bilateral acoustic neuromas are typically seen in which condition:

Answer 25

Neurofibromatosis type 2

Question 26

MS spasticity treatment:

Answer 26

Baclofen / gabapentin.

Question 27

Type of stroke that presents with purely motor, purely sensitive or mixed deficit?

Answer 27

Lacunar stroke

Question 28

Total anterior circulation infarct symptoms:

Answer 28

Unilateral weakness of face, arm and leg, homonymous hemianopia, and a symptom of higher cerebral disfunction.

Question 29

Management for nausea in migraine:

Answer 29

Metoclopramide because of prokinetic effects:

Question 30

Most common complication following meningitis:

Answer 30

Sensorineural hearing loss

Question 31

DVLA seizures:
1st unprovoked, no abnormalities:
1st, epilepsy or unprovoked:

Answer 31

6 months
12 months

Question 32

DVLA Syncope:
- simple faint
- single episode, explained and treated:
- single episode, unexplained
- two or more episodes

Answer 32

No restriction
4 weeks off
6 months off
12 months off

Question 33

DVLA Stroke or TIA:

Answer 33

1 month

Question 34

First line for epilepsy tonic-clonic seizures in male and female:

Answer 34

male: sodium valproate
female: lamotrigine or levetiracetam

Question 35

First line for focal epilepsy

Answer 35

lamotrigine or levetiracetam or carbamazepine

Question 36

What is used to treat cerebral oedema in patients with brain tumours?

Answer 36

Dexamethasone

Question 37

When to start anticoagulation after a non-haemorrhagic stroke?

Answer 37

2 weeks after the event, antiplatelets for those 2 weeks

Question 38

TIA treatment:

Answer 38

Aspirin + clopidogrel for 21 days, then clopidogrel monotherapy

Question 39

Treatment for status epilepticus:

Answer 39

Buccal midazolam, rectal diazepam or IV lorazepam

Question 40

How to differentiate cauda equina syndrome from spinal cord compression?

Answer 40

Cauda equina syndrome is below L2, and can present with urinary and bowel incontinence and buttock numbness, weakness is usually in feet and toes. Whereas weakness in upper or lower limb may be cause by spinal cord compression.