neurology

Question 1

raised ICP presentation: (7)

Answer 1

Cushing’s triad:
1. bradycardia
2. wide pulse pressure
3. irregular respirations

+ raised BP
vomiting
papilloedema
reduced GCD

Question 2

EDH
i. blood vessel most commonly affected

Answer 2

middle meningeal a.

Question 3

EDH typical hx

Answer 3

acceleration/ deceleration trauma
or trauma to side of head
LOC followed by lucid interval

Question 4

SDH
i. vessels most commonly affected

Answer 4

i. bridging veins

Question 5

SDH
ii. RF
iii. presentation

Answer 5

ii. alcoholism
old age
anticoagulation

iii. fluctuauting confusion/ consciosuness especially for chronic

Question 6

diffuse axonal injury

i. what causes it
ii. 2 components

Answer 6

i. rapid head acceleration/ deceleration

ii.
1. mulitple haemorrhages
2. diffuse axonal damage in white matter

Question 7

triptan CI:

Answer 7

IHD/ cerebrovascular disease

Question 8

triptans adverse effects:

Answer 8

“triptan sensations”
–> tingling, heat, tightness (e.g. throat and chest), heaviness, presure

Question 9

generalised tonic clonic seizures

mgt in males

Answer 9

sodium valproate

Question 10

generalised tonic clonic seizures

mgt in females

Answer 10

lamotrigene or leviteracetam

may also offer sodium valproate if <10 and unlikely require rx when child bearing age

Question 11

focal seizures:

i. 1st line mgt
ii. 2nd line

Answer 11

i. lamotrigine/ leviteracetam

ii. carbamazeoine, oxcabapazepine or zonisamide

Question 12

absence seizures:

i. 1st line

ii. 2nd line

Answer 12

i. ethosuximide

ii. in M: sodium valproate

in F: lamotrigene/ leviteracetam

Question 13

which anti-epileptic can exacerbate absence seizures?

Answer 13

carbemazapine

Question 14

myoclonic seizures mgt

Answer 14

in M: Na valproate

in F: levetiracetam

Question 15

tonic/ atonic seizures mgt

Answer 15

in M: sodium valproate

in F: lamotrigene

Question 16

GCS

Answer 16

Mo6 V5 E4

motor response:

6. Obeys commands
7. Localises to pain
8. Withdraws from pain
9. Abnormal flexion to pain (decorticate posture)
10. Extending to pain
11. None

verbal response:

5. Orientated
6. Confused
7. Words
8. Sounds
9. None

eye opening:

4. Spontaneous
5. To speech
6. To pain
7. None

Question 17

anti-hypertensives are required for stroke mgt if BP > what?

Answer 17

> 185/110