Neurology

Question 1

Which medications are used for spasticity in MS?

Answer 1

Baclofen
Gabopentin

Other options include diazepam, dantrolene and tizanidine

Cannabis and botox are under investigation

Question 2

What is Weber syndrome?

Answer 2

Midbrain stroke - ipsilateral CN III palsy and contralateral hemiparesis

Question 3

Which bug triggers Guillan Barre?

Answer 3

Campylobacter Jejuni

Question 4

Prophylactic options for migraine and their contra-indications

Answer 4

Propanolol - not in asthma or HF

Topiramate - not in pregnancy

Amitriptyline

Question 5

Prophylaxis for cluster headaches?

Answer 5

Verapamil

Question 6

Which headache has an absolute response to indomethacin?

Answer 6

Paroxysmal hemicrania

• Severe unilateral headache with autonomic features
  10-30 mins, up to 40x / day

Question 7

What is the treatment for IIH?

Answer 7

Weight loss
Acetazolamide

Question 8

Abx for meningitis an option if the patient is pen allergic?

Answer 8

Tx = IV ceftriaxone +IV amox if listeria suspected

Pen allergic - IV chloramphenicol and IV vancomycin

Question 9

What abx do you give as a single dose as prophylaxis to people who have been in close contact with someone with meningitis?

Answer 9

Ciprofloxacin

Question 10

What is the most common cause of meningitis in children under the age of 4?

Answer 10

Haemophilus influenza type B

Question 11

Which patients are at risk of streptococcus pneumonia meningitis?
Which patients are at risk of listeria meningitis?

Answer 11

Hospitalised patients, CSF skull fractures, diabetics, alcoholics - strep pneumo
Pregnant women - listeria

Question 12

What’s the difference between communicating and non-communicating hydrocephalus?

Answer 12

Communicating hydrocephalus - no obstruction to flow, reduced CSF absorption

Non-communicating hydrocephalus (more common) - obstruction to flow : tumours etc

Question 13

What is syringomyelia?

Answer 13

Cystic enlargement of the spinal cord
Damage to the spinothalamic + corticospinal tracts
Most commonly caused by Arnold Chiari II malformation

Question 14

What is CIDP?

Answer 14

Chronic inflammatory demyelinating polyradiculopathy

Peripheral neuropathy that comes on over months - years

Like the chronic version of guillain barre

Question 15

Which anti-emetic is contra-indicated in PD patients?

Answer 15

Metoclopramide (because it is a dopamine antagonist - so exacerbates symptoms)

Question 16

What is Sydenham’s syndrome?

Answer 16

Chorea due to previous rheumatic fever

Question 17

What is degenerative cervical myelopathy?

Answer 17

Central disc prolapse within the cervical spine

Question 18

Which vessels are involved in the following brain bleeds?

Extradural
Subdural
Subarachnoid

Answer 18

Extradural - middle meningeal
Subdural - bridging veins
Subarachnoid - circle of willis

Question 19

Why do you get hyperacusis (hear more) in Bell’s Palsy?

Answer 19

The facial nerve supplies the stapedius, which is a muscle that contracts to stabilise the stapes (ear ossicle) when loud sounds are heard, to make them less loud. Paralysis of this muscle means the stapes will be able to move freely and thus sounds are heard louder.

Question 20

Which anti-epileptic can cause the SE of peripheral neuropathy?

Answer 20

Phenytoin

Question 21

Expressive (Broca’s) and receptive (Wernicke’s) aphasia correlate with problems in which parts of the brain?

Answer 21

Broca’s - frontal
Wernickes - temporal

Spoken word is heard at the ear. This passes to Wernicke’s area in the temporal lobe (near the ear) to comprehend what was said. Once understood, the signal passes along the arcuate fasciculus, before reaching Broca’s area. The Broca’s area in the frontal lobe (near the mouth) then generates a signal to coordinate the mouth to speak what is thought (fluent speech).

Question 22

Which anti-emetic is safest in parkinson’s?

Answer 22

Domperidone - doesn’t cross the BBB

Question 23

Which class of medications used in parkinson’s are most associated with the side effects of: hallucinations, excessive sleepiness and impulse control disorders?

Answer 23

Dopamine agonists eg ropinirole

Question 24

Which lesions cause superior versus inferior bitemporal hemianopia visual field defects?

Answer 24

PITS: PITuitary tumour = S uperior quadrant defect is worse (ofc the main defect is bitemporal hemianopia)
The same mnemonic can be used for
PITS: parietal inferior, temporal superior

Lower quadrant defect - craniopharyngioma

Question 25

Which medication is useful for managing tremore in drug induced parkinson’s?

Answer 25

Procyclidine