Neurology

Question 1

How can you reposition the bed to reduced ICP in patients with head injuries?

Answer 1

Reposition the bed to 30 degrees.

Question 2

Cushing’s triad.

Answer 2

Bradycardia
Hypertension
Irregular respirations (abnormal breathing patterns—>Cheyne-Stokes)

Question 3

Spinal cord compression immediate management.

Answer 3

Immobilise and administer corticosteroids (e.g., dexamethasone) to reduce inflammation/oedema.

Question 4

Lewy-Body dementia may cooccur with which neurodegenerative condition?

Answer 4

Parkinson’s disease.

Question 5

Parkinson’s pathophysiology.

Answer 5

Depletion of dopaminergic neurones in the substantia nigra pars compacta.

Question 6

A mutation of what gene causes Rett Syndrome?

Answer 6

MECP2

Question 7

Central necrosis is a common feature of what type of brain tumour?

Answer 7

Glioblastoma multiforme.

Question 8

Bell’s palsy gold-standard treatment.

Answer 8

Steroids (prednisolone) within 72 hours of onset of symptoms.

Question 9

Bell’s palsy gold-standard treatment.

Answer 9

Steroids (prednisolone) within 72 hours of onset of symptoms.

Question 10

Is the onset of Bell’s palsy rapid or slow?

Answer 10

Rapid

Question 11

A 55-year-old man presents with a 2-month history of progressive headaches, nausea, and speech difficulties. His family notes occasional confusion. Neurological exam shows mild right-sided weakness and papilloedema.

A CT scan reveals a large, irregular, heterogeneously enhancing mass with central necrosis and surrounding vasogenic oedema in the left frontal lobe.

What are the next steps in the management of this patient?

Answer 11

1. Multidisciplinary Team (MDT) Assessment: Refer the patient to a specialist MDT for comprehensive evaluation and management planning.
2. Surgical Resection: If feasible, perform surgical resection to reduce tumor burden and alleviate symptoms.
3. Radiotherapy: Administer radiotherapy, typically 60 Gy in 30 fractions, with concomitant temozolomide. For patients aged around 70 or over, or those with a Karnofsky performance status of less than 70, consider 40 Gy in 15 fractions.
4. Adjuvant Temozolomide: Offer up to 6 cycles of adjuvant temozolomide for patients with MGMT methylation-positive tumors. For those with MGMT methylation-negative tumors or unknown status, consider up to 12 cycles of adjuvant temozolomide.
5. Supportive Care: Provide supportive care to manage symptoms and improve quality of life.