Neurology

Question 1

Causes of sensory polyneuropathy

Answer 1

Diabetes
Hypothyroidism
Uraemia
B1, B6 and B12 deficiencies
Chemotherapy
Alcohol
CIDP
Sarcoidosis
ANCA positive vasculitis
Rheumatoid
Paraneoplastic - solid organ/paraprotienaemia

Question 2

Bedside tests in sensory polyneuropathy

Answer 2

Bedside glucose
Fundoscopy
Urine

Question 3

Signs in Charcot-Marie-tooth

Answer 3

Wasting in distal muscle
High arched feet
Flaccid tone
Power reduced distally
Reduced reflexes
Sensation, vibration and proprioception reduced
High steping gait with foot drop
Rhomberg’s positive

Question 4

Genetic cause of Charcot-Marie-Tooth

Answer 4

Multiple types, most commonly autosomal dominant

Question 5

EMG findings in Charcot-Marie-Tooth

Answer 5

Severe uniformly reduced neuropathy
Type 1 - demyelinating

Question 6

Treatment in Charcot-Marie-Tooth

Answer 6

Family testing
Physiotherapy
Podiatrist
Orthotics
Occupational therapy
Nil disease modifying

Question 7

Signs of stroke in limb exam

Answer 7

Increased tone
Hyperreflexia
Reduced power
Clonus

Question 8

Additional clinical signs in stroke to elicit

Answer 8

Pulse - irregular ?AF
Auscultate the carotids ?bruit
Blood pressure
Murmur ?valvular heart disease
BM - diabetes

Question 9

Management of acute stroke

Answer 9

Urgent CT head +/- CTA
?MRI brain
USS doppler carotid - stenosis >70%
ECG
Ambulatory ECG/BP measurement

If under 50 years ECHO with bubble studies - foramen ovale

Question 10

Causes of spastic paraparesis

Answer 10

Compressive:
- Disc herniation
- Tumours
- Spinal stenosis

Vascular:
- Spinal stenosis

Autoimmune
- MS
- Lupus
- Sarcoid

Infectious
- HIV
- Varicella

Nutritional
- B12
- Copper deficiency

Hereditary spastic paraparesis

Question 11

Investigations in MS

Answer 11

MRI brain and spinal cord
LP - oligoclonal bands

Question 12

Management of acute relapse of MS

Answer 12

High dose IV steroids - methylpred
No signs of infection eg urine dip and CXR
Monitoring BMs
PPI cover

Question 13

Causes of cerebellar ataxia

Answer 13

Stroke - ischaemic or haemorrhagic
MS
Alcohol
B12 deficiency
Genetic e.g Friedrichs ataxia, ataxia telangiectasia, Fragile X
Paraneoplastic

Question 14

Investigation of cerebellar ataxia

Answer 14

MRI

Question 15

Signs of cerebellar syndrome

Answer 15

Scanning dysarthria (staccato)
Titulating head tremor
Dysdiadokinesia
Past pointing
Intention tremor
Hypotonia
Ataxia

Question 16

Signs in sensory Ataxia

Answer 16

Pseudoathetosis
Finger nose testing difficult in eyes closed
Impaired sensation and vibration sense
Worsening of symptoms with eyes closed

Question 17

Causes of sensory ataxia

Answer 17

Central - spinal cord (dorsal column) damage

Peripheral
- Alcohol
- B1, 6 or 12 deficiency
- Diabetes
- Hypothyroidism

Chemotherapy and medications (antibiotics and antivirals)

Rheumatoid arthritis or GPA

SCID or GBS

HIV

Genetic causes

Question 18

Management of MND

Answer 18

Referral to specialist neurology clinic
Riluzole
Early morning blood gas and FVC
Cough assistive devices
BiPAP
MDT - OT, PT
Weight and swallowing
Dietician
PEG
Communication aids
Screen for frontotemporal dementia
Screening family and genetics e.g. C9orf72 expansion (most common) and Kennedys disease (X-linked)

Question 19

Findings in MND

Answer 19

Fasciculations
Wasting
Weakness
Combined UMN and LMN signs

Question 20

Ix in MND

Answer 20

Clinical diagnosis
EMG - denervation
MRI brain and cervical cord to exclude lesions
Potentially genetic testing

Question 21

Ix in sensory ataxia

Answer 21

BM
Urine dip

Eye exam - diabetic retinopathy

Bloods:
- Hba1c
- TFTs
- CTD screen
- U&Es and LFTs
- IG and electrophoresis

Nerve conduction studies
- Axonal degeneration
- Demyelination seen in CIDP or GBS

Question 22

Similar conditions to MND

Answer 22

Spinal muscular atrophy
Kennedy’s disease
Multifocal motor neuropathy