Neurology

Question 1

Driving advice in TIA?

Answer 1

1 month off driving, don’t need to tell DVLA

Question 2

Driving advice new seizure?

Answer 2

6 months off driving, tell the DVLA

Question 3

3rd nerve palsy + contralateral weakness?

Answer 3

Brainstem stroke = Weber syndrome

Question 4

Which lobe is affected in receptive dysphasia (Wernicke’s)?

Answer 4

Temporal lobe

Question 5

Which lobe is affected in expressive dysphasia (Broca’s)?

Answer 5

Frontal lobe

Question 6

If there is no receptive or expressive dysphasia, but there is poor repetition, what is affected?

Answer 6

The conduction pathway between temporal and frontal lobe (ARCUATE NUCLEUS)

Question 7

What to do if someone with Motor Neurone Disease is unable to feed?

Answer 7

PEG tube

Question 8

What are the characteristics of trigeminal neuralgia?

Answer 8

Paroxysmal attacks of sharp facial pain along Nerve V distribution, triggered by touch

Question 9

How do you manage raised BP >200 in acute ischaemic stroke

Answer 9

labetolol

Question 10

What are the management options for acute ischaemic stroke?

Answer 10

Thrombolysis within 4.5 hours

Thrombectomy within 6

Question 11

Cabergoline used in PD. What is a side effect of cabergoline?

Answer 11

Pulmonary fibrosis

Question 12

Which arteries are affected in a posterior circulation stroke?

Answer 12

Vertebrobasillar arteries

NB// there is a single basillar and two vertebral

Question 13

What are the symptoms of Wallenberg’s/Lateral medullar syndrome? Which artery is affected?

Answer 13

DANNN

Dysphagia, ataxia, ipsilateral nystagmus, numbness, nerve palsy

poster inferior cerebellar artery

Question 14

What are symptoms of Weber’s?

Answer 14

Brainstem stroke

Ipsilateral 3rd nerve palsy plus hemiparesis

Question 15

Laughing episode triggering loss of muscle tone?

And which further condition is it associated with?

Answer 15

= Cataplexia

Associated with narcolepsy

Question 16

causes of peripheral neuropathy?

Answer 16

B12/folate
diabetes
alcohol
uraemia

GBS

Question 17

side effect of taking too much vit b6 (pyridoxine)?

Answer 17

Peripheral neuropathy

Question 18

What is the most common cause of B12 deficiency? (+ what are other causes)

Answer 18

Most common = pernicious anaemia

Others:
gastrectomy
Crohn’s (affects ileum, where most of it is absorbed)

Question 19

What are the neurological sequelae of B12 deficiency?

Answer 19

SCAD - dorsal column (proprioception, vibration)

Peripheral neuropathy

Question 20

What are the diagnostic criteria for migraine?

Answer 20

5 attacks which fulfil the following criteria

1)lasting 4-72 hours
2) features of unilateral, throbbing, brought on by physical activity
3)nausea + vomiting or photophobia + phonophobia

Question 21

What is Hoffman’s sign and which condition does it indicate?

Answer 21

Flick down on nail on middle finger, causes involuntary flexion of distal thumb and index finger

Indicates an UMN - seen in DCM

Question 22

What can exacerbate myasthenia gravis?

Answer 22

Certain medication such as beta blockers and antibiotics

(Note gentamicin can precipitate life-threatening myasthenia crisis and so should never be given in myasthenia gravis)

Question 23

What is the medical management of Status Epilepticus?

Answer 23

IV lorazepam 4mg
After 10mins, another IV lorazepam 4mg

If no improvement, try second line anti-epilepetic

If after 45mins, no response, will need to be induced under GA

Question 24

Which bacteria responsible in meningitis and which Abx?

Answer 24

NHS - IV cefotaxime

But if <3 months or >65, susceptible also to Listeria - cover with IV Amxocillin as well

Question 25

What should be given alongside Abx in bacterial meningitis? In which type of bacteria, is this most important?

Answer 25

IV Dexamethasone to reduce inflammation sequelae

Most important in pneumococcal (i.e. streptococcus pneumoniae)

Question 26

If Myasthenia Gravis is suspected, what imaging must be done?

Answer 26

CT CHEST TO EXCLUDE THYMOMA

Question 27

Most common mental health issue in PD?

Answer 27

Depression (not dementia)

Question 28

Difference between Weber’s and Wallenburg’s?

Answer 28

Weber’s = brainstem (midbrain) stroke - ipsilateral 3rd nerve palsy and contralateral hemiparesis

Dan Wallenburg = DANNN (posterior inferior cerebellar artery)

Question 29

What is the acute and preventative treatment for migraines?

Answer 29

Acute = oral triptan + paracetamol/NSAID

(in adolescents, use nasal triptans)

Preventative = propranolol

Question 30

Which nerve roots do these reflexes test?
biceps
triceps
knee
ankle

Answer 30

bicep = c5,c6
tricep = c7,c8
knee = l3,l4
ankle = s1,s2

Question 31

Which anti-emetics should you use in PD?

Answer 31

DomPeridone (does not cross BBB)

Should NOT use haloperidol or metoclopramide

Question 32

Criteria for lacunar stroke?

Answer 32

Would have either sensory loss, OR motor loss, OR ataxic hemiparesis OR sensorimotor

since lacunar doesn’t affect cortex, does not usually affect higher cognitive functions such as speech, recognition, awareness etc.

Question 33

Management of PD?

Answer 33

If motor symptoms main issue -> Levodopa (compared to other drugs, improves motor symptoms better)

If need further meds, can add MAO inhibitor or dopamine agonists (bromocriptine, ropinerole)

Question 34

Downside of dopamine agonists in PD?

Answer 34

This drug class, compared to Levodopa, and MAO-I, cause hallucinations! Also don’t have as good improvement in motor symptoms.