Neurology

Question 1

Brain abscess management:

Answer 1

Surgery
IV antibiotics (IV ceftriaxone PLUS metronidazole)
IV dexamthasone may be given to reduce ICP if problematic

Question 2

Disease with:
Foot drop
High-arched feet (pes cavus)
Hammer toes
Distal muscle weakness
Distal muscle atrophy
Hyporeflexia
Stork leg deformity

Answer 2

Charcot-Marie-Tooth

Question 3

Cluster headache management:
Acute attack:
Prophylaxis

Answer 3

High flow O2 and Triptan
Verapamil

Question 4

First line epilepsy drugs:
Generalised tonic clonic

Answer 4

Male: Sodium Valproate
Female: Lamotrigine or levetiracetam

Question 5

First line epilepsy drugs: focal seizures

Second line:

Answer 5

Lamotrigine or levetiracetam

carbamazepine, oxcarbazepine or zonisamide

Question 6

First line epilepsy drugs: Absence seizures (Petit mal)

Second line:

Answer 6

ethosuximide

Male: Valproate
Female: Lamotrigine

Question 7

Which drug may exacerbate absence seizures

Answer 7

Carbamazepine

Question 8

Supply of facial nerve:

Answer 8

‘Face, ear, taste, tear’

face: muscles of facial expression
ear: nerve to stapedius
taste: supplies anterior two-thirds of tongue
tear: parasympathetic fibres to lacrimal glands, also salivary glands

Question 9

Intracranial venous thrombosis
Ix.
Blood test which may be elevated:

Treatment:

Answer 9

MRI venography - gold standard

D-dimer

LMWH (or warfarin in some cases)

Question 10

Most common symptom on lacunar stroke

Other symptoms:

Answer 10

Purely motor

purely sensory
sensorimotor stroke
ataxic hemiparesis
ipsilateral weakness and limb ataxia that is out of proportion to the motor deficit
dysarthria-clumsy hand syndrome

Question 11

Lambert-Eaton Myasthenic syndrome symptoms:

Treatment:

Answer 11

Repeated muscle contractions lead to increased muscle strength (in contrast to myasthenia gravis)
limb-girdle weakness (affects lower limbs first)
hyporeflexia
autonomic symptoms: dry mouth, impotence, difficulty micturating
ophthalmoplegia and ptosis not commonly a feature (unlike in myasthenia gravis)

Treat underlying cancer (Squamous cell carcinoma)
3,4-diaminopyridine
Immunosuppression
IVIg

Question 12

Lamotrigine MoA

Answer 12

Sodium channel blocker

Question 13

M/C complications of meningitis

Other complications

Answer 13

sensorineural hearing loss

seizures
focal neurological deficit
infective
sepsis
intracerebral abscess
pressure
brain herniation
hydrocephalus

Question 14

Most common presenting symptoms of ALS

Does not affect:

Answer 14

asymmetric limb weakness

Ocular muscles
No cerebellar signs
abdominal and sphincteral functions preserved until latein disease

Question 15

MS investigations findings:
Scan
CSF

Answer 15

MRI
high signal T2 lesions
periventricular plaques
Dawson fingers: often seen on FLAIR images - hyperintense lesions penpendicular to the corpus callosum

oligoclonal bands (and not in serum)
increased intrathecal synthesis of IgG

Question 16

MS management:
Acute attack:
Drugs to reduce risk of relapse

Answer 16

High dose prednisolone for 5 days (shorten length of attack but do not improve degree of recovery)

Natalizumab
Fingolimod
Beta interferon (not as effective)
Glatiramer

Question 17

MS management of specific symptoms:

Fatigue
Spasticity
Bladder dysfunction

Answer 17

Amantadine

Baclofen and Gabepentin

US to assess emptying
If retaining -> intermittent self catheterisation
If not -> anti-cholinergics

Question 18

Which drug may help in neuroleptic malignant syndrome:

2nd drug which may be used?

Answer 18

Dantrolene
Bromocriptine may also be used