Neurology

Question 1

Prehospital stroke score ?

Answer 1

Cincinnati - FAS
Face
Arm
Speech

Add BE FAST
Balance
Eye sight blurred
Face
Arm
Speech
Time to call help

Question 2

CT scan hyperacute ischaemic signs ?

Answer 2

Dense MCA
Ínsular Ribbon sign
Lentiform nucleus obscured
Sucal effacement
Loss of grey/white differentiation

Question 3

Descending paralysis

Answer 3

Botulism
Myasthenia gravis
Miller fisher

Question 4

Ascending paralysis

Answer 4

GBS
Polio
CIDP

Question 5

Conus medullaris vs cauda equina syndrome

Answer 5

UMN & LMN
Vs
LMN

Question 6

NMJ disease ?

Answer 6

Myasthenia gravis
Lambert-Eaton Myasthenic syndrome (LEMS)
Botulism

Question 7

Stroke score ?
NIHSS components

Answer 7

NIHSS
NH stroke score
If <4 or >25 not for thrombolysis

LOC
Orientation
Task
Horizontal gaze
Visual fields
Facial palsy
Arm drift
Leg drift
Limb Ataxia
Sensation
Language/ aphasia
Dysarthria
Extinction/ inattention

Question 8

Stroke territories ?

Answer 8

MCA - UL> LL / aphasia (dominant hemisphere)
ACA - LL>UL / dysarthria / incontinence
PCA - cerebellar signs and visual changes ( contralateral homononous hemianopia)
VANISH DDT
Lacunar infarct - deep white matter

Question 9

Time from onset of Sx to thrombolysis window?

Answer 9

4.5hrs

(Perfusion CT/MRI to check core:penumbra ratio ? Can give tPa up to 9hrs)

Question 10

Contraindications for thrombolysis ?

Answer 10

1. Head trauma/ CVA last 3 months
2. SAH Sx
3. Arterial puncture last 7 days (non compressible site)
4. Hx of ICH
5. Known intracranial neoplasm/AVM/aneurysm
6. Recent surgery to brain or spine 3 months
7. BP >185/110
8. Active internal bleeding
9. Bleeding disorder - plt <100 / INR >1.7/ heparin/Clexane use
10. Glucose abnormal <5
11. GIT malignancy
12. GIT bleed within last 21 days

Question 11

TIA?
ABCD2 Score for risk of stroke?

Answer 11

Transient loss of neuro function / resolves within 1 hour
No changes on CTB

A - age >60
B - blood pressure >140/90
C - clinical symptoms
D - duration of Sx
D- diabetes mellitus
i - imaging

Question 12

Canadian TIA score ?
Slightly better than ABCD2 ?

Question 13

Neuroprotective measures?

Answer 13

Head up 30degrees
Normothermia
Euglycemia
Avoid hypoxia or abnormal CO2
Analgesia

Reduce BP by 20%
If ICP - hypertonic saline or mannitol

Question 14

ICH Score - outcome prediction

Answer 14

GCS
ICH volume
Intraventricular
Infra tentorial
Age

Question 15

Spot sign on CT ?

Question 16

Stroke types ?

Answer 16

Ischaemic vs haemorrhagic

Ischaemic
- thrombotic
- embolic
- Watershed

Haemorrhagic
- ICH
- SAH

Question 17

What is amarousis fugax?

Answer 17

Transient monocular or binocular vision loss (TIA)
- ophthalmic artery occlusion/ carotid embolism
- painless
- curtain in visual field

Question 18

VANISH DDT

Answer 18

Vertigo
Ataxia
Nystagmus
Intension tremor
Staccato speech
Hypotonia
Dysmetria
Dysdiadokokinesia
Titubation

Question 19

Second prophylaxis ?

Answer 19

Aprin
Simvastatin

Question 20

Second prophylaxis ?

Answer 20

Aprin
Simvastatin

Question 21

GUSS

Answer 21

Gugging
Swallowing screen

Question 22

Types of SAH

Answer 22

Traumatic
Atraumatic

Question 23

Ottawa SAH rule ? To rule out SAH

Answer 23

> 40yra
Neck pain or stiffness
LOC
Onset during exertion
Peaked within 1min (thunderclap)
Meningism

Patient has to be:
GCS15
>15yrs
Nontraumatic headache
Max intensity 1hr
Headache onset in last 14 days

Can’t use if:
New neuro deficits
Known aneurysm
Known brain tumor
Prev SAH
Chronic headaches

Question 24

Dx of SAH?

Answer 24

<6hrs = CTB
> 6hrs = CTA /LP (ask for xanthochromia)

Question 25

Mx of SAH?

Answer 25

Neuro surgery Neuro protective measures including BP CCB: nimodipine to prevent vascular spasm

Question 26

RF for SAH?

Answer 26

CVD Fam Hx Prev aneurysm AD polycystic kidney disease Ehlers danlos

Question 27

Status epilepticus ?

Answer 27

>5 mins duration or recurrent seizures with no return to baseline

Question 28

Mx and dosages

Answer 28

Oxygen HGT Abort seizure - benzos - lorazepam 4mg IV - midazolam 15mg - diazepam 10mg - Phenobarbital Loading after 2 seizures or if known epileptic - epilim 20-30mg/kg - phenytoin 20mg/kg

Question 29

Subclinical seizures ? How to check ?

Answer 29

Eye movements Due to underdosing, can repeat benzo dose

Question 30

Delirium DDX I WATCH DEATH

Answer 30

Infections Withdrawal Acute metabolic Trauma CNS pathology Hypoxia Deficiencies Environmental/ endocrine Acute vascular Toxins/drugs Heavy metals

Question 31

tPa actilyse dosage for ischaemic CVA

Answer 31

0.9mg/kg (max 90mg) 10% over 1 min 90% over 1 hr

Question 32

Temporal arteritis (Giant cell arteritis) Which size arteries ? Sx? Labs? Mx?

Answer 32

Medium and large Unilateral headache, blindness , jaw claudication Increased ESR >100 Biopsy vasculitis with granulomatous changes High dose steroids

Question 33

Extradural haematoma Sx Which vessel Shape on CT

Answer 33

Hx of LOC Lucid period Secondary LOC MMA Lemon

Question 34

Subdural haematoma Vessels At risk patients CT shape

Answer 34

Bridging veins Alcoholics and demented/elderly - brain atrophy and stretching of veins Banana

Question 35

Migraines Clinical features Prophylactic Rx

Answer 35

Propranolol