Neurology 2

Question 1

When to do surgery in ICH?

Answer 1

Cerebellar hemorrhage > 3cm, Brainstem compression

Hydrocephalus

Question 2

What is rule of 0,3,6,12 rule?

Answer 2

Restart NOAC after 
0 days - TIA
3 days - small infarct
6 days - medium infarct
12 days - large infarct

Question 3

Dabigatran compare to warfarin?

Answer 3

Lower ICH risk but higher GI bleeding risk

Question 4

Dabigatran, Rivaroxaban compare to warfarin?

apixaban compare to warfarin?

Answer 4

Lower ICH risk but higher GI bleeding risk

Lower ICH/GI and all bleeding risk - superior to warfarin

Question 5

In embolic stroke of unknown source ? (ESUS)

Answer 5

Use only aspirin. The rest not beneficial

Question 6

Raedar syndrome?

Answer 6

Ipsilateral trigeminal sensory deficits + Partial horner ( without anhidrosis)

+
Headache mimic trigeminal cephalagia

Question 7

Why partial horner’s syndrome?

Answer 7

The sweat glands travel together with external carotid artery ( which is not affected)

Question 8

Pathophysiology of Raedar syndrome?

Answer 8

Lesion in internal carotid artery compressing sympathetic ganglion + it’s pathway

Question 9

Multiple sclerosis - pathophysio?

Answer 9

B cell mediated - trigger B/T cells towards specific antigen

• lead to axonal loss/astrocyte gliosis
• then re-myelination

Question 10

Majority of Optic neuritis location?

Answer 10

Retrobulbar - so no optic disc swelling

Question 11

Oligoclonal bands in CSF are what type of Ig]?

Answer 11

IgG

Question 12

Strong predictor of MS?

Answer 12

Oligoclonal bands and CIS

Question 13

Older Men, spinal cord lesions likely to have one pattern of MS?

Answer 13

Primary progressive MS

Question 14

Which approach treatment better for MS?

Answer 14

Intensive/induction therapy

• less disability
• more time spent in Single PMS time

Question 15

Glatiramer Acetate mechanism of action in MS?

Answer 15

Act as altered MHC II - stimulate Treg cells

Question 16

Side effect of Teriflunomide?

Answer 16

Hair thinning/ GI upset/ Teratogenic

Question 17

Dimethyl fumarate mechanism of action in MS?

Commonest side effect?

Answer 17

Activate Nuclear factor erythroid 2 - Nrf2 transcriptional pathway ( protective) - reduce lymphocytes

diarrhea - commonest
PML!

Question 18

Similarity of Natalizumab and Fingolimod?

Answer 18

Rebound post cessation of therapy

Question 19

Fingolimod extremely high risk of what side effects ?

Answer 19

First dose - bradycardia
Macular oedema - OCT every 6 months
Varicella zoster re-activation

Question 20

JC virus does what?

When virus titre consider high risk?

Answer 20

Attack oligodendrocytes - so demyelination

> 1:5

Question 21

PML treatment?

Answer 21

Pembrolizumab - use for BK virus as well

Question 22

Alemtuzumab known to cause what autoimmune disease?

Answer 22

Graves disease

ITP

Question 23

Best MS treatment in reducing relapse?

Answer 23

Natalizumab

Question 24

Best Primary progressive MS + Oligoclonal bands in CSF treatment?

Answer 24

Ocrelizumab

Question 25

Best Secondary progressive MS treatment?

Best Relapse Remitting MS treatment?

Answer 25

Siponimod ( 2nd generation fingolimod)

Ofatumomab

Question 26

Aggressive secondary progressive MS treatment?

Known side effect of this treatment?

Answer 26

Mitoxantrone ( chemo - inhibits B/T cells)

Cardiac toxicity - don’t use if EF < 50%

Question 27

Drugs in MS treatment - avoid in pregnancy?

Answer 27

Teriflunomide
Dimethyl fumarate
Fingolimod
Rituximab/Ocrelizumab - not to use in 2nd/3rd trimester

Question 28

MOG antibody found in what disorder?

Answer 28

Recurrent bilateral ON

ADEM

Question 29

Treatment for NMO?

Answer 29

Inebilizumab (anti-CD19) - mainly targets plasma cells/plasmablasts

Eculizumab

Satralizumab (IgG bind to IL6)

Question 30

What is Valproic-acid role in patient with encephalopathy?

Risk factors?

Answer 30

Induce hyperammonaemia = causing cerebral oedema

Sodium valproate inhibits glutamate - can’t metabolise nitrogen

risk factor = Urea cycle disorder, topiramate