Neurology

Question 1

What type of signs does MS give? Upper or Lower?

Answer 1

UMN signs

Question 2

(MS) How is vision effected?

Answer 2

Washed out colors, especially red.

Nystagmus.

Question 3

(MS) What lesions can you see on an MRI?

Answer 3

Periventricular lesions in CORPUS CALLOSUM.

Question 4

(MS) What can a lumbar puncture show?

Answer 4

Oligoclonal Bands

Useful in differential diagnoses, SLE and Sjogren’s (increase in cells WBCs?)

Test antibodies

Question 5

(MS) How do you treat relapses?

Maintenance treatment?

Answer 5

IV methylprednisalone

Beta-Interferon and Azothioprine

Question 6

Can treatment slow progression?

Answer 6

No, it may decrease relapses however.

Question 7

What is the differential for Parkinson’s disease?

Answer 7

Ideopathic PD
Wilson's
Multiple System Atrophy (MSA)
Drug induces
Progressive Supranuclear Palsy (PSP)
Corticobasal Degeneration (CBD)
Frontotemporal Dementia (FTD)
Vascular 
Tumours/SOL
Repeated head injury
MPTP drug use
Magnesium poisoning

Question 8

Drugs used in PD?

Answer 8

Dopamine Agonists (apomorphine, rapinerol)
Levodopa
COMT inhibitors
MAOi (A and B) (A=anti-depressant; B=PD) (Tyrosin cheese reaction is a side effect)
Deep Brain Stimulation (DBS)
Acetly Choline inhibitors (v. bad side effects hallunicaitons, confusion)

Treatment should start once ADL are effected.

Question 9

What are the main features of PD?

Answer 9

T - (resting pill rolling) tremor
R - cog wheel rigidity
A - akinesia/bradykinesia (short shuffling gait, fatiguing small movements)
P - postural instability

Question 10

What can you look for on examination to rule our potential differentials?

Answer 10

Cerebellar signs (CBD)
Are signs bilateral (if +ve then prob PD plus)
Eye movements (PSP has decreased vertical movements)
Kayser–Fleischer rings - Wilson’s
Signs in lower limbs? - Vascular
SOL - check eyes for papilloedma
MSA patients will have autonomic problems such as post. hypotension and sinus arrhythmia (breathing in and out)

Question 11

Risk factors for stroke?

Answer 11

HTN
Cardiac disease: arrythmias, enlargement, failure
Diabetes
Heredity
Blood lipids, cholesterol, smoking, diet/obescity
Race
Oral contraceptives

Question 12

Levels of cerebral blood flow (ml/100g/min) produce which events?

Answer 12

20 - electrocortical function affected
15 - electrical failure
10 - ion pump failure
<10 - death

Question 13

Classification of the subtypes of cerebral infarction:

Answer 13

TACS (Total Ant Circulation Syndrome)
Motor and sensory deficit
Hemianopia
Higher function disturbance (dysphasia)

PACS (Partial Ant Circulation Syndrome)
2 of the above or isolated cerebral funciton disturbance

POCS (Post Circulation Syndrome)
Signs of brainstem dysfunction
Isolated hemianopia

LACS (Lacunar Ant Circulation Syndrome)
Pure motor stroke or
Pure sensory stroke or
pure sensorimotor stoke or
hemiparesis

Question 14

Investigations?

Answer 14

1. Confirm Dx:
   CT scan
2. ID site of primary lesion:
   US of extra-/intracranial vessels
   Transthoracic cardiac US (esp in young: structural defect)
   MRA/CTA
   DSA (digital intravernous subtraction angiography)

3. ID factors influencing treatment:
CXR
ECG
Blood glucose
Serum lipids/cholesterol 
ESR/antibodies - vasulitis causing disorders
FBC - thrombocytopenia/polycythemia 
INR
Drug Hx

Question 15

Management?

Answer 15

Ensure adequate oxygen and glucose supply. Hydration, oxygenation, BP, glucose all v important.

Thrombolysis: give within 4.5 hours (NICE g’s) of ant stroke

Assess swallow for apsiration pneumonia

Early mobilisation

Prevention of further stroke

Question 16

What deficiency causes Wernicke Korsakoff syndrome?

Answer 16

Thiamine

Question 17

Symptoms of Wernicke’s (acute)?

Answer 17

Abdormal eye movements (horizontal and vertical nystagmus) and conjunctival haemorrhage

Ataxia
Confusion

Question 18

Symptoms of Korsakoff’s psychosis (chronic)?

Answer 18

Selective impairment of short term memory

Confabulation

Question 19

Treatment of WK syndrome?

Answer 19

IV Pabrinex immediately

Question 20

First line treatment in idiopathic generalized epilepsy?

Answer 20

Diazepam PR 20mg

Question 21

How can you differentiate Bell’s (ideopathic ) from other causes of facial nerve palsy?

Answer 21

Bell’s palsy can display a symptom of hypersensitivity to sounds

Question 22

What are the features of benign essential tremor?

Answer 22

Both hands usually effected
Fine action tremor
Made worse by: stress, difficult tasks, caffeine, cold
Made better by: Beta-blocker, alcohol

Question 23

What are the symptoms/signs of benign intracranial HTN?

Answer 23

Gradual presentation
Normal MRI
Increased ICP
Strong link with obesity

Question 24

What type of Sz is Jacksonian?

Answer 24

Partial - when a simple foal sz spreads from a distal part of the limb towards the face, ipsilaterally.

Question 25

What are the functions of the Facial Nerve?

Answer 25

Sens: Taste Ant 2/3 (chrodae tympani)
Motor: Muscles of facial expression
Parasym: Submandibular and sublingual glands

Question 26

What is a common side effects of anticonvulsants?

Answer 26

Ataxia

Question 27

What should always be considered in an epileptic with recurrent seizures?

Answer 27

Patient adherence to medication - you can check blood levels of phenytoin for example

Question 28

How do patients with primary generalised epilepsy present post-ictally?

Answer 28

Drowsy, low GCS

Question 29

First intervention in someone with comprimised airway?

Answer 29

Jaw thrust and head tilt/chin lift (no in trauma/?C spine injury)

Question 30

This type of head injury results in a lucid phase but will present acutely…

Answer 30

Extra-dural - these present acutely unlike sub-dural which can take weeks/months to declare themselves