Neurology

Question 1

What is the criteria for a migraine if there is no aura?

Answer 1

More than 5 headaches lasting from 4-72 hours 
2 of:
- unilateral 
- pulsating 
- impairing daily life 
1 of:
-nausea/vomiting 
-photo or phonophobia

Question 2

What symptoms can occur in migraines?

visual, somatosensory, motor, speech

Answer 2

• THROBBING PULSATILE EPISODE UNILATERAL HEADACHE. Worse with movement.
• Nausea and vomiting
• Photophobia, phonophobia
• Allodynia: all stimuli are painful
• Visual: Chaotic hemianopia
• Somatosensory: Parasthesia from fingers to face
• Motor: Ataxia, ophthalmoplegia, hemiparesis (weakness)
• Speech: Dysphasia, paraphasia (words meaningless), dysarthria

Question 3

What can occur before a migraine?

Answer 3

An aura - 15-30 mins: visual changes, tingling

Prodrome: mood changes, sleepy, cravings

Question 4

Relieving factors of a migraine?

Answer 4

Lying down in a dark room.

Question 5

Triggers of migraine?

Answer 5

Stress (even to light, sound, weather), anxiety, trauma, foods, sleep, OCP

Question 6

What would you examine if you suspected a migraine?

Answer 6

Optic fundi
BP
Head and neck

Question 7

What medication can be taken as soon as headache starts in a migraine to provide relief?

Answer 7

Triptans

Question 8

What headache would present as an episodic bilateral tight band brought on by stress?

Answer 8

Tension headache

Question 9

What is a cluster headache?

Answer 9

A rapid onset unilateral headache behind one eye. Can cause the eye to water and become bloodshot.

Question 10

When is a cluster headache often worse?

Answer 10

At night

Question 11

Are cluster headaches there all the time?

Answer 11

Often pain free months after 1-3 months of headaches.

Question 12

What is Kernig’s sign?

Answer 12

Pain and resistance when the knee is passively extended and the hip fully flexed

Question 13

When may you see a petechial non-blanching rash?

Answer 13

Meningitis

Question 14

What are the features of a bacterial meningitis LP?

Answer 14

Cloudy and turbid.
Increased neutrophils.
High protein.
V. low glucose.

Question 15

What white cells are raised in viral meningitis CSF?

Answer 15

Lymphocytes.

Question 16

What is the first line ABx for meningitis?

Answer 16

Cefotaxime

Question 17

What is the term for occlusion of an optic artery leading to visual loss?

Answer 17

Amaurosis fugax

Question 18

In a TIA what is the optimum time to start treatment within?

Answer 18

72 hours

Question 19

What is the ABCD2 referral score for?

Answer 19

TIA - score over 6 
Age: over 60 (1)
BP: over 140/90 (1)
Clinical features:
- unilateral weakness (2)
- speech disturbance (1)
Duration: 10-59 mins (1), 1hr+ (2)
Type 2 diabetes (1)

Question 20

What type of stroke is suggested by meningism, sever headache and potential coma within hours?

Answer 20

Haemorrhagic

Question 21

Where will an ischaemic stroke be located that causes: contralateral sensory loss, hemiplegia, dysphasia, homonymous hemianopia, visuo-spatial deficit?

Answer 21

Cerebrum

Question 22

Where will an ischaemic stroke be located that causes visual disturbances, quadraplegia and locked in syndrome?

Answer 22

Brainstem

Question 23

What type of ischaemic stroke causes ataxia and dysarthria?

Answer 23

Lacunar

Question 24

How are strokes managed?

Answer 24

Urgent CT (within 1 hour)
Ischaemic: thrombolysis & antiplatelets.
Nil by mouth.

Question 25

What are the three common berry aneurysm sites in the brain?

Answer 25

1) Junction of posterior communicating and internal carotid. 2) Bifurcation of middle cerebral and anterior communicating artery 3) Anterior cerebral and anterior communicating arteries

Question 26

What are the symptoms of a subarachnoid haemorrhage?

Answer 26

``` Thunderclap headache (occipital). Vomit. Collapse. Seizure. Coma. ```

Question 27

If a subarachnoid haemorrhage involves the posterior communicating artery, what sign may be present?

Answer 27

Painful third nerve palsy.

Question 28

When may you see bloody CSF?

Answer 28

In a subarachnoid haemorrhage.

Question 29

What is the management of a subarachnoid haemorrhage?

Answer 29

Immediate neuro-surgical referral.

Question 30

What are 4 complications following a subarachnoid haemorrhage?

Answer 30

1) 20% rebleed within 24 hours 2) Vasospasm cerebral ischaemia 3) Hyponatraemia 4) Hydrocephalus

Question 31

What is the Parkinon's triad?

Answer 31

1) Tremor: pill rolling, worse at rest. 2) Hypokinesia: - slow to initiate movement - reduced blink rate - monotone - Gait: flexed trunk shuffle with reduced arm swing. - expressionless - freezing 3) Rigidity - Increased tone: - cogwheeling in pronation and supination

Question 32

How does reduced dopamine in the brain lead to Parkinons?

Answer 32

Basilar has a greater inhibitory effect on the thalamus, reducing the excitatory output.

Question 33

What is 'wearing off'?

Answer 33

L-Dopa: towards end of dosage intervals symptoms worsen

Question 34

What is an 'on off effect'?

Answer 34

L-Dopa: Involuntary movements may worsen at the beginning of the dosage interval.

Question 35

What should L-Dopa always be given with in Parkinsons?

Answer 35

Peripheral dopa-decarboxylase inhibitor: carbidopa. Reduces systemic effect, lowering therapeutic dose.

Question 36

What is a primary generalised seizure?

Answer 36

Simultaneous electrical discharge across the cortex

Question 37

In what seizure will the person loss consciousness, their limbs jerk and stiffen? How may they feel after?

Answer 37

Tonic Clonic Post-ictal drowsiness and confusion

Question 38

What seizure might through someone to the ground due to a sudden jerk?

Answer 38

Myoclonic

Question 39

What seizure may cause a fall due to a sudden loss of muscle tone?

Answer 39

Atonic

Question 40

What is a seizure known as that's localised to one hemisphere?

Answer 40

Partial

Question 41

In what seizure is someone aware of what is going on?

Answer 41

Simple

Question 42

What occurs in a complex seizure?

Answer 42

The person's awareness is impaired.

Question 43

What may happen before a seizure?

Answer 43

Aura: deja vu, smells, flashing lights, gut changs

Question 44

Where is the seizure: a) Hallucinations, lip-smacking, grabbing/fiddling, emotional changes. Complex motor. b) Tingling and numbness. May have sensory or motor impairment, c) Visual disturbances d) Behavioural disturbances, dyphasia & speech arrest, pedalling leg, motor arrest. Jacksonian March: focal motor seizure spreading from face to thumb.

Answer 44

a) temporal b) parietal c) occipital d) frontal

Question 45

What is the driving advice in epilepsy?

Answer 45

No driving until 1 year seizure free.

Question 46

Name three anti-convulsant medications. What effect do they all have on cytochrome p450?

Answer 46

Carbamezapine Phenytoin BOTH CP450 inducers Sodium valproate - CP450 inhibitor

Question 47

What is anti-epileptic hypersensitivity syndrome?

Answer 47

Severe skin reaction to medication with fever and lymphadenopathy.

Question 48

What reduces the efficacy of anticonvulsants?

Answer 48

Drugs that reduce the seizure threshold: SSRIs, tricyclics, ABxs

Question 49

What can happen in phenytoin over dose?

Answer 49

Respiratory depression and cardiovascular collapse.

Question 50

Why does plasma conc of phenytoin have to be monitored?

Answer 50

It has a low therapeutic index

Question 51

What structure to carbamezapine and phenytoin both bind to in order to reduced neuronal excitability?

Answer 51

Neuronal sodium channels

Question 52

What effect does valproate have in the brain?

Answer 52

Increases GABA: primary inhibitory neurotransmitter

Question 53

What effect can valproate have on hair?

Answer 53

Can cause it to fall out with curly regrowth.

Question 54

Who should not receive valproate?

Answer 54

Women of child bearing age. Hepatic impairment. (liver monitored for first 6 months) Severe renal impairment.

Question 55

What causes symmetrical and widespread polyneuropathy?

Answer 55

Diabetes | Alcohol

Question 56

What would someone experience with sensory peripheral neuropathy?

Answer 56

Numbness, pins & needles Glove and stocking: starts at extremities Joint deformities

Question 57

What would someone experience with motor peripheral neuropathy?

Answer 57

Progressive weakness and clumsiness Problems with walking and breathing Wasting and weakness of hands and feet Decreased reflexes

Question 58

What type of pain can exist in peripheral neuropathy?

Answer 58

Sharp, jabbing Freezing, burning Hypersensitivity

Question 59

What autonomic symptoms are there in a peripheral neuropathy?

Answer 59

Heat intolerance inc. altered sweating Bowel and bladder changes Digestion problems BP changes: Light headed, postural hypotension

Question 60

Damage to what nerve leads to a claw hand? (for example through elbow trauma)

Answer 60

ULNAR Medial wrist flexors, interossei, medial lumbricals, 1.5 sensory.

Question 61

Damage to what nerve leads to wrist drop? | from a humeral fracture

Answer 61

RADIAL Brachioradialis, extensors, supinator, triceps

Question 62

Damage to what nerve leads to a hand of benediction?

Answer 62

Median Occurs when making a fist. Can be due to carpal tunnel 2 Lumbricals, opponens pollicis, flexor pollicis brevis and abductor pollicis.

Question 63

How can a peripheral neuropathy be managed?

Answer 63

Managing cause Splinting Foot care Amitriptylline for neuropathic pain

Question 64

What is the management of carpal tunnel?

Answer 64

Splinting Local steroid injection Decompression surgery

Question 65

What are people with peripheral neuropathy at risk of?

Answer 65

Burns & trauma to skin Infection Falls

Question 66

What type of immune response occurs in MS?

Answer 66

T cell mediated

Question 67

What is the mean age of onset of MS?

Answer 67

30 years

Question 68

Does MS present with many symptoms or just one?

Answer 68

Just one - monosymptomatic

Question 69

How can MS present?

Answer 69

- Unilateral optic neuritis: pain on moving - Sensory loss: numbness, tingling - Leg weakness - Brainstem/cerebellar: diplopia/ataxia - urinary symptoms: retention or incontinence - Swallowing difficulty - Constipation - Intention tremor - Falls - Amnesia - Mood changes

Question 70

What can exacerbate MS symptoms?

Answer 70

Heat | Exercise

Question 71

What is the definition for diagnosing MS?

Answer 71

Requires lesions disseminated in time and space, unattributable to other causes.

Question 72

What is Macdonald's Criteria?

Answer 72

2+ attacks & 2+ lesions 2+ attacks & 1 lesion: MRI/positive CSF 1 attack & 2 + lesions disseminated in time 1 attack & 1 lesion disseminated in space

Question 73

How do steroids help in MS?

Answer 73

Shorten length of an acute relapse

Question 74

How do Interferons help in MS?

Answer 74

Reduce relapses and accumulation of lesions

Question 75

How to some of the mAbs help in MS?

Answer 75

- Target T cells reducing relapse | - Prevent immune cells crossing blood, brain barrier

Question 76

What do the palliative treatments of MS consist of?

Answer 76

Baclophen/diazepam to reduce spasticity Botox for tremor Catheterisation for urinary control