Neurology

Question 1

Symptoms of raised ICP

Answer 1

Headache, papilloedema, vomiting

Question 2

DANISH

Answer 2

Dysdiadokinesia & dysmetria Ataxia Nystagmus Intention tremor Slurred speech Hypotonia

Question 3

Brown sequard

Answer 3

Ipsilateral motor weakness Ipsilateral loss of touch Contralateral pain & temperature

Question 4

Central cord syndrome symptoms

Answer 4

More weakness in upper versus lower limbs Varying level of sensation below level of lesion Possibly micturition difficulties

Question 5

Myasthenia Gravis

Answer 5

Ptosis Fatigue Double vision Decreased strength Fasciculations

Question 6

Hydrocephalus

Answer 6

Communicating vs non-communicating Congenital - agenesis of foramen of monroe Acquired - Tumours, aqueduct stenosis

Question 7

Normal pressure hydrocephalus

Answer 7

Wet (incontinence) Wacky (confusion) Wobbly (gait distrurbance)

Question 8

Multisystem atrophy

Answer 8

Wet & wibbly wobbly Ataxia, postural hypotension, incontinence

Question 9

Supranuclear palsy

Answer 9

Wobbly (bradykinsea) Winky (ophthalmoplegia)

Question 10

Parkinson’s Plus Syndromes

Answer 10

MSA SNP Dementia with Lewybodies

Question 11

Most common primary brain tumour

Answer 11

Glioma Then astrocytoma

Question 12

Signs of coning (4)

Answer 12

CN VI palsy (stretches over brain stem) Upgoing plantars Cheynes stoke respiration (progressively deeper, then faster, then slower breathing) Cushigns reflex - High BP

Question 13

How to manage raised ICP (4)

Answer 13

Raised head of the bed to 45*C Neuroprotective hyperventilation (CO2 blow-off constricts cerebral vessels) IV mannitol Dexamethasone (if SOL)

Question 14

Management acute dystonia

Answer 14

Procyclidine IM - antimuscarinic

Question 15

Sign of venous sinus thrombosis on CT

Answer 15

Empty Delta sign

Question 16

Botulism symptoms

Answer 16

Blurred vision Difficulty speaking & swallowing

Question 17

Name three drugs that reduce seizure threshold

Answer 17

Amitriptyline Metronidazole Antidepressants

Question 18

Give three none tumour causes of Spinal Cord Compression

Answer 18

Trauma Haematoma Advanced spondylosis

Question 19

Man with SCC presents with low blood pressure & slow heart rate

Answer 19

Neurogenic shock due to lesions above T6 damaging the sympathetic pathway

Question 20

Two causes of RAPD

Answer 20

Optic neuritis Acute ischaemic optic neuropathy

Question 21

MS 2x classic symptoms

Answer 21

Uhtoff phenomena - vision gets worse with increased temperatures Bilateral intranuclear opthalmoplegia

Question 22

Two treatments for neurogenic shock

Answer 22

Dopamine ADH

Question 23

What is intranuclear ophthalmoplegia?

Answer 23

A lesion in the medial longitudinal fasiculus connecting CN3 and CN6, resulting in failure of adduction of affected eye and nystagmus in contralateral

Question 24

Give four investigations for MS

Answer 24

BLOODS: - FBC, Inflammatory markers, U&E, LFT, TFT, glucose, HIV serology, calcium and B12 levels - anti-myelin basic protein autoantibodies Other fluids: - rise in total protein with increase in immunoglobulin concentration with presence of oligoclonal case X: MRI for sclerotic plaques of CN Electrophysiology: Demyelination detection

Question 25

Management of MS Acute Chronic

Answer 25

Acute - methylprednisolone Chronic - DMARDS, Interferon beta • 2 relapses in past 2 yrs • able to walk 100m unaided

Question 26

Atypical features of MS (worse prognosis)

Answer 26

- Primary Progressive MS - Male - Age \>40 - motor syptoms @ presentaiton - early relapses - incomplete remissions

Question 27

Contraindications to lumbar puncture

Answer 27

Try LP Unless ContraINdicated Thrombocytopenia \<50 Late - ABx would be delayed Pressure - RICP Unstable - CV/resp sx Coagulation disorder Infection at LP site Neurology

Question 28

Lumbar puncture meningitis

Answer 28

Glucose low everything else high

Question 29

Long term complications of meningitis

Answer 29

Sensorineural hearing loss

Question 30

First sign Cervical syringomyelia

Answer 30

Loss of pain/temp in cape distribution

Question 31

MG links

Answer 31

Grave's disease Thymus disease

Question 32

Ptosis test

Answer 32

Apply ice to eyelid in MG, should stay open

Question 33

MG management

Answer 33

Corticosteroids (pred) & pyridostigmine (anticholinesterase inhibitor)

Question 34

Paraneoplastic MG symptoms

Answer 34

Lambert Eaton myasthenic syndrome -\> Occurs in paraneoplastic syndrome due to anti-voltage gated calcium channel autoantibody production

Question 35

Migraine management

Answer 35

o Migraine  Sumitriptan – acute!!  Topimarate

Question 36

peripheral neuropathy causes

Answer 36

- Diabetic neuropathy - Alcohol neuropathy - B12 deficiency - Uraemia - Syphillis

Question 37

Management acute seizure

Answer 37

A-E – recovery position IV lorazepam 4mg – 10-minute interval Escalate IV phenytoin 18mg/kg, rapid sequence induction & intubate, ITU

Question 38

Management GUillan Barre

Answer 38

IV IG Intubation

Question 39

Most common type of MND

Answer 39

Amyotrophic Lateral Sclerosis

Question 40

Management MND

Answer 40

Riluzole

Question 41

Management of spasticity

Answer 41

Baclofen