Neurology

Question 1

trigeminal neuralgia - key features

Answer 1

unilateral pain - brief electric shock like pains

evoked by light touch - shaving, smoking, talking, toothbrushing, or spontaneously

Question 2

management of trigeminal neuralgia

Answer 2

carbamazepine

Question 3

what nerve has a palsy if eye deviated down and out?

Answer 3

3rd nerve (oculomotor)

Question 4

features of a 3rd nerve palsy

Answer 4

deviated down + out
ptosis
dilated pupil

Question 5

myasthenia gravis - GI effects

Answer 5

dysphagia with liquids + solids

Question 6

Which nerves supply larynx muscles?

Answer 6

Recurrent + superior laryngeal (branches of vagus)

Question 7

Functions of trigeminal nerve

Answer 7

Sensation in face

Motor function eg chewing + biting

Question 8

Role of facial nerve

Answer 8

Motor function + taste sensation

Question 9

Which is the only CN to enter the thorax?

Answer 9

Vagus

Question 10

Hallmark blood finding of haemochromatosis

Answer 10

High ferritin

Question 11

unilateral parkinsonism + severe autonomic disturbance - likely diagnosis?

Answer 11

multiple system atrophy (MSA)

Question 12

PSP - differentiating feature

Answer 12

ocular pathology

Question 13

multiple system atrophy - features

Answer 13

unilateral parkinsonism
autonomic disturbance (atonic bladder, postural hypotn)
cerebellar signs

Question 14

what can be used for long-term prophylaxis of cluster headaches?

Answer 14

verapamil

Question 15

what is first line for focal seizures?

Answer 15

carbamazepine or lamotrigine

Question 16

stroke in AF - when do you start anticoagulation?

Answer 16

don’t usually start till 2 weeks after stroke onset

Question 17

thrombolysis in stroke - what are criteria for giving it?

Answer 17

within 4.5h of stroke onset

imaging excludes haemorrhage

Question 18

ischaemic stroke - secondary prevention

Answer 18

clopidogrel
2wk after - anticoag if AF
statin - after 48h if cholesterol > 3.5
carotid endarterectomy - if carotid, pt not vv disabled + carotid stenosis is >50-70%

Question 19

stroke - acute management

Answer 19

maintain hydration, glucose, sats, temp + don’t lower BP

aspirin 300 if haemorrhage excluded
alteplase if <4.5h

Question 20

role of cerebellum

Answer 20

coordination of movement

Question 21

what is charcot marie tooth disease?

Answer 21

hereditary sensorimotor neuropathy

Question 22

types of ischaemic stroke

Answer 22

posterior vs anterior circulation
major vessel vs deep perforating artery (affecting the thalamus, internal capsule or corona radiata - would be a localised ‘lake’ of brain = lacunar)

Question 23

what is a TACS?

Answer 23

3 of hemianopia, hemiloss + higher cortical dysfunction (eg neglect, speech probs, dyspraxia)

Question 24

what is a PACS?

Answer 24

2 of hemianopia, hemiloss + higher cortical dysfunction (eg neglect, speech loss, dyspraxia)

hemiloss doesn’t have to be whole side of body

Question 25

what is a POCS?

Answer 25

1 of:
hemianopia
cerebellar signs
brainstem signs - horner’s, conjugate gaze palsy, ipsi CN lesion with contra hemiparesis)

Question 26

what is a LACS?

Answer 26

4 features are absent:
no higher cortical dysfunction as cortex not affected
no hemianopia - lesion away from optic radiation
no drowsiness
no brainstem signs

several lacunar syndromes:
pure motor or sensory
sensorimotor
clumsy hand syndrome

Question 27

why is there relative sparing of upper face in UMN facial weakness as opposed to LMN?

Answer 27

bilateral cortical representation of upper face:

the part of the facial nerve nucleus responsible for the upper face has an UMN input from both cerebral hemispheres

ie there’s bilateral input into the upper part of the facial nerve nucleus

Question 28

horner’s syndrome - presentation

Answer 28

ptosis + constricted pupil

Question 29

when is selegiline used in parkinson’s?

Answer 29

late stage when l-dopa alone is failing to control symptoms

Question 30

when are COMT inhibitors used in parkinson’s? what do they do?

Answer 30

inhibit peripheral breakdown of dopamine

used later in PD - esp when end-dose effect is a problem

Question 31

B12 deficiency - presentation

Answer 31

large fibre neuropathy
-ve symps: unsteady gait, “walking on cotton wool”
+ve symps: paraesthesiae, band-like feeling around calf

Question 32

alcoholic neuropathy - presentation

Answer 32

small fibre neuropathy
-ve symps: pain + temp loss
+ve symps: burning, hyperalgesia