Neurology

Question 1

Optic chiasm tumour superior or inferior

Answer 1

Bitemporal hemianopia
More UQ - superior eg pit tumour
More LQ - inferior - craniopharyngioma

Question 2

Homonymous quadrantopia

Answer 2

PITS

Question 3

Macula sparing

Answer 3

Occipital lesion

Question 4

L homonymous hemianopia

Answer 4

R sided stroke

Question 5

GBS - what is it

Answer 5

immune mediated patchy demyelination of the PNS often triggered by an infection (Campylobacter jejuni), viral EBV, CMV.

Question 6

Miller Fisher syndrome

Answer 6

variant GBS
ophthalmoplegia, areflexia and ataxia. The eye muscles are typically affected first
descending paralysis rather than ascending
anti-GQ1b antibodies

Question 7

Treatment GBS

Answer 7

IV immunoglobulins

Plasmapheresis

Question 8

Features GBS

Answer 8

progressive weakness of all 4 limbs- ascending i.e. the lower extremities are affected first
proximal > distal
Sensory symptoms tend to be mild (e.g. distal paraesthesia)
Some patients - back pain initially
Areflexia
cranial nerve involvement e.g. diplopia
autonomic involvement: e.g. urinary retention, diarrhoea
papilloedema: thought to be secondary to reduced CSF resorption

Question 9

DVLA unprovoked seizure

Answer 9

6 months off

Structural abnormalities - 12

Question 10

DVLA epilepsy

Answer 10

12 months, normal liscence if seizure free 5 years

Question 11

DVLA withdrawal epilepsy meds

Answer 11

6 months

Question 12

DVLA - explained/ unexplained syncope

Answer 12

4 weeks

6 months

Question 13

DVLA - stroke/ TIA

Answer 13

1 month, inform in residual neuro deficit

Question 14

DVLA - craniotomy for meningioma, pit tumour

Answer 14

1 year

6 months

Question 15

DVLA - chronic neuro disorder

Answer 15

Tell DVLA

PK1 form - state of health application

Question 16

Cerebellar Disease causes

Answer 16

M - MS
A - alcohol
V - vascular
I - Inherited - Freidrich's
S - SOL

Question 17

UMN lesion

Answer 17

decreased power
increased tone, spasticity
increased reflexes
pyramidal

Question 18

LMN lesion

Answer 18

decreased power, tone, reflexes
muscle wasting
fasciculations

Question 19

Bamford Classification

Answer 19

1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

Question 20

Progressive supranuclear palsy

Answer 20

Early postural instability
vertical gaze palsy ± falls
rigidity of trunk > in limbs
symmetrical onset
speech and swallowing problems
little tremor

Question 21

Multiple system atrophy

Answer 21

Early autonomic features, eg impotence/incontinence, postural BP
Cerebellar + pyramidal signs
rigidity > tremor

Question 22

MUSK antibodies

Answer 22

MG

Question 23

MG pathophysiology

Answer 23

antibodies to nicotinic acetylcholine receptors (AChR)

interfering with neuromuscular transmission via depletion of working post-synaptic receptor sites

Question 24

MG tx

Answer 24

Anticholinesterase, eg pyridostigmine

Question 25

Lambert–Eaton myasthenic syndrome

Answer 25

``` paraneoplastic (SCLC) / autoimmune Gait difficulty before eye signs Autonomic involvement Hyporeflexia and weakness, improves after exercise Antibody to pre-synaptic membrane’s voltage-gated Ca2+ channels anti-P/Q type VGCC antibodies in 85% Tx: 3,4-diaminopyridine or IV Ig CXR/ CT regular to check cancer ```

Question 26

Syringomyelia

Answer 26

cape-like’ (neck and arms) loss of sensation to temperature but preservation of light touch, proprioception and vibration full spine MRI with contrast to exclude a tumour or tethered cord. A brain MRI is also needed to exclude a Chiari malformation.

Question 27

anti-GQ1b antibodies

Answer 27

GBS

Question 28

UMN lesion

Answer 28

Weak, spastic tone Hyperreflexia upward plantars

Question 29

LMN lesion

Answer 29

reduced reflexes plantars down muscle atrophy, fasciculations Flaccid tone

Question 30

wernicke's aphasia

Answer 30

left middle side of the brain difficulty with language comprehension receptive aphasia fluent nonsense

Question 31

Broca's aphasia

Answer 31

is a non-fluent type expressive dyshpasia Comprehension intact - understands but cannot say sentence anterior brain

Question 32

Cerebellar signs

Answer 32

``` DANISH Dysdiadokinesia / dysmetria. Ataxia. Nystagmus. Intention tremor. Speech - slurred or scanning. Hypotonia. ```

Question 33

Management of TIA

Answer 33

See within 24 hours, aspirin 300mg

Question 34

Syringomyelia

Answer 34

Collection of CSF in the spinal cord | Chiari malformation etc