Neurology

Question 1

Useful features to distinguish between a seizure and a syncope

Answer 1

1. Post ictal headache (without trauma)
2. Amnesia
3. Tongue biting (side, not the tips)

Question 2

THALES trial

Answer 2

Ticagrelor + Aspirin vs Aspirin alone in acute ischaemic stroke/TIA
Increased bleeding risk, some benefit in composite of stroke or death within 30 days (5.5 vs 6.6)

Question 3

When to anticoagulate in AF and stroke

Answer 3

In TIA/stroke - immediately

Large infarct - wait 10-14 days, can start aspirin in the interim

Small infarct with haemorrhagic transformation - start aspirin in 48 hours, anticoagulation in 10-14 days

Question 4

Antiplatelet choice in following choices (up to date as of October 2020)

1. High risk TIA/minor stroke
2. Large vessel atherosclerosis
3. Intracranial atherosclerosis
4. Cervical artery dissection

Answer 4

1. High risk TIA/minor stroke - Aspirin and Clopidogrel/Ticagrelor for 3 weeks, then aspirin monotherapy
2. Large vessel atherosclerosis - as above
3. Intracranial atherosclerosis - Aspirin and clopidogrel for 3 months, then aspirin alone
4. Cervical artery dissection - Aspirin

Question 5

Examination approach in tremor

Answer 5

1. Rest with mental distraction (distract with months backwards, or counting backwards from 100)
		○ Different hand positions are useful 
			§ Prone
			§ Semi-prone
			§ Supine
			§ Hand hanging
2. Posture
		○ Hands outstretched
		○ Turning arms
		○ Nose targeting position
			§ Observe for re-emergence (wait after posture movement, specific to PD)
3. Functional tasks
		○ Writing, spirals, holding a cup, cutlery
4. Walking
5. Look for tremors elsewhere
		○ Voice
		○ Neck
6. Look for other neurological signs such as parkinsonism

Question 6

Treatment of essential tremor

Answer 6

Propranolol (upto 160-240mg/day)
Primidone
Gabapentin
Topiramite