Neurology

Question 1

What are 5-HT3 antagonists, examples and adverse effects?

Answer 1

• anti-emetics
• chemotherapy related nausea
• ondansetron, graniestron
• ADR: constipation, prolonged QT

Question 2

What are absence seizures, features and management?

Answer 2

• generalised epilepsy mostly seen in children
• unaware, quick, triggered by hyperventilation or stress
• EEG: bilateral, symmetrical 3Hz spike and wave pattern
• manage with ethosuximide
• alternatively sodium valproate in male and lamotrigine/levetiracetam in females
• exacerbated by carabamazpine

Question 3

Wernicke’s (receptive) aphasia:

Answer 3

• lesion of superior temporal gyrus
• inferior division of left MCA
• sentences make no sense but speech remains fluent
• comprehension impaired

Question 4

Broca’s (expressive) aphasia:

Answer 4

• lesion of inferior frontal gyrus
• superior division of left MCA
• speech non-fluent, repetition impaired
• normal comprehension

Question 5

Conduction aphasia:

Answer 5

• stroke affecting arcuate fascicles (connecting Wernicke’s and Broca’s)
• speech fluent but repetition poor
• aware of errors
• normal comprehension

Question 6

Global aphasia:

Answer 6

• large lesion affecting all 3 areas
• severe expression and receptive aphasia
• can communicate using gestures

Question 7

What is an Arnold-Chiari malformation and features:

Answer 7

• downward displacement or herniation of cerebellar tonsils through foramen magnum
• congenital or trauma
• non-communicating hydrocephalus due to CSF outflow obstruction
• headache
• syringomyelia

Question 8

What causes ataxia?

Answer 8

• cerebellar hemisphere lesions cause peripheral ataxia

- cerebellar vermis lesions cause gait ataxia

Question 9

Ataxia Telangiectasia

Answer 9

• autosomal recessive
• defect in ATM gene coding for DNA repair enzymes
• early childhood with abnormal movements
• IgA deficiency resulting in recurrent chest infections
• 10% risk of malignancy, lymphoma, leukaemia and non-lymphoid tumours

Question 10

Autonomic dysreflexia

Answer 10

• spinal cord injury above T6
• briefly afferent signals cause sympathetic spinal reflex
• triggered by faecal impaction or urinary retention
• cord lesion prevents parasympathetic response
• causes extreme hypertension, flushing and sweating above level of lesion

Question 11

What are the features of Bell’s palsy?

Answer 11

• acute, unilateral, idiopathic, facial nerve paralysis
• lower motor neurone facial nerve palsy (including forehead)
• post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis

Question 12

How do you manage Bell’s palsy?

Answer 12

prednisolone 1mg/kg for 10 days within 73 hours of onset

acyclovir no benefit

Question 13

What is Erb-Duchenne paralysis?

Answer 13

• damage to C5-6 roots
• winged scapula
• may be caused by breech presentation

Question 14

What is Klumpke’s paralysis?

Answer 14

• damage to T1
• loss of intrinsic hand muscles
• due to traction

Question 15

What can cause brain abscesses?

Answer 15

• extension of sepsis from middle ear or sinuses
• trauma or surgery to scalp
• penetrating head injuries
• embolic events from endocarditis

Question 16

Features of brain abscesses:

Answer 16

• headache
• fever
• focal neurology
• raised ICP: nausea, papilloedema, seizures

Question 17

Management of brain abscesses:

Answer 17

• surgery: craniotomy and debridement
• IV antibiotics: IV 3rd generation cephalosporin and metronidazole
• ICP management e.g. dexamethasone

Question 18

Parietal lobe lesion symptoms:

Answer 18

• sensory inattention
• apraxia
• astereognosis
• inferior homonymous quadrantopia
• Gerstmann’s syndrome (dominant parietal): alexia, acalculia, finger agnosia and right-left disorientation

Question 19

Occipital lobe lesion symptoms:

Answer 19

• homonymous hemianopia (with macula sparing)
• cortical blindness
• visual agnosia

Question 20

Temporal lobe lesions:

Answer 20

• Wernicke’s aphasia
• superior homonymous quadrantopia
• auditory agnosia
• prosopagnosia

Question 21

Frontal lobe lesions:

Answer 21

• Broca’s aphasia
• disinhibition
• perseveration
• anosmia
• inability to generate list

Question 22

Cerebellum lesions:

Answer 22

• midline lesions: gait and truncal ataxia

- hemisphere lesions: intention tremor, past pointing, dysdiadokinesis, nystagmus

Question 23

What condition is associated with the sub thalamic nucleus of the basal ganglia?

Answer 23

Hemiballism

Question 24

What conditions is associated with the striatum of the basal ganglia?

Answer 24

Huntington’s chorea

Question 25

What condition is associated with the substantia nigra of the basal ganglia?

Answer 25

Parkinson’s

Question 26

What condition is associated with the amygdala?

Answer 26

Kluver-Bucy syndrome: hyper sexuality, hyperorality, hyperplasia, visual agnosia

Question 27

Which cancer spreads most commonly to the brain?

Answer 27

lung

also breast, bowel, skin and kidney

Question 28

Which primary brain tumour is the most common in adults?

Answer 28

• glioblastoma
• solid tumours with central necrosis and rim
• vasogenic oedema
• pleomorphic tumour cells

Question 29

Which is the second most common primary brain tumour in adults?

Answer 29

• meningioma
• typically benign
• arise from dura of meninges
• symptoms of compression rather than invasion
• spindle cells in concentric whorls and calcified bodies

Question 30

What is a vestibular schwannoma?

Answer 30

(acoustic neuroma)

• benign tumour arising from vestibulocochlear nerve
• seen in cerebellopontine angle
• presents with hearing loss, facial nerve palsy and tinnitus
• bilateral assoc with neurofibromatosis type II
• Antoni A or B patterns and verocay bodies seen

Question 31

What is the most common primary brain tumour in children?

Answer 31

• pilocytic astrocytoma

- rosenthal fibres

Question 32

What is a medulloblastoma?

Answer 32

• aggressive paediatric tumour
• infratentorial compartment
• spreads through CSF
• small blue cells, rosette pattern of cells

Question 33

What is an ependymoma?

Answer 33

• 4th ventricle
• may cause hydrocephalus
• perivascular pseudoreosettes

Question 34

What is an oligodendroma?

Answer 34

• benign, slow-growing tumour common in frontal lobes

- calcifications with fried egg appearance

Question 35

What is a haemangioblastoma?

Answer 35

• vascular tumour of cerebellum
• associated with von Hippel-Lindau
• foam cells and high vascularity

Question 36

What is a craniopharyngioma?

Answer 36

• most common paediatric supratentorial tumour
• solid, cystic tumour of cellar region derived from remnants of Rathke’s pouch
• hormonal disturbance, hydrocephalus, bitemporal hemianopia

Question 37

What is Brown-Sequard syndrome?

Answer 37

• lateral hemisection of spinal cord
• ipsilateral weakness below lesion
• ipsilateral loss of proprioception and vibration sensation
• contralateral loss of pain and temperature sensation

Question 38

Indications of carbamazepine, mechanism of action, ADR:

Answer 38

• used for epilepsy, trigeminal neuralgia, bipolar disorder
• binds to sodium channels to increase refractory period
• ADR: P450 enzyme inducer, dizziness and ataxia, drowsiness, headache, visual disturbances (diplopia), Steven-Johnson syndrome, leucopenia and agranulocytosis, hyponatraemia

Question 39

What is cataplexy?

Answer 39

sudden and transient loss of muscular tone caused by strong emotion (2/3 of narcoleptics have cataplexy)