Neurology

Question 1

Criteria for doing LP without CT head in suspected meningitis

Answer 1

• age < 60
• not immune compromised
• no Hx of CNS disease
• no seizure in the week prior
• normal LOC and function
• no focal neurological signs
• no papilloedema

Question 2

Causes of sudden hearing loss

Answer 2

• external ear:
  
  • wax
  • foreign body
  • otitis externa
• middle ear
  
  • otitis media with effusion
  • barotrauma
  • haemotympanium
  • ossicular chain discontinuity
• inner ear
  
  • infection
  • miniere’s disease
  • noise induced
  • ototoxic drugs eg gentamicin
  • acoustic schwannoma
  • autoimmune eg SLE
• neurological disorder
  
  • vestibulocochlear nerve palsy
  • multiple sclerosis
  • migraine
• vascular
  
  • cerebrovascular accident brainstem
  • sickle cell disease
• idiopathic sudden sensorineural hearing loss( diagnosis of exclusion )
• non organic hearing loss

Question 3

Features of delirium

Answer 3

• acute onset
• fluctuating course
• attention deficit
• generalized severe disorganization of behavior
• changes in arousal (hypo or hyperactive)
• perceptual deficit
• altered wake-sleep cycle

Question 4

Non-pharmacological and pharmacological approach to treating delirium

Answer 4

• one on one nursing for constant reassurance
• nurse in quiet environment
• ensure good lighting
• minimize unnecessary interventions

Meds

• try oral
• small doses
• slow increments
• regular review

Question 5

Risk factors for subarachnoid hemorrhage

Answer 5

1-previous SAH, most important
2-first or second degree relative with SAH
3-female>male
4-poly cystic kidney disease
5-connective tissue disease, marfan and ehler danlos
6-coarctation of the aorta and bicuspid aortic valve
7-pheocromcytoma
8-smoking
9-alcohol binges
10-hypertension
11-Finnish ethnicity

Question 6

Differential diagnosis of severe acute onset headache

Answer 6

• Subarachnoid hemorrhage
• Idiopathic thunderclap headache
• Vertebral or carotid artery dissection
• Benign post coital sudden acute headache
• Benign post exertion sudden acute headache
• Pituitary apoplexy
• Recurrent cerebral vadospasm syndrome

Question 7

Treatment of non-traumatic subarachnoid hemorrhage

Answer 7

• Attention to ABC
• pain relief
• antiemetic
• control hypertension, maintain 140-180
• mannitol if raised ICP
• 30 degrees head up
• nimodipine to prevent vasospasm and delayed neurological deficit , 60 mg q4hr po or ng, or 15 mcg/kg/hr IVI ( 1 mg/hr )