Neurology

Question 1

most common gene mutation seen in Charcot-Marie-Tooth

Answer 1

PMP22 duplication

Question 2

Clinical findings in CMT

Answer 2

• foot drop
• inverted bottle appearance to lower extremities
• sensory and motor deficits

Question 3

genetics of Dystrophinopathies

Answer 3

• X-linked recessive

- mutation in the gene encoding dystrophin

Question 4

Gower’s sign

Answer 4

child uses arms to stand up from a squatted position

Question 5

Lhermitte’s syndrome

Answer 5

paraesthesia in limbs on neck flexion - seen in MS

Question 6

presentation of a fixed, dilated pupil, unresponsive to light as well as ptosis means which cranial nerve is affected?

Answer 6

third cranial nerve

Question 7

first-line management of post-herpetic neuralgia

Answer 7

NICE recommend using amitriptyline, duloxetine, gabapentin or pregabalin first-line.

Don’t - Duloxetine
Get - Gabapentin
Pain - Pregabalin
Again - Amitriptyline

Question 8

which blood test can differentiate between true seizure and a pseudoseizure

Answer 8

prolactin

Question 9

first line investigations for patients with a suspected diagnosis of vestibular schwannoma

Answer 9

audiogram and gadolinium-enhanced MRI head scan

Question 10

management of status epilepticus

Answer 10

Oh My Lord Phone the Anaesthetist!

Oh –– Oxygen (after checking ABC)
My –– Midazolam (buccal; or rectal diazepam; or IV lorazepam)
Lord –– Lorazepam (IV)
Phone –– Phenytoin (infusion IV)
the Anaesthetist –– Rapid induction anaesthesia

Question 11

cape-like loss of pain and temperature sensation

Answer 11

Syringomyelia:

- compression of the spinothalamic tract fibres decussating in the anterior white commissure of the spine

Question 12

Brown-Sequard syndrome

Answer 12

• caused by damage to one-half of the spinal cord
• results in paralysis and loss of proprioception on the same side as the lesion
• loss of pain and temperature sensation on the opposite side as the lesion.

Question 13

Complex Regional Pain Syndrome can present with:

Answer 13

PORTS:

Pain
Oedema
Restriction of Movement
Temperature/ colour change
Stiffness

Question 14

Management of Complex Regional Pain Syndrome

Answer 14

• early physiotherapy is important
• neuropathic analgesia in-line with NICE guidelines
• specialist management (e.g. Pain team) is required

Question 15

most common underlying cause of TIA

Answer 15

atrial fibrillation

Question 16

Patients with raised ICP may exhibit Cushing’s triad, which is:

Answer 16

• widening pulse pressure
• bradycardia
• irregular breathing

Question 17

what is an increased gamma-glutamyl transpeptidase (gamma GT) suggestive of

Answer 17

excess alcohol consumption

Question 18

first-line for spasticity in multiple sclerosis

Answer 18

baclofen and gabapentin

Question 19

neurological manifestation of sarcoidosis

Answer 19

facial nerve palsy

Question 20

most important causes of status epilepticus to rule out immediately

Answer 20

hypoxia and hypoglycaemia

Question 21

which anti-emetic is most appropriate for someone with Parkinson’s

Answer 21

Domperidone

Question 22

what is a crescendo TIA

Answer 22

two or more TIAs within a week

Question 23

which intracranial bleed can be associated with a fracture of the temporal bone?

Answer 23

extradural haemorrhage

Question 24

which intracranial bleed can be associated with cocaine use and sickle cell anaemia?

Answer 24

subarachnoid haemorrhage

Question 25

what is multiple sclerosis?

Answer 25

a chronic cell-mediated autoimmune disorder causing demyelination in the central nervous system

Question 26

two key phrases of sixth nerve palsy

Answer 26

internuclear ophthalmoplegia & conjugate lateral gaze disorder

Question 27

what can be detected in a lumbar puncture of an MS patient

Answer 27

oligoclonal bands in the CSF

Question 28

long-term prophylaxis of cluster headaches

Answer 28

verapamil

Question 29

clinical features of normal pressure hydrocephalus

Answer 29

‘wet, wobbly and whacky’

urinary incontinence, gait ataxia, and dementia