Passmed Neuro

Question 1

blood findings for neuroleptic malignancy syndrome

Answer 1

raised CK and leukocytosis (high WBC)

Question 2

parkinson plus syndrome with postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction

Answer 2

progressive supranuclear palsy

Question 3

parkinson plus syndrome with with parkinsonism + autonomic disturbance (erectile dysfunction, postural hypotension, atonic bladder) + cerebellar signs

Answer 3

multiple system atrophy

Question 4

Parkinson plus syndrome with spontaneous activity by an affected limb or akinetic rigidity of that limb

Answer 4

corticobasal degeneration

Question 5

dominant hemisphere middle cerebral artery stroke presentation

Answer 5

aphasia

Question 6

lateral medullary syndrome- artery

Answer 6

posterior inferior cerebellar artery

Question 7

lateral medullary syndrome presentation

Answer 7

ipsilateral ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy with contralateral hemisensory loss. Can be caused by PICA strokes

Question 8

lacunar infarct presentation

Answer 8

numbness with no other neurological symptoms

Question 9

Posterior cerebral artery stroke/occipital stroke presentation

Answer 9

homonymous hemianopia with macula sparing

Question 10

weber’s syndrome- cause and presentation

Answer 10

midbrain stroke

presents with CN3 palsy and contralateral hemiplegia/hemiparesis

Question 11

visual field defect when a patient has urinary retention

Answer 11

pt with urinary retention may suggest diabetes insipidus due to a craniopharyngioma; this causes a lower bitemporal hemianopia

Question 12

posterior cerebral artery/occipital lobe visual field lesion

Answer 12

contralateral homonymous hemianopia with macular sparing

Question 13

haemorrhage which presents with lucid interval + biconvex (lentiform) on CT

Answer 13

extradural haemorrage

Question 14

haematoma which presents long after head injury + crescent shaped lesion

Answer 14

subdural haematoma

Question 15

migraine prophylaxis (a) first line and (b) where patient has asthma

Answer 15

(a) propanolol

(b) topiramate

Question 16

nerve lesion which presents with weakness of finger abduction + thumb adduction + wasting of the hypothenar eminence

Answer 16

ulnar nerve injury

Question 17

Mid shaft humeral fracture - nerve injury

Answer 17

radial nerve injury

Question 18

nerve injury which causes wrist drop

Answer 18

radial nerve injury (mid shaft humeral fracture)

Question 19

Klumpke’s paralysis + Horner’s syndrome - nerve injury

Answer 19

brachial trunks c8-t1

Question 20

Arm hanging loose on side, pronated and medially rotated- nerve lesion

Answer 20

Erb’s palsy- c5-c6 lesion

Question 21

Smith’s fracture- nerve lesion

Answer 21

median nerve

Question 22

Nerves frequently injured during axillary node clearance

Answer 22

intercostobrachial nerves (causing impaired sensation in the armpit)

Question 23

nerve lesion causing loss of extension in the fingers

Answer 23

radial nerve injury

Question 24

nerve lesion causing loss of adduction of fingers

Answer 24

ulnar nerve injury

Question 25

nerve lesion causing loss of pronation of the affected hand

Answer 25

median nerve injury

Question 26

drug class which increases the risk of IIHP

Answer 26

tetracyclines

Question 27

ocular signs of IIHP

Answer 27

third nerve palsy- eye deviated down and out

Question 28

diuretic used to reduce ICP

Answer 28

mannitol

Question 29

the most appropriate anti-emetic to prescribe for a Parkison’s patient with nausea

Answer 29

Domperidone

Question 30

anti-emetic which can make parkinsonian symptoms significantly worse

Answer 30

Metoclopramide

Question 31

imaging to view demyelinating lesions (MS)

Answer 31

MRI with contrast

Question 32

triceps reflex nerve roots

Answer 32

C7-C8

Question 33

biceps reflex nerve roots

Answer 33

C5-C6

Question 34

causes of cerebellar injury

Answer 34

``` P - Posterior fossa tumour A - Alcohol S - Multiple sclerosis T - Trauma R - Rare causes I - Inherited (e.g. Friedreich's ataxia) E - Epilepsy treatments S – Stroke ```

Question 35

tracts affected in subacute combined degeneration of the spinal cord & presentation

Answer 35

- dorsal columns (loss of proprioception and vibration) | - lateral corticospinal tract (muscle weakness and hyperreflexia)

Question 36

Presentation- lateral hemisection of the spinal cord (Brown-Sequard sundrome)

Answer 36

SAME-SIDED WEAKNESS & PROPRIOCEPTION/VIBRATION LOSS OPPOSITE-SIDED LOSS OF PAIN/TEMPERATURE

Question 37

Hoffman's sign

Answer 37

Demonstrates UMN lesion. offmans sign is elicited by flicking the distal phalaynx of the middle finger to cause momentary flexion. A positive result is exaggerated flexion of the terminal phalanyx of the thumb.

Question 38

level of spinal cord where injury must happen for autonomic dysreflexia to occur

Answer 38

above T6 level

Question 39

treatment for cerebral oedema in patients with brain tumours

Answer 39

Dexamethasone

Question 40

antibodies in myasthenia gravis

Answer 40

• Classically, serum acetylcholine receptor antibodies are positive in MG but if the result is negative or equivocal, anti-muscle-specific tyrosine kinase antibodies should be measured as these are positive in up to 70% with acetylcholine receptor sero-negative generalised myasthenia gravis

Question 41

what is syringomelia

Answer 41

a collection of CSF within the spinal cord. Presents with cape-like loss of pain and temperature sensation due to compression of the spinothalamic tract fibres decussating in the anterior white commissure of the spine

Question 42

first line treatment for myasthenia gravis

Answer 42

Pyridostigmine- long acting acetylcholinesterase inhibitor in the neuromuscular junction

Question 43

restless leg syndrome management

Answer 43

ropinirole (dopamine agonist)

Question 44

spinal tract lesion associated with cerebral palsy

Answer 44

pyramidal (corticospinal) tracts

Question 45

trinucleotide repeat disorder in the DMPK or ZNF9 gene

Answer 45

Myotonic dystrophy

Question 46

epilepsy medication side effect-rash

Answer 46

• Lamotrigine is associated with Stevens-Johnson syndrome, causes a large blistering rash throughout the body

Question 47

lumbar puncture findings for GBS

Answer 47

Raised proteins and NORMAL WCC on LP

Question 48

Important sign to monitor during GBS and why

Answer 48

Forced vital capacity is important to monitor due to the risk of respiratory failure

Question 49

Lambert Eaton syndrome vs Myasthenia Gravis

Answer 49

Lambert eaton syndrome- muscles become stronger with repetition myasthenia- muscle fatigability is worse with repetition

Question 50

First line treatment for relapsing-remitting MS

Answer 50

Injectable beta-interferon