Passmed - Neuro

Question 1

Bell’s Palsy features

Answer 1

lower motor neuron facial nerve palsy → forehead affected
(in contrast, an upper motor neuron lesion ‘spares’ the upper face)

post-auricular pain (may precede paralysis)
altered taste
dry eyes
hyperacusis

Question 2

Bell’s palsy management?

Answer 2

Oral prednisolone
Eye care (lubricant)

Question 3

a simple first-step in the management of patients with raised ICP

Answer 3

Head elevation to 30º

(IV mannitol may be used as an osmotic diuretic)

Question 4

Dilated, fixed pupil CN

Answer 4

III

Question 5

‘down and out’ eye with a fixed (non-reactive to light), dilated pupil

Answer 5

typical presentation of oculomotor nerve palsy.

Question 6

inability to abduct the left eye and worsening double vision when looking to the left are consistent with

Answer 6

left 6th nerve palsy

innervates the lateral rectus muscle, which is responsible for abduction of the eye. When this nerve is affected, it results in medial deviation of the eye (esotropia) at rest and difficulty or inability to abduct the affected eye

Question 7

Wernicke’s encephalopathy features? CAN OPEN

Answer 7

Confusion
Ataxia
Nystagmus
Ophthamoplegia
PEripheral
Neuropathy

Question 8

Middle-aged, personality changes, involuntary movements →

Answer 8

?Huntington’s disease

Autosomal dominant
Features typical develop after 35 years of age
chorea
personality changes (e.g. irritability, apathy, depression) and intellectual impairment
dystonia
saccadic eye movements

Question 9

Huntington’s disease fewtures

Answer 9

Features typical develop after 35 years of age
chorea
personality changes (e.g. irritability, apathy, depression) and intellectual impairment
dystonia
saccadic eye movements

Question 10

Acoustic neuromas are best visualized by

Answer 10

MRI of the cerebellopontine angle

Question 11

Contralateral homonymous hemianopia with macular sparing and visual agnosia

Answer 11

posterior cerebral artery

Question 12

ongoing vertigo, tinnitus and hearing loss, absent corneal reflex

Answer 12

Acoustic neuroma

Question 13

first line radiological investigation for suspected stroke?

Answer 13

Non-contrast CT head scan

Question 14

Distal sensory loss, tingling + absent ankle jerks/extensor plantars + gait abnormalities/Romberg’s positive →

Answer 14

subacute combined degeneration of the spinal cord

Question 15

Confusion, ataxia, nystagmus/ophthalmoplegia→ give

Answer 15

Pabrinex (IV B/C vitamins)

Question 16

A maximum of ? doses of IV benzodiazepines can be administered during convulsive status epilepticus

Answer 16

Two

Question 17

If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA, they should be

Answer 17

admitted immediately for imaging to exclude a haemorrhage

Question 18

Defective downward gaze and vertical diplopia

eye deviates supero-laterally

Answer 18

CN IV

Question 19

MS acute relapse management?

Answer 19

high dose steroids can be used in the management of acute relapse

E.g. oral/IV methylprednisolone