Passmedicine

Question 1

What is Weber’s syndrome?

Answer 1

Ipsilateral third nerve palsy with contralateral hemiplegia -caused by midbrain strokes

Question 2

Brocas area

Answer 2

Involved in producing coherent speech

Question 3

Wernickes area

Answer 3

Involved in speech processing and understanding language

Question 4

Driving rules if you are withdrawing from epilepsy medication?

Answer 4

Cannot drive till 6 months after last dose (ie stop meds and wait six months)

Question 5

Driving and fainting

Answer 5

No restriction

Question 6

Driving and syncope? (explained and non-explained)

Answer 6

Explained - 4 weeks off
Non-explained - 6 months off
Two or more episodes - 12 months off

Question 7

Stroke/TIA and driving?

Answer 7

1 month off driving, may not need to inform DVLA if no neurological deficit
Multiple TIAs - 3 months off driving and inform DVLA

Question 8

Gold standard marker for CSF?

Answer 8

Beta-2 transferrin
If not, then just check for glucose :)

Question 9

How does phenytoin work?

Answer 9

Binds to sodium channels and increases the refractory period

Question 10

What do you need to be careful of when starting a phenytoin infusion?

Answer 10

Need to monitor heart because it is unpredictable and can cause arrhythmias

Question 11

Which muscles are likely to waste in motor neurone disease?

Answer 11

Small hand muscles
Tibialis anterior

Question 12

When might the symptoms of carpal tunnel syndrome be worse?

Answer 12

At night e.g. “might wake patient during the night”

Question 13

Which hand muscles are supplied by the median nerve?

Answer 13

LOAF muscles

Question 14

Someone has a painful third nerve palsy, what should you be worried about?

Answer 14

Posterior communicating artery aneurysm

(pupil dilated)

Question 15

What is Weber’s syndrome? Which part of the brain does it occur in?

Answer 15

Caused by midbrain stroke
Ipsilateral third nerve palsy with contralateral hemiplegia

Question 16

Treatment for cluster headache? and prophylaxis?

Answer 16

100% oxygen and triptan
Prophylaxis: verapamil

Question 17

Which nerve wraps around the humerus and may be damaged in shoulder dislocation?

Answer 17

The axillary nerve

Question 18

Which level is affected in Klumpkes palsy, and which other syndrome might occur?

Answer 18

Klumpke’s palsy is C8-T1
Involvement of T1 may also cause Horner’s syndrome

In Klumpke’s paralysis, there is typically weakness of the hand intrinsic muscles

Question 19

Which level is affected in Erb’s palsy?

Answer 19

C5 and C6
(brachial trunks)

Question 20

Obese young females with headaches/blurred vision, what should you think

Answer 20

Idiopathic intracranial hypertension

Question 21

Which nerve palsy might be present in idiopathic intracranial hypertension?

Answer 21

Sixth nerve palsy

Question 22

Which medications can increase risk of idiopathic intracranial hypertension?

Answer 22

Tetracyclines
Isotretinoin
Contraceptive pill
Steroids
Levothyroxine
Lithium

Question 23

Management of idiopathic intracranial hypertension?

Answer 23

Weight loss
Repeated lumbar puncture
Acetazolomide

(might need to do optic nerve sheath decompression and fenestration to prevent damage to the optic nerve)
-remember idiopathic intracranial hypertension can cause blindness if not treated promptly

Question 24

Which nerve supplies the extensors of the arm/hand

Answer 24

The radial nerve

Question 25

Which muscle supplies the interosseous muscles of the hand?

Answer 25

The ulnar nerve

Question 26

Which rami make up the brachial plexus?

Answer 26

C5 - T1

Question 27

Real Teenagers Drink Cold Beer

Answer 27

Roots Trunks Divisions Cords Branches

Question 28

Normal pressure hydrocephalus triad

Answer 28

Incontinence Dementia Gait

Question 29

Why do you have to be careful when combining sodium valproate and lamotrigine?

Answer 29

Combining sodium valproate and lamotrigine can cause serious skin rashes, such as Steven-Johnson's syndrome

Question 30

Which test should you perform if you suspect degenerative cervical myelopathy?

Answer 30

You should perform Hoffman's test (flick the patients middle finger, and you are looking for abnormal flexion in the thumb) A positive Hoffman's sign is a sign of motor neurone dysfunction and points to a disease of the CNS

Question 31

When should you give someone migraine prophylaxis?

Answer 31

When someone is experiencing more than 2 migraines per month

Question 32

Migraine prophylaxis for pregnant women?

Answer 32

Give them propanolol (acute treatment - paracetamol)

Question 33

Why should you avoid using topiramate as migraine prophylaxis in pregnant women?

Answer 33

Associated with cleft lip and palate if used in the first trimester of pregnancy (although used in migraine prophylaxis, topiramate is an anticonvulsant) Not much evidence about triptans in pregnancy so usually avoided

Question 34

Medication particularly useful for prophylaxis of menstrual migraines?

Answer 34

Triptans

Question 35

What is CADASIL syndrome?

Answer 35

Cerebral autosomal dominant ateriopathy with subcortical infarcts (type of genetic condition where you get strokes)

Question 36

Someone develops a foot drop, which nerve might be involved?

Answer 36

Common peroneal

Question 37

Someone develops a foot drop and then a wrist drop, which condition should you consider?

Answer 37

Mononeuritis multiplex

Question 38

What arteries are involved in a posterior circulation infarct?

Answer 38

The vertebrobasilar arteries

Question 39

When is essential tremor more noticeable?

Answer 39

When arms are stretched out

Question 40

What makes essential tremor better?

Answer 40

Propanol and alcohol (i guess remember the "ol's")

Question 41

A 69 year old woman presents with a 3 week history of headache, which is worse on the right side. She is generally unwell and feels "weak", noting particular difficulty in getting up from a chiar

Answer 41

Temporal arteritis

Question 42

What type of seizure is Carbamazepine of no use in?

Answer 42

Absence seizure

Question 43

Most common presenting feature of MS

Answer 43

Optic neuritis

Question 44

A 32 year-old female presents with a 3 day history of altered sensation on her left foot and right forearm. On examination she has clonus in both legs and has hyperreflexia in all limbs.

Answer 44

Multiple sclerosis

Question 45

First line treatment for trigeminal neuralgia

Answer 45

Carbamazepine

Question 46

Migraines and hormone replacement therapy?

Answer 46

Safe to prescribe hormone replacement therapy however might make migraines worse

Question 47

Which nerve is associated with a wrist drop

Answer 47

Radial nerve