pastest neuro

Question 1

what muscles does the radial nerve supply?

Answer 1

Muscles supplied by the radial nerve
B	Brachioradialis
E	Extensors
S	Supinator
T	Triceps

Question 2

how does mysthaenia gravis usually present?

Answer 2

bulbar weakness (fatigueability) (ptosis / double vision / dysphagia / easy fatigueability of neck movements)
can be precipitated by stresses on the body
generally repeated weakness on repeated testing of a muscle NOT on first movement (still a fair bit of ACh knocking about the synapses)

Question 3

guillain barre syndrome - how does it present?

Answer 3

ascending fashion - lower extremities first

Question 4

describe a typical presentation of lupus (if there is one…)

Answer 4

arthralgias
myalgias
malar photosensitive rash

Question 5

PMR - how does it usually present

Answer 5

frank weakness in proximal muscles

pain - generalised myalgia

Question 6

state the different types of dementia and how they might present:

Answer 6

frontotemporal - Pick’s (frontal lobe features) - often late middle age with SIGNIFICANT personality change

multi-infarct dementia - stepwise fashion

Normal pressure hydrocephalus - urinary incontinence and gait abnormalities + cognitive decline

Sporadic CJD - RAPIDLY progressive onset of dementia + myoclonic jerks / gait abnormalities / cerebellar syndromes

Alzheimer’s disease is a diagnosis made after exclusion of other causes of dementia (non-reversible)

Question 7

fungal meningitis - what are the two main causative organisms?

Answer 7

Fungal meningitis
C Cryptococcus (associated with HIV infection)
C Candida

Question 8

Progressive peripheral polyneuropathy with hyporeflexia suggests…?

Answer 8

Guillain-Barre syndrome

Question 9

The tremor seen in Parkinson’s disease is a…

Answer 9

a unilateral tremor that improves with voluntary movement

Question 10

The tremor seen in Parkinson’s disease is a…

Answer 10

a unilateral tremor that improves with voluntary movement

Question 11

what visual field defect does a primary open angle glaucoma cause?

Answer 11

Unilateral peripheral visual field loss

Question 12

how do you remember the visual field defect in a patient with an extensive stroke causing paresis etc..

Answer 12

homonymous hemianopia is always on the same side as the paresis.

Question 13

what is lateral medullary syndrome

which vessel is often affected to cause this?

Answer 13

quick phase of nystagmus towards the affected side
ipsilateral ataxia of upper and lower limbs
drooping of palate on eliciting gag reflex ipsilateral to lesion ( cos of involvement of vagus nerve)
may be assoc with dysphagia and dysphonia because of the above…

THINK MEDULLARY SYNDROME - IPSILATERAL

medullary syndrome is caused by blockages in the PICA artery - posterior inferior cerebellar

Question 14

what symptoms might be associated with an:

1. anterior choroidal artery blockage
2. labyrinthine artery blockage

Answer 14

think - what does it supply?

1. ant choroidal supplies optic tract / choroid plexus (produces csf) / cerebral peduncle / some of the thalamus / the posterior limb of the internal capsule

occlusion therefore = contralateral hemiparesis/ sensation loss / homonymous hemianopia with loss of contralateral hemianopia

2. right labyrinthine arteries - branch from AICerebellarArtery - ischaemia may = unilateral deafness / vertigo

Question 15

Bell’s palsy:

1. 4 causes?
2. Management of bell’s palsy?
3. how would you clinically differentiate between a UMN and LMN lesion?

Answer 15

1. STROKE - commonest cause of facial nerve palsy!!! - key to differentiate between LMN and UMN
   acoustic neuroma
   idiopathic
   Parotid infiltration (remember facial nerve (? branch) passes through parotid…
   Herpes Zoster (Ramsey Hunt syndrome)
   Mononeuritis multiplex - ?MS - check…?
2. 10 days oral prednisolone if an early presentation (within 72 hours? - check…)
   reassure that most will resolve spontaneously (not all though…)
   Obvs aciclovir if evidence of herpes zoster - severe pain etc…
3. LMN lesions cause a total hemifacial palsy
   UMN lesions have sparing of the forehead and the upper eyelid

Question 16

1. which nerve is most commonly damaged in a humeral shaft fracture?
2. which nerve is most commonly damaged in a humeral neck fracture?
3. which nerve is most commonly damaged in a medial epicondylar fracture?

Answer 16

1. radial nerve
2. axillary nerve
3. ulnar nerve

Question 17

1. name 3 common clinical features of Pick’s disease..

2. what might be seen on an MRI or a CT head in Pick’s disease?
think of it’s other name…

Answer 17

repetitive behaviour 
hoarding / criminal behaviour
disinhibition
aggresion
anxiety 
emotional disturbance
echolalia - repeating examiner's words
echopraxia - imitating the examiner's actions

NB - patients tend to perform well on cognitive tests

2. frontotemporal lobe degeneration
   build up of Pick’s bodies (spherical aggregations of tau proteins in neurons

Question 18

what are the key features of multisystem atrophy (a nice triad…)

and what is its eponymous name

Answer 18

1. autonomic dysfunction
2. ataxia
3. parkinsonism

Shy-Drager syndrome..

Question 19

what would be a typical presentation of CJD?

Answer 19

rapidly progressive dementia
hallucinations

may also lead to personality changes…