Neurology

Question 1

What are the side effects of levodopa?

Answer 1

Nausea
Orthostatic hypotension
Confusion & hallucinations
Sleepiness
Motor fluctuations and dyskinesia
Contributes to impulse control disorders

Question 2

Where is levodopa absorbed?

Answer 2

Small intestine - duodenum & jejunum
Depends on gastric emptying

Question 3

What are the side effects of dopamine agonists?

Answer 3

Nausea
Orthostatic hypotension (more common than with levodopa)
Confusion & hallucinations (more common than with levodopa)
Sleepiness & sleep attacks
Peripheral oedema
Skin irritation/rash (rotigotine)
Contributes to impulse control disorders

Question 4

What are examples of MOA inhibitors, their MoA?

Answer 4

Selegiline, rasagiline
Prolongs half life of dopamine

Question 5

What are examples of COMT inhibitors and their MoA?

Answer 5

Entacapone, tolcapone

Acts on COMT to prevent conversion of levodopa/dopamine

Works inside/outside of BBB

Question 6

What drugs may worsen REM behavioural disorders?

Answer 6

Mirtazapine
Beta blockers
Tramadol

Question 7

Treatment for dementia in Parkinson’s Disease?

Answer 7

Cholinesterase inhibitors (rivastigmine, donepezil)
Memantine

Question 8

Cardinal features of Parkinson’s Disease?

Answer 8

Rest tremor, bradykinesia, rigidity

2 of 3 features required for diagnosis
1 has to be bradykinesia

Question 9

Anti-epileptics to avoid in women of childbearing age?

Answer 9

Phenobarbitone
Valproate

Lamotrigine and levetiracetam relatively favourable

Question 10

NMO spectrum disease?

Answer 10

Female
Asian/African preponderance
Relapsing B cell disease
Targets astrocytes
More severe than MS
Attacks likely to result in permanent neurological deficit
Presentation: bilateral optic neuritis. longitudinal transverse myelitis (>contiguous over 3 vertebral segments), area postrema syndrome (hiccups/nausea/vomiting), acute brain stem syndrome, symptomatic narcolepsy

AQP4 antibody - in serum
>99% specific for NMO

MOG antibody
50% of all AQP4 neg cases
MOGAD - steroid responsive
Poorer response to rituximab
Tendency to cause recurrent optic neuritis
Associated with ADEM

<30% have oligoclonal bands - usually transient
(Unlike MS)

Management:
IV methylpred
PLEX
Long term: aza/myco, steroid, rituximab
Eculizumab (terminal C’ inhibitor, AQP4 pos)
Inebilizumab (CD19 depletion, AQP4 pos)

Question 11

ADEM?

Answer 11

Increases risk of MS

Question 12

NCS pattern for preganglionic lesions?

Answer 12

Normal

Question 13

NCS in preganglionic issues?

Answer 13

Normal

Question 14

What is F wave in NCS?

Answer 14

Used in motor NCS testing
May be only abnormality in early GBS
Assess proximal nerve

Question 15

What does positive HINTS test suggest?

Answer 15

HINTS - head impulse, nystagmus, test of skew

Positive HINTS test indicates disruption to vestibulo-ocular reflex/peripheral cause.
- Central cause of vertigo less likely.

Concerning features on HINTS:
Bidirectional nystagmus - concerning for central cause (+ vertical nystagmus, pure torsional nystagmus)

Abnormal test of skew

Normal head impulse test

Question 16

Tauopathies?

Answer 16

PSP
CBD
FTD

Question 17

Alpha synucleinopathies?

Answer 17

Parkinson’s
DLB
MSA

Question 18

First line treatment of juvenile myoclonic epilepsy?

Answer 18

Valproate
Caution in post pubertal girls - teratogenic risks

Avoid: carbamazepine, phenytoin - may aggravate absence seizures and myoclonic jerks