Neurology

Question 1

DVLA rules post TIA or stroke

Answer 1

Cannot drive for 1 month

Question 2

Definitive diagnostic test for acoustic tumours?

Answer 2

MRI of cerebellopontine angle with contrast

Question 3

Features of a midbrain space occupying lesion

Answer 3

Unequal pupils, unable to move eyes up/down, amnesia

Question 4

Features of a frontal space occupying lesion

Answer 4

Dysinhibition, expressive dysphasia, Personality changes, anosmia, grasp reflex

Question 5

Features of a parietal space occupying lesion

Answer 5

Visuospacial, sensory, language

Question 6

Features of a temporal lobe space occupying lesion

Answer 6

Memory, verbal, personality, receptive dysphasia

Question 7

Features of Friedrich’s ataxia

Answer 7

Autosomal recessive, presents in childhood, ataxic gait, optic atrophy, cardiac abnormalities, pes cavus, absent lower limb reflexes, weakness/wasting

Question 8

Donepazil contraindications

Answer 8

Bradycardia

Question 9

First line treatment of absence seizures in girls/women of childbearing age

Answer 9

Ethosuximide

Question 10

Do cerebellar strokes present with ipsilateral or contralateral symptoms?

Answer 10

Ipsilateral

Question 11

5 year old with head injury. Dilated left pupil which is deviated laterally and downwards. Ptosis is also present. Which cranial nerve is affected?

Answer 11

Third cranial nerve (Oculomotor)

Question 12

68 year old women, tingling sensation in her left cheek bone and painful rash in same area. Reduced sensation across cheek bone and upper lip. Which cranial nerve?

Answer 12

Fifth cranial nerve (trigeminal)

Question 13

28 year old woman has unequal pupils. The larger pupil does not constrict to light but does constrict when a light is shone in the other eye.

Answer 13

Optic neuritis

Question 14

Medication to help slow disease progression in someone who has recently been diagnosed with MS?

Answer 14

Linoleic acid supplementation

Question 15

Triceps reflex nerve root?

Answer 15

C7-C8

Question 16

Biceps reflex nerve root?

Answer 16

C5-C6

Question 17

Left femoral nerve damage features?

Answer 17

Weakness of the quads and iliopsoas muscle (weakness of hip flexion and knee extension) and decreased/absent patellar reflex

Question 18

Ipsilateral pyramidal weakness and ipsilateral loss of joint position/vibration sensation. Contralateral loss of pain/temperature sensation.

Answer 18

Brown Sequard syndrome or hemisection of the spinal cord.

Question 19

Diagnostic criteria for migraine

Answer 19

At least 5 headache attacks that last 4-72 hours + 2 of the following: unilaterl, throbbing/pulsating, worsened by movement, moderate or severe intensity

Question 20

Management of patients with TIA?

Answer 20

Aspirin 300mg and to be seen by stroke team within 24 hours

Question 21

What is hemiballismus

Answer 21

Flailing, ballistic undersired movements of the limbs. It can occur as a result of stroke, traumatic brain injury, space occupying lesion, non-ketotic hyperglycaemia

Question 22

Inclusion criteria for PSP

Answer 22

Onset >40 years; gradually progressive; vertical supranuclear palsy and prominent postural instability with tendency to fall in the first year of disease onset.

Question 23

A patient has drooping and weakness of the left side of the face and is unable to raise the left eyebrow?

Answer 23

7th cranial nerve (facial)

Question 24

List the cranial nerves

Answer 24

I = olfactory
II = Optic
III = Oculomotor
IV = Trochlear
V = trigeminal
VI = Abducens
VII = Facial
VIII = vestibulocochlear
IX = glossopharngeal
x = Vegas
XI = accessory
XII = Hypoglossal

Question 25

Treatment of asymptomatic carotid dissection?

Answer 25

Medical management: antiplatelets or anticoagulation. If cannot be anticoagulated consider stenting

Question 26

Right incongruous homonymous hemianopia - where is the lesion?

Answer 26

Left optic tract

Question 27

Peripheral neuropathy - which drug?

Answer 27

Simvastatin

Question 28

62 year old, vertigo, vomiting, nystagmus on left gaze and ataxia, paralysis of left palatal movement, left partial ptosis, reduced pain and temp on right side of body. Where is the most likely site of this lesion?

Answer 28

Posterior inferior cerebellar artery

Question 29

81 year old, sensory loss over the whole of the right side of the body. No other symptoms or signs.

Answer 29

Lacunar infarct- can be pure motor or pure sensory or mixed

Question 30

Locked in syndrome -where is the problem?

Answer 30

Basilar artery

Question 31

Investigation for suspected GBS?

Answer 31

Lumbar puncture

Question 32

First line treatment for primary generalised epilepsy in young man?

Answer 32

Valproate