capsule neuro

Question 1

parkinsons sign (3)

Answer 1

unilateral tremor in arm worse when arm not in use or pt anxious and then spreads to involve other limbs in asymetrical manner
lead pipe or cogwheel ridgidity
inc tone in limbs and trunk (UMN)

Question 2

treatment for parkinsons

Answer 2

levodopa to inc dopamine, can lead to psychosis if too much dopamine
SPA: need to dec dopamine so pt can have parkinson like sympotms

Question 3

sudden onset left sided facial weakness, initial pain around left ear, taste altered, dribbling saliva, difficulty closing left eye.

Answer 3

CN VII palsy, eg bells palsy
also cause paralysis of stepedius muscle and hyperacusis
taste impairement in ant tongue and speech impairment

Question 4

cause of bells pasly

Answer 4

can be idiopathic, or viral aetiology secondary to Herpes simplex virus

Question 5

Ix for bells palsy

Answer 5

clinical diagnosis but can also have nerve conduction studies in persisitent bells palsy

Question 6

Mx bells palsy

Answer 6

short course oral prednisolone if pt present early (before 72hrs) to reduce nerve oedema
, consider anti viral agent orally,
encourage eyelid closure to protect eye
but most recover completelry in 3 months

Question 7

Ix for sub arachnoid haemorrage

Answer 7

CT can pick up SAH in first 6 hours, but does not exclude it. if still high clinical suspiciion then should do LP which may show RBC in CSF, but best done in 12 hrs of symptom onset

Question 8

lamotrigene risk

Answer 8

rash, interact with other medication including OCP, risk of harm to fetus if she falls pregnant again

Question 9

PC MS

Answer 9

mono symptomatic presentation:
-optic neuritis (painful loss of vision)
-limb numbness or paraesthesia. double vision, ataxia
-headache= most common
-fatigue, vertigo, memory loss, depression
-impotence, constipation, urinary incompetence

Question 10

myasthenia gravis

Answer 10

fatiguable muscle weakness

Question 11

Ix for MS (3)

Answer 11

MRI of brain (multiple focal white matter lesions suggestive of demyelination) and spine and LP (oligoclonal IgG bands)

Question 12

RF MS

Answer 12

feamle, mean age of presentation=30, Sx worsen in heat or exercise

Question 13

Mx of MS (3)

Answer 13

bolus methylprednisolone (shorten length of relapse)
beta interferon (reduce frequency of relapse- disease modifiying treatment)
baclofen- treat spasticity

Question 14

parkinsons disease

Answer 14

age of onset 50-85
tremor (common but can present without it)
positive family history in younger patients
can also present wiht pain, depression, sleep disturbances

Question 15

initial Mx of parkinsons disease

Answer 15

levo-dopa (avoid in younger patients due to inducing dyskinesia and motor fluctuations later in disase)
physiotherapy

Question 16

side effects of dopamine agonist

Answer 16

behavioural changes- gambling, hypersexuality, compulsive behaviors= impulse control disorder

Question 17

PC of MND

Answer 17

mixed UMN and LMN signs affecitve limbs (fasciulations, wasting-L, hyper reflexia-UMN) bulbar (tongue fasiculation?), resp muscle (use of accessory)
risk of aspiration pneumonia

Question 18

PC of peripheral vascular disease

Answer 18

claudication

Question 19

where in brain does parkinsons affect?

Answer 19

degernative changes in dopmainergic neuons in substantia nigra
heroin can chemically destroy neurons in substantia nigra

Question 19

where in brain does parkinsons affect?

Answer 19

degernative changes in dopmainergic neuons in substantia nigra
heroin can chemically destroy neurons in substantia nigra

Question 20

essential tremor

Answer 20

DDX: parkinsons, enhanced physiology (anxiety)
PX: gradual onset, worse when lifting up cup, bilateral, no other associated sympotms
Ix: blood test to rule out other causes of tremor
Mx: reduce caffeine,propranolol (contra indicated in asthma due to resp depression) primidone

Question 21

parkinsons vs drug induced parkinson

Answer 21

both have gradual onset and can cause postural instability
but: parkinsosn has symptomatic benefit from levodopa, dysdiakinesia not caused by parkinsons medication generally but parkinsons not cause this side effect
need DaT scan scan that shows loss of dopaminergic neurons implying neurodegenerative disease eg PD

Question 22

which SPA medication is less likely to give you parkinson like side effects

Answer 22

quetiapine, so should switch from risperidone

Question 23

pt cant see fingers in left side of vision

Answer 23

homonymous field defect- lesion behind chiasm so in brains- both eyes.
only 1 eye: problem in front of chiasm- eye, retina, optic nerve
prblem on right side, so left arm weakness, somatosensory neglect

Question 24

which cancers are most likely to metastasise to brain

Answer 24

melanoma and squamous cell carcinoma.
thyroid or basal cell carcinoma do not metastasise outside theri organ of origin but may invade adjacent tissue

Question 25

how does vestibular problems usually present?

Answer 25

dizziness and problems with movement

Question 26

brisk relfexes in lower limb, muscle wasting in upper limb

Answer 26

UMN signs on lower limb-CNS problem involving corticospinal (pyramidal, motor) tracts.
wasting in hands- involvement of LMN in cervicals spinal cord

Question 27

pt dizzy and nauseas and vertigo when awake, repeated throughout the day

Answer 27

BBPV-hallpike test

Question 28

treatment for BBPV (4)

Answer 28

epley manouvre
vestibular rehab- carthorne-cooksey exercise
self limiting so watch and wait
drus are innefective

Question 29

what precedes cardiac syncope

Answer 29

chest pain, palpitations, SOB. but exercise induced cardiovascular syncope is also possible

Question 30

common PC of vasovagal syncop

Answer 30

feeling dizzy, nauseaus, heat. vision went grey and able to use phone afterwards

Question 31

why is FHx of sudden unexplained death worrying

Answer 31

can suggest heritable cardiac arrythmia: eg long QT syndrome.

Question 32

what CSF result suggests MS

Answer 32

antibodies in CSF that isnt in serum. immunnoglobulin cross BBB and so electrophoresis of proteins in CSF shows gamma globulins just as serum protein electrophoresis does
OLIGOCLONAL BANDS!

Question 33

how would you diagnose relapsing remiting MS

Answer 33

CNS inflammation not due to alternative cause in different places in CNS and at different times (dissemination in time and place)

Question 34

how to manage moferate level relapsing remitting MS

Answer 34

beta interferon, dimethyl fumarate