Neurology

Question 1

Cluster headache presentation

Answer 1

unilateral pain, usually located around or behind one eye, accompanied by ipsilateral lacrimation, nasal congestion, and restlessness

Question 2

Cluster headache management

Answer 2

Oxygen 100%
Subcutaneous triptan

Verapamil - prophylaxis

Question 3

Acute ischaemic stroke

Answer 3

within 4.5 hr - thrombolysis + thrombectmy
within 6 hr - thrombectomy

Question 4

Generalised tonic-clonic seizure treatment

Answer 4

1. Sodium valproate (unless premenopausal female)
2. Lamotragine

Question 5

Normal pressure hydrocephalus

Answer 5

Triad: Gait disturbance, dementia, urinary incontinence

Question 6

CN VI
- AKA
- Innervates
- Palsy

Answer 6

Abducens nerve
LR6 - lateral rectus muscle
Palsy = failure of abduction

Question 7

CN II

Answer 7

Optic nerve
Sight
Palsy = loss of vision

Question 8

CN III
- AKA
- Palsy

Answer 8

Oculomotor nerve
Palsy = Down and out + Ptosis
Pupil involvement = surgical/compression of parasympathetic fibres eg by posterior communicating artery aneurysm

Question 9

CN IV
- AKA
- Innervates
- Palsy

Answer 9

Trochlear nerve
Superior oblique muscle
Palsy = Upwards deviation

Question 10

Uhtoff’s phenomenom

Answer 10

Worsening of neurological symptoms when body overheated in demyelinating diseases

Question 11

Charcot’s neurological triad

Answer 11

Multiple sclerosis: nystagmus, intention tremor, staccato speech

Question 12

NICE criteria CT Head within 1 hour of head injury

Answer 12

2+ episodes of vomiting
GCS < 13 or <15 after 2 hours post injury
Suspected open or depressed skull fracture
Signs of basal skull fracture
Post-traumatic seizure
Focal neurological deficit

Question 13

NICE criteria CT Head within 8 hours of head injury

Answer 13

Age 65 +
Hx of bleeding/clotting disorders or anticoagulants
30+ minutes retrograde amnesia pre-injury
Dangerous mechanism of injury

Question 14

AVPU to GCS conversion

Answer 14

A = 15
V = 12
P = 8
U = 3

Question 15

Bell’s Palsy
- presentation
- cause
- management

Answer 15

Unilateral facial distortion, hyperacusis, lacrimation, loss of taste
Latent herpes virus in CN VI
oral steroid(prednisolone 50mg 10/7) if within 72hr of onset

Question 16

Brown-Sequard syndrome

Answer 16

incomplete spinal cord syndrome - hemiplegia due to hemisection of spinal cord

Ipsilateral loss of proprioception, motor function
Contralateral loss of pain, vibration, temperature sensation

Penetrating trauma, lateral compression

Question 17

Anterior cord syndrome

Answer 17

Bilateral loss of motor function, pain and temperature sensation
Vibration + proprioception in tact

Hyperflexion injury or disruption of anterior spinal artery

Question 18

Central cord syndrome

Answer 18

Sensory and motor deficit
Affects upper extremities > lower extremities

Hyperextension injury, often older people with underlying cervical disease

Question 19

Ramsey Hunt Syndrome
- cause
- management

Answer 19

Varicella zoster reactivation within geniculate ganglion of CN VII
- Steroids and acyclovir
LMN pattern like Bell’s palsy but less likely to recover function

Question 20

Common peroneal nerve lesion

Answer 20

Foot drop PLUS weakness in foot eversion
Dorsal aspect sensory deficit