geeky medics neuro

Question 2

intracranial pressure increases intermittently in normal pressure hydrocephalus

Question 3

unilateral temporal lobe infarctions lost the ablility to

Answer 3

locate sound in space

Question 4

melatonin is important in sleep regualtion and is formed in the

Answer 4

pineal gland

Question 5

Central lesions cause anhidrosis of the arm, trunk and face
Pre-ganglionic lesions cause anhidrosis of the face

Question 6

occulmotor opens eye

Answer 6

facial nerve closes eye

Question 7

subarachnoid haemorrhage is what arery

Answer 7

posterior communicating

Question 8

Pyridostigmine is used in myasthenia gravis as an acetylcholinesterase inhibitor.

Question 9

is suspect spinal cord compression give steriods immediately

Question 10

if middle cerebral artery stroke and right side of body affected what side is affected on homonymous hemianopia

Answer 10

right

Question 11

when is triptans contrainidcates

Answer 11

history of coronary artery disease

Question 12

Prosopagnosia (also known as face blindness or facial agnosia)

Question 13

Miss Yorke is presenting with relapsing-remitting multiple sclerosis (MS), therefore methylprednisolone is the correct answer

Answer 13

dexamethason is not used in MS

Question 14

rombergs test does not test cerebellar function but it tests

Answer 14

sensory ataxia

Question 15

shaking baby in child abuse can cause what

Answer 15

subdural haemorrhage

Question 16

lewy body dementia is associated with

Answer 16

syncope

Question 17

In between the posterior cerebral artery and the superior cerebellar artery is the oculomotor nerve.

Question 18

left occulomotr nerve supplies the

Answer 18

left eye

Question 19

berry aneurysms are associated with polycystic kidney disease

Answer 19

rupture of berry aneurysm can cause subrarachnoid haemorrhage

Question 20

having low cd4 so high chance she has HIV so increased risk of

Answer 20

fungal meningitis

Question 21

trochlear nerve palsy eye will be

Answer 21

up and out

Question 22

Hepatic dysfunction, e.g. raised AST, is an important adverse effect of sodium valproate use and should be suspected in those presenting with ‘persistent vomiting and abdominal pai

Question 23

Fasciculations are typical findings within lesions of the anterior horn cells as these are where lower motor neurons can be found.

Question 24

dopamine agonist - impulse spending

Answer 24

ropinirole

Question 25

tonic is

Answer 25

stiffenign

Question 26

Phenytoin has a narrow therapeutic range and can lead to symptoms of toxicity such as nausea, vomiting, seizures and nystagmus.

Question 27

The most likely diagnosis is metastatic spinal cord compression from a recurrence of his previously treated prostate cancer. Of the options presented, oral dexamethasone (a potent corticosteroid) would be the most appropriate choice in the hope of reducing the local mass effect exerted by the tumour on the spinal cord (by reducing oedema).

Answer 27

steriods given before the definitive treatment of surgery

Question 28

This patient has clinical features of meningeal irritation, such as photophobia, and painful knee extension when the hip is flexed to 90 degrees (Kernig’s
The correct answer is subarachnoid haemorrhage (SAH), as this is the only option likely to present with headache and signs of meningeal irritation in an afebrile patient.

Answer 28

SAH can cause meningism

Question 29

The CSF flows from the two lateral ventricles –> foramina of Monro –> third ventricle –> cerebral aqueduct –> fourth ventricle –> foramina of Luschka & Magendie –> subarachnoid space.

Question 30

This is a classic presentation of a Marcus-Gunn pupil, which is due to a lesion to cranial nerve II, the optic nerve. Clinical findings for a Marcus-Gunn pupil include a de-afferented pupil which constricts to consensual but not to direct light.

Question 31

B12 deficiency can lead to subacute degeneration of the spinal cord. This presents with a mixture of UMN signs (extensor plantars) and LMN signs (absent reflexes). Usually, the dorsal column and corticospinal tracts are most affected, whilst the spinothalamic tract may remain unaffected, even in severe disease. This explains why Jenny may still be able to feel temperature and pain sensations, but they may have lost their vibration sense.

Answer 31

spinothalamic tract generally not affected in subacute degeneration of the cord

Question 32

The posterior limb of the internal capsule is an area of the brain that fibers of the corticospinal tract travel through and therefore a lesion to this area would result in a positive pronator drift.

Question 33

The corneal reflex is an excellent way to test the sensory component of the trigeminal nerve, as well as the facial nerve. To test this reflex, the cornea is touched with a wisp of cotton and the resultant direct and consensual eye blink is noted. The afferent information for this reflex is carried by the ophthalmic division of the trigeminal nerve, and the efferent information is carried by the facial nerve.

Question 34

Lumbar puncture is only indicated if the CT is negative but subarachnoid haemorrhage is still suspected.

Question 35

mx for SAH

Answer 35

endovascular coiling and nimodipine

Question 36

This vignette is describing trigeminal neuralgia for which Carbamazepine (anticonvulsant) is first-line management. Verapamil (calcium channel blocker) is used for prophylaxis.

Question 37

nimodipine cab be used for prophylaxis for cerebral vasospasm

Question 38

Mark, a 29-year-old male is suspected of having viral encephalitis.

Which of the following is the most likely result from CSF analysis?
Raised protein + raised lymphocytes + normal glucose

Question 39

A patient that demonstrates a “clasp knife” phenomenon is virtually pathognomonic for an upper motor neuron lesion.

Question 40

In patients presenting with diplopia, mydriasis and ptosis, a third nerve palsy should be suspected. The most important diagnosis to exclude is a posterior communicating artery aneurysm which could lead to a fatal subarachnoid haemorrhage. The first line investigation is a CT Angio head which will allow visualisation of the cerebral vasculature.

Question 41

huntingtons

Answer 41

striatum affected