neuro

Question 1

associated features with migraine

Answer 1

photophobia
phonophobia
worse on exercise

nausea
vomitting

Question 2

bed side tests to rule out meningitis + SOL

Answer 2

look for papilloedema
cranial nerve examination
kernig’s + brudzinki’s

Question 3

migraine Mx

Answer 3

prophylaxis

• topiramate
• propanolol (use women of child bearing age, topiramate is tetra)

Acute Mx:
- triptan + NSAID/paracematol

• triptans (sumatriptans) - 5HT1 agonist
  constricts the cranial arteries

Question 4

clinical features of parkinson’s

Answer 4

tremor
bradykisea
rigidity

• micrographia
• mask-like expression on face
• shuffling gait
• stooped posture
• postural HTN (automomic dysfunction)
• increased tone (cogwheel)

Question 5

Parkinson’s mx

Answer 5

medically:
- dopamine agonists (L-Dopa) - metabolised before BBB
- peripheral dopa decarboxylase inhibitor (carbidopa)
(slows down metabolising of L-dopa - long term effect)

physio:

• prevent falls
• speech therapys
• SALTs

SSRIs
- depression

neurosurgery

• only for young + selective
• deep brain stimulation

education
- parkinson’s disease society

Question 6

what is the oxford stroke classification?

Answer 6

assessed on:

1. unilateral hemiparesis / hemisensory loss
2. homonymous hemianopia
3. higher congitive dysfunction (dysphasia)

Question 7

Ix after ischaemic stroke diagnosed

Answer 7

carotid doppler
echo
ecg - AF / MI
FBC - polycythemia

Question 8

stroke Mx

Answer 8

CT determines if ischaemic / haem

ischaemic

• aspirin 300mg
• statin (>3.5)
• SALT assessment
• oxygen <94%
• avoid hypoglycaemia (brain injury)

<4.5hrs symptoms onset

• alteplase
• VTE propylaxis heparin

> 4.5hrs symptoms

• VTE propylaxis heparin
• supportive

Question 9

stroke secondary prevention

Answer 9

stop smoking
good glycaemia control / diabetic
bp control
statin
wafarin in AF

Question 10

stroke complications

Answer 10

seizures
thromboemblism - VTE / PE
speech impairment
swallowing impairment
infection (hospital admission, aspiration pneumonia)
reduced mobility
pressure sores

Question 11

pathophysiology of MS

Answer 11

autoimmune disease which attacks the myelin of the nerves

neurological dysfunction - separated in time + space

Mx attempts to reduce the potential for triggering the bursts of inflammatory activity of relapses

Question 12

pathophysiology of MS

Answer 12

autoimmune disease demyelinating of the nerves in white matter

neurological dysfunction - separated in time + space

Mx attempts to reduce the potential for triggering the bursts of inflammatory activity of relapses

Question 13

Ix for MS

Answer 13

MRI brain - looking for areas of demyelination

visual evoked potential
- delayed conduction on central white matter

Question 14

causes for epliepsy

Answer 14

alcohol withdrawal / intoxification
head trauma
infection (meningitis, encephalitis, abcess)
psychogenic
metabolic disturbance - sodium / calcium / magnesium
intracranial tumours

Question 15

carbemazipine uses

Answer 15

anti-epileptic
neuropathic pain
bipolar

Question 16

things to inform patient with newly diagnosed epilepsy

Answer 16

• have to be one year epilepsy free on medication before driving
• ## can’t operate heavy goods vehicles

Question 17

causes of SAH

Answer 17

80% berry aneurysms
congential AV malformations
trauma
infective aneurysms

Question 18

complications fo SAh

Answer 18

rebleeding
hyponatriaemia (siadh)
hydrocephalous
death

Question 19

Ix for SAH

Answer 19

CSF - xathochromnia

CT head - hyperdense in basal cisterns, sulci

Question 20

mX for SAH

Answer 20

clipping for acute

Question 21

RF for subdura

Answer 21

elderly
alcoholics
anti-coagulations
DM

Question 22

mx for subdura

Answer 22

surgical evacuation through burr holes
- due to cause of raised ICP

risk of coning
- rise to brain ischaemia in the basal ganglia leading to respiratory depression + death

Question 23

pathophysiology of epidural

Answer 23

low impact trauma
- commonly middle meningeal artery

lucid interval - expanding haematoma and brain herniation

fixed, dilated pupil due to compression of the parasymtpathetic fibers of 3rd CN

Question 24

causes of peripheral neuropathy

Answer 24

predominantly motor loss:

• guillian-barre
• charcot-marie-tooth
• chronic inflammatory demyelinating polyneuropathy (CIDP)

predominantly sensory loss:
- diabetes
- alcohol
- B12 deficiency 
(subacute combined degeneration of the spinal cord)
- uraemia
- leprosy
- amyloidosis

Question 25

how to Mx peripheral neuropathy of diabetic patient

Answer 25

goog glycaemic control
diabetic shoes
diabetic foot specialist referral
neuropathic analgesias (TCA, gabapentin, pregabalin, duletoxine )

Question 26

meningitis comp

Answer 26

epilepsy
brain abscess
hydrocephalus
focal neurological deficeit (sensorineural loss)

Question 27

what is myopathic facies

Answer 27

facial appearance due to muscular facial weakness

indicative of:
MG
myotonic dystrophy

Question 28

pathophysiology of MG

Answer 28

autoimmune disorder of the post-synaptic membrane at the NMJ

antibodies against the acetylcholine receptor

features of muscle weakness, repetative, improves on rest

Question 29

signs on examination for patient with MG

Ix

Answer 29

ptosis
diplopia
ophthalamopegia

1. serum antibodies acetylcholinesterase antibodies in 90% of MG patients
2. tensilon test - give short anti-cholinesterase (positive = rapid improvement in weakness)
3. nerve stimulation - decreased evoked potential
4. mediastinal imaging (CT/MRI) - thymoma

Question 30

Mx of MG

Answer 30

pyridostigmine / neostigmine - cholinesterase inhibitor

corticosteroids
immunosuppression

plasmaphoresis - removal of antibodies through machine

Question 31

describe history of cluster headache

Answer 31

intense period of headaches over a week (4 - 12 weeks)

more common in men

alcohol can trigger attack

Question 32

cluster headache Mx

Answer 32

acute

• 100% oxygen
• SC triptan

prophylaxis:
- verapamil

Question 33

tension headache

Answer 33

tight band round head

symptoms bilateral

migraine - unilateral

Question 34

tension head mx

Answer 34

acute
- aspirin / naproxen / ibuprofen

chronic
1. antidepressants / amitriptyline

2. muscle relaxants