clinical 3

Question 1

2 main categories of seizures

Answer 1

generalised and partial

Question 2

general seizures include (4)

Answer 2

grand mal (tonic-clonic)
petit mal (absence seizures)
myoclonic: brief, rapid muscle jerks
partial seizures progressing to generalised seizures

Question 3

types of partial seizure

Answer 3

simple (no disturbance of consciousness or awareness)
complex (consciousness is disturbed)
temporal lobe → aura, déjà vu, jamais vu; motor → Jacksonian

Question 4

type of tremor improved by alcohol

Answer 4

essential tremor

Question 5

which tremor has a strong family history

Answer 5

essential tremor (autosomal dominant)

Question 6

in what position is essential tremor worse

Answer 6

outstretched arms

Question 7

which features would suggest a tremor is caused by thyrotoxicosis

Answer 7

hyperthyroid signs: Weight loss, tachycardia, feeling hot

Question 8

3 common signs of cerebellar disease

Answer 8

intention tremur
past pointing
nystagmus

Question 9

in what gender is parkinsons more common

Answer 9

males 2:1

Question 10

what is pathophysiology of parkinsons

Answer 10

degeneration of dopaminergic neurons in the substantia nigra

Question 11

classic triad of features in parkinsons

Answer 11

tremor, bradykinesia, rigidity

Question 12

type of rigidity in parkinsons

Answer 12

leap pipe

cog wheel: due to superimposed tremor

Question 13

what are triptans

Answer 13

specific 5-HT1 agonists used in the acute treatment of migraine

Question 14

contraindications of triptans

Answer 14

history of/risk of: ischaemic heart disease or cerebrovascular disease

Question 15

what drug do you give in a prolonged seizure

Answer 15

rectal benzodiazapine (diazepam) usually 10mg in >12yrs, can give up to 30mg

Question 16

site of stroke: Contralateral hemiparesis and sensory loss, lower extremity > upper

Answer 16

Anterior cerebral artery

Question 17

site of stroke: Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

Answer 17

Middle cerebral artery

Question 18

site of stroke: Contralateral homonymous hemianopia with macular sparing
Visual agnosia

Answer 18

Posterior cerebral artery

Question 19

site of stroke: Ipsilateral CN III palsy

Contralateral weakness

Answer 19

Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)

Question 20

site of stroke: Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

Answer 20

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)

Question 21

site of stroke: Symptoms are similar to Wallenberg’s, but:

Ipsilateral: facial paralysis and deafness

Answer 21

Anterior inferior cerebellar artery (lateral pontine syndrome)

Question 22

site of stroke: Amaurosis fugax

Answer 22

retinal artery

Question 23

site of stroke: ‘Locked-in’ syndrome

Answer 23

Basilar artery

Question 24

in ABCD2 score which 2 factors give highest risk of having a stroke

Answer 24

• unilateral weakness

- TIA >60 mins ** 2 points each **

Question 25

what is cataplexy

Answer 25

describes the sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened)

Question 26

cataplexy is strongly associated with which other condition

Answer 26

narcolepsy

Question 27

high stepping gait suggests what

Answer 27

foot drop from neuropathy

Question 28

if high stepping gait (indicting foot drop) is unilateral, where is the most likely site of lesion

Answer 28

a common peroneal nerve

Question 29

if foot drop is bilateral this indicates what type of neuropathy

Answer 29

peripheral

Question 30

in regards to facial palsy, how do UMN and LMN features differ

Answer 30

upper motor neurone lesion spares upper face (forehead) where lower affects all of face

Question 31

what 4 conditions can cause bilateral facial palsy

Answer 31

sarcoidosis Guillain-Barre syndrome polio Lyme disease

Question 32

way to remember what the facial nerve innervates

Answer 32

face (expression), ear (tapedius), taste (anterior 2/3), tear

Question 33

first line treatment for generalised seizures

Answer 33

sodium valproate

Question 34

how does sodium valproate work

Answer 34

by increasing GABA activity

Question 35

which anti epileptic drug causes weight gain

Answer 35

sodium valproate

Question 36

type of 5-HT drug used in: acute: prophylaxis:

Answer 36

acute: 5-HT receptor agonist prophylaxis: 5-HT receptor antagonist

Question 37

who should get migraine prophylaxis

Answer 37

if 2+ migraines a month

Question 38

low CSF glucose indicates what

Answer 38

TB meningitis or bacterial

Question 39

CSF glucose in viral meningitis is usually

Answer 39

60-80% plasma glucose

Question 40

which 2 anti epileptic drugs should not be given together due to skin reactions

Answer 40

sodium valproate and lamotrigine

Question 41

at what point should anti seizure medication be started

Answer 41

after 2nd seizure - unless meets other criteria that suggest to start after 1st seizure

Question 42

criteria for starting anti seizure medication after 1st seizure

Answer 42

- the patient has a neurological deficit - brain imaging shows a structural abnormality - the EEG shows unequivocal epileptic activity - the patient or their family or carers consider the risk of having a further seizure unacceptable

Question 43

first line treatment for partial seizures

Answer 43

carbamazepine

Question 44

first line treatment for generalised seizures

Answer 44

Sodium valproate

Question 45

which drug may actually exacerbate absence seizure

Answer 45

carbamazepine

Question 46

propanolol is a prophylaxis for migrane, but who shouldn't get this

Answer 46

those with asthma

Question 47

migraine prophylaxis for those with asthma

Answer 47

topiramate

Question 48

preferred drug deliver method for triptans in: 12-17yrs > 17yrs

Answer 48

12-17 yrs = nasal | > 17 yrs = oral

Question 49

if first line acute treatment of migraine doesn't work, what is then used

Answer 49

non-oral preparation of metoclopramide or prochlorperazine and consider adding a non-oral NSAID or triptan

Question 50

woman of child baring age should receive which migraine prophylaxis

Answer 50

propanolol (topiramate may be teratogenic and it can reduce the effectiveness of hormonal contraceptives)

Question 51

if first line migraine prophylaxis fails what is recommended

Answer 51

10 sessions of acupuncture over 5-8 weeks' or gabapentin