Core Knowledge

Question 1

What are the key common features of Stroke?

Answer 1

Vision loss or visual field defect

Weakness

Aphasia

Impaired Co-Ordination (ataxia)

Question 2

What are the first investigations to order in Stroke?

Answer 2

Non-contrast CT scan

MRI Brain

Serum Glucose - exclude hypoglycaemia

UEC - Rule out renal failure and metabolic causes

Cardiac Enzymes and ECG - exclude arrhythmia or ischaemia

FBC - Excludes anaemia or thrombocytopenia prior to possible initiation of thrombolytics, anticoagulants, or antithrombotics.

Question 3

DDX of ischaemic stoke

Answer 3

Intracerebral haemorrhage
TIA
Hypoglycaemia
Seizure
Brain tumour

Question 4

Management of Ischaemic stroke

Answer 4

Intravenous thrombolysis

Aspirin

Question 5

What are the key features of a TIA?

Answer 5

By definition TIA symptoms are brief and the majority will resolve within the first hour.

Patient/caregiver report of focal neurological deficit

Question 6

What are strong risk factors for TIA? (5)

Answer 6

AF

Valvular disease

Carotid stenosis

Congestive heart failure

Hypertension

Diabetes mellitus

Cigarette smoking

Alcohol abuse

Advanced age

Question 7

How is TIA managed?

Answer 7

Similar to MI

Anticoagulation

Antiplatlet

Lipid Lowering Agent

Lifestyle Modification (Weight loss, smoking cess, alcohol reduction, regular exercise)

Question 8

What are the key diagnostic factors of Parkinson’s disease? (5)

Answer 8

Presence of risk factors (advancing age, fam hx)

Bradykinesia

Resting tremour

Cogwheel Rigidity

Postural Instability

Masked facies

Hypophonia

Question 9

What are the ddxs for Parkinson’s disease? (5)

Answer 9

Progressive supranuclear palsy (PSP)

Multiple system atrophy (MSA; formerly Shy-Drager syndrome)

Lewy body dementia

Corticobasal degeneration

Alzheimer’s disease with parkinsonism

Drug-induced parkinsonism

Metabolic abnormalities

Normal pressure hydrocephalus

Question 10

How is Parkinson’s disease managed?

Answer 10

Levodopa (L-DOPA) mainstay therapy

Dopamine Agonists – Bromocriptine, Pergolide
Anticholinergics for tremor – Benztropine, Benzhexol

Complimentary drugs to enhance L-DOPA:

Carbidopa/Benserazide (DOPA decarboxylase inhibitor)
Tolcapone/Entacapone (COMT Inhibitor)
Selegeline – MAO-B Inhibitor

Question 11

What is Progressive Supranuclear Palsy?

Answer 11

Parkinsonian sx and vertical gaze palsy

Tremor might not be as prominent.

Question 12

Parkinsonian Symptoms. Strong sx of autonomic dysfunction especially orthostatic hypotension; UMN sx: hyperreflexia, primitive reflexes; cerebellar sx; nystagmus

Answer 12

Shy-Drager Syndrome

AKA Multiple Systems Atrophy

Question 13

What are the Lung causes of Dyspnoea? (7)

Answer 13

Pneumonia
Pneumothorax
Pulmonary Embolism
Pleural Effusion
Pulmonary Cancer
Obstructive Lung Disease
COPD and Asthema
Restrictive Lung Disease
Alveolar Haemorrhage

Question 14

What are the cardiac causes of Dyspnoea?

Answer 14

• MI
• CHF
  
  • SYS or DIA
  • Ischemic or Non-Ischemic
  • All cardiomyopathies
  • Pericardial tamponade
  • Valve issues
• Arrhythmia

Question 15

What are the cardinal features of Guillian-barre?

Answer 15

Preceding viral illness

Progressive symmetrical muscle weakness usually affecting lower extremities before upper extremities and proximal muscles before distal muscles accompanied by paraesthesias in the feet and hands.

Respiratory distress
Speech problems
Paraesthesia

Areflexia / Hyporeflexia

Question 16

What are the investigations for Gullian Barre?

Answer 16

Nerve conduction studies

Lumbar puncture (LP) - elevated CSF protein with normal cell count

LFTs (AST and ALT)

Spirometry (may show reduced vital capacity)

Question 17

What are the ddxs for Guillain-Barre syndrome?

Answer 17

Myasthenia gravis
Lambert-Eaton myasthenic syndrome (LEMS)
Botulism
Polymyositis

Question 18

What is the difference between LEMS and Myasthinia Gravis?

Answer 18

Lambert–Eaton myasthenic syndrome is caused by autoantibodies to the presynaptic membrane.

Myasthenia gravis is caused by autoantibodies to the postsynaptic acetylcholine receptors.

LEMS improves over time.

Myasthinia Gravis fatigues.

Question 19

How is Guillian-Barre treated?

Answer 19

IVIG

Question 20

What are the cardinal features of MS?

Answer 20

Visual disturbance in one eye
Peculiar sensory phenomena
Female
Age 20 to 40 years
Fatigue
Urinary frequency
Bowel dysfunction
Spasticity/increased muscle tone
Increased deep tendon reflexes

Question 21

What are the ddxs for MS?

Answer 21

Vitamin B12 deficiency

Ischaemic stroke

Guillain-Barre syndrome
Amyotrophic lateral sclerosis (ALS)
Systemic lupus erythematosus

Question 22

How is MS treated? (5)

Answer 22

Methylprednisolone

Interferon Beta 1a/1b

Glatiramer

Fingolimod

Natalizumab

Question 23

What is the pathophys of MS?

Answer 23

Immune-mediated inflammatory disease that attacks myelinated axons in the central nervous system, destroying the myelin and the axon in variable degrees.

Thought to be linked to T-cells crossing the BBB

Question 24

What are the types of headache?

Answer 24

Migraine

Cluster

Tension

SAH

Question 25

How is migraine treated?

Answer 25

Abortive - Tryptans High flow oxygen NSAIDs Anti-emetics Hydration Caffeine

Question 26

How are cluster headaches treated?

Answer 26

High dose Oxygen Sumatriptan

Question 27

How are tension headaches treated?

Answer 27

Simple analgesia Chronic - amitriptyline

Question 28

When is another drug added in Hypertension?

Answer 28

Not tolerated or target not reached after 3 months

Question 29

What is the standard first line drug for hypertension?

Answer 29

ACE Inhibitors

Question 30

What is not a standard first line drug for hypertension?

Answer 30

Beta Blockers

Question 31

What investigations should be ordered in Hypertension?

Answer 31

ECG - LV Hypertropher Fasting metabolic panel with estimated GFR - end organ damage, conns syndrome Lipid panel - Metabolic Syndrome Urinalysis - End organ damage Hb - Decreased in chronic renal failure Thyroid-stimulating hormone

Question 32

What are the causes of seizures?

Answer 32

V - Vascular Malformation (CT / MRI) I - Infection (CBC), Inherited conditions T - Trauma (Hx) A - Alzheimers (H) M - Metabolic derangements (CMP) - low Ca, Na, Mg, Glucose. I - Idiopathic N - Neoplasm (CT / MRI) S - pSychiatric.

Question 33

What are the general principles of AEDs?

Answer 33

Inhibition of sodium channel function Inhibition of calcium channel function Enhancement of GABA action