extra + secondary care (neuro)

Question 1

features of a temporal lobe seizure (3)

Answer 1

Motionless staring, automatisms (such as lip-smacking) and post-ictal dysphasia

Question 2

what is the traid of wernicke’s encephalopathy

Answer 2

1. ophthalmoparesis with nystagmus;
2. ataxia;
3. confusion

Question 3

what causes wernicke’s enephalopathy

Answer 3

subacute deficiency of thiamine (vitamin B1)

Question 4

where do M1 neurons decussate

Answer 4

in the medulla-spinal chord

Question 5

why is hyper-reflexia seen in pts w UMN lesions

Answer 5

lack of inhibitory modulation of the reflexes from the brain

Question 6

if Hx of peripheral sensory involvement (e.g. numb feet) what else should be asked about and why

Answer 6

autonomic involvement e.g. bladder, bowel, sexual function -> the sympathetic chain may be involved in SC lesions but not usually in peripheral neuropathy

Question 7

why are abnormal smells often seen in auras of those with mesial temporal lobe epilepsy

Answer 7

the primary rhinal cortex (smell) is situated close to the hippocampus (the site of seizure generation) -> smells are often associated with memory

Question 8

occipital -> temporal lobe pathway (what does it encode)

Answer 8

‘what’ pathway i.e. what objects are, semantic memory

Question 9

occipital -> parietal lobe pathway (what does it encode)

Answer 9

‘where’ pathway i.e. where in space objects are, spatial awareness

Question 10

what is the fastest onset NDD

Answer 10

motor neuron disease

Question 11

what is the commonest genetic neurological conditoin

Answer 11

charcot-marie-tooth disease

Question 12

characterisitic history of progression of someone with charcot-marie-tooth

Answer 12

normal at primary school but gradual onset throughout life -> gradually get worse at sport etc.

Question 13

what can cause brown-sequard syndrome

Answer 13

MS is the commonest cause but can also be caused by other inflammatory conditions

Question 14

what DH tracts are supplied but the anterior spinal artery (2)

Answer 14

spinothalamic + motor

Question 15

if there is a stroke in the anterior spinal artery what sensations remain intact

Answer 15

proprioceptions + fine touch + vibrations (i.e. whatever is in the dorsal column)

Question 16

lead pipe vs clasp knife rigidity

Answer 16

lead pipe - persists throughout the range of movement of a particular joint, seen in PD
clasp knife - after an initial resistance to passive movement of a joint, there is a sudden reduction in tone and the limb moves quite freely through the rest of the range of the particular movement, seen in spasticity

Question 17

what is Pseudoathetosis

Answer 17

movement disorder that is characterized by involuntary, slow, and writhing movements -> proprioceptive defect, can be seen when testing pronator drift

Question 18

what is dysmetria

Answer 18

the inability to control the distance, speed, and range of motion necessary to perform smoothly coordinated movements - as sign of cerebellar damage

Question 19

what muscle has pure C6 innervation

Answer 19

brachoradialis

Question 20

what is hoffman’s sign

Answer 20

an involuntary flexion movement of the thumb and or index finger when the examiner flicks the fingernail of the middle finger down -> this is an abnormal sign and indicated UMN damage

Question 21

what condition is pes cavus seen in

Answer 21

charcot-marie-tooth

Question 22

how many beats is abnormal in clonus test

Answer 22

3-5 beats

Question 23

what is a CT scan good for picking up (2)

Answer 23

1. blood
2. bone injuries (fractures)

i.e. trauma

Question 24

what area of the brain/skull may have high numbers of artifacts in CT scans

Answer 24

posterior fossa

Question 25

what gland may normal calcification be seen (on a CT head scan)

Answer 25

pineal gland

Question 26

what does T1 vs T2 MRI show

Answer 26

T1 - anatomy; T2 - pathology (fluid appears white)

Question 27

what is malignant MCA syndrome

Answer 27

and increase in pressure due to massive MCA infarct in a young pt leading to mass effect (as less brain atrophy so no space for the swelling in the skull)

Question 28

malignant MCA syndrome mgx

Answer 28

surgery - hemicraniotomy

Question 29

what usually surrounds a haemorrhage in the brain and why

Answer 29

a haemorrhage is usually surrounded by oedema as blood is very irritable to the brain leading to inflammation

Question 30

SAH CT presentation (not star sign)

Answer 30

may look like the sulci/gyri are "coloured in" (star sign not always present)

Question 31

subdural vs extra dural blood supply (vein/artery)

Answer 31

subdural - venous => low pressure extradural - arterial +> high pressure

Question 32

what is a ring enhancing lesion (CT/MRI head)

Answer 32

an abnormal radiological sign where there is a lesion with area of hypodensity surrounded by a bright rim from contrast -> must be in a contrast scan

Question 33

what can cause ring enhancing lesions (3)

Answer 33

1. abcess; 2. secondary tumour 3. inflammation (e.g. demyelinating, but this is usually a 'c' shape)

Question 34

why should a pt w a brain haemorrhage be rescanned at 6 weeks

Answer 34

to look for metastesis -> melanoma often metastesises to the brain and can cause tumours that haemorrhage

Question 35

what 3 brain areas are demyelinating plaques commonly found in MS

Answer 35

1. periventricular 2. posterior fossa 3. juxtacortical

Question 36

how can symptoms arising from the commonly demyelinated areas (in MS) be distinguished from vascular disease

Answer 36

they are vascularly protected areas

Question 37

meningiomas presentation (CT)

Answer 37

hyperdense region with areas of calcification and a tail coming out of it

Question 38

encephalitis vs differntials - how to distinguish from a scan

Answer 38

encephalitis usually occurs bilaterally, if unilateral then consider a differential

Question 39

what will an AVM look like on a T2 MRI scan

Answer 39

signal void - signal loss occurring within moving fluids, when the fluid is moving at a sufficient velocity relative to the MRI apparatus

Question 40

how can ocular fatigability be checked

Answer 40

ask the pt to look up and see how long until they experience double vision (can also look at corneal light sign to tell this)

Question 41

what does "bulblar" mean

Answer 41

the medulla oblongata, which looks like a swelling, or bulb, at the top of the spinal cord is known as the bulbar area -> damage to CN IX-XII leads to bulbar involvement

Question 42

what infection causes LMN involvement only

Answer 42

polio

Question 43

what is syringomyelia

Answer 43

a chronic progressive disease in which longitudinal cavities form in the cervical region of the spinal cord - a collection of cerebrospinal fluid within the spinal cord.; This characteristically results in wasting of the muscles in the hands and shoulders (cape like distribution) and a loss of sensation

Question 44

basal ganglia function analogy

Answer 44

a record player - involved in learned automatic activities e.g. walking, driving

Question 45

what congential malfomation is syringomyelia associated with

Answer 45

Arnold-Chiari malformation

Question 46

7 neurological emergencies

Answer 46

1. SAH 2. status epilepticus 3. meningitis 4. myastehnic crisis 5. cauda equina 6. stroke 7. guillian-barre

Question 47

why do learning difficulties increase the chance of status epilepticus

Answer 47

ppl are born with abnormal connections in the brain -> more likely to have continuous seizures

Question 48

9 causes of seizure w not hx of epilepsy

Answer 48

1. space occupying lesion 2. meningitis 3. CVD 4. encephalitis 5. SAH 6. metabolic deragement (hypoglycaemia/natrurina etc.) 7. alcohol intoxication 8. withdrawal 9. toxins (cocaine, carbon monoxide)

Question 49

if glucose levels are low in someone with status epilepticus what should be done

Answer 49

1. give glucose gel 2. give buccal medazilone

Question 50

what demographic of people is venous sinus thrombosis prevelent in

Answer 50

pregnant women

Question 51

signs of venous sinus thrombus (4)

Answer 51

1. headache 2. ptosis 3. increased ICH signs 4. optic disc swelling

Question 52

what is the normal opening prerssure of a lumbar puncture

Answer 52

9-12 mmHg

Question 53

what should be checked in the CSF samples

Answer 53

1. microscopy 2. biochem 3. xanthochromia (photosensitive so sample must not be exposed to light) 4. presence of rbcs (check to see if levels are deceasing or remain the same -> if decreasing then likely just due to traumatic tap, if not then more serious cause)

Question 54

what to look for in the LP of suspected guillian-barre

Answer 54

inflammatory features -> high protein but normal WBCs

Question 55

4 key presenting features of gullian-barre

Answer 55

1. ascending pattern 2. symmetrical 3. usually motor 4. loss of deep tendon refelxes

Question 56

what is weber's syndrome

Answer 56

a form of midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis

Question 57

does a RAPD +ve finding indicate a partial or complete defect

Answer 57

partial defect pre optic chiasm

Question 58

what infection might result in trigeminal neuralgia arising after it

Answer 58

shingles (post herpatic neuralgia)

Question 59

what is the mgx of shingles

Answer 59

acylcovir 800mg x5 a day

Question 60

what nerves does the corneal reflex test

Answer 60

CN V (afferent) and CN VII (efferent)

Question 61

what is often a warning sign in someone about to have a seizure

Answer 61

looking up/away -> if seen help them to the ground

Question 62

what can be done as risk reduction measures in someone having a seizure

Answer 62

remove scarves/other dangerous items; place something soft under their head

Question 63

what is the most important thing to do when someone is having a seizure

Answer 63

time the length of the seizure

Question 64

what should be done if there are signs of airway comprimise

Answer 64

place in recovery position -> otherwise don't interfere until seizure is over (and then put in recovery position)

Question 65

what might someone with temporal lobe epilepsy do during a seizure

Answer 65

wander around - stay with them + move objects out of their way

Question 66

what is pre-eclampsia

Answer 66

high blood pressure during pregnancy and after labour -> may develop into eclampsia (fit)

Question 67

what drug is given if someone experiences eclampsia

Answer 67

magnesium sulphate

Question 68

what is hypomimea

Answer 68

lack of facial expression (parkinson's)

Question 69

lead pipe vs cogwheel rigidity

Answer 69

lead pipe - persists throughout the range of movement of a particular joint, seen in PD; cogwheel - amalgamation of tremor + lead pipe rigidity simultaneously leading to cog-like movement

Question 70

where is cogwheel rigidity best felt usually

Answer 70

at the wrist

Question 71

why might sleep disruption be seen in PD

Answer 71

medication wears off at night leading to disordered dreaming

Question 72

what part of normal gait is lost in shuffling gait

Answer 72

loss of heel strike (and reduced arm swing)

Question 73

3 principle symptoms of PD

Answer 73

1. tremor 2. stiffness 3. small movement impairment

Question 74

11 non-motor PD symptoms

Answer 74

1. sleep disturbances 2. overproduction of saliva 3. depression 4. sweating problem (autonomic dysfunction) 5. bowel/bladder dysfunction 6. low BP 7. loss of smell 8. impulse control change 9. seborrheic dermatitis 10. visual hallucinations 11. altered speech

Question 75

what test should be done in an emergency situ in someone w Guillian-barre

Answer 75

spirometry - may show rapid respiratory depression

Question 76

at what level is a lumbar puncture taken

Answer 76

L3-4

Question 77

what is the cushing triad (raised ICP)

Answer 77

1. hypertension (with wide pulse pressure) 2. bradypnoea 3. bradycardia (opposite of shock)