Formative

Question 1

How would the patient present with an expanding tumour around the spinal cord in T5-T7 region?

Answer 1

Would expand to affect where STT neurones are decussating across the anterior white commissure, but not affect ascending/descending neurones = bilateral loss of pain and temp sensation in T5-T7 segments only

Question 2

When is Thiamine given?

Answer 2

Alcohol dependence (usually Thiamine, B1 deficient)

Question 3

How would the pupils change with a lesion in the midbrain, pons or medulla?

Answer 3

Pons and medulla lesions would affect sympathetic outflow = pin point pupils

Midbrain lesion affects EWN = dilated pupils

Question 4

What’s the hierarchy of evidence ?

Answer 4

Systematic reviews
RCTs
Cohort
Case
Cross sectional studies

Question 5

Which area of basal ganglia generates tremors?

Answer 5

Globus pallidus

Question 6

Which area of the ganglia is associated with hemiballismus?

Answer 6

Subthalamic nucleus

Question 7

What type of movements does damage to the striatum cause (HD)?

Answer 7

Chorea and athetosis

Question 8

What are signs of cerebellar damage?

Answer 8

DANISH
Dysdiadochokinesia
Dysmetria (pass pointing)
Dystonia (hypotonia)
Dysarthria (difficulty articulating speech)
Dysphagia (problems with swallowing)

Question 9

What’s the role of the suprachiasmatic nucleus?

Answer 9

Diurnal rhythm

Question 10

What’s the role of the supraoptic nucleus?

Answer 10

Osmoregulation

Question 11

What’s the role of the paraventricular nucleus?

Answer 11

ANS - stress, appetite

Question 12

In a CSF sample when would lymphocytes or neutrophils be raised?

Answer 12

Lymphocytes - viral or TB

Neutrophils - bacterial

Question 13

What’s the key sign of meningococcal disease?

Answer 13

Non-blanching (purpuric) rash

Question 14

What types of dementia present cortically? What are their features?

Answer 14

Frontotemporal dementia
AD
CJD

Higher cortical abnormalities, dysphasia, agnosia, apraxia

Question 15

What are types of subcortical dementia and how do they present?

Answer 15

PD, HD, normal pressure hydrocephalus

Apathetic
Forgetful and slow
Depression
Impaired visuospatial

Question 16

Which types of dementia present cortically and sub-cortically?

Answer 16

DLB

Multi infarct

Question 17

What parts of the brain does Korsakoff’s predominantly damage?

Answer 17

Mamillary bodies of hypothalamus
Anterior thalamic nucleus
= anterograde amnesia and confabulations

Question 18

Where would the damage be for unilateral or bilateral hearing loss?

Answer 18

Unilateral: cochlear nerve of cochlear nuclei
Bilateral: primary auditory cortex

Question 19

What’s the relationship between the 4th ventricle and CN VI and VII?

Answer 19

4th ventricle tumour/swelling can result in papilloedema, visual disturbance (unable to abduct), weakness of facial muscles

Question 20

Which sinus runs close to the internal occipital protuberance?

Answer 20

Superior sagittal sinus drains posteriorly, where it splits into the transverse sinuses

Question 21

Which cranial nerve nuclei are tested by the gag reflex?

Answer 21

Nucleus ambiguus and spinal trigeminal sensory nucleus

Question 22

What’s the efferent limb of the corneal reflex?

Answer 22

Facial nerve to orbicularis oculi

can be damaged in forceps delivery by damaging stylomastoid foramen

Question 23

What are the 3 features of DLB?

Answer 23

Parkinsonism, Dementia, Hallucinations

Question 24

How does AD and DLB differ on imaging?

Answer 24

Rapid atrophy of hippocampus in AD

Question 25

What class of drugs is used to slow progression of dementia?

Answer 25

Anticholinesterases

Question 26

Despite the hallucinations, why are antipsychotics contraindicated in patients with DLB?

Answer 26

Will exacerbate the parkinsonism symptoms (D2 antagonism)

Question 27

What are lay health beliefs? What are 4 sources of them?

Answer 27

Ordinary people (non medical professionals) knowledge of health and illness that are generally rooted in their own experience Society, culture, personal experience, social identity

Question 28

What's the difference between moderate sedation and general anaesthesia?

Answer 28

In moderate sedation, patients are conscious but relaxed and able to maintain verbal communication In GA there is loss of consciousness - the patient is without awareness and sensation

Question 29

What scale is used to assess sedation and what's the ideal score?

Answer 29

Ramsay scale 2 = calm | Richmond/Riker agitation scales too

Question 30

What type of bleeds are lentiform or crescent shaped?

Answer 30

``` Lentiform = extradural (arterial) Crescent = subdural (venous) ```

Question 31

What are the 2 legal principles under which someone who lacks capacity to consent can be treated?

Answer 31

Doctrine of necessity | Best interests

Question 32

Which 2 people can make decisions on behalf of those without capacity?

Answer 32

Court appointed deputy | Lasting power of attorney

Question 33

What are some visuospatial tests (of hemispatial neglect)?

Answer 33

Ask patient to draw a clock face | Draw a flower

Question 34

What's the visual deficit called when the lesion is in Meyer's loop?

Answer 34

Upper quadrantopia | lower quadrantopia when superior aspect of optic radiation damaged

Question 35

What's inability to track movements/objects called? Damage where results in it?

Answer 35

Akinetopia | Dorsal pathway of vision runs through the parietal lobes to the frontal lobes