General neurological

Question 1

Where is the lesion if the pattern is affecting muscle groups, not individual muscles, with little muscle wasting, spasticity in large muscles and hyperreflexia?

Answer 1

UMN lesion

Question 2

Where is the lesion if the pattern is affecting muscle groups, not individual muscles, with little muscle wasting, and loss of skilled fine finger movements.

Answer 2

UMN lesion

Question 3

Where is the lesion if the affected muscles show wasting and fasciculation, there is hypotonia and hyporeflexia?

Answer 3

LMN lesion.

Question 4

Where is the lesion if the pattern is weakness of all movements of a hand or foot, with normal or decreased tone?

Answer 4

Cortical lesion

Question 5

Where is the lesion if there is hemiparesis with epilepsy?

Answer 5

Contralateral cerebral hemisphere

Question 6

Where is the lesion if there is hemiparesis with decreased cognition?

Answer 6

Contralateral cerebral hemisphere

Question 7

Where is the lesion if there is hemiparesis with homonymous hemianopia?

Answer 7

Contralateral cerebral hemisphere

Question 8

Where is the lesion if there is hemiparesis with a contralateral cranial nerve palsy?

Answer 8

The brainstem on the side of the cranial nerve palsy.

Question 9

Peripheral neuropathy that often causes proximal lesions

Answer 9

Guillain-Barre syndrome.

Question 10

What lesion gives dorsal column loss on the side of the lesion, and spinothalamic loss on the contralateral side?

Answer 10

Brown-Sequard picture; a hemicord lesion.

Question 11

What domain does carotid artery occlusion affect?

Answer 11

At worst, the anterior 2/3 of its hemisphere and the basal ganglia, more often it appears like a middle cerebral artery occlusive picture.

Question 12

Occlusion of which artery in the brain gives just dizziness?

Answer 12

Superior cerebellar artery

Question 13

Occlusion of which artery in the brain gives dizziness and deafness?

Answer 13

Anterior inferior cerebellar artery

Question 14

Occlusion of which artery in the brain gives dizziness with dysphagia and dysphonia?

Answer 14

Posterior inferior cerebellar artery

Question 15

Occlusion of which artery in the brain gives a weak numb contralateral leg and similar but milder arm symptoms, with face being spared.

Answer 15

Anterior cerebral artery

Question 16

Occlusion of which artery in the brain gives akinetic mutism?

Answer 16

Bilateral occlusion of anterior cerebral arteries.

Question 17

Occlusion of which artery in the brain gives hemiparesis, hemisensory loss and dysphagia?

Answer 17

Contralateral middle cerebral artery (of dominant hemisphere)

Question 18

Occlusion of which artery in the brain gives hemiparesis, hemisensory loss and homonymous hemianopia?

Answer 18

Contralateral middle cerebral artery

Question 19

Occlusion of which artery in the brain gives hemiparesis, hemisensory loss and visuo-spatial disturbance (can’t get dressed, gets lost etc)?

Answer 19

Contralateral middle cerebral artery (of non-dominant hemisphere)

Question 20

Occlusion of which artery gives homonymous hemianopia only?

Answer 20

Posterior cerebral artery.

Question 21

Drugs enhancing GABA activity are used in which conditions? What is an example of such a drug?

Answer 21

Epilepsy, neuropathic pain and spasticity.

Gabapentin, valproate and baclofen.

Question 22

Causes of vertigo

Answer 22

Benign positional vertigo
Acute labyrinthitis
Meniere's disease
Ototoxicity
Acoustic neuroma
Traumatic damage
Herpes Zoster

Question 23

What is benign positional vertigo?

Answer 23

Vertigo caused by debris in the semicircular canal.

Question 24

Maneuvers to be used in benign positional vertigo.

Answer 24

Hallpike’s for diagnosis

Epley’s for treatment.

Question 25

Acute labyrinthitis - symptoms

Answer 25

Acute vertigo, vomiting, nausea but NO tinnitus or deafness.

Question 26

Meniere's disease

Answer 26

Endolymphatic hydrops causes recurrent vertigo lasting more than 20 mins, sensineuronal hearing loss and tinnitus.

Question 27

Meniere's disease treatment

Answer 27

Antihistamine can be useful. | Surgery in very severe cases

Question 28

Ototoxicity symptoms

Answer 28

Deafness and vertigo

Question 29

Drugs with ototoxicity

Answer 29

Aminoglycosides, loop diuretics or cisplatin

Question 30

Acoustic neuroma symptoms

Answer 30

A schwannoma arision from vestibular nerve. Presents with unilateral hearing loss, with vertigo later. Ipsilateral Vth, VIth, IXth and Xth nerves may also be affected.

Question 31

What must you rule out in cases of unilateral tinnitus?

Answer 31

Acoustic neuroma

Question 32

Organic causes of tinnitus

Answer 32

Focal hyper-excitability in auditory cortex, hearing loss, wax, viral, presbycusis, excess noise, head injury, septic otitis media, post-stapedectomy, Meniere's, anaemia, increased BP.

Question 33

Drugs causing tinnitus

Answer 33

Aspirin (reversible), aminoglycosides and loop diuretics.

Question 34

Where is the likely cause of a lesion causing weak legs?

Answer 34

Cord or distal lesion (unless parasagittal meningioma)

Question 35

Causes of unilateral foot drop

Answer 35

DM | common peroneal nerve palsy, stroke, prolapsed disc, MS.

Question 36

Causes of weak legs with no sensory loss

Answer 36

MND, polio, parasagittal meningioma,

Question 37

Causes of chronic spastic paraparesis in the legs

Answer 37

MS, cord tumour, cord metastases, MND, syringomyelia, subacute combined degeneration of the cord, hereditary spastic paraparesis.

Question 38

Causes of absent knee jerks and extensor plantars with leg weaknes

Answer 38

Combined cervical and lumbar disc disease Conus medullaris lesions MAST (MND or Friedreich's ataxia, subacute degeneration of the cord, taboparesis)

Question 39

What is the significance of sudden onset bilateral leg weakness?

Answer 39

This is an emergency; cord compression. | Can lead to permanent paralysis, faecal incontinence and neurogenic bladder.

Question 40

Significance of sensory loss with leg weakness?

Answer 40

Spinal cord disease.

Question 41

Symptoms of cord compression

Answer 41

Leg weakness and sensory loss Sometimes preceded by spinal pain Bladder and sphincter involvement manifests as hesitancy, frequency and later painless retention.

Question 42

Causes of cord compression

Answer 42

Secondary malignancy is commonest | Rarerly: infection, cervical disc prolapse, haematoma, intrinsic cord tumour, atlanto-axial subluxation, myeloma.

Question 43

Differential diagnoses for bilateral leg weakness that you think is cord compression.

Answer 43

Transverse myelitis, MS, carcinomatous meningitis, cord vasculitis, spinal artery thrombosis, trauma, dissecting aneurysm.

Question 44

What is different about cauda equina and conus medullaris lesions compared to higher in the cord?

Answer 44

Leg weakness is flaccid and areflexic in the former, the reverse in the latter.

Question 45

What is the cause of a rest tremor?

Answer 45

Parkinsonism (abolished on movement)

Question 46

Cause of intention tremor?

Answer 46

Cerebellar damage (MS, stroke)

Question 47

Causes of postural tremor?

Answer 47

Benign essential tremor (autosomal dominant), thyrotoxicosis, anxiety and B-agonists. Present on maintained posture.

Question 48

What is chorea?

Answer 48

Non-rhythmic, jerky, purposeless movements flitting from place to place.

Question 49

Causes of chorea?

Answer 49

Huntington's disease, Sydenham's chorea.

Question 50

What is hemiballismus?

Answer 50

Large, flinging hemichorea contralateral to vascular lesoin of subthalamic nucleus esp in elderly diabetics.

Question 51

What is athetosis?

Answer 51

Slow, sinuous, confluent, purposeless movements

Question 52

Causes of athetosis

Answer 52

Cerebral palsy.

Question 53

Features of MND

Answer 53

Rarely presents before 40 Commonly shows: fasciculation lower motor neuron signs in arms and upper motor neuron signs in legs wasting of the small hand muscles/tibialis anterior is common abdominal reflexes are usually preserved and sphincter dysfunction if present is a late feature doesn't affect external ocular muscles no cerebellar signs absence of sensory signs/symptoms*

Question 54

Otosclerosis

Answer 54

Autosomal dominant, replacement of normal bone by vascular spongy bone. Onset is usually at 20-40 years - features include: conductive deafness tinnitus tympanic membrane - 10% of patients may have a 'flamingo tinge', caused by hyperaemia positive family history

Question 55

Typical features of a Parkinsonian tremor

Answer 55

Difficulty in initiating movement (bradykinesia), postural instability and unilateral symptoms (initially) are typical of Parkinson's

Question 56

Features of essential tremor

Answer 56

postural tremor: worse if arms outstretched improved by alcohol and rest most common cause of titubation (head tremor)

Question 57

Management of essential tremor

Answer 57

propranolol is first-line | primidone is sometimes used

Question 58

What is the ABCD2 score?

Answer 58

``` A scoring system for stroke. You score A Age >= 60 years B Blood pressure >= 140/90 mmHg C Clinical features - Unilateral weakness - Speech disturbance, no weakness D Duration of symptoms - > 60 minutes - 10-59 minutes Patient has diabetes ```

Question 59

Carpal tunnel syndrome - key features of history

Answer 59

pain/pins and needles in thumb, index, middle finger unusually the symptoms may 'ascend' proximally patient shakes his hand to obtain relief, classically at night

Question 60

Carpal tunnel syndrome - key features on examination

Answer 60

weakness of thumb abduction (abductor pollicis brevis) wasting of thenar eminence (NOT hypothenar) Tinel's sign: tapping causes paraesthesia Phalen's sign: flexion of wrist causes symptoms

Question 61

Guillain-Barre syndrome

Answer 61

An immune mediated demyelination of the peripheral nervous system often triggered by an infection (classically Campylobacter jejuni).

Question 62

Guillain-Barre presentation

Answer 62

Progressive weakness of all four limbs. The weakness is classically ascending i.e. the lower extremities are affected first, however it tends to affect proximal muscles earlier than the distal ones. Sensory symptoms tend to be mild (e.g. distal paraesthesia) with very few sensory signs. Some patients experience back pain in the initial stages of the illness

Question 63

Guillain-Barre non-presenting symptoms

Answer 63

areflexia cranial nerve involvement e.g. diplopia autonomic involvement: e.g. urinary retention