Medicine

Question 1

Name the four major types of Parkinson Plus Syndromes.

Answer 1

Progressive Supranuclear Palsy (PSP), Multiple System Atrophy (MSA), Corticobasal Degeneration (CBD), and Dementia with Lewy Bodies (DLB).

Question 2

What differentiates Parkinson Plus Syndromes from idiopathic Parkinson’s disease?

Answer 2

Poor response to levodopa and the presence of additional neurological signs such as early falls, autonomic dysfunction, or dementia.

Question 3

What is the hallmark clinical feature of PSP?

Answer 3

Supranuclear gaze palsy, particularly difficulty with downward gaze.

Question 4

What is the ‘hummingbird sign’ in PSP?

Answer 4

Atrophy of the midbrain on MRI, resembling a hummingbird or penguin in sagittal view.

Question 5

What is the primary pathological finding in PSP?

Answer 5

Accumulation of tau protein in neurons and glia.

Question 6

What are the subtypes of MSA?

Answer 6

MSA-P (parkinsonian type)
MSA-C (cerebellar type)
MSA- A (Autonomic type) = Shy Dragger syndrome

Question 7

Which autonomic dysfunction is a hallmark of MSA?

Answer 7

Orthostatic hypotension.

Question 8

What is the ‘hot cross bun sign’?

Answer 8

Cross-shaped hyperintensity in the pons on MRI, seen in MSA-C.

Question 9

Name a distinguishing feature of MSA compared to Parkinson’s disease.

Answer 9

Early autonomic dysfunction and poor response to levodopa.

Question 10

Which protein accumulates pathologically in MSA?

Answer 10

Alpha-synuclein in oligodendrocytes.

Question 11

What is the hallmark motor abnormality in CBD?

Answer 11

Asymmetric rigidity and apraxia, often referred to as ‘alien limb syndrome.’

Question 12

Which cognitive domain is primarily affected in CBD?

Answer 12

Apraxia and visuospatial dysfunction.

Question 13

What is the typical age of onset for CBD?

Answer 13

Around 60–70 years of age.

Question 14

Which part of the brain is predominantly affected in CBD?

Answer 14

The parietal cortex and basal ganglia.

Question 15

What imaging feature supports the diagnosis of CBD?

Answer 15

Asymmetric cortical atrophy, especially in the parietal lobe, on MRI.

Question 16

What are the core features of DLB?

Answer 16

Fluctuating cognition, visual hallucinations, and parkinsonism.

Question 17

Which symptom differentiates DLB from Parkinson’s disease dementia?

Answer 17

Early cognitive impairment in DLB, occurring within 1 year of parkinsonism onset.

Question 18

What type of hallucinations is most common in DLB?

Answer 18

Well-formed visual hallucinations.

Question 19

Which neurotransmitter system is primarily affected in DLB?

Answer 19

Cholinergic system, leading to cognitive dysfunction.

Question 20

What is the role of imaging in diagnosing DLB?

Answer 20

SPECT or PET showing reduced dopamine transporter uptake in the basal ganglia.

Question 21

Name a supportive therapy used in MSA for orthostatic hypotension.

Answer 21

Fludrocortisone or midodrine.

Question 22

Which non-motor symptom management is crucial in PSP and MSA?

Answer 22

Speech therapy and supportive care for swallowing difficulties.

Question 23

What are the primary glomerular causes of haematuria?

Answer 23

IgA nephropathy, post-streptococcal glomerulonephritis, membranoproliferative glomerulonephritis

These conditions are classified as intrinsic renal pathology.

Question 24

Name a secondary glomerular cause of haematuria.

Answer 24

Systemic lupus erythematosus (SLE)

Other examples include small-vessel vasculitis and Henoch-Schönlein purpura.

Question 25

What is Alport syndrome?

Answer 25

A hereditary/structural defect causing haematuria ## Footnote It is characterized by progressive kidney disease and hearing loss.

Question 26

List two infectious causes of haematuria.

Answer 26

* Pyelonephritis * Cystitis ## Footnote Urethritis due to sexually transmitted infections is also a non-glomerular infectious cause.

Question 27

Identify a neoplastic cause of haematuria.

Answer 27

Renal cell carcinoma ## Footnote Other examples include bladder cancer, ureteric tumour, and prostate cancer.

Question 28

What structural/obstructive causes can lead to haematuria?

Answer 28

* Renal/ureteric stones * Polycystic kidney disease * Vascular malformations ## Footnote These conditions can create physical barriers affecting urine flow.

Question 29

What is benign prostatic hyperplasia (BPH) and its relevance to haematuria?

Answer 29

A common cause of haematuria in elderly males due to vascular congestion and irritation ## Footnote BPH can lead to urinary symptoms and complications.

Question 30

How can trauma cause haematuria?

Answer 30

Blunt or penetrating trauma to kidneys, ureters, bladder, or urethra ## Footnote Iatrogenic causes like catheterization or biopsy can also result in haematuria.

Question 31

What role does coagulopathy play in haematuria?

Answer 31

Anticoagulant therapy and platelet disorders can lead to increased bleeding ## Footnote Examples include warfarin, heparin, ITP, and DIC.

Question 32

What is exercise-induced haematuria?

Answer 32

Haematuria occurring after vigorous physical activity ## Footnote It is often benign but can be a sign of underlying issues.

Question 33

What is pseudohaematuria?

Answer 33

False positive dipstick results for blood in urine ## Footnote Causes include haemoglobinuria, myoglobinuria, and pigmenturia.

Question 34

Fill in the blank: The '4 I's Rule' for non-glomerular causes includes Infections, Injury, Impairment, and _______.

Answer 34

Intrinsic pathology ## Footnote This rule helps in recalling the categories of non-glomerular causes of haematuria.

Question 35

What does the 'Primary, Secondary, Hereditary' classification refer to?

Answer 35

It refers to the categorization of glomerular causes of haematuria ## Footnote Each category encompasses different underlying conditions.