neuro

Question 1

treatment of a brain abscess

Answer 1

Brain abscess: IV 3rd-generation cephalosporin (ceftriaxone) + metronidazole

Question 2

presentation of a brain abscess

Answer 2

Fever, headache and features of raised intracranial pressure (vomiting, blurring of vision)

Question 3

suspected vestibular shwannoma- diagnosis

Answer 3

audiogram and MRI head scan

Question 4

presentation of vestibular schwannoma/ acoustic neuroma

Answer 4

The classical history of vestibular schwannoma includes a combination of vertigo, hearing loss, tinnitus and an absent corneal reflex.

Question 5

what condition can bilateral vestibular schwannoma/ acoustic neuroma commonly occur within?

Answer 5

NF2

Question 6

What is autonomic dysreflexia?

Answer 6

clinical syndrome occurs in patients who have had a spinal cord injury at, or above T6 spinal level.

Question 7

presentation of autonomic dysreflexia

Answer 7

extreme hypertension, flushing and sweating above the level of the cord lesion, agitation, and in untreated cases severe consequences of extreme hypertension have been reported, e.g. haemorrhagic stroke.

Question 8

MS- CSF findings

Answer 8

oligoclonal bands

Question 9

presentation of dyskinesia

Answer 9

dystonia, chorea, athetosis

Question 10

examples and noteable side effect of dopamine agonists

Answer 10

bromocrimptine, cabergoline, pergolide

side effect= pulmonary fibrosis

Question 11

describe a 6th cranial nerve palsy

Answer 11

internuclear ophthalmoplegia and conjugate lateral gaze disorder

so problems moving the eye (muscles) with a lateral gaze

Question 12

presentation of optic neuritis

Answer 12

Optic neuritis presents with unilateral reduced vision developing over hours to days. Key features are:

Central scotoma. This is an enlarged blind spot.
Pain on eye movement
Impaired colour vision
Relative afferent pupillary defect

Question 13

management of MS relapses

Answer 13

methylprednisolone

Question 14

oculomotor palsy presentation

Answer 14

‘down-and-out’ eye position, hence the patient’s difficulty with eye adduction

ptosis and inability to adduct eye

Question 15

presentation of syringomyelia

Answer 15

a ‘cape-like’ (neck, shoulders and arms)
loss of sensation to temperature but the preservation of light touch, proprioception and vibration

Question 16

presentation of encephalitis

Answer 16

fever, headache, psych symptoms, seizures, vomit

focal symptoms (aphasia etc)

Question 17

what cranial nerves does a vestibular schwannoma affect

Answer 17

Cranial nerves V, VII and VIII are affected in vestibular schwannomas

Question 18

trochlear nerve palsy

Answer 18

Palsy results in defective downward gaze → vertical diplopia

Question 19

trigeminal nerve palsy

Answer 19

Lesions may cause:
trigeminal neuralgia
loss of corneal reflex (afferent)
loss of facial sensation
paralysis of mastication muscles
deviation of jaw to weak side

Question 20

abducens nerve palsy

Answer 20

Palsy results in defective abduction → horizontal diplopia

Question 21

facial nerve palsy

Answer 21

Lesions may result in:
flaccid paralysis of upper + lower face
loss of corneal reflex (efferent)
loss of taste
hyperacusis

Question 22

vestibulocochlear nerve palsy

Answer 22

Hearing loss
Vertigo, nystagmus
Acoustic neuromas are Schwann cell tumours of the cochlear nerve

Question 23

glossopharyngeal nerve palsy

Answer 23

Lesions may result in;
hypersensitive carotid sinus reflex
loss of gag reflex (afferent)

Question 24

vagus nerve palsy

Answer 24

Lesions may result in;
uvula deviates away from site of lesion
loss of gag reflex (efferent)

Question 25

accessory nerve palsy

Answer 25

Lesions may result in; weakness turning head to contralateral side

Question 26

hypoglossal nerve palsy

Answer 26

Tongue deviates towards side of lesion

Question 27

side effects of levodopa

Answer 27

dry mouth anorexia palpitations postural hypotension psychosis

Question 28

epilepsy- localising features of focal seizures- temporal lobe

Answer 28

Hallucinations (auditory/gustatory/olfactory), Epigastric rising/Emotional, Automatisms (lip smacking/grabbing/plucking), Deja vu/Dysphasia post-ictal)

Question 29

epilepsy- localising features of focal seizures- frontal lobe

Answer 29

Head/leg movements, posturing, post-ictal weakness, Jacksonian march

Question 30

epilepsy- localising features of focal seizures- parietal lobe

Answer 30

paraesthesia

Question 31

epilepsy- localising features of focal seizures- occipital lobe

Answer 31

flutters/ flashes

Question 32

MS- first line management of spasticity

Answer 32

baclofen and gabapentin

Question 33

normal pressure hydrocephalus presentation

Answer 33

Urinary incontinence + gait abnormality + dementia wet, wobbly, wacky

Question 34

encephalitis- CSF findings

Answer 34

lymphocytosis, elevated protein

Question 35

what is encephalitis commonly associated with?

Answer 35

measles

Question 36

criteria for a total anterior circulation infarct

Answer 36

involves middle and anterior cerebral arteries all 3 of 1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg 2. homonymous hemianopia 3. higher cognitive dysfunction e.g. dysphasia

Question 37

criteria for a partial anterior circulation infarct

Answer 37

2 of: 1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg 2. homonymous hemianopia 3. higher cognitive dysfunction e.g. dysphasia

Question 38

criteria for a Lacunar infarct

Answer 38

involves perforating arteries around the internal capsule, thalamus and basal ganglia presents with 1 of the following: 1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three. 2. pure sensory stroke. 3. ataxic hemiparesis

Question 39

criteria for a posterior circulation infarct

Answer 39

involves vertebrobasilar arteries presents with 1 of the following: 1. cerebellar or brainstem syndromes 2. loss of consciousness 3. isolated homonymous hemianopia

Question 40

criteria for lateral medullary syndrome

Answer 40

ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner's contralateral: limb sensory loss

Question 41

criteria for Webers syndrome

Answer 41

ipsilateral III palsy contralateral weakness

Question 42

what medications should be avoided in myasthenia gravis?

Answer 42

penicillamine quinidine, procainamide beta-blockers lithium phenytoin antibiotics: gentamicin, macrolides, quinolones, tetracyclines

Question 43

myasthenia gravis- investigations

Answer 43

Acetylcholine receptor (ACh-R) antibodies (85% of patients) Muscle-specific kinase (MuSK) antibodies (10% of patients) LRP4 (low-density lipoprotein receptor-related protein 4) antibodies (less than 5%) A CT or MRI of the thymus gland is used to look for a thymoma. The edrophonium test can be helpful where there is doubt about the diagnosis.

Question 44

treatment of myasthenia gravis

Answer 44

Reversible acetylcholinesterase inhibitors (usually pyridostigmine or neostigmine) Immunosuppression (e.g. prednisolone or azathioprine) suppresses the production of antibodies Thymectomy can improve symptoms even in patients without a thymoma Monoclonal antibodies- Rituximab, Eculizumab

Question 45

which anti-emetic is safe to use in Parkinsons and why?

Answer 45

domperidone- does not cross the blood-brain barrier

Question 46

clinical signs of idiopathic intracranial hypertension

Answer 46

headache blurred vision papilloedema (usually present) enlarged blind spot sixth nerve palsy may be present (inability to abduct eye)

Question 47

medication overuse headache- how should analegesia (simple and opioids) be discontinued?

Answer 47

simple analgesia + triptans: stop abruptly opioid analgesia: withdraw gradually

Question 48

parkinsons- describe the tremor

Answer 48

unilateral tremor that improves with voluntary movement

Question 49

diagnosis of an acoustic neuroma

Answer 49

MRI of the cerebellopontine angle

Question 50

characteristic features of CJD

Answer 50

Creutzfeldt-Jakob disease is characterised by rapid onset dementia and myoclonus

Question 51

migraine prophylaxis

Answer 51

topiramate/ propanolol

Question 52

what medication used in the management of epilepsy must you be cautious with if the patient is on warfarin?

Answer 52

sodium valporate

Question 53

what cranial nerves does a vestibular shwannoma effect?

Answer 53

Cranial nerves V, VII and VIII

Question 54

what is neurofibromatosis type 2 assosciated with?

Answer 54

Neurofibromatosis type 2 is associated with bilateral vestibular schwannomas

Question 55

nerve supplying the innervation to the finger extensors (motor)

Answer 55

radial

Question 56

nerve supplying the interossei muscles (adduction of the fingers)

Answer 56

ulnar

Question 57

nerve supplying sensation to the lateral shoulder

Answer 57

axillary nerve

Question 58

what drugs can cause exacerbations of myasthenia gravis?

Answer 58

The following drugs may exacerbate myasthenia: penicillamine quinidine, procainamide beta-blockers lithium phenytoin antibiotics: gentamicin, macrolides, quinolones, tetracyclines