neuro

Question 1

low levels of which ion can cause seizures?

Answer 1

phosphate

Question 2

how long does it take for delirium to resolve and its significance?

Answer 2

takes 4-6 weeks, sometimes up to 2-3 months. (means patient can’t be diagnosed w dementia unless symptoms longer than this)

Question 3

when are headaches associated with raised ICP the worst?

Answer 3

in the mornings

Question 4

what is a big risk after an SAH?

Answer 4

cerebral vasospasm

Question 5

which prophylaxis do you give for cerebral vasospasm?

Answer 5

nimodipine -type of calcium blocker that decreases risk of vasospasm

Question 6

what is roseola infantum caused by?

Answer 6

HHV-6

Question 7

what is the presentation of roseola infantum?

Answer 7

viral illness-3-4 days of fever, 24 hours of maculopapular rash, self resolving

Question 8

what is progressive supranuclear palsy?

Answer 8

degenerative condition of unknown aetiology that produces an akinetic-rigid form of parkinsonism characterised by early falls and abnormalities of extraocular movements

Question 9

what are the typical signs of progressive supranuclear palsy?

Answer 9

backwards falls
hypometria
dysarthria
dysphagia
bradykinesia

Question 10

what is hypometria?

Answer 10

when the eyes undershoot when trying to focus on an object

Question 11

what visual field defect would a stroke affecting the optic radiation cause?

Answer 11

contralateral HH

Question 12

what visual field defect would a stroke affecting the occipital lobe cause?

Answer 12

HH usually with macular sparing

Question 13

what is brown-sequard syndrome?

Answer 13

result of hemisection of spinal cord-ipsilateral loss of fine touch, vibration, and proprioception, contralateral loss of pain and temp

Question 14

what is the preferred imaging modality for TIA?

Answer 14

MRI brain with diffusion weighted imaging-to determine area of ischaemia

Question 15

what is functional MRI used for?

Answer 15

assess regional blood flow in brain whilst patient performs tasks, may be used to study the effect of TIA once confirmed.

Question 16

what drug is used as first line treatment of MS?

Answer 16

methylprednisolone

Question 17

what is the recommended empirical therapy for adults >50 with suspected bacterial meningitis?

Answer 17

IV cefotaxime/ceftriaxone + amoxicillin/ampicillin

Question 18

what is tardive dyskinesia?

Answer 18

disorder that result in involuntary repetitive body movements eg grimacing, sticking out tongue, smacking lips. most common=chewing, pouting jaw.

Question 19

what medication is usually prescribed to relieve headache due to raised ICP?

Answer 19

dexamethasone

Question 20

what is mannitol used for and why?

Answer 20

cerebral oedema, raised intra-ocular pressure, CF as add-on therapy (helps with pulmonary oedema)
is an osmotic diuretic

Question 21

what is the nice treatment for neuropathic pain?

Answer 21

amitriptyline, duloxetine, gabapentin, or pregabalin
if one doesn’t work try one of the others-switch don’t add
tramadol can be used as ‘rescue therapy’
topical capsaicin can be used for localised neuropathic pain, eg post herpetic neuralgia
carbamazapine-1st line for trigeminal neuralgia

Question 22

what is the 1st line treatment for early status epilepticus?

Answer 22

IV lorazepam

Question 23

what do you do if it’s an ischaemic stroke but it’s been more than 4.5 hours?

Answer 23

give aspirin

Question 24

what are the rules on epilepsy and driving?

Answer 24

1st ever seizure with LOC: license gone for 6 months, then have to reapply if no seizures for 6 months
have had more than one seizure with LOC: license gone for a tear, can reapply
if seizure because of medication change: can reapply after 6 months if back on previous medication and no more seizures in that time

Question 25

what are the rules on stroke and driving?

Answer 25

driving may resume after 1 month if satisfactory clinical recovery-dvla doesn't need to be notified unless residual neurological deficits

Question 26

name 3 risk factors for MS

Answer 26

female gender age 20-40 vit D deficiency

Question 27

what is the investigation of choice for optic neuritis MS?

Answer 27

MRI with contrast-allows visualization of the demyelinating lesions

Question 28

what is the drug management of status epilepticus?

Answer 28

1st line: IV benzos like lorazepam, diazepam (generally IV lorazepam) PR diazepam or buccal midazolam can be given too 2nd line: phenytoin or phenobarbital infusion if no response within 45 minutes, induce general anaesthesia.

Question 29

when do you do thrombolysis AND thrombectomy to treat stroke?

Answer 29

confirmed occlusion of the proximal anterior circulation on imaging

Question 30

what artery is occluded if you have amaurosis fugax stroke?

Answer 30

retinal/opthalmic artery on the side you're experiencing symptoms

Question 31

what visual field defect would you get if you have an MCA stroke?

Answer 31

contralateral homonymous quandrontanopia/hemianopia

Question 32

what visual field defect would you get if you have an MCA stroke?

Answer 32

contralateral homonymous quandrontanopia/hemianopia

Question 33

what is hoover's sign and its significance?

Answer 33

diagnostic test from neurological as opposed to psychological hemiplegia positive hoover's sign suggests it is psychogenic and not truly neurological

Question 34

what is conversion disorder?

Answer 34

symptom, usually neuro, presenting after period of stress.

Question 35

what is factitious disorder?

Answer 35

feigning of symptoms in order to receive compassion from healthcare professionals

Question 36

what is titubation?

Answer 36

(involuntary) nodding movement of head or body usually caused by neuro disorder

Question 37

what's the firstline imaging for stroke?

Answer 37

NON CONTRAST CT head

Question 38

what is the correct first line imaging for SAH?

Answer 38

non contrast CT head

Question 39

when should you do a LP when suspecting SAH?

Answer 39

if the CT head had been performed after 6 hours from the onset of symptoms and came back normal. The timing of the LP should be 12h after the onset of symptoms to allow for the development of xanthochromia-not recommended to do any earlier.

Question 40

what is essential to rule out in someone presenting with vertigo?

Answer 40

posterior stroke

Question 41

what is a broad based ataxic gait associated with?

Answer 41

midline cerebellar pathology, eg a lesion in MS or degeneration of the cerebellar vermis due to chronic alcohol excess

Question 42

in unilateral cerebellar disease what does their gait look like?

Answer 42

ataxic (staggering, slow, unsteady) and patient veers towards side of lesion.

Question 43

what blood gas abnormality does meningitis show?

Answer 43

metabolic acidosis

Question 44

what are some examples of third gen cephalosporins?

Answer 44

ceftriaxone, cefotaxime

Question 45

what is the most common electrolyte abnormality complication of SAH?

Answer 45

hyponatraemia -usually due to SiADH

Question 46

which GCSs indicate when to do a CT head?

Answer 46

<13 at first presentation: CT head within an hour <15 2h post injury: CT head within 8 hours

Question 47

what is the classic symptoms of normal pressure hydrocpehalus?

Answer 47

wet, wacky, and wobbly: urinary incontinence, gait ataxia, dementia

Question 48

what are the features of viral labyrinthitis?

Answer 48

recent viral infection sudden onset vertigo, N+V, can affect hearing

Question 49

what are the features of vestibular neuronitis?

Answer 49

recent viral URTI recurrent vertigo attacks lasting hours/days no hearing loss

Question 50

what are the features of vertebrobasilar ischaemia?

Answer 50

vertigo dizziness on extension of neck happens in older people

Question 51

what are the features of accoustic neuroma?

Answer 51

hearing loss, vertigo, tinnitus absent corneal reflex associated with neurofibromatosis type 2

Question 52

what can acute severe hyponatraemia cause?

Answer 52

cerebral oedema