Neuro

Question 1

Neurocutaneous syndromes

Answer 1

Neurofibromatosis
Sturge Weber
Tuberous sclerosis
Von Hippel Lindau
Ataxia telegiectasia

Question 2

Operating and historical definition of status epilepticus

Answer 2

Operating: >5Mins
Hisorical: >30mins

Question 3

Difference between medical and surgical third nerve palsies

Answer 3

Surgical CN3 palsy usually affects pupil(Causes mydriasis)
Medical CN3 palsy may spare the pupil

Question 4

Causes of peripheral neuropathy

Answer 4

Diabetic neuropathy
Alcoholism
Syphilis
Charcot Marie tooth
Leprosy

Question 5

Triad of Miller Fisher Syndrome

Answer 5

A subset of GBS

Ophthalmoplegia
Ataxia
Areflexia

Question 6

Webers test

Answer 6

Localises towards side of conductive hearing loss

OR

Localises away from side of sensorineural hearing loss

Question 7

Rinne test

Answer 7

Positive: AC>BC (Normal or sensorineural hearing loss)
Negative: BC>AC(conductive hearing loss)

Question 8

CN and muscles involved in bulbar palsy(medulla oblongata lesion)

Answer 8

CN 9,10,11,12 LMN lesion

Palate and tongue muscles

Question 9

1st rule of 4 of Brainstem

Answer 9

4 CN in brainstem and above
4 CN in pons
4 CN in medulla oblongata

Question 10

2nd rule of 4 of brainstem

Answer 10

4 midline nuclei that can divide 12

CN 3,4,6,12

Question 11

3rd rule of 4 of brainstem

Answer 11

4 midline structures

1. Motor(corticospinal)
2. Medial Lemniscus(DCML)
3. MLF
4. Motor nuclei of midline(3,4,6,12)

Question 12

4th rule of 4 of brainstem

Answer 12

4 side structures

1. Spinothalamic
2. Spinocerebellar
3. Sympathetic pathway
4. Sensory nucleus of CN V

Question 13

Dydx MG and LEMS

Answer 13

LEMS has reduced reflexes,MG does not

Question 14

Chronic Mx of MG

Answer 14

AchE-inhibitor: Pyridostigmine
Immunosuppression: Corticosteroids or azathioprine

Question 15

5 key signs in neuro exam

Answer 15

Wasting
Reflexes
Tone babinski

Question 16

Non modifiable risk factors for stroke

Answer 16

Age
Gender
ethnicity

Question 17

Modifiable stroke risk factors

Answer 17

DM
HLD
HTN
Atrial fibrillation

Smoking
Atherosclerotic disease
Vasculitides
HIV
OCPs
Haem eg Thrombophilias

Question 18

Signs of POCS posterior occipital circulation stroke

Answer 18

1. CN palsy with contralateral motor loss
2. Bilateral motor sensory deficit
3. Conjugate eye movement
4. Cerebellar dysfunction
5. Isolated homonymous hemianopia

Question 19

Features of TACS total anterior circulation stroke

Answer 19

ALL of the following
-loss of higher cortical dysfunction
-homonymous hemianopia
-motor/sensory stroke
-

Question 20

Features of partial anterior circulation stroke(PACS)

Answer 20

2 of the TACS criteria

OR

1) higher cortical dysfunction alone
2) Limited sensory motor deficit

Question 21

Features of Lacunae stroke(LACS)

Answer 21

Any of
1) Pure motor deficit
2) Pure Sensory deficit
3) Ataxic Hemiparesis
4) Sensorimotor
5) NO higher cortical function loss or posterior circulation issues

Question 22

Nerves that pass through the cavernous sinus

Answer 22

CN3, CN4, CNV1 CNV2 CN6

Question 23

Nerves that pass through the superior orbital fissure

Answer 23

CN2 CN3 CN4 CNV1 CN6

Question 24

Exclusion criteria for rTPA

Answer 24

1. Age >80
2. On anticoagulation regardless of INR
3. NIHSS >25
4. Hx of stroke/DM

Question 26

6Ms of complex opthalmoplegia

Answer 26

1. Myasthenia Gravis 2. Myopathy of EOMs 3. Miller Fisher Syndrome 4. Mononeuritis multiplex 5. Multiple Sclerosis 6. Multiple CN pathology

Question 27

4 steps to multiple CN neuropathies

Answer 27

1. Rules of 4 2. Brainstem clubs 3. Meninges/base of skull lesions 4. Peripheral neuropathy

Question 28

Gold standard for SAH diagnosis

Answer 28

4 vessel cerebral angiogram -2 ICA 2 vertebral artery CT or digital subtraction

Question 29

Dx criteria of NF1

Answer 29

2/7 of Cafe au lait spots or hyperpigmented nodules(6+ , >5mm for prepubertal, >15mm for postpubertal) Neurofibromas Crowe sign( Freckles on axillary/inguinal region) Lisch nodules(2+) Optic nerve Gliomas Sphenoid dysplasia/ long bone abnormalities First deg relative with NF1

Question 30

Gene affected by NF1

Answer 30

NF1 gene on chromosome 17

Question 31

Gene affected by NF2

Answer 31

NF2 gene on chromosome 22

Question 33

Criteria for fitness to drive for an patients with epilepsy in Singapore

Answer 33

3 years seizure free and 1 year off anti epileptic drugs