Neuro

Question 1

Rx of ischaemic stroke
Including time windows

Answer 1

If <4.5hrs give alteplase
If beyond, give aspirin 300mg
If <6 thrombectomy

Question 2

Medication used to treat idiopathic intracranial hypertension

Answer 2

acetozolamide

Question 3

Sx and signs of IIH

Answer 3

whooshing sound
headaches
b/l papilloedema
intermittent visual loss
obesity

Question 4

what medication should be prescribed in all cases of suspected encephalitis and to cover for what

Answer 4

acyclovir
cover for HSV (cause of 95% of encephalitis in the UK)

Question 5

rx of myasthenia crisis

Answer 5

IV Immunoglobulins
ITU for breathing support

Question 6

first line drugs for muscle spasticity in MS

Answer 6

baclofen and gabapentin

Question 7

first line ix for suspected acoustic neuroma

Answer 7

audiogram and gadolinium enhanced Mri head

Question 8

is ophthalmoplegia observed in mnd

Answer 8

nope, eyes are typically spared

Question 9

what must be measured regularly in pts with MG

What is the target

what is rx plan if below target

Answer 9

FVC every 4 hrs

> 20ml/kg

contact ITU for respiratory support

Question 10

cause of subacute degeneration of the cord

Answer 10

B12 deficiency

• crohns
• pernicious anaemia
• NO
• vegans
• chronic pancreatitis
• wernickes encephalopathy

Question 11

presentation of wernickes encephalopathy

Answer 11

confusion, ophthalmoplegia, difficult with balance
may have ascites

Question 12

triad of Parkinson’s

Answer 12

rigidity
tremor
bradykinesia

Question 13

common GI issues in Parkinson’s

Answer 13

constipation and volvulus

Question 14

ix for Gillian barre

Answer 14

lumbar puncture - + proteins
nerve conduction studies

Question 15

what response failure may myasthenia develop

Answer 15

type 2

Question 16

airway adjunct in seizures

Answer 16

NPA

Question 17

lorazepam dose

Answer 17

4mg IV

Question 18

most common type of MS ie its course

Answer 18

relapsing remitting

Question 19

causes of ischaemic stroke

Answer 19

afib
valvular heart disease
obesity, htn, carotid athero

Question 20

difference in presentation between ischaemic and haemorrhage stroke

Answer 20

haemorragic - reduced GCS and seizures

Question 21

most common cause of deep brain haemorrhage

Answer 21

HTN

Question 22

what artery damaged in subdural
who is it common in

Answer 22

bridging veins

old, alcoholics

Question 23

rx of brain bleed fy1

Answer 23

if on anti coags stop
If on warfarin check INR and reversal if needed
give levetiracetam for seizure prevention

Question 24

what artery damaged in extradural

Answer 24

middle meningeal artery

Question 25

extradural classic presentation

Answer 25

LOC Lucid Interval Confusion +/- LOC

Question 26

cushings reflex triad

Answer 26

irregular breathing wide pulse pressure bradycardia

Question 27

Pt with a head injury starts to irregularly breathe. What other signs would make this a very concerning case

Answer 27

wide pulse pressure bradycardia - bushings reflex - emergency !!!

Question 28

rx of raised ICP - (not idiopathic)

Answer 28

iv mannitol head elevation controlled hyperventilation

Question 29

how does controlled hyperventilation work in raised ICP

Answer 29

reduce CO2 - vasoconstriction of cerebral arteries causing reduced ICP

Question 30

rx of acute relapse of MS

Answer 30

high dose steroids

Question 31

rx of bells palsy

Answer 31

prednisolone an eye care (as can't close eye)

Question 32

rx of essential tremor

Answer 32

propanolol

Question 33

presentation of guillain barre

Answer 33

lower back pain progressive weakness and peripheral neuropathy hx of gastroenteritis hyporeflexia

Question 34

side effects of levodopa

Answer 34

dyskinesias: dystonia, chorea, athetosis postural hypotension n+v lossof appetitie sleep problems

Question 35

where is brocas area what does brocas do

Answer 35

left lateral frontal lobe actual enunciation of words ie they can think of them but can't say them

Question 36

Where is wernickes what wernickes do

Answer 36

left posterior aspect of superior temporal lobe understanding information

Question 37

Vessesl associated with each stroke type

Answer 37

TACS - MCA, Internal carotid PACS - branch of MCA Lacunar - lenticulostriae POCS - basilar, PCA, cerebellar, vertebral

Question 38

TACS

Answer 38

Homonymous hemianopia Higher cortical dysfunction Unilateral motor or sensory loss

Question 39

PACS

Answer 39

2/3 of TACS

Question 40

Lacunar

Answer 40

Pure motor Pure sensory ataxic hemiplegia Sensorimotor

Question 41

POCS

Answer 41

contralateral hemiparesis with ipsilateral cranial nerve cerebellar - DANISH isolated homonymous hemianopia internuclear ophthalmoplegia b/l motor and/or sensory

Question 42

apart from headache, signs and sx of SAH

Answer 42

meninges - photophobia and stiffness nausea and vomiting seizures focal neurology visual disturbance collapse

Question 43

signs to test for meningism

Answer 43

kernigs and brudzinskis

Question 44

when to perform LP in SAH

Answer 44

if a CT >6hrs was normal but clinical suspicion still high. Must wait at least 12 hrs before performing

Question 45

what is the role of nimodipine in SAH

Answer 45

reduce vasospasm

Question 46

within how many hrs should a TIA be referred to a specialist

Answer 46

24hrs