neuro

Question 1

how to screen for diabetic nephropathy? what value is considered abnormal?

Answer 1

ACR may be measured on a spot sample if a first-pass sample is not provided (but should be repeated on a first-pass specimen if abnormal)

ACR > 2.5

Question 2

A patient with AF + an acute stroke (not haemorrhagic) should have anticoagulation therapy started _______ (when?) ________

Answer 2

two weeks after the event

Question 3

Painful third nerve palsy = lesion where?

Answer 3

posterior communicating artery aneurysm

Question 4

associated effects of stroke in -
1. anterior cerebral artery
2. middle cerebral artery
3. posterior cerebral artery

Answer 4

1. anterior cerebral artery: contralateral hemiparesis and sensory loss, lower > upper
2. middle cerebral artery: contralateral hemiparesis ans sensory loss, upper > lower. Contralateral homonymous haemianopia, aphasia.
3. posterior cerebral artery: contralateral homonymous hemianopia with macular sparing, visual agnosia

Question 5

associated effects of stroke in -
1. Weber’s
2. Wallenberg
3. Lateral pontine syndrome

Answer 5

1. Weber’s (branches of postrior cerebral artery): ipsilateral CN lll palsy, contralateral weakness of upper and lower exremities
2. Wallenberg (PICA): ipsilateral paina and tempterature loss, contralateral loss of pain and temprature in limbs. Ataxia and nystagmus.
3. Lateral pontine syndrome (Anterial inferior cerebellar artery): Ipsilateral facial paralysis and deafness (due to damage to facial nerve)

Question 6

medication overuse headaches:
- simple analgesia
- opioid analgesia

Answer 6

• stop immediately
• withdraw gradually

Question 7

Headache linked to Valsalva manoeuvres =
Other signs of raised ICP?

Answer 7

raised ICP
Papilloedema, Cushing’s triad (widened pulse pressure, bradycardia, irregular increased respirations)

Question 8

Distal sensory loss, tingling + absent ankle jerks/extensor plantars + gait abnormalities/Romberg’s positive →

Answer 8

subacute combined degeneration of the spinal cord

Question 9

If a patient is on warfarin/a DOAC/ or has a bleeding disorder and they are suspected of having a TIA,

Answer 9

they should be admitted immediately for imaging to exclude a haemorrhage

Question 10

Progressive peripheral polyneuropathy with hyporeflexia suggests

Answer 10

Guillain-Barre syndrome

Question 11

acute vs chronic subdural haematoma - difference in presentation?

Answer 11

chronic: dark –> hypodense
acute: bright –> hyperdense

Question 12

which muscles does myasthenia gravis affect first?

Answer 12

proximal, extra-ocular

Question 13

According to NICE guidelines patients over 65 get a CT head if they

Answer 13

have had some loss of consciousness or amnesia since a fall

Question 14

visual field defects

Answer 14

Question 15

explain how SDOSC presents

Answer 15

Damage to the posterior columns - loss of proprioception, light touch and vibration sense (sensory ataxia and a positive Romberg’s test).
Damage to lateral columns - spastic weakness and upgoing plantars (UMN signs).
Damage to peripheral nerves - absent ankle and knee jerks (LMN signs).

When there is a mix of UMN and LMN signs in a patient, always consider SCDC.

Question 16

LP findings in GBS

Answer 16

raised protein, normal WBC

Question 17

what exacerbates myasthenia gravis

Answer 17

bblockers

Question 18

papilloedema, 6th nerve palsy, no other focal neuro signs =

Answer 18

Idiopathic intracranial hypertension

Question 19

Lesions at ____ will cause finger abduction weakness

Answer 19

T1
Klumpke’s paralysis

Question 20

________ is a common consequence of subarachnoid haemorrhage

Answer 20

SIADH

Question 21

Ptosis + dilated pupil =
ptosis + constricted pupil =

Answer 21

1. third nerve palsy
2. Horner’s

Question 22

A history of Intravenous drug use coupled with a descending paralysis, diplopia and bulbar palsy is characteristic of infection with

Answer 22

Clostridium botulinum

Botulism does not usually present with fever, loss of sensation or loss of awareness

Question 23

Pt started on steroids for exacerbation of COPD shows raised WCC - what do you do

Answer 23

nothing - Corticosteroids can induce neutrophilia

Question 24

Low CSF headaches can occur due to spontaneous intracranial hypotension (not necessarily post-LP) and are classically worse on standing and improve when lying flat

Question 25

Conduction dysphasia:

Answer 25

speech fluent, but repetition poor. Comprehension is relatively intact

Question 26

MS Tx - to reduce fatigue - to reduce spasticity - to reduce frequency of attacks

Answer 26

- to reduce fatigue: amantidine - to reduce spasticity: baclofen - to reduce frequency of attacks: nalaizumab

Question 27

Autonomic dysreflexia can only occur if the spinal cord injury occurs above the ____ level

Answer 27

T6

Question 28

spinal cord compression: which lesions cause which signs

Answer 28

. Lesions above L1 usually result in upper motor neuron signs in the legs and a sensory level. Lesions below L1 usually cause lower motor neuron signs in the legs and perianal numbness. Tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion

Question 29

____________ increase the risk of idiopathic intracranial hypertension

Answer 29

Tetracyclines

Question 30

CMD only has ________ signs

Answer 30

LMN

Question 31

Phenytoin is a cause of

Answer 31

aplastic anaemia

Question 32

Raised ICP can cause

Answer 32

a third nerve palsy due to herniation

Question 33

how does cavernous sinus thrombosis present?

Answer 33

Cavernous sinus thrombosis is another important complication in sinusitis but usually presents with unilateral facial oedema, photophobia, proptosis and palsies of the cranial nerves which pass through it (III, IV, V, VI).

Question 34

what pathophysiological finding is CHARACTERISTIC of Alzheimer's?

Answer 34

Amyloid plaques and tau proteins

Question 35

Lady presents with Sx of stroke + fixed splitting of second heart sound - Dx?

Answer 35

ASD can cause paradoxical stroke where embolism travels from veins and bypasses pulmonary circulation

Question 36

A 21-year-old man is involved in a road traffic accident. After a transient period of concussion he is found to have a GCS of 15 by the paramedics. On arrival at hospital he is monitored in a side room of the emergency department. When he is next observed he is noted to have a GCS of 3 and a blown right pupil. Which of the processes below best accounts for this deterioration?

Answer 36

1. extradural bleed 2. trans-tentorial herniation

Question 37

How does SDotSC present? Which tracts are affected?

Answer 37

Subactute Combined Degeneration = Spinocerebellar, Corticospinal, Dorsal Spinocerebellar: sensory ataxia, positive Romberg's Corticospinal: (UMN) so brisk knee reflexes, absent ankle reflexes, spasticity, weakness Dorsal: symmetrical tingling/burning

Question 38

When are phenytoin levels checked?

Answer 38

immediaely before next dose

Question 39

A 28-year-old female presents with a two-day history of a gradual onset severe headache associated with nausea and three episodes of vomiting. She comes across as blunted and states she is having difficulty in finding the right words. She has no significant past medical history and her only medication is the combined oral contraceptive pill. The only thing of note in her family history is that her mother had an unprovoked DVT in her 30s. Given the likely diagnosis, what is the gold standard test to diagnose her condition?

Answer 39

MR Venogram is the gold standard test for diagnosing venous sinus thrombosis

Question 40

A 65-year-old male with known nasopharyngeal carcinoma presents with double vision over a few weeks. On examination he is found to have left eye proptosis and it is down and out. He reports pain on attempting to move the eye. There is an absent corneal reflex. What is the most likely diagnosis?

Answer 40

Cavernous sinus syndrome Diagnosis is based on signs of pain, opthalmoplegia, proptosis, trigeminal nerve lesion (opthalmic branch) and Horner's syndrome.

Question 41

___________ is a scale that measures disability or dependence in activities of daily living in stroke patients

Answer 41

The Barthel index

Question 42

_____________is completely responsive to treatment with indomethacin

Answer 42

Paroxysmal hemicrania

Question 43

Parkinsonism with associated autonomic disturbance (atonic bladder, postural hypotension) points towards

Answer 43

Multiple System Atrophy autonomic disturbance erectile dysfunction: often an early feature postural hypotension atonic bladder cerebellar signs

Question 44

what i Hoffman's sign + what disease can it show?

Answer 44

Hoffmans sign is elicited by flicking the distal phalaynx of the middle finger to cause momentary flexion. A positive result is exaggerated flexion of the terminal phalanyx of the thumb. Shows UMN stuff like degenerative cervical myelopathy and MS

Question 45

Motion sickness Tx -

Answer 45

hyoscine > cyclizine > promethazine