Neuro

Question 1

Causes of olfactory nerve problems

Answer 1

COVID
Trauma to nose which disrupts cribriform plate
Frontal and temporal lobe tumours
Kallmans syndrome

Question 2

If problem with visual acuity what is first thing do

Answer 2

Assess with pinhole occluder to see if refractive errors

Question 3

What does impaired colour vision suggest

Answer 3

Problem with the optic nerve

Question 4

CN7 tests

Answer 4

Smile
Raise eyebrows
Close eyes and then try to oppose opening

Question 5

If notice impaired hearing on crude assesment what do

Answer 5

Otoscopy
Webers and rinnes

Question 6

How assess CN9-10

Answer 6

Look for NG tube/PEG
Ask to repeat phrases to assess speech- british constitution, red lorry, yellow lorry
Look at uvula and say ahhh
Offer gag reflex

Question 7

How assess CN12

Answer 7

Look at tongue
Ask to poke out tongue

Question 8

What looking for in inspection of limb exams

Answer 8

Involuntary movements
Wasting
Fasiculations
Scars
Trauma damage

Question 9

Spasticity vs rigidity

Answer 9

Spasticity- increases as move the limb
Rigidity- tense throughout

Question 10

Potential sites of neuro lesions

Answer 10

Brain
Spine
Spinal root
Peripheral nerve
Neuromuscular junction

Question 11

Acute stroke management

Answer 11

A-E approach initially- low GCS requiring intubation or identifying AF etc
Examination-assessing dysfunction with NIHSS
CT scan to exclude haemorrhage and identify if proximal cerebral artery occlusion, could then do CTPA and MRI to identify ischaemic penumbra if
Management then could involve thrombolysis, thrombectomy or 300mg aspirin depending on duration of symptoms

Question 12

Post stroke management

Answer 12

Swallow assessment and feeding- SALT within 24 hours
Glycaemic control
BP control
Fluid balance
Rehab assessed using barthel index

Question 13

What is the mcdonald criteria

Answer 13

Used to diagnose MS
Gold standard is 2 clinical attacks disseminated in time with 2 objective lesions on MRI
Other options include
- 2 clinical attacks with evidence of 1 lesion but then require additional evidence such as CSF oligoclonal bands or another attack

Question 14

UMN differentials

Answer 14

Stroke
Tumour
Infection- encephalitis, abscess
Motor neurone disease
Spinal pathology- traumatic transection, ischaema, infection

Question 15

Cerebellar differential causes

Answer 15

MS
Stroke
Tumour
Infection
Drug induced- alcohol, anti-epileptics like phenytoin, carbamazepine
B12 deficiency
Wernickes
Cerebral palsy
Genetic- friedrichs ataxia, ataxia telengiectasia, episodic ataxia
Paraneoplastic syndromes

Question 16

MS management

Answer 16

MDT approach led by neurology team including physios, occupational therapists, opthalmologist, SALT, psychologists
Managing exacerbations- oral or IV methylprednisolone depending on severity
Preventing progression with immunological agents such as natalizumab, peg interferon b and alemtuzumab
Managing complications
- spasticity with gabapentin, benzos, baclofen
- erectile dysfunction with sildenafil
- tiredness- amantadine and CBT
- incontinence- intermittent catheterisation or oxybutynin
- depression- amitryptyline

Question 17

Causes of horners

Answer 17

Split into central, preganglionic and post ganglionic
Central- MS, stroke
Pre ganglionic- cervical rib, trauma, thyroidectomy
Post- carotid artery dissection and

Question 18

Causes of motor neuropathy

Answer 18

Acquired
- GBS
- Lead poisoning
- Diphteria
Hereditary
- porphyria
- hereditary sensorimotor neuropathy

Question 19

Sensory predominant peripheral neuropathy

Answer 19

Metabolic
- uraemia
- B12
- hypothyroid
- alcohol
- uraemia
Infective
- leprosy
Systemic diseases
- Amyloidosis
- vasculitis

Question 20

Charcot marie tooth presentation

Answer 20

Pes cavus
Wine shaped leg
Foot drop
Hyporeflexia
Weakness in foot

Question 21

Charcot marie tooth management

Answer 21

MDT approach led by neurology
- physiotherapy which encourages exercise
- occupational therapy
- bracing
- orthopaedics to correct foot

Question 22

Nerve conduction studies findings

Answer 22

Demyelination- reduced speed
Axonal injury- reduced amplitude

Question 23

Investigations for charcot marie tooth disease

Answer 23

Nerve conduction studies- depends on the subtype
- CMT 1 is axonal loss
- CMT 2 is demyelination

Question 24

Causes of peripherla demyelination

Answer 24

GBS
Chronic inflammatory demyelination polyradiculoneuropathy
CMT type 2

Question 25

Central demyelination conditions

Answer 25

MS
JC virus causing progressive multifocal leukoencephalopathy

Question 26

Parkinsons management

Answer 26

MDT approach led by neurology
- include physio, OT, SALT
- medication includes- levodopa, dopamine agonists, monoamine oxidase B inhibitors
- first line depends if interruption of daily life, if so then levodopa with peripheral decarboxylase inhibitor like carbidopa

Question 27

Differentials for parkinsons

Answer 27

Drug induced
Essential tremor
Lewy body dementia

Question 28

Investigations for parksinsons

Answer 28

Clinical diagnosis but if diagnostic uncertainty could do DAT scan which will show reduced dopamine uptake in substantia nigra

Question 29

Proximal muscles weakness

Answer 29

Endocrine- cushings, steroids, thyrotoxicosis
Muscular dystrophy
Osteomalacia
Inflam- myositis, polymyalgia rheumatica
Neuromuscular disorders- MG, LEMs

Question 30

Bilateral upper motor neurone signs

Answer 30

MS
Myelopathy
MND

Question 31

Myelopathy damage areas and main findings

Answer 31

Central transection- spinothalamic+UL>LL
Anterior transection- bilateral below lost, dorsal preserved
Posterior transection- dorsal column
Brown sequard

Question 32

Causes of central spinal transection

Answer 32

Syringiomyelia