Neuro

Question 1

Neurofibratosis vs tuberous sclerosis

Answer 1

TS
- epilepsy
- shagreen patches
- ash leaf spots
- sublingual fibromata
- retinal hamartomas

NF
- cafe au lait
- phaechromocytoma
- acoustic neuroma (Type 2)
- Lisch nodules

Question 2

Complication of intraventricular haemorrhages

Answer 2

Hydroephalus

Question 3

What medication may be stopped in patients with dementia

Answer 3

TCA

Question 4

Most common cause of viral meningitis in adults

Answer 4

enteroviruses: coxsackie b

Question 5

gold standard test for venous sinus thrombosis

Answer 5

MR venogram

Question 6

motion sickness treatment

Answer 6

hyoscine transdermal patch
cyclizine
promethazine

Question 7

right cranial nerve 6 palsy

Answer 7

right eye adducted and horizontal diplopia

Question 8

Most common neurological infection seen with HIV

Answer 8

toxoplasmosis

Question 9

What is seen on CT head with toxoplasmosis

Answer 9

multiple ring enhancing lesions

Question 10

ill-defined hypodense areas in the bilateral temporal lobes and inferior frontal lobes with history of HIV

Answer 10

Herpes simplex encephalitis

Question 11

Painful third nerve palsy

Answer 11

posterior communicating artery aneurysm

Question 12

3rd nerve palsy vs horners

Answer 12

Ptosis + dilated pupil = third nerve palsy; ptosis + constricted pupil = Horner’s

Question 13

total anterior infarct.

Answer 13

1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

Question 14

Lacunar infarct

Answer 14

1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

Question 15

Posterior infarct

Answer 15

1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia

Question 16

what will EMG show with lambert eaton

Answer 16

incremental response to repetitive electrical stimulation

Question 17

what is Waterhouse-Friderichsen syndrome

Answer 17

meningococcal meningitis complication
adrenal insufficiency secondary to adrenal haemorrhage).

Question 18

bitemporal hemianopia

Answer 18

lesion of optic chiasm
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour

lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

Question 19

homonymous hemianopia

Answer 19

incongruous defects: lesion of optic tract
congruous defects: lesion of optic radiation or occipital cortex
macula sparing: lesion of occipital cortex

Question 20

anterior cerebral artery vs middle cerebal artery stroke

Answer 20

contralateral hemiparesis and sensory loss

ACA: lower > upper
MCA: upper > lower

Question 21

Posterior cerebral artery stroke

Answer 21

contralateral homonymous hemianopia with macular sparing
visual agnosia

(specsavers POSTS my contacts)

Question 22

Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)

Answer 22

ipsilateral CN III palsy
Contralateral upper and lower weakness

Weber never SAW how his interns were the OPPOSITE of weak

Question 23

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)

Answer 23

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

Question 24

Anterior inferior cerebellar artery (lateral pontine syndrome)

Answer 24

same as PICA but with facial paralysis and deafness

Question 25

definition of TIA

Answer 25

a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.

Question 26

headache red flags

Answer 26

- vomiting without other obvious cause - worsening headache with fever - headache triggered by cough, valsalva (trying to breathe out with nose and mouth blocked), sneeze or exercise - recent head trauma - impaired level of consciousness - new onset cognitive dysfunction

Question 27

brain abscess treatment

Answer 27

IV 3rd-generation cephalosporin + metronidazole

Question 28

post TIA treatment

Answer 28

clopidogrel and statin

Question 29

migraine triggers

Answer 29

Chocolate Hangovers Orgasms Cheese Caffeine The oral contraceptive pill Lie-ins Alcohol Travel Exercise

Question 30

DVLA rule following TIA

Answer 30

1 month and not need to inform

Question 31

ataxia causes (lesions)

Answer 31

Cerebellar hemisphere lesions cause peripheral ('finger-nose ataxia') Cerebellar vermis lesions cause gait ataxia

Question 32

multisystem atrophy

Answer 32

parkinsonism autonomic disturbance erectile dysfunction: often an early feature postural hypotension atonic bladder cerebellar signs

Question 33

what extra test is done in young people strokes

Answer 33

autoimmune and thrombophillia screening

Question 34

SAH imaging

Answer 34

ct head WITHOUT contrast

Question 35

'empty delta sign'

Answer 35

Sagittal sinus thrombosis

Question 36

normal pressure hydrocephalus imaging

Answer 36

ventriculomegaly in the absence of, or out of proportion to, sulcal enlargement

Question 37

what is required when using iv phenytoin?

Answer 37

cardiac monitoring

Question 38

carotid enderectomy criteria

Answer 38

Carotid endarterectomy is considered in a patient who has had a TIA with carotid artery stenosis exceeding 70% on the side contralateral to the symptoms

Question 39

ondansetron SE

Answer 39

prolonged QT interval constipation is common

Question 40

rectal diazepam dose

Answer 40

kids - 5mg adults - 10mg

Question 41

most common cause of brain mets

Answer 41

lung (most common) breast bowel skin (namely melanoma) kidney

Question 42

autonomic dysreflexia

Answer 42

FIGHT OR FLIGHT response BELOW lesion (due to initial noxious stimulus), and REST AND DIGEST response ABOVE lesion (as it attempts to counteract sympathetic fight or flight response)

Question 43

carbamezapine uses

Answer 43

- partial seizures - trigeminal neuralgia - bipolar

Question 44

aphasia causes

Answer 44

dominant hemisphere (left) MCA

Question 45

miller fisher triad

Answer 45

ophthalmoplegia, areflexia and ataxia

Question 46

how to know if it will be hyperreflexia vs hypo

Answer 46

hyper -> UMN -> CNS hypo -> LMN -> peripheral

Question 47

drugs causing IIH

Answer 47

combined oral contraceptive pill steroids tetracyclines retinoids (isotretinoin, tretinoin) / vitamin A lithium

Question 48

vision loss with temporal arteritis

Answer 48

anterior ischemic optic neuropathy - swollen pale disc and blurred margins

Question 49

which anti-epileptic is most associated with weight gain

Answer 49

sodium valproate

Question 50

TOS

Answer 50

compression of brachial plexus, subclavian artery or vein

Question 51

where does ondansetron act

Answer 51

medulla oblongata