Neuro 2

Question 1

secondary causes of demyelination

Answer 1

central pontine myelinosis, progressive multifocal leucoencephalopathy, subacute sclerosis pariencephalitis, AIDs, axonal degeneration

Question 2

MS when

Answer 2

any age but childhood and over 50 is rare

Question 3

where are the plaques

Answer 3

in white matter (so external brain and spinal cord looks fine)
commonly in optic nerve, periventricular white matter, corpus callous, brain stem and spinal cord

Question 4

what can plaques of MS act like

Answer 4

SOL

Question 5

acute MS

chronic MS

Answer 5

yellow/brown, ill defined edge

well demarcated grey/brown, classically lateral ventricles

Question 6

ix for MS

Answer 6

MRI

CSF - 90% show oligoclonal bands

Question 7

relapsing remitting

Answer 7

distinct symptom that fade away partially or completely

Question 8

secondary progressive

Answer 8

relapsing and remitting that stops relapsing

Question 9

progressive relapsing

Answer 9

relapses then doesn’t relapse again

Question 10

primary progressive

Answer 10

no remissions just worsens

Question 11

commonest type of MS

Answer 11

relapsing remitting

Question 12

treatment of fatigue

Answer 12

amontodine
modafinic if sleepy
hyperbaric oxygen

Question 13

treatment of acute exacerbation

Answer 13

methylprednisolone PO
severe - admit and IV steroids
regular relapses - aziothoprine

Question 14

pyramidal

Answer 14

OT, physio

Question 15

spasticity

Answer 15

physio, baclofen, gabapentin, botulonim toxin

Question 16

sensory

Answer 16

gabapentin, amitrip, acupuncture, ligocaine infusion

Question 17

LUT

Answer 17

oxybutinin, desmopressin, catheter

Question 18

DMARDs first line

Answer 18

interferon beta and copioxon

tecfidera (dimethylfumeratic)

Question 19

DMARDs second line

Answer 19

tysabri (natalzimub) or lemtrada (alemtrizumab)

fingolimed

Question 20

third line DMARD

Answer 20

mitoxantrone

Question 21

first line when

Answer 21

interferon beta and copioxone or tecfidera (dimethyl)

at least 2 attacks both times recovered partially or completely, can walk 100m
relapsing remitting

Question 22

tysabri (natalzimub) or lemtrada (alemtrizumab)

Answer 22

monoclonal antibodies

highly active RR rapidly evolving or high disease activity despite treatment with interferon beta

Question 23

mitoxantrone

Answer 23

Relapsing progressive
12 infusions over 2 years
cardiac toxicity dose related

Question 24

motor features of parkinson’s

Answer 24

tremor, muscular rigidity, amnesia, resting tremor, gait, postural impairment

Question 25

non motor features of parkinsons | when

Answer 25

olfactory dysfunction, cognitive impairment, psych symptoms, sleep disorders, autonomic dysfunction, pain and fatigue, RBD can be present for a decade before motor symptoms

Question 26

commonest neuro degen | 2nd

Answer 26

alzheimers | parkisnosn

Question 27

after 17 yrs of parkinson's

Answer 27

80% gait freezing | 50% choking

Question 28

after 20 yrs of parkinsosn

Answer 28

83% have dementia

Question 29

ix for RBD

Answer 29

overnight polysomnography to rule out mimics - obstructive sleep apnea, seizures, rapid eye movement parasomnia

Question 30

rx of RBD | cx

Answer 30

clonazapam or melatonin at bedtime isolated increases the risk of neurodegen dx with PD - severe autonomic dysfunction, gait impairment, dementia

Question 31

loss of what in pd

Answer 31

dopimergic neurones in the SNpc and lewy body pathology sections through the brain stem show loss of normally black pigment in substantia nigra and locuscoerleus pigment correlates with dopinemergic loss

Question 32

SNCA Px | LRRK2 Px

Answer 32

inherited | dom PD

Question 33

treatment of early px

Answer 33

``` levodopa and careldopa/sinemet dopamine agonist (ropinirole, pramipexole) MAO/bi - selegiline ```

Question 34

treatment of late px

Answer 34

patient on levodopa and developed motor complications | MAOIB, apomorphine, entacapone (COMTI)

Question 35

anticholinergic in px

Answer 35

trihexypheridyl/clozapine for tremor | cause confusion in elderly

Question 36

SE of DA

Answer 36

nausea, daytime solemence, oedema, avoid in patients with history of addiction, OCD, impulse personality commonly associated with hallunicaiton - not given to elders esp those with cognitive impairment

Question 37

long term cx of levodopa and DA

Answer 37

motor fluctuations and dyskinesia in later stages non motor fluctuations psychosis

Question 38

decrease fluctuations

Answer 38

Add DA, MAOBI, COMTI (tolapone, entacapone)

Question 39

direct delivery of stable levedopa

Answer 39

carbidopa gel/duodopal into dueodenum

Question 40

sub cut infusion od

Answer 40

apomorphine - potent DA

Question 41

psychosis

Answer 41

clozapine | 2nd quetiapone

Question 42

visual hallucinations and delusions in dementia | also for

Answer 42

rivastigamine | late stage dementia in PD

Question 43

when does dyskiniesia occur with levedopa

Answer 43

movements at peak of concentration | or at beginning and end of dose (biphasic dyskinesia)

Question 44

constipation GI motility fatigue orthostatic hypotension

Answer 44

polyethyleneglyco domperidone methylphenidate, madanfil clomperidone, fludrestirone, midorine, pyridogmiostigine

Question 45

vascular parkinsonism symp | ix

Answer 45

lower body predom affected no resting tremor other signs of brain lesions vascular poor levodopa response. do structural brain imaging

Question 46

drug induced

Answer 46

symm. coarse postural tremor. tardy dystonia. akathesia

Question 47

essential tremor

Answer 47

symm postura/kinetic 12Hz autosomal dom alcohol responsive propanolol

Question 48

resting tremor in parkinson's

Answer 48

3-6Hz

Question 49

multisystem atrophy who ix

Answer 49

60-70s suboptimal and short lived levedopa response only 1/3 get a response MRI cerebellar and pontine atrophy hot cross bun sign

Question 50

progressive supra nuclear palsy | ix

Answer 50

vertical supranuclear palsy reterocolitis staring no response to levedopa

Question 51

``` fragile x tremor and ataxia syndrome what is it who symp females children ix ```

Answer 51

``` abnormal number of CGGs in FMRI gene >50s cerebellar symptoms premature ovarian failure, early menopause classical fragile x syndrome ``` Mri - T2 hypersensitivities in middle cerebellar peduncles molecular testing to confirm