Neuro

Question 1

Wernicke’s aphasia

Answer 1

Temporal lobe affected with receptive aphasia or fluent aphasia (comprehension intact but difficulty forming words )

Question 2

Lateral medullary syndrome or Wallenberg’s syndrome

Answer 2

Occlusion of PICA
4 S structures
Spinothalamic tract - contralateral pain and temperature, crude touch, itch
Sympathetic Nervous System -horner’s
Spinocerebellar - ataxia
Sensory nuclei of CN V- ipsi loss of facial sensation

Question 3

4 midline structure at medulla

Answer 3

Motor nuclei of CN 3,4,6,12
Motor tract - corticospinal tract
Medial lemniscus tract - proprioception?
MEDIAL LONGITuDinaL FASCICULUS —-> intranuclear opthalmoplegia

Question 4

Fatiguable ptosis/ fatigue on climbing stairs/ teacher with sloppy handwriting towards the end of the day

Answer 4

Myasthenia gravis

Autoantibodies against ACh receptors?

Question 5

Paraneoplastic NMJ manifestation ?

Answer 5

Arising from small cell Lung carcinoma

Ease of movement improves with more motion

Question 6

Wernicke’s encephalopathy classic triad

Answer 6

1. Confusion
2. Ataxia - wide based gait
3. Opthalmoplegia ( nystagmus, LR or conjugate palsy. Supranuclear opthalmoplegia)

Due to thiamine B1 deficiency

Question 7

Korsakoff’s syndrome

Answer 7

Hypothalamic damage and cerebral atrophy due to thiamine (B1) deficiency.

Decrease ability to form new memories, confabulation (inventing memories) lack of insight and apathy.

Question 8

Broca’s aphasia

Answer 8

Frontal lobe affected with expressive aphasia or non fluent aphasia (difficulty comprehending but formation of non logical sentences)

Question 9

Down and out gaze with ptosis

Answer 9

Cranial Nerve III palsy

Question 10

Multiple sclerosis is associated with

Answer 10

Intranuclear opthalmoplegia
Optic neuritis
Patchy neurological symptoms

Question 11

Investigations for Stroke

Answer 11

Bedside:
ECG and holter
Bloods: FBE, ESR, Coags, Troponin,
Non contrast CT, Echo

Question 12

Mx of Stroke

Answer 12

Ischaemic Stroke: O2 control, BSL, alteplase, Maintain BP, DVT prophylaxis, aspirin

Haemorrhagic Stroke: reverse , refer to Nsx, decrease BP, manage seizure

Question 13

Pathology of Brain Infarcts 
<24 hours
1-3 days (S-L-O)
3-5 days (Liq-M -G)
Long term

Answer 13

<24 hours - no change
1-3 days - soft swollen pale/ loss of grey white differentiation/ oedema
3-5 days - liquefactive necrosis, macrophage infiltrate, gliosis
Long term - fluid filled cystic change

Question 14

Cause/location of extradural haemorrhage

Answer 14

B/w dura and skull

rupture of middle meningeal artery

Question 15

Typical presentation of extradural haemorrhage

Answer 15

Head trauma, unconscious lucid interval coma

Question 16

CT finding of extradural hx

Answer 16

Biconvex finding, adherance to sutures

Question 17

Subdural haematoma

• rupture
• CT
• presentation

Answer 17

• bridging emissary vein (b/w dura and arachnoid)
• elderly pt from fall (brain atrophy, rattle in skull)
• crosses sutures, crescent shape

Question 18

Subarachnoid hx

• presentation
• location
• Ix
• Management

Answer 18

-Gradually increasing neuro symtom - thunderclap headache, meningism, preceded by sentinel headache ‘warning leak’
-Rupture of berry aneurysm
- Ix - CT and LP (xanthochromia, blood in CSF)
- Clip and coil. Increase volume, increase BP, decrease Hct
induce hypertension, hypervolaemia, haemodilution (Triple H)

Question 19

What are common causes of coma?

COMA

Answer 19

CO2 narcosis: COPD, asthma, GBS, respiratory depression
Overdose: alcohol, opiates, benzo, antidepressants,
Metabolic: Hypo/hyperglycaemia, hypo/hypernatraemia, uraemia, hypothyroid, adrenal failure
Apoplexy: stroke, head trauma, encephalitis, epilepsy,

Question 20

Mx of decrease consciousness

Answer 20

First aid: DRSABCD- immobilise C spine, O2, 2 large bore IV cannula
Examination: Vital BSL,
Ix:
Manage underlying cause:

Question 21

Causes of headache x 4

Answer 21

Tension headache 
migraine 
Cluster headache 
Trigeminal neuralgia 
OR ( meningitis, sinusitis, temporal arteritis, raise ICP)

Don’t forget rebound headaches - caffeine or med withdrawal

Question 22

Tension Headache

• Epi
• Rx

Answer 22

Most common in adults, tight band like sensation

Paracetamol, NSAID, amitriptyline

Question 23

Migraine Headache

• presentation
• Rx

Answer 23

Common in females, and ED presentation 
Prodrome: photophobia --> prodrome:aura --> severe unilateral throbbing headache 4-7 hours --> nausea, vomiting -->postdrome: lethargy
Rule out others with MRI 
Acute: Paracetamol, NSAID
Dark room, avoid triggers

Question 24

MIGRAINE triggers: CHOCOLATE

Answer 24

Chocolate cheese 
Hydration 
OCP, menstruation 
Caffeine withdrawal 
Odours 
Light loud noise 
alcohol red wine 
Travel 
Eating poorly 
Sleep deprivatoin 
Stress

Question 25

Cluster headaches - presentation - rx

Answer 25

- most common in males, triggered by alcohol - severe consecutive unilateral headaches alternating with headache free period - pain behind eyes, lacrimation, rhinorrhoea (sinusitis ddx) triptan, verapamil, HIGH flow oxygen for 15 minutes.

Question 26

Trigeminal neuralgia

Answer 26

Treat with carbamazepine (antiepileptic) Extreme pain with trigger points 'suicide disease'

Question 27

Temporal arteritis - classic presentation - rx

Answer 27

>50 year old with high ESR Scalp tenderness, jaw claudication, amaurosis fugax, Treat with : high dose prednisolone, then temporal artery biopsy.

Question 28

What is associated with PMR

Answer 28

Temporal arteritis | Due to inflammation of medium and large vessel arteries in body containing elastin

Question 29

Benign intracranial hypertension | - presentation

Answer 29

Overweight female with daily headaches worse in the morning. Assoc with vomiting, diplopia and tinnitus

Question 30

Indications for CT

Answer 30

- First or worst severe headache - Change in pattern - Neurological signs - Over 50 - Fever (consider LP) - Occipital headache (seizure syndrome)

Question 31

Occipital headache can be associated with:

Answer 31

Subarachnoid haemorrhage

Question 32

Triad for brain abscess | Presentation and treatment

Answer 32

Fever Headache Focal neurology fluclox metro ceftaz

Question 33

Encephalitis - cause - rx

Answer 33

Commonest cause: viral HSV, EBV, varicella, adenovirus Empirical: acyclovir

Question 34

Commonest primary brain tumours

Answer 34

Meningiomas (good prognosis) 36% Gliomas - 2nd commonest (good prognosis except GBM) Pituitary adenomas schwannomas

Question 35

CT MRI findings of - abscess - metastases - primary

Answer 35

- Abscess and metastases found at corticomedullary junction - A: central necrosis, reactive edge - M: small, multiple, rounded satelite - P: solid tissue, single large

Question 36

5 causes of peripheral neuropathy

Answer 36

``` DEBUT Diabetes ETOH B12 deficiency Uraemia (kidney failure) Thyroid (hypo) ```

Question 37

Charcot Marie tooth has what typical gait

Answer 37

Flat footed - crane like? | High arched foot

Question 38

Most common bacterial pathogens for bacterial meningitis

Answer 38

``` Strep pneumoniae Neisseria meningitides Haemophillus influenzae Listeria monocytogenes Mycoplasma tuberculosis ```

Question 39

Most common viral causes of viral meningitis

Answer 39

Herpes simplex virus HSV Coxsackie virus Echovirus

Question 40

Causes of SeizuresL TIMED P

Answer 40

``` Trauma Infection Metabolic glucose Mass Epilepsy DRugs Pseudoseizure ```

Question 41

Triggers for Seizures IFSSAD

Answer 41

``` Illness Flashing lights stress sleep deprivation alcohol withdrawal drugs (illicit/noncompliance) ```

Question 42

If icp is raised, first cranial nerve to be affected ?

Answer 42

CNVI