Neuro

Question 1

Where abouts are neurones most affected in MND?

Answer 1

Anterior horn

Question 2

How does weakness initially present in MND?

Answer 2

Starts in one area and gradually spreads

Question 3

What are some UMN symptoms seen in MND?

Answer 3

Hypertonia
Hyperreflexia
Up going plantars
Weakness

Question 4

What are some LMN symptoms seen in MND?

Answer 4

Muscle wasting
Fasciculations
Reduced tone
Reduced reflexes

Question 5

If you were to see foot drop in an MND patient, what area would you suspect to be affected?

Answer 5

Lumbar

Question 6

What are the bulbar signs in MND?

Answer 6

Difficulty speaking and eating

Jaw jerk

Question 7

Name some non-motor signs of Parkinsons

Answer 7

1. Drooling
2. Depression
3. Problems with smell
4. Sleep problems
5. Memory problems

Question 8

Is Parkinsons usually uni or bilateral?

Answer 8

Unilateral

Question 9

Acute causes of headache (5)

Answer 9

1. Meningitis
2. Encephalitis
3. Sinusitis
4. Subarachnoid haemorrhage
5. Extradural haemorrhage
6. Acute glaucoma

Question 10

Chronic causes of headache (5)

Answer 10

1. Migraine
2. Tension headache
3. Trigeminal neuralgia
4. Giant cell arteritis
5. Medication overuse headache

Question 11

What MUST be done in all people with trigeminal neuralgia?

Answer 11

MRI head

Question 12

What treatment is given for trigeminal neuralgia?

Answer 12

Anti-epileptics

e.g. carbamazepine, phenytoin

Question 13

What Ix must be done in someone who has suspected giant cell arteritis?

Answer 13

ESR
CRP raised
Temporal artery biopsy?

Question 14

What treatments are given for giant cell arteritis?

Answer 14

Prednisolone

PPI / Bisphosphonates (protective)

Question 15

What symptom is really important to look out for if someone has giant cell arteritis?

Answer 15

Visual loss

Question 16

Name as many risk factors for stroke as you can

Answer 16

1. Hypertension
2. DM
3. Obesity
4. Smoking
5. COCP
6. AF
7. CV disease
8. Hyperlipidaemia
9. Alcohol
10. Previous TIA
11. Clotting problems
12. Peripheral vascular disease

Question 17

What scoring system is used for TIA?

Answer 17

ABCD2

Question 18

What drug treatment is given for Mx of TIA?

Answer 18

Clopidogrel (75mg)

Question 19

What artery is affected in amourosis fugax?

Answer 19

Retinal artery

Question 20

Mx of an ischaemic stroke?

Answer 20

300mg aspirin

Thrombolysis

Question 21

Name the drug used as thrombolysis

Answer 21

Alteplase

Question 22

When can you use thrombolytic drugs (alteplase)?

Answer 22

If it is = 4.5 hours since presentation and HAEMORRHAGE HAS BEEN RULED OUT

Question 23

Define a stroke

Answer 23

Sudden onset of focal neurological signs of vascular origin, lasting >24h

Question 24

Someone presents with facial, leg and arm weakness, amaurosis fugal and impaired language - where is the stroke likely to be?

Answer 24

Carotid

Question 25

Someone presents with dysarthria, dysphagia, diplopia, dizziness, ataxia and diplegia - where is the stroke likely to be?

Answer 25

Posterior circulation

Question 26

What risk score is used to calculate risk of stroke if someone has a TIA?

Answer 26

ABCD2

Question 27

Management of TIA?

Answer 27

``` Aspirin Admit Treat BP Order CT Do ABCD2 ```

Question 28

Someone has high risk TIA 2 weeks previously. What treatment should they be started on?

Answer 28

Clopidogrel

Question 29

Why would you do a carotid doppler in someone who has high risk TIA?

Answer 29

To look for stenosis of the internal carotid artery

Question 30

What intervention should someone with carotid stenosis + stroke/TIA have?

Answer 30

Carotid endarterectomy and carotid stent

Question 31

What 3 investigations does someone with a TIA need?

Answer 31

1. MRI 2. 24 hour ECG 3. Carotid doppler

Question 32

Differentials for stroke (may mimic it)?

Answer 32

``` Seizure Tumour/abscess Migraine Metabolic Functional Spinal cord Peripheral nerve Cranial nerve ```

Question 33

Someone presents and you aren't sure whether they have had a stroke or not. Should you admit them and if so where?

Answer 33

Yes, to the acute stroke unit

Question 34

What time frame do you HAVE to do a CT head in if suspected stroke?

Answer 34

24 hours

Question 35

Name some indications for immediate head CT (6 examples)

Answer 35

1. Less than 4.5 hours from onset 2. Taking anticoagulants 3. Known bleeding disorder 4. Decreasing consciousness 5. Fluctuating symptoms 6. Papilloedema 7. Severe headache with symptoms

Question 36

What bloods must you do in stroke? (7)

Answer 36

1. FBC 2. ESR 3. Clotting 4. U and E 5. LFTs 6. Glucose 7. Cholesterol

Question 37

What raised blood would indicate further, non-stroke investigations?

Answer 37

ESR

Question 38

If a patient has raised ESR with neuro symptoms, what do you need to exclude?

Answer 38

Endocarditis Myoxoma Vasculitis

Question 39

What drug is used as thrombolysis?

Answer 39

Alteplase

Question 40

What is the key time frame for thrombolysis?

Answer 40

4.5 hours !!!!!!!