Neuro Q's

Question 1

Normal pressure hydrocephalus

Answer 1

‘wet, wobbly and wacky’
*shuffling broad based gait
*urinary incontinence
*cognitive impairment

Question 2

Alzheimer’s Dementia

Answer 2

*early symptoms of memory impairment especially short term
*getting lost in familiar surroundings
*difficulty finding words
*hallucinations
*lack of insight
*difficulty with learned tasks
*urinary incontinence (in later stages)

Question 3

slow, effortful speech with intact comprehension. Lesion location

Answer 3

Dominant (speech centre always in dominant hemisphere)
Broca’s area - frontal lobe supplied by MCA

Question 4

word salad, intact speech but no comprehension

Answer 4

Wernicke’s area
temporal lobe

Question 5

chronic sinusitis

Answer 5

nasal congestion, purulent discharge last >3/12
+/- headache, cough, anosmia

Question 6

migraine in children

Answer 6

*throbbing bilateral/unilateral headache lasting hrs - days
*assoc with photophobia, phonophobia, N+V
*tearing, nasal congestion, facial swelling
*+/- aura
*Normal neuro exam

Question 6

benzodiazepine risk in elderly

Answer 6

risk of confusion, falls and paradoxical agitation

Question 7

exposure to loud noises overtime will lead to hearing loss pathology

Answer 7

*high frequency hearing loss
*2o cochlear hair cell damage

Question 8

penetrating injury to neck

Answer 8

could lead to damage above C5 leading to hypercapnic resp failure 2o diaphragmatic paralysis.
*leading to neurogenic shock i.e hypotension, bradycardia

Question 9

spinal epidural abscess presentation

Answer 9

*fever
*focal , severe back pain
*acute neurological sign –> LL weakness, urinary retention
*emergency MRI diagnostic

Question 10

inadequate emergence from general anesthesia

Answer 10

could be delayed (30mins -60mins)
or emergence delirium
mgx:- reassurance and reorientation

Question 11

acute, sudden, painless, monocular vision loss

Answer 11

*2o central retinal artery occlusion 2o to embolus from carotid thrombus or cardiac e.g AF
*amaurosis fugax –> curtain dropping down
*O/E :- pale retina, cherry red macula

Question 12

NF1 presentation

Answer 12

*cafe au lait spots
*Lisch nodules in iris
*neurofibromas
*axillary, inguinal freckling
* decreased visual acuity
*risk of optic pathway glioma ( headache worse in am 2o increased ICP overnight, reduced VA –> MRI)

Question 13

NF2

Answer 13

bilateral acoutic neuroma –> causing sensorineural hearing loss
*tinnitus
*vertigo
*balance issues

Question 14

Lhermitte sign

Answer 14

electric shooting pain with neck flexion

Question 15

Cervical spine cord compression

Answer 15

• Lhermitte sign
  *UMN signs below the level of the compression
  *LMN signs at the level of the compression

Question 16

sparing of the forehead leison

Answer 16

UMN leison

Question 17

Unilateral facial nerve palsy workup

Answer 17

• commonest cause is Bell’s palsy (not further Ix) only if no red flags
• if >3/52 duration or assoc with hearing loss, vertigo –> MRI r/o cerbellopontine angle tumour

Question 18

cauda equina syndrome

Answer 18

*common cause herniated lumbosacral disc
* L2 L5 - S1-S5 symptoms
*asymmetric weakness/ numbness in legs UMN signs
*radicular pain –> shooting pain on straight leg raising
*bowel, bladder, sexual dysfunction
*absent ankle reflex
*saddle anaesthesia

Question 19

indications for CT Cx spine in trauma pt

Answer 19

*high energy mechanism of injury
*neurologic deficit
*altered mental status
*spinal tenderness
*intoxication
*other distracting injury

Question 20

indications for thoracolumbar CT in trauma pt

Answer 20

• presence of cx spine fracture
  *high energy mechanism of injury
  *focal signs of injury ( bruising, step-off)
  *nerurological deficit
  *altered mental state
  *other distracting injury

Question 21

malignant hyperthermia

Answer 21

*occurs a few mins after coming off general anesthesia ( succinylcholine, halothane)
*masseter / generalised muscle rigidity
*hypercarbia, tachypnoea
*tachycardia
*sweating
*hyperthermia
*myoglobulinuria –> red urine

Question 22

hyperextension injury

Answer 22

• can cause central cord syndrome
  *UL weakness
  *loss of pain and temp sensation UL
• in elderly pts with cervical degenerative changes

Question 23

cervical radiculopathy

Answer 23

• 2o nerve root compression (pressure on individual nerve root) causing neck/arm pain radiates with neck movement
  *sensorimotor deficits
  *diagnosis is clinical
  *treatment symptomatic

Question 24

otosclerosis

Answer 24

*2o fixation of the stapes *unilateral or bilateral *young women *conductive hearing loss

Question 25

pt 20-30's fhx of hearing loss presents with bilateral sensorineural deafness and instability > when eyes closed. Diagnosis

Answer 25

NF2

Question 26

femoral nerve

Answer 26

*hip flexion and knee extension *sensation to ant thigh and medial leg *decreased patellar reflex

Question 27

Normal pressure hydrocephalus

Answer 27

*ventriculomegaly with normal pressure on LP *wide shuffling gait, cognitive impairment, urinary incontinence ( can appear late)

Question 28

orbital fracture with vertical diplopia

Answer 28

* inferior rectus muscle entrapment * vertical diplopia with restriction of upward movement of the eye *follows blowout fracture - orbital floor fracture

Question 29

subdural haematoma

Answer 29

think b's, c and d *tearing of the Bridging vessles *concave shape bleed on imaging *SubDural *occurs in older age, chronic alcoholisim, anticoagulant use. * 2o head trauma

Question 30

epidural haematoma

Answer 30

*injury to middle meningeal artery *Convex on imaging *20 trauma to sphenoid bone

Question 31

brain herniation

Answer 31

*midline shift on CT * rapid shift in clinical condition *need to mgx ABC's first *intubate and ventilate

Question 32

autonomic dysreflexia

Answer 32

*complication of spinal cord injury above T6 * diaphoresis, HTN, flushing, BRADYcardia, headache *noxious stimuli is cause e.dg urinary retention, tight fitting clothes

Question 33

C6 cervical radiculopathy

Answer 33

*neck/shoulder pain *worsening paresthesia with lateral flexion of the neck * impormvent with shoulder abduction test *sensorimotor deficit --> dermatomal --> thumb and index finger *motor deficit:- elbow flexion and loss of biceps reflex

Question 34

cerebellar haemorrhage features

Answer 34

*risk factors :- HTN, on anticoagulants, cerebral amyloid angiopathy *c/o progressive headache, N+V, vertigo, ipsilateral ataxia, dysarthria, nystagmus *CT:- posterior fossa hyperdensity

Question 35

indications for surgical decompression in cerebral haemorrhage

Answer 35

*haemorrhage >3cm *deterioation in neurology --> impaired consciousness *obstructive hydrocephalus, brainstem compression

Question 36

wound botulisim

Answer 36

*contamination of wound with clostridium botulinum *descending motor paresis *CN esp 3,4 and 6 --> ptosis, mydriasis and diplopia * diaphragmatic paralysis -->resp failure *autonomic dysfunction --> orthostatic hypotension, urinary retention, ileum MgX:--> immediate equine botulism antitoxin

Question 37

Thunderclap headache

Answer 37

*severe acute onset <1hr headache associated with N+V and altered mental state *multiple causes

Question 38

Pituitary apoplexy

Answer 38

*haemorrhage or acute ischaemia of the pituitary assoc with large pituitary adenoma other feature *bilateral visual field loss 2o optical chasm compression *opthalomoplegia 2o CN III palsy 2o compression *hypotension 2o low ACTH --> ant pituitary affected

Question 39

Spinal epidural abscess features

Answer 39

Triad *fever *focal severe back pain *neuro deficit :- > sensory/motor change, bladder/bowel dysfunction, paralysis * imaging shows fluid collection can span adjacent spinal levels *Mgx:--> urgent IV abx and surgical laminectomy and surgical decompression