Neurological disease

Question 1

What is the difference between primary and secondary headaches?

Answer 1

Secondary is caused by underlying condition e.g. infection, neoplasm, stroke

Question 2

What are the different types of primary headache disorders?

Answer 2

Tension type headache
Migraine
Trigeminal autonomic cephalalgias (e.g. cluster headache).

Question 3

What are the red flags in the history of headaches?

Answer 3

Worsens with valsalva
Wakes out of sleep
Change in character
Age of onset
Sudden onset (Thunderclap)
Focal neurological deficits
Constitutional symptoms (fever, meningism, rash, weight loss)

Question 3

What red flags for headaches might you see on examination?

Answer 3

Sick appearing, skin changes, trauma
Altered cognition
Occular: Hyphema, pupil non-reactivity, optic disc swelling, proptosis, restricted eye movements
Meningism
Focal neurological findings

Question 4

How quickly do thunderclap headaches peak?

Answer 4

Within 60 seconds

Question 5

What investigations might you consider for a headache?

Answer 5

Bloods - FBC, U+E’s, ESR, CRP, Glucose
Imaging - CT Head (acute), CT Venogram Head, MRI Brain
Lumbar puncture

Question 6

What is SNNOOP10?

Answer 6

Question 7

How do you treat secondary headaches?

Answer 7

Treat underlying cause
Consider medication overuse

Question 8

How do you treat primary headaches?

Answer 8

Question 9

What type of primary headache is most prevalent?

Answer 9

Tension type

Question 10

Describe tension type headache

Answer 10

Question 11

Describe migraine headache

Answer 11

Question 12

Describe cluster headache

Answer 12

Question 13

In which type of headache is agitation more common

Answer 13

Cluster (Trigeminal Autonomic Cephalalgia)

Question 14

Frequency of episodic and chronic tension type headache?

Answer 14

Question 15

Frequency of episodic and chronic migraines?

Answer 15

Question 16

What is status migrainosus?

Answer 16

Migraine attack lasting longer than 72 hours

Question 17

What is the trigeminocervical complex?

Answer 17

Physiological complex of how head and neck sensory information combine.

Nerves come together and pathway loops up into ventralposteriormedial thalamic nucleus (VPM), then goes to other sensory components in the brain.

Explains why people with migraine get neck pain etc.

Question 18

When would you give high flow O2 in a headache?

Answer 18

For cluster

Question 19

What medications should you not give for the acute treatment of tension type and migraine headaches?

Answer 19

opiods

Question 20

To prevent medication overuse headaches, you should limit monthly use of triptans, non-opioid analgesics and opioids to how much?

Answer 20

Question 21

When would you start using preventative headache medication?

Answer 21

If someone get’s a headache 15 days in the month

Question 22

What preventative treatment is used for tension type headache?

Answer 22

Question 23

What preventative treatment is used for migraines?

Answer 23

Question 24

What preventative treatment is used for cluster headaches?

Answer 24

Question 25

How long do preventative treatments for headache stake to work?

Answer 25

Up to three months

Question 26

Trigeminal neuralgia sx?

Answer 26

Question 27

What is trigeminal neuralgia also known as?

Answer 27

Tic Doloreux

Question 28

What are the secondary causes of trigeminal neuralgia?

Answer 28

Tumour at cerebellopontine angle, arteriovenous malformation or multiple sclerosis

Question 29

What is classical trigeminal neuralgia?

Answer 29

Nerve root atrophy or displacement due to neurovascular compression

Question 30

What is idiopathic trigeminal neuralgia?

Answer 30

No cause identified

Question 31

What imaging would you get in tigeminal neuralgia?

Answer 31

MRI + MRA with thin cuts through the trigeminal nerve to look for compression. MRA to look at blood vessels.

Question 32

First line treatment for trigeminal neuralgia?

Answer 32

Carbamazepine 2nd line - Other anticonvulsants (gabapentin, pregabalin, lamotrigine) Used as they stabalise neuronal firing

Question 33

What are the surgical options for trigeminal neuralgia?

Answer 33

Percutaneous procedures Stereotactic radiosurgery Microvascular decompression

Question 34

What is a seizure?

Answer 34

Abnormal firing of the brain

Question 35

60% of seizures are from which lobe in the brain?

Answer 35

Temporal

Question 36

Status epilepticus is a seizure after how long?

Answer 36

5 mins

Question 37

Difference between focal and generalised seizure?

Answer 37

Question 38

Temporal lobe seizure symptoms?

Answer 38

Question 39

Frontal lobe seizure symptoms?

Answer 39

Question 40

Parietal lobe seizure sx?

Answer 40

Question 41

Occipital lobe seizure sx?

Answer 41

Question 42

Criteria for epilepsy?

Answer 42

Question 43

Criteria for resolves epilepsy?

Answer 43

Question 44

Non-epileptic seizure signs?

Answer 44

Question 45

What are the common causes for seizures in well controlled epilepsy?

Answer 45

Question 47

What general seizure precautions do you advise patients?

Answer 47

Question 48

What is SUDEP?

Answer 48

Question 49

What is drug resistant epilepsy?

Answer 49

Question 50

What type of diet in childcare can cause remission of epilepsy?

Answer 50

Ketogenic

Question 51

Most recurrence of epilepsy occurs within how long of discontinuing drugs?

Answer 51

1 year

Question 52

What is a tremor?

Answer 52

Question 53

What is akathasia?

Answer 53

Question 54

What is asterixis?

Answer 54

Question 55

What is a motor tic?

Answer 55

Question 56

What is chorea?

Answer 56

Question 57

What is dystonia?

Answer 57

Question 58

What is myoclonus?

Answer 58

Question 59

What is clonus?

Answer 59

Question 60

What is asterixis associated with?

Answer 60

Metabolic disturbances e.g. hepatic encephalopathy or renal dysfunction

Question 61

What specific bits of history do you want to find out with someone with a tremor?

Answer 61

Question 62

How do you assess a tremor at rest?

Answer 62

Question 63

How do you assess a tremor on action?

Answer 63

Question 64

What do you look for in the finger tap test?

Answer 64

Question 65

What investigations do you do for tremor?

Answer 65

Question 66

What is a DAT scan?

Answer 66

Dopamine transporter scan Looks for any dopamine deficiency

Question 67

Essential tremor can worsen with what?

Answer 67

Caffeine some medications

Question 68

What improves essential tremor?

Answer 68

Alcohol

Question 69

Why does essential tremor happen?

Answer 69

Alteration in the cerebello-thalamo-cortical circuit Thalamus and cortex involved in movement Cerebellum involved in finessing movement.

Question 70

Dx for essential tremor?

Answer 70

Question 71

What is essential tremor plus?

Answer 71

Question 72

How does essential tremor and parkinsons differ in history?

Answer 72

Question 73

How does essential tremor and parkinsons differ in examination findings?

Answer 73

Question 74

What is the treatment for essential tremor?

Answer 74

Question 75

What part of the face is affected in an upper motor neuron lesion?

Answer 75

Question 76

What part of the face is affected in an lower motor neuron lesion?

Answer 76

Question 77

Which conditions present with bilateral lower motor neuron facial nerve palsy?

Answer 77

Question 78

How do you assess CN VII?

Answer 78

Question 79

What is bells palsy associated with?

Answer 79

Question 80

How is bells palsy treated?

Answer 80

Question 81

What are the complications of recovery from bells palsy?

Answer 81

Question 82

What causes wernicke's encephalopathy?

Answer 82

Question 83

Signs of wernickes encephalopathy?

Answer 83

Question 84

What can untreated wernickes encephalopathy lead to?

Answer 84

Question 85

Why should you give thiamine before glucose in nutritionally deficient patients?

Answer 85

Can precipitate wernickes encephalopathy

Question 86

What would you see on imaging in wernickes encephalopathy?

Answer 86

Question 87

Alcohol blocks absorption of thiamine and what?

Answer 87

Magnesium

Question 88

You get Wernicke-Korsakoff from damage of the what?

Answer 88

Medial dorsal thalamus

Question 89

Thiamine deficiency can present as dry beri beri. What are the sx of this?

Answer 89

Question 90

Thiamine deficiency can present as wet beri beri. What are the sx of this?

Answer 90

Question 91

Thiamine deficiency can present as gastrointestinal beri beri. What are the sx of this?

Answer 91

Question 92

What is Machiafava bignami disease?

Answer 92

Question 93

What tool do you use to assess for alcohol withdrawal?

Answer 93

Question 94

Why do we give thiamine in alcohol withdrawal?

Answer 94