Neurology

Question 1

Ataxia telangiectasia (inheritance)

Inheritance pattern

Answer 1

Autosomal recessive

Question 2

Friedrich’s ataxia (inheritance)

Answer 2

Autosomal recessive

Question 3

Lateral medullary syndrome

Answer 3

Wallenberg’s syndrome
Occlusion of posterior inferior cerebellar artery (PICA)
-> ataxia, nystagmus, ipsilateral Horner’s/pain and temp sensation loss, contralateral limb sensory loss

Question 4

Right pupil larger than left, no reaction to light directly or consensually
Reduced/absent deep tendon reflexes

Answer 4

Adie’s pupil

Question 5

Afferent pupillary defect

Findings

Answer 5

Due to impaired ipsilateral optic nerve function
Brief paradoxical pupillary dilatation on swinging light test

Question 6

Bilaterally small pupils
Accommodate but do not react to light

Answer 6

Argyll Robertson pupils

Question 7

Ptosis
Ipsilateral small pupil

Syndrome?

Answer 7

Horner’s syndrome

Question 8

Ipsilateral ptosis
Pupil enlargement

Answer 8

Third nerve palsy

Question 9

Miller Fisher Syndrome

Features
Antibodies

Answer 9

Variant GBS
Triad: ataxia, external ophthalmoplegia, areflexia

GQ1B antibodies

Question 10

Gerstmann’s syndrome
Dominant parietal lobe infarct

Features

Answer 10

Finger agnosia
Acalculia
Agraphia
Left-right limb disorientation

Question 11

Contralateral hemiparesis and sensory loss; worse in lower limbs

vessel?

Answer 11

Anterior cerebral artery

Question 12

Contralateral hemiparesis; upper limbs affected more than lower
Contralateral homonymous hemianopia
Aphasia

Answer 12

Middle cerebral artery

Question 13

Contralateral homonymous hemianopia with macular sparing

vessel?

Answer 13

Posterior cerebral artery

Question 14

Weber’s syndrome (branches of posterior cerebral artery that supply midbrain)

Signs

Answer 14

Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

Question 15

Lateral pontine syndrome (anterior inferior cerebellar artery)

Answer 15

Ipsilateral: facial paralysis and deafness
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

Question 16

Retinal/ophthalmic artery

Presentation

Answer 16

Amaurosis fugax

Question 17

Mild-mod learning disability
Narrow face, large ears, flexible fingers, large testicles

Condition?
Gene
Inheritance

Answer 17

Fragile X syndrome
FMR-1 gene
X linked dominant

Question 18

Torticollis muscle

Answer 18

Ipsilateral sternocleidomastoid

Question 19

Fixed gaze palsy

Answer 19

Eyes look towards the lesion e.g. fixed gaze lesion to the right = right sided lesion

Question 20

Multi-system atrophy

Answer 20

Parkinsonism
Autonomic disturbance: erectile dysfunction, postural hypotension, atonic bladder
Cerebellar signs (ataxic gait)

Question 21

Progressive supranuclear palsy

Answer 21

Vertical gaze
Postural instability
Parkinsonism
Cognitive impairment within months

Question 22

Dementia with Lewy bodies

Answer 22

Visual hallucinations

Question 23

Normal pressure hydrocephalus

Answer 23

Dementia + urinary incontinence

Question 24

Subacute combined degeneration of the spinal cord (Vitamin B12 and E deficiency)

Answer 24

Affects posterior columns

• Ipsilateral UMN weakness (spastic paresis)
• Ipsilateral loss of proprioception and vibration
  Ataxic gait

Question 25

Syringomelia features

Answer 25

LMN signs and spinothalamic loss (pinprick and pain sensation)

Question 26

Neurocutaneous disorders Retinal hamartomas Epilepsy Developmental problems Ash leaf spots Shagreen patches Subungal fibromata Condition?

Answer 26

Tuberous sclerosis

Question 27

Cafe au lait spots Axillary/groin freckles Neurocutaneous disorders Iris hamartomas NF2: bilateral acoustic neuromas and other CNS tumours

Answer 27

Neurofibromastosis 1 and 2

Question 28

Pituitary apoplexy

Answer 28

Bleeding into/impaired blood supply of pituitary Sudden onset headache and non-functioning pituitary

Question 29

Bilateral spastic paresis and loss of temp/temp sensation

Answer 29

anterior spinal artery occlusion

Question 30

Sensory loss of postero-lateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test

Answer 30

S1

Question 31

Ramsay Hunt treatment

Answer 31

oral aciclovir and prednisolone

Question 32

CT head: hypodense (dark), crescentic collection around the convexity of the brain diagnosis?

Answer 32

chronic subdural haematoma

Question 33

Restless legs treatment

Answer 33

Dopamine agonist - Pramipexole, ropinirole

Question 34

Cerebellar ataxia and telangiectasia, onset is in childhood Immunodeficiency

Answer 34

Ataxic telangiectasia

Question 35

Infantile-onset spinocerebellar ataxia

Answer 35

Friedreich's ataxia

Question 36

Causes of facial palsy

Answer 36

- Bells palsy - Ramsay-Hunt syndrome - acoustic neuroma - parotid cancer - HIV - multiple sclerosis - diabetes mellitus

Question 37

Distal muscle wasting and weakness

Answer 37

Charcot-Marie Tooth

Question 38

Bilateral spastic paresis and loss of pain/temperature sensation occlusion where

Answer 38

Anterior spinal artery occlusion Dorsal columns no affected as these are posterior

Question 39

Lambert Eaton syndrome Which channels affected

Answer 39

Voltage gated calcium channels

Question 40

Myasthenia Gravis Channels affected

Answer 40

Nicotinic acetylcholine receptors

Question 41

Treatment of myasthenic crisis

Answer 41

IV immunoglobulins OR plasma exchange

Question 42

Third nerve palsy and headache Important to exclude...

Answer 42

Posterior communicating artery aneurysm

Question 43

Treatment of SAH

Answer 43

Calcium channel blocker (Nimodipine) -> prevents vasospasm

Question 44

Measure of disability or dependence in activities of daily living in stroke patients

Answer 44

Barthel index

Question 45

involuntary, sudden, jerking movements which occur contralateral to the side of the lesion

Answer 45

Hemiballism