Neurology

Question 1

Syncope

Answer 1

Black outs - loss of consciousness

Question 2

Common causes of blackouts

Answer 2

Vasovagal “faint”
Postural hypotension
Cardiac arrhythmia
Epileptic seizure
Hypoglycaemia

Question 3

Vasovagal “faint”

Answer 3

Brought on by fear, emotion, heat, prolonged standing, hunger.
Prodrome: feeling faint, nausea, visual fields closing in
Due to low BP and low heart rate
Recover within 2 mins
Management: lie flat and elevate legs to increase venous return

Question 4

Postural hypotension

Answer 4

A drop in blood pressure when you stand up after lying or sitting down.
Commonly drugs are a common cause of PH

Question 5

Haemorrhage

Answer 5

Bleed on the brain

Question 6

Subdural haematoma

Answer 6

Ventricle is compressed and midline is shifted
Bleed underneath the dura

Question 7

Extradural haematoma

Answer 7

Bleed outside the dura

Question 8

Impaired consciousness

Answer 8

A state where consciousness has been affected by damage to the brain e.g head injury, stroke, tumour.
Impaired conscious level can be due to any organ system disfunction as well as a primary brain problem.
Often can have more than one cause

Question 9

The Glasgow Coma Scale (GCS)

Answer 9

Measures the severity of a coma
Generally, comas are classified as: severe, with GCS ≤8, moderate, GCS 9–12, and minor, GCS ≥13

Question 10

NEWS score - AVPCU scale

Answer 10

Alert
Verbal
Pain
C new confusion
Unresponsive

Question 11

Metabolic causes of impaired conciousness

Answer 11

Hypoglycaemia - where the level of sugar in your blood (glucose) drops too low
Hypoxia - low levels of oxygen in body tissues
Hypercapnia - too much CO2 in the blood
Hyponatraemia - concentration of sodium in the blood is abnormally low
Hyperglycaemia - calcium level in your blood is too high
Hypothyroidism - underactive thyroid

Question 12

Impaired consciousness caused by infections

Answer 12

Brain - encephalitis, meningitis, cerebral abscess
Any other severe bacterial infection causing sepsis - pneumonia

Question 13

Impaired consciousness caused by drugs and toxins

Answer 13

Alcohol
Opiates
Recreational drugs
Overdose of prescribed medication

Question 14

ABCDE approach

Answer 14

Airway
Breathing
Circulation
Disability
Exposure

Question 15

Epilepsy

Answer 15

Excessive electrical discharges in brain

Question 16

Focal (partial) seizures

Answer 16

Presentation depends on part of brain affected

Question 17

Generalised seizures

Answer 17

Whole brain affected - whole body presentation

Question 18

How do you investigate epilepsy

Answer 18

Blood tests
Brain imaging - MRI
Electroencephalogram - EEG

Question 19

Tonic phase of a seizure

Answer 19

causes a sudden stiffness or tension in the muscles of the arms, legs or trunk

Question 20

Clonic phase of a seizure

Answer 20

repeated jerking movements of the arms and legs on one or both sides of the body, sometimes with numbness or tingling

Question 21

Emergency treatment of seizure >5 minutes or repeated seizures

Answer 21

High flow oxygen
Midazolam oromucosal solution 10mg buccally
999 if needed

Question 22

Primary headache disorders

Answer 22

tension headache
migraine
cluster headache
medication overuse headache
trigeminal neuralgia

Question 23

Tension headache

Answer 23

feels like a “tight band” around the head
often stress related
symmetrical

Question 24

treatment for tension headaches

Answer 24

conventional analgesia
tricyclic antidepressants for prophylaxis

Question 25

Migraine

Answer 25

prolonged reduction in cerebral blood flow following a brief spell of increased flow

Question 26

treatment for a migraine

Answer 26

conventional analgesia (paracetamol, aspirin, ibuprofen) metoclopramide serotonin agonists e.g. sumatriptan, zolmitriptan

Question 27

cluster headaches

Answer 27

severe pain around eye watery, blood shot, lid swelling, runny nose

Question 28

treatment for cluster headache

Answer 28

sumatriptan, oxygen

Question 29

trigeminal neuralgia headache

Answer 29

intense stabbing pain 10/10 severity

Question 30

treatment for trigeminal neuralgia headache

Answer 30

carbamazepine sometimes surgery

Question 31

secondary headache disorders

Answer 31

head injury CNS tumours CNS infections intracerebral or subarachnoid bleeds giant cell arteritis glaucoma

Question 32

giant cell arteritis

Answer 32

inflammatory condition affecting the arteries in the temple

Question 33

glaucoma

Answer 33

a common eye condition where the optic nerve, which connects the eye to the brain, becomes damaged.

Question 34

CNS infections - bacterial meningitis

Answer 34

Bacteria that enter the bloodstream and travel to the brain and spinal cord.

Question 35

CNS infections - encephalitis

Answer 35

inflammation of brain parenchyma

Question 36

diagnosis of bacterial meningitis

Answer 36

lumbar puncture blood cultures CT or MRI brain

Question 37

diagnosis of encephalitis

Answer 37

lumbar puncture EEG MRI

Question 38

what is a stroke?

Answer 38

an acute compromise of blood supply to the brain

Question 39

what are the 2 types of strokes and likeliness percentage?

Answer 39

cerebral infarction (90%) cerebral haemorrhage (10%)

Question 40

cerebral infarction

Answer 40

disrupted blood flow to the brain due to problems with the vessels that supply it. common cause of strokes

Question 41

cerebral haemorrhage

Answer 41

bleeding in the surrounding tissues of the brain

Question 42

subarachnoid haemorrhage

Answer 42

blood in subarachnoid space

Question 43

diagnosis of subarachnoid haemorrhage

Answer 43

CT scan Angiography to identify aneurysms lumbar puncture

Question 44

intracerebral haemorrhage

Answer 44

bleed directly into the brain tissue

Question 45

what is a thrombectomy?

Answer 45

innovative surgical procedure used to remove blood clots from arteries and veins

Question 46

what is the FAST campaign

Answer 46

Face Arms Speech Time when a stroke arises act fast

Question 47

what are the 2 main movement disorders

Answer 47

parkinson's disease essential tremor

Question 48

what is parkinson's disease

Answer 48

a degeneration of the dopaminergic neurones in the basal ganglia

Question 49

what are the main clinical features of parkinson's disease?

Answer 49

bradykinesia - slowness and reduced movement rigidity - inability to bend tremor

Question 50

treatment for parkinson's disease

Answer 50

dopaminergic drugs - levodopa (co - careldopa, co - beneldopa). dopamine receptor agonists (ropinirole, rotigotine, pramipexole) rehab/supportive care - physio and occupational therapy surgical - deep brain stimulation

Question 51

what causes parkinson's disease

Answer 51

when cells in the substantia nigra stop working and die off, leaving the body to lack dopamine. The brain uses dopamine to send messages to help control movement. the reason this happens is undetermined

Question 52

essential tremor

Answer 52

a nervous system (neurological) disorder that causes involuntary and rhythmic shaking

Question 53

what is multiple sclerosis (MS)?

Answer 53

auto immune destruction of myelin sheath of neurones in CNS

Question 54

is MS more common in men or women

Answer 54

women

Question 55

what are the two forms of MS?

Answer 55

relapsing/remitting chronic progressive

Question 56

diagnosis of MS

Answer 56

Clinical lumbar puncture MRI

Question 57

treatment for MS

Answer 57

High dose steroids in acute relapse drugs to reduce relapse and progression of disability in relapsing remitting disease (betaferon, glatiramer) rehab and supportive care

Question 58

what is Motor Neurone Disease (MND)

Answer 58

The destruction of motor neurones

Question 59

is MND more common in male or female

Answer 59

male

Question 60

diagnosis of MND

Answer 60

clinical neurophysiology

Question 61

treatment for MND

Answer 61

medication mainly supportive e.g. feeding tubes, wheelchair, NIV, communication aids etc

Question 62

prognosis of MND

Answer 62

usually < 5 yrs

Question 63

what is peripheral neuropathy

Answer 63

Peripheral neuropathy develops when nerves in the body's extremities, such as the hands, feet and arms, are damaged. The symptoms depend on which nerves are affected.

Question 64

What is bell's palsy?

Answer 64

a condition that causes sudden weakness in the muscles on one side of the face