Neurology

Question 1

How should you refer to a stroke?

Answer 1

As a cerebrovascular accident

Question 2

What are the two types of cerebrovascular accidentws CVA??

Answer 2

Ischeamic
or
haemorrhagic (intracranial haemorrhage)

Question 3

What is a TIA?

Answer 3

Transient ischaemic attack, symptoms which reslove after 24 hours. On imaging there is ischaemia but no infarction

Question 4

What are the symptoms of a stroke?

Answer 4

Sudden onsent asymmetrical
weakness of limbs
facial weakness
dysphagia
visual or sensory loss

Question 5

How do you manage stroke?

Answer 5

Managed at stroke centre

ABCDE
exclude hypoglyceamia, review drugs for bleeding risk

CT Head
aspirin 300mg for 2 weeks
Alteplase thrombolysis

Question 6

What drugs should somone who has had a stroke be on for secondary prevention?

Answer 6

clopidogrel 75mg
atorvastatin 80mg

Question 6

What percentage of strokes are bleeds and which are thrombotic?

Answer 6

80% thrombotic
20% ischaemic

Question 6

How is the GCS scored?

Answer 6

Eyes
Spontaneous -4
Speech - 3
Pain - 2
None -1

Verbal response
Orientated - 5
confused - 4
single strange words - 3
sounds - 2
none =1

Motor
obeys commands -6
Localises pain - 5
Normal flexion - 4
abnormal flexion -3
extends - 2
none - 1

Question 6

How do intracranial bleeds present?

Answer 6

sudden onset headache
seizures
weakness
vomiting
altered consciousness

Question 7

What are the eye components of GCS?

Answer 7

Sponaneous - 4
Speech - 3
Pain - 2
None - 1

Question 8

What are the motor components of GCS?

Answer 8

Motor
obeys commands -6
Localises pain - 5
Normal flexion - 4
abnormal flexion -3
extends - 2
none - 1

Question 9

What are the verbal components of GCS?

Answer 9

5 verbal
oriented speech 5
confused speech 4
inapproriate words 3
sounds 2
none 1

Question 10

Where does a subdural haemorrhage occour?

Answer 10

between the dura mater and arachnoid mater

Question 11

What do extra dural haemorrhages look like on CT?

Answer 11

bi-convex and are limited by cranial sutures?

Question 11

What does a subdural heamrrohage look like on CT scan?

Answer 11

cresent shape not limited by cranial sutures

Question 11

What is a intracerebrall haemorrhage and how does it present?

Answer 11

Bleeding into the brain tissue, presents similar to a haemorrhagic stroke

Question 11

What does a extradural haemorrhage occour?

Answer 11

Between the skull and the dura matter.

Question 11

What is the subarachnoid space?

Answer 11

it is where cerebrospinal fluid is located, between the Pia and arachnoid mater

Question 11

What causes an extradural heamorrhage?

Answer 11

Rupture of the middle meningeal artery

Question 12

How does a subarrachnoid haemorrhage present?

Answer 12

sudden onset occipital headache during stress associated with neurological symptoms

Question 13

What are the risk factos for a subarachnoid haemorrage?

Answer 13

cocaine
alcohol
hypertension

Question 14

How do you investigate for a subarachnoid haemorrhage?

Answer 14

CT Head
Lumbar puncture

Question 15

Describe multiple sclerosis

Answer 15

Chronic and progresive condition invloving demyelination of the myelinated neurones in the central nervous system. It is an inflammatory disease.

Question 16

How can MS present?

Answer 16

Eye movement disorders
eye movement abnormality
focal weakness
focal sensory symptoms
ataxia

Question 17

How is MS diagnosed?

Answer 17

made by a neurologist and is a diagonsis of exclusion

Question 18

How are MS relapses treated?

Answer 18

steroids - methylprednisolone

Question 19

What are the DVLA requirements for MS

Answer 19

Patient must inform the DVLA of their condition and recieve an assesment

Question 20

How does Motor neurone disease present?

Answer 20

60 year old man with insidious, progressive weakness of the muscles throughout the body affecting limbs trunk face and speech

Question 21

What is parkinson's disease?

Answer 21

progressive reducition of dopamine in basal ganglia resulting in disordered movements and coordination

Question 22

What is a parkinsons tremour like?

Answer 22

resting tremour 4-6hertz worse at rest. unliateral

Question 23

What is an benging essential tremor like?

Answer 23

bilateral, worse with intention

Question 24

How is parkinsons disease treated?

Answer 24

MDT levadopa Monoamine Oxidase-B Inhibitors

Question 25

What do monoamine oxidase enzymes do?

Answer 25

breakdown dopamine, seritonin and adrenaline

Question 26

What are seizures?

Answer 26

transient episodes of abnormal electical activity in the brain

Question 27

How is epilepsy investigated?

Answer 27

EEG MRI brain ECG

Question 28

what is the classic shaking seizure called?

Answer 28

Tonic clonic seizure

Question 29

What is the first line treatment for tonic clonic seizure?

Answer 29

sodium valporate

Question 30

what are the 6 types of seizures

Answer 30

Tonic Clonic seizure Focal seizure Absence seizure Atonic seizure Myoclonic seizure Infantile spasms

Question 31

What are the notable side effects of the epilepsy medications

Answer 31

sodium valporate - teratogenic Carbamazepine - agranulocytosis Lamotrogine - safe in pregnancy

Question 32

What happens when a seizure lasts more than 5 minutes

Answer 32

Status Epilepticus

Question 33

How do you manage status epilepticus

Answer 33

ABCDE IV lorazepam 4mg, repeated after 10 minutes Phenytoin or Buccal midazolam or diazepam

Question 34

What are the four analgesics for use in neuropathic pain?

Answer 34

amitriptyline Duloxetine Gabapentin Pregabalin

Question 35

How do you differnetiate between an upper motor neurone or lower motor neurone lesion in the facial nerve and why?

Answer 35

if Upper motor neuron suspect stroke, if lower then manage in community If forehead is spare then upper motor neuron

Question 36

What is Bell's palsy?

Answer 36

unilateral lower motor neurone facial nerve palsy

Question 37

What should you check in suspected Bell's palsy?

Answer 37

Forehead should not be spared

Question 38

How is Bell's palsy managed?

Answer 38

Prednisolone