Neurology

Question 1

Common complications of COVID 19 vaccine who presented with headache
Sx
∆?
Ix?

Answer 1

SX: headache after 4-42 days post vaccine
∆: CSVT
Ix : d- Dimer, fibrinogen, plt
CT brain

Question 2

Hemineglect
What?
Site?

Answer 2

Spatial neglect on contralateral post stroke as if the side does not exist
Eg shaving one side of face
Site: parietal cortex

Question 3

Carotid artery stenosis

Answer 3

1. CDUS initial choice
2. Symptomatic: endarterectomy in 2 weeks (> 50%)

Question 4

Brain tumour in elderly

Answer 4

nagging headaches in the morning and the associated vomiting not preceded by nausea (projectile vomiting) are highly suggestive of a space occupying lesion in the brain such as a tumor or an abscess

Question 5

Temporal lobe epilepsy
PABAPA pneumonic SX

Answer 5

Aura
Autonomic dysfunction
Psychic sensation: jamais vu deja vu
Blank stare, pupil dilation
Post ictal drowsiness , confusion,amnesia
Automatism: chewing, fidgeting

Question 6

Optic neuritis
SX?
Ix?

Answer 6

Pain on eye movement, reduced vision , reduced V/A ( retrobulbar)
Ix: Visual evoked potentials

Question 7

Vertebro basilar insufficiency
Sx

Answer 7

Vertigo
Cerebellar signs
Diplopia
Horner syndrome: unilateral

Question 8

Bppv
Sx
Ix
Rx

Answer 8

Vertigo, nausea, nystagmus
Dix halpike
Epley manoeuvre, ressurance and vestibular rehab

Question 9

Acute labyrinthitis
Sx

Answer 9

Sudden acute vertigo, hearing loss and tinnitus with nausea+ vomiting
50% post urti

Question 10

Vestibular neuronitis vs
Bppv

Answer 10

Similar vertigo, nausea and imbalance, nystagmus.. but more profound imbalance in VN
Caloric test : COWS ( cold opposite warm same)

Question 11

PICA occlusion ( lateral medullary syndrome/ Wallenberg syndrome)

Answer 11

Part of vertebrobasillar artery:
Vertigo, hearing loss
Ipsilateral Horner syndrome, contralateral sensory loss of limb

Question 12

PCA stroke

Answer 12

Acute confusion, memory, vision loss, posterior headache

Question 13

Temporal lobe epilepsy
Rx

Answer 13

Carbamazepine

Question 14

Syringomyelia

Answer 14

Fluid filled cavity
Tumor/trauma/congenital
Cape like distribution of deficits
Hand 👏 upwards progression
Sensory,motor pain+temperature

Question 15

Syringomyelia
Ix
Rx

Answer 15

MRI
Tumor excise
Fluid : drainage

Question 16

Ulnar nerve injury at elbow

Answer 16

Small muscles of of hand affected
Most: hypothenar, lumbricals, introssei muscle
Median: 2nd and 3rd lumbricals only

Question 17

Anterior interosseous nerve

Answer 17

Branch of medial nerve
Supplies flexor digitorum profunda, pronator quadratus, flexor pollicis longus

Question 18

Parkinson disease vs drug induced Parkinson
Sparing effect

Answer 18

Tremor absent in DIP
Unilateral in PD

Question 19

ALS
Stephen Hawking

Answer 19

Umn + Lmn
20-40 yrs
Progressive loss of MOTOR function only !!!
Swallowing if bulbar involved

Question 20

ALS
Complications?
Rx?
Ix?

Answer 20

Aspiration, pneumonia
Rituzole
EMG and NCS

Question 21

SAH

Answer 21

Sudden, thunder ⚡ clap headache
Severe

Question 22

Sciatic nerve root formed by

Answer 22

L4, L5, S1, S2, and S3 nerve roots.

Question 23

Sciatic nerve injury specific

Answer 23

Weak or absent ankle reflex

Question 24

Ankle jerk present+
Eversion,inversion , flexion and extension loss ( -)

Answer 24

Common peroneal nerve injury

Question 25

Stroke less than 4.5 hrs CT 🧠: not hemorrhage

Answer 25

rTPA

Question 26

Stroke ( CT 🧠 negative) > 4.5 hrs

Answer 26

Aspirin+ Clopidogrel for 3 weeks

Question 27

Carotid endarterectomy Indicated?

Answer 27

Carotid endarterectomy (CEA) is considered for secondary prevention of ischemic stroke and TIA in selected patients. It prevents further ischemic events but does not affect the outcomes of the patient’s current condition

Question 28

Lung monitoring in GBS

Answer 28

Patient should always be managed in an inpatient setting. Vital capacity should be monitored 4-hourly and if it falls to less than 20 ml/kg or is declining rapidly, the patient should be transferred to an intensive care unit.

Question 29

Amaurosis fugax

Answer 29

Emboli at retinal artery is likely which is originating from carotid So CDUS is a priority

Question 30

Transient monocular vision loss aka amaurosis fugax Carotid bruit absent

Answer 30

Still perform CDUS as the embolization could be occurred at ICA or retinal arteries

Question 31

Commonest brain tumour metastasis

Answer 31

Breast Lung Melanoma

Question 32

Melanoma risk of metastasis

Answer 32

Male Mucosal surfaces Upper trunk, head or neck Acral lentiginous, nodular Wide, deep, thick, ulcerated lesions Involvement of > 3 regional lymph nodes

Question 33

Parkinson disease Rx Mild

Answer 33

Mild: benztropine & trihexyphenidyl : anticholinergic to reduce tremor and rigidity Amantadine: > 60 yrs not tolerate Ach (-)

Question 34

Severe Parkinson disease Rx

Answer 34

Severe : levodopa + carbidopa Prob: on & off phenomenon COMT (-) Capone only used for those on Rx with levodopa+ carbidopa , reducing the on/off phenomenon MAO (-) : sepegiline either as single or adjuvant Deep brain stimulation: highly effective for tremor and rigidity

Question 35

Huntington disease Triad Ix

Answer 35

Autosomal dominant Dementia+chorea+behaviour ∆ Usually 30-50 yrs Genetic testing ( CAG trinucleotide repeat) at 18yrs old

Question 36

Multiple sclerosis SX Ix Rx Remember white matter, white lady

Answer 36

Usually focal sensory deficit and gait /imbalance + eye:optic neuritis+ internuclear opthalmoplegia MRI best initial and most accurate High dose steroids Glatiramer

Question 37

Charcot Marie Tooth What? SX? Ix? Rx?

Answer 37

Genetic loss of motor a d sensory Distal weakness & sensory loss Muscle leg wasting Decreased DTR Tremor Pes cavus ( high arched foot) EMG Nil of Rx