Neurology

Question 1

Give at least 5 main headaches

Answer 1

1. Cluster
2. Tension
3. Giant cell arteritis
4. Migraine
5. Subarachnoid or intracranial haemorrhage
6. Glaucoma
7. Encephalitis or ICP
8. Tumour

Question 2

5 main red flag symptoms

Answer 2

Fever
Photophobia
Photophonia
Neck stiffness
Visual disturbances
Vomiting
Trauma
Cancer
Worse coughing and in different positions
Sudden occipital pain
Pregnancy

Question 3

What can fundoscopy be used to detect?

Answer 3

Papilloedema

Question 4

What can papilloedema suggest?

Answer 4

Raised ICP

Question 5

What is papilloedema

Answer 5

Swelling of optic discs due to pressure

Question 6

Initial investigations for headache?

Answer 6

1. History and red flag symptoms
2. Fundoscopy?
3. CT/ neuro imaging?

Question 7

What is a cluster headache

Answer 7

Unilateral throbbing behind an eye that can be red and swollen lacrimating and recurrent/reappearing

Question 8

How long does a cluster headache last

Answer 8

15mins -3hrs

Question 9

4 key signs of cluster headache

Answer 9

Miosis (pupillary constriction), ptosis (drooping eye), nasal discharge, facial swelling

Question 10

management of cluster headache? (2?)

Answer 10

High flow oxygen 100%
Triptans

Question 11

What prevents cluster headaches?

Answer 11

Verapamil

Question 12

What’s a tension headache

Answer 12

Mild band pressure around the head, develops gradually and goes gradually

Question 13

3 main causes of tension headaches

Answer 13

Dehydration, skipping meals, alcohol

Question 14

3 management?

Answer 14

1. Reassurance
2. Water
3. Simple analgesia (paracetamol ibuprofen)

Question 15

What is used for chronic tension headaches

Answer 15

Amitriptyline

Question 16

How many stages of migraine are there?

Answer 16

5

Question 17

How many classes of migraines are there??

Answer 17

4

Question 18

List the classes of migraines

Answer 18

Migraine with aura
Migraine without aura
Silent migraines
Hemiplegic migraines

Question 19

What’s a silent migraine

Answer 19

Migraine with aura no headache

Question 20

What’s a Hemiplegic migraine

Answer 20

Migraine that paralyses one side, resembles tia or stroke

Question 21

5 stages of migraine?

Answer 21

Prodromal/pre - days before mood changes etc
Aura - visual/sesation/language
Headache - 4-72hrs
Resolution
Postdromal/recovery

Question 22

What is aura

Answer 22

Visual disturbances or hallucinations
Sensations of tingling or numbness
Dysphasia

Question 23

Can you have menstrual migraine?

Answer 23

Yes, 2 days before

Question 24

Tx for migraine?

Answer 24

NSAIDs, paracetamol, Triptans and antiemetics if vomiting

Question 25

What makes migraines worse?

Answer 25

Opiates

Question 26

What are Triptans

Answer 26

5-ht receptor agonists, cause cranial vasoconstriction, inhibit pain signals, release inflammatory neuropeptides

Question 27

What can prevent migraines?

Answer 27

Propanolol, amitriptyline

Question 28

What is a stroke?

Answer 28

Ischaemia or infarction or intracranial haemorrhage

Question 29

What is a TIA

Answer 29

Transichaemic attack

Question 30

What risk does TIA pose with relation to stroke

Answer 30

Crescendo TIA (2+) within a week = stroke risk

Question 31

What tools can be used to identify stroke?

Answer 31

FAST or ROSIER

Question 32

What is the classification system for stroke called?

Answer 32

Oxford/bamford

Question 33

3 criteria for oxford

Answer 33

1. Unilateral hemiparesis and/or hemisensory loss of face/arm/leg 2. Homonymous hemianopia (field loss deficient in the same halves of the visual field of each eye) 3. Higher cognitive dysfunction (speech)

Question 34

What signs does anteriro lesions have?

Answer 34

Contralateral hemisensory and hemiparesis

Question 35

What signs does middle lesion have?

Answer 35

Hemisensory and hemiparesis (anterior - but of upper more common) + Contralateral homonomymous hemianopia Aphasia

Question 36

What would posterior lesion present as?

Answer 36

Contralateral homonymous hemianopia with macula sparing + visual agnosia (LOTS OF VISION)

Question 37

What would Webers region legion affect ?

Answer 37

Same sided CN3 palsy Weakness of opposite upper and lower extremity

Question 38

What would wallenbergs lesion suggest?

Answer 38

Same side face pain and temp loss Opposite sensation change/temp loss Ataxia Nystagmus DANVAH!!!!

Question 39

What causes Amaurosis fugax

Answer 39

Retinal/opthalamic lesion

Question 40

What causes locked in syndrome

Answer 40

Pons affected, basilar artery

Question 41

What causes Wallenberg and facial paralysis and deafness (same side)?

Answer 41

Lateral pontine, anterior inferior

Question 42

Risk assessment for stroke?

Answer 42

QRISK 3

Question 43

Medical option for stroke prevention?

Answer 43

Anticoag/platelet, aspirin and statins

Question 44

Tx for suspected TIA?

Answer 44

300mg aspirin, specialist tx within 24 hrs and lifestyle advice BP/HTN monitored Clopidogrel + aspirin lastly

Question 45

3 investigations for stroke

Answer 45

1. FAST/ROSIER 2. CT/MRI 3. Carotid endartectomy

Question 46

How does haemorrhage show on CT

Answer 46

Grey spot

Question 47

How does ischamia show on ct

Answer 47

Black

Question 48

Tx for acute stroke?

Answer 48

Alteplase (haemorrhage cause excluded) Aspirin asap Ppi for those with reflux/gord

Question 49

Tx for acute haemorrhagic stroke

Answer 49

Surgical intervention, hTN tx and anticoag stopped and reversed (NO LMWH)