Neurology

Question 1

How do you diagnose carpal tunnel syndrome and what does it show?

Answer 1

Nerve conduction studies show prolonged action potential

Question 2

How do you manage mild to moderate cases of carpal tunnel syndrome?

Answer 2

Wrist splints at night
Corticosteroid injections

Question 3

What do you do at the bedside before sending a patient with signs suggestive of cauda equina to have a whole spine MRI?

Answer 3

Full neurological examination

Question 4

How do you manage severe or refractory cases of carpal tunnel syndrome?

Answer 4

Surgical decompression- flexor retinaculum division

Question 5

What gene is mutated in Huntington’s disease?

Answer 5

IT15 (HTT gene)

Question 6

A patient with a history of diabetes and hypertension is more likely to get which type of stroke?

Answer 6

Ischaemic stroke

Question 8

A patient has a headache that feels like they were hit on the back of their head, signs of meningism and no fever. What do they have?

Answer 8

Subarachnoid haemorrhage

Question 9

What is the mode of inheritance for neurofibromas?

Answer 9

autosomal dominant inheritance

Question 10

If one dose of rectal diazepam has been given in status ellipitucs and they are still seizing with IV access, what do you administer next?

Answer 10

IV lorazepam

Question 11

What does facial weakness with hyperacusis and absent vesicles around ear suggest?

Answer 11

Bell’s palsy

Question 12

What are the precursor proteins found in Alzheimer’s disease?

Answer 12

Beta and gamma secretase

Question 13

Which foramen does the middle meningeal artery run through?

Answer 13

Foramen spinosum

Question 14

List three conditions where a CT Head is needed within 8 hours

Answer 14

1. some loss of consciousness since injury
   2 >65 years old
2. bleeding disorders

Question 15

When is a CT head indicated within 1 hour?

Answer 15

If there is both a loss of consciousness at any point AND:
2 >65 years old
3. bleeding disorders
4. dangerous mechanism of injury

Question 16

A patient with a stroke has AF. What is the treatment and when is it given?

Answer 16

Abixapan 2 weeks after to prevent haemorrhagic transformation.

Question 17

What is the sign when knee extension is painful in meningitis?

Answer 17

Kernig sign

Question 18

What is the sign when neck flexion causes knee/hip flexion in meningitis?

Answer 18

Brudzinski sign

Question 19

Which artery is affected in stroke patients with prosopagnosia and homonymous hemianopia only?

Answer 19

Posterior cerebral artery

Question 20

Name five factors that gives a better MS prognosis

Answer 20

Female
<25
First presentation of optic neuritis
>1 year between episodes
Less lesions on MRI

Question 21

What is one of the first things to do with a stroke patient in the hospital to prevent complications?

Answer 21

Make them NBM to prevent aspiration pneumonia

Question 22

If the onset of a stroke is unknown what is contraindicated?

Answer 22

Thrombolysis

Question 23

What dermatome covers the medial lower leg?

Answer 23

L4

Question 24

What causes paraplegia and what is it?

Answer 24

Spinal cord compression
5/5 upper limbs
0/5 lower limbs

Question 25

What is the sensory level at the umbilicus?

Answer 25

T10

Question 26

A lesion where in the brain causes a left mouth droop?

Answer 26

Left brain stem due to cranial nerves

Question 27

Where is the lesion causing intranuclear opthalmoplegia in MS?

Answer 27

medial longitudinal fasciculus this causes eyes not to align

Question 28

Would MS or spinal cord compression cause absent ankle jerks?

Answer 28

NO MS never affects LMN Spinal cord can compress LMN roots

Question 29

What does Romberg test test?

Answer 29

proprioception

Question 30

What antibiotics are used to treat a cerebral abscess?

Answer 30

IV metronidazole and cefuroxime

Question 31

What is the most useful step after a patient present with epillepsy or syncope?

Answer 31

Gain collateral history of what happened before and after the episode

Question 32

A patient with meningitis has a seizure, what are you going to do next?

Answer 32

Add IV acyclovir for enecephalitis

Question 33

What is the difference in visual defect between an MCA stroke and a PCA stroke?

Answer 33

MCA stroke- homonymous hemianiopia PCA stroke- visual agnosia

Question 34

What nerve lesion causes a winged scapula?

Answer 34

Long thoracic nerve

Question 35

What nerve is damaged in a hip dislocation and what signs are seen?

Answer 35

Sciatic nerve Loss of flexion and extension of foot and hamstrings Loss of sensation below the knee except medial leg

Question 36

What nerve injury causes a shuffling gait and claw foot

Answer 36

Tibial nerve injury blow to the back of the knee

Question 37

A pregnant/ obese woman presents with burning sensation in their thigh. Why?

Answer 37

Lateral femoral cutaneous nerve trapped in inguinal ligament

Question 38

What GCS Verbal score is given to confused and muddled speech?

Answer 38

4

Question 39

What GCS Verbal score is given to inappropriate words without conversational exchanged speech?

Answer 39

3

Question 40

How can alcohol intoxication affect speech

Answer 40

Dysarthria (cerebellar speech) Due to cerebellar dysfunction

Question 41

What dermatome covers the dorsum of the foot?

Answer 41

L5

Question 42

What dermatome covers the cheek?

Answer 42

trigeminal nerve

Question 43

What is the next step after a patient with Parkinsons is refractory with levodopa?

Answer 43

Decrease levodopa dose and add a dopamine agonist e.g ropinerole

Question 44

What type of gait is seen in parkinsons?

Answer 44

Extrapyrimidal gait

Question 45

What type of gait is seen in stroke or cerebral paslsy?

Answer 45

Spastic gait

Question 46

What type of ataxia and gait is seen in Vitamin B12 deficiency?

Answer 46

Sensory ataxia ->stomping gait Loss of proprioception

Question 47

What type of gait is seen in proximal muscle weakness?

Answer 47

Waddling gait

Question 48

What type of gait is seen in post hip surgery to avoid pain?

Answer 48

Antalgic gait

Question 49

What type of gait is seen in Guillain barre syndrome, MS or peroneal nerve injury?

Answer 49

High stepping gait

Question 50

What type of gait is seen in normal pressure hydrocephalus?

Answer 50

Gait apraxia

Question 51

Is there confusion in lacunar stroke?

Answer 51

No

Question 52

Cauda equina is the compression of sensory fibres leaving which spinal levels? And how does this affect reflexes?

Answer 52

S3-S5 LMN affected so reduced reflexes

Question 53

What type of strokes are carotid dopplers not useful in?

Answer 53

Posterior circulation stroke

Question 54

What kind of meningitis in a patient with a history of alcoholism and recent chest infection? What is the mortality?

Answer 54

Pneumococcal meningitis 20% mortality

Question 55

Which meningitis bacterial vs viral presents more suddenly and severe?

Answer 55

Bacterial

Question 56

What is the most sensitive test for subarachnoid haemorrhage within 48 hrs?

Answer 56

Non contrast CT head

Question 57

How would you administer Parkinsons medication if they are NBM?

Answer 57

Insert NG tube to administer medication Rotigotine patch If they have dementia: rivastigmine patch

Question 58

What is the most common form of GBS? What is a complication of this?

Answer 58

Inflammatory demyelinating polyneuropathy (which can affect sensory nerves too unlike MG) which can lead to type 2 respiratory failure

Question 59

Does frontotemporal dementia cause motor issues?

Answer 59

No Consider Huntington's disease

Question 60

Which headaches occur roughly the same time everyday?

Answer 60

Cluster headaches

Question 61

What is a contraindication to a lumbar puncture apart from raised ICP?

Answer 61

rapidly evolving non blanching rash

Question 62

What risk does clozapine cause and what investigation is needed?

Answer 62

Agranulocytosis - do an FBC

Question 63

What type of memory is most impaired in dementia?

Answer 63

Short term memory

Question 64

What is the best treatment for a neuropathic bladder in an MS patient

Answer 64

self-catheterisation medication is unlikely to helpI

Question 65

In neuroleptic malignant syndrome what blood marker is diagnostic?

Answer 65

CK levels

Question 66

Where is the lesion if there is intrinsic hand muscle wasting and sensory loss of forearm?

Answer 66

T1