Neurology

Question 1

How do we reduce ICP?

Answer 1

Head up 30 degrees
Hyperventilate –> low CO2 –> vasoconstriction

Question 2

What kind of haemorrhage doesn’t tend to cause a midline shift?

Answer 2

Subarachnoid haemorrhage

Question 3

How do we manage a non-traumatic (aneurysmal) subarachnoid haemorrhage?

Answer 3

CT angiogram to locate site of aneurysm

Nimodipine 60mg 5 per day

Minimise valsalvas (bed rest, codeine to stop coughing, laxatives to stop constipation, antiemetics to stop vomiting)

Don’t give antiepileptic unless prev. seizure

Question 4

If a pt has a typical subarachnoid haemorrhage history but the CT head comes back normal, what should we consider?

Answer 4

Delayed lumbar puncture

Question 5

What’s the most common brain tumour in adults?

Answer 5

Metastasis

Question 6

How do we investigate an abscess?

Answer 6

Diffusion-weighted MRI

Question 7

If a patient has back pain and insensate incontinence (wet/soiled without realising) then what do we suspect?

Answer 7

Cauda equina

Question 8

How do we investigate cauda equina?

Answer 8

Lower limb neuro exam, PR exam

Pin-prick saddle exam

Pregnancy test if Female

Post-void bladder scan

MRI non-contrast of the lumbar spine

Question 9

On a CT head, if we have “white” blood do we do a Burr hole or not?

Answer 9

No bc white blood = thick so Burr hole won’t relieve pressure

Question 10

On a CT head, if we have “grey” blood do we do a Burr hole or not?

Answer 10

Yes, bc grey blood = thin

Question 11

If we suspect early hydrocephalus, what can we do to manage it?

Answer 11

External ventricular drain in theatre

Question 12

What does chorea mean?

Answer 12

Involuntary, random, irregular, purposeless movements

Question 13

What does the hummingbird sign indicate?

Answer 13

Progressive supranuclear palsy

Question 14

What does the hot cross bun sign indicate?

Answer 14

Multiple systems atrophy

Question 15

What are three types of hyperkinetic movement disorders causing involuntary movements?

Answer 15

Tremor, chorea, dystonia

Question 16

What does finger-thumb tapping getting smaller and slower indicate?

Answer 16

Parkinsonism

Question 17

What do we need to include in a movement disorder history?

Answer 17

Tone
Power
Reflexes
Sensation
Co-ordination

Question 18

What’s the pathophysiology of Parkinson’s disease?

Answer 18

Depletion of dopamine in the basal ganglia

Reduction of dopamine-producing neurons in the substantia nigra

Inhibition of the thalamus –> bradykinesia

Question 19

What are six causes of seizures?

Answer 19

HIP SEA

Hypoglycaemia

Infection: HSV encephalitis

Psych

Question 20

If you have a left cerebellar infarct, where will you see the problem?

Answer 20

Left side

(Ipsilateral)

Question 21

Wasting, fasciculations, reflexes present. What are you thinking?

Answer 21

Motor Neurone Disease

Question 22

What does pronator drift indicate?

Answer 22

Weakness in that arm

Question 23

Does parkinsons have spastic or rigid tone?

Answer 23

Rigid

Question 24

What’s the difference between spastic and rigid?

Answer 24

Rigid: all the way through
Spastic: worse at the start

Question 25

What can cause promixal weakness?

Answer 25

Upper motor neurone lesion Myopathy

Question 26

What can cause distal weakness?

Answer 26

Neuropathy

Question 27

If we just have pain in the dermatome of C7?

Answer 27

Radiculopathy - disc jutting out and compressing the nerve

Question 28

What kind of conditions can cause a glove and stocking distribution of sensory loss?

Answer 28

Diabetic neuropathy Alcoholic neuropathy

Question 29

What could "tripping over small steps" indicate?

Answer 29

Foot drop (common peroneal nerve palsy)

Question 30

What looks like Guillian Barre but isn't?

Answer 30

Chronic Inflammatory Demyelinating Polyradiculopathy - polyphasic unlike GB, and milder symptoms, requires long-term treatment, whereas GB is self-limiting.

Question 31

Guess the diagnosis: 24M, high plantar arch, lower leg weakness and distal muscle wasting, peripheral sensory loss.

Answer 31

Charcot Marie Tooth disease

Question 32

What are the causes of peripheral neuropathy?

Answer 32

ABCDE A – Alcohol B – B12 deficiency C – Cancer (e.g., myeloma) and Chronic kidney disease D – Diabetes and Drugs (e.g., isoniazid, amiodarone, leflunomide and cisplatin) E – Every vasculitis

Question 33

What's characteristic of Myasthenia Gravis?

Answer 33

Variability

Question 34

What causes dyskinetic cerebral palsy? (slow, writhing movements of the limbs)

Answer 34

Damage to the basal ganglia and substantia nigra

Question 35

What kind of signs would MS show most? (UMN, LMN, mixed, etc.)

Answer 35

UMN AKA Pyramidal AKA Long tract

Question 36

What is Lhermitte's sign?

Answer 36

Barber chair sign in MS When neck is flexed (chin-to-chest), electric shock-like pain

Question 37

What is Uhthoff's phenomenon?

Answer 37

In the context of MS, it is the worsening of vision following rise in body temperature

Question 38

What are the investigations for MS and what would positive results show?

Answer 38

Bloods --> HLAB-27 MRI --> demyelinated (white) T2 lesions, periventricular plaques, Dawson fingers LP --> oligoclonal bands in the CSF, increased intrathecal synthesis of IgG Delayed visual evoked potentials

Question 39

What do we need evidence of to diagnose MS?

Answer 39

Lesions that vary in location and are disseminated in time and space. --> Evidence of two or more relapses: EITHER objective evidence of =>2 lesions OR objective evidence of 1 lesion + history of previous relapse

Question 40

Parkinsonism + autonomic disturbance (postural hypotension, atonic bladder) = ?

Answer 40

Multiple System Atrophy