Neurology

Question 1

Six Neurological causes of SIADH

Answer 1

1) Stroke
2) SDH/SAH
3) Encephalitis, Meningitis, Abscess

Question 2

How do you treat Viral Meningitis

Answer 2

Supportive management

Question 3

How do you Diagnose Viral Meningitis

Answer 3

Lumbar Puncture will show:
- Raised WCC
- Predominantly Lymphocytic response
- Raised Serum Glucose compared to CSF Glucose (>66% DIFFERENCE)
- GRAM Stain -VE

Question 4

How would you characterize the causes of vertigo

Answer 4

Peripheral vs Central

Question 5

What are the peripheral causes of Vertigo

Answer 5

BPPV
Menier’s disease
Labrynthitis
Vestibular neuritis

Question 6

What are the central causes of vertigo

Answer 6

Stroke - TIA/Stroke affecting the brainstem
Tumours - Acoustic Neuroma
Multiple sclerosis - Demyelination of the vestibular tract
Migrain assosciated vertigo

Question 7

What are the characteristics of BPPV

Answer 7

30-60Second sensation of the room spinning, self terminates, exacerbated by head turning

Question 8

How do you Dx BPPV

Answer 8

Dix-Hallpike manouvre

Question 9

How do you treat BPPV

Answer 9

Epley manouvre - 1st line
Betahistine - 2nd line

Question 10

Pathophysiology of BPPV

Answer 10

Otolith deposition - Calcium stones block the flow of endolymph in the labrynths

Question 11

Characteristics of Labrynthitis

Answer 11

Preceeding infection:
Tinnitus
Sensorineural hearing loss
Aural fullness
Vertigo

Question 12

Characteristics of Vestibular nueritis

Answer 12

Preceeding infection - Usually URTI
Vertigo

Question 13

Characteristics of Meniers disease

Answer 13

Progressively worsening Vertigo, Sensorineural hearing loss, Tinnitus and aural fullness

Question 14

How to distinguish between Meniers vs Labrynthitis

Answer 14

1) Post infectious
2) Progressive vs acute

Question 15

Pathophysiology of Meniers disease

Answer 15

Endolymph Hydrops - Build up on endolymph fluid

Question 16

How to distinguish Labrynthitis from vestibular neuritits

Answer 16

Both are post infectious
- Labrynthitis affects both cochlea and labrynth hence hearing loss + Vertigo
- Vestibular neuritis only affects the vestibular system hence only vertigo

Question 17

When to start treatment for epilepsy

Answer 17

1) After 2nd epileptiform seizure

Question 18

When is it acceptable to start antiepileptic medications after a first seizure

Answer 18

• neurological defecit
• structural brain abnormality
• unequivocal epileptiform acitivity on EEG

Question 19

Management of generalized tonic clonic seizure in Males

Answer 19

1st line - Sodium valproate
2nd line: Lamotrigine/Levetiracetam

Question 20

Management of generalized tonic clonic seizures in women of child bearing age

Answer 20

1st line - Lamotrigine/Levetiracetam

Question 21

Management of focal/partial seizures

Answer 21

1st line - Lamotrigine/levetiracetam
2nd line - Carbamazepine

Question 22

Management of Absence seizures

Answer 22

1st line - Ethosuximide
2nd line:
- Males - Sodium valproate
- Females - Lamotrgine/levetiracetam

Question 23

What AED can exacerbate absence seizures

Answer 23

Carbamazepine

Question 24

Management of Myoclonic seizures

Answer 24

Males - Sodium valproate
Females - Levetiracetam

Question 25

Management of tonic/atonic seizures

Answer 25

Males - Sodium valproate Females - Lamotrigine

Question 26

Community management for suspected meningococcal meningitis

Answer 26

IM BenPen

Question 27

Criteria for senior review - warning signs of severe meningitis

Answer 27

Rapidly progressing rash CRT >2Seconds Resp <8/>30 hr <40 >140 pH<7.3 Lac>4 GCS <12/ Dropped 2 points since arrival

Question 28

Indications to DELAY LP for suspected meningitis

Answer 28

cardiorespiratory compromise severe bleeding risk Signs of cerebral oedema: - Focal neurology - GCS <12 - Papilloedema - Seizure

Question 29

Gold standard investigation for Dx of Meningitis

Answer 29

Lumbar puncture - Sent for CSFR Glucose paired with serum glucose - MCS, Gram staining - PCR - Lactate levels - ?TB if from high risk region

Question 30

Abx management for patients who have suspected Meningitis ages <3 mo old

Answer 30

IV Cefotaxime + Amox

Question 31

Abx Mx for patients with suspected Meningitis aged > 3mo - 50 YO

Answer 31

IV cefotaxin (Ceftriaxone)

Question 32

Abx Mx for for patients with suspected Meningitis aged >50

Answer 32

Iv Ceftriaxone + Amoxicillin

Question 33

Abx Mx for Meningitis caused by Pneumococcus, Meningococcal, Haemophilus

Answer 33

IV Ceftriaxone (Cefotaxime)

Question 34

Abx Mx for meningitis caused by listeria

Answer 34

IV Amoxicillin + Gentamicin

Question 35

Apart from Abx what are the indications of giving IV dexamethasone in Meningitis

Answer 35

If known/strong suspicion of Pneumococcal Meningitis Signs of cerebral oedema

Question 35

Abx management for patients with Pencillin allergy causing anaphylaxis

Answer 35

IV CHLORAMPHENICOL

Question 36

Post exposure prophylaxis for Meningococcal Meningitis

Answer 36

Ciprofloxacin (One off dose) or Rifampicin (Oral)

Question 37

What is optic neuritis

Answer 37

It is an inflammatory condition of the optic nerve

Question 38

Hallmarks cahracteristics of optic neuritis

Answer 38

- Retrobulbar occular pain - worse on movement - Visual loss -Visual field defec - Central scotoma - Defective colour perception - specically red-green

Question 39

Causes of optic neuritis

Answer 39

Multiple sclerosis - Ulthoff's sign - Vision is worse when exposed to warm temps - Iatrogenic: Ethambutol (TB Mx)

Question 40

Ix to diagnose Optic neuritis

Answer 40

MRI

Question 41

Mx of optic neuritis

Answer 41

High dose corticosteroids If visual loss - then for IV METHYLPRED