Neurology

Question 1

Cerebellar signs (DANISH)

Answer 1

Effects: DANISH
x Dysdiadochokinesia
x Dysmetria: past-pointing
x Ataxia: limb / trunkal
x Nystagmus: horizontal = ipsilateral hemisphere
x Intention tremor
x Speech: slurred, staccato, scanning dysarthria
x Hypotonia

Question 2

Cerebellar dysfunction causes (PASTRIES)

Answer 2

Common Causes: PASTRIES
x Paraneoplastic: e.g. from bronchial Ca
x Alcohol: thiamine and B12 deficiency
x Sclerosis
x Tumor: e.g. CPA lesion
x Rare: MSA, Friedrich’s, Ataxia Telangiectasia
x Iatrogenic: phenytoin
x Endo: hypothyroidism
x Stroke: vertebrobasilar

Question 3

ACA infarct signs

Answer 3

Anterior Cerebral Artery
x Supplies frontal and medial part of cerebrum
x Contralateral motor / sensory loss in the legs > arms
x Face is spared
x Abulia (pathological laziness)

Question 4

MCA infarct signs

Answer 4

Middle Cerebral Artery
x Supplies lateral / external part of hemisphere
x Contralateral motor / sensory loss in face and arms >
legs.
x Contralateral homonymous hemianopia due to
involvement of optic radiation
x Cognitive changes
ƒ Dominant (L): aphasia
ƒ Non-dominant (R): neglect, apraxia

Question 5

PCA infarct signs

Answer 5

Posterior Cerebral Artery
x Supplies occipital lobe
x Contralateral homonymous hemianopia c¯ macula
sparing.

Question 6

Vertebrobasilar system infarct signs

Answer 6

Vertebrobasilar Circulation
x Supplies cerebellum, brainstem and occipital lobes
x Combination of symptoms
ƒ Visual: hemianopia, cortical blindness
ƒ Cerebellar: DANISH
ƒ CN lesions
ƒ Hemi- / quadriplegia
ƒ Uni- / bi-lateral sensory symptoms

Question 7

Causes of Blackouts (CRASH)

Answer 7

Cardiac - Brady/Tachy/LVF/AS/HOCM/PE/Stoke-Adams attack
Reflexes -Vagal overactivity/ postural HypoTN
Arterial - Stroke/TIA, Subclavian Steal, shock,HTN
Systemic - hypoglyc, hypoxia, hypercapnia, anaemia
Head - epilepsy, drop attacks

Question 8

Ix in blackouts

Answer 8

x ECG ± 24hr ECG
x U+E, FBC, Glucose
x Tilt table
x EEG, sleep EEG
x Echo, CT, MRI brain

Question 9

Definition postural hypotension

Answer 9

Postural hypotension: difference of >20/10 after

standing for 3min vs. lying down

Question 10

Resting tremor

Answer 10

Features
ƒ 4-6Hz, pill-rolling
ƒ Abolished on voluntary movement
ƒ ↑ c¯ distraction (e.g. counting backwards)
x Causes: Parkinsonism
x Rx: Da agonists, antimuscarinic (e.g. procyclidine)

Question 11

Action/postural tremor

Answer 11

Features
ƒ 6-12Hz
ƒ Absent at rest
ƒ Worse c¯ outstretched hands or movement
ƒ Equally bad at all stages of movement
x Causes: BEATS
ƒ Benign essential tremor
ƒ Endocrine: thyroxicosis, ↓glucose, phaeo
ƒ Alcohol withdrawal (or caffeine, opioids…)
ƒ Toxins: β-agonists, theophylline, valproate, PHE
ƒ Sympathetic: physiological tremor may be
enhanced: e.g. in anxiety

Question 12

Intention Tremor

Answer 12

x Features
ƒ >6Hz, irregular, large amplitude
ƒ Worse at end of movement
ƒ E.g. past-pointing
x Causes: cerebellar damage

Question 13

Benign essential tremor

Answer 13

Autosomal dominant
x Occur c¯ action and worse c¯ anxiety, emotion, caffeine
x Arms, neck, voice
x Doesn’t occur during sleep
x Better c¯ EtOH

Question 14

Acute Dystonia

Answer 14

Torticollis, trismus and/or occulogyric crisis
x Typically a drug reaction:
ƒ Neuroleptics
ƒ Metoclopramide
ƒ L-DOPA
x Rx: procyclidine (antimuscarinic)

Question 15

Chorea

Answer 15

Non-rhythmic, purposeless, jerky, flitting movements
x E.g. facial grimacing, flexing / extending the fingers
x Causes
ƒ Huntington’s
ƒ Sydenham’s
ƒ Wilson’s
ƒ L-DOPA

Question 16

Athetosis

Answer 16

Slow, sinuous, writhing movements
x Causes
ƒ Cerebral palsy
ƒ Kernitcterus

Question 17

Hemiballismus

Answer 17

Large amplitude, flinging hemichorea
x Contralateral to a vascular lesion in the subthalamic
nucleus: often elderly diabetics
x Recovers spontaneously over months

Question 18

Reversible causes of Dementia

Answer 18

Infection
x Viral: HIV, HSV, PML
x Helminth: cysticercosis, toxo
Vascular
x Chronic subdural haematoma
Inflammation
x SLE
x Sarcoid
Neoplasia
Nutritional
x Thiamine deficiency
x B12 and folate deficiency
x Pellagra (B3 / niacin deficiency)
Hypothyroid
Hypoadrenalism
Hypercalcaemia
Hydrocephalus (normal pressure)

Question 19

Biceps reflex

Answer 19

C5-6

Question 20

Knee reflex

Answer 20

L3-4

Question 21

Triceps reflex

Answer 21

C7-8

Question 22

Ankle reflex

Answer 22

S1-2

Question 23

Anti emetic in parkinsons

Answer 23

Domperidone - doesn’t cross the BBB

Question 24

Lacunar infarct

Answer 24

involves perforating arteries around the internal capsule, thalamus and basal ganglia
presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

Question 25

Lateral medullary syndrome

Answer 25

(posterior inferior cerebellar artery) aka Wallenberg's syndrome ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner's contralateral: limb sensory loss

Question 26

Weber's syndrome

Answer 26

ipsilateral III palsy | contralateral weakness

Question 27

Erbs palsy

Answer 27

Brachial trunks C5-6. | Pronated and medially rotated arm - waiters tip

Question 28

Klumpke's palsy

Answer 28

Brachial trunks C8-T1. Classically there is weakness of the hand intrinsic muscles. Involvement of T1 may cause a Horner's syndrome. It occurs as a result of traction injuries or during delivery.

Question 29

Pseudoseizures

Answer 29

Phenomenon that can mimic true seizures but generally have findings which are not entirely consistent with a seizure. They are often psychiatric in origin, but it is important to note that while not involuntary, they are usually not deliberate; the movement is compulsive and unwanted. The ability to control the location of symptoms is very typical of a pseudoseizure and does not fit with any of the other options presented Widespread convulsions without conscious impairment is likely to represent a pseudoseizure

Question 30

Optic neuritis

Answer 30

Blurred vision and painful movements of one eye

Question 31

Essential tremor Rx

Answer 31

Improved with propanolol and alcohol

Question 32

Reasons to start anti-epileptics after first seizure

Answer 32

- the patient has a neurological deficit - brain imaging shows a structural abnormality - the EEG shows unequivocal epileptic activity - the patient or their family or carers consider the risk of having a further seizure unacceptable

Question 33

stopping AEDS

Answer 33

can be considered if seizure free for >2y, with AEDS being withdrawn over 2-3y

Question 34

cataplexy

Answer 34

sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened)

Question 35

Medical Rx Trigeminal Neuralgia

Answer 35

carbamazepine

Question 36

Cardinal features of Parkinsons

Answer 36

Bradykinesia and 2 of the following - postural instability - rigidity - resting tremor