Neurology

Question 1

what type of epilepsy is associated with aura and automatisms?

Answer 1

Temporal lobe seizure

Question 2

How does Jacksonian epilepsy present?

Answer 2

focal attacks start in one limb/corner of mouth and rapidly ascend
then preceded with Todd’s paresis

Question 3

AED used in status epilepticus

Answer 3

Lorazepam 4mg IV bolus once and again after 10 minutes

Question 4

classic EEG finding in absence seizures

Answer 4

3Hz spikes

Question 5

when is AED treatment considered?

Answer 5

2 or more seizures within 2 years

Question 6

first line AED in a) generalised seizures b) partial seizures c) absence seizures

Answer 6

a) valproate
b) carbamez
c) valproate

Question 7

Presentation of optic neuritis

Answer 7

usually unilateral pain on movement of eye, blurred vision which may progress to blindness.
RAPD

Question 8

define the following

a) Lhermitte Phenomenon

b) Uhthoff phenomenon

Answer 8

a) tingling down arms and legs on neck flexion

b) all MS symptoms worsen in heat

Question 9

Investigations in MS

Answer 9

1. MRI- Dawson’s fingers

2. oligoclonal bands in CSF

Question 10

Management of acute relapses

Answer 10

Depends on severity

- use IV/PO methylpred for 3-5days

Question 11

long-term management of RR-MS

Answer 11

DMARDS

• beta inteferon
• natalizumab

Question 12

in which lobes are broca and wernicke’s area?

Answer 12

broca- inferior left frontal lobe

wernickes- superior left parietal lobe

Question 13

1. TACI
2. PACI
3. POCI
4. LACI

Answer 13

1. hemiparesis, hemisensory loss and homonymous hemianopia
2. two of TACI
3. ataxia, diplopia, LMN facial palsy
4. pure motor/pure sensory/ataxic hemiparesis

Question 14

in which patients are watershed infarcts more common?

Answer 14

pts with carotid stenosis who drop their BP for whatever reason

Question 15

what is a watershed infarct?

Answer 15

ischaemia at borders of vascular territories to aca,mca and PCA

Question 16

Pt <55 with stroke what tests do you want to do?

Answer 16

Coagulation screen for thrombophilias

Question 17

secondary prevention of stroke

Answer 17

1. lifestyle changes
2. atorvastatin 80mg
3. aspirin for 2 weeks then clopidogrel
4. antihypertensive

Question 18

What is Wallenberg syndrome?

Answer 18

Lateral medullary syndrome (posterior inferior cerebellar artery)

ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss

Question 19

What is Weber’s syndrome?

Answer 19

branches of the posterior cerebral artery that supply the midbrain
- ipsilateral CN3 palsy and contralateral weakness

Question 20

what are reflexes like in M.Gravis?

Answer 20

normal/brisk

Question 21

investigations in m.gravis

Answer 21

AchR antibodies
EMG- decrement on repetitive stimulation
CT chest- thymoma

Question 22

Treatment of M. gravis

Answer 22

1. Pyridostigmine

2. immunosuppress: pred/azathiopine

Question 23

M.gravis crisis and what is the treatment?

Answer 23

Weakness of resp muscles during relapse
Monitor FVCs
treat with IV Ig

Question 24

Lambert eaton syndrome

• association
• features
• management

Answer 24

• small cell lung cancer/AI
• Limb girdle weakness, HYPOreflexia, autonomic sx, REVERSE fatiguability
• immunosuppress with pred

Question 25

medical management of SAH

Answer 25

Nimodipine (cause vasospasm)

Question 26

acute and prophylactic Rx of migraine

Answer 26

``` acute first line: combo of oral triptan and NSAID * if young give nasal triptan prophylaxis - betablocker or topiramate (2nd line) ```

Question 27

Cluster headaches - classic presentation - acute attack Rx - prophylactic rx

Answer 27

- like 'clockwork' for 2-6 weeks often at night time for 30-60 mins - 100% oxygen for 10-15mins/sumitriptan - verapamil TDS

Question 28

Venous sinus thrombosis - treatment - MRI sign?

Answer 28

- anticoag | - Delta sign

Question 29

treatment of choice for trigeminal neuralgia

Answer 29

carbamezapine

Question 30

at what ICP is treatment required?

Answer 30

exceeds 15mmHg for >5 mins

Question 31

causes of obstructive and communicating hydrocephalus

Answer 31

obs: chiari malformation comm: Meningitis, SAH

Question 32

classic presentation of idiopathic intracranial HTN | - first line rx

Answer 32

young obese female with papilloedema, headaches and machinery noise in ears - weight loss

Question 33

conditions associated with SAH

Answer 33

- PCKD - Coarctation aorta - Ehlers Danlos

Question 34

surgery in subdural AND extradural haematoma

Answer 34

Decompressive craniotomy

Question 35

Encephalitis - presentation - inv - management - differential

Answer 35

- infective prodrome followed by worst headache ever, confusion, fevers - contrast CT shows focal bilateral temporal involvement if HSV - Aciclovir STAT - encephalopathy (afebrile)

Question 36

Cerebral abscess - presents? - CT sign? - Rx

Answer 36

- 3-4 hx of progressive fever, headache, focal neurology - ring enhancing lesion - surgical craniotomy and debride