Neurology

Question 1

Features of TTH

Answer 1

Diffuse, bilateral
“Band like”
Present most of the time
Constant ache with little variation

Question 2

Features of migraine

Answer 2

Hemi cranial pain Throbbing 
Pulsatile 
Abdo. pain 
Vomiting 
Releived by rest/dark/ quiet room  
Photophobia/ phonophobia 
Visual, sensory, motor aura
\+ve FH

Question 3

Pointers to increased intracranial pressure

Answer 3

Aggravated by activities that raise ICP
e.g coughing, bending straining
Woken from sleep with headache/vomiting
Papilloedema

Question 4

Pointers to analgesic overused headaches

Answer 4

Particularly relevant to TTH
Vicious cycle 
Back before allowed to use another dose
Paracetamol/NSAIDs
Particular problem with compound analgesics e/g Cocodamol

Question 5

Indications for neuroimaging

Answer 5

Features cerebellar dysfunction 
Increased ICP signs 
New focal neurological deficit 
Seizures
Personality change 
Unexplained deterioration at schoo,

Question 6

Rx for TTH

Answer 6

Aim reassurance
No sinister cause 
MDT approach 
Acute attacks = simple analgesia 
Prevention = amitriptyline

Question 7

Rx for medication overuse headaches

Answer 7

Stop analgesics

Question 8

Acute attack Rx for migraine

Answer 8

Pain relief (triptans)

Question 9

Preventative Rx for migraine

Answer 9

Pizotifen, Propanolol, Amitryptiline, Topiramate, Valproate

Question 10

Most common types of primary headaches

Answer 10

TTH

Migraine

Question 11

Dx criteria for epilepsy

Answer 11

Tendency to recurrent (at least 2), unprovoked (spontaneous) epileptic seizures

Question 12

2 broad types of epileptic seizures

Answer 12

Generalised

Partial

Question 13

does a single seizure = epilepsy

Answer 13

no

Question 14

Causes of epileptic seizures

Answer 14

Often idiopathic
Infection 
Hyponatraemia 
glc
Trauma 
Metabolic defects 
Tuberous sclerosis 
CNS tumour 
Arrhythmia

Question 15

Rx for generalised seizures

Answer 15

Sodium Valproate

Question 16

Who is sodium valproate CI in

Answer 16

F of child bearing age

Question 17

Rx for focal seizures

Answer 17

Carbamezepine

Question 18

New AEDs examples

Answer 18

Lamotrigine
Levatiracetam
Perampanel
Gabapentin

Question 19

Other therapies to Rx epilepsy

Answer 19

Steroids 
Immunoglobulin 
Ketogenic diets 
VNS 
Surgical

Question 20

What is the purpose of AEDs

Answer 20

Used to control seizures not cure epilepsy

Question 21

Types of non-epileptic seizures

Answer 21

Acute Symptomatic seizures 
Reflex anoxic seizure
Syncope 
Parasomnias e.g night terrors 
Behavioural stereotypies 
Psychogenic seizures

Question 22

What is the commonest cause of acute symptomatic seizure in childhood

Answer 22

Febrile convulsion

Question 23

What is a febrile convulsion

Answer 23

Convulsion that occurs in 3mnths-5yrs
Associated with fever
But without evidence of intracranial infection or defined cause for seizure

Question 24

Ix for epilepsy

Answer 24

Hx
Video recording 
EEG (convulsive seizures)
MRI brain 
Genetics (e.g tuberous sclerosis)
Metabolic tests

Question 25

What is a generalised seizure

Answer 25

Affects both lobes of the brain | Generalised

Question 26

What is a focal seizure

Answer 26

Affects only one part of the brain

Question 27

Types of Childhood epilepsy syndromes

Answer 27

Infantile Spasms (West Syndrome) Benign Rolandic Epilepsy (BRE) Juvenile Myoclonic Epilepsy (JME) Lennox-Gastaut Syndrome (LGS) Childhood Absence Epilepsy

Question 28

Inheritance mode of Duchenne Muscular Dystrophy

Answer 28

X-linked recessive pattern

Question 29

Which gender are affected by Duchenne Muscular dystrophy

Answer 29

Male

Question 30

How many muscular dystrophies are there

Answer 30

9

Question 31

What is the milder form of Duchennes known as

Answer 31

Becker

Question 32

Clinical features of Duchennes

Answer 32

Symmetrical proximal weakness Bulky calf muscles Gowers Sign +ve Waddling gait Scoliosis Cardiomyopathy Resp. involvement in teens

Question 33

Ix for Duchennes

Answer 33

Elevated Creatinine Kinase Muscle biopsy EMG

Question 34

Why is Benign Rolandic Epilepsy called benign

Answer 34

Because many children outgrow it by adolescents

Question 35

Describe benign rolandic epilepsy syndrome

Answer 35

``` Simple partial seizures Often nocturnal Prodrome: Tingling feeling in mouth Speech can be affected Jerking of the mouth ```

Question 36

Name some childhood epilepsy syndromes

Answer 36

``` Benign Rolandic Epilepsy Childhood absence seizures Juvenile Myoclonic Epilepsy Lennox Gastaut Syndrome Infantiles Spasms (West Syndrome) ```

Question 37

Explain Childhood absence seizures syndrome

Answer 37

``` Seizures occur frequently V. brief (few scs) Often go unnoticed Look bland or stare Eyelids may flutter Unresponsive to surroundings Abrupt onset Abrupt offset ```

Question 38

Rx for absence seizures

Answer 38

Ethosuximide

Question 39

What 3 types of seizures occur in juvenile myoclonic epilepsy

Answer 39

Myoclonic Tonic cloni Absence

Question 40

What is the trigger for seizures in 40% juvenile myoclonic epilepsy

Answer 40

Photosensitivity | Flashing/flickering lights

Question 41

What types of seizures can occur in Lennox Gastaut Syndrome

Answer 41

``` Tonic Atonic Myoclonic Tonic clonic Atypical absences ‘drop attacks’ ```

Question 42

Rx for Lennox Gastaut Syndrome

Answer 42

Difficult to treat | Sodium valproate 1st line generally

Question 43

Describe seizures in infantile spasms (west syndrome)

Answer 43

Brief spasms or jerks Involving head, trunk, extremities Happen in clusters (episodes 1-2 secs) Typically occur before sleep, after waking

Question 44

When does infantile spasm syndrome typically begin

Answer 44

First year of life

Question 45

What does EEG show in infantile spasm

Answer 45

Hypsarrhythmia

Question 46

Rx for infantile spasms

Answer 46

Vigabatrin Ketogenic diet Prednisolone

Question 47

What can infantile spasms develop into/

Answer 47

Lennox Gastaut syndrome

Question 48

What do many children with Lennox-Gastaut syndrome

Answer 48

Learning difficulties | Behavioural problems

Question 49

when does Juvenile Myoclonic Epilepsy occur

Answer 49

Adolescents | Typically 12-18yrs