Neurology

Question 1

What lesion has occurred if patient cannot do tandem gait? (Toe to toe)

Answer 1

Cerebellar, DCML

Question 2

Where is the lesion if a patient cannot do the rombergs test?

Answer 2

DCML lesions

Question 3

Name the spinal roots for the following reflexes:

• biceps
• supinator
• triceps

Answer 3

• C5/6
• C5/6
• C7

Question 4

Name the spinal roots for the following reflexes:

• knee
• ankle

Answer 4

• L3/4

- S1/2

Question 5

What are the 4 main roles of occulomotor nerve?

Answer 5

Movement of eye
Raises eyelids
Accommodation
Pupillary constriction

Question 6

What condition needs to be considered if sinusitis is followed by unilateral severe facial pain and signs of cerebral irritation (e.g. seizures)?

Answer 6

subdural empyema

Question 7

Describe the distinguishing features of trigeminal neuralgia, atypical facial pain and post herpetic neuralgia.

Answer 7

trigeminal-short bursts of intermittent severe lightning like pain
Atypical facial pain-constant, persistent, non relapsing pain over maxilla. common in middle aged women
Post herpetic-hx of shingles (ophthalmic div of trigeminal), with burning pain-sensitive to light touch

Question 8

What is the rx of choice for trigeminal neuralgia and name 2 other treatment options if the 1st line is ineffective.

Answer 8

• Carbamezepine

- Phenytoin and Gabapentin

Question 9

Name 2 surgical interventions for treating trigemina neuralgia and indications for each.

Answer 9

• Injection of alcohol (older pts as less frequent injections needed)
• Nerve compression with vessel, through post. craniotomy (younger patients due to repeated injections becoming less effective)

Question 10

How can you distinguish these 3 conditions causing vertigo? Labrynthitis (vestivular neuronitis), BPPV and menieres disease

Answer 10

Labrynthitis-vertigo, ear pain and vomiting w/o tinnitus or deafness-usually comes on with waking-unknown cause, can be viral
BPPV-Occurs with brisk head movement (determined by dix hallpike-repeat testing reduces vertigo and nystagmus), lasts seconds and can lead to tension headache, hyperventilation and depression. A series of exercises and manouvers used to treat
Meniers-vertigo+fullness in ear+deafness and tinnitus O/E: rinnes and webers shows sensorineural hearing loss

First two diseases show transient nystagmus

Question 11

What drug treatments are used for labrynthine vertigo?

Answer 11

Cinnarizine, prochlorperazine, betahistine (vestibular sedatives

Question 12

what is jacksonian epilepsy?

Answer 12

Jerking attacks begin in one area (e.g. mouth thumb etc), then spread gradually

Question 13

What is todd’s palsy?

Answer 13

Temporary limb paralysis seen after seizure has seized

Question 14

what is a versive seizure?

Answer 14

Frontal focus-eyes deviate with head turning to opposite side-may become generalised tonic clonic

Question 15

Name 3 triggers of epilepsy

Answer 15

Sleep deprivation
alcohol (withdrawal)
Drug misuse
Metabolic disturbance
exhaustion
Flickering lights

Question 16

What is the treatment for most primary generalised epilepsies?

Answer 16

Sodium valproate

Question 17

Name 5 secondary causes of generalised epilepsy,

Answer 17

Drugs
Hydrocephalus
Cerebral anoxia
Traumatic birth
SLE
Metabolic-HYPO natraemia, calcaemia, magnesia, glycaemia, renal and liver failure 
Meningitis

Question 18

Name 5 causes of partial seizures (i.e. focal seizure in brain cerebral cortex)

Answer 18

Genetic-von hippel lindau, neurofibromatosis, tuberous sclerosis
intracerebral haemorrhage, AV malformation infarcts, haemangioma
Infection-cerebral abscess, subdural empyema, HIV
Inflammatory-sarcoidosis, vasculitis

Question 19

DVLA: Steps to take if first seizure has occured.

Answer 19

Be seizure free for 1 year then can resume driving

Question 20

DVLA: Confirmed dx of epilepsy

Answer 20

Seizure free for 1 year or seizures during sleep for 3 years

Question 21

DVLA: withdrawl of anti convulsants

Answer 21

don’t drive within withdrawl period and 6 months after

Question 22

Which anti epileptic drugs are not preferable for use in young women and why?

Answer 22

Phenytoin+carbamezepine due to liver enzyme induction so reduces effectiveness of COCP
Also accelerates oestrogen metabolism and can cause break through bleeding

Question 23

Define simply-status epilepticus. What can it be precipitated by?

Answer 23

A series of seizures occuring over 30 mins without gain ing of awareness in between
-abrupt withdrawal of AED’s

Question 24

Name the 3 first steps in managing status epileticus.
If persistent after 30mins, what should be added?
What needs to be doen if persisting after 60mins?

Answer 24

• Airway management, life support and recovery
• Gain IV access
• Give IV lorazepam to stop seizure. Give another dose in 10mins if hasnt stopped

If >30mins add phenytoin IV
If>60mins, intubate and ventilate

Question 25

What are the usual diazepam and lorazepam doses?

Answer 25

Diazepam-10mg IV

Lorazepam-4mg IV

Question 26

What should be taken daily 2 months before conception, in women with epilepsy and why?

Answer 26

Folic acid supplements (5mg PO daily)

Prevents fetal abnormalities (e.g. cleft lip, spina bifida)

Question 27

How do you prevent haemorrhagic disease of the newborn in pregnant women on AED’s?

Answer 27

• AED’s can cause inc liver enzyme activity
• Reduces Vit K levels
• Have PO vit k daily in last month+ IM vit K after birth for baby

Question 28

Name 3 presentations of someone with psychogenic/pseudo seizures.

Answer 28

• arching of back
• flailing of limbs
• pelvic thrusting

Question 29

Describe transient global amneasia

Answer 29

• amnesia lasting a few hours-one off occurence in the middle aged
• retrograde amnesia with events over past few weeks
• preserved motor function etc, with no aetiology
• Benign process