Neurology

Question 1

What are some causes of transient loss of consciousness?

1. Cardiac (4)
2. Neuro (3)
3. Other (2)

Answer 1

1. Cardiac - vasovagal, arrhythmias, HOCM, postural hypotension
2. Neuro - epilepsy, NEAD, migraines
3. Other - hypoglycaemia, vestibular disorders

Question 2

What are some possible diagnoses for four limb weakness?

Answer 2

GBS
Acute cervical cord syndrome 
Cauda equina 
Myasthenia gravis
Acute myositis

Question 3

What type of infections can precipitate GBS?

Answer 3

Respiratory or GI infections

Question 4

What would you expect to see on LP for GBS?

What other test can you order to support your diagnosis?

Answer 4

Raised protein with normal cells and glucose

Nerve conduction studies

Question 5

What is the general management for GBS? (4)

Answer 5

1. Frequent obs - peak flow, standing and lying BP (autonomic dysfunction)
2. IV immunoglobulin
3. DVT prophylaxis
4. Pain relief

Question 6

What antibodies are there in myasthenia gravis? (2)

What other test is required?

Answer 6

ACh receptor antibodies
MuSK

CT thymus

Question 7

Which medications are used in myasthenia gravis? (2)

What treatment is available for exacerbations of myasthenia gravis?

Answer 7

Acetylcholinesterase inhibitor e.g. pyridostigmine
Immunosuppression e.g. prednisolone, azathioprine

IV immunoglobulin

Question 8

How long does it usually take people to recover from Bell’s palsy?
When should steroids be considered?
Differential diagnoses for Bell’s palsy?

Answer 8

3-4 months
If presenting within first 72h
Ramsay-Hunt syndrome, Lyme disease, sarcoidosis, trauma, inner ear (e.g. otitis media, cholesteatoma, acoustic neuroma)

Question 9

What would you expect to find if these nerves are compressed?

1. Common peroneal nerve
2. L5 nerve root

Answer 9

1. weakness of dorsiflexion and eversion of foot

2. weakness of inversion and eversion of foot

Question 10

What are the symptoms of optic neuritis? (4)

What can cause optic neuritis? (6)

Answer 10

Pain on eye movements, impaired colour vision, RAPD, scotoma

MS, sarcoidosis, SLE, Lyme, mumps, measles

Question 11

What are you trying to show when testing for MS?

What are the main tests for MS?

What criteria is used to diagnose MS?

Answer 11

Dissemination in time and space

Time - 2 episodes of neurological symptoms OR presence of oligoclonal bands on LP
Space - MRI brain and spine

McDonald criteria

Question 12

What lifestyle advice should you give those with MS? (4)
When should disease modifying agents be considered?
What is the treatment for a relapse of MS?

Answer 12

Inform DLVA, stop smoking, avoid stress, regular exercise

More than 2 relapses in 2 years

PO/IV methylprednisolone

Question 13

What is the management for migraines?

1. Acute (3)
2. Prophylactic (3)

Answer 13

1. NSAIDs, paracetamol or triptans; anti-emetics

2. Propranolol, amitryptiline, topiramate

Question 14

What is the management for cluster headaches?

1. Acute (2)
2. Prophylactic (3)

Answer 14

1. High flow oxygen, SC triptans

2. Verapamil, lithium, prednisolone (short term)

Question 15

What are some general measures for managing raised ICP? (4)

Answer 15

Head tilt
Avoid hypotension
Maintain euvolaemia
Maintain normal CO2 (as causes vasodilation)

Question 16

What is the most common type of malignant brain tumour?

What is the most common type of benign brain tumour?

Answer 16

Glioblastoma multiforme

Meningioma

Question 17

What are the types of focal seizures?

Which medication is used first-line?

Answer 17

Simple focal, focal dyscognitive, focal to GTC

Carbemazepine or lamotrigine

Question 18

What are the types of generalised seizures? (4)

What medication is used first-line?

Answer 18

Tonic-clonic, absence, atonic, myoclonic
Sodium valproate for all plus:
- ethosuxamide for absence
- lamotrigine for GTC

Question 19

What is the criteria for formally diagnosing epilepsy? (3)

Answer 19

1. 2 or more unprovoked seizures more than 24h apart
2. 1 unprovoked seizure with probability of further seizures similar to (1)
3. Diagnosis of epilepsy syndrome

Question 20

Which investigations can you order after a suspected seizure? (4)

Answer 20

Exclude reversible causes e.g. blood glucose, infection, electrolytes
ECG
EEG
MRI

Question 21

Which anti-epileptic drug is most likely to cause:

1. Rash?
2. Agranulocytosis?
3. PCOS?

Answer 21

1. Lamotrigine
2. Carbamazepine
3. Sodium valproate

Question 22

What should people with epilepsy be told to avoid? (4)

Answer 22

Working at height
Cycling in traffic
Working with dangerous machinery
Alone in a bath

Question 23

What are the driving rules for epilepsy?

Answer 23

Reapply for licence after 1 year (10 years if lorry driver)

One-off seizure, no risk of another seizures - 6 months (5 years if lorry driver)

Question 24

What conditions are associated with epilepsy?

Answer 24

Neurofibromatosis

Tuberous sclerosis

Question 25

Can you remember the scoring for GCS? - eyes

Answer 25

Eyes: 1. No movement 2. Opens eyes in response to pain 3. Opens eyes in response to speech 4. Spontaneous movements of eyes

Question 26

Can you remember the scoring for GCS? - verbal

Answer 26

Verbal: 1. No verbal response 2. Incomprehensible sounds 3. Inappropriate words or cannot use language properly 4. Confused but able to engage 5. Able to engage in conversation

Question 27

Can you remember the scoring for GCS? - motor

Answer 27

Motor: 1. No motor response 2. Extension to pain 3. Abnormal flexion to pain 4. Normal flexion in response to pain 5. Localises to pain 6. Obeys commands

Question 28

Which type of intracranial bleeds causes the following on CT? 1. Crescent shape 2. Biconvex shape Which blood vessels are most likely to be affected?

Answer 28

1. Subdural - bridging veins | 2. Extradural - middle meningeal artery