List the features of cerebellar syndrome
DANISH:
- dysdiadochokinesia (unable to form rapid hand movements)
- ataxia (broad-based, unsteady gait)
- nystagmus
- intention tremor (occurs during purposeful movement)
- slurred speech
- hypotonia
What are the possible causes of cerebellar syndrome?
VITAMIN C
- vascular (eg. stroke)
- infective (eg. lyme disease)/inflammatory (eg. MS)
- trauma (eg. trauma to posterior fossa)
- metabolic (eg. alcoholism)
- iatrogenic (eg. drugs - phenytoin)
- neoplastic
- congenital
Describe the treatment and secondary prevention of a cerebral stroke
- thrombolysis can be given within 4.5hrs onset of symptoms
- IV altepase is given
- secondary prevention is aspirin for 2 weeks then long term clopidogrel
What are the clinical features of Huntington’s disease?
- dominant inheritance
- choreoathetosis (jerky involuntary movements)
- dementia
What would you expect to see on a CT/MRI of a brain with Huntington’s disease?
- loss of striatal volume
- increased size of frontal horns of lateral ventricles
How can Huntington’s be treated?
- tetrabenazine (monoamine transporter 2 inhibitor) to manage chorea
- SSRI to manage depression
What is the pathogenesis of Lewy Body Dementia?
- caused by abnormal deposits of proteins in brain cells
- alpha-synuclein cytoplasmic inclusions (Lewy bodies) in substantia nigra, paralimbic and neocortical areas
What are the clinical features of LBD?
- fluctuating cognition
- parkinsonism
- visual hallucinations
Describe the differentials you would have of a patient presenting with diplopia
- CN III palsy: eye will be down and out, ptosis and exophthalmos may be seen
- CN IV palsy: eye will be superiorly medial, patient may tilt head to compensate
- CN VI palsy: eye will be medially deviated and diplopia will worsen with abduction of the eye
- Graves’ disease: diplopia can be caused by compression of the extraocular muscles and lack of space for the eye to rotate
What drugs are suitable for all types of seizure?
- lamotrigine (drug of choice for child-bearing age women)
- levetiracetam
- valporate
What drugs are good for focal/partial seizures?
- carbamazepine
- gabapentin
- phenytoin
List the types of focal seizure
Complex: patients lose consciousness. Most common at temporal lobe. Associated with a post-ictal state
Simple: no loss of consciousness, only focal symptoms, no post-ictal state
Secondary generalised: focal seizure which develops into tonic-clonic generalised seizure
List the types of generalised seizures and their drugs of choice
Absence: occurs in seconds, loss of awareness/responsivness. Ethosuximide (first-line) or sodium valporate.
Tonic-clonic: patients lose consciousness then limbs stiffen (tonic) and jerk (clonic). Post ictal state common. Lamotrigine or sodium valporate.
Myoclonic: sudden jerk in limb, trunk or face. Sodium valporate unless wanting to get pregnant then topiramate.
Atonic: sudden loss of muscle tone, causing patient to fall but not lose consciousness. Sodium valporate or lamotrigine.
Describe the criteria for a CT of the head after an injury
- evidence of skull fracture
- seizure
- GCS <13 on arrival or <15 more then 2 hours after injury
- 1 episode of vomiting
- amnesia of events over 30 mins before event
Describe the management of a migraine
- prophylaxis with propranolol or topiramate
- acute attack can be managed with a triptan (eg. sumatriptan) + paracetamol
Describe what a cluster headache is and its management
- recurrent attacks of unilateral periorbital pain associated with eye watering, lacrimation, miosis and facial flushing
- treatment: verapamil or triptan
What is the treatment of a tension headache
- relaxation
- avoid triggers of stress
- analgesia per the pain ladder (usually paracetamol/NSAID)
What is the treatment of trigeminal neuralgia?
carbamazepine
Describe features of different types of intracranial haemorrhages
extradural: between skull and dura mater. Associated with contralateral hemiplegia with a biconvex haematoma on CT.
subdural: between dura mater and arachnoid mater. Presents with gradual increase in confusion and headache with a crescent haematoma on CT.
subarachnoid: beneath arachnoid mater. Acute severe ‘blow to the back of the head’ headache. Associated with seizures, neurological deficits and possible sudden death. Positive CT scan or blood present in LP fluid.
Describe the stroke classification
TAC (anterior and middle cerebral arteries):
- contralateral hemiplegia/hemiparesis
- contralateral homonymous hemianopia
- higher cerebral dysfunction (eg. aphasia)
PAC (anterior OR middle cerebral arteries): 2 of the above criteria
Lacunar stroke:
- pure motor OR
- pure sensory OR
- sensorimotor OR
- ataxic
POC (vertebrobasilar arteries which supply cerebellum, brainstem and occipital lobe):
- cerebellar dysfunction OR
- bilateral motor/sensory deficit OR
- ipsilateral cranial nerve palsy and contralateral motor/sensory deficit OR
- isolated hemianopia
What is secondary stroke prevention treatment?
HALTSS:
- hypertension: ACEi
- antiplatelet therapy: clopidogrel 2 weeks then NOAC eg. rivaroxaban
- lipid-lowering therapy: statin
- tobacco: smoking cessation
- sugar: diabetes screening and management
- surgery: if indicated (carotid artery stenosis)
What investigations would you order in suspected meningitis?
- bloods (FBC, Us and Es, clotting, glucose)
- ABG
- blood cultures
- CT head
- lumbar puncture
What are the major motor features of Parkinson’s disease?
- bradykinesia
- tremor
- rigidity
What is the treatment of Parkinson’s disease?
- levodopa can help cognitive impairment
- dopamine agonists (eg. bromocriptine) and MAO inhibitors (eg. selegiline)
-
MSK Pathologies (Remember Imaging - X-ray/CT/MRI)15
-
Cardiac Pathologies (Remember ECGs and CXR)22
-
ECG interpretation8
-
ENT Pathologies4
-
Endocrinology Pathologies8
-
Gastroenterology Pathologies (Remember LFTs, Us and Es)18
-
Haematology Pathologies (Remember Blood Films)6
-
OSCE Practical Questions5
-
Respiratory Pathologies (Remember CXR)7
-
Chest X-Rays12
-
Us and Es7
-
Nephrology Pathologies8
-
Neurology Pathologies24
