Neurology pre-placement

Question 1

what are the main PC in neurology

Answer 1

• Headache
• Loss of consciousness
• Weakness of limbs
• Sensory alteration
• Impaired speech
• Vertigo or dizziness
• Confusion
• Change in vision

Question 2

how does increased ICP usually present

Answer 2

Headache triggered by changes in position or exertion. Changes in vision when leaning forwards

Question 3

how does migraine usually present

Answer 3

Unilateral, pounding, multiple triggers, lasts for hours, aversion to bright light and loud noises, can be preceded by aura

Question 4

how does acute glaucoma present

Answer 4

Pain around eye, blurred vision with halos around lights

Question 5

how does subarachnoid haemorrhage present

Answer 5

Sudden onset, excruciating headache

Question 6

how does trigeminal neuralgia present

Answer 6

Brief stabbing pain when brushing teeth or chewing

Question 7

how does cluster headache present

Answer 7

20 minute unliteral, debilitating episodes of retro-orbital pain with red eye and eye watering

Question 8

How does temporal arteritis present

Answer 8

scalp tenderness, unilateral, jaw claudication

Question 9

how does meningitis present

Answer 9

Photophobia, neck stiffness and fever

Question 10

how does tension headache present

Answer 10

Tight band like sensation, precipitated by stress

Question 11

how does sinusitis present

Answer 11

facial tenderness and rhinorrhoea

Question 12

name the red flags for for headache

Answer 12

Sudden onset high severity headache
Headache with fever
New onset neurological deficit
New onset cognitive dysfunction
Change in personality
Impaired level of consciousness
Recent head trauma (within past three months)
Headache triggered by cough, sneeze, exercise, or changes in posture.
Headache associated with halos around lights or headaches that get worse in the dark.
Headache associated with jaw claudication and scalp tenderness.

Question 13

name some things to consider when taking a LOC history

Answer 13

what happened before LOC, was there any trigger
did you get any warning
what happened during
the characteristics
what happened after
any post ictal symptoms, tongue biting, incontinence, injury
any episodes in the past

Question 14

during fundoscopy what would indicate raised ICP

Answer 14

papilloedema

Question 15

what does rapid afferent pupillary defect suggest

Answer 15

sign of damage to the optic nerve of the affected side

Question 16

tell me which cranial nerves are responsible for the different eye movement

Answer 16

SO4, LR6 all the rest are 3

Question 17

what are saccades and how are they tested

Answer 17

rapid eye movements between the two targets are known as saccades ( may indicate movement disorder such as progressive supra nuclear palsy PSP)

hold palm one side and fist in the other

Question 18

if the forehead is spared in facial weakness what does this suggest

Answer 18

stroke as this is an upper motor neurone pathology

Question 19

if there is a CNX palsy which way will the uvula deviate

Answer 19

away from the side with the lesion

Question 20

if there is a CNXII palsy which way will the tongue deviate

Answer 20

towards the side with the lesion

Question 21

if there is pronator drift what does this suggest

Answer 21

indicates a lesion in the pyramidal tracts, an UMN lesion

Question 22

tell me about the reflexes in LMN pathology

Answer 22

they are decreased or absent

Question 23

tel me about the reflexes in UMN pathology

Answer 23

exaggerated

Question 24

which nerves are the following reflexes 
biceps
supinator 
tricep
knee 
ankle

Answer 24

biceps C5/6
supinator C6/7
tricep C7/8
knee L3/4
ankle S1

Question 25

if the plantar reflex points upwards what does this suggest

Answer 25

UMN pathology

Question 26

what should you check in a patient with meningitis

Answer 26

neck stiffness and photophobia

Question 27

in Parkinson's disease what kind of tremor do they have

Answer 27

resting pill tremor (most easily seen when the patient is distracted with another task ie get them to close their eyes and count backwards from 20)

Question 28

medical research council scale for reporting muscle strength from 1 to 5. what does each number mean §

Answer 28

``` 0 no power 1 twitching but no movement 2 movement but can't overcome gravity 3 can overcome gravity 4 movement against gravity and resistance 5 normal muscle strength ```

Question 29

name the structures that are considered CNS structures and therefore UMN

Answer 29

white matter tracts, motor cortex and the spinal cord

Question 30

name the structure that are considered PNS structures and therefore LMN

Answer 30

neuromuscular junction, nerve root, anterior horn cell and motor nerve

Question 31

both upper and lower motor neurone injuries will have non specific weakness however what is the main difference

Answer 31

UMN will have increased reflexes and tone | LMN will have decreased reflexes with normal/decreased tone and fasciculations

Question 32

what information does the dorsal columns carry

Answer 32

fine touch and proprioception

Question 33

what information does the spinothalamic tracts carry

Answer 33

pain and temperature

Question 34

where do motor pathways cross and why does this matter in terms of lesion location

Answer 34

cross at medulla so if lesion is above medulla will be contralateral signs if below the medulla will be ipsilateral signs

Question 35

what signs will brainstem lesions show

Answer 35

contralateral signs in the limbs and ipsilateral cranial nerve signs

Question 36

if someone has a stab wound affecting a semi section of the spinal cord what is this referred to and

Answer 36

brown-sequard syndrome

Question 37

what signs would you expect to see in a right sided brown-sequard syndrome

Answer 37

affected spinal cord so will get UMN signs such as increased tone and brisk reflex loss of sensation to right side below lesion right side loss of vibration, proprioception and fine touch left side loss of temperature and pinprick as the nerves decussation at the level of the spinal cord

Question 38

where does the dorsal column nerves decussate compared to spinothalamic

Answer 38

dorsal column decussate in brainstem whereas spinothlamic decussate at the level of the spinal cord

Question 39

in homonymous hemianopia which part of the visual pathway is damaged

Answer 39

the occipital cortex or optic radiation

Question 40

in bitemporal hemianopia which structure of the visual pathway is damaged

Answer 40

the optic chiasm

Question 41

in monocular blindness which part of the visual pathway is damaged

Answer 41

the optic nerve

Question 42

note that a sudden onset of excruciating headache with a background of polycystic kidney disease is suggestive of what

Answer 42

subarachnoid haemorrhage

Question 43

what scan would you order to distinguish between haemorrhage and ischaemic stroke

Answer 43

CT scan as it will show the intraparenchymal blood collections seen in a haemorrhagic stroke

Question 44

in MS what symptoms may spontaneously resolve and so need to ask about

Answer 44

incontinence, leg weakness and eye pain