Neurology & psych

Question 1

Not able to drive for how long after a single TIA?

Answer 1

1 month (no need to tell DVLA)

Question 2

Not able to drive for how long after multiple TIAs over a short period?

Answer 2

3 months and need to tell DVLA

Question 3

Section 3 of mental health act =

Answer 3

Compulsory admission for under 6 months for treatment

Question 4

Section 2 of mental health act =

Answer 4

Compulsory admission for 28 days or less for assessment

Question 5

Section 4 of mental health act =

Answer 5

Exceptional circumstances
Compulsory admission for 72hrs if unable to get section 2 sorted

Question 6

Section 5 - 2 =

Answer 6

Doctor holding powers, 72hrs

Question 7

1st line medical management in delerium

Answer 7

Haloperidol

Question 8

What Rosier score indicates a potential stroke

Answer 8

1 or greater

Question 9

Treatment in severe myasthenia gravis crisis

Answer 9

IV immunoglobulin

Question 10

Pick’s disease

Answer 10

Pick’s disease is a rare neurodegenerative disorder that causes a slowly progressive frontotemporal dementia.

Question 11

Mild-to-moderate Alzheimer’s disease 1st line medical management

Answer 11

The AChE inhibitors are:
Donepezil (Aricept)
Galantamine
Rivastigmine

Question 12

Medical tx for normal pressure hydrocephalus

Answer 12

Acetazolamide

Question 13

Severe Alzheimer’s disease medical management

Answer 13

Memantine acts by blocking NMDA-type glutamate receptors and is recommended for use in patients with moderate Alzheimer’s disease that are intolerant of or have a contraindication to AChE inhibitors, or in patients with severe Alzheimer’s disease.

Question 14

Korsakoff psychosis, is characterised by:

Answer 14

Retrograde amnesia
An inability to memorise new information
Disordered time appreciation
Confabulation

Question 15

T-ACE is primarily used to screen for

Answer 15

alcohol abuse in pregnant women

Question 16

Meadow syndrome

Answer 16

the caregiver fabricates the appearance of health problems in another person, typically their child.

Question 17

The highest risks for suicide are:

Answer 17

Previous episode of self-harm (5) – 4% of people who attend A&E with self-harm will kill themselves within five years
Previous mental illness (4)
Male sex (3)
Severe depression (2)
Misuse of drugs and alcohol (2)

Question 18

Gedankenlautwerden

Answer 18

Thought echo occurs when a patient hears their own thoughts as if they are being spoken aloud. When heard simultaneously this is Gedankenlautwerden

Question 19

The following are considered to be good prognostic factors in schizophrenia:

(10)

Answer 19

Acute onset
Precipitating stressful event
No family history of schizophrenia
Family history of depression
Older age of onset
No history of previous episodes
Normal intelligence
Preponderance of affective symptoms
No loss of emotion
Prompt treatment

Question 20

SADQ or or LDQ

Answer 20

Severity of alcohol dependence

Question 21

APQ

Answer 21

for the nature and extent of the problems arising from alcohol misuse.

Question 22

AUDIT

Answer 22

identification and as a routine outcome measure of alcohol dependency

Question 23

Lhermitte’s sign

Answer 23

sudden sensation resembling an electric shock experienced by patients with MS

Question 24

Imaging modality to help diagnose Wernicke’s encephalopathy

Answer 24

MRI brain

Question 25

Meningococcal meningitis, what abx is given in hospital if there is hx of anaphylaxis to cephalosporins

Answer 25

Chloramphenicol IV

Question 26

Anterior cerebral artery stroke signs

Answer 26

Contralateral motor weakness (leg/shoulder > arm/hand/face) Minimal contralateral sensory loss Dysarthria, aphasia Left limb apraxia Urinary incontinence Behavioural and personality changes

Question 27

Middle cerebral artery stroke signs

Answer 27

Contralateral hemiparesis (face/arm > leg) Contralateral hemisensory loss Expressive or receptive dysphasia (dominant hemisphere) Contralateral neglect (non-dominant hemisphere)

Question 28

Posterior cerebral artery stroke signs

Answer 28

Contralateral homonymous hemianopia Quadrantic visual field defects Contralateral thalamic syndrome (PCA supplies thalamus)

Question 29

Wallenberg’s syndrome

Answer 29

Occlusion of the posterior inferior cerebellar artery causes the lateral medullary syndrome Contralateral loss of pain and temperature sense on the body (damage to spinothalamic tracts) Ipsilateral loss of pain and temperature sense on the face (damage to CN V) Vertigo, nystagmus, tinnitus, deafness and vomiting (damage to CN VIII) Horner’s syndrome (damage to the descending hypothalamospinal tract)

Question 30

Neisseria meningitidis meningitis contacts, chemoprophylaxis drug Pregnancy

Answer 30

Rifampicin 600 mg PO BD for two days OR single dose of ciprofloxacin 500mg Both contraindicated in pregnancy, so IM ceftriaxone 250mg

Question 31

In the UK, most cases of meningococcal septicaemia are caused by

Answer 31

Neisseria meningitidis group B

Question 32

The initial dose of alteplase

Answer 32

0.9 mg/kg (up to a maximum of 90 mg), given intravenously over 60 minutes

Question 33

Benedikt syndrome

Answer 33

Lateral midbrain syndrome

Question 34

Weber’s syndrome

Answer 34

Medial midbrain syndrome

Question 35

Wallenberg’s syndrome

Answer 35

Lateral medullary syndrome

Question 36

Logorrhoea

Answer 36

pertaining to the overuse of words or excessive talkativeness

Question 37

Who needs prophylaxis for meningococcal disease

Answer 37

Household members who have had prolonged close contact within 7 days before the onset of illness Kissing contacts Healthcare workers who have had direct exposure to droplets or respiratory secretions prior to completion of 24 hours of antibiotics

Question 38

What abx is used as a prophylaxis in menigococcal disease?

Answer 38

Rifampacin / Ciprofloxacin IV Cef in pregnant patients

Question 39

Pathogenesis of MS

Answer 39

MS is a multicentric, multiphasic inflammatory disorder of the central nervous system (CNS) in which focal lymphocytic infiltration leads to damage to myelin and axons.

Question 40

Uhthoff symptom

Answer 40

a temporary worsening of multiple sclerosis (MS) symptoms that occurs when the body temperature increases

Question 41

Commonest cause of BPPV

Answer 41

Posterior semicircular canal otoliths (calcium oxalate crystals)

Question 42

labyrinthitis

Answer 42

When ipsilateral hearing loss is associated with the symptoms of vestibular neuritis

Question 43

At what % of carotid stenosis is surgery offered?

Answer 43

>50%

Question 44

How long after a TIA can patients drive?

Answer 44

4 weeks

Question 45

The risk for stroke after a TIA is highest during the first:

Answer 45

48hrs

Question 46

Typical LP result in GBS

Answer 46

A raised CSF protein (>0.4 g/L) with normal white cell count

Question 47

Treatment for patients with GBS who can't walk

Answer 47

IVIG or plasma exchange

Question 48

1st line in mild acute myasthenia gravis

Answer 48

Pyridostigmine

Question 49

The only medical treatment for vasospasm, due to SAH, with proven clinical benefit is

Answer 49

oral nimodipine 60 mg 4-hourly

Question 50

Bacteria causing tetanus

Answer 50

Clostridium tetani (bacillus)

Question 51

Which antibiotics can treat Clostridium tetani

Answer 51

BenPen and Metronidazole

Question 52

Potential LP findings in cerebral sinus thrombosis?

Answer 52

Many patients have raised protein levels and pleocytosis on CSF analysis

Question 53

Wernicke's encephalopathy features (4)

Answer 53

confusion, ataxia, nystagmus and ophthalmoplegia

Question 54

Chronic tension headache is defined by...

Answer 54

Episodes at least 15 days per month

Question 55

Meningococcal prophylaxis in pregnancy

Answer 55

IM ceftriaxone 250mg

Question 56

Dose of initial benzo in SE in children

Answer 56

Lorazepam 0.1 mg/kg Buccal midazolam 0.5 mg/kg or rectal diazepam 0.5 mg/kg

Question 57

Dose of levetiracetam in SE in children

Answer 57

40 mg/kg of levetiracetam IV (maximum 3 g) over 5 minutes

Question 58

Dose of phenytoin in SE in children

Answer 58

20mg/kg over 20 mins

Question 59

Autonomic involvement in cluster headaches

Answer 59

Ipsilateral conjunctival injection Ipsilateral rhinorrhoea Ipsilateral lacrimation Ipsilateral miosis Ipsilateral ptosis

Question 60

Which type of scan shows evidence of Wernicke's encephalopathy?

Answer 60

MRI

Question 61

The initial dose of alteplase for stroke is?

Answer 61

0.9mg/kg

Question 62

In the UK, most cases of meningococcal septicaemia are caused by

Answer 62

N.meningitidis B

Question 63

Time cut off for thrombectomy

Answer 63

6hrs

Question 64

What imaging must be confirmed for a patient to be eligible for thrombectomy

Answer 64

CTA or MRA showing occlusion of the proximal anterior circulation