Neurology Revision

Question 1

What are the findings of NCS for a nerve root lesion?

Answer 1

normal NCS, but denervation on EMG

Question 2

What are the causes of foot drop?

Answer 2

L5 nerve root
common peroneal nerve
sciatic peroneal nerve component

Question 3

What is the most common site of a common peroneal nerve palsy?

Answer 3

compression at the fibular neck

Question 4

How can you differentiate an L5 nerve root injury from a common peroneal nerve injury?

Answer 4

L5 affects inversion and eversion whereas common peroneal is just eversion

Question 5

What are the classic findings of a lumbosacral plexopathy (diabetic amyotrophy)?

Answer 5

pain, quadriceps wasting, EMG changes in iliopsoas, hip adductors, quads

Question 6

Is sensory or motor usually affected first in carpal tunnel syndrome?

Answer 6

sensory then motor

Question 7

What are the common sites of compression of the ulnar nerve?

Answer 7

elbow, palm

Question 8

What are the common sites of compression of the radial nerve?

Answer 8

axilla, spiral groove of humerus

Question 9

How can you differentiate a radial nerve palsy from a C7 radiculopathy?

Answer 9

a radial nerve palsy will have wrist drop but flexion is preserved

Question 10

Which antibody is associated with multifocal motor neuropathy?

Answer 10

anti GM1

Question 11

What are the NCS findings for multifocal motor neuropathy?

Answer 11

conduction block at non compressed sites

Question 12

What are the NCS findings for CIDP?

Answer 12

demyelinating

Question 13

What is the best test to diagnose myasthenia?

Answer 13

NCS - repetitive stimulation decrement or single fibre EMG ‘jitter’ in an involved muscle

Question 14

What is the key clinical feature of myasthenia?

Answer 14

fatigability

Question 15

What are the findings on NCS for axonal injury?

Answer 15

reduced amplitude

absent sural sensory potentials

Question 16

What are the findings on NCS for demyelination?

Answer 16

reduced velocity
dispersion
delayed F waves
focal block (>50% drop in amplitude)

Question 17

What are the findings on EMG for a neurogenic injury?

Answer 17

high amplitude and increased duration polyphasic units

Question 18

What are the findings on EMG for a myopathic injury?

Answer 18

low amplitude and duration

Question 19

What are the findings on EMG for myotonia?

Answer 19

‘dive bomber’ sound

Question 20

What are the typical features on history for GBS?

Answer 20

preceding illness
ascending weakness +/- paraesthesia
diffuse back pain

Question 21

What are the typical features on examination for GBS?

Answer 21

areflexia
symmetrical weakness
usually minimal sensory signs

Question 22

What are the CSF findings for GBS?

Answer 22

elevated protein

Question 23

What are the NCS findings for GBS?

Answer 23

prolonged/absent F waves

Question 24

What proportion of patients with GBS have anti GM-1 antibodies?

Answer 24

40-50%

Question 25

What are the features of Miller Fischer?

Answer 25

ataxia, ophthalmoplegia and areflexia

Question 26

What are the examination features of botulism?

Answer 26

``` dilated pupils ptosis, diplopia bradycardia, hypotension reduced reflexes minimal/no sensory features ```

Question 27

What are the clinical features of porphyria?

Answer 27

``` abdo pain psychosis seizures descending weakness precipitated by medications/menstrual cycle distal sensory loss reduced reflexes urine discoloration when left in sunlight ```

Question 28

What is the management for GBS?

Answer 28

IVIG OR PLEX (equivalent but can't do both)

Question 29

What is the treatment for a myasthenia crisis?

Answer 29

IVIG or PLEX steroids pyridostigmine check for thymoma check for other autoimmune diseases (B12, TFTs) start long term steroid sparing agent e.g. azathioprine

Question 30

What is the differential diagnosis for a painful sensory neuropathy?

Answer 30

``` diabetes alcohol medications vitamin deficiency thyroid disease renal disease paraprotein vasculitis HIV heavy metals paraneoplastic ```

Question 31

What is 'split hand' and what does it usually indicate?

Answer 31

wasted FDI and thenar with preserved hypothenar, usually indicates MND

Question 32

What is the management for cerebral venous sinus thrombosis?

Answer 32

IV heparin or enoxaparin followed by warfarin for 6 months

Question 33

What are the risk factors for cerebral venous sinus thrombosis?

Answer 33

inherited thrombophilia acquired thrombophilia local sepsis (sinusitis, mastoiditis)

Question 34

What is the main concern with alemtuzumab?

Answer 34

autoimmune complications - ITP, thyroid etc

Question 35

What is the classic presentation of optic neuritis?

Answer 35

reduced colour vision and visual acuity eye pain on movement onset over hours to days, recovery over weeks

Question 36

What percentage of patients with optic neuritis will have a second demyelinating episode?

Answer 36

40%

Question 37

What is the usual starting medication for focal seizures?

Answer 37

carbamazepine

Question 38

What is the usual starting medication for generalised seizures?

Answer 38

valproate

Question 39

What is the most specific sign for Bell's palsy?

Answer 39

loss of taste

Question 40

What does anti Hu usually cause?

Answer 40

limbic encpehalitis or peripheral neuropathy

Question 41

What does anti Yo usually cause?

Answer 41

cerebellar degeneration

Question 42

What does anti GAD usually cause?

Answer 42

stiff person syndrome

Question 43

What malignancy is anti Hu associated with?

Answer 43

lung cancer

Question 44

What malignancy is anti Ma associated with?

Answer 44

testicular cancer

Question 45

What malignancy is anti Yo associated with?

Answer 45

cerebellar

Question 46

What is the classic MRI finding for CADASIL?

Answer 46

anterior temporal white matter disease