neurosciences

Question 1

causes of carpal tunnel syndrome

Answer 1

idiopathic
pregnancy
oedema e.g. heart failure
lunate fracture
rheumatoid arthritis

Question 2

The following drugs may exacerbate myasthenia:

Answer 2

Pills likely to produce bad quality myasthenia gravis

Penicillamine, Lithium, Tetracycline, Procainamide, Beta blockers, Quinolones, Macrolides, Gentamicin

Question 3

best and worst anaesthetic to use in patients with MG

Answer 3

worst : suxamethonium
best : rocuronium

Question 4

what test is used in the diagnosis for MG

Answer 4

antibodies to acetylcholine receptors

Question 5

what cancer is associated with MG

Answer 5

thymoma

Question 6

what is the pathophysiology of carpal tunnel syndrome

Answer 6

action potential prolongation in both sensory and motor axons

Question 7

how long do symptoms need to be present for a diagnosis of chronic fatigue syndrome to be made

Answer 7

3m

Question 8

what is the management of a myasthenic crisis

Answer 8

supportive care
IV immunoglobulin
plasma exchange

Question 9

what are the features of Wernicke’s encephalopathy

Answer 9

oculomotor dysfunction : nystagmus, ophthalmoplegia ( lateral rectus palsy, conjugate gaze palsy)
ataxia

Question 10

what additional symptoms are seen in Korsakoff syndrome

Answer 10

amnesia ( retrograde and anterograde)
confabulation

Question 11

what is the nature of inheritance of essential tremor ?

Answer 11

autosomal dominant

Question 12

what are the features of essential tremor

Answer 12

postural tremor: worse if arms outstretched
improved by alcohol and rest
most common cause of titubation (head tremor)

Question 13

which medications are prescribed in Parkinson’s disease ?

Answer 13

quality of life affected : Levodopa
quality of life not affected : dopamine agonist, levodopa or MAO-B

Question 14

what are some of the side effects of drugs used to manage Parkinson’s

Answer 14

excessive sleepiness
hallucinations
impulse control disorders

Question 15

what are some of the side effects of levodopa

Answer 15

dry mouth
anorexia
palpitations
postural HTN
psychosis

Question 16

what are some adverse effects of levodopa ?

Answer 16

end of dose wearing off
on-off phenomenon
dyskinesia’s at peak dose ( involuntary writhing movements)

Question 17

what other medications can be used to manage parkinsons

Answer 17

dopamine receptor agonists ( bromocriptine)
MAO-B
amantadine
COMT inhibitors ( entacapone)

Question 18

what is the definition of a TIA

Answer 18

'’tissue based definition’’

transient episode of neurological dysfunction caused by focal brain, spinal cord, retinal ischaemia WITHOUT ACUTE INFARCTION

Question 19

What type of tremor is seen with voluntary movements ?

Answer 19

Unilateral tremor that improves with movement

Question 20

Neuroimaging is not normally indicated in suspected bacterial meningitis unless there are signs of:

Answer 20

raised ICP

Question 21

infantile spasms ( West syndrome)

Answer 21

hypsarrhythmia –> EEG
brief spasms
poor prognosis

Question 22

lennox gastaut syndrome

Answer 22

extension of infantile spasms
1-5 y
atypical falls and jerks
EEG : slow spike
manage w ketogenic diet

Question 23

benign rolandic epilepsy

Answer 23

paraesthesia (e.g. unilateral face), seizures characteristically occur at night

Question 24

juvenile myoclonic epilepsy

Answer 24

Typical onset in the teens, more common in girls
1. Infrequent generalized seizures, often in morning
2. Daytime absences
3. Sudden, shock-like myoclonic seizure
usually good response to sodium valproate

Question 25

what are the key features of MS

Answer 25

optic neuritis: common presenting feature optic atrophy Uhthoff's phenomenon: worsening of vision following rise in body temperature internuclear ophthalmoplegia

Question 26

what are the most common causes of bacterial meningitis in the neonatal period

Answer 26

Group B streptococcus , E.coli , Listeria monocytogenes

Question 27

what are the main causative agents of bacterial meningitis in kids

Answer 27

Neisseria meningitidis Streptococcus pneumoniae

Question 28

what autonomic dysfunction is seen in Parkinson's

Answer 28

postural Hypotension

Question 29

what are the symptoms of drug induced Parkinson's

Answer 29

rapid onset and bilateral rigidity and rest tremor uncommon

Question 30

How does bone metastases generally present ?

Answer 30

pathological fractures and bone pain

Question 31

posterior cerebral artery stroke

Answer 31

macular sparing visual agnosia contralateral homonymous hemianopia

Question 32

what is the first line management for a myoclonic seizure in women

Answer 32

Levetiracetam

Question 33

what is a PICA infarction also known as ?

Answer 33

Lateral medullary syndrome Wallenberg syndrome

Question 34

what is the most common complication of meningitis

Answer 34

Sensorineural hearing loss

Question 35

what is the pathophysiology of spastic cerebral palsy

Answer 35

Upper motor neurones in the periventricular white matter

Question 36

what investigation should be used to view demyelinating lesions

Answer 36

MRI with contrast

Question 37

how do seizures present depending on the lobe they originate from

Answer 37

temporal : automatisms ( lip smacking) frontal lobe : head/ leg movements, post-ictal weakness, Jacksonian march parietal lobe : paraesthesia occipital : floaters and flashers

Question 38

when should migraine prophylaxis be commenced in patients

Answer 38

2/ more attacks per month

Question 39

what are the symptoms of ALS

Answer 39

asymmetric limb weakness mixed LMN and UMN fasciculations wasting of the small hand muscles/ tibialis anterior Absence of sensory signs and symptoms

Question 40

what remains preserved in MND

Answer 40

ocular muscles not affected no cerebellar signs abdo reflexes

Question 41

what is the management of acute relapse of MS

Answer 41

high dose steroids such as methylprednisolone for 5 days

Question 42

which drugs reduce the risk of relapse in MS

Answer 42

natalizumab ocrelizumab

Question 43

how is spasticity managed in MS

Answer 43

Baclofen and gabapentin

Question 44

what are the most common causes of viral meningitids

Answer 44

coxsackievirus B

Question 45

______________is the preferred modality in patients with suspected TIA who require brain imaging

Answer 45

MRI brain with diffusion-weighted imaging

Question 46

what are the symptoms of Duchenne muscle dystrophy?

Answer 46

progressive proximal muscle weakness from 5 years Gower sign - child uses arms to stand up from a squatted position intellectual impairment calf pseudohypertrophy

Question 47

Ivx for Duchenne muscular dystrophy

Answer 47

raised ck genetic testing - definitive

Question 48

nature of inheritance of Duchenne muscular dystrophy

Answer 48

X linked recessive

Question 49

what cardiac condition is Duchenne muscular dystrophy ass. with

Answer 49

dilated cardiomyopathy

Question 50

what is the investigation of a brain abscess

Answer 50

CT scan showing ring enhancing lesion

Question 51

what is the management of a brain abscess

Answer 51

cephalosporin and metronidazole

Question 52

what 2 antiepileptics are used in the management of focal seizures

Answer 52

lamotrigine / levetiracetam

Question 53

kernig's sign

Answer 53

extension of the knee when