Passmed questions

Question 1

Urinary incontinence + gait abnormality + dementia

Answer 1

normal pressure hydrocephalus

Question 2

a reversible cause of dementia seen in elderly patients ?

Answer 2

normal pressure hydrocephalus

Question 3

variant of fast score to assess stroke risk?

Answer 3

stROke ROsier score

Question 4

Obese, young female with headaches and blurred vision, think?

Answer 4

idiopathic, intercranial hypertension.

Question 5

idiopathic intercranial hypertension treatment?

Answer 5

weight loss and diuretic (acetazolamide)

Question 6

two drugs that may cause peripheral neuropathy? “feels like walking on cotton wool”

Answer 6

nitrofurentoin and metronidazole

Question 7

Normal pressure hydrocephalus management?

Answer 7

Normal pressure hydrocephalus

Question 8

What is the most common presentation of multiple sclerosis?

Answer 8

optic neuritis

Question 9

worsening of vision following rise in body temperature?

Answer 9

Uhthoff’s phenomenon: worsening of vision following rise in body temperature. Seen in MS

Question 10

Colours, particularly reds, may appear “washed out” or less bright than usual. Which eye condition?

Answer 10

optic neuritis

Question 11

Patients with MS can present with non specific symptoms. How do 75% present?

Answer 11

significant lethargy

Question 12

what can you get in neck flexion in MS?

Answer 12

paraesthesia in limbs (Lhermittes syndrome)

Question 13

what is paraesthesia?

Answer 13

abnormal sensation such as tingling, tickling or burning of a person’s skin with no apparent physical cause

Question 14

Progressive degenerative disesase of brain. Accounts for majority of dementia in the UK?

Answer 14

alzheimers disease

Question 15

what is thought to cause the inherited form?

Answer 15

mutations in amyloid precursor protein

Question 16

what is apoE4?

Answer 16

class of proteins involved in the metabolism of fats in the body

Question 17

macroscopic changes in alzheimers>

Answer 17

macroscopic: widespread cerebral atrophy, particularly involving the cortex and hippocampus

Question 18

microscopic changes in alzheimers?

Answer 18

cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein

Question 19

biochemically, what is there a deficit of in alzheimers?

Answer 19

acetylcholine

Question 20

paired helical filaments are partly made from a protein called tau?

Answer 20

neurofibrillary tangles

Question 21

There is a deficit of acetylcholine in amlzheimers. NICE now recommend the three acetylcholinesterase inhibitors. what are they?

Answer 21

donepezil, galantamine and rivastigmine

Question 22

if intolerant of first l in drugs, what can be given second line ?

Answer 22

memantine (clementine)

Question 23

DVLA advice post multiple TIAs: cannot drive for

Answer 23

3 months

Question 24

if you have a seizure/fit, what must you do?

Answer 24

inform the DVLA

Question 25

for patients with established epilepsy or those with multiple unprovoked seizures: → may qualify for a driving licence if they have been free from any seizure for?

Answer 25

12 months | if there have been no seizures for 5 years (with medication if necessary)

Question 26

single episode syncope, explained and treated. restriction on driving?

Answer 26

4 weeks

Question 27

single episode syncope, unexplained?

Answer 27

6 months off driving

Question 28

stroke or TIA. If not residual neurological deficit. how long do you need to take off driving and do you need to inform DVLA?

Answer 28

1 month off driving. may not need to inform DVLA

Question 29

craniotomy e.g. For meningioma. How long off driving

Answer 29

1 year

Question 30

chronic neurological disorders e.g. multiple sclerosis, motor neuron disease: DVLA should be informed, what form is filled out?

Answer 30

PK1 form

Question 31

levodopa side effects?

Answer 31

``` !Reduced effectiveness with time! dyskinesia (writhing movements) palpitations psychosis postural hypotension ```

Question 32

name 3 dopamine receptor agonists?

Answer 32

dope | bromocriptine, ropinirole, cabergoline

Question 33

what kind of drug is cabergoline?

Answer 33

dopamine agonist

Question 34

what should patients being started on dopamine agonists be warned about ?

Answer 34

potential to cause impulse control disorders

Question 35

side effect of dopamine agonist>

Answer 35

hallucinations

Question 36

which drugs are associated with pulmonary and cardiac fibrosis?

Answer 36

dopamine agonists

Question 37

when do most neurologists start ant epileptic treatment ?

Answer 37

following a second epileptic seizure

Question 38

in what situations would you start an anti epileptic following a first seizure?

Answer 38

the patient has a neurological deficit brain imaging shows a structural abnormality the EEG shows unequivocal epileptic activity the patient or their family or carers consider the risk of having a further seizure unacceptable

Question 39

first line in generalised seizures?

Answer 39

sodium valpraote (sodium is a general flavouring)

Question 40

second line?

Answer 40

lamotrigine and carbamazepine

Question 41

which drug can precipitate absence seizures?

Answer 41

carbamazepine

Question 42

first line for partial/focal seizures?

Answer 42

carbamazepine or lamotrigine (carbs only part of balanced diet)

Question 43

2nd line in partial/focal seizures?

Answer 43

levetiracetam, oxcarbazepine or sodium valproate

Question 44

myoclonic seizure treatment ?

Answer 44

sodium valproate (mayoclinic eating)

Question 45

2 drugs you can use in absence seizures? (petit mal)

Answer 45

2 drugs that don't like being absent from each other. sodium valproate and ethoSUXamide

Question 46

Useful in patients with absence seizures who are intolerant of sodium valproate?

Answer 46

ethosuxamide

Question 47

A 24-year-old man with focal seizures. He previously developed a rash whilst taking lamotrigine?

Answer 47

carbamazepine

Question 48

what drug does carbamazepine always go with?

Answer 48

lamotrogine

Question 49

what is titubation?

Answer 49

head tremor

Question 50

that is made worse by intentional movement, made better by alcohol and propranolol?

Answer 50

essential tremor

Question 51

if you see "fasciculations" think of?

Answer 51

motor neurone disease

Question 52

if you have first seizure and if there are no relevant structural abnormalities on brain imaging and no definite epileptiform activity on EEG. how long off driving ?

Answer 52

6 months

Question 53

what is phenytoin used in ?

Answer 53

the management of seizures

Question 54

side effects of phenytoin?

Answer 54

large list of side effects Acute initially: dizziness, diplopia, nystagmus, slurred speech, ataxia later: confusion, seizures Chronic common: gingival hyperplasia (secondary to increased expression of platelet derived growth factor, PDGF), hirsutism, coarsening of facial features, drowsiness megaloblastic anaemia (secondary to altered folate metabolism) peripheral neuropathy enhanced vitamin D metabolism causing osteomalacia lymphadenopathy dyskinesia ``` Idiosyncratic fever rashes, including severe reactions such as toxic epidermal necrolysis hepatitis Dupuytren's contracture* aplastic anaemia drug-induced lupus ``` Teratogenic associated with cleft palate and congenital heart disease

Question 55

what is saturday night palsy?

Answer 55

compression of the radial nerve against the humeral shaft, possibly due to sleeping on a hard chair with his arm draped over the back. cannot extend wrist

Question 56

Leg crossing, squatting or kneeling may cause a foot drop secondary to a common peroneal neuropathy. women who works in a nursery with foot drop. management?

Answer 56

avoid to stop leg crossing, kneeling and squatting. review in 4 weeks

Question 57

cluster headache - acute treatment?

Answer 57

subcutaneous sumatriptan + 100% O2

Question 58

risk factors for developing idiopathic inter cranial hypertension?

Answer 58

obesity female sex pregnancy drugs*: oral contraceptive pill, steroids, tetracycline, vitamin A, lithium

Question 59

features of tuberous sclerosis?

Answer 59

“ash leaf spots” which fluoresce under UV light roughened patches of skin over the lumbar spine adenoma sebaceum (angiofibromas) in butterfly distribution over nose fibromata beneath nails café au lait spots may be seen

Question 60

if you get nausea in parkinson, which anti emetic?

Answer 60

domperidone

Question 61

reduced sensation in a glove-and-stocking distribution

Answer 61

peripheral neuropathy. hands and feet are affected first, then the reduced sensation travels up the limbs

Question 62

A positive Hoffmans sign is a sign of?

Answer 62

upper motor neuron dysfunction and points to a disease of the central nervous system

Question 63

Neuroleptic malignant syndrome is typically seen in patients?

Answer 63

who have just started treatment. its a rare but dangerous condition seen in young males who have just started anti psychotic medication