ques

Question 1

differnce in testing for myasthenia gravis and lambert eatonsydnrome

Answer 1

. It also only has a small response to edrophonium and shows areflexia. Myasthenia gravis on the other hand, has a good response to edrophonium, displays fatigability and there are normal reflexes

Question 2

edrophonium moa

Answer 2

reversible acetylcholinesterase inhibitor, competitive muscarinic antagonist.

Question 3

most common cuase of encephalitis

Answer 3

herpes simplex

aciclovir

Question 4

ramsay hunt syndrome tx

Answer 4

Prednisolone and oral acyclovir

Question 5

spinal ALS stand for

Answer 5

Spinal amyotrophic lateral sclerosis
MND

Question 6

difference between ALS and MS

Answer 6

This patient has presented with symptoms purely affecting his motor function. Examination findings show a mixture of upper motor neuron signs (hyperreflexia and increased tone) and lower motor neuron signs (fasciculations and muscle atrophy). most common variant of motor neuron disease which presents with a mixture of upper and lower motor neuron signs.

MS is caused by demyelination of the CNS and would present with a mixture of motor and sensory deficits affecting upper motor neurons. As this patient has lower motor neuron signs and no sensory deficit, a diagnosis of multiple sclerosis is unlikely.

Question 7

types of motor neurone disease

Answer 7

Spinal ALS (the classic MND syndrome)

Bulbar ALS (with early tongue and bulbar involvement)

Progressive muscular atrophy (with only lower motor neuron features)

Primary lateral sclerosis (with only upper motor neuron features).

Question 8

What is the most appropriate first-line treatment for neuropathic pain?

Answer 8

Gabapentin

This is the correct answer. Gabapentin, Pregabalin, Amitriptyline and Duloxetine are commonly used to treat neuropathic pain

Question 9

causes of sensory peripheral neuropathy

Answer 9

A helpful mnemonic that some use is ABCDE:

Alcohol
B12/Folate
Chronic Renal Failure
Diabetes Mellitus
Everything Else (!) - Vasculitis and Paraneoplastic

Question 10

space ocupying lesion sx

Answer 10

Headache may be prominent, which is worse on waking, lying down or coughing/straining, and may be associated with vomiting.

CN palsy - 6 as goes through cavernou ssinus

drwosy seizure

need 2ww

Question 11

what would herpes simplex virus show on MRI

Answer 11

HSV has a predilection for the temporal lobes and bilateral multifocal haemorrhage is typical.

Question 12

what can anterior spinal artery infarct cause

Answer 12

As there is a single anterior spinal artery running down the midline of the spinal cord (in the anterior median fissure), blockage causes loss of pain, temperature, motor and autonomic function below that level.

Dorsal column function is preserved.

Question 13

1st line cluster

Answer 13

High-flow Oxygen

Question 14

propanolol CI for migraine what use

Answer 14

topiramate

Question 15

Subacute combined degeneration of the cord caused by

Answer 15

B12 deficency
both the dorsal columns and corticospinal tracts (pain and temperature sensation are typically preserved).

Question 16

SX of subacute degeneration of cord

Answer 16

Symmetrical distal sensory sx
Begin in feet and spread to hands
ataxia
loss of vibration and proprioception legs
Limb reflexes exaggerated/diminished/absent ( mixed Upper & Lower Motor Neuron signs- can be)
Autonomic bladder or bowel symptoms
presence/absence of haematological manifestations.

Hydroxocobalamin 1 mg IM on alternate days until there is no further improvement then administer hydroxocobalamin 1 mg intramuscularly every 2 months (NICE Guidelines)

Question 17

prostate cance rand spinal problems what Ix

Answer 17

whole spine MRI

Question 18

MS eye lesion where

Answer 18

optic nerve

Question 19

does lambert eaton syndrome improve on repetition

Answer 19

yes

Question 20

what do high CO2 levels do to the bood vessels

Answer 20

dilate - raised ICP - need to hyperventilate patient

Question 21

raised ICP

Answer 21

hyperventilate
mannitol

Question 22

got a haemorrhagic stroke on dabigatran what do you do

Answer 22

Give idarucizumab - reversal agent

Question 23

most common visual defect in optic neuritis

Answer 23

Central scotoma

Question 24

Thiamine deficiency most commonly occurs in alcohol abuse, but is also be seen in

Answer 24

malnutrition, bariatric surgery, and hyperemesis gravidarum

Question 25

described raised ICP

Answer 25

This is not the correct answer. Headaches secondary to raised intracranial pressure would usually be persistent rather than episodic, worse in the mornings and alleviated by vomiting, and associated with neurological deficits depending on the site of the pathology