1
Q
What are the characteristics of Progressive Supranuclear Palsy?
A
- Backward falls
- Slow vertical saccades (hummingbird sign on MRI)
- impairment of vertical gaze
- parkinsonism
- frontal lobe dysfunction
2
Q
Which spinal columns are affected in B12 deficiency?
A
- Dorsal column (vibration and proprioception)
- Lateral corticospinal tracts (fine movements of limbs)
3
Q
CSF analysis for viral encephalitis?
A
Raised protein, lymphocytes
Normal glucose
4
Q
What is Brown-Sequard syndrome?
A
A syndrome with a lesion affecting one half of the spinal cord, often after trauma
5
Q
What neurological signs are found with B-S syndrome?
A
- Contralateral loss of pain and temperature
- Ipsilateral loss of sensation to light touch, vibration and proprioception
- Ipsilateral UMN pattern weakness below the lesion
6
Q
First line treatment for trigeminal neuralgia?
A
Carbamazepine
7
Q
How do you tell the difference between Partial and Complete Androgen Insensitivity?
A
Partial would have ambiguous genitalia
8
Q
TACS stroke signs?
A
- Unilateral weakness
- Homonymous Hemianopia
- Cerebral dysfunction
9
Q
PACS stroke signs?
A
2 of the following:
- Unilateral weakness
- Homonymous Hemianopia
- Cerebral dysfunction
10
Q
Posterior circulation stroke signs? (POCS)
A
- Cerebellar syndrome
- Loss of consciousness
- Isolated homonymous hemianopia
11
Q
Lacunar stroke signs? (LACS)
A
- Unilateral weakness
- Sensory stroke
- Ataxic
12
Q
What is an important side effect of sodium valproate?
A
Hepatotoxicity
13
Q
What is cafe au lait spots associated with?
A
Neurofibromatosis Type 1
14
Q
What anti-emetic should be given to someone with Parkinsons?
A
Domperidone
15
Q
What is Ménière’s disease?
A
- Vertigo
- Tinnitus
- Hearing loss
16
Q
What is the treatment for spasticity in MS?
A
Balcofen / Gabapentin
17
Q
If a patient presents with TIA symptoms in the last 7 days when should they see a specialist?
A
Within 24 hours
18
Q
Why can Parkinsons cause postural hypotension?
A
Due to autonomic dysfunction
19
Q
What is the most common hereditary peripheral neuropathy?
A
Charcot-Marie Tooth syndrome
20
Q
What is syringomelia?
A
Cape-like loss of temperature and pain sensation due to compression of spinothalamic tract fibres
21
Q
What drugs are common precipitants of myasthenia crises?
A
Beta-blockers
22
Q
How does a focal-aware seizures commonly present?
A
Sudden changes in the senses whilst the patient remains fully conscious
23
Q
What are the features of Conduction dysphasia?
A
- Fluent Speech
- Poor reptition
- Comprehension is intact
24
Q
What is the preferred way to support nutrition in patients with MND?
A
PEG
24
What is the preferred way to support nutrition in patients with MND?
PEG
25
When should a carotid endardectomy be done?
Patient who has had a TIA with carotid artery stenosis over 70%
26
What does progressive perisperhal neuropathy with hyporeflexia suggests?
Guillan-Barre
27
What does hypsarrythmia on EEG suggest?
Infantile spasms
28
What is the inheritance of essential tremor?
AD
29
Treatment for essential tremor?
Propranolol
30
What is Weber's syndrome?
A midbrain stroke with occlusion of the posterior cerebral artery
31
How does Weber's syndrome present?
Ipsilateral cranial nerve 3 palsy and contralateral weakness
32
What is the first line management of a patient with raised ICP?
Elevating the head of the bed to 30 degrees
33
Treatment for Bells palsy
Prednisolone
34
What type of seizure do Lip smacking + post-ictal dysphasia associate with?
Temporal lobe
35
What do Sudden onset headache, visual field defects + evidence of pitutary insufficiency suggest?
Pituitary apoplexy
36
What are mid-shaft humeral fractures associated with?
Radial nerve injury
37
Which type of haematoma presents several weeks after the initial head injury?
Subdural
38
What type of epilpepsy are clonic movements that travel proximally assoicated with?
Frontal-lobe
39
What should you rule out in patients having acute recurrent seizures?
Hypoxia and Hypoglycaemia
40
What is the second line management for Bells palsy when steroids have not improved symptoms?
Urgent referral to ENT
41
What is C/I in patients with CAD and cluster headaches?
Triptans due to risk of coronary vasospasm
42
What cranial nerve palsy causes defective eye abduction and horizontal diplopia?
CN 6
43
What is used for long-term prophylaxis of cluster headaches
Verapamil
44
What is used to treat cerebral oedema in patients with brain tumours?
Dexamethasone
45
What type of dementia is associated with MND?
Fronto-temporal
46
What does Hoovers sign = distinguish between?
Organic and non-organic lower leg weakness
47
What does Barthel index measure?
disability or dependence in activities of daily living in stroke patients
47
What does Barthel index measure?
disability or dependence in activities of daily living in stroke patients
48
What does Urinary incontinence + gait abnormality + dementia suggests?
Normal pressure hydrocephalus
49
Which artery is affected in amaurosis fugax?
retinal/opthalmic/internal carotid artery
50
What would occlusion of the basilar artery present with?
Locked in syndrome
51
Treatment for status epillepticus in prehospital setting?
PR diazepam or buccal midazolam
52
If both upper and lower part of the face are affected, what does this suggest?
LMN pathology (think Bell's palsy)
53
What is the management of Bells palsy?
Oral corticosteroids within 72 hours
54
What does a postural headache within normal imaging suggests?
Idiopathic intracranial HTN
55
Motor GCS section?
6. Obeys commands
5. Localises to pain
4. Withdraws from pain
3. Abnormal flexion to pain (decorticate posture)
2. Extending to pain
1. None
56
Verbal GCS section?
5. Orientated
4. Confused
3. Words
2. Sounds
1. None
57
Eye opening GCS section?
4. Spontaneous
3. To speech
2. To pain
1. None
58
What should a GCS below 8 indicate?
Review by anaesthetist with possible intubation/ventilation
59
What does loss of visual fields in the superior aspect indicate?
Lesions of optic radiations in the temporal lobe
60
What does loss of visual fields in the inferior aspect indicate?
Lesions of optic radiations in the parietal lobe?
61
What is carbamazepine used for in epilepsy?
Focal epilepsy - not GTC as it may exacerbate these
62
Seizure medications in men
Generalised: sodium valproate
Focal: lamotrigine/leviteracetam
63
What are unilateral tinnitus, vertigo and deafness associated with?
Acoustic neuroma
64
What is labyrinthitis?
Inflammation of the inner ear, that usually occurs following a viral infection and results in vertigo and hearing loss.
65
Treatment for Wernickes encephalopathy?
Pabrinex (IV Vit B/C)
66
Triad of Wernicke's encephalopathy?
- Nystagmus
- Opthalmoplegia (double vision)
- Ataxia
67
What is Ramsay Hunt syndrome?
LMN lesion caused by reactivation of the varicella zoster virus in the facial nerve
68
What is multiple system atrophy?
Parkinsonism plus autonomic features (erectile dysfunction, postural hypotension, atonic bladder)
69
What type of inheritance is Charcot-Marie-Tooth?
Autosomal dominant
70
What is first line for absence seizures in child/adolescents?
Ethosuximide
71
What is prophylaxis for migraines/
Topiramate/Propranolol
72
What does loss of corneal reflex indicate?
Acoustic neuroma
73
What is one of the first signs of brain metastases?
CN6 palsy presenting as diplopia
74
What do asymmetrical symptoms indicate in Parkinsons?
Idiopathic cause
75
What is autonomic dysreflexia?
A condition characterised by high blood pressure in the context of a spinal cord injury, usually above the level of T6
76
Treatment of autonomic dysreflexia?
Removal of stimulus and treatment of any life-threatening HTN/bradycardia
77
What is a wide-based gait with loss of heel to toe walking
Ataxic gait
78
When might someone have a high stepping gait?
Foot drop
79
Common cause of brain abscess?
Ascending infection from ear or frontal sinuses
80
Features of brain abscess?
Headache, fever and focal neurology
81
Treatment of idiopathic intracranial HTN?
Acetazolamide - a carbonic anhydrase inhibitor
82
What blood test helps to differentiate between seizures and pseduoseizures?
Prolactin - elevated in true seizures
83
Investigation of choice for acoustic neuroma?
MRI of the cerebellopontine angle
84
What is the mechanism of hyperventilation to help reduce ICP?
Reduce blood CO2 to induce cerebral vasoconstriction
85
Seizures vs Syncope?
Syncopal episodes are associated with a rapid recovery and short post-ictal period
86
What would damage to the radial nerve present as?
Inability to extend the wrist
87
What would damage to the ulnar nerve present as?
Weakness of the ring and the little fingers
88
Which column conveys fine touch, proprioception and vibration?
Dorsal
89
What are axillary freckles indicative of?
Neurofibromatosis Type 1
90
What is the MRI finding of normal pressure hydrocephalus?
Ventriculomegaly without/in proportion to sulcal enlargement
91
What is lethargy a very common early symptom of?
MS
92
First line for spasticity in MS?
Baclofen and gabapentin
93
What is Webers syndrome?
Midbrain stroke characterised by the an ipsilateral CN III palsy and contralateral hemiparesis
94
What is Charcot-Marie tooth?
Sensory and peripheral neuropathy with no UMN signs
95
Side effects of levodopa?
- Psychosis
- Postural HTN
- Cardiac arrythmias
- 'On Off' effect
- drug induced dyskinesias
96
In trauma, what do you test for to confirm if fluid from nose/ear is CSF?
Glucose
97
First line for ocular MG?
Pyridostigme
98
Cause of subdural haemorrhage?
bridging veins between cortex and venous sinuses
99
What kind of headache commonly follows an LP?
Low-pressure headache
100
What does Weakened dorsiflexion, inversion and eversion of the ankle indicate?
L5 nerve lesion
101
What does Obese, young female with headaches / blurred vision suggest?
IIH
102
What would contralateral homonymous hemianopia with macular sparing and visual agnosia indicate?
Posterior cerebral artery - Webers
103
What medications are associated with intracranial idiopathic HTN?
Tetracyclines Abx, Contraceptives, Steroids, Lithium
104
What does it mean that Parkinsons drugs are critical?
They should not be stopped on acute admissions and should be taken on time
105
Falling to the ground and laying motionless?
Atonic seizure
106
What nerves does absent triceps reflex correspond to?
C7-C8
107
S/E of triptans?
Tightness of the throat and chest
108
How do you differentiate between a stroke involving the anterior inferior cerebellar artery and the posterior inferior cerebellar artery?
Anterior would have facial paralysis and deafness
109
What is a hyper dense collection on CT suggestive of?
Haemorrhage
110
What is empty delta sign on venography suggestive of?
Saggital sinus thrombosis
111
Which migraine medication is likely to cause EP side effects?
Metoclopramide
112
Mechanism of sodium valproate?
Inhibition of the P450 system
113
What would fracture of the shaft of the humerus cause?
Wrist drop
114
What should be given to patients not responding to BDZ in status epileptics?
Phenytoin
115
What does CT head showing temporal lobe changes suggest?
Herpes simplex encephalitis
116
What does diffusion-restricting lesion suggests?
Abscess
117
What is gait ataxia caused by?
cerebellar vermis lesions
118
What does reduced GCS, paralysis and bilateral pin point pupils suggest?
Pontine haemorrhage
119
What screening tool can be used to assess likelihood of stroke?
ROSIER
120
What is the treatment for restless leg syndrome?
Dopamine agonists e.g. ropinirole
121
Lower half of facial weakness, dry mouth, ear pain?
Bells
122
Treatment of brain abscess
3rd gen cephalosporin + metronidazole
123
What cancer is associated with myasthenia gravis?
Thyoma
124
What is a complication of raised ICP?
Herniation - loss of consciousness and diplopia
125
Which Parkinsons medication is linked to impulse control disorders (impulsivity)
Dopamine agonists
126
When can anti-epileptic drug be stopped?
Seizures free for 2 years and them stopped over 2-3 months
127
What is recommended for patients with an acute ischaemic stroke who present within 4.5 hours?
Thrombolysis and Thrombectomy
128
What condition is hyperacusis linked with?
Bells palsy
129
What reflex is a response to raised ICP?
Cushings - bradycardia and hypertension
130
Secondary prevention of stroke?
1. Clopidogrel
2. Aspirin + MR Dipyridamole if clopidogrel not well tolerated
131
What is paroxysmal hemicrania?
Severe uniltateral headache, usually in the orbital, supraorbital or temporal region in women - treated with indomethacin
132
How are drugs for neuropathic pain used?
Monotherapy - if one does not work, it should be switched for another
133
MND vs MG
MND will usually be ocular sparing
134
Extradural vs subdural?
Extradural is limited by the suture lines
135
Acute vs chronic haematoma?
Acute appears hyper dense and chronic appears hypodense
136
If falls occur soon after a Parkinsons diagnosis, what should be considered?
Progressive Supranuclear Palsy
137
What is the key investigation in diagnosis of Guillan Barre syndrome?
Lumbar Puncture
138
Side effects of carbamazepine?
- Dizziness and ataxia
- Drowsiness and Headache
- Diplopia
- Hyponatreaemia secondary to SIADH
139
What area of the brain is the haemorrhage in subarachnoid?
Between arachnoid mater and the pia mater
140
What area of the brain is the haemorrhage in subdural?
Between the arachnoid mater and the inner layer of the dura mater
141
What area of the brain is the haemorrhage in extradural?
Between the dura mater and the skull
142
Symptoms of neurosphyilis?
loss of proprioception and vibration sensation. No motor deficit
143
What is a C/I to triptans?
Ischaemic heart disease
144
What is Wernicke's aphasia?
- Fluent speech
- Don't make sense
- Difficulty understanding others
145
What is Broca's aphasia?
- Laboured, non fluent speech
- Understand what others are saying
146
What arteries are involved in TACS?
Anterior and Middle Cerebral Artery
147
Which CN supplies taste for anterior 2/3rds of the tongue?
Facial (7)
148
Which CN supplies taste for posterior 1/3 of the tongue?
Glossopharyngeal (9)
149
Presentation of Herpes Simplex Encephalitis?
Fever, headache, vomiting, seizures -> typically affects temporal or inferior frontal lobe
150
A lesion with which CN may cause nystagmus?
CN8
151
Which arteries are involved in posterior circulation stroke?
Vertebrobasilar arteries
152
What is the most common hereditary ataxia?
Frederick's ataxia
153
How does Frederick's ataxia present?
- Loss of lower limb reflexes
- Cerebellar ataxia
- Optic atrophy
- Spinocerebellar tract dysfunction
154
Duchennes vs Beckers?
Becker onset > 10 years, Duchenne onset < 5 years
155
Craniopharyngioma vs Pituitary tumour?
Both have bitemporal hemianopia but CP will have a lower that is worse than upper
156
What syndrome is lamotrigine associated with?
Steven-Johnson syndrome
157
Neurofibromatosis vs Tuberous Sclerosis?
NF - pigmented spots
TB - depigmented spots
158
What chromosome is defective in neurofibromatosis T1?
17
159
Laughter leading to fall/collapse?
Cataplexy
160
What is associated with a congenital hydrocephalus?
Arnold-Chiari malformation
161
Low CSF headache worse on standing and improve when lying flat associated with connective tissue disorder?
Spontaneous intracranial hypotension
162
What is a meningioma?
A benign tumours that arise from the arachnoid cap cells of the meninges but are typically located next to the dura
163
What is the gold standard for diagnosis venous sinus thrombosis?
MR Venogram
164
Features of Neuroleptic Malignant Syndrome?
- Fever
- Muscle rigidity
- Delirium with confusion
- HTN and tachycardia
- AKI may develop in severe cases
165
What does isolated result of high protein in the CSF suggests?
Guillan-Barre
166
Management of Bells palsy except prednisolone
Artificial tears and advise eye taping at night
167
Presentation of subacute combined degeneration of the spinal cord?
Loss of proprioception and vibration sensation, muscle weakness and hyperreflexia
168
What type of seizures is pulling of clothes associated with?
Temporal lobe seizures
169
Management of symptomatic chronic subdural bleeds?
Burr hole evacuation
170
Management of degenerative cervical myelopathy?
Cervical decompressive surgery
171
What should be investigated in those having a stroke < 55?
Thrombophilia and autoimmune screening
172
Subdural vs extradural on CT?
SD - crescent/concave shaped
ED - convex/lemon shaped
173
What area of the brain is affected when there is lip smacking + post-ictal dysphasia?
Temporal lobe
174
Location of the lesion if someone presents with Wernicke's aphasia?
superior temporal gyrus
175
Location of the lesion if someone presents with Broca's aphasia?
inferior frontal gyrus
176
Will amaurosis fugax present with atherosclerosis of ipsilateral or contralateral side?
Ipsilateral
177
What blood abnormality can phenytoin cause?
Macrocytic anaemia due to altering folate mechanism
178
Lambert Eaton vs MG?
Weakness in Lambert Eaton improves after exercise, unlike myasthenia gravis; which worsens after exercise
179
What is forehead sparing UMN or LMN?
UMN - so forehead not affected
180
What are psychiatric co-morbitidities a risk factor for?
Psychogenic non-epileptic seizures
181
What is a common cause of 3rd nerve palsy where there is pain and dilated pupils?
Posterior communicating artery aneurysm
182
What should be prescribed for chemo-related N+V?
Ondansetron
183
What should be given before giving folate to a patient?
Vitamin B12
184
What would happen if you gave folate to a patient who is deficient in B12?
Subacute degeneration of the spinal cord
185
What is the gold standard investigation for cervical myelopathy?
MRI spine
186
What condition is associated with subungual fibromata?
Tuberous Sclerosis
186
What condition is associated with subungual fibromata?
Tuberous Sclerosis
187
Where in the brain does ondansetron act?
Medulla oblongata
188
What condition is associated with diminished response to repetitive stimulation on EMG?
Myasthenia Gravis
189
What would ipsilateral cranial nerve findings and contralateral weakness findings suggest?
Brainstem
190
What condition is associated with adenoma sebaceum?
Tuberous Sclerosis
191
What are the investigations of choice for vestibular schwannomas?
audiogram and gadolinium-enhanced MRI head scan
192
Treatment for migraines associated with menstruation?
- Triptans for acute
- Mefenamic acid/Aspirin
193
What is Progressive bulbar palsy?
A type of MND associated with palsy of the tongue, muscles of chewing/swallowing ude to loss of function of the brainstem motor nuclei
194
Typical presentation of primary lateral sclerosis (MND)
UMN signs only
195
Typical presentation of Progressive muscular atrophy (MND)
LMN signs only
196
UMN signs?
- Spasticity, rigidity
- Hyperreflexia
- Normal nerve conduction
- Hypertonia
197
LMN signs?
- Hypotonia
- Hyporeflexia
- Abnormal nerve conduction
- Fasiculations and fibrillation
198
Menieres vs Acoustic neuroma?
Menieres would have attacks with a duration of several hours whereas acoustic neuroma would be progressively getting worse
199
What condition presents with wasting of the thenar eminence associated with sensory loss to the palmar aspect of lateral (radial) three fingers
Carpal tunnel
200
First lines for neuropathic pain?
Amitriptyline, duloxetine, gabapentin or pregabalin
201
What improves the tremor found in patients with Parkinsons?
Voluntary movement
202
Which psychiatric condition is most associated with Parkinsons?
Depression
203
Eye deviates supero-laterally -> problem with downward gaze and vertical diplopia
Trochlear nerve
204
Eye deviates medially -> problem with lateral gaze and horizontal diplopia
Abducens nerve
205
How are absence seizures brought on?
Hyperventilation
206
What is the investigation of choice for narcolepsy?
multiple sleep latency EEG
207
What can 'down and out' position of the right eye be suggestive of?
Raised ICP
208
Sensation of sensation of fine touch, proprioception and vibration are conveyed in which column?
Dorsal column
209
What does inferolateral deviation of the eye suggest?
CN3 palsy - down and out eye
210
What are Exomphalos and diaphragmatic herniae assoicated with?
Malrotation
211
bitemporal superior quadrantanopia
Pituitary adenoma
212
bitemporal inferior quadrantanopia
Craniopharyngioma
213
Inferior homonymous quadrantanopia?
inferior visual field defect due to lesion in superior optic radiations in the parietal lobe
214
What type of seizures is Jacksonian march?
Focal aware
215
Presentation of thoracic outlet syndrome?
- Muscle wasting of the hands
- Numbness and tingling
- Possibly autonomic symptoms
216
What is persistent foetal bradycardia an indication for?
Cat 1 C-section
217
What will dominant hemisphere middle cerebral artery strokes cause?
Aphasia
218
How does Steven-Johnson syndrome normally present?
- Up to 2 months after starting an anti-convulsant
- Prodromal illness which mirrors a viral resp infection
- Red rash which starts on trunk and spreads to face/limbs
219
Management of SJ syndrome?
Cease all medications, obtain IV access and begin fluid therapy
220
Which Parkinsons medication is most likely to cause disinhibition?
Dopamine agonists e.g. ropinirole
221
What blood test results would be in neuroleptic malignant syndrome?
Raised CK and raised WCC
222
What condition is associated with adduction of the ipsilateral eye, the contralateral eye abducts, however with nystagmus.
Internuclear ophthalmoplegia
223
What condition is assoicated with roughened patches of skin over lumbar spine?
Tuberous Sclerois
224
What does alcohol often help improve?
Benign Essential Tremor
225
What are the first line treatments for essential tremor?
Propranolol / Primidone
226
What should be normal in a patient with a benign essential tremor?
DAT scan
227
What is an appropriate first line investigation for benign essential tremor?
Bedside FVC assessment
228
Signs of tuberculous meningitis?
- High CSF Pressure
- High protein
- Very low glucose
- Significantly elevated CSF count
- High temperature
229
Malignant meningitis vs TB meningitis?
TB meningitis will generally have a raised temperature
230
What is the most common recessive ataxia in the UK? f
Freiderich
231
What area of the brain is degenerated in Freiderich ataxia?
Dorsal root ganglion
232
Impairment of tandem walk in seen indicates what disease?
Cerebellar
233
Papillitis vs Papilloedema of raised ICP?
Papillitis presents with pain on eye movement and will have visual loss
234
What is myelopathy a disease of?
Spinal cord
235
How to differentiate between a fixed dilated pupil caused by a squeeze on the parasympathetic fibres of the third nerve and a blind eye?
Testing for indirect pupillary reflex -
236
What is the typical pattern of weakness associated with myelopathy?
Proximal, symmetrical
237
Commonest causes of generalised axonal neuropathy in the UK?
Diabetes and Alcohol
238
Fasciculation potentials and normal motor unit potentials are assoicated with what condition?
Benign cramp fasciculation potentials
239
Proximal muscle weakness and muscle pain is characteristic of which condition?
Polymyositis
240
Hand paraesthesia that wakes the patient at night suggetss what condition?
Carpal tunnel
241
What is the imaging of choice for someone who has had a TIA with no risk of bleeding?
MRI brain with diffusion-weighted imaging
242
What commonly develops following LP?
Postural headache - treated with caffeine and fluids
243
What is the treatment for pituitary apoplexy?
Urgent corticosteroids
244
Treatment for reducing relpase in MS?
Monoclonal antibodies such as natalizumab
245
What does delta sign on MR venography suggest?
Saggital sinus thrombosis
246
What is Neurofibromatosis type 2 assoicated with?
Vestibular Schwannomas
247
What happens to ICP in normal pressure hydrocephalus?
It rises intermittently
248
What is between the posterior cerebral artery and the superior cerebellar artery?
Occulomotor nerve
249
What is the pathophysiology of MS?
Autoimmune demyelination of the CNS and axonal loss of the oligodendrocytes
250
Which cells are not affected in MS?
Schwann cells
251
What are the 2 specialised cells in the CNS?
- Nerve cells
- Neuroglia e.g astrocytes, oligodendrocytes
252
What are Schwann cells?
Glial cells of the PNS which myelinate axons
253
What condition has Antibodies to voltage-gated calcium channels?
Lambert-Eaton syndrome
254
Juvenile myoclonic epilepsy is classically associated with
seizures in the morning/following sleep deprivation
255
Definition of postural hypotension?
Drop of 20
256
Atonic seizure presentation?
Sudden loss of muscle tone leading to a fall with no loss of consciousness
257
What sign on MRI suggests encephalitis?
Bilateral medial temporal lobe involvement
258
What is Ramsay Hunt syndrome?
Bells + severe pain and hearing loss
259
What kind of ptosis does Horners cause?
Partial
260
Most common cause of right third occulomotor nerve palsy?
Diabetes
261
What does posterior cerebral artery supply and what visual loss will you see?
Corresponding occipital cortex -> contralateral visual field
262
Investigation of choice for encephalitis?
Viral CSF PCR
263
Signs of parietal lobe damage?
Visual inattention, apraxia,
264
DMARD used for MS?
Beta interferon
265
Mechanical thrombectomy provides most benefit for strokes in which location?
Proximal MCA and internal carotid artery thrombosis
266
Surgical management of SAH?
Endovascular coiling
267
Enlarged blind spots and constriction of the visual filed?
Idiopathic Intracranial HTN
268
Burning pain, ear ache, vertigo, weakess?
Ramsay-Hunt - herpes virus
269
Which tumour assoicated with Meigs syndrome (pleural effusion, ascites)
Fibroma
270
Risk factors for subdural haematoma?
Recent trauma (falls), anticoag use, older age
271
What clinical feature is part of optic neuritis?
Red desaturation
272
Vertigo with no tinnitus or hearing loss and recent viral illness?
Vestibular neuritis
273
Gold standard imvestigation for SAH?
Digital subtraction catheter angiography
274
Signs of Primary Lateral Sclerosis?
Only UMN features
275
Signs of progressive muscular atrophy?
Only LMN signs
276
MRI findings of Huntingtons?
Atrophy of caudate nucleus and putamen
277
Drugs to help with faitgue in MS?
Modafanil/Amantadine
278
Which epilepsy has seizures in the morning/following sleep deprivation?
Juvenile Myoclonic
279
2nd line for focal seizures?
Carbamazepine
280
What medication can exacerbate absence seizures?
Carbamazepine
281
Medication for tonic/atonic seizures?
Males - Sodium Valproate
Females - Levetiracetam
282
What is lateral medullary syndrome?
Occlusion of posterior inferior cerebellar artery
283
Tx for agitation in autoimmune encephalitis?
Risperidone/Quetiapine
284
Vesicular rash around the external ear canal + LMN palsy?
Ramsay Hunt Type 2
285
First line investigation for acute presentation of GBS?
Vital Capacity - assess respiratory failure
286
Personality changes are more likely to occur in what type of stroke?
anterior cerebral artery strokes
287
Cushing's triad?
bradycardia, hypertension and irregular/abnormal breathing
288
Vertigo when turning head to one side?
Benign Positional Paroxysmal Vertigo
289
Cause of BPPV?
Debris in the semicircular canals
290
Diagnostic investigation for BPPV?
Hallpike maneouvre
291
Treatment of BPPV?
Epley maneouvre
292
embolic infarcts confined to one hemisphere of the brain?
Source is after the heart but before the brain -> carotids
293
What are oligoclonal bands?
distinct bands of IgG on Western Blot
294
‘string of beads’ appearance on MRI angiography
Fibromuscular dysplasia
295
First line investigation for suspected Alzheimers?
Serum B12 levels - rule out reversible causes of cognitive decline
296
Temporal arteritis vs Trigeminal neuralgia?
TN will normally not have any visual/eye involvement
297
Vestibular neuritis vs Labyrinthitis
VN will have no hearing loss
298
Cause of Freireich?
triple repeat in the FXN gene encoding the frataxin protein
299
What condition is assoictaed with high-arched palate, pes cavus, and kyphoscoliosis?
Friederich
300
What is acute vestibular syndrome?
vestibular neuronitis and labyrinthitis
301
When is LP most sensitive after SAH?
12 hours following
302
SOD1 mutation?
Familial ALS
303
If FH and sounds like ALS?
Not sporadic (more common) - familial ALS
304
2nd line autoantibody check for MG?
Positive muscle-specific tyrosine kinase antibodies
305
Unilateral supratentorial arterial bleed
Extra-dural haematoma
306
Side effects of topiramate?
weight loss, renal stones and cognitive and behaviour changes
307
Medications which can cause ototoxicity?
- Gentamicin
- Furosemide
- Vancomycin
308
Alpha-synuclein cytoplasmic inclusions would be found with which condition?
Lewy-body dementia
309
Common peroneal vs L4/5 radiculopathy?
Normal foot inversion in common peroneal
310
What reduces morbidity and mortality in bacterial meningitis?
Dexamethasone IV -> should be given within 4 hours of starting Abx
311
All CN lesions are ipsilateral except which?
Trochlear
312
Absent corneal reflex indicates a lesion where?
Pons
313
Absent corneal reflex indicates a lesion where?
Pons
314
Emergency opthalmic condition affecting the aqueous humour?
Acute glaucoma - drainge of AH becomes blocked
315
Symptoms of glaucoma
- Rise in Intraocular pressure
- Pain
- Red eye
- N+V
- Blurred vision
316
Tx of glaucoma?
- Pilocarpine eye drops
- Acetazolamide 500mg
-Steroids/Beta-blockers
- Surgical management is definitive
317
Vitreous Haemorrhage
- Haemorrhage into vitreous humour
- Prevents light travelling from lens to retina
- Caused by diabetes, trauma, macular degeneration
318
Presentation and Tx of Vitreous Haemorrhage?
- Floated, haze and shadows
- Visual loss in severe cases
- Tx is stop the cause and then repair with laser
319
Retinal detachment
- Retina pulled away from the underlying surface
- Flashers/Floaters/Curtain over past of vision
- Needs scleral buckle surgery/vitrectomy
320
Central Retinal Vein Occlusion
- Dilatation of branch veins (due to backflow)
- Cotton wool spots
- Retinal haemorrhages
- Mild cases don't need Tx
- Severe cases need steroid injections/Anti VEGF
321
Central retinal artery occlusion
- Occular equivalent of stroke (same risk factors)
- Cherry red spot in macula
- Pale optic disc
- Relative afferent pupillary defect
- Tx includes ocular massage, increased blood oxygen content and acetazolamide
322
Optic Neuritis
- Inflammation of the optic nerve
- MS, B12 deficiency, Lymes, Syphilis, HIV
- Pain, reduced acuity, RAPD
- Resolves in around 6 weeks
323
What is clinically isolated syndrome?
First episode of symptoms due to inflammatory demyelination
324
Lhermittes?
Uhthoffs?
L - electric shock like sensation on neck flexion
U - increase in body temp worsens neurology
325
Cardiac Syncope
- Arrhythmias
- Valvular pathology e.g aortic stenosis
- ECG/Echo
326
Pathophysiology of neurogenic syncope
Inappropraite active activation of PNS (vagus) and decrease of SNS
327
Components of ABCD2 scoring system?
Age >60
BP >140/90
Clinical features
- Unilateral - 2points
- Speech impairment with no weakness - 1
Duration - >60 1 point
D - Diabetes
328
What supplies the anterior and posterior half of the spinal cord?
Anterior - spinothalamic and corticospinal - anterior spinal artery
Posterior - dorsal - 2 posterior spinal arteries
329
Anterior cord syndrome
- Anterior part is damaged
- Bilateral loss of pain/temperature and bilateral spastic paralysis
- Fine touch, proprioception and vibration preserved
330
Posterior cord syndrome
- Fine touch, proprioception and vibration affected
- Pain/temperature preserved
331
What is associated with Chiari malformation?
Syringomyelia
332
What is spinal cord concussion?
- Transiet loss of spinal cord function, usually resolves within 48 hours
333
What is spinal stenosis?
Spinal canal narrows to compress on the cord, presenting with glute/leg pain on walking/standing
334
CN3,4 and 6 lesions
3 - Ptosis, down and out, dilated fixed pupil
4 - Defective downward gaze, vertical diplopia
6 - Defective abduction, horizontal diplopia
335
CN5/7 lesions
5 - loss of corneal reflex, loss of focial sensation, paralysis of mastication, deviation of jaw to weak side
7 - paralysis of upper/lower face, loss of taste, hyperacusis
336
CN8,9,10 lesions
8 - hearing loss, vertigo, nystagmus
9 - hypersensitive carotid sinus reflex, loss of gag reflex
10 - uvual deviates way from lesion
337
CN11,12 lesions
11 - weakness turning head to opposite side
12 - tongue deviates toward side of lesion
338
What is lyme disease?
Caused by the spirochaete Borrelia burgdorferi
339
Presentation of Lyme disease
- painless, bulls eye rash at site of stick bite
- headaches, fever, lethargy
- Later features include heart block, meningitis, pericarditis
340
Investigations for lyme disease?
- ELISA antibodies
341
Management of tick bite/confirmed lyme?
Tick bites - remove it and then wash
Doxycycline if early disease otherwise Ceftriaxone
342
What is Jarisch-Herxheimer reaction?
Fever, rash tachycardia after first dose of Abx - Lyme disease
343
shooting pains along the outer aspect of the upper leg?
Meralgia Paresthetica
344
What causes pseudobulbar palsy?
bilateral lesion affecting the corticobulbar tracts
345
Presentation of pseudobulbar palsy?
spastic tongue, a slow thick ("hot-potato") speech, a brisk jaw jerk reflex, and emotional lability
346
Where is the lesion for internuclear opthalmoplegia?
Medial longitudinal fasciculus on the side that fails to adduct
347
Presentation of PICA?
Dysphagia
ipsilateral Ataxia,
ipsilateral Nystagmus,
Vertigo,
Anaesthesia (Ipsilateral facial numbness and contralateral pain loss on the body)
ipsilateral Horner's syndrome
348
What is Devics disease?
Optic neuritis
Transverse myelitis
Positive NMO-IgG (an antibody targeting aquaporin 4
349
pupil-sparing third nerve palsy, associated with foot drop in a diabetic?
Mononeuritis multiplex
350
left-sided ring enhancing lesion
cerebral abscess
351
Ulnar claw
Ulnar nerve neuropathy
352
What does owl's eye on axial imaging suggest?
Anterior spinal artery occlusion
353
Px of Horners
- Ptosis (dropped eyelid)
- Miosis (contricted pupils)
- Anhidrosis (loss of sweating)
- Enopthalmos
354
Venous sinus thrombosis Px?
- Hx of VTE/COCP
- Severe headache but less insidicous than SAH
- N+V
- Subtle neurology
355
Mechanism of action of ondansetron?
5-HT3 anatgonist
356
What type of MRI should be used for MS?
With contrast
357
What cranial nerves are affected in vestibular schwannoma?
5,7,8
358
Creutzfeldt-Jakob disease is characterised by what?
Rapid onset dementia and myoclonus (twitching, jerks)
359
Medical treatment for neuroleptic malignant syndrome?
Bromocriptine
360
Big risk factor for Bells?
Pregnancy
361
normal motor conduction on nerve conduction studies
MND
362
Tx for acute phosphotaemia in adults?
Intravenous infusion of phosphate polyfusor
363
WHat nerves do thumb adduction and abduction?
Adduction - ulnar
Abduction - median
364
Signs of spinal cord compression?
UMN - below the lesion
LMN - at the lesion
365
Dangling hand over the edge of bed?
Carpal tunnel
366
Centro-temporal spikes?
Benign Rolandic Epilepsy
367
Tx for Lambert Eaton
Amifampridine
Phase 3A
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