Neuro quick

Question 1

Most common side effect of levodopa

Answer 1

Dyskinesia

Question 2

What is sumatriptan contraindicated in?

Answer 2

Ischaemic heart disease

Question 3

Sodium valproate side effects

Answer 3

Tremor

Question 4

Metronidazole side effect

Answer 4

Peripheral neuropathy

Question 5

Stroke management ( ischaemic)

Answer 5

Give aspirin 300mg
Thrombolysis with alteplase or tenecteplase.
Administer within 4.5 Horus of symptom onset, BP lowered to 185/110 before;

Also offer thrombectomy asap within 6-12 hours if
- confirmed proximal anterior circulation and potential to salvage brain tissue

Question 6

Anti coagulation post stroke - AF

Answer 6

TIA - anticoagulation for AF should start immediately once imaging has excluded haemorrhage

in acute stroke patients, in the absence of haemorrhage, anticoagulation therapy should be commenced after 2 weeks.

• Apixaban

Question 7

Anti coagulation [ost stroke

Answer 7

Clopidogrel

Question 8

Absolute contraindications to thombolysis ?

Answer 8

Previous intracranial haemorrhage, seizure at onset of stroke, suspected sAH, stroke in preceding 3 months, LP in preceding 7 days, active bleeding, varices

Question 9

Treatment of chronic subdural if they are symptomatic

Answer 9

Surgical decompression with burr hole

Question 10

basilar stroke

Answer 10

Locked in

Question 11

Retinal/ ophthalmic stroke

Answer 11

Amourisos fugax, curtain coming down

Question 12

Cerebella strokes sign

Answer 12

Ataxia and nystagmus
PICA and AICA

PICA- Ipsilateral facial pain and temperature loss,
Contralateral - limb pain and temp loss

AICA- same as PICA + ipsilateral facial paralysis and deafness

Question 13

Cerebral stroke - anterior

Answer 13

Contraleral hemiparesis, sensory loss
Lower >upper

Question 14

Cerebral stroke - middle

Answer 14

Contralateral hemiparesis, sensory loss
Upper >lower
Contralateral homogenous hemianopia and aphasia

Question 15

Posterior cerebral stroke

Answer 15

Contralateral homonymous hemianopia
Visual agnosia= can’t recognise objects

Question 16

LMN lesion

Answer 16

Doesnt spare the forehead

Question 17

TIA treatment

Answer 17

Aspirin 300mg and clopidogren for 21 days
Then continue the clop

Question 18

HSV encephalitis treatment

Answer 18

IV acliclovir

Question 19

Homonynous quadrantonopias

Answer 19

superior: lesion of the inferior optic radiations in the temporal lobe (Meyer’s loop)

inferior: lesion of the superior optic radiations in the parietal lobe
mnemonic = PITS (Parietal-Inferior, Temporal-Superior)

Question 20

Homonygous hemianopia

Answer 20

Incongruous defects: lesion of optic tract
congruous defects: lesion of optic radiation or occipital cortex
macula sparing: lesion of occipital cortex

Question 21

MND treatment

Answer 21

Riluzole, resp care and nutrition

Question 22

PLS, ALS vs PMA

Answer 22

ALS - UMN and LMN e.g. fascinations and hypertonia

PLS - UMN only

PMA - LMN only

Question 23

Cluster headache management

Answer 23

O2 and SC triptan

Question 24

Cluster headache investigations

Answer 24

MRI with gangolium contrast

Question 25

CLuster prophylaxis?

Answer 25

Verapamil. Pred and lithium carbonate

Question 26

IIH treatment

Answer 26

Acetazlamide

Question 27

Migraine prophylaxis

Answer 27

Propranolol or topiramate

Question 28

Trigeminal neuralgia treatment

Answer 28

Carbamezapine

Question 29

Brain abscess treatment

Answer 29

Dex + cephalosporin and metronidazole

Question 30

Raised iCP

Answer 30

Cushings triad - bradycardia, HTN, wide pulse pressure Wet wacky and wobbly

Question 31

Myasthenia gravis

Answer 31

muscle fatigue, double vision, proximal muscle weakness, ptosis Antibody testing for acetyl choline receptor antibodies

Question 32

Myasthenia crisis

Answer 32

IV immunogloublins and plasma exchange

Question 33

Bells palsy

Answer 33

LMN facial nerve palsy Altered taste, forehead affected, dry eyes, Pred, lubicating eye drops

Question 34

Ramsay hunt

Answer 34

VZV Unilateral LMN lesion Painful dn tender vesicular rash around ear Oral aciclovir and corticosteroids

Question 35

Guillian barre syndrome

Answer 35

Demyelination of PNS caused by campylobacter Back/leg pain, weakness ascending, LP, high protein, normal WCC Nerve conductions IV immunoglobulins adn plasma exchange

Question 36

Thumb and index finger dermatome

Answer 36

c5,c6

Question 37

Wrist drop

Answer 37

C5, radial nerve

Question 38

Picks dementia

Answer 38

Most common type of front temporal Disinhibition, personality change Knife blade arrange DO NOT USE ACEylcholinerase or memantadinbe

Question 39

Treatment of dementia?

Answer 39

3 acetylcholinerase inibitors- donezapil, galantamine and rivastigmine. NMDA antagonist - menetine. 2nd line

Question 40

What is donezpail contraindicated in?

Answer 40

Bradycardia and it can cause insomnia!

Question 41

Parkinson's signs

Answer 41

Bradykinesia Asymmetrical rigidity Tremor Pil rollin g fatigue

Question 42

Treatment of parkinsons?

Answer 42

If symptoms are affecting QOL - levodopa if not.. Dopamine agonists e..g bromocriptien or MAO-B e.g. selegilline

Question 43

What are dopamine agonists contraindicated in?

Answer 43

Hallucinatiosn and impulse

Question 44

Side effects of levodopa?

Answer 44

Dry mouth, anorexia, impulse control disorders DO NOT ACUTELY STOP Combined with a COMT e.g. entacopone

Question 45

Seizure rules - re driving

Answer 45

6 months off driving if no abnormalities on imaging 12 months off till no seizure

Question 46

Obturator nerve palsy

Answer 46

Hip adduction

Question 47

Common perineal nerve lesion

Answer 47

foot dro

Question 48

brown Squared

Answer 48

paralysis on the same side as injury, loss of pain and temperature on the other side

Question 49

Wernickes - who does it affect?

Answer 49

Alcoholics, anorexia, stomach cancer and dietary deficiency

Question 50

Wenches treatment

Answer 50

urgent thiamine replacement

Question 51

Wernicke's sign

Answer 51

Opthalmoplegia ( LR palsy), nystagmus, ataxia, encephalopathy

Question 52

Korsakoffs signs

Answer 52

amnesia and confabulation

Question 53

Subacute degeneration of spinal cord?

Answer 53

Due to vitamin b12 deficiency, impairment of dorsal columns, lateral corticospinal tracts and spinocerebellar tracts Hyperreflexia, loss of proprioception and loss of vibration Distal tingling, legs>arms, positive rombergs

Question 54

Status epilepticus treatment

Answer 54

Pre hosp = PR Diaz or buccal midazolam Hosp - IV lorazepam, repeat after 5 mins, Levetricetam, PHENOYTOIN IV or sodium valproate If been 45 mins --> GA or phenobarbitrate

Question 55

Charcot marie tooth

Answer 55

Hereditary peripheral neuropathy.

Question 56

Treatment of meninigitis?

Answer 56

IV access → take bloods and blood cultures lumbar puncture if this cannot be done within the first hour, IV antibiotics should be given after blood cultures have been taken IV antibiotics 3 months - 60 years: BNF recommends ceftriaxone ≥60 years: BNF recommends ceftriaxone + amoxicillin (or ampicillin) for adults add IV vancomycin if recent prolonged/multiple antibiotic use or travel to areas with highly resistant pneumococci IV dexamethasone

Question 57

Prophylactic abx for meningiti?

Answer 57

Oral cipro, rifampicin if u were in contact wit them within 7 days before onset

Question 58

SAH treatment

Answer 58

Nimodipine and refer

Question 59

Complications post SAH

Answer 59

Menigism, SIADH,

Question 60

Subdural

Answer 60

Bridging veins, fluctuating consciousness, Sausage

Question 61

Extradural

Answer 61

Lucid, rapid decline, middle meningeal

Question 62

Huntington

Answer 62

Involuntary movements

Question 63

Absence

Answer 63

Ethysiximide

Question 64

Focal seizure

Answer 64

Lamotrigine or levetrivactem

Question 65

Side effect of lamotrigine

Answer 65

Sodium channel blocker Can cause SJS