Neurology

Question 1

What is the functional test to check that the median nerve is functional?

Answer 1

OK sign

Question 2

What is the functional test to check that the radial nerve is functional?

Answer 2

Thumbs up sign

Question 3

What is the functional test to check that the ulnar nerve is functional?

Answer 3

Finger abduction

Question 4

What sensation to the arm and hand is innervated by the median nerve?

Answer 4

Lateral 3.5 fingers
Skin over thenar eminence
Lateral 2/3 palm

Question 5

What sensation to the arm and hand is innervated by the radial nerve?

Answer 5

Posterior arm and forearm
Lateral 2/3 dorum of hand
First web space on dorsum of hand

Question 6

What sensation to the arm and hand is innervated by the ulnar nerve?

Answer 6

Medial 1.5 fingers
Hypothenar eminence
Medial 1/3 of hand

Question 7

What motor supply to the arm and hand is innervated by the median nerve?

Answer 7

Anterior compartment of forearm and some intrinsic muscles of the hand

Question 8

What motor supply to the arm and hand is innervated by the radial nerve?

Answer 8

Posterior compartment of forearm
Triceps

Question 9

What motor supply to the arm and hand is innervated by the ulnar nerve?

Answer 9

Instrinsic hand muscles
2 muscles in anterior compartment of the forearm

Question 10

What is the typical presentation of a median nerve injury?

Answer 10

Wasting of anterior forearm and thenar eminence
Hand of benediction on attempted finger flexion

Question 11

What is the typical presentation of a radial nerve injury?

Answer 11

Wasting of triceps and posterior compartment of forearm
Wrist drop on wrist extension

Question 12

What is the typical presentation of a ulnar nerve injury?

Answer 12

Wasting of hypotenar eminence and intrinsic muscles of hand
Claw hand on attempted finger extension

Question 13

What is the typical EEG pattern in Lennox-Gastaut syndrome?

Answer 13

Diffuse slow spike wave pattern at 1.5-2.5Hz

Question 14

What is the first line antiepileptic agent in Lennox-Gastaut syndrome?

Answer 14

Sodium valproate

Question 15

Which type of nerve is primarily affected in GBS?

Answer 15

Motor nerves

Question 16

Which pathogen causing gastroenteritis is more likely to cause GBS?

Answer 16

Campylobacter

Question 17

Which pathogen causing respiratory infection is more likely to cause GBS?

Answer 17

Mycoplasma

Question 18

What is the pattern of weakness in GBS?

Answer 18

Gradual symmetrical ascending weakness

Question 19

What test is most useful in determining level of care need in patients with GBS?

Answer 19

FVC on spirometry

Question 20

What would be expected in CSF from an individual with Guillan-Barre Syndrome ?

Answer 20

High protein
Else normal

Question 21

What is the most useful confirmatory test in GBS?

Answer 21

Nerve conduction studies

Question 22

What is the tyoical management for Guillan-Barre Syndrome?

Answer 22

IVIG
Corticosteroids

Question 23

What is Cushing’s response in raised ICP and why should it be noted?

Answer 23

HTN
Bradycardia
Irregular breathing
Often a pre-terminal sign

Question 24

What non-pharmacological meausres are important in treated raised ICP?

Answer 24

Head up at 30degrees
Avoidance of hypoxia
Avoidance of hypercarbia
Avoidance of pyrexia

Question 25

What 2 treatments can be used to lower ICP?

Answer 25

Mannitol Hypertonic saline (3%)

Question 26

What is a Dandy Walker malformation?

Answer 26

Under-development of cerebellum Cystic expansion of 4th ventricle Enlargement of posterior skull base

Question 27

What is an Arnold Chiari Malformation?

Answer 27

Lower part of the cerebellum pushes down into the spinal canal

Question 28

Which brain lesion most commonly causes hydrocephalus?

Answer 28

Medulloblastoma

Question 29

Where is CSF absorbed?

Answer 29

Arachnoid granulations in dural venous sinuses

Question 30

Where is CSF produced?

Answer 30

Choroid plexus in 3rd and 4th ventricles

Question 31

What is the Sunsetting sign in hydrocephalus?

Answer 31

Eyes deviated downwards Caused by pressure on midbrain

Question 32

Which cranial nerve is most likely to be affected in raised ICP?

Answer 32

Abducens

Question 33

What is the definitive treatment for hydrocephalus?

Answer 33

VP shunt Ventriculostomy

Question 34

What 2 factors determine the cerebral perfusion pressure?

Answer 34

MAP ICP CPP = MAP-ICP

Question 35

What happens to CPP as ICP increases?

Answer 35

Decreases

Question 36

What happens when CPP falls?

Answer 36

BP rises and cerebral vessels dilate further increasing ICP

Question 37

Under what CPP does ischaemia of the brain usually occur?

Answer 37

40mmHg

Question 38

What is the Monroe-Kellie Doctrine?

Answer 38

The volume inside the skull is fixed, therefore if one component increases then the others must decrease to maintain normal ICP

Question 39

What treatment helps prevent vasospasm in SAH?

Answer 39

Nimodipine

Question 40

What will LP show in SAH?

Answer 40

Xanthochromia

Question 41

What is the most common cause of SAH in children?

Answer 41

AVM Aneurysm rupture also occurs but rarer

Question 42

At what GCS is a head injury considered severe?

Answer 42

8 or lower

Question 43

What does epidural haemorrhage appear like on CT scan?

Answer 43

Lentil shape

Question 44

What does subdural haemorrhage appear liek on CT scan?

Answer 44

Crescent shape

Question 45

What risk factors that if present need a CT scan within 1 hour of identifying them in head injury?

Answer 45

GCS <14 on initial assessment GCS <15 2 hours post injury Open or depressed skull # or tense fontanelle Signs of basal skull # Post-traumatic seizure Focal neurological deficit Bruise, swelling or laceration >5cm in child <1y/o

Question 46

What risk factors that if more than one present need a CT scan within 1 hour of identifying them in head injury?

Answer 46

Witnessed LOC >5mins 3 or more discrete episodes of vomiting Abnormal drowsiness Dangerous mechanism of injury Amnesia lasting longer than 5 minutes

Question 47

What happens with the arms and legs in decerebrate posturing?

Answer 47

Involuntary extension in arms and legs

Question 48

What happens with the arms and legs in decorticate posturing?

Answer 48

Flexed arms and extended lesg in response to pain

Question 49

Which vessel is most commonly associated with epidural haemorrhage?

Answer 49

Middle meningeal artery