Neurology

Question 1

What scoring system is used to stratify the risk of stroke after a TIA?

Answer 1

ABCD2

• Age (>60) - 1 point
• BP (>140/90) - 1 point
• Clinical features (Unilateral weakness - 2 points) (Speech deficit no weakness - 1 point)
• Duration (>60mins - 2 points) (10-60mins - 1 point)
• Diabetes - 1 point

Question 2

What is high risk on ABCD2 score and what does it mean?

Answer 2

6-7 points is high risk

8.1% two-day recurrent stroke risk

Question 3

Gold standard treatment for stroke due to thrombus?

Answer 3

Alteplase - recombinant tissue plasminogen activator

WITHIN 3 HOURS (or 4.5hrs if >80yrs)

Question 4

Treatment for haemorrhagic stroke?

Answer 4

• Reduce blood pressure (CCB, nitrites)

- Correct clotting if off

Question 5

Raised lymphocytes (Monocytes)
Normal protein
Normal glucose
CSF of which meningitis?

Answer 5

VIRAL

Question 6

Lyme disease in neuro disease?

Answer 6

Neuroborreliosis

Long term lyme disease. Presentation is varied

Question 7

Contra indication to lumbar puncture?

Answer 7

Raised global CNS pressure due to risk of coning. Purely intracranial pressure is not a contraindication.

Question 8

Treatment of suspected meningococcal disease in secondary care. <3 months and >3 months old?

Answer 8

< 3 months = cefotaxime + amoxicillin/ampicillin

> 3 months = ceftriaxone

Question 9

Raised lymphocytes (PMN)
Raised protein
Low glucose
CSF of which meningitis?

Answer 9

Bacterial

Question 10

Initial morphine dose?

Answer 10

10mg (elderly/frail = 5mg)

Every 4 hrs

Question 11

WHO analgesic ladder?

Answer 11

1. Paracetamol
2. ADD mild opiod e.g. co-codamol
3. Substitute morphine 10mg/4hrs titrate up

Question 12

Septic shock unresponsive to fluid resuscitation?

Answer 12

Epinephrine/norepinephrine

Question 13

When to add Vancomycin for bacterial meningitis?

Answer 13

Young people/children who have:

• Recently travelled outside of UK
• Multiple/prolongued exposure to antibiotics in last 3 months

Question 14

When to use corticosteroids in bacterial meningitis?

Answer 14

Dexamethasone upto 10mg QD

• Frankly purulent CSF
• CSF WBC >1000/mcl
• Bacteria on gram stain
• Raised protein (>1g/L) and WBC

Question 15

Analgesia in children?

Answer 15

< 16yrs
Not together, but can be administered alternately
- Paracetamol
OR
- Ibuprofen

Other NSAIDs and aspirin and codeine are not
- NB codeine can be used 3rd line if > 12 yrs

Question 16

When to treat epileptic seizure?

Answer 16

After 5 minutes of tonic-clonic
OR
3 seizures in 1 hour

Question 17

What to treat epileptic seizure with in community?

Answer 17

Buccal midazolam
OR
Rectal diazepam

Question 18

Other treatment for epileptic seizure?

Answer 18

IV Lorazepam (in hospital)

Question 19

Anti-epileptic drugs?

Answer 19

Taken everyday to prevent seizure
Eg. Sodium valproate
Carbemazapine
Phenytoin
Phenobarbital
Lamotrigine

Question 20

What nociceptors are there? And what are they responsible for?

Answer 20

A-delta fibres - FAST, non-specific involved in reflex arc (unmyelinated)
C-fibres - SLOW, (myelinated)

Question 21

AED drugs for absence seizures?

Answer 21

Ethosuximide or sodium valproate

lamotrigine if unsuitable, not tolerated etc

Question 22

General tonic-clonic seizures AED drugs?

Answer 22

Sodium valproate

Lamotrigine 2nd

Question 23

Focal seizures AED drugs?

Answer 23

Carbemazapine or lamotrigine

Question 24

Myoclonic seizures AED drugs?

Answer 24

Sodium valproate

Question 25

Tonic or atonic seizures AED drugs?

Answer 25

Sodium valproate

Question 26

Spinothalamic tract pathway and transmit?

Answer 26

Pathway: 1st order neurons enter via dorsal roots, synapse and decussate in cord. Up to thalamus. Primary sensory cortex. Transmit: Pain, temperature, touch

Question 27

Syringomyelia presentation?

Answer 27

Bilateral loss of pain, temperature, fine touch. | Due to expanding lesion in central canal, where fibres decussate.

Question 28

Corticospinal tract pathway and transmit?

Answer 28

Pathway: Arise in motor cortex Through internal capsule In medulla - pyramidal decussation Transmit: Control of muscles

Question 29

Brown-Sequard definition and presentation?

Answer 29

Damage to a hemisection of the spinal cord. Loss of proprioception ipsilateral side to lesion Paralysis ipsilateral side to lesion Loss of temperature and pain contralateral side to lesion

Question 30

ALS definition and presentation?

Answer 30

Progressive degeneration of coricospinal tracts and ventral horn cells Progressive weakness/atrophy (lower limbs first) Leading to loss of function, fasciculations, eventually loss of swallow, respiratory muscles etc

Question 31

Most common pathogen in bacterial neonatal meningitis?

Answer 31

Group B streptococcus

Question 32

Common pathogens of bacterial meningitis in babies and children?

Answer 32

Strep pneumoniae | Neisseria meningitidis

Question 33

Common pathogens of bacterial meningitis in teens/young adults?

Answer 33

Neisseria meningitidis | Strep pneumoniae

Question 34

Common pathogens of bacterial meningitis in older adults?

Answer 34

Strep pneumoniae Neisseria HIb

Question 35

Treatment for trigeminal neuralgia?

Answer 35

Carbamazepine

Question 36

Treatment for neuropathic pain?

Answer 36

Amitryptiline Duloxetine Pregabalin Gabapentin