Neurology questions – questions only
EMQ
1. Essential tremor
2. Parkinsons disease
3. Parkinsons plus disorder
4. Thyrotoxicosis
5. task specific tremor
6. Tardive dyskinesia
Select the most likely diagnosis for the clinical pictures below, then give 2 management strategies for each
A) a 55 year old female presents with history of unintentional weight loss of around 5kg in the past 2 months. She has been feeling a bit agitated and on further questioning seems to not feel the cold despite everyone else around her at home having to wear multiple layers. On examination she has a rest tremor that is unchanged with movement. Heart rate is 98 beats per minute and she reports intermittent palpitations in the past month.
Dx:
Management:
B) A 34 year old female presents with tremor which she has noted in both hands. It seems to be much worse after drinking coffee or if she has to give a presentation at work. She states that her mother had a similar problem but it did not require any specific treatment. She also notes that it seemed to be a little better last Friday night after drinking a glass of wine after work with her friends. Examination showed normal tone, muscle bulk and a resting tremor 4-12 Hz which was unchanged with activity
Dx:
Mx:
C) A 36 year old female office clerk who is otherwise fit and well with no past medical history and no current medication use. She has been experiencing worsening tremor that is only present when she has to handwrite in her work.
Dx:
Mx:
D) A 66 year old gentleman presents with 2 year history of worsening right arm tremor. He seems to be a little bit more clumsy on this side. On examination, there is rest tremor, and he has lead pipe rigidity on tone examination.
Dx:
Mx
E) a 78 year old female presenting to the emergency department and is admitted for acute viral gastroenteritis with a plan for antiemetics and IV rehydration. She has a background history of depression with psychotic features.She becomes aggressive towards staff and other patients. The medications on her chart include metoclopramide and her dose of risperidone was increased for management of aggression. She is observed to have repetitive tongue and lip smacking movements in a somewhat rhythmic pattern.
Dx-
Mx-
Which of the following medications should be avoided in patients with parkinson’s disease? (More than 1 may be correct)
A) Metoclopramide
B) Domperidone
C) Haloperidol
D) Prochlorperazine
E) Ondansetron
Outline the management of progressive motor problems with advanced parkinsons disease ( 3 points)
Give 3 examples of non motor manifestations of Parkinsons disease and their management
Which of the following should prompt a review of the diagnosis of idiopathic parkinson’s disease?
A) early dementia
B) early falls
C) early severe autonomic dysfunction, other neurological signs such as upper motor neurone signs, abnormal eye movements, or cerebellar signs
D)dopamine antagonist treatment (eg antipsychotic drugs, metoclopramide) at onset of symptoms
E)history of repeated strokes with stepwise progression of parkinsonian features
F) All of the above
EMQ:
1. Sinus pain
2. Dental abscess
3. Trigeminal neuralgia
4. Glossopharyngeal neuralgia
5. HSV stomatitis
6. HZV Facial pain
7. TMJ dysfunction
8. Angina
9. Acute glaucoma
10. Facial migraine
A) a 28 year old female presenting with paroxysms of unilateral facial pain, stabbing in nature. The pains never wake her from sleep. She sometimes notices that the attacks seem to be triggered by touching on the face, or brushing her teeth.
B) Sudden brief attacks of pain at the back of the throat, base of tongue, beneath the angle of the jaw and the R external auditory meatus in a 38 year old man.
C) 22 year old female with family history of migraine presents with acute unilateral facial pain, associated nausea and vomiting. She is phonophobic. She has had 3 episodes previously in the last few months which resolved with rest in a quiet room after a few hours and some over the counter analgesia
D) Severe unilateral facial pain in a 60 year old male with history of varicella infection aged 5. 2 days later he returns to your practice with a vesicular rash
E) 32 year old female with history of anxiety presents to your practice with 3 day history of R ear pain. TM appears normal on examination. There have been no recent RTI symptoms. She has had increasing ear pain with chewing.
F) Pain in the L eye and forehead in a 58 year old gentleman. He has had some change in his vision in the last few hours. On examination he has a diffusely red L eye with corneal clouding, clear watery discharge and a mid-dilated, fixed pupil
MCQ:
Which of the following statements is false?
A) There is an increased risk of stroke in patients who suffer migraines with aura approximately 2 times increased risk compared to non migraneurs
B) The overall incidence of stroke attributed to migraine is very low (<5:100000)
C) COCP must be used with extreme caution in patients who have a history of migraine with aura, and ideally should be ceased especially where other risk factors( smoking, poorly controlled hypertension) are present
D) Aspirin and clopidogrel have evidence to support their use in protecting against stroke in migraine
With regards to the treatment of migraine Which is TRUE?: (MORE THAN ONE MAY BE CORRECT)
A) more than 2 attacks in a month should be considered for prophylactic therapy
B) NSAIDS can be continued for management until the 2nd trimester until 32 weeks
C) Dihydroergotamine or triptan therapy may be safe to use throughout the pregnancy
D) Amitryptyline, propanolol, sodium valproate can be used for migraine prophylaxis in mothers who are breastfeeding
E) Migraine in children can present with acute abdominal pain and vomiting
F) CBT is as effective as drug therapy in preventing migraine
With regards to the risk of stroke, which of the following is true:
A) the absolute risk of stroke in patients with non valvular atrial fibrillation is between 2-18 % per year
B) the relative risk of patients with migraine with aura for CVA is 2
C) the relative risk of patients with known cardiovascular disease, diabetes or currently smoking is 2
D) the relative risk of hypertension is 4
E) All of the above
True or false?
1. Low dose aspirin is of more benefit in primary prevention for cerebrovascular disease than it is in prevention of acute coronary events.
2. Routine use of aspirin is recommended for primary prevention of stroke in all patients
3. Suitability of patients for low dose aspirin is based on absolute risk of CV events and stroke, with patients at moderate risk of CV disease (1+ risk factors) suitable for LDA therapy
4. The ABCD2 score is used to predict CVA risk in AF and guide decisions re: anticoagulation
5. In patients with AF who are unable to take warfarin due to bleeding risk, clopidogrel should be used instead of aspirin, even when there is no contraindication to aspirin.
6. In an asymptomatic patient with a stenosis >70 % there is a equivalent or greater risk of acute coronary events than stroke events
7. Aspirin should be routinely given in acute stroke at a dose of up to 300mg on the first day, after haemorrhage is excluded by CT Brain
Mcq
Maggie is a 72 year old female admitted to emergency after she woke with with L sided weakness and numbness. Her blood pressure is 201/105. With regards to her management, which is true? (more than one correct)
A) She should be offered thrombolysis after CT scan
B) She should be given aspirin after CT scan
C) She should be given fluids containing glucose as the cause may be a correctable hypoglycaemia and may have reduced oral intake due to weakness with swallow
D) Her blood pressure should be acutely lowered to <140/80.
E) Her BP should be lowered but aiming for a target of 180/95
F) She should be commenced on combination of aspirin+ clopidogrel if she does not tolerate aspirin+dipyridamole(asasantin) for secondary prevention
Which of the following conditions can mimic acute stroke?
G) Migraine
H) Subdural haematoma
I) Tumour
J) Post ictal paralysis
K) Hypoglycaemia
L) Cerebral abscess
M) All of the above
